First Steps to Overcoming Anxiety
Overcoming anxiety after it's developed into a major difficulty in your life can often be confusing and upsetting. However,
anxiety disorders are very treatable problems.
This article is a consumer guide for people who seek anxiety relief, but don't know how to get there. However, I suggest that everyone who seeks relief from chronic anxiety should review these steps, and complete any which you haven't yet done.
Learn a little about anxiety disorders
Understanding how anxiety "works" is one of the keys to overcoming anxiety. Read my description of the different anxiety disorders and compare your experience with those descriptions. Take a look at these sites, hosted by nonprofit organizations, which offer a wealth of consumer information about anxiety disorders, anxiety treatment, and overcoming anxiety:
Anxiety Disorders Association of America
Association for Behavioral and Cognitive Therapies
Obsessive Compulsive Foundation
Use these sites to learn more about overcoming anxiety disorders. The purpose here is not to self diagnose yourself - please consult a licensed clinician for a diagnosis - but to inform yourself as much as possible before you consult a clinician so that you can evaluate what a clinician tells you, be an informed consumer, and find effective methods for overcoming anxiety.
The internet is full of
and it may be worse than you think, so be wary! When something sounds too good to be true, it probably is.
It's common to experience some depression along with an anxiety disorder, and this is often a source of confusion to people. If this sounds relevant to you, read a little bit about
Consult with your primary physician
A consultation with your physician is a must if you suspect you
have panic attacks or generalized anxiety.
These symptoms can be caused by a variety of physiological disorders, and you should rule them out as part of the diagnostic process. You should certainly have one complete physical after the onset of these symptoms.
The other anxiety disorders don't generally require a physical, because there isn't any reason to think that they are caused by another physical ailment. However, you might still want to consult your physician, especially if you have a long history with that person. You might want his/her opinion about your situation; you might want a referral; or you might want to find out about possible medications you could use.
Be aware, however, that most physicians, because they specialize in various aspects of physical health, have very little training in the area of anxiety disorders. What training they do have, with respect to overcoming anxiety, is usually limited to medications. They may often be surprisingly unaware of cognitive behavioral treatment for anxiety disorders, even though it is generally regarded as the treatment of choice. When it comes time to seek professional help for overcoming anxiety disorders, you will probably need to go elsewhere.
If you don't have panic attacks or generalized anxiety, and have no other reason to consult your physician about overcoming anxiety, then skip ahead to Step Three.
Before you call for an appointment, make some written notes of what you want to discuss with your physician. The doctor's staff will probably ask you why you want an appointment; tell them that you've been having some problems and summarize them, briefly.
Many people have a fear of doctors, and have trouble making an appointment. This is a phobia, and will generally respond to the same CBT approach, once you decide that a visit to the doctor, however anxiety provoking, is in your best interest.
What to Expect from Your Physician
Your physician should listen to your symptoms, review your history, ask questions, and offer feedback and recommendations for overcoming anxiety. Since most physicians are trained principally in physical health and medicine, there is no reason to expect him/her to be an expert in anxiety disorders. However, your physician should take your complaints seriously, evaluate them, and offer suggestions for finding additional help.
If you are having panic attacks and have never been tested for thyroid malfunction, for instance, you should receive such a test, because thyroid problems can sometimes cause a person to have panic-like symptoms. If your symptoms resemble those associated with mitral valve prolapse, you should probably have
an echocardiogram to evaluate that possibility. There are numerous physical conditions which can produce panic symptoms, and your physician should evaluate you for those possibilities if that has never been done before.
However, if you have had those tests before, and your doctor assured you that you were in good health, do not push for continual retesting! Many people do this because they hate the idea that they may have an anxiety disorder, and instead hope to find a physical problem. You can waste lots of time and money this way.
One set of tests is generally enough. If you need a second opinion for a particular reason, then get one. If you get more than two sets of tests, seriously consider the possibility that you are getting diverted from your task of overcoming anxiety!
Let's suppose that you've had a good consultation with your physician, the appropriate tests have ruled out any physical ailments which could be causing your symptoms, and you want to get professional help with overcoming anxiety. Now you're ready for step three.
Learn about the available treatments
There are basically two kinds of treatment which clinical research has shown to be effective in overcoming anxiety disorders: cognitive behavioral treatment (CBT) and certain forms of medication. Other forms of psychotherapy are often helpful in resolving some of the issues associated with anxiety disorders, but are generally not regarded as capable of resolving the primary problem. Which form of treatment should you choose?
My view is that most people with anxiety disorders are best served by trying a cognitive behavioral treatment first, and seeing what kind of results you get from that. You can always try medication later, if the CBT doesn't provide all the results
There are three principal reasons to try CBT first. First, unlike medication, CBT has no side effects. Second, the use of medications tends to lead a person to believe that he or she is now "protected" from anxiety disorders, and the sense of being protected often leads an anxiety sufferer to feel more vulnerable in the long run. Third, the results you get from CBT treatment will generally be much more long lasting than those you get from medications. Results from medication treatments tend to fade after the medications are withdrawn.
Some patients will need medication in addition to CBT, and some will not, depending on the severity of their condition and their
particular diagnosis. Medication is nothing to be avoided if
it seems necessary. However, I do believe it's true that in our
culture, medications are overprescribed for these problems. This can be avoided if you start with CBT first.
The Anxiety Disorders Association of America website includes an overview of medications used to treat anxiety disorders
There are new forms of CBT in development, often labeled as "Third Wave" therapies. One in particular, Acceptance and Commitment Therapy (ACT) is quite useful in the treatment of Panic Disorder and other anxiety disorders. In my work, I blend methods from both traditional CBT and ACT, and find them both very useful in overcoming anxiety disorders.
To read about CBT and some of its various forms, click here.
Do I Need "Treatment" at All?
You may be wondering if you really need to see a professional, or if you can't just solve this problem on your own. In general,
the more difficulty you are having, the more you may need professional help, but only you can decide how urgent your need is. Certainly there are many good sources of self help information you can use in overcoming anxiety disorders. If you choose to try anxiety self help, I suggest you follow a few guidelines.
* Get a "buddy", a coach, or a support person, with whom you
can discuss your efforts on a regular basis. They don't have
to be an expert. A major benefit is that, by telling someone
of your efforts, you will find it easier to monitor your
progress and hold yourself accountable. It's easy to forget
about all your good intentions when you keep them to yourself.
* Follow an organized plan. Find a good self help book which
pertains to your problem, and make that the basis of your
work. If you have panic attacks and like the approach you
find on this website, then try my Panic Attacks Workbook.
* Evaluate your progress at regular intervals, at least monthly.
After six months, re-evaluate your progress. If you're satisfied
you're making reasonable progress toward overcoming anxiety, continue on course. If you're not, consider seeking professional help at that time.
* Sign up for my free e-mail newsletter for more thoughts and suggestions for overcoming anxiety.
What about Group Treatment?
Among the advantages of group treatment for overcoming anxiety are lower cost and the opportunity to share experiences with others who can relate to your situation. This can be particularly important for people who feel especially ashamed and imagine that they are one of a very few who suffer in this way.
I don't really think there are any disadvantages to a well run
group treatment, although many people shy away from it because
they believe they would pick up more fears from hearing other
people's problems. In my experience in running groups, this has
not been a problem and, while people are usually quite nervous
before the first meeting, their anxiety is usually much lower by the end of the meeting.
Group treatments are often not available, so consider yourself fortunate if they are offered in your area. Your own personal preference is probably the most important deciding factor in the choice between group and individual treatment.
...And Support Groups?
You may also find it helpful to attend a support group. There are general purpose support groups designed to help people with a variety of psychological problems, and there are anxiety support groups which have a more specific focus - anxiety problems in general, or specific anxiety disorders such as Panic Disorder, Obsessive Compulsive Disorder, etc.
I think most people with a clearly defined anxiety disorder are
better served by a support group which focuses specifically on their kind of problem, if such a group is available. However, there are also some good "general purpose" groups, such as
Identify and Interview Some Therapists
If you decide to get professional help, be prepared to do some work to find a good therapist. You can start by getting the names of therapists in your area who offer the kind of treatment you seek. The websites of the Anxiety Disorders Association of America and the Association for Behavioral and Cognitive Therapies offer a "therapist finder" section to help you find a specialist in your area. The sites for the
Obsessive Compulsive Foundation and the
Trichotillomania Learning Center (compulsive hair pulling) offer similar lists of professionals who specialize in those areas.
You will probably be better off if you can find a therapist who has specialized training and experience with the anxiety disorder for which you seek help. However, be aware that these lists will generally include any therapist who wishes to be included; they are not a licensing or accreditation process, simply a place to start. You still need to be an informed consumer.
If you live in the Chicago area, and want to work with me, I would be happy to schedule an appointment with you.
Select a Therapist and Begin Treatment
An initial evaluation with a therapist may take anywhere from one to two sessions. It should enable the therapist to learn enough about you to give you some feedback about your situation and how that therapist proposes to help you, and should also give you a chance to ask more questions. One area you should certainly discuss with the therapist is what to expect in treatment, i.e., how will you know it is working? What would be a sign that it is not working?
You will probably also want to know how long treatment will take. What I tell new patients is that, while I can't immediately predict how long their particular situation will require, I do expect that they will have a gut feeling that we are moving in the right direction within the first month of weekly sessions, and that they should see some progress within the first two months. If this doesn't happen, it's a sign that something isn't working right, and we should figure out what's wrong.
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