FIRST STEPS TO RECOVERY

This section is written for people who recognize that they have an anxiety problem but don't know what to do. However, I suggest that everyone at any stage of dealing with an anxiety problem review this list of steps, and complete any which you have not yet done.

| STEP ONE | STEP TWO | STEP THREE | STEP FOUR | STEP FIVE |

STEP ONE: Learn a little about anxiety disorders Read the section "Anxiety Disorders at a Glance" and compare your experience with those descriptions. Make use of some of the printed and Internet resources listed in our Resource Directory, and contact some of the organizations listed there. The purpose here is not to self diagnose yourself - please consult a licensed clinician for this - but to inform yourself as much as possible before you consult a clinician so that you can evaluate what a clinician tells you and be an informed consumer.

STEP TWO: Consult with your primary physician.
A consultation with your physician is a must if you suspect you have panic attacks or generalized anxiety, because such symptoms can be caused by a variety of physiological disorders and, while such instances are relatively rare, you should first rule them out. You should certainly have one complete physical after the onset of your symptoms.

The other problems I address at this site do not 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.

However, if you don't have panic attacks or generalized anxiety, and have no other reason to consult your physician about your anxiety, then skip ahead to Step Three.

If you don't have a physician, find one by asking your friends and relatives for a recommendation. You might be on an insurance plan which requires you to select your physician from their list of doctors, but ask for recommendations anyway. Then get a list of doctors from your insurance plan (insist on the whole list, not just a couple of names) and look for the recommended ones.

Make some written notes of what you want to discuss with your physician before you call for an appointment. 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.

Avoiding the Doctor: a Common Problem
People commonly fear (and avoid) going to the doctor, for a variety of reasons. If you are claustrophobic, you may fear waiting in a small examination room. You may be afraid you will have a panic attack while waiting for the doctor; you may be afraid of hearing "bad news" from the doctor; you may regularly experience a rise in blood pressure on visiting the doctor, and fear the doctor or his/her staff will exaggerate its importance. You may fear any situation from which it is inconvenient or difficult to leave quickly, be it a haircut, a shower at the health club, a dressing room at a clothing store, or a visit to the doctor. Or you may be afraid of needles and the sight of blood.

My experience in working with people and their fears about the doctor's office is that to try to hide these fears and "tough it out" almost always makes the anxiety worse. So I recommend that when you call for the appointment, you speak with the nurse, or whoever keeps the appointment schedule, and tell that person, briefly, that you sometimes have difficulty with doctor visits because of anxiety or phobias; explain briefly what that fear is; and ask for them to help make it easier for you.

If you just don't know how to explain your problem so others will understand, you might want to explain by likening it to claustrophobia, a condition in which people become very frightened whenever they are in a closed, small place. Since most people seem to know what claustrophobia is, this comparison can make your explanation easier.

Some of the arrangements that my clients have made include the following: shorter times waiting in the examination room; taking several measures of blood pressure throughout the visit, in the knowledge that it will go down as you get used to being there; having a glass of water available; having a staff member check in on you while you wait for the doctor; or having a support person with you. I'm sure there are as many possible arrangements as there are worries. I once worked with a woman whose fear of the dentist centered on seeing his white coat, so we arranged for him to wear street clothes for her visit.

Beyond the specifics of these arrangements, it can be very helpful to know that the doctor is aware of your anxiety, and that you can talk about it, rather than try to hide it and fight it. In my experience, the effort to hide and fight the anxiety is often the most significant obstacle to recovery.

People often worry that the doctor won't want to be bothered, or that the doctor's staff will find their concerns ridiculous.

My clients have generally found that, once they talk to their doctor about this, the doctor is usually more understanding than they expected.

But if your doctor really doesn't want to be bothered, find another doctor!

What to Expect from Your Physician
Your physician should listen to your symptoms, review your history, ask questions, and offer feedback and recommendations. Since most physicians are trained principally in physical health and medicine, there is no reason to expect him/her to be an expert in mental health. 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 avoiding the issue!

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 for anxiety. Now you're ready for step three.

STEP THREE: Learn about the available treatments.
There are basically two kinds of treatment which clinical research has shown to be effective for anxiety disorders: cognitive behavioral treatment 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? Many sources recommend a combination of both medication and cognitive behavioral treatments. However, it's unclear if they do this because it's really the best way, or because if they recommend only one method, the people who provide the other method will become very unhappy.

In order to get effective help, you need to understand how our mental healthcare system works. And principally, what you need to know is that our mental healthcare system is divided between psychiatrists, most of whom provide medication treatments, and non-physician therapists such as psychologists, social workers, and other mental health counselors, who provide a variety of treatments that don't rely on medication. (There are also important differences among the non-physician therapists, and you may want to investigate those differences further).

What this means to the consumer is that your initial choice of what kind of professional to see will virtually decide what kind of treatment you are offered, at least initially. If you see a psychiatrist, the chance of being offered medication is very high, and if you see a non-physician therapist, the chance of being offered the form of nonmedication treatment they most favor is very high. A good clinican will, of course, always refer you to another professional if he/she sees that you need a form of treatment they don't provide.

But, do not assume that all mental health professionals work in similar ways, or have similar training and experience, or are equally good at adapting their way of working to your particular needs.

You will be much better off if you can figure out what kind of help you need, and then find someone who regularly provides that. This is not always an easy task, but it's well worth the effort.

My view is that most people with anxiety disorders are best served by cognitive behavioral treatment; that some will need medication in addition to this, and some will not, depending on the severity of their condition and their particular diagnosis; and that most people will be better off starting with the cognitive behavioral treatment first, and seeing how that works out for them before trying a medication treatment.

But I'm also a psychologist who specializes in the cognitive behavioral treatment of anxiety disorders, and so I'm undoubtedly biased in this direction. So don't just take my word for it.

Use our Resource Directory to get connected with such organizations as the Anxiety Disorders Association of America, and the National Institue of Mental Health, and see what they have to say.

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. If you choose to try 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. Take a look at the self help books listed in the Resource Directory which pertain to your problem. Make one of these 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. Whatever method you choose, supplement it with the self help articles posted here and in my newsletter, Anxiety Coach®.
• 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, continue on course. If you're not, consider seeking professional help at that time.

Are There Classes I Can Take?
I should also mention that there are some anxiety problems which can often be resolved just as well in a "class" as in therapy. The fears of flying and public speaking are good examples. I teach classes for both these problems, and find that some people can get very good results from a short, focused class. However, please understand that some people have a fear of flying and no other anxiety problem, while others have a fear of flying as part of panic disorder and agoraphobia. In a similar way, some peopIe have a fear of public speaking all by itself, while others have it as part of social phobia.

Those with more complicated problems may benefit more from therapy, at least initially. The procedure I follow with my classes is I ask each prospective member to have one individual session with me, to enable me to determine if the class is suitable for that person. If you're considering such a class, be sure an evaluation with a qualified therapist is part of the program.

There are also many classes designed to teach you a variety of stress management techniques, such as meditation, self hypnosis, yoga, etc. These can be very useful parts of a recovery program. However, don't rely on them as your exclusive method of recovery.

How About Group Treatment?
Among the advantages of group treatment are lower cost and the opportunity to share experiences with others who 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.

However, your own comfort level 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 groups which focus on more specific areas - 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.

STEP FOUR: 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. I recommend you contact the Anxiety Disorders Association of America and the Association for Advancement of Behavior Therapy to get a list of specialists in your area (if you have Obsessive Compulsive Disorder, or Trichotilomania, get the list specific to that disorder as well: all are listed in our Resource Directory). You will probably be better off if you can find a therapist who has specialized training and experience with the anxiety problem for which you seek help.

If you live in the Chicago area, and want to work with one of us, we would be happy to schedule an appointment with you.

Once you have a list, call three or four of the therapists to ask a few questions before making your first appointment. Tell whoever answers the phone (or the voice mail) that you are a potential client looking for a therapist, and you want to ask the therapist a few questions. Do not try and disguise what you are doing - there's no need for that! You will be paying for a service, and are entitled to get the information you need to make a good choice as a consumer.

A therapist who is too busy to talk to you for at least a few minutes on the telephone, for free, is probably too busy to be your therapist.

Questions to Ask Prospective Therapists

• What kind of problems do you treat?
• What kind of treatment do you offer?
• Does it include cognitive behavioral therapy (or whatever treatment method you seek)?
• What is your therapy style like (i.e., are you active in discussing things with me, or do you mostly listen?)
• How many people have you treated with my problem?
• Do you offer medication if needed?
• How long is a typical course of treatment?
• What does it cost?
• Do you accept insurance?
• How soon could I have an appointment once I make up my mind?
• Do you include family members in the treatment?
• How long have you been treating these problems?
• What is your professional background?
• Are you licensed?
• Where did you get your degree?

STEP FIVE: Select a Therapist and Begin Treatment.
The evaluation may take anywhere from one to three 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. Most of my clients do. What I tell them 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; and if this does not happen, we need to discuss that and figure out why not.

If you are satisfied with the evaluation, continue in treatment with that therapist. If you are unhappy about it, or just don't feel comfortable with that therapist, try another one. You might want to discuss your misgivings with that therapist, and see if your concerns can be addressed - but if you just don't feel comfortable with that person, don't feel obligated to continue. If you decide to discontinue seeing a therapist, do let him/her know that you won't be back, and cancel any appointments that you don't intend to keep. People often feel uncomfortable about this, but remember that the therapist is a professional and should accept your decision gracefully.

In the same way, the therapist should treat your questions about treatment, and any dissatisfactions you may have, in a professional manner and try to incorporate your concerns in the treatment.

If all has gone well to this point, congratulations! You are engaged in treatment with a therapist and making progress toward your goals. Make use of additional resources such as are listed in our Resource Directory, the Self Help articles, and our e-mail newsletter and be sure to mention these to your therapist. Talk regularly to your therapist about how your treatment is going. If you have concerns or dissatisfaction with the treatment, it is very important to discuss these with your therapist. That's part of his/her job!

If all has not gone well, retrace your steps through this section and try to figure out what went wrong. Remember that it's very common to have a few false starts - don't let that trick you into giving up!

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This page was last modified on 6-1-2007.