What is anxiety? Psychologist Tamar E. Chansky defines it as “the first reaction of a sensitive system that is wired to keep us alert to danger and protected from harm.”

Irrational thoughts often spur those first reactions. In order to manage anxiety, she says strategies are needed to react appropriately, including “shrinking the risk and being willing to approach the situation” to figure out what is really happening.

Chansky first describes four general steps people can use to help overcome anxiety. She then follows those up with strategies to help slow that initial fight or flight reaction.

The four steps are:

• “Pause and Re-label or don’t believe everything you think.”
• “Get Specific or narrow down the problem to the one thing that really matters.”
• “Optimize or re-think what’s possible and broaden your choices.”
• “Mobilize or don’t just stand there, do something.”

Most of the strategies are simple to understand and implement.  For example, to optimize choices, the read is told to “consult the possibility panel.”  This involves creating a “board of directors” to offer advice.  Anyone can be a member of the possibility panel in your brain, whether or not you know them.  It might sound a little strange to create a “mental” panel of advisers. Chansky says, “Just stepping out of your own spin of ideas for a moment to contemplate getting other opinions instantly frees you up.”  Since anyone alive or dead can be on the panel, this activity can also be kind of fun.

Are you afraid of trying new things?  Chansky suggests trying a strategy which she calls “practice brings confidence and mastery.”  Instead of believing “that you just should know how to do something [new]… think how you would teach someone else to do it, then sketch out a practice routine for yourself.  Create a script, practice in the mirror, [and] practice with a friend.”  This commonsense advice might not be new, but she also includes other strategies that might not be as familiar. The reader has a good chance to find a strategy that will help.

After covering the four steps, Chansky discusses “additional tools to free yourself, like generating an accurate list of your strengths. Another one is called disappointment proofing, which discusses how to create “safe, resilient expectations” and “cultivating empathy, compassion, and gratitude.”

The last part of the book consists of shortcuts to help you “find your way through the detours of life.”  Those “detours” include anger, jealousy, loss, shame, procrastination, perfectionism, failure, and criticism.

For each of the detours, Chansky lists the beliefs that keep people stuck in that emotion. She offers a list of “better beliefs” and specific strategies to help confront the beliefs causing the emotional bottleneck. For example, a bottleneck belief for “shame” is “All of me is bad, damaged, and unacceptable.”  A better belief is “This is not who I am; this is what happened to me.”

Another strategy to help change a belief about shame is called re-labeling.  Chansky explains that “shame makes us feel like we are damaged [but] that is a feeling, not a fact.”  To recover from shame, it’s necessary to figure out what our “enduring value” is aside from the shame.

One very useful aspect of the book  is that each chapter also includes advice about how to help others struggling with anxiety.  Her suggestions can “help you become the voice of reason for those you care about.” When a friend is worried, don’t say “everything will be okay.”  Instead, “remind them of something similar that happened to you that turned out okay” to help them “focus on the finish line.”

The only section of the book which seems cursory is the chapter on anxiety disorders. Chansky covers a lot of ground touching on generalized anxiety disorder, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, and social anxiety disorder.  Even though she crams all those disorders into one chapter, some people might still find it valuable. After reading Chansky’s descriptions, a reader have a pretty good idea if they suffer from normal anxiety or have an anxiety disorder.  She gives some suggestions for “cracking the code” of each disorder, as well as summarizing treatment options for each.

I believe that this book could become a standard reference in the field with therapists assigning it to clients.  Anyone who suffers from anxiety could find it useful, because Chansky offers so many strategies to try.  Chansky’s strategies provide concrete methods to use when feeling anxious.  You may find some strategies more useful than others. However, by adding just one new strategy to your repertoire of habits, you may help yourself feel less anxious.

Freeing Yourself from Anxiety: The 4-Step Plan to Overcome Worry and Create the Life You Want
Tamar E. Chansky, PhD
Da Capo Lifelong Books, Jan. 31, 2012
Paperback, 336 pages
$10.51

According to the International Association of Reiki Professionals (IARP), “Reiki is [a] subtle and effective form of energy healing using spiritually guided life force energy… [p]racticed in every country of the world.” While often considered to be spiritual in nature, Reiki is not “[a]ffiliated with any particular religion or religious practice.”

Reiki is increasingly offered in hospital, hospice, and private practice settings, applied to a variety of illnesses and conditions. Those who receive such treatments report relief of symptoms from numerous health challenges, including mental health issues. Research shows that reiki primarily helps in the reduction of stress, anxiety and depression, as well as relief of chronic pain — the last of which can bring on anxiety and depression, or make episodes worse.

Many Studies, Varying Quality

There are now sufficient peer-reviewed, published research results available to begin to sort out Reiki’s effectiveness in various areas. The Center for Reiki Research has intensively examined a group of them through their “Touchstone Process,” “…a uniquely rigorous peer review method for analyzing a group of scientific studies” [using Reiki]. Its end product is a set of critical summaries derived from an impartial and consistent process…. [T]he process incorporates existing best practices for scientific review…” (CRR)

This process looks at all aspects of the study design and how each investigation was actually carried out. Results are analyzed, and study strengths and weaknesses are determined. The Touchstone Process has produced a group of nearly three dozen carefully analyzed studies. The CRR draws some conclusions about Reiki’s effectiveness from only the studies they have examined that they judge to be of at least satisfactory or better quality. (CRR)

In addition to the CRR/Touchstone studies, a varied body of research on Reiki demonstrates its effect on mental health. For example, Joe Potter, a Reiki Master in the United Kingdom, has been conducting an ongoing investigation into Reiki’s effectiveness. An online search in PubMed lists dozens of studies involving Reiki or other healing touch methods, investigating a broad range of conditions in many different populations.

Some investigations were conducted on animals, which helps eliminate some questions of bias and design control among Reiki recipients. Some studies used “sham” Reiki as a form of control (nonpractitioners administered a “Reiki-like” treatment), and others involved distance Reiki (Reiki delivered from too far away to permit touch). Each of these variables lends something importing to understanding the efficacy of the treatment itself.

Demonstrated Effects on Stress, Depression, Anxiety and Pain

Potter reports that “[s]tress was the most common word written by clients as a description or part description of their condition during their first session. Here 20.27% of the total client group treated used this word on their initial visit for Reiki treatment….” In animal studies, Reiki treatment produced clear signs of reduced stress as indicated by changes in autonomic, biological measurements such as heart rate (Baldwin, Wagers and Schwartz, 2008) and certain cellular signs of stress-related damage (Baldwin and Schwartz, 2006). In a study of nurses with “burn out syndrome,” biological indicators of a significant relaxation response were found as a result of Reiki treatment (Diaz-Rodriguez et al., 2011). When nurses administered Reiki to a group of patients with acute coronary syndrome, physiologic indicators of a significant relaxation effect were recorded. (Friedman et al., 2011)

Shore (2004) followed patients being treated for mild depression and stress. After six weeks of treatment and for up to a year afterward, those who had received Reiki showed both immediate and long-term improvements in depression, stress and hopelessness. In a small study, complete elimination of typical postoperative depression was seen in heart surgery patients given Reiki during surgery (Motz, 1998).

Pain often causes depression and anxiety. Reducing difficult-to-treat chronic pain can have a substantial effect on psychological well-being. Some studies have found Reiki to be effective for pain, anxiety and depression relief. However, their design or conclusions are unclear as to whether Reiki’s emotional benefits were a result of pain reduction or a separate phenomenon. Nonetheless, research demonstrated Reiki’s positive results for both pain and anxiety or depression.

Dressing and Sing (1998) found that among cancer patients, Reiki brought about significant levels of pain relief, anxiety and depression reduction, improvements in sleep quality, relaxation and general well-being. This effect was stronger in men than women. These benefits remained when checked after three months. Among abdominal hysterectomy patients, Reiki helped reduce pain and anxiety, particularly in a preoperative setting (Vitale and O’Conner, 1998).

Investigating Effects of Gentle Touch, Distance

Research shows that gentle touch in a safe environment aids stress reduction and pain relief (for example, Weze et al., 2005). Since Reiki generally involves a similar type of touch, the results of Reiki studies often can be confounded by the known impact of gentle touch vs. the effects of Reiki itself. Studies that include sham Reiki treatment groups, as well as those that involve a distance Reiki group, have been important to help sort out the relative effects of Reiki versus gentle touch – or even the effects of the presence of a “therapist,” real or sham.

Reiki is becoming an increasingly accepted presence in hospitals and clinics. (The Center for Reiki Research website lists 70 institutions at the time of this article that include Reiki in their offerings.) It is seen as an effective and cost-reducing method to improve health outcomes and quality of care. Hospital staff, such as physicians and nurses, are adding Reiki treatments to their work. Scientific validation of Reiki’s effectiveness have helped bring this method to the mainstream, where it is able to aid patients in all realms, including those with mental health challenges.

References

Baldwin, A. L.. Reiki, the Scientific Evidence. (Fall, 2011). pp. 29-31.

Baldwin, A.L., Schwartz, G.E. (2006). Personal Interaction with a Reiki Practitioner Decreases Noise-Induced Microvascular Damage in an Animal Model. Journal of Alternative and Complementary Medicine, 12(1):15–22, 2006. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Baldwin, A.L., Wagers, C. and Schwartz, G.E. (2008). Reiki improves heart rate homeostasis in laboratory rats. Journal of Alternative and Complementary Medicine, 14 (4): 417-422. Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Center for Reiki Research (CRR). Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Diaz-Rodriguez, L., Arroyo-Morales, M, Fernández-de-las-Peñas, C., García-Lafuente, F., García-Royo, C. and Tomás-Rojas, I. (2011). Immediate effects of Reiki on heart rate variability, cortisol levels, and body temperature in health care professionals with burnout. Biol Res Nurs, 13: 376 originally published online 5 August 2011. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Dressin, L.J., Singg, S. (1998). Effects of Reiki on pain and selected affective and personality variables of chronically ill patients. Subtle Energies and Energy Medicine, 9(1):53-82.

Friedman, R.S.C., Burg, M.M., Miles, P., Lee, F. and Lampert, R. (2010). Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome. Journal of the American College of Cardiology. 56: 995-996. In Baldwin, Fall, 2011.

International Association of Reiki Professionals (IARP). Definition of Reiki. Retrieved June 22, 2012, from http://www.iarpreiki.org/

Motz, J. (1998). Hands of Life. New York: Bantam Books.

Potter, Joe, Research Report, Introduction and General Findings. Retrieved July 21, 2012 from http://www.reiki-research.co.uk/

PubMed. Retrieved July 24, 2012 from http://www.ncbi.nlm.nih.gov/pubmed

Shore, A.G. (2004). Long term effects of energetic healing on symptoms of psychological depression and self-perceived stress. Alternative Therapies in Health and Medicine, 10(3):42-48.

Vitale, A.T., O’Conner, P.C. (1998). The effect of Reiki on pain and anxiety in women with abdominal hysterectomies. Holistic Nursing Practice, 20(6): 263-272, 2006. In Center for Reiki Research, Retrieved June 23, 2012, from http://www.centerforreikiresearch.org/

Weze C, Leathard H.L., Grange J, Tiplady P, Stevens G. (January, 2005). Evaluation of healing by gentle touch. Public Health. 119(1):3-10.

Challenge: Uncontrollability

“Bipolar disorder can feel uncontrollable,” according to Sheri L. Johnson, Ph.D., professor of psychology at the University of California-Berkeley and director of the Cal Mania (CALM) Program. Symptoms, such as mood changes, can seem to appear suddenly and without provocation. And they can diminish daily functioning and ruin relationships, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder.

Strategies: While bipolar disorder can seem unpredictable, there are often patterns and triggers you can watch out for. And even if you can’t prevent symptoms, you can minimize and manage them.

One way to monitor changes is to keep a mood chart, Van Dijk said. Depending on which chart you use, you can record everything from your mood to the number of hours you slept, your anxiety level, medication compliance and menstrual cycle, she said. (This is a good chart, she said.) For instance, you can anticipate a potential depressive episode if you see that your mood has been progressively sinking in the last few days, Van Dijk said.

Practicing healthy habits is an effective way to lessen the hold emotions have on you. Make it a priority to get enough sleep, going to bed at the same time and waking up at the same time, Van Dijk said. Create a calm bedtime routine, avoid substances such as alcohol – which disrupts sleep – and don’t exercise in the evenings, said Johnson, also co-author of Bipolar Disorder: A Guide for the Newly Diagnosed.

Sleep deprivation can trigger mania, and “it makes you more susceptible to being controlled by your emotions, such as irritability,” Van Dijk said. On the other hand, sleeping too much can cause lethargy and also reduce your ability to manage emotions, she said.

Exercise helps to reduce depressive symptoms. Eliminating caffeine can reduce irritability and anxiety and improve sleep, Van Dijk said. She suggested cutting out caffeine for two weeks and paying attention to any changes. Some people also find that certain foods exacerbate their mood swings. You can check by cutting out specific foods from your diet, and watching the results, she said.

You also can use a variety of strategies to stave off the negative consequences from your symptoms. For instance, if impulsive spending is a problem, gain control by having a low limit on your credit cards, Johnson said. When you’re experiencing early signs of mania, have someone else hold onto your checks and cards, Johnson said. If you do overspend, return your purchases, she said. You can even ask a friend to go with you, she added.

Challenge: Medication

“There is no ‘one size fits all’ medication that helps everyone with bipolar disorder,” Johnson said. Lithium is typically the first line of treatment. But for some people the side effects are especially troublesome, she said. Finding the right medication (or combination of medications) can seem like a daunting process.

Strategies: Learn as much as you can about mood-stabilizing medications, Johnson said, including their potential side effects. “Find a doctor who will work with you to make adjustments based on your experiences with the different medications,” she said. Expect that it might take several tries to figure out the best medications for you.

Many of the side effects dissipate after the first two weeks, Johnson said. Changing the dose schedule helps to minimize side effects. For instance, if you feel groggy, your doctor might suggest taking your medication in the evening, she said.

Support groups are another valuable tool, Johnson said. (She suggested looking at the Depression and Bipolar Support Alliance website for a group.) For instance, individuals in these groups are usually familiar with compassionate doctors in the area, she said.

Challenge: Relationships

Bipolar disorder is hard on relationships. The very symptoms – swinging moods, risky behaviors – often leave loved ones feeling confused, exhausted and like they’re walking on eggshells, Van Dijk said.

She also sees loved ones have difficulty distinguishing between the illness and the person. They might invalidate the person’s feelings and either blame everything on the illness or believe the person is making conscious choices when it is the illness.

Strategies: Bipolar disorder is difficult to understand, Van Dijk said. “Different affective episodes, [such as] depression versus hypomania, result in different symptoms, and one episode of depression or hypomania can be different from the next within the same person,” she said.

So it’s incredibly important for loved ones to get educated about the illness and how it functions. Individual therapy, family therapy and support groups can help. Refer loved ones to self-help resources and biographies or memoirs of people with bipolar disorder, Johnson said.

Getting a handle on your emotions also improves relationships, she said. Working on assertiveness is key, too, she said. Individuals with bipolar disorder tend to have a tough time being assertive. Therapy is a good place to learn assertiveness skills. But if you’d like to practice on your own, Van Dijk suggested using “I statements”: “ I feel _____ when you ______.” She gave the following example: “I feel scared and hurt when you threaten to leave me.”

Challenge: Anxiety

According to Johnson, about two-thirds of people with bipolar disorder also have a diagnosable anxiety disorder.

Strategies: Johnson stressed the importance of using relaxation techniques and not using avoidance behaviors. As Van Dijk explained, “the more you avoid things because of your anxiety, the more your anxiety will actually increase, because you never allow your brain to learn that there’s nothing to be anxious about.”

Psychotherapy is tremendously helpful for managing bipolar disorder and the above challenges. If you’ve been prescribed medication, never stop taking it abruptly – this boosts the risk for relapse – and communicate regularly with your doctor.

Jason Eric Schiffman, MD, MA, MBA, a psychiatrist at the UCLA Anxiety Disorders programs and editor of Anxiety.org says it’s one of the paradoxes of anxiety disorders. The severity of the disorder, the fear of being stigmatized, and general mistrust of conventional treatment may create obstacles to seeking help.

What Makes Complementary and Alternative Treatments Attractive Options?

The fear of conventional therapy could explain why complementary and alternative therapies (CAT) — such as vitamin supplements and yoga and meditation — are becoming increasingly popular. There was a time not long ago when we trusted Western medicine more than alternative treatments, but today the opposite is said to be true.

What accounts for this shift? Schiffman identifies four reasons why patients may be leaning toward complementary and alternative techniques to relieve their anxiety.

1. General mistrust of pharmaceutical companies.

The 2010 movie Love and Other Drugs does a good job of explaining patients’ growing mistrust of pharmaceutical companies. In a sentence, the relationship between pharmaceutical companies and physicians has become blurred. While Hollywood exaggerates the issue, the movie raises a legitimate concern: How much influence do pharmaceutical companies have on a doctor’s decision to prescribe certain medications? “The pharmaceutical companies are, by and large, publicly traded health companies, which means they have a fiduciary responsibility to their stockholders to maximize profit and that does not always align with the goal of doing what’s best for the greatest number of people,” says Schiffman. Although there have been recent efforts to prevent bias by limiting the way physicians and pharmaceutical companies interact, the general mistrust has stayed.

2. Side effects from commonly used SSRIs.

Schiffman says there is a correlation between the “amount of desired effects that a medication has and the amount of undesired side effects.” In other words, pharmaceutical treatments used are more effective than nonconventional treatments, but they tend to come with more side effects. In the case of selective serotonin reuptake inhibitors (SSRIs), a class of medications commonly used to treat anxiety disorders, sexual side effects can be perceived as intolerable. A previous post written by Psych Central founder and editor-in-chief John Grohol on Managing the Painful Side Effects of Antidepressants lists several of these common side effects. These reasons may be enough to pique patients’ interest in seeking alternative treatments.

3. No relief from SSRIs or difficulty in treating certain anxiety disorders.

According to Schiffman, “Only somewhere between 30-40% of people respond to their first treatment with SSRI’s.” And for some anxiety disorders, such as severe obsessive compulsive disorder (OCD), conventional treatment approaches may not always work. In fact, he says some patients in a “heroic effort to get relief” have even tried neurosurgery. The truth is that in comparison to Generalized Anxiety Disorder (GAD), OCD patients will require a higher dosage of medication. “If people have tried conventional approaches and are still suffering, it makes sense that they would then be willing to try complementary and alternative approaches.”

4. It’s human nature to believe natural products are better than synthetic.

When you hear the words “all natural” do you immediately associate it with low- or no-risk products? Equating natural products with safety and trust is a common and prevailing misconception with CAT. In fact, Schiffman says, “Natural products can be just as dangerous as synthetic products. Just because something is marketed as a natural supplement doesn’t mean that it is without risks.” In March 2002, the U.S. Food and Drug Administration (FDA) issued a warning about kava kava, a supplement used to treat anxiety, because of its potential negative side effects such as severe liver damage.

Yet, people who take supplements are more likely to trust companies and individuals promoting alternative treatments and supplements than pharmaceutical companies and the FDA. Instead Schiffman says, “the FDA and pharmaceutical companies and the marketers of supplements deserve the same degree of healthy skepticism.”

The Challenge with Seeking Alternative Treatments

It is understandable that individuals suffering from anxiety disorders want to seek alternative therapies — even more so because they can find information about them via the Internet in the comfort of their own homes. But because what’s out there on the World Wide Web isn’t regulated, patients may get misinformation that could have costly consequences.

Another problem is that many psychiatrists are not up to date with the latest research and information on alternative therapies. And if they are, Schiffman says they may be reluctant to comment on them either way. “One of the problems is that these medications have not been evaluated by the FDA [and] they’re fearful of the liability associated with recommending treatment that hasn’t been thoroughly evaluated or approved by the FDA.” As a result, people who are most qualified in terms of training and experience (such as psychiatrists) are less likely to evaluate potential treatments than people who aren’t trained because of the fear of liability issues.

What to Do if You’re Interested in Seeking Complementary and Alternative Therapies

If you think you are experiencing an anxiety disorder, you should always seek treatment from a mental health provider. If you are working with a therapist and are interested in pursuing an alternative route, consider asking them about potential treatments. In addition, a pharmacist or physician may also be able to answer your questions on supplements and provide information on any potential negative interactions with medications you are taking.

And while Schiffman has seen the positive effects of behavioral interventions such as yoga, meditation and deep breathing on anxiety patients, he advises individuals to avoid making decisions based on anecdotal evidence. Sites such as PubMed that publish current and evidence-based research are the best route for obtaining information via the Internet.

If you are suffering from a less severe anxiety disorder such as General Anxiety Disorder, Schiffman suggests “non-pharmalogical approaches first whether those approaches are complementary or alternative approaches like yoga or meditation or conventional approaches like cognitive behavioral therapy.” This is because there is less risk involved and fewer physiological side effects. However, it is important to note that if you are experiencing more severe symptoms or in the moment anxiety as in the case of phobias or panic attacks, CAT may be less effective. Cognitive Behavioral Therapy (CBT) alongside complementary and alternative techniques might work best in those situations.

Knowing all the work and research involved, is it worth seeking complementary and alternative therapies?

Schiffman wholeheartedly says yes. “When someone gets better from anxiety through a practice such as yoga, meditation or through therapy, they get better because they’ve learned something rather than getting better because a pill has made a change or caused a change to their neurochemistry.” Making an effort to change your lifestyle by learning ways to reduce stress and anxiety not only empowers individuals, but creates change that is “much more profound and long-lasting.”

The choice ultimately is yours. But Schiffman leaves us with this final thought to mull over: “If the goal is to increase the quality of life of the person who’s suffering from anxiety, it doesn’t make sense to limit one’s self to either conventional or non-conventional treatment.”

But the woman has done her research. I will give her that. And is much more nuanced than I gave her credit to be. She has divided the book into two sections, the problem and the solution. Makes sense, right? She starts off by helping readers identify and tell their “core story,” the early programming they received and life experiences that formed their beliefs, attitudes, and modus operandi throughout the rest of their lives.

One of the more intriguing lists throughout the book — and her book is full of engaging lists — can be found on page 3, where she lists all the famous, rich, successful people who were high school or college dropouts, to drive home the point that your past doesn’t necessarily dictate your future. I don’t know why it’s so inspiring to read that Winston Churchill flunked the sixth grade, James Cameron took up street racing while working as a truck driver and a high school janitor after dropping out of California State University, and Rachael Ray, author of the successful cookbooks, has no formal training as a chef and never attended college, but it is!

As with the rest of her chapters, Bassett draws from the lives of celebrities and experts to nail down certain points. Take Donald Trump in Chapter 2, about worry. Writes Bassett: “Talk about moving forward instead of worrying! Talk about a pro-active approach to a negative situation with the potential for a negative outcome!” The chapter on worry, one of my favorites, also includes a quiz or “worry inventory” to see how much a person worries, a description of the 13 kinds of worriers, and five concise but very wise steps to “worry reversal.”

In Chapter 4, Bassett takes on fear … a pretty bold move, but once again she packs her pages full of research and wise nuggets that both inform and inspire the reader. After a little biology lesson on what is happening inside our brains when we panic, she examines the different kinds of fear, and how we might turn fear into a motivator, as a driver to success.

My favorite chapter in her second section, the solution part, is the one on healthy detachment. Because, just as the Buddhist teachings suggest, all of our worry, sadness, and angst are basically caused by unhealthy attachment. After exploring the reasons why we attach ourselves unnecessarily to persons, places, or things, Bassett offers 11 steps to detach or let go of unhealthy attachments.

She concludes her book with a power session in chapter 12, called “The Best is Yet to Come,” where readers have a chance to clarify their priorities and to make a plan of action. I did wince a few times throughout the book when I questioned the simple answer, but, on the whole, I was extremely impressed with Bassett’s research and her well-founded advice.

Hardcover: 288 pages
Publisher: Sterling (January 4, 2011)
ISBN-13: 978-1402779886

But you’re not powerless over your worry and anxiety. You can move forward. In his book, LeJeune offers a 5-step model to help you cope, whether you’re an occasional worrier or a full-time worrywart.

LeJeune’s model is based on acceptance and commitment therapy (ACT). As he writes in The Worry Trap, LLAMP (his acronym for the approach) focuses on “letting go of the struggle to control unwanted thoughts and feelings, being mindfully aware of the present moment, and committing to a course of action that is consistent with what you value most in life.”

Worry & Its Evolution

Before delving into the model, LeJeune says that it’s important to learn how worry works. Imagine you’re hiking along a cliff, he says. Your brain tells you “I might fall,” and you picture yourself falling. This thought helps you realize that you need to be extra careful about where you’re walking. This is “a helpful thought to have,” he says.

However, “when your anxiety is high, you’ll experience that image not as ‘I might fall,’ [but as] ‘I will fall.’” With heightened anxiety, “we’re less able to discriminate [between] the thought that might happen” and the reality. This is called “cognitive fusion,” when “a thought becomes fused with what it refers to.” We experience a thought “as a reality, an almost inevitability.”

Evolutionarily speaking, cognitive fusion is adaptive, LeJeune says. Consider this scenario: A person is sitting in a forest and hears something rustling through the bushes. “It could be something dangerous, like a tiger, or something benign, like a small animal,” LeJeune says. “The brain starts to generate hypotheses about what it could be.” The person who didn’t pay much attention to the thought “It might be a tiger” “got eaten first.” But the other person, whose anxiety shot up, responded by running away. He didn’t wait around to see who the noise belonged to. He assumed the situation was dangerous and got out of there. So “it’s more adaptive in a dangerous situation to experience your thoughts as real.” But this can backfire when the situation isn’t risky, fueling anxiety and worry.

The 5-Step Model

1. Label worry thoughts.

According to LeJeune, this step is about identifying “when the phenomenon of worry is happening.” Most worriers have worries around several similar themes, such as health, their job, relationships and finances. Because people see their worries as facts, it can be hard to distinguish a normal thought from a worry thought.

In the book, LeJeune writes that worry thoughts typically follow patterns such as “what if” thoughts (e.g., “What if I’m terminally sick?” “What if I faint?”) and ruminations. When people ruminate, they typically think and worry about the past, sometimes strongly wishing that they could go back in time and make a different decision. People also can ruminate around the word “Why.” For instance, you might ask yourself “Why is that today there’s a torrent of traffic?” or “Why does this have to happen to me of all people?”

Labeling your worry thoughts lets you know when to apply the model, and helps you start separating yourself from these thoughts.

2. Let go of control.

This step encourages worriers to slow down the fight-or-flight response and relax the body by using “traditional stress management” techniques, LeJeune says. Examples include breathing deeply and relaxing your hands and all your muscles.

But this isn’t to gain control over your anxiety. Trying to overpower worry only ignites anxiety and worry thoughts. When you “have a thought you don’t like, your body responds by struggling physically to control it and escape from it. And that intensifies the thought,” LeJeune says.

So your goal is actually the opposite — to interrupt the urge to stronghold your anxiety. It’s to allow acceptance and mindfulness to enter, LeJeune writes in The Worry Trap. As he says, some people will try to use relaxation techniques as weapons in their anti-anxiety arsenal. They’ll try “to furiously breathe away their anxiety,” or get stressed out because yoga isn’t eliminating their angst. They might walk away from a massage feeling fantastic, but they let the inevitable sprinklings of stress undo that relaxation.

It’s unrealistic to think that we can sail through life without any stressors, he says. This perspective also sets people up for more anxiety, he adds, and puts a lot of pressure on yourself.

3. Accept and observe thoughts and feelings.

The goal is to look at your worry thought instead of “looking through it,” LeJeune says. That is, you begin viewing these thoughts as “separate from yourself,” he says. You remind yourself that your thoughts are not reality. They’re not actual events. Separating thoughts from reality is called “cognitive defusion” in ACT.

There are various defusion exercises that can help. For instance, let’s say that you have a fear of earthquakes, and you’re in California for the first time. Not surprisingly, you’re on edge, and every time you hear a loud noise, you think it’s an earthquake. One way to accept and observe this worry thought is by imagining an earthquake gnome, LeJeune says. Imagine the earthquake gnome saying the worry thoughts in a squeaky voice. You might say, “He’s not very smart. I’m not going to listen to him.”

You aren’t trying to rid yourself of these thoughts but you’re trying to distance yourself from them.

4. Be mindful of the present moment.

Mindfulness means “getting out of your head” and “being aware of your immediate surroundings,” using all your senses. You do this in a nonjudgmental and compassionate away, according to LeJeune. He gives the example of an exercise: “picking a color, like red, and for the next two minutes, [you] notice everything that’s the color red.”

The importance of being mindful, LeJeune writes, isn’t to distract yourself. It’s to support observing your thoughts and accepting them.

5. Proceed in the right direction.

Worry “takes us out of the moment and away from connecting with the way we want to move forward,” LeJeune says. We become “focused on what could happen.” Oftentimes, we find ourselves placating our anxiety. Our anxiety might drive many of our choices. In fact, our anxiety might drive our lives.

Instead, the key is to make conscious choices based on your values. Values propel people forward, and give us a rationale or purpose for proceeding, even while anxiety is present. LeJeune likens this to sailing a boat. Consider that “The journey in the boat is your life,” and you’ve got two instruments: a compass and a barometer. When you focus on anxiety, it’s like you’re steering the boat with a barometer, which provides you with the weather, not the direction. Using a barometer means you avoid any potential bad weather and you sail where the waters are calm. But using it to steer the ship also gives you no sense of direction. The compass, however, represents your values. When you use the compass, you know where you’re going, “even if the water is rough or the weather is dicey” (or you’re experiencing anxiety or difficult emotions).

“The more clarity you have [about your values and direction], the more willing you are to do the work.” When thinking about your values, avoid focusing on society’s standards. As LeJeune emphasizes, values are very individual. Consider what “make[s] your life worth living,” he says.

Your attitude about coping with worry and anxiety is also important. LeJeune says that, understandably, many people with acute anxiety are serious and upset and think they have to get a handle on their anxiety immediately. He suggests using a “playful and lighter manner,” which is how he approaches working with his clients.

In June of 2010, there were more than 32 confirmed or suspected suicides among soldiers. Studies confirm that individuals in the military are at higher risk than the general population due to the situations to which they are exposed. Wartime pressures are high, and soldiers come back from combat showing signs of psychiatric illnesses and addictions. These factors can combine into a powerful cocktail that triggers thoughts of suicide. It’s time to take a closer look at them.

This article is about prevention. It will detail some of the warning signs soldiers exhibit prior to a suicide attempt and will discuss preventive measures. Yet this article is for everyone; it has been estimated that 65% (PTSD Research Quarterly) of the general population knows someone who has committed suicide.

Military efforts to reduce risk have improved and new programs are being created. But although suicide prevention rides on the shoulders of the government, it depends on other soldiers and civilians as well. It is imperative that we are armed with awareness and effective prevention measures.

Disorders Commonly Found Among Suicidal Soldiers

The military has identified Post Traumatic Stress Disorder (PTSD), other mental illnesses, and addiction as suicide risk factors. Understanding conditions like these can help individuals ascertain that someone is at risk and provide the support they need.

The following disorders are commonplace among soldiers who commit suicide. Some of the signs and symptoms will be explained in detail. Please note that when someone meets the following criteria, it does not necessarily mean they are suicidal. These are simply red flag disorders often associated with thoughts of self-harm. This is also not an exhaustive list of predictors; soldiers may exhibit other behaviors that signal concern.

Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) may result from exposure to a traumatic event. It is the body’s and the mind’s way of responding to an overwhelming situation involving fear. And, as often the case for soldiers, the threat of, or contact with, death.

PTSD is characterized by clusters of three kinds of symptoms: intrusive, arousal, and avoidance. All three of these need not be present to be concerned about the possibility of suicide among a soldier.

Intrusive Symptoms: These are symptoms that literally intrude in a soldier’s life. They are thoughts and feelings associated with combat that come “out of the blue.” Intrusive symptoms may come in the form of nightmares, flashbacks, or negative reactions to anything associated with combat or the military in general.

Arousal Symptoms: When someone is experiencing intrusive symptoms, their anxiety will begin to peak. This results from not knowing when the next intrusive symptom will occur. This response mirrors the “fight” response to a stimulus. An example of an arousal symptom is an exaggerated startle response commonly referred to as “jumpiness” or “watchful waiting.” The soldier may feel “on edge” all the time as if something is going to harm him or her. These symptoms may manifest themselves in irritability or explosiveness.

Avoidance Symptoms: It is normal to want to avoid something that is painful. If intrusive and arousal symptoms are painful enough, the soldier may make every attempt to avoid the pain associated with them. This is the “flight” response. Avoidance symptoms include not wanting to talk about the combat or military experience, not remembering key events, “checking out” when reminders of the trauma are presented, or engaging in drug and alcohol use.

Depression

Depression is common in individuals who have thoughts of suicide. It is important to note that there is a normal depression that comes along with having a traumatic event in the past. This does not necessarily mean that it will lead to suicide.

Some symptoms of depression include:

• Feelings of helplessness and hopelessness – feeling as if nothing will get better and there is nothing that one can do to improve the situation
• Loss in interest in daily activities
• Loss of ability to experience joy and pleasure
• Appetite or weight changes – either losing or gaining a significant amount of weight
• Irritability and restlessness – low tolerance for stress
• Loss of energy – feeling fatigued or physically drained
• Feelings of low self worth or excessive guilt
• Concentration problems
• Changes in sleep pattern – either sleeping significantly more or less than normal

Anxiety

Anxiety can be described as a continuing state of hyper-vigilance. It is constantly feeling as if something bad is about to happen. Anxiety can manifest itself both mentally and physically. Symptoms of anxiety vary from person to person. Some individuals may feel acute panic at certain times, while others may feel nervous about everything no matter what the significance.

Symptoms of anxiety include:

• Feelings of panic or fear
• Feeling uneasy most of the time
• Obsessive thoughts
• Negative thoughts about the future
• Ritualistic behavior such as checking doors or washing hands
• Problems sleeping
• Sweaty or tingling hands
• Shortness of breath
• Heart palpitations
• Muscle tension
• Inability to stay calm
• Explosiveness

Addiction

At times, addiction may accompany a history of trauma or the disorders described above. A simple description of addiction is continued use despite consequences associated with the use of a substance. To illustrate, if a soldier often exhibits problematic behavior (like aggressiveness or increased depression) when using alcohol yet continues to drink, abuse issues may be present.

Symptoms of addiction include:

• Marked increase in tolerance to the substance
• Withdrawal symptoms
• Difficulty cutting down or controlling use of substance
• Increased time and energy spent on obtaining and using the substance
• Compromised social and occupational roles (such as missing work due to a hangover)
• Negative consequences associated with use of substances
• Desire to cut down coupled with unsuccessful attempts

People feel as if they have zero control over their bodies. Their hearts pound, they feel dizzy or faint, and they suffer from an intense sense of nervousness. They become short of breath, start to sweat, shake or feel uncomfortable in general. Many people report thinking they’re “going crazy.” People may also mistake the symptoms of a panic attack for those of a heart attack.

Panic attacks are fairly common. Some people experience panic attacks on a regular basis and are diagnosed with panic disorder. Roughly six million Americans experience panic disorder every year.

But there are ways you can prevent a panic attack from escalating or minimize attacks in general. Below, John Tsilimparis, MFT, director of the Anxiety and Panic Disorder Center of Los Angeles, shares the anti-anxiety techniques he uses with his clients.

• “Don’t believe everything you think.” Tsilimparis uses this motto with his clients. That’s because when you’re having a panic attack, it’s common to experience racing thoughts that feel intense and catastrophic. Remembering that these thoughts are simply a symptom of the panic attack — like a cough to a cold — can help to de-escalate it, he said.

• Ground yourself. Another common symptom of a panic attack is derealization, an unnerving feeling of being disoriented. People feel like they’re floating, and things just don’t seem real, says Tsilimparis, who’s also one of the therapists on A&E’s Obsessed, a show about severe anxiety disorders.

  He suggests that readers “ground themselves in something that feels tangible,” such as running your fingers along your keys or grabbing the doorframe.

• “Be reflective, not reactive.” This is another motto Tsilimparis uses to help clients stop letting irrational thoughts overwhelm them. It’s common to experience phobic thoughts that further accelerate your attack.

  For example, many people have thoughts such as, “I’m going crazy,” “I’m going to die” or “everyone will leave me,” Tsilimparis notes. Writing these negative thoughts down on paper helps your mind switch “from victim to observer.” It gets people outside their minds, he said.

  After recording their thoughts, Tsilimparis has clients “write up more rational and grounded statements,” such as “that phobic thought is just part of my panic attack” or “I have a loving family.”

• Practice positive self-talk. People can feel ashamed about their panic attacks and become very self-critical. Instead of pointing fingers, talk to yourself in positive ways. Remember that there’s no shame in experiencing panic attacks. You can say a statement such as “I’m going to be OK.”
• Use ice cubes. This technique can help you divert your attention away from a panic attack, especially if you’re in the throes of a particularly intense attack. Take out an ice cube and hold it to your hand for as long as you can (you can put the cube in a paper towel). Then, place the ice cube on your other hand. This focuses your mind on the discomfort, de-escalating your symptoms.
• Know the “anatomy of a panic attack.” Remember that the sensations you experience are simply symptoms of a panic attack, which occurs when your body’s fight or flight system is triggered, although there’s no real danger. For instance, even though you feel like you’re about to faint, chances are that you won’t.

  In 15 years of treating people with panic disorder, Tsilimparis has never known anyone to faint, become incapacitated, go psychotic or die from a panic attack. As he said, there’s a lot of catastrophic thinking that typically never occurs.

  Read more about the anatomy of an attack.

• Stimulate your mind. Engage in activities that stimulate your brain and keep you busy, such as getting outside, exercising or taking a shower.

  In fact, a recent study analyzing 40 randomized clinical trials of 3,000 people with various medical conditions found that people who exercised regularly experienced a 20 percent reduction in their anxiety symptoms compared to non-exercisers.

• Learn deep breathing. Shallow breathing can cause hyperventilation, but deep breathing helps to slow down a panic attack. Learn how to practice deep breathing.

General Practices to Help with Panic Attacks

Panic attacks can be debilitating and cause a lot of distress, but they’re very treatable, Tsilimparis says. “If you begin to look at your anxiety like you would diabetes or another condition, you start to get better quicker,” he asserts. “Understand that you have a condition and not a weakness.”

Psychotherapy, particularly cognitive-behavioral therapy (CBT) is highly effective for treating panic attacks. If a person experiences regular and intense panic attacks that impair daily life, medication also can help.

Making lifestyle changes is critical. That includes getting enough sleep, minimizing stress, being active, cutting down on caffeine (not just in coffee, but in other caffeine-packed foods, such as chocolate, tea and soda) and avoiding alcohol and drugs. For example, once alcohol’s sedating effects wear off, “the panic usually comes back much stronger because your defenses are done,” Tsilimparis says.

Finally, don’t isolate yourself. People with panic attacks may feel ashamed, keep to themselves and avoid seeking help. Again, anxiety is not a weakness, and having social support is vital to your getting better.

Photo by photologic, available under a Creative Commons attribution license.

In A Brief History of Anxiety: Yours and Mine, Pearson describes the Flu Wiki:

“The conversations ranged widely, from scientific discourses on virus mutation to historical analysis of pandemics, to tips for home fuel storage—on the presumption that self-quarantine would be the only effective protection from contracting the virus.”

Though she realizes that her fears may be unwarranted and absurd, she can’t stop stockpiling her house with twelve containers of freeze-dried vegetables and powdered butter, which requires 27 cups of water. Still, she isn’t hypervigilant about everything: She doesn’t fear house fires, terrorism, crime or harm striking her two small children.

But she fears other things, including the dark, the state of her finances and on one occasion, her car exploding. Her phobias are chameleons:

“My anxiety is a shape-shifter. It visits me in unfamiliar guises. Phobias, in particular, tend to take me by surprise, as they rear up and then fade away depending upon the stresses in my life. One minute, I’ll be going about my business, being the sort of person who likes to fly on airplanes and to marvel at the deceptive fluffiness of clouds, and the next thing I know I’m in a state of white-knuckled panic as the jet I’ve just boarded powers itself off the tarmac. After a few years, that phobia resolves and something else—some other act or object—unexpectedly becomes the embodiment of all that is terrifying.”

As she delves into her own anxiety — triggered by a devastating relationship — Pearson tries to understand our anxiety, too, wondering why America tops the list of countries with anxiety disorders. While 28.8 percent of us suffer from anxiety disorders, only 6.6 percent of Mexicans do. We’re also nine times more likely to be anxious than citizens in Shanghai.

For insight, Pearson looks to a variety of experts, including psychologists, psychoanalysts, psychiatrists, philosophers and writers. In turn, she creates a book that’s rich with research without being overwhelming or reading like a textbook. She weaves her own experiences with the work of today’s thinkers and luminaries from long ago. Her writing is witty, humorous and powerful. There’s no highfalutin’ language. No psychobabble. Individuals with anxiety may very well see themselves and find that Pearson captures perfectly the gnawing angst of anxiety:

“There are several ways to cope with dread, but I specialize in what psychologist Maria Miceli calls ‘hypothetical analytical planning.’ This is where you lie in bed at night and run through as many perspective scenarios as you can imagine and then rehearse them in French, or from the vantage point of a cat.”

“The signature vexation of anxiety is that it is objectless. It washes over one in formless waves, pulls one under until the pressure and constriction are tangible and panic rears: I’m in deep, I’m going to drown.”

Part of our problem, Pearson concludes, is that we turn to pills at a time when our anxiety might be telling us that we’re “caught and flailing in arrested development.” She draws on this conclusion after quoting Danish philosopher Søren Kierkegaard:

“Anxiety is an alien power which lays hold of an individual, and yet one cannot tear oneself away, nor has a will to do so; for one fears, but what one fears, one desires.”

Kierkegaard viewed his own time as “the cowardly age,” when a person “does everything possible by way of diversions and the Janizary music of loud-voiced enterprises to keep lonely thoughts away.” Pearson sees the same thing with today’s society, except that we push existential philosophy aside. We’ve also sidelined meaning, a result of rationalism, which was supposed to reduce our fears. Instead it’s only “invalidated meaning, which merely served to heighten our dread.” The idea that we can control our lives hasn’t helped us either.

Pearson also talks about the culture of the workplace, where employee loyalty has been replaced with fake “team building” and traits viewed as positive and polite in countries like Japan — “being deferential, soft-spoken, courteous and self-effacing” — are considered disordered here in the U.S. (i.e., “social phobia,” “avoidant personality disorder,” “workplace depression”).

She dedicates a chapter to “a drug’s odyssey,” in which she describes her own experience with medication. In the first few weeks taking Effexor, Pearson feels like it’s “heaven-sent.” But then she begins to feel “apathetic insincerity.” She likens her “secure and yet largely disengaged” state of being to her first job out of college ghost-writing letters at Ontario’s Ministry of Labour:

“I did not enjoy this ghostwriting job, mostly because I spent the day responding to genuine human calamity by (a) pretending that I was someone else, and (b) lying. Yet, it was effortless. Paperwork and coffee breaks and lunch, all at a placid pace. I watched the clock a lot, waiting for it to hit five. ‘Dear Widow Whose Husband Drowned in a Vat of Toner at the Wallpaper Factory, thank you for—‘Oh, five o’clock, gotta go.”

Pearson was addicted to Effexor for five years. Of her horrifying, heroin-like withdrawal, she writes:

“My withdrawal featured night sweats, muscle aches, and shortness of breath. There were the electric pulses but I was used to those from the times I missed a dose. (Seth Silverman in Slate best described them as feeling like someone had removed your skull cap and dragged a staticky blanket across your naked brain.)…On most days, I felt a sort of hypercaffeinated wiring and buzzing sensation, a feeling of continuous adrenal rush. It was like being mildly electrified. And then on certain days, it was as if someone had pulled the plug from the socket and the energy simply winked out. I experienced nothing but darkness, an unbearable density and weight that almost brought me to my knees.”

She faults her psychiatrist for failing to inform her of Effexor’s side effects, and criticizes psychiatry as a whole for steering away from talk therapy and withholding important information:

“How can so many thousands of people, very possibly millions, have been abandoned by so many of the practitioners of medical science and been made to fall back upon rumors and whispers about how to manage their meds? At first, I could only think that these particular doctors needed to be in control, to fix what they’re interested in fixing; they suspect that they’ll lose control if they allow their patients to make an informed choice. ‘I can repair your illness, but you need to know that you’ll become emotionally bland, sexually absent, likely fat, probably at risk of getting diabetes, and every time you miss a dose, you’ll feel like you’ve been shocked with a cattle prod. It’s up to you.’ They don’t want it to be up to you. They don’t trust your judgment. They think you’re nuts.”

It’s understandable why Pearson holds such a negative view of medication. Had she been provided with all the facts—which would’ve taken mere minutes to discuss—she could have avoided years of agony. However, as she scours history for insights on anxiety, she does little to explore all facets of pharmacology. Medication does help many people. It can be used to facilitate psychotherapy, jump-start recovery or help diminish debilitating, severe anxiety. But Pearson gives little in a well-rounded discussion. Her “cautionary tale,” as she describes it, certainly can help others to seek better treatment. If you’re considering medication, see a psychiatrist who specializes in anxiety disorders and who can answer all of your questions (and be sure to ask many). Don’t hesitate to do your own research and remember that you and your doctor are a team. You should never feel like a powerless bystander when it comes to your treatment.

Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders — and a highly successful one at that. In fact, the success rates make other researchers envious, as one expert put it. So it’s disappointing that Pearson devotes just several pages to her experiences with the treatment. This does a disservice for readers who are learning about anxiety disorders for the first time. They may easily feel like there’s nothing out there that can help them. Pearson could’ve noted CBT’s efficacy and demystified the treatment for her readers.

What’s Pearson’s prescription for anxiety? For one, she calls for American society to grow up. She writes:

“What we need is to bend to the tempest like pine and palm trees—flexible, adaptive, attuned, yet fully rooted in our principles. What we need, in essence, is to grow up.”

We also should look inward and seek meaning. Pearson introduces her last chapter with a quote from the philosopher Rumi:

“Don’t look for the remedy for your troubles outside yourself. You are the medicine. You are the cure for your own sorrow.”

While this quote is empowering, it also implies that it’s best to treat an anxiety disorder on your own. And if you can’t reduce your anxiety, there’s something inherently awry. Again, anxiety disorders are treatable, and oftentimes, avoiding treatment only amplifies the anxiety. Seeking treatment means that you’re taking care of yourself; you’re seeking the resources that will help you get better. There’s no reason to suffer with anxiety. But Pearson’s point is important: Meaning is missing from our lives. In our “I want,” ever-entitled culture, it can be tough to find. But it’s key to us thriving.

Overall, Pearson’s book is a powerful read, which provides a refreshing perspective on anxiety in our age. It offers profound words of wisdom, coming from both Pearson and a slew of gifted, inspiring thinkers. And it can help jump-start your exploration into your own anxiety. At the same time, however, there’s no need to suffer. If you’re experiencing anxiety, make an appointment with a therapist who specializes in anxiety disorders.

A Brief History of Anxiety: Yours and Mine
By Patricia Pearson
Bloomsbury USA; Reprint edition (paperback) March 3, 2009
$13
208 pages

You can also learn more about these techniques on your own, and through self-help books. Keep in mind that not every technique is appropriate for every kind of concern or every person — some may work better than others for you. If you fail at one, don’t despair; it means you should either try again until you succeed with that technique, or try another one from the list.

1. The Experimental Method

Do an experiment to test your belief that you’re “cracking up,” having a heart attack, or losing control.

2. Paradoxical Techniques

Exaggerate your fears instead of running away from them. If you have the fear of cracking up or having a stroke, you try your hardest to crack up or have a stroke.

3. Shame-Attacking Exercises

Purposely do something silly in public, in order to overcome your fear of appearing foolish.

4. Confront Your Fears

Expose yourself to a frightening or high-anxiety situation instead of avoiding it and allowing your fear to control you. There are three common methods:

• Sudden Exposure or “Flooding.” You allow yourself to experience all your symptoms, no matter how bad they get. You endure your fears until they run their course and wear out.

• Gradual Exposure. You gradually expose yourself to whatever you’re afraid of (such as being away from home alone, going into grocery stores, or riding a bus or elevator). Thereafter, you withdraw when your anxiety becomes excessive.
• The Partnership Method. If you are afraid of walking alone, you can ask a trusted person to walk a certain distance ahead of you, and wait. After walking to meet her or him at the location, the individual will walk further ahead before you meet her or him again. This gradual method of managing fear-related anxiety will increase the distance to a point that you are able to walk reasonable distances alone.

5. Daily Mood Log

Write down the negative thoughts that make you feel anxious or frightened. Identify the cognitive distortions associated with those thoughts, and replace them with realistic and positive thoughts. Instead of worrying and constantly predicting failure and catastrophes, tell yourself that things will turn out reasonably well.

6. The Cost-Benefit Analysis

Make a list of the advantages and disadvantages of worrying and avoiding whatever you fear. Weigh the advantages against the disadvantages (refer to the Cost-Benefit Analysis worksheet). Make a second list of the advantages and disadvantages of confronting your fears. Contrast the advantages with the disadvantages.

7. Positive Imaging

Substitute reassuring and peaceful images for the frightening daydreams and fantasies that make you feel excessively anxious.

8. Distraction

Distract yourself with intense mental activity (e.g., crossword puzzle), strenuous exercise, or by getting involved with your work or a hobby.

9. The Acceptance Paradox

When you feel anxious or panicky, you may make matters worse by insisting that you should not feel that way. This type of verbal or sub-verbal negativity only increases your anxiety. One way to develop greater self-acceptance is to write out a dialogue with an imaginary hostile stranger who puts you down for feeling excessively anxious. The hostile stranger is simply a projection of your own self-criticism. When you talk back to that symbolic person, you will develop greater self-acceptance, and you are better able to manage your anxiety or fear.

10. Getting in Touch

When you feel anxious or panicky, you could be ignoring a problem that is best addressed instead of being ignored. Review your life, and identify situations that are making you feel uncertain and fearful. When you find the courage to address a problem such as the fear of rejection in a direct and open manner, a sense of calm will replace uncertainty or fear.

Reference:

Burns, D.D. (1989). The feeling good handbook. New York: William Morrow.

By educating yourself about panic attacks, you can begin to gain control of the problem. You don’t have to live in fear and uncertainty any longer. We’ll get you started on your journey toward well-being.

Accepting a panic attack for what it is can help to lessen its effect. To start feeling in control of your anxiety, make an appointment with your doctor and get a full physical exam. This will help you focus your approach, as you’ll find out for certain that you’re coping with panic attacks and not some other ailment. A clean bill of health can also help alleviate irrational fears of dying and doom, which can surface during a panic attack.

Also, your doctor can differentiate between occasional panic attacks and a more serious panic disorder, which may require professional treatment and possibly medication. Working with your doctor, you can also determine if you have a genetic susceptibility to panic attacks, and if your episodes are triggered in part by other conditions, such as a thyroid disorder or lactose sensitivity.

Recognize the Symptoms of a Panic Attack

Familiarizing yourself with panic attack symptoms can help you feel more in control while one’s happening. Once you realize you’re experiencing a panic attack and not a heart attack, allergic reaction, or some other serious ailment, you can focus on techniques for calming yourself.

Being able to recognize it for what it is will help you decide what action to take to overcome it. Although symptoms differ from person to person, and only a trained professional can provide a definite diagnosis, some common ones include:

• Irregular heartbeat
• Dizziness and lightheadedness
• Shortness of breath
• Choking sensations and nausea
• Shaking and sweating
• Fatigue and weakness
• Chest pain and heartburn
• Muscle spasms
• Hot flashes or sudden chills
• Tingling sensations in your extremities
• A fear that you’re going crazy
• A fear that you might die or be seriously ill

Depression is a Mental Disorder, not a Disease

While psychiatric medications and their resulting television commercials in the 1990′s and this decade have done much to help people seek treatment for a mental disorder like depression, they haven’t done much to help people understand the complexities of things like “depression” and “bipolar disorder.” These things are called disorders, not diseases, for a reason. A disorder simply means something that is out of the ordinary, which depression and other mental disorders are. They are more specifically a cluster of symptoms that research has shown to correlate highly with a specific emotional state.

A medical disease, on the other hand, according to Webster’s, is

a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms

Diseases are manifestations of a problem with some physical organ or component within the body. And while the brain is also an organ, it is one of the least understood and easily the most complex organ within the body. Researchers and doctors refer to a diseased organ when something is clearly wrong with it (via a CAT scan or X-ray or laboratory test). But with our brains, we have no test to say, “Hey, there’s something clearly wrong here!”

One could make the argument, as many have, that because brain scans show abnormalities in certain biochemical levels within the brain when they suffer from depression or the like, this “proves” that depression is a disease. Unfortunately, research hasn’t gotten quite that far yet. The brain scans show us something, that much is true. But whether the scans show the cause or the result of depression has yet to be determined. And more tellingly, there is a body of research that shows similar changes in brain neurochemistry when people are doing all sorts of activities (such as reading, playing a video game, etc.).

The Bio-Psycho-Social Model of Mental Disorders

While brain biochemistry and genetic makeup are important components of most people’s battle with a mental disorder, there are two other equally important components that are all too often left out of the picture – the psychological and the social. The most commonly accepted model of mental illness today takes these three components into account – the biopsychosocial model. This is the model most mental health professionals who practice subscribe to.

People who have phobias often are so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces or flying in an airplane.

Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity.

Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with phobias.

How Common Are Phobias?

Approximately 4 to 5 percent of the U.S. population has one or more clinically significant phobias in a given year.

Specific phobias occur in people of all ages. The average age of onset for social phobia is between 15 and 20 years of age, although it can often begin in childhood.

What Causes Phobias?

Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.

What Treatments Are Available for Phobias?

Social phobia can be effectively treated with medications including, MAOIs, SSRIs and high- potency benzodiazepines. People with a specific form of social phobia called performance phobia have been helped by drugs called beta blockers.

There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before one faces a phobic situation. A type of cognitive-behavioral therapy known as “exposure therapy” is also a very useful treatment for phobias. It involves helping patients become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.

Can People With Phobias Also Have Other Physical and Emotional Illnesses?

People with phobias, particularly social phobia, may also have problems with substance abuse. Many people with social or a specific phobia become so anxious that they experience panic attacks, which are intense and unexpected bursts of terror accompanied by physical symptoms.

As more situational panic attacks occur, people with phobias may take extreme measures to avoid situations where they fear another attack might happen or where help would not be immediately available. This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Appropriate diagnosis and treatment of other disorders are important to successful treatment of phobias.

Generalized Anxiety Disorder: GAD is characterized by persistent anxiety unrelated to a specific event. People suffering from GAD cannot help worrying about anything and everything, even in calm situations. They have difficulty relaxing, falling asleep, or concentrating, and tend to be impatient and irritable. Physical symptoms accompanying GAD include sweating; an upset stomach; diarrhea; frequent urination; cold, clammy hands; a lump in the throat; a dry mouth; shortness of breath; headaches; and dizziness. Managing the normal demands of a job, relationships, and everyday life can become more and more difficult for people with this disorder. GAD appears in four percent of the general population.

Case Study: Amy, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries that she worries so much and isn’t always sure what it is that she is worried about. She can’t let her husband or children leave the house without making them call her regularly to reassure her that they are okay. Her husband is growing weary of her fretting. Her children can’t understand what all the fuss is about. Their impatience with her only makes her worry more. Amy has generalized anxiety disorder.

Panic Disorder: Panic attacks are just that—sudden, inexplicable waves of panic that seem to come out of the blue. The body responds with the “fight-or-flight” response, anticipating clear and immediate danger. Often, these attacks subside as mysteriously as they occur. A person who has experienced one or more panic attacks often develops a fear of having one again. Some professionals call this a “fear of fear.” The individual may even try to stay away from anything that reminds him or her of the last attack to avoid having another one. People can have panic attacks with or without agoraphobia (see “Phobias” below).

These attacks include symptoms such as heart palpitations, shortness of breath, chest pain, feelings of choking or smothering, nausea, dizziness, sweating, and trembling. An afflicted person might also be overwhelmed by a fear of dying, going crazy, or losing control.

Case Study: Annie is a 20-year-old student at a local community college. On several occasions recently, she has experienced sudden, absolute panic. During these episodes, her heart pounds; she trembles; her mouth gets dry and it feels as if the walls are caving in. The feelings only last a few minutes but, when they occur, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won’t ride in cars any more unless she is driving so she is sure that she can stop if necessary. She will only go to class if she can find an aisle seat in the back row so that she can leave quietly should she have another attack. She avoids any situation in which she might feel out of control or embarrassed by her own terror. Annie is suffering from panic attacks.

Some amount of anxiety and worrying is a normal and necessary part of life. It is because we are concerned about our children’s safety, for example, that we watch them carefully when we are at the beach. It is because we are concerned about our own well-being that we fasten our seatbelts when we get into a car. These kinds of concerns help keep us aware and alert, but don’t interfere with our daily life in any way. On the contrary, worry on this level means that our internal protective systems are doing what they are supposed to do.

Anxiety rooted in stress is what is commonly known as “fight-or-flight.” It is a physical and emotional response to real or perceived danger. This kind of anxiety, although it can be very uncomfortable, is still very useful in that it helps us respond to a crisis. Intense worry about a sick child prompts us to prepare for any eventuality, for better or for worse.

Stress anxiety is caused by a clearly identifiable event and fades as soon as the crisis is over. (Amusement parks make a great deal of their money by provoking this kind of anxiety. The jolt in your stomach when you speed down a roller coaster or when something jumps out at you is the fight-or-flight response in action. The rush of adrenaline feels so good, you want to take another ride.)

When Does Normal Anxiety Become an Anxiety Disorder?

Anxiety disorders take normal anxiety responses to another level. For people with anxiety disorders, worrying (or worrying about worrying) disrupts the flow of daily life. These worries and even the fight-or-flight adrenaline rush are not necessarily connected to any specific event. Often they happen for no apparent reason, and disappear as mysteriously as they started. What best characterizes an anxiety disorder is that it is out of proportion and out of the individual’s control.