Treating Anxiety Part 1: cycles and patterns

Anxiety is by far the most addressed issue in clinical therapy. It is the big kahuna of psychiatric treatment. The 3 largest selling prescription drugs in the U.S. for all ailments of body and mind are approved to treat anxiety. These drugs usually produce moderate to excellent initial success, but are known for profound side-effects and increased tolerance. That's why learning to manage it on your own is so important.

Although anxiety manifests itself in many ways, there are some common elements we can identify that help us gain an understand of the cause-effect relationship and behavior chains that make it an obstacle to enjoy and function in our daily lives. Here are a few commonalities:

The Tension Mounts: Anxiety accumulates through stress. Most people report anxiety heightening by the end of the day. Panic attacks occur far more often in the PM then AM. It is therefore very important for sufferers to take stress breaks during the day. If you have an anxiety problem and you are spending your lunch or coffee break surfing the net, calling family or friends or some other activity that requires significant attention and concentration, then you are making poor use of your time. Take a few minutes periodically during the day implement a stress reduction technique (much more on them later). This will at least slow the accumulation of stress during the day and make it more manageable as it peaks.

Domino Effect: When we are under stress, we often make hasty and impulsive decisions. The consequences of these decisions are often cause for more stress and anxiety. Like a bad lie made from a politician, things start to unravel and we experience chaos and a loss of control. The saying or song "one thing leads to another," probably alludes to this phenomena. This dynamic once again points to the need to keep stress at a minimum and reset periodically during the day.

The Mind-Body Relationship: There are several measurable physical response directly associated with anxiety: increased and variable heart rate, adrenalin being dumped in the blood stream, increased muscle tension to name a few. These will be further addressed in the discussion of biofeedback in part 2. When we experience uncomfortable physical sensations the result is generally, you guessed it, more anxiety. Someone's heartbeat increases and palpitates and they wonder if they need to go to ER. Or someone begins to perspire in a social setting and they become more self-conscious and less confident.

The common theme between these 3 elements of anxiety disorders is one of mounting and accumulating stress. We see a chain of events and behaviors that help feed the anxiety. The preventive or proactive element of treating this disorder is vital. The onus is on you to identify these maladaptive trends as they happen and try to subvert them. Then the therapist or other resource can give you a repertoire of techniques to help you tame this debilitating beast.

up next: Treating Anxiety Part 2: relaxation techniques

My 1st Letter!

After patiently waiting for 3 weeks now I finally got a request for advice from an anonymous source. As I clicked the link to view the correspondence I was anxiously anticipating the content, The snail mail equivalent would be having trembling hands as I opened the unsealed envelope.

This inquiry is excellent because of it's focus on equity, respect and control in significant relationships, an issue so many of us can identify with:

Hi Jeff, How are you doing? I clicked on your blog page. I also bookmarked it. I need all the advice I can get in life....lol... I still have an insecure feeling inside when it comes to men. Is this normal? Like one thing about Trent that irritates me is that like he said he would call me last night and he didn't. This is about the 3rd time he has done this. Should I not be so petty or realize now he is not always a man of his word? I honestly would just like to learn to be happy without a man. lol Have a good day. Anonymous

Ty for the wonderful thoughts and your letter. I guess we all wish we could be content by ourselves. But having a romantic relationship that meets our needs is an important part of anyone's life. And having someone you can rely on and is consistent is very important too. So I can see why you are disappointed in Trent's recent behavior.

As adults seeking relationships we all fight this constant battle of 2 mutually strong desires: between being alone an accountable to no one and having our romantic and companionship needs met by someone significant in our lives. Both seem like strong and persuasive needs. Unfortunately it is difficult to satisfy both: in sharing your time and space with someone else, we are forced to surrender some of the freedom and autonomy we can enjoy when we focus on our own interests and self-care.

Developmental psychologist and psychoanalyst Erik Erikson makes reference to this quandary in his eight stages of human development:

Intimacy vs. isolation (young adult stage) refers to the 6th stage of Erik Erikson's theory of Psychosocial development where the social task of the young adult is to create strong, long-lasting bonds of friendship and love. Those that fail in this task risk remaining isolated for the rest of their lives.

He identifies this as a conflict that begins at young adulthood. I would contend that in this era of transient and more temporary romantic bonds this conflict carries on into middle adulthood, given the slowing of the aging process and our youthful and neotenous values and outlook in modern society.

I would also argue that the "risk of remaining isolated for the rest of their lives," is a gloomy exaggeration of the isolation outcome, as some people are quite content with a solitary existence.

Ok, I need to get some advice in here at some point and get away from the academic digression.

So how can we try to live our lives in a way where both needs are satisfied? What are some of the common misconceptions or cognitive errors that we bring into the relationship? Here are a few "bullets" that contend with my writer's difficulty with her boyfriend.

• Never Again: it is unreasonable to expect the same intense feelings and bonds in a later adult relationship as you had as a young adult. Both parties are more protective of their hearts and set in their ways and you will never get that feeling of "oneness,' that you did with earlier love interests. It is a sad fact, but a realistic expectation. Even young couples that do stay together for years and beyond to a golden anniversary drift apart in terms of insatiable attachment and time spent together. But their appreciation for each other and love grows in many other ways; their shared time together, the mutual pride of raising a family. That mutual love can also be gleaned in a relationship that starts in later adulthood. It is a matter of duplicating that appreciation by finding mutual pride in shared and productive activities (including the combining of two families) and sharing time in activities that are spontaneous, fun and unique enough to be chronicled as an enduring and sustained memory.
• Be Confrontational: If your partner does something that you believe falls short of your mutual agreement, don't just sit back and keep taking it in a patterned way. Take a stand, but frame it in a way that is constructive and encourages further growth and so he/she does not feel put on the spot. "I want to ask you about something because I really care about our mutual satisfaction in this relationship," for example. Keep your emotions in check, moderately positive and upbeat. You will in most cases get some honest dialogue and know where you stand in the relationship. Maybe you won't like the answer, but it beats the uncertainty and painful lingering effect of feeling like you are being taken advantage of and not knowing where your partner stands.
• Keep Yourself Centered: Aware of what you have control over and do not. Remember your self-worth and that it is reasonable, desirable and you are deserving of having a healthy relationship. When you start to say you must have this relationship and you must have it right now, that's when you cross over to irrational thoughts that lead to unrealistic expectations and a deteriorating mood.

We all have to find a balance between our own personal content and the satisfaction of having someone special in our lives. Once we have found our place in that continuum and find a person that shares our dreams and values, the conflict between autonomy and belonging will be resolved.

Small Craft Warning: Politics and Emotion in 2008

Still waiting for that 1st advice letter/inquiry. Having a friend, former client (one sent an amusing prank email) or even myself send me one would be easy, but I want the letters to be real and genuine. I know quite a few of you are giving me my share of impressions, so please help me get this thing rolling.

Ah, but there is plenty of treatment fodder out there anyways. I was thinking about the current economic "crisis" and the upcoming election and how this cultural climate might impact treatment. What are some attitudes and feelings I am picking up on in these turbulent times? I may see this exaggerated in my practice because I live in a Detroit suburb and this area is being impacted by the economic downturn more than any other area in the US. I have a few listed below and the how and why as it relates to a mounting tension in American culture. As the third wave feminists would say "the person is political" and I have been observing how the political seas of change are effecting my clientele, many who are finding how these hard times are compounding the stress associated with their already unsettled lives.

wait and see

people's dreams and aspirations are being put on hold. Fearful of making large purchases. Reluctant to take on new challenges, such as school or a new business venture. Hopeless thinking about their future endeavors panning out. A pessimistic paralysis as they tread water and wait for the cultural environment to change in a way that makes personal growth more feasible.

bargaining with themselves

A lost job, a foreclosed home, will lead to self-reflection. Having explored all reasonable options, they endeavor in magical thinking: perusing luck, ritual behaviors and excessive use of faith.

slash and burn

A sense of abandonment. People feel they may as well run up the credit cards and enjoy life because "I am loosing my home and going bankrupt anyways." Hedonistic tendencies follow.

sour grapes

As the election nears, and the outcome becomes more evident, those who see that their ideas for change are not going to take place. They begin to express anger and hatred towards those that do not see things their way.

these are all irrational responses to an albeit overwhelming challenge. We need to contain and moderate these feeling as a starting point to our own personal adaptation to these changes in our political and economic environment. We need to have a grip on how much influence these socio-economic factors have on our lives and how much control we can exert over this phenomena and how much support we can glean from those around us. And lastly, in terms of exerting our own control, DON'T FORGET TO VOTE.

Jeff aka “Dr. Memory.”

Press Release for Webpage

Launch of New Personal Advice Blog

At some point in our life we encounter an obstacle or challenge that seems insurmountable or unsolvable. Getting true objective advice from friends or loved ones can be difficult for a number of reasons. They may be to close to the problem to have the needed perspective and clarity to address the Issue. They may be reluctant to be confrontive in fear that they might hurt your feelings or damage their rapport and alliance with you. We can find the objective help we need in a number of ways, be it through the church, employee assistance, self-help fellowship or psychotherapy.

I am offering one more resource for anyone seeking objective advice. I have worked in the area of counseling for over 30 years with a wide array of populations, regardless of race, sexual orientation or socioeconomic background. I really enjoy my work and pride myself in individualizing treatment for every client.

This same meticulous approach will be taken in my free advice blog. Interested readers can send me confidential emails regarding some disturbing, disruptive or debilitating personal or relationship issue. I pledge to respond to every email, either by posting the advice on the blog or personally responding by replied email. This becomes a viable resource to anyone who needs objective advice and lacks or has exhausted other avenues. If interested, please visit my blog site at http://askdrmemory.blogspot.com/ or simply write me with your presenting problem via drmemory@hotmail.com.

Thank you for your consideration.



Jeff aka “Dr. Memory.”

Treatment Considerations and a Case Study

This is my first day "on the blog," so I am giving treatment considerations and a case study in lieu of advice. This will not be my usual format, but an opportunity to see how I approach one on one therapy.

Life in this modern world zips by. We are in a fast-paced society that is fueled by impulsively and the need for immediate gratification. To compliment this facet of society, professional and self-help must be geared for a quick solution to a presenting problem.

In the realm of psychotherapy, long gone are the days of an elaborate clinical course utilizing psychoanalytic techniques. The recline on the couch and the reciting of childhood memories have been outmoded due to the restrictions of managed health care, the time constraints and personal demands of the client.

Solution-focused therapy holds the belief that the client has already done allot of deliberate internalizing regarding "the problem." When they present to a therapist, assuming they are fairly high functioning, the process of solving the problem is already well underway. It is the therapist's job to identify the stumbling blocks, obstacles or where the client got stuck in trying to resolve their issues along the way. The therapist may present some ideas to overcome these obstacles that were not previously considered by the client. He/she may propose ways to alter or "tweak" approaches that have already been attempted.

It would be easy but ineffective to mechanize therapy and categorize presenting problems and create pat answers and solutions for those in need. This is where adept and advanced listening skills come into play. The active listener will absorb the details and nuances of the situation and be able to hypothetically place themselves in the clients’s realm while having an appreciation of their background, personality, demeanor and deficits and attributes. I call this ability "Individualizing," the ability to immerse one's self into the present day challenges of the client with an appreciation of their past experience, present dilemma and future aspirations and dreams. I suppose a frivolous analogy could be made with the sci-fi "mind melding" fantasy. This treatment approach is selfless, time consuming and requires a tremendous amount of energy. But I would argue that is the only way to be an effective behavioral counselor. The complicated problem solving process can not take place without these devote approaches to therapy.

A case study:

Korrina was a 35 year old divorced female. She had 2 children and was in skilled trades. She presented as anxious and depressed. She stated she was in a "committed" relationship of almost 2 years. She complained that the relationship was not going anywhere. The commitment she spoke of was very arbitrary and ill defined. Her partner often referred to his own personal freedom as a means to avoid any obligation or emotional support to her. When she would make the subtlest of demands from him, he would castigate and demean her. He felt that she was always trying to pin him down and their weekend plans were often not settled until a day or 2 before they got together.

She realized that they wanted 2 completely different things in this relationship. She had tried to leave him a couple times, but a physical attachment had been formed and the idea of "starting all over again," seemed difficult. The idea of finding someone accepting of her and her preadolescent children, her past failed relationships and her busy work schedule made dumping her self-absorbed friend and finding the "right one" seem like an impossible task. She knew the current relationship was unhealthy to the point of fueling her anxiety and depression, but the physical attachment to her current partner and the belief that she was not "good enough," based on her past failed relationships kept her from moving on.

Korrina was at that immobilized or "stuck" point I referred to earlier. She was an intelligent, emotionally mature woman and had tried to change her life for the better in the past. As her therapist I had to identify the hurdles she had to overcome to solve her problem. It was also my task to identify what assets she had to overcome these obstacles and give her the confidence to operationalize the agents of change.

She had got as far as realizing the poor quality of her relationship and attempting to break things off. The obstacles were her perceived physical and emotional attachment and the belief that she wasn't capable or didn't "deserve" a healthy relationship.

One quick revelation I gave to her was how intertwined these 2 obstacles were. She had been programmed by her current partner to believe that she was inadequate to obtain the closeness she longed for in a relationship. In convincing her of these inadequacies she felt more and more dependent on him. Her physical dependence was not formed from admiration and genuine affection but the irrational belief that she was destined to be in a relationship where her partner was aloof and uncaring. She may have loved him, but for all of the wrong reasons.

The disappointment of her divorce and subsequent failed relationships had made her lose sight of what a healthy relationship was and discard the belief they could exist. I gave her examples of healthy relationship and encouraged her to describe some couples she personally knew who had been happy a long time. We kicked around what made them successful relationships. She began to appreciate that although there may be no prince charming or perfect man for her as she may have expected from a developmental, adolescent schema she had developed, there were healthy relationships out there.

The next task was getting her to refute the demeaning observations that her partner had made to her. He was trying to program her in such a way to keep her under his thumb. Without being flattering or flirtatious I contested his observations about her personality and appearance and help invigorate her self-esteem. I pointed to many of her outstanding personal qualities.

The identification of these personal strengths signaled the next phase of therapy. She was professionally employed in trades, committed to family life and of strong Christian faith. Her ability to love her children and God made an easy transition to self-love and a renewed confidence.

She had tried dating sites in the past, ones geared towards the general population and Christian oriented ones. She had always give them a half-hearted try because the thought of returning to the unhealthy relationship was always there and seemed like an easy way out. And the notion that she was truly in love. This obstacle was now removed due to the recent appreciation of how badly she had been treated, the realization that there was something better out there for her and her more positive self-concept. She began a more vigorous approach to Internet dating. More important she realized the value of her beliefs and children and gleaned the support of church and family. She had become more content, happy for who she was and not beholden to anyone.

After sometime dating several men she found someone who fit her values and beliefs and is fortunate enough to feel the genuine benefits of having someone whom is loving, considerate and caring and appreciates that she gives him all of these things in return. A happy ending.

To review the course of treatment and to try to step-by-step a very personalized process: 1) An identification of "the problem (in the context of the client's personal experience)," and where the client was at in terms of already solving that problem. 2) Specifically pinpointing the obstacles that were cause for the client to fall short of bettering her life. 3) The refuting of irrational beliefs, cognitive errors and long-held schema that were cause for emotional and mental paralysis and 4) The operalization of the client's strengths and assets in overcoming the pinpointed obstacles.

This is an example my approach to therapy. I am eclectic enough to use any modern treatment approach for the betterment of the client. In this case study, short-term, solution focused, cognitive-behavioral and strengths/asset based therapy were the recipe for my client’s betterment. May I leave you with a poem by Bessie Stanley:

Success

To laugh often and much;

To win the respect of intelligent people and the affection of children;

To earn the appreciation of honest critics and endure the betrayal of false friends;

To appreciate beauty, to find the best in others;

To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition;

To know even one life has breathed easier because you have lived.

This is to have succeeded.

Ask Dr. Memory

To the Humble Masses:

I am venturing into the advice column realm. I am doing this at the encouragement of friends and as a bit of fun. I am a trained psychotherapist and I wonder how well being an adept one on one therapist translates into general advice.

The format for the blog will consist of taking emails from interested readers regarding some disturbing, disruptive or debilitating personal or relationship issues. I will then post select answers to help the person cope and problem solve these issues. If enough emails are generated, I am going to pledge to answers ALL emails personally if their questions do not get on the site. I want to emphasize ANONYMITY and CONFIDENTIALITY for all inquirers.

You can send your personal questions/dilemmas to drmemory@hotmail.com


To enhance the bit of fun aspect, I will occasionally post a "spoof reply," One that contains ridiculous and absurd advice. These will be laden with cynicism and satire and will be a "how not to" primer for advice bloggers. They will be labeled as such for the easily confused or mislead.

OK lets get this thing rolling, throw caution into the wind while I check my liability coverage.

thanks,
Jeff


Ask Dr. Memory Advice Blog by Jeffrey Deneau is licensed under a Creative Commons Attribution-No Derivative Works 3.0 United States License.


disclaimer: I am not a real doctor, but I do have a Master of Social Work degree and several certifications, including those for the treatment of anxiety, depressive and bipolar disorders, substance abuse and couples counseling. I have over 30 years experience in this field.
The advice given here is not intended to be a substitute for psychotherapy or psychiatric intervention; rather it is intended as a means of basic asessment and possible referral to a professional source.