Treating Anxiety in Therapy

Anxiety is a feeling of worry, nervousness, or unease. Often, we worry about situations that feel threatening and/or have uncertain outcomes. A threat does not have to actually be happening at the moment for us to worry. Perceived threats trigger anxiety. For example, thinking that you could perform poorly on a presentation, make a fool of yourself at a social event, or that the plane could crash. These things haven’t happened. It’s the idea of them that triggers anxiety.

In this sense, your anxiety alarm is misfiring. It is telling you a threat is occurring right now and it is not. One way to think about this is a house alarm system going off when a leaf falls on the roof. A leaf on the roof is not a threat. So, if the alarm goes off when a leaf falls on the roof the alarm is malfunctioning. Anxiety is a very helpful and important emotion. It protects us from danger. And, it is also sensitive to misfiring.

Unfortunately, the idea of a threat can cause the same anxiety symptoms as an actual threat. You may sweat, have a dry mouth, increased heart rate, feel dizzy, etc. when simply thinking anxious thoughts. These unpleasant symptoms lead us to avoid whatever makes us anxious. Anxiety can be a vicious cycle of anxious thoughts, anxiety sensations, and anxiety-maintaining behaviors. Nonetheless, one way to cope with anxiety is to remind yourself that it is not all bad. This New York Times article highlights some of the benefits of anxiety including its ability to improve performance, enhance conscientiousness, and signal when a possible change is needed.

Evidence-based anxiety management techniques involve changing how we relate to anxious thinking, practicing not avoiding anxiety-provoking situations – as doing so will increase anxiety in the long run - and practicing exercises to decrease physical symptoms of anxiety such as deep breathing.

Let’s say I am invited to a close friend's birthday celebration and think, “I can’t go. I always sound like an idiot when talking to people I don’t know well and everyone there will think I am stupid and weird.” Just imagining myself at the party, my heart starts to pound and I feel sweaty. I then text my friend with an excuse and tell her I can’t make it.

In this example, I am engaging in two common anxious thinking patterns: all-or-nothing thinking and mind-reading. I am telling myself I always sound like an idiot (all-or-nothing) and that everyone will think I am stupid and weird (all-or-nothing and mind reading). I don’t know what others are thinking and while it is unlikely that I objectively sound like an idiot, it is an exaggeration to say I always sound like an idiot and everyone thinks of me that way.

Noticing and challenging anxious thinking, and creating more helpful thoughts that can be repeated to yourself when anxious thoughts arise is helpful. It can also be helpful to practice creating mental space around our thoughts by learning to let thoughts come and go without becoming mentally hooked by them. You can do this by reminding yourself that thoughts are simply thoughts and not necessarily true – Just because I think it, doesn’t mean it's true - and by using visualization. For example, imagine your thoughts as clouds in the sky that slowly pass by.

Calming physical sensations is also an important part of anxiety management. This can be done through relaxation exercises such as slow rhythmic breathing where the focus is placed on lengthening the exhale portion of the breath and diaphragmatic breathing.

Finally, it is key to not engage in behaviors that may initially provide a sense of relief yet actually worsen anxiety over time. What we call avoidant behaviors. Avoiding situations, people, and events that increase anxiety. While it can be relieving to not do things that cause you anxiety, when you don’t confront these situations you cut yourself off from the opportunity to learn to manage them and decrease your anxiety over time. Avoidance will lead to more anxiety the next time an anxiety-provoking situation rolls around.

Anxiety likes to control your behavior and tell you that you can’t handle situations. This is untrue and unhelpful. You can cope! It takes practice and a willingness to feel anxious. Learning and practicing anxiety coping skills allows you to be in the driver’s seat of your life, not anxiety.

To learn more about therapy for anxiety, please contact us at CBTDenver.