Cognitive Behavioral Therapy for Anxiety
Cognitive Behavioral Therapy for Anxiety
To use Cognitive Behavioral Therapy for anxiety is a clever approach because it’s a way to treat anxiety, get rid of it, and be done with it. It’s a way to enable you to go on with your life and focus on something valuable instead of being trapped and inhibited by something that might not need to be in your way.
“Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence” from Dialogues Clin Neurosci. 2015 Sep; 17(3): 337–346 tells us:
“Exposure therapies for each anxiety disorder tend to take on similar forms, with differences emerging most often in the emphasis on the content of exposure, which is specific to the patienfs presenting concerns. Exposure therapies also differ in their relative emphasis on the different exposure techniques (in vivo, imaginal, and/or interoceptive). The efficacy and effectiveness of exposure therapy has been well documented for anxiety disorders, and exposure therapy is considered the treatment of choice for many forms of pathological anxiety.”
What it’s used for varies.
Anxiety is fear – an important and valuable function and reaction that could help you survive real dangers. But if it keeps you away from too many aspects of life, it’s not particularly useful. It’s no longer functional but a handicap, so you’d benefit from relearning.
Relevant blog post:
Panic attacks
This isn’t uncommon to come and go, or just come and then persist, with stress or depression, but you could get it without either of them.
Panic is an intensive reaction to stress. It’s completely natural – but panic attacks often teach people quite bad things. They condition you to respond with panic [panic = the response] to what you saw, found, felt, or heard [the stimuli]. That’ll often happen again and again because such grand emotions are such great teachers.
They escalate in a few minutes, and the attack usually peaks after ~10 minutes. The heart beats quickly, you sweat and shake, you’re unable to breathe, there’s pain and pressure in or around the chest, perhaps you’re nauseous or dizzy, you might feel unsteady, hot/cold, and sometimes there’s a sensation of an altered reality; things feel unreal… or perhaps more real than ever.
It’s generally incredibly uncomfortable and commonly interpreted as something very serious by the one who had it. Many people think they’ve had a heart attack or are going insane when they have their first one. They fear that they’ll die because they can’t breathe. Emergency care is common.
Because of the incredible stress and discomfort, it’s something you remember well, and you learn to hate it quickly. Learning to hate it makes you fear more attacks afterward, which turns into anxiety between the attacks or just after the one, even though you never get more than one. The fear of getting more attacks might lead to avoiding things and places that might give an attack, and “agoraphobic”, fear and avoidance of public places. The definition of panic SYNDROME is to have attacks and anxiety in between, a fear of having the attacks, along with avoidance of some sort.
(Of course, you’re avoiding terrifying things. Who’d expose themselves to THAT voluntarily?)
This usually affects life quite a lot, for obvious reasons.
The syndrome commonly comes with a hyper-awareness of sensations in the body – which works day AND night. That way, attacks might occur even when you sleep. This is usually because of a high pulse or muscle activity. Small things give an enormous response. Same thing as during the day, but you’re not conscious, so you can’t notice what starts it. Physiology winds up, and the brain interprets it. Fear starts and increases. Things wind up more – and it turns into a full-blown panic attack since it is interpreted as a catastrophe.
Hyperventilation is common when having an attack. This behavior causes several symptoms by changing the blood’s ratio between carbon dioxide and oxygen. Breathing more gives disproportionately large amounts of oxygen and small amounts of CO2, which might give dizziness, nausea, tunnel-vision, tingling or numbness in hands and feet, a feeling of pressure or tightness in the chest, and a feeling of “not being able to breathe”. The last one is a bit ironic since too much breathing causes the problem, so breathing more doesn’t really help.
How is it treated today?
In two ways, generally. Pills, pills, and more pills – and keep away from what’s scaring you.
If you’re bothered by anxiety and your mind is playing tricks on you instead of just leaving you alone so you can get things done and live in peace, add anti-depressants and calming agents of a decent sort. Start with anti-histamines. They might help. You’ll be sleepy and groggy, but you might get slightly less anxiety.
If that doesn’t work, it might be time to level up. Go for the benzodiazepines. They might be powerful enough to be used as rape drugs, and you might do strange stuff when you’re on them. It’s not too uncommon to hear people having hallucinations or getting blackouts. Another thing could be to get an altered personality and interact with people without remembering when you’re sobering up the next day. Exciting, perhaps, but not likely what you want your calming agent to help you achieve.
Not worse than alcohol, one might think… “And I could get that practically anywhere”.
Perhaps. Is that good enough? The equivalent of turning into an alcoholic to treat anxiety? It seems to be for quite a lot of people. It’s how we treat it today. Pills, rather than relearning. Medication rather than tending to life. As long as the patient is happy enough, that’s fine, I guess…
I’d say it’s a bad solution. The approach is rarely good enough to eliminate anxiety, and there are often side effects. It usually leads to an inhibited life because you’re still anxious – and with the addition of medications, you’re also affected in other ways. You might be sleepy, dizzy, or have trouble focusing… Or worse.
What could one do instead?
If you’re bothered by anxiety, and it’s something you’d want to get rid of, it’s not achieved by pills. It’s treated elsewhere. It’s not necessarily easy, but if it’s troubling you, taking care of it and getting rid of the dysfunctional emotions generally beats mitigating them with pharmaceuticals. One part of it is to narrow it down and define it.
What do you fear?
What action leads to what emotion?
Why?
Doing so could limit the fear tremendously in and of itself. When you fear something, you prefer to avoid it. You prefer to avoid talking about it, and you prefer to avoid exposure to it. That’s reasonable. But if you avoid talking about and experiencing it, it usually grows into unreasonable proportions. If you talk about it, define it, and put it in an appropriate box where you fear x because of y, you’ve got it in a box where it’s unable to grow infinitely.
You want to define your fears and face them.
You’ve heard of “getting back up on that horse”, right? That’s why. Avoiding what’s uncomfortable makes it worse.
That goes regardless of:
If you’re actively avoiding horses and running away from them in a full-blown panic.
Or:
If you’re avoiding horses by not being there because you moved away from the countryside into a large city where you’re not getting close to horses anymore.
It doesn’t matter what clever way you can think of to get away. If there are anxiety-lowering safety behaviors around and you use them – they’ll keep you anxious. If you avoid fear, the fear of whatever frightens you will grow. That could be fine if you never, ever stumble upon that again. But if you cannot leave the city because you fear horses, that fear is still a problem. If you can’t watch TV because you fear needles, heights, spiders, mice, or snakes, that’s not reasonable.
Relearn.
Conditioning is to connect a previously neutral stimulus to a less neutral response. You teach your nervous system to react to something in a specific way. Your anxiety is likely taught like that. You’ve learned that it should be there, for some reason or in some way. You’ll need to relearn – you don’t have to mask and hide what’s been taught with pills by trying to remove the stress response or avoiding the scary thing.
If you’ve got the option to use CBT, that could eliminate the anxiety instead of masking or mitigating it. That’s far more helpful long term.