Asked by Dawn Armstead, Queens, New York
How can I calm myself down when anxiety strikes? I hate feeling nervous.
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
Your very simple but poignant question suggests all sorts of answers, but also points to what a painful -- and sometimes terrifying -- thing anxiety is. I want to start my answer by tipping my hat to a reader from last week's column who gently took me to task for not giving enough credit to psychotherapy in treating even very difficult psychiatric conditions -- in this case, bipolar II disorder.
As with all psychiatric conditions or symptoms, there are three basic things one can do -- two that require a clinician's help and one that you can do on your own. Clinicians can offer medications and psychotherapy. On your own, you can work to change the things in your life that are contributing to the problem. That in a nutshell is the entire psychiatric world. Each condition and each individual will benefit most from some unique combination of these three elements.
Anxiety comes in many flavors, but in all instances, it tends to share one important thing in common: It is an internal sense of fear, discomfort, panic even, that is out of proportion to the events in the world that have triggered it. Sometimes, people can't even find an event upon which to hang the blame for their terrible, restless sense of unease.
Consider the following statements: "I need help. I get anxious every time someone pulls a gun on me." "I've got a problem. I had real panicky feelings that night I came home to find a robber in my house." "I've got to get a hold of this social anxiety. I was so nervous when President Obama picked me by lottery to come with him to help give the State of the Union address to Congress." We don't call this anxiety (we often use the word "nervous") because the feeling is appropriate to the situation.
The problem with anxiety is not that it feels bad. This feeling bad evolved to help us deal seriously with situations of real danger and to remove ourselves from these situations to the best of our ability. The problem with anxiety is that it is a worthless response to situations that aren't typically dangerous enough to warrant all the misery. And then, of course, the anxiety itself becomes a huge problem in people's lives. In a world of relative safety, very anxious people live as if they are constantly in danger.
Medications can help blunt physical activity in brain and body that give rise to anxiety, and sometimes this is a necessary intervention. But psychotherapy is at least as good for treating anxiety and offers a couple of advantages.
First, a good psychotherapist can help us better understand why certain things make us anxious. Usually, the things that set us off represent troubles from our childhoods. Often these associations are not conscious, and making them conscious can significantly weaken their impact and give us control over them. If I had more words to spend on this piece, I could give you examples from my own life.
Second, a number of psychotherapeutic techniques designed specifically to treat anxiety do so by helping expose us gradually to those things that cause our anxiety. Variously called "desensitization," "exposure" or "extinction," these techniques are built upon the scientific discovery that if we learn to tolerate the things that frighten or bother us, the feelings subside and eventually fade. Not only do these techniques work, but they also provide patients with a skill they can continue to practice at home to deal with new sources of anxiety.
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