On the Internet a lot has been written about anxiety disorders and how to deal with them. If there is already so much known about it then you would think that many people could solve their own problems by now. Luckily for psychologists, that is not the case. Too bad for all those suffering from anxiety, be it attacks or any form of disorders, because it truly is quite a hell.
Many websites about this topic present a good overview of what kind of anxiety disorders there are and what the best treatments are. Well, at least the names of these treatments are mentioned, for example: cognitive behavioral therapy, hypnotherapy, medication. However, quite remarkably, hardly ever the specific details are shown of those treatments. As a person fearing something you will not benefit anything from all information normally given about anxiety treatments. Quite logical in fact: if ALL information would be out there on the Internet there would not be any need for psychologists. We would be out of work!
However, as a clinical neuropsychologist I truly believe in transparancy and sharing of information to enlighten and better ourselves. I would gladly work for this, in a much higher pace than only my regular work would accomplish. Spreading knowledge via the Internet is another form of helping people to make the best out of themselves and their lives. That is the reason I will tell you more in detail about HOW you can treat different anxiety disorders. I will try to summarize current scientific understandings in my own words (not pretending to know everything), to get sufficient tips and tricks to solve your own problems. Furthermore, I will tell about my own experiences in treating patients with anxiety disorders. Because they have all shown me how to better my treatments. Their stories about what did and did not work with them, THAT is also scientific evidence!
Of course, not everybody will profit from reading these pages. Especially with the more severe anxiety disorders self-help will not work optimally. Those people I really advise to get some professional help. But they can use these pages to help shape their therapist and treatment to increase the efficacy of the treatment.
On the Internet you can find enough people who claim to get rid of all your anxieties. Well, such people have always been around: so do anxiety disorders! Due to despair, a lot of patients will do anything or will believe anything they hear. Unfortunately, such supposed therapists or healers do have their own fees, usually quite expensive.
However, to be honest, you cán find persons without any degree in medicine or psychology who can help you get rid of your emotional problems. They only have to use the right ‘ingredients’ of a therapy to be succesful in treating anxiety or panic attacks. We as psychologists should not be too arrogant as to state that only we can help people in need. That’s BS. Someone like your uncle or a good friend, who has read a lot about anxieties, about their treatments, about the prevailing theories about emotional disorders, someone like that can surely find a way to treat someone. Also, people who have been a patient themselves and have finally mastered their problems can help because they have stumbled upon some good insights. Eckhart Tolle (the Power of Now) comes to mind.
But again: be very careful to whom you’re going with your anxiety disorder. A certified psychologist is not a guarantee for a succesful treatment but it surely can increase your chances of being treated fairly and succesfully.
Anxiety is thé most prevailing basic emotion in both humanoid and normal animals. Our brain is built upon it. From an evolutionary standpoint this is quite understandable: without this basic emotion a species would not have survived very long in nature. Anxiety serves as a warning signal to escape your enemies and predators. Just imagine a Neanderthaler during a group hunt for mammoths losing his fear. He would walk towards these large animals without any doubt, with his spear, trying to kill one of them. Chances are who would not survive on his own. Just imagine if all Neanderthalers would be like this: we wouldn’t have heard of them because they would have been extinct in no time.
Anxiety is our best warning system! Strongly related to this system is another basic emotion: Aggression. In fact, angry and fear are two sides of the same coin. Also know as the fight or flight response. Aggression is needed to cope with our fears, in fact it regulates fear. Too much fear and your system may shutdown, you may be paralyzed (the so-called Todesschreck). Just watch this video of the so-called fainting goats: https://www.youtube.com/watch?v=2nxCqAYnLLQ It is a clear example of an extreme flight response: the fear is so high that the muscle system freezes instantaneously, in an (unconscious) reflex. However, such fear is not helpful. Imagine that all antilopes or goats would do this where there are lions or wolves. There would not be many sheep or goats around.
That is why our (and in other animals) amygdala regulates both fear and aggression. More aggression gives us power to act or to fight. The connections of the amygdala are extensive: to the prefrontal region, to the hippocampus (memory region), to the thalamus, the basal ganglia and parts of the brain stem. To put it differently: in almost everything we do these 2 basic emotions are involved, more or less.
On these pages I will focus on fear. You can be afraid of almost everything! Of course, being afraid of spiders or mouses is very well known. But there are many more things one can be afraid of. A nice and very informative website is the one of the Anxiety centre: www.anxietycentre.com . It lists a lot of anxiety disorders but it has also a positive ring to it: it firmly believes you can get rid of any form of anxiety. That’s certainly true!
The psychiatric handbook The Diagnostic Manual of Mental Disorders (DSM-V) has listed many anxiety disorders:
· Acute Stress Disorders
· Agoraphobia (afraid to go outside your own territory)
· Panic disorder
· Generalized anxiety disorder (worrying about almost anything)
· Obsessive-compulsive disorder
· Phobias (spider or mouse phobia)
· Post Traumatic Stress Disorder (PTSD).
The advantage of the much criticized DSM-V is that a lot of symptoms can now be categorized into one of those anxiety disorders. Such ordering helps the research community but also therapists. They can now pinpoint much easier the varied symptoms of patients. Because that’s what a therapist should do: narrow down all the complaints to one diagnosis. If you know what you are up against, it is much easier to look for the cure. For most anxiety disorders research has already shown what is and is not succesful. Phobias can be treated with cognitive behavior therapy and exposure is the treatment of choice. Also Eye Movement Desensitisation and Reprocessing (EMDR) is a very good treatment.
The biggest disadvantage of putting things into boxes is that symptoms are not put into perspective. You have to see them in a specific context, they just don’t pop up out of nowhere. For example, when panic attacks are the result of underlying stress due to a bad relationship (as is often the case), then a protocol treatment can relieve the symptoms but the causes are not addressed. So the panic attacks can return. That’s the reason that a treatment seems effective after 10 weeks but the panick attacks can be back in several months.
Symptoms can and may not be seen independently of the personality as a whole, the surroundings in which the client is and the current stressors. Unfortunately, modern times demand that a therapist uses more and more only protocol treatments. Treatments that subscribe specific protocols to follow. No need to make a so-called holistic theory about why and how the symptoms are related to each other. Without such explanation and clarification of the problem areas, such treatments are quite superficial and more than once patients do relapse. Often it is said that this is due to the ‘fragility of the client’, without realizing that it actually is due to incomplete or incompetent therapies.
A group that uses the holistic model much better is the alternative medicine branch. Whether these are homeopaths, paragnosts, aura-readers or other therapists who usually don’t have enough scientific evidence to back their treatment, that does not matter much. What they do much better than most ordinary ‘scientific’ therapists is that they try to look at many more factors that can explain the varied symptoms of patients. In this way they are sometimes more succesful than ‘normal’ treatments. However, it is also often the case that such therapists think pseudo-scientifically. They make a lot of non sense explanations and see causations where there are none, or not proven ones. Of course, science has not proven much (in fact, less than 20% of all diseases can be explained) and you have to be careful not to confuse true science with the current religion of randomized controlled trials.
You have to think critically, either in following scientific enterprises or alternative therapists. Science is all about rationalism (thinking logically) and empiricism (using experiments to verify and falsify ideas). Not being able to verify or falsify an idea means that they are dogma’s, such as in religion. Who is to say that such dogma’s are the truth, the only truth? If you believe that you shut down all thinking and depend solely on a dogma. As I said: like religion. Just follow the leader. Where that leads to we have already seen in the last 2 world wars…
Here I would like to draw a general working model about anxiety disorders so that one can understand this matter. I will try to summarize information from different scientific branches that can help explain most anxiety disorders. Furthermore, I will use my clinical experience of over 4000 clients with their stories and experiences. I will use the application of scientific knowledge into the clinical practice in treating fear. All those stories can also be considered evidence. You have to realise that science has not even studied more than 20% of all symptoms that clients can have. Science is per definition sort of ‘narrow-minded’ due to very strict scientific rules.
Let me start with something very obvious: every thing you are afraid of has only one basic emotion: FEAR, residing in the emotional brain. Modern imaging techniques show us that our brain functions as a neuronal network. It is simply NOT true that certain parts of the brain are responsible for one cognitive function. This is a very common mistake in interpreting MRI scans. All we know is that certain regions are more active during the execution of some task or during experiencing certain emotions. Usually several regions are active (actually quite a few) when experiencing something. Furthermore, in such MRI-scans such images do NOT incorporate the subcortical areas and the brain stem and/or cerebellum; although those areas are usually active as well. So, let me state it very clearly here: NO single region is responsible for just one cognitive function or even one basic emotion like FEAR. Usually it is a complex neuronal network in which there are certain ‘hubs’ (cross roads) that are active during experiencing fear or anger.
In this sense, it is simply NOT true that only the amygdala is the important anxiety generator of the brain. According to Panksepp this is not true: it is the peri-aquaductal grey area in the brain stem from where the emotion FEAR is formed. Next to the amygdala also the hypothalamus is involved in fear (conditioning).
Now what happens when you are afraid? Let me first state that each basic emotion (fear, anger, sadness) is ALWAYS active in your brain: when you are reading, sleeping, cycling, talking, watching TV. Never is such a basic emotion ever absent! However, the intensity of a basic emotion and especially the amount of how much we are conscious of such an emotion, can differ a lot between people. It can happen that you do not have to be conscious of the fact that your basic emotion is quite intense and is actually steering your cognitive functions (and decision making). In an anxiety disorder however, the intensity of the emotion is so high that you are aware of it and…suffering from it. Because you think you are out of control, the emotion is overwhelming you. You do not think you can do anything anymore about it.
In the movie The Hungergames part I president Snow makes a very wise remark in saying that only HOPE is stronger than FEAR. With an anxiety disorder you have lost the hope that YOU can do something about your fears.
That’s the main reason you can not get rid of the fears. Please read this again: the ONLY reason you have not got rid off your fears is that you have lost hope in your self, in your ability to concur your fears. You think you are helpless and weak. This holds true for ALL anxiety disorders.
That’s the reason that the most negative behavior when you have an anxiety disorder is avoidance. You will run from your fears. It is the fundamental stress reaction: either flight or fight. In Flight mode you either do this passively (making yourself small, paralyzing) or actively (running away). Avoidance is a disaster for getting rid of your fears. Because it does NOT destroy your ideas about fear, it keeps them alive.
Stress reactions in FEAR are known: a higher heart rate, sweating, higher aspiration, blood pressure changes and a higher muscle tension. Immediately after the stress reactions several cognitions are attracted (emotions function as a kind of a magnet) so that your intensity of your basis emotion is heightened. For example, if your heart rate goes up you can very easily think that you are about to get a serious heart attack. Obviously, this will only increase your fear.
If the above working model is right – that you have given up all hope in fighting your fears – then you already know what to do to finally get rid of your fears: you have to work on your self-confidence.
First of all, you have to become conscious of this fact that YOU do not believe in your self anymore and it is just this kind of believing (of loss of belief) that keeps feeding your fears. You have to understand that all your fears can indeed be overwon. You will have to have HOPE again that YOU can do this. A good therapist can convince you that you can have your hope back again. A good therapist will not say that you need medication because you can not deal with your anxiety, ever again. That makes you a victim for ever. That’s good, because then you will keep using medicines. Of course, there are situations where someone really can not cope anymore with there extreme fears and medicines are then needed to calm one down. I am not opposed to medicines but it should be a last resort in treating fears.
So the second thing you should do is to find a better therapist: one that can give you your hope back. Someone whom you can trust and who really understands how FEAR in your brain is working.
A third thing you must do is to understand how the reality of your fears is. For that you have to educate yourself: read about fears, anxiety or get a very good explanation of your therapist. You should emphasize that you need a good holistic model in which most of your symptoms are clearly explained and a picture is drawn how things are related to each other. In this way, you finally get some control over your situation. And control we need to overcome your fears.
A fourth and very important aspect of the best treatment for an anxiety disorder is that you have to face and confront your fears AND experience that YOU can handle it. You must realize and experience that all those things you are afraid of (like dying, suffocating, passing out, heart attack), actually will NOT happen. Because you have avoided your worst fears, you never have proved to yourself that you can withstand a lot of fear, without something really bad is happening. You can indeed control your worst fears. Treatments like EMDR and EFT (Emotional Freedom technique) can learn you as well that no matter what, YOU can withstand any fears. This fundamental belief in yourself will ultimately soothen you. However, for this to realize you have to undergo your worst fears, you have to get afraid…long enough. And you have to test if you can withstand this. You can (with a good therapist). The essence is that your self-confidence after such treatments should be higher than before.
Finally, you have to find out how and why you have become so afraid of something. You have to explain to yourself where your stress reaction did come from, WHY your self-confidence was damaged in the first place. When you do know the factors that caused your fears, you can detect them earlier and fight them. In this way, the chances of a relapse will be lessened.
On other pages in this blog I will explain to you about treating other anxiety disorders such as the much common panic disorder.
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