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The Best Anxiety Treatment I’d Recommend as a Psychotherapist

The Best Anxiety Treatment I’d Recommend as a Psychotherapist

In Part I of this two-part series, we looked at what anxiety is and how to tell if you or someone close to you is suffering from an anxiety disorder.

Now let’s explore the causes of anxiety disorders and the treatments for them. We’ll also delve into the best self-help strategies anxiety sufferers can practice themselves and how their friends and families can help.

Types of people who are prone to anxiety disorders

The causes of anxiety disorders are not completely understood, but most people I’ve worked with seem to have one or more of the following: a more sensitive temperament, to have suffered events that felt traumatic to them early in life, and to have endured a period of stressful situations. The combination of these factors brought them to a tipping point that created an anxiety disorder. Specific risk factors for anxiety disorders include:

  • Childhood trauma, such as abuse, neglect, or witnessing a traumatic event.
  • Stress build-up due to a single, very stressful event or a sequence of smaller stressful situations.
  • Having close relatives with an anxiety disorder.
  • Chronic physical illness.
  • Substance abuse.
  • Borderline Personality Disorder and Histrionic Personality Disorder.

The most common misconceptions about anxiety

Common misconceptions about anxiety disorders include:

  • Anxiety is not a “real” illness and people who have anxiety just need to get over it.
  • Anxiety is part of who a person is and can’t change.
  • Anxiety disorders can’t be cured, you just have to live with them.
  • An anxiety disorder is a brain disorder.
  • There are quick-fix remedies for anxiety disorders.

None of these is true. Anxiety is a real illness, it is caused by multiple factors, and although there are no “quick fixes,” it can be cured by a combination of therapy, self-help strategies, supports, and life-affirming activities.

When to consider medication

When I work with people who have anxiety, I suggest medication only after we have tried other methods.

Most people can resolve an anxiety disorder by developing a “package” that includes developing a different attitude toward their lives, doing specific practices and activities that relax and stabilize, removing unnecessary stresses, and understanding the underlying issues that caused their anxiety disorder.

When the anxiety is so great that a client can’t make the needed changes, medication can often be a helpful supplement to therapy and self-care. Occasionally, medication is necessary in an ongoing way, but I haven’t found that often to be so.

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The one exception is Obsessive-Compulsive Disorder (OCD). People who have OCD often respond very well to the Prozac family of antidepressants, usually administered in larger doses than given for depression.

Medications that help with anxiety come in two varieties: antidepressants and anxiolytics.

Some antidepressants help with both depression and anxiety, particularly the antidepressants in the Prozac family, known as selective serotonin reuptake inhibitors (SSRIs). Sometimes people remain on antidepressants for a long time, but often they can stop after they have learned other ways to handle anxiety and depression.

Anxiolytics work on the specific parts of the brain that are associated with anxiety. These include medications such as Xanax, Ativan, Klonopin, and Valium. They are fast-acting, but they don’t address underlying causes. Although they are sometimes prescribed as long-term treatments, in my experience they are best used on a short-term, as-needed basis. They tend to lose effectiveness when they are taken regularly, and they are physically addicting. For many people, stopping an anxiolytic they have become physically dependent on is harder than quitting smoking.

The right approach to tackle anxiety

The most important thing people with an anxiety disorder can do is to learn as much as they can about their problem and how to treat it. People who take charge of their illnesses, whether physical or psychological, always do better than people who are more passive.

The next most important thing to do is to find a therapist who understands anxiety disorders, has had success working with them, and who seems to “get” you. All therapists are not created equal.

Interview your prospective therapist on the phone about how he or she might help with your anxiety, and ask how many clients he or she has successfully treated. If someone is helping you, keep seeing that person. If, after a few sessions, you don’t feel significantly helped, discuss it with the therapist. If, after the discussion, you continue not to feel helped, this therapist is probably not right for you. Ask for a referral, and also consult therapist directories such as Goodtherapy.org and the Find-a-Therapist service sponsored by Psychology Today.

A good self-help book on anxiety disorders is an extremely useful supplement to therapy. The best I’ve found, and one I often recommend to clients, is The Anxiety & Phobias Workbook by Edmund Bourne. It’s a virtual encyclopedia of knowledge, self-tests, and strategies for dealing with anxiety.

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Along with therapy, some of the most effective activities I’ve found helpful for reducing anxiety and becoming more resilient include:

  • Learning to treat yourself with the same compassion you would show to others you love.
  • Developing a healthy lifestyle, including proper nutrition, exercise, and good sleep habits.
  • Building nurturing relationships with friends, families, and other social supports.
  • Regularly practicing centering, self-soothing techniques such as meditation, yoga, and walks in nature.
  • Developing a creative activity that you can look forward to doing even when you feel anxious.
  • Noticing what helps – and doing more of it!

What not to do when having anxiety

The list of things NOT to do is pretty short:

  • Don’t use alcohol and drugs, since they can make anxiety worse.
  • Quit smoking, as nicotine can also worsen anxiety.
  • Cut down on your consumption of foods and beverages that contain caffeine, such as coffee, tea, cola, energy drinks, and chocolate. Caffeine can increase anxiety symptoms.
  • Don’t overcommit to activities that increase your anxiety. Pushing too hard doesn’t speed up recovery.
  • But don’t always give in to anxiety, either. Gently challenging anxiety is helpful.

The best things friends and family can do to help

These are some of the things friends and family can do to help people who have anxiety disorders.

Learn about anxiety disorders

Knowledge is power. The most helpful thing friends and family can do is to help the person with anxiety feel seen, heard, and understood. You can’t help someone if you don’t understand what they are going through.

Ask how to help

Everyone is different, and everyone needs different kinds of support. People with anxiety can tell you what helps and what doesn’t.

Be reassuring

Remind anxiety sufferers not to be too hard on themselves, and reassure them that the disorder is not their fault. Praise accomplishments and progress. Let them know you care.

Be a companion

People with anxiety are often reluctant to start new things. Offer to go to a yoga class, take a walk or bike ride, or do some other kind of relaxing physical activity together.

Encourage treatment

No matter how compassionate and how smart you are, someone with an anxiety disorder probably also needs professional help. Offer to help them find a therapist. See if they would like a ride to a therapy session.

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Get help yourself

Being supportive of someone with an anxiety disorder can sometimes be taxing, so make sure you have someone to talk to, too.

The worst things friends and family can do

These are some of the things people with anxiety disorders have described as unhelpful:

Acting like nothing is wrong or minimizing the problem

Minimizing the problem, in an attempt to make someone feel better, often has the reverse effect.

Telling them that if they stop dwelling on their issues they’ll go away

Part of the problem is that they can’t simply stop dwelling on their issues. Don’t ask them to do what seems impossible.

Telling them to “get their act together.”

If people with anxiety could just “get their act together,” they would have done so already.

Blaming their problems on bad life decisions

Anxiety is not the result of bad life decisions.

Giving unsolicited advice

Like almost everyone else, people with anxiety welcome advice when it’s asked for, but not when it’s unsolicited.

Pressuring them to go out and do things

People with anxiety have to go at their own pace. Encouragement is fine. Pressure is counterproductive.

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Getting frustrated

It’s difficult to remain patient when someone seems to keep suffering in ways that you, the non-anxious person, would find easy to change. If you feel frustrated, imagine how you’d respond to someone with a physical problem and you’ll probably regain your patience.

Enabling

Although pushing is rarely helpful, enabling anxiety by never challenging the “rules” the anxious person has set up is not helpful either. Finding the right balance between encouraging and accepting current limitations is an ongoing experiment, both for the anxious person and for the people who are trying to help.

Treatments I’ve found most effective

The generally recommended treatment for anxiety disorders is Cognitive Behavioral Therapy (CBT). Cognitive Behavior Therapy is a structured form of therapy that focuses mainly on identifying and correcting mistaken beliefs and on teaching skills to modify dysfunctional thinking and behavior.

In my experience, CBT is a useful framework around which to structure therapy for anxiety disorders, but it is not usually sufficient. I adapt the treatment to the individual, and to where the individual is in his or her recovery. Although treatments are different for different people and vary throughout the course of recovery, the basic components include:

  • Forming a trusting client/therapist relationship.
  • Helping the person build additional supports that help him or her to thrive.
  • Identifying contributing factors in the person’s history, environment, and their ways of processing perceptions, thoughts, and feelings
  • Identifying contributing factors that can be changed, and developing strategies for changing them.
  • Identifying contributing factors that cannot be changed, and developing strategies for accepting them.
  • Teaching skills necessary for functioning in a more satisfying way.
  • Teaching methods for monitoring and maintaining progress.

To give you an idea of how varied treatment for anxiety disorders can be, here are a few snapshots of clients who have successfully dealt with their disorders.

With a client who had social anxiety, we focused mainly on helping her remove stressors, including a too-demanding job and a dysfunctional romantic relationship. Then we worked on developing the ability to enjoy small talk and other social lubricants and on understanding how some of her patterns in social situations were shaped by her family of origin but didn’t apply to her current life.

With a client who had a phobia about germs as well as OCD symptoms, what helped most was asking the client to research the germ situations he was afraid of and really test them. I also asked him to vary his counting and checking routines to help him see that they were not always necessary. For example, instead of always locking a door three times, he would sometimes do it seven times, sometimes two, and so on. Eventually, he stopped counting entirely.

A client whose untreated OCD made it impossible to leave a room without a complex set of time-consuming rituals was unable to make progress with therapy until she started on a relatively large dose of Prozac, after which the OCD symptoms quickly subsided. When she tried getting off the Prozac, the rituals returned. Staying on Prozac was the best solution for her.

I helped a client who had Generalized Anxiety Disorder and I found that her anxiety was not really related to the things she worried about. Instead, it was an ever-present free-floating anxiety that “landed” on various circumstances in her life. Using a technique from Gestalt therapy, she learned to befriend her anxious part and to pay direct, compassionate attention to it rather than trying to suppress or correct it.

Where to go from here?

Over the years, I’ve worked with many people who have fully recovered from anxiety disorders and now live much richer, fuller, and far less worried lives. Where there’s a will there’s a way. With the right kind of professional help, the right supports, and, most importantly, the right person at the helm – you! – I’m confident you’ll find your way, too.

More by this author

David J. Bookbinder, LMHC

Psychotherapist, writer, and photographer north of Boston, MA.

Anxiety Symptoms That Many People Overlook The Best Anxiety Treatment I’d Recommend as a Psychotherapist

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Last Updated on October 30, 2019

How the Stages of Change Model Helps You Change Your Habits

How the Stages of Change Model Helps You Change Your Habits

Change is tough, there’s no doubt about it. Old habits are hard to shift, and adopting a new lifestyle can feel like an uphill battle!

In this article, you will learn about a simple yet powerful model:

Stages of change model, that explains the science behind personal transformation.

You’ll discover how and why some changes stick whereas others don’t last, and how long it takes to build new habits.

What is the Stages of Change Model?

Developed by researchers J.O. Prochaska and Carlo C. DiClemente over 30 years ago[1] and outlined in their book Changing For Good, the Stages of Change Model, also known as the Transtheoretical Model, was formed as a result of the authors’ research with smokers.

Prochaska and DiClemente were originally interested in the question of why some smokers were able to quit on their own, whereas others required professional help. Their key conclusion was that smokers (or anyone else with a bad habit) quits only when they are ready to do so.

Here’s an illustration done by cartoonist and illustrator Simon Kneebone about the different stages a smoker experiences when they try to quit smoking:

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    The Stages of Change Model looks at how these conscious decisions are made. It emphasizes that change isn’t easy. People can spend a long time stuck in a stage, and some may never reach their goals.[2]

    The model has been applied in the treatment of smoking, alcoholism, and drugs. It is also a useful way of thinking about any bad habit. Social workers, therapists, and psychologists draw on the model to understand their patients’ behaviors, and to explain the change process to the patients themselves.

    The key advantages to the model is that it is simple to understand, is backed by extensive research, and can be applied in many situations.

    The Stages of Change Model is a well-established psychological model that outlines six stages of personal change:

    1. Precontemplation
    2. Contemplation
    3. Determination
    4. Action
    5. Maintenance
    6. Termination

    How are these stages relevant to changing habits?

    To help you visualize the stages of change and how each progresses to the next one, please take a look at this wheel:[3]

      Let’s look at the six stages of change,[4] together with an example that will show you how the model works in practice:

      Stage 1: Precontemplation

      At this stage, an individual does not plan to make any positive changes in the next six months. This may because they are in denial about their problem, feel too overwhelmed to deal with it, or are too discouraged after multiple failed attempts to change.

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      For example, someone may be aware that they need to start exercising, but cannot find the motivation to do so. They might keep thinking about the last time they tried (and failed) to work out regularly. Only when they start to realize the advantages of making a change will they progress to the next stage.

      Stage 2: Contemplation

      At this stage, the individual starts to consider the advantages of changing. They start to acknowledge that altering their habits would probably benefit them, but they spend a lot of time thinking about the downside of doing so. This stage can last for a long time – possibly a year or more.

      You can think of this as the procrastinating stage. For example, an individual begins to seriously consider the benefits of regular exercise, but feels resistant when they think about the time and effort involved. When the person starts putting together a concrete plan for change, they move to the next stage.

      The key to moving from this stage to the next is the transformation of an abstract idea to a belief (e.g. from “Exercise is a good, sensible thing to do” to “I personally value exercise and need to do it.)[5]

      Stage 3: Preparation

      At this point, the person starts to put a plan in place. This stage is brief, lasting a few weeks. For example, they may book a session with a personal trainer and enrol on a nutrition course.

      Someone who drinks to excess may make an appointment with a drug and alcohol counsellor; someone with a tendency to overwork themselves might start planning ways to devise a more realistic schedule.

      Stage 4: Action

      When they have decided on a plan, the individual must then put it into action. This stage typically lasts for several months. In our example, the person would begin attending the gym regularly and overhauling their diet.

      Stage 4 is the stage at which the person’s desire for change becomes noticeable to family and friends. However, in truth, the change process began a long time ago. If someone you know seems to have suddenly changed their habits, it’s probably not so sudden after all! They will have progressed through Stages 1-3 first – you probably just didn’t know about it.

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      Stage 5: Maintenance

      After a few months in the Action stage, the individual will start to think about how they can maintain their changes, and make lifestyle adjustments accordingly. For instance, someone who has adopted the habit of regular workouts and a better diet will be vigilant against old triggers (such as eating junk food during a stressful time at work) and make a conscious decision to protect their new habits.

      Unless someone actively engages with Stage 5, their new habits are liable to come unstuck. Someone who has stuck to their new habits for many months – perhaps a year or longer – may enter Stage 6.

      Maintenance can be challenging because it entails coming up with a new set of habits to lock change in place. For instance, someone who is maintaining their new gym-going habit may have to start improving their budgeting skills in order to continue to afford their gym membership.

      Stage 6: Termination

      Not many people reach this stage, which is characterized by a complete commitment to the new habit and a certainty that they will never go back to their old ways. For example, someone may find it hard to imagine giving up their gym routine, and feel ill at the thought of eating junk food on a regular basis.

      However, for the majority of people, it’s normal to stay in the Maintenance period indefinitely. This is because it takes a long time for a new habit to become so automatic and natural that it sticks forever, with little effort. To use another example, an ex-smoker will often find it hard to resist the temptation to have “just one” cigarette even a year or so after quitting. It can take years for them to truly reach the Termination stage, at which point they are no more likely to smoke than a lifelong non-smoker.

      How long does each stage take?

      You should be aware that some people remain in the same stage for months or even years at a time. Understanding this model will help you be more patient with yourself when making a change. If you try to force yourself to jump from Contemplation to Maintenance, you’ll just end up frustrated. On the other hand, if you take a moment to assess where you are in the change process, you can adapt your approach.

      So if you need to make changes quickly and you are finding it hard to progress to the next stage, it’s probably time to get some professional help or adopt a new approach to forming habits.

      The limitations of this model

      The model is best applied when you decide in advance precisely what you want to achieve, and know exactly how you will measure it (e.g. number of times per week you go to the gym, or number of cigarettes smoked per day). Although the model has proven useful for many people, it does have limitations.

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      Require the ability to set a realistic goal

      For a start, there are no surefire ways of assessing whereabouts in the process you are – you just have to be honest with yourself and use your own judgement. Second, it assumes that you are physically capable of making a change, whereas in fact you might either need to adjust your goals or seek professional help.

      If your goal isn’t realistic, it doesn’t matter whether you follow the stages – you still won’t get results. You need to decide for yourself whether your aims are reasonable.[6]

      Difficult to judge your progress

      The model also assumes that you are able to objectively measure your own successes and failures, which may not always be the case.[7] For instance, let’s suppose that you are trying to get into the habit of counting calories as part of your weight-loss efforts. However, even though you may think that you are recording your intake properly, you might be over or under-estimating.

      Research shows that most people think they are getting enough exercise and eating well, but in actual fact aren’t as healthy as they believe. The model doesn’t take this possibility into account, meaning that you could believe yourself to be in the Action stage yet aren’t seeing results. Therefore, if you are serious about making changes, it may be best to get some expert advice so that you can be sure the changes you are making really will make a positive difference.

      Conclusion

      The Stages Of Change Model can be a wonderful way to understand change in both yourself and others.

      While there’re some limitations in it, the Stages of Change Model helps to visualize how you go through changes so you know what to expect when you’re trying to change a habit or make some great changes in life.

      Start by identifying one of your bad habits. Where are you in the process? What could you do next to move forwards?

      Featured photo credit: Unsplash via unsplash.com

      Reference

      [1] Psych Central: Stages Of Change
      [2] Boston University School Of Public Health: The Transtheoretical Model (Stages Of Change)
      [3] Empowering Change: Stages of Change
      [4] Boston University School Of Public Health: The Transtheoretical Model (Stages Of Change)
      [5] Psychology Today: 5 Steps To Changing Any Behavior
      [6] The Transtheoretical Model: Limitations Of The Transtheoretical Model
      [7] Health Education Research: Transtheoretical Model & Stages Of Change: A Critique

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