Physician Russell Portenoy, a prominent New York pain specialist, twenty years ago spearheaded the movement that encouraged doctors to prescribe more painkiller medications to suffering patients, a movement that helped many but at the same time minimized the dangers of addiction. Now Dr. Portenoy has come full circle. He has become a leader in warning physicians and the general public of the addictive potential of painkillers, particularly when used for on-going longterm problems as opposed to for brief acute pain such as from a surgery.
Is a similar re-thinking needed for the widespread prescribing by doctors of drugs that quell emotional pain and stress, i.e., anxiety? TV pharmaceutical ads would have us believe that anxiety, an unpleasant sensation for sure, is a chemical phenomenon that needs to be subdued, soothed, or in some other way eliminated. Their recommended route to calm is to take a pill.
Many physicians prescribe antianxiety medications, and may use them themselves, to decrease feelings of worry, stress, stomach butterflies, and other anxiety manifestations. That strategy though, like use of physical painkillers, risks addiction. Anti-anxiety drugs, like physical pain reducers, are highy addictive substances.
This article explores alternatives to medications for calming the emotional discomfort of stress and anxiety.
Fortunately, as this series of four cases illustrates, multiple options beyond pills now exist for folks who want to get rid of painfully stressed feelings.
What these strategies all share in common is encouragement to look directly at the sources of your stress to hear the message that your nerves are anxiously trying to tell you.
In what way is anxiety good for you?
The good news is that anxiety is almost always a valuable signal. It tells you that troubling is brewing. Like a blinking yellow traffic light, anxious feelings signal "Pay Attention. There's a problem here that merits addressing!" Anxiety warns you that there is a problem that needs to be solved. Get to work gathering information and already the anxiety is likely to begin to lift.
Anxiety is thus like a good angel. It arrives to give you a message. Once you have adequately addressed the problem that the anxiety is warning you about, the anxiety will have accomplished its mission and so will disappear of its own accord.
What if the anxiety doesn't go away? How can a therapist potentially help?
Whereas pill-giving is a get-rid-of-that-feeling-without-listening-to-its-message approach, I much prefer to help my anxious clients identify the underlying concerns triggering their anxious feelings. We then can map a plan of action to address these concerns.
With clarity about the concerns plus a plan for how to address them, anxiety most of the time dissipates on its own. If not, my client and I look together more deeply at earlier life experiences that had triggered a similar feeling. Once those root experiences also have come to light, too-anxious-for-the-current-situation feelings make sense. Those experiences mean that your body is reacting now as if the earlier experience were going on again.
No problem. Once an earlier source for intense anxiety has been clarified, deep relaxation, EMDR, EFT tapping or Emotion Code therapy techniques can quell remaining anxious feelings without resorting to potentially addictive drugs.
Let’s look at how these approaches have worked for various clients who were suffering from anxiety problems:
Anxiety Treatments Case #1: Fears his wife was having an affair.
Joe couldn’t sleep at night because his mind was racing with thoughts about his wife’s recent affair. He had stumbled on evidence the day before when he glanced at her open computer screen and noticed a disturbing email. He confronted his wife, she confessed, expressed extreme regret, and immediately ended the relationship, but Joe's anxiety continued to feel overwhelming.
Joe consulted a psychiatrist, but threw out the pills he’d been prescribed when he saw that they had serious addictive potential.
Joe then consulted me for an alternative approach. I asked him to close his eyes, focus on the anxious feeling, and give me a number from 1 to 10 of how intense the feeling felt. He said “12.”
“OK,” I said. “Now, keeping your eyes closed, allow thoughts to come to mind that will make that anxiety even worse. As you say them, I’ll write each thought down. After we have the full list you can open your eyes and we’ll talk each fear through one by one. For each fear we’ll map a potential solution. You’ll end up with a comprehensive plan of action.”
Joe’s thoughts began with “My wife will leave me for the other guy!”, continued with “I work too much out of town and am fearful about what’s happening now when I’m away.”, "How can I earn back her love so she stops thinking about the other guy," and so on for multiple more very serious concerns.
Once the full list was out of his head and onto paper, Joe already felt calmer. We then mapped a plan of action for how to proceed vis a vis each fear. Most of the action plans had to do with how to get more information, which fits with the general saying that "the best antidote for anxiety is information."
John’s anxiety gradually diminished, transformed into determination to move forward with his actions plans.
Information plus an action plan are remarkably strong antidotes to anxiety. By the end of the session Joe’s anxiety was down to a manageable 1-2 level. With a clear and comprehensive plan of action for how to manage the situation he was facing, he felt confident that he would sleep well that night.
Anxiety Treatments Case II: Chronic anxiety when nothing seemed to be wrong in her life.
NPR’s Talk of the Nation on Friday August 10, 2012 included comments from a woman who suffered pervasive anxiety. One medication after the next failed to subdue it.
In this case looking to list her thoughts to identify the situational and cognitive triggers would also have yielded a dry well in terms of findings that would produce a reduction in her anxiety.
The address-the-underlying-causes strategy then says that in addition to looking at the external situation that may be triggering nervousness, or as cognitive therapists do at anxiety-increasing thoughts, anxiety may be a signal of an internal problem. Thyroid difficulties, a reaction to a medication, a reaction to birth control pills (which turned out in this woman’s case to have been the problem), an allergy, insufficient sleep, or adrenal or other gland or hormonal problem can be important to explore.
Anxiety Treatments Case III: Panic after his wife discovered he'd been telling lies and asked him to leave.
Max was in a state of panic. He had told his wife a series of lies about their financial situation. Their bills had been much larger than they were going to be able to pay, and he couldn't face giving this bad news to his wife. When his wife the week prior had found out, she insisted that he leave the house. The anxiety that welled up and still remained now, days afterwards, felt overwhelming, so much so that Max couldn’t think straight or even go to work.
For this case I brought in my colleague Dale Petterson, about whose energy therapy techniques I’ve written multiple PT postings. Dale first checked for psychological reversal and eliminated that state, which is essential to be certain that subsequent treatments will hold. He then used the tapping technique known as EFT, which within minutes lowered Max’s anxiety levels from a 10 on a scale of 0 to 10 to about 4. He concluded with Bradley Nelson’s Emotion Code treatment strategy which further lowered the intensity of the anxiety from 4 to a 1.
After the session with Dale, Max was calm enough to return to work. He continued briefly in therapy with me where we utilized the techniques I describe in Case I above: clarifying his underlying concerns, particularly regarding how to save his marriage and how to change his habit of lying as an escape mechanism for unpleasant circumstances.
Anxiety Treatments Case #4: Intense anxiety with stomach aches and vomiting when he first woke up on workday mornings.
Chris knew that his job was not an ideal fit for him. While he didn't hate his work, he was ready to move on to something more challenging and that would pay more. Still, when he woke up each workday morning, his anxiety was so intense that his stomach hurt and he often would vomit.
I asked Chris to close his eyes and allow an image to come up of another time earlier in his life when he had had a similar feeling. An image came up of when his mother and dad had left him off at boarding school when he was about 14. Chris had felt totally panicked at the time, fearful of whether he'd make friends and be able to do the work, and grieving the loss of his supportive parents and fun sisters. Discussing what was the same in these two incidents (going to work now and going to boarding school then), and then clarifying what was different (he was a grownup, married, and in a far less scarey situation) helped to ease the anxiety somewhat.
We then added Dale Petterson's help. Dale used Emotion Code techniques, including muscle kinesiology, to uncover the subconscious historical root source of the anxiety. These "energy psychology" techniques focused Chris on an episode that Chris had forgotten about on the conscious level. When he had been 7 years old, his parents had left him off at a summer camp. Seeing from his bunkroom his parents' car driving off out down the camp's long driveway, Chris had panicked. He ran, barefoot, after their car, waving and shouting to them, but his parents drove off without having noticed him. Dale then used a Magboy magnet to neutralize this long-stored negative emotion of panic.
To his delight, Chris woke up starting the very next morning feeling almost normal. The anxiety and stomach pain was significantly reduced, and over time seemed to be heading down to zero. He could wake up, eat breakfast and enjoy his family in the mornings before work without significant further nervous episodes.
In conclusion, anxiety emerges to help you understand something that is troubling you. The best anxiety treatments help you identify and deal effectively with these issues.
Anxiety is uncomfortable so that it motivates you to do something about a problem. Simply bringing the problem to conscious awareness and figuring out a plan of action will often be sufficient to calm the nerves. If not, looking more deeply to find and neutralize the biological or subconscious triggers can lead to a breakthrough.
To learn more about these anxiety treatments and how they might help calm nerves for you as a client or as a therapist, please feel welcome to download the audio program, called Anxiety: Friend or Foe on my website, www.therapyhelp.com. For those who don't do downloads, the talk is available also as a CD on Amazon.
I hope you also will find my blogposts on anxiety in relationships helpful, and my website for fixing the difficulties that give rise to relationship anxiety.
Susan Heitler, Ph.D., is a clinical psychologist in Denver and author of multiple publications including the audio program Anxiety: Friend or Foe? which is now on her website as a free podcast. Her online program for couples, PowerOfTwoMarriage.com, addresses the sources and cures for anxiety and tension in relationships.