Off the Couch

Thoughts about the therapeutic process, and the dynamics of client-therapist interactions.

Finding your own path from anxiety to pleasure

We each need our own toolbox for managing anxiety -- some tools you can use

Marti* had been in therapy for several months. She had suffered from anxiety most of her life and was hoping that I could help her change the way she dealt with it. She worried about a lot of different things, including her children, husband, parents, friends, colleagues, work and many other things. She had some, but not all of the symptoms of a Generalized Anxiety Disorder (see the Mayo clinic's and the US Goverment's descriptions of the disorder and related symptoms)  In fact, what she had was what I think of as a normal anxiety response to the crazy world we live in.

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A generalized anxiety disorder may manifest itself in concerns that cannot be soothed, an inability to relax, and difficulty concentrating and falling or staying asleep. People with this diagnosis are easily startled and often have difficulty concentrating. They may suffer from a variety of physical and psychological symptoms, including fatigue, headaches and muscle tension. These and other symptoms fluctuate, often depending on external stressors in a person’s life. How many of us have not felt this way at some time in our lives?

Marti and I had been working to understand some of the causes of her anxieties. Like many people with these symptoms, she was well-liked, had good friends, and was happily married. She worked at a job that she liked and was good at. But she was often unhappy because of her worries. She had been in therapy before and had come to understand that some of her anxiety was related to “scripts” or expectations she had learned in childhood. “My mom was always worried,” she said, “so I guess I learned that it’s a scary world out there!”

But the understanding didn’t always help her feel better. One day she came in for her session looking more peaceful than I had ever seen her. She settled herself in a chair and looked at me with a twinkle in her eye. “Okay,” she said. “I admit it. You were totally right.”

Like most people, I love it when someone acknowledges that I am right, but in this case, I had no idea what she was talking about. I must have looked puzzled, because she grinned and said, “I’m feeling peaceful today for the first time in ages. And do you know why?”

I said that I didn’t, but that I could see that she was more relaxed than she had been. She nodded. “I took a yoga class,” she said. “Like you’ve been encouraging me to do.”

Now, we had talked about her taking yoga as a possible way of making herself feel better; but I was sure that I had not suggested that yoga would take away all of her anxiety. In fact, I believe that most people who struggle with anxiety and related symptoms need a psychological toolbox that they fill with tools for soothing themselves, so that they have a number of different ways to make themselves feel better. When one tool doesn’t work, another is there to try instead.

But I was curious about what Marti had taken from our conversations, and about how yoga had helped her. Marti said that the teacher had presented the class as an opportunity for finding “peacefulness and a sense of serenity.” They would use the yoga practice to “reset their mindspace.” Marti loved the idea.

“I thought of each breath as a way of resetting my psyche,” she said. Focusing on her breath, in the presence of a calming and soothing teacher and the other students, and paying attention to how she breathed as she did each yoga pose, gave Marti a respite from her worries. And not worrying for that ninety minute period, actually seemed to have helped her reset herself.

Would it last? Probably not forever. But there is a theory that says that every period of time when we are free of our habitual ways of thinking and acting allows us to build new skills – new “feeling muscles,” so to speak – that will help us manage anxiety and other feelings differently. Marti had been building new muscles in therapy. I had the sense that the yoga experience was strengthening those muscles. We had discussed other ways she could “exercise” her psyche as well – for example, removing herself from anxiety-provoking situations, taking a walk, listening to music, talking to a friend on the phone, reading a book, watching a movie or a television program that would both engage and entertain her without stirring up her anxieties, cooking and baking (which were both activities that she loved), and doing crossword puzzles (which she also enjoyed).

We continued to work on understanding the underlying causes of her anxieties – for example, a deep-seated feeling that she was not deserving of the good things she had attained in her life, and a fear that she was really not a lovable or nice person – but we also worked on her ability to make herself feel comfortable and safe despite these worries. Interestingly, as she got better at soothing herself, she also lost some of the fear that she was not deserving. Which came first? I don’t know. I think they work together. But one thing I do know: somehow, her mindspace really did seem to re-set, and even in the midst of a very chaotic world, she seemed to have found some serenity.

*names and identifying information changed to protect privacy

 Teaser Image: copyright fdbarth November 2013

 

 

F. Diane Barth, L.C.S.W., is a psychotherapist, teacher, and author in private practice in New York City.

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