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 long-term problems as opposed to for brief acute pain such as from a surgery.
Many doctors similarly have begun to rethink the frequency with which they prescribe drugs to quell physical pain. The Wall Street Journal (12-15-2012) reports that 16,500 people die of overdoses annually from these medications, more than from all illegal drugs combined.
Many physicians prescribe anti-anxiety medications to decrease feelings of worry, stress, stomach butterflies, and other anxiety manifestations. For patients who are suffering with extreme and chronic anxiety, the medication is a godsend. They can relax and live normal lives.
That strategy though, like use of physical painkillers, risks addiction. Many anti-anxiety drugs, like physical pain reducers, are highly addictive substances. So while using them briefly to calm short-term major anxiety may be worthwhile, wariness is appropriate.
Benzodiazepine medications, with familiar names such as Halcion, Klonopin, Librium, Resteril, Valium and Xanax, are among the most widely prescribed pharmaceuticals in America, and also the deadliest. Like opioids, benzodiazepine drugs are highly addictive if used for more than a brief period of time and on a regular, as opposed to occasional basis.
Instead of risking addiction and potential overdose from benzodiazepines, doctors and nurse practitioners are increasingly prescribing antidepressant drugs for anxiety relief as some of these have sedative (relaxing) side effects. These SSRI medications have another downside however. They make you drug dependent, which is the same as addicted but without feelings of craving. Ceasing the use of these medications once you have been on them for some time can engender sick feelings and/or trigger an intense withdrawal-induced depression.
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.
A similar re-thinking as what has happened with opioids for physical pain may be needed for this widespread prescribing by doctors of drugs to quell the emotional pain of anxiety.
The good news is that anxiety, like physical pain, 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!"
Because anxiety warns you that there is a problem that needs to be solved, a best first response to anxiety is to get to work gathering information about the problem and mapping an effective plan of action for dealing with it. Already then the anxiety is likely to begin to lift.
Anxiety in this regard is 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.
Whereas pill-giving is a get-rid-of-that-feeling-without-listening-to-its-message approach, therapists help anxious clients identify the underlying concerns triggering their anxiety, and then help them to 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. Sometimes, in fact, even just beginning to move forward toward problem-solving by seeking out more information about the situation can alleviate the fears.
In this regard, therapists sometimes quote the mantra the best antidote for anxiety is information. Think, for instance, of when you have worried that you have a serious physical problem. Speaking to a physician who explains that your symptoms are benign can give you information that instantly dissipates the anxious feelings.
Sometimes an anxious person, perhaps with the help of a therapist, aims to track down earlier life experiences that may have triggered a similar frightened feeling. Once those root experiences have come to light, overly strong feelings in response to a current situation make sense. Those experiences mean that your body is reacting now as if the earlier experience were going on again.
If for instance, your father tended to be harshly critical, adult-to-adult interactions with male authority figures may evoke seemingly excessive anxious feelings. Clarifying what is different now, in the present situation, from in the earlier one can release the anxious feelings. The free That Was Then, This is Now video that you can find here illustrates this technique.
In addition, there's many options, both conventional and alternative.
In cases where anxiety is chronic, intense, and debilitating, anti anxiety medications may merit giving a try. Relief from this kind of suffering is a great blessing. Sometimes too a medication such as a beta blocker (not addictive) that dulls performance anxiety before a specific event may help.
The downsides of anxiety treatment with medications arise primarily with their extended use, and with the specific class of medications called benzodiazepines.
At the same time, non-pill psychotherapy techniques often can quell anxious feelings that have arisen in response to a situational trigger without your needing to resort to drugs. In addition, especially for phobias, ptsd and chronic anxiety, and social anxiety, do check out the newer treatment techniques listed above, especially Emotional Freedom Technique.
Fortunately, 1) looking squarely at a problem that has triggered anxious feelings, 2) gathering information about it, and then 3) picking a plan of action for dealing with the situation more often than not proves to be a happily effective option.
So next time you feel anxious, aim to return to well-being—and solve the triggering problem along the way. Better yet, aim to relieve your anxiety, solve the anxiety-engendering situation, and use this life episode to reap an added bonus of deepened self-understanding, self-acceptance and psychological wisdom.
Clinical psychologist Dr. Susan Heitler, educated at Harvard and NYU, trains therapists across the US in the therapy and self-help treatment methods that she explains in her latest book, Prescriptions Without Pills.
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