In my last post, I provided a structural framework for anxiety that I share with clients to reduce shame and conceptualize treatment. Before I shift focus and begin outlining a structural concept of depression, I wanted to share some of the ways that I approach the treatment of anxiety and panic with clients in my practice. My approach to treating anxiety builds on the concept I outlined prior of anxiety as the threat detection system within the body and focuses on fine tuning this system in two areas, distress tolerance and stress reduction, a two-pronged approach if you will.
Distress tolerance is the first prong and foundational to any effort in reducing anxiety. The goal is simply teaching the brain to maintain or regain a state of calm during stressful situations and encounters. This calm state is accomplished through the practice of deep breathing, muscle relaxation, and grounding exercises.
Deep breathing helps to alleviate anxiety by redistributing oxygen to parts of the brain responsible for rational decision-making and away from the part of the brain responsible for emergency responses (aka fight, flight, or freeze). Grounding exercises help to reconnect the internal and external sensory systems, which may not be communicating effectively with one another due to long-term activation of the sympathetic nervous system. Regular practice of deep breathing and grounding exercises work like a fire drill for the brain. Practicing what we want our brains to do in an emergency will increase the likelihood that we will be able to remain calm and make rational decisions when those emergencies arise and will help us gauge between conditions that are stressful and ones that are true crises.
Stress reduction is the second prong and is the practice of reducing or eliminating stressful interactions and situations from our lives, or reframing them in a way that makes them appear less threatening. A large part of a stress reduction approach is in practical application. A very simple representation of a practical stress reduction approach might be taking a different route to work if your current route is filled with potholes and traffic, or unplugging from social media when you find yourself obsessing over keeping up with the Joneses. There may be many stressors that could be removed from your life with minimal effort or consequence.
Additionally, there are preventative measures that can be practically taken in a stress reduction approach. These measures may consist of improving sleep hygiene, getting more exercise, reducing or eliminating substance use, and reconnecting with or building an adequate support system of friends and family members. Another part of a stress reduction approach is philosophical in nature and has to do with boosting one's self-confidence through utilizing positive self-talk and facing stressful encounters with courage and optimism, also through reframing, the taking of a different perspective that sees stressful encounters as opportunities to practice skills and boost effectiveness.
When it comes to building self-esteem, I do recognize that challenging oneself and attaining goals is an important part of this development. However, much like my perspective on motivation, my experience has been that clients do not seem to have difficulty pushing themselves. Quite the contrary, I see many of my clients excessively focused on achievement/success, to the point of burnout, and constantly comparing themselves to others. I’m all for doing one’s best and striving for excellence. However, too much focus on achievement often has the opposite effect on self-confidence than intended, as a client’s self-valuation becomes solely about what they can do, instead of being about who they are.
It is here that I begin a conversation about self-worth, often in true dad joke fashion, by pointing out that we call ourselves human beings and not human doings. After clients either laugh or groan (I get more groans than laughs), I focus on instilling what I believe is foundational to any effort to establish healthy self-worth and self-esteem, an acceptance of oneself as intrinsically valuable. A person’s worth does not come from their ability to complete tasks, people are not tools that we use to achieve some other outcome. This would be a description of instrumental value, or value based on the capacity to help us achieve something else. An example of instrumental value might be one’s car, as its worth is based on its ability to get us from point A to point B and not just in being a car (sorry car enthusiasts).
Conversely, a person’s worth is not based on what they can achieve, it flows from their unique inner experience. A person is not a means to some end, people are an end unto themselves. This is in no way meant to diminish or dismiss the achievements of anyone. Many of us have found great fulfillment in our personal achievements, as long as those efforts and goals are meaningful to us. Achievement for achievement's sake or as an obligatory exercise for gaining someone else’s approval are paths to less fulfillment and an inaccurate perspective of one’s own worth. Alternatively, if we can build a foundation of intrinsic self-worth, we can then begin to develop confidence and esteem through challenging ourselves appropriately about the conditions that cause us worry, anxiety, and fear.
Much like increasing distress tolerance, generating positive inner dialogue and shifting to healthier perspectives requires practice and specificity. In my experience, positive self-talk and reframing often need to be tailored to a client’s particular concerns. Sometimes a supportive professional will be needed to help identify negative thinking and offer alternative perspectives. If you are struggling to address anxiety on your own, please reach out to a trusted professional like your family doctor or a counselor for help.