Un­der­stand­ing And Over­com­ing Anx­i­ety

ForbesWeekly - - NEWS - BY JEENA CHO, CON­TRIB­U­TOR

Ac­cord­ing to the Anx­i­ety and De­pres­sion As­so­ci­a­tion of Amer­ica, an es­ti­mated 40 mil­lion Amer­i­can adults suf­fer from anx­i­ety dis­or­ders. Only about one-third of those suf­fer­ing from an anx­i­ety dis­or­der re­ceive treat­ment, even though the dis­or­ders are highly treat­able.

Six years ago, I was di­ag­nosed with so­cial anx­i­ety dis­or­der. I re­mem­ber feel­ing both re­lieved and frus­trated. I felt re­lieved be­cause I re­al­ized I wasn’t the only one. I felt frus­trated be­cause, in many ways, this “dis­or­der” didn’t feel real. I didn’t have a bro­ken bone, a virus or a bac­te­ria that was caus­ing the dis­or­der. It was com­pletely in my head.

Anx­i­ety is the dread or fear of some fu­ture an­tic­i­pated event. Ac­cord­ing to Dr. Ben Ep­stein, a psy­chol­o­gist who blends tra­di­tional cog­ni­tive be­hav­ioral ther­apy (CBT) with mind­ful­ness and ac­cep­tance tech­niques, anx­i­ety is by def­i­ni­tion “fu­ture-ori­ented.” Peo­ple who suf­fer from anx­i­ety worry about the pos­si­bil­ity of a stock mar­ket crash, fail­ing an exam, miss­ing a dead­line, get­ting a neg­a­tive re­view at work, etc.

Sadly, many peo­ple who suf­fer from anx­i­ety or anx­i­ety dis­or­ders fail to seek help. Ep­stein lists a few dif­fer­ent rea­sons why peo­ple may avoid get­ting help: “Peo­ple gen­er­ally avoid seek­ing out treat­ment for psy­cho­log­i­cal is­sues be­cause of stigma and/or eco­nomic rea­sons. There is still a strong sense of con­cern over be­ing la­beled ‘men­tally ill.’” The other rea­son is the fi­nan­cial bar­rier. “Be­cause of the ubiq­ui­tous na­ture of men­tal ill­ness, there is a big lack of par­ity be­tween cov­er­age for is­sues re­lated to men­tal health and other ar­eas of health­care, so there may be a sig­nif­i­cant fi­nan­cial bar­rier which serves to ob­fus­cate peo­ple from reach­ing out to men­tal health providers.”

For me, the anx­i­ety slowly crept into my life over many years un­til it in­vaded all ar­eas of so­cial in­ter­ac­tions. In the be­gin­ning, the feel­ing of anx­i­ety, which for me felt as though I was fall­ing into an end­less pit of dark­ness, com­bined with feel­ing as though my stom­ach would burst from the in­tense feel­ing of be­ing in tight knots, only hap­pened when I was in front of large groups of peo­ple. This was easy enough to avoid. I turned down speak­ing en­gage­ments, stopped at­tend­ing net­work­ing func­tions, etc. How­ever, over time, those so­cial in­ter­ac­tions that trig­gered the anx­i­ety in­creased. I felt anx­ious in small groups of peo­ple—even groups of friends. Then, over time, I no­ticed I felt anx­ious all the time.

Treat­ing anx­i­ety

For­tu­nately, neu­ro­science has been mak­ing strides in de­ter­min­ing the ar­eas of the brain that are re­spon­si­ble for the anx­i­ety re­sponse. In one Stan­ford study:

“The re­searchers also found that both amyg­dala re­gions had less con­nec­tiv­ity to the re­gion of the brain re­spon­si­ble for de­ter­min­ing the im­por­tance of stim­uli. This could mean that peo­ple with the [anx­i­ety] dis­or­der have a harder time dis­cern­ing truly wor­ri­some sit­u­a­tions from mild an­noy­ances. At the same time, the amyg­dala was more con­nected to a cor­ti­cal ex­ec­u­tive-con­trol net­work pre­vi­ously found to ex­ert cog­ni­tive con­trol over emo­tion.”

Other stud­ies have been us­ing brain scans to de­ter­mine which ther­apy will be most ef­fec­tive for those suf­fer­ing from anx­i­ety dis­or­ders.

Ac­cord­ing to Ep­stein, ef­fec­tive treat­ments for anx­i­ety in­clude med­i­ca­tion and psy­chother­apy. Com­monly-pre­scribed

med­i­ca­tions in­clude se­lec­tive sero­tonin re­up­take in­hibitors (SSRI) or another class of an­tide­pres­sants known as tri­cyclic an­tide­pres­sants. He em­pha­sizes that, of­ten, a com­bi­na­tion of med­i­ca­tion and ther­apy is the most ef­fec­tive treat­ment com­bi­na­tion.

Cur­rently the most com­mon forms of psy­chother­apy used to treat anx­i­ety are cog­ni­tive be­hav­ioral ap­proaches and be­hav­ioral ther­apy. Ep­stein says, “Cog­ni­tive be­hav­ioral ther­apy is help­ful to teach in­di­vid­u­als to be­come able to bet­ter rec­og­nize mal­adap­tive thought pat­terns and the con­cur­rent bodily sen­sa­tions that might pre­cede or ac­com­pany those pat­terns, as well as ex­ter­nal sit­u­a­tions that might trig­ger anx­i­ety and the ca­pac­ity to re­spond dif­fer­ently.” Other treat­ment in­cludes be­hav­ioral ther­apy, which uses tech­niques such as flood­ing, grad­ual ex­po­sure to what­ever a per­son is afraid of, sys­tem­atic de­sen­si­ti­za­tion and pro­gres­sive mus­cle re­lax­ation to help me­di­ate the ef­fects of anx­i­ety.

Mind­ful­ness as treat­ment for anx­i­ety

I chose both CBT and mind­ful­ness-based stress re­duc­tion (MBSR) for my treat­ment. It wasn’t a panacea. I wasn’t cured overnight and I still ex­pe­ri­ence oc­ca­sional anx­i­ety. Anx­i­etypro­vok­ing sit­u­a­tions are still plenty in my life. How­ever, what has changed is my re­la­tion­ship to the feel­ings of anx­i­ety. When my stom­ach starts tight­en­ing and I get that sen­sa­tion of fall­ing into a pit of de­spair, I im­me­di­ately rec­og­nize it as anx­i­ety. I can then de­ploy the many tools in my arse­nal for dif­fus­ing the anx­ious feel­ings.

Ini­tially, while I was go­ing through the MBSR treat­ment pro­gram, I ques­tioned how sit­ting qui­etly ev­ery day in med­i­ta­tion can “cure” anx­i­ety. Ep­stein ex­plains it in this way:

“Anx­i­ety is per­pet­u­ated by avoid­ance. If we avoid the un­pleas­ant thoughts and feel­ings, we are able to re­duce their power in the short term. But they in­evitably re­turn with a vengeance. When you prac­tice mind­ful­ness, you make the con­scious de­ci­sion to stay present and ex­am­ine your own un­fold­ing in­ner ex­pe­ri­ence with­out judg­ment or cen­sure.”

What I’ve learned is a dif­fer­ent way of ap­proach­ing anx­i­ety. I no longer panic over the fact that I am anx­ious. Anx­i­ety is sim­ply a sen­sa­tion, a thought, just like any other. I credit my daily mind­ful­ness prac­tice for this shift. As Ep­stein puts it, prac­tic­ing mind­ful­ness al­lows you to “gain the abil­ity to cor­rectly eval­u­ate and change your at­ti­tudes and be­hav­iors.”

TIM ROBBERTS/GETTY IMAGES

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