How to Kick Anxiety's Ass Pt. 2
In my previous blog, I shared some techniques and strategies to calm yourself and get to a more regulated state in moments of anxiety. Now, I’m going to elaborate further on how to get to the root of your anxiety and techniques to use for a longer-term approach to healing anxiety. This means trying to determine whether your experience is part of another disorder or a specific type of anxiety disorder. From there, we can begin to discuss Exposure and Response Prevention (ERP), one effective treatment for many anxiety disorders.
Anxiety as a Symptom of Another Disorder
Anxiety can be a disorder on its own or a symptom of another disorder. A longer-term approach to treating anxiety must first focus on determining which kind of anxiety you have and its source. The Diagnostic and Statistical Manual, 5th edition (DSM-5) describes several primary disorders where anxiety is a possible symptom that a person may experience. A few of these disorders include:
Bipolar Disorder - Anxiety, along with irritability, can be a temporary stage in the mood cycles of someone with this condition.
Borderline Personality Disorder - An individual may experience strong fears of abandonment or anxiety during or after an emotional dysregulation episode. They may fear they damaged an important relationship or another aspect of their life.
Dissociative Disorder - A person is anxious over fears of lost time or feels cut off from some part of themself or reality. If they are trying to hide their disorder from others, they may also feel anxiety about being discovered.
Post-Traumatic Stress Disorder - An individual can feel considerable anxiety any time they are reminded of the original trauma or if they fear they are in a similar situation and are likely to be retraumatized.
It’s important to have a proper and thorough evaluation to accurately diagnose if anxiety is a symptom of another disorder so that the primary disorder is addressed. Addressing the primary disorder is important for long-term healing and benefits.
Comorbid Conditions
It is common for a person to have more than one diagnosis at a time. They could have a combination of Bipolar Disorder and Social Anxiety, Autism Spectrum Disorder and Social Anxiety, Post-Traumatic Stress Disorder and Dissociative Disorder, etc. Mental health professionals call two or more coexisting diagnoses “comorbid” or “comorbid conditions.” When this is the case, your therapist will help you determine what is causing you the most distress in the present. This will guide you and your therapist to decide what needs to be addressed first and how to go about addressing it.
When Anxiety is the Primary Disorder
The DSM-5 recognizes seven types of anxiety disorders:
Generalized Anxiety Disorder
Separation Anxiety Disorder
Social Phobia Disorder, aka Social Anxiety
Specific Phobia Disorders (fear of blood, injections, spiders, etc.)
Panic Disorder
Agoraphobia
And, Anxiety Disorders due to medical conditions
Though Obsessive Compulsive Disorder (OCD) is listed separately in the DSM 5, many psychotherapists consider OCD to be an anxiety disorder since the obsessive behaviors (if present) are performed to escape, appease, or relieve anxiety.
To treat these disorders, psychotherapists use a variety of techniques. Exposure and Response Prevention (ERP) is one of those techniques. It’s pretty much what it sounds like. You and your therapist identify the triggers to your anxiety, then you expose yourself in small, manageable bits to the things that trigger your anxiety, while at the same time using the techniques to retrain your brain to have a different response.
Exposure and Response Prevention (ERP) is considered the gold standard treatment for many Anxiety Disorders and OCD, with a couple of caveats:
Medications are often prescribed for Anxiety and Panic Disorders.
Benzodiazepines such as Valium, Xanax, Klonopin, and Atavan are effective but can be highly addictive. If prescribed, they should be used with caution and for short-term assistance.
Beta-blockers are also intended for short-term use in conjunction with therapy due to longer-term negative health effects.
Antidepressants are frequently helpful with anxiety and are often prescribed for longer-term use. The best results with antidepressants are to use them in conjunction with therapy.
It’s important to note that Exposure and Response Prevention is not appropriate for some people with PTSD. You can’t ethically “expose” an assault survivor to assault or a combat-exposed person to combat. Additionally, many people with PTSD need to build up their inner strengths and resources before they can address their trauma without decompensating.
There are methods for “exposing” a traumatized person through imagination work, such as in EMDR (Eye Movement Desensitization and Reprocessing) and with Clinical Hypnosis, and there are other more somatic therapies using body movement, meditation, and yoga that have been very effective in treating PTSD and I feel all of these are kinder and gentler for healing PTSD than using ERP.
Minus the above caveats, if anxiety is your primary disorder, ERP is likely the best method for a longer-term approach to kicking anxiety’s ass and kicking it out of your life.
Stopping the Noise in Your Head, by Dr. Reid Wilson, is a great book that explains how to use ERP techniques. I have found it useful myself and recommend it to my clients with anxiety disorders other than PTSD.
Stay tuned for my next and final blog in this series, where I describe several of Dr. Wilson’s techniques in more detail and how to apply them in a safe, effective way to help you kick your anxiety’s ass.