Generalized Anxiety Disorder
# 1 in a short series of blogs about Anxiety
This is the first in a series of blogs that I will write about anxiety. In this blog I will imagine that I am meeting with a new client about anxiety and explain to you how we can begin to address generalized anxiety disorder.
As we live through the second wave of COVID what I am seeing is that a lot more people are experiencing anxiety (or at least talking about it) than they have in the past. Anxiety wears many faces and presents in different ways for each person. It is also often the presenting issue that potential clients call me.
Saying Hello
I greet you at the door and welcome you to my office by first of all introducing myself and checking your name to make sure you are in the right place at the right time. I take your coat and hang it up then invite you into my office. I offer you tea or water and once we are settled in our chairs I generally ask you what brought you in or what got you to call me now. I know that generally people have been thinking about coming for counselling for a long time before they make the call. Not always but sometimes I will ask you if you have any questions that you would like to ask me, about counselling, my education or if I have worked with your problem before. Usually sometime after we get started I will ask you, in one way or another, what you need from counselling or what your goals are for your work with me. Sometimes when I ask people what their goals are they get a deer in the headlights look in their eyes. They just want to feel better again. I don’t push this question too much right now.
Once the ice is broken a little bit we can then begin to work together.
Introduction to Understanding Anxiety
When I started my first job as a counsellor I had no idea what anxiety was even though I had lived with it for a long time. When I started work as a social worker I quickly learned that the average person, at that time, visited 7 different medical professionals before being diagnosed with some form of anxiety disorder. That is a lot of disappointment and frustration for the person living with anxiety disorder. The symptoms of anxiety include much more than excessive worrying or feeling a bit nervous. Anxiety is a startlingly physical condition, which includes heart palpitations, excessive sweating, blurred vision, frequent urination, headaches, and indisputable physical pain.
Living with Anxiety: Real People
If you are interested in knowing what it is like to live with Generalized Anxiety Disorder (GAD) CBC Gem has a series called You Can’t Ask That. The show on Anxiety is in season 2 episode 8. It’s the best I have seen about anxiety and it features real people who live with anxiety. You do need to sign up for a Gem account but its free so that is a good thing.
Here is the link.
https://gem.cbc.ca/media/you-cant-ask-that/season-2/episode-8/38e815a-0131921589b.
Dr. Claire Weekes (AKA-Deb’s Hero)
Dr. Claire Weeks, who for me at least, is the pioneer of addressing the reality of anxiety as a lived experience . She talks about accepting anxiety by doing the following.
“Face, Accept, Float, Let time pass”
Face the fear, Accept all thoughts and sensations, Float through the discomfort, Let time pass.
One of my favourite stories about Dr. Weekes came from a interview that she did with psychiatrist Dr. Robert DuPont. Dr. Weekes was elderly and had been studying and living with anxiety for most of her career. The interviewer asked if she still experienced panic attacks. She said yes, then he offered sympathy to her. She replied:
“Save your sympathy for someone else. I don’t need it or want it. What you call a panic attack is merely a few normal chemicals that are temporarily out of place in my brain. It is of no significance whatsoever to me!
Dr. Weekes believed that anxiety is a normal response that can be misconstrued by the brain. As I listen to each person’s story I often hear that their particular form of anxiety started when they were children. When clients come in to see me with anxiety I tell them this little story about the relationship between anxiety and depression.
Anxiety and its best buddy Depression[i] are two friends in high school. Everyone around them knows that these two kids should not hang out together but they are seldom apart, In fact they are a bit like FRENEMIES[ii]. They don’t really like each other but need each other to remain the bullies that they are. Our jobs as counsellor and client are to help break up these frenemies because then we can deal with them individually. As the client you can hear the messages that each condition is sending to you as well as the physical side effect each of them encourage.
So what I do with that little analogy or story is the help the client begin to externalize anxiety and begin to see that they are much more than either anxiety or depression. That in fact they can be brave. I also acknowledge that one of the bravest things that people can do is make an appointment to see a counsellor.
We begin then to change your narrative about who you are and how you have control over self. I read somewhere today that anxiety does not have to control your actions, nor does it define who you are as a human being. I like that because when we see ourselves as not being in control we lose a bit of our independence. When we acknowledge anxiety as not part of whom we are as a human being then we begin to take control again.
Purposeful Questions I will ask
When people first come in for an appointment I will ask some background questions such as
o How long have you experienced anxiety?
o How does it present to you?
o Have you had suicidal thoughts or thoughts or behaviours around self harm?
o Tell me about your diet and how much caffeine do you drink?
o Can you tell me about your alcohol consumption?
o What about other social drug use including marijuana?
o What do you do that helps?
These questions generally happen during our first hour together. I hope they don’t feel intrusive. Since our time together is often limited I want our interactions to be purposeful. The more I know about your relationship with anxiety, the better it is for your time with me. My purpose is to try and understand what you are experiencing.
After getting as much background information as I can that relates to your understanding of anxiety I like to give you a few tools so that you understand what is going on in your brain/ Sometimes I draw you a nice picture of your brain. That’s a big lie! I am a terrible artist and I often draw the brain incorrectly . But my purpose it to get the general idea of which parts of your brain are being affected and how the chemicals that cause anxiety . I will look at that a bit more in my next blog in this series. I might even attempt to draw the brain , no…I won’t , I will find an accurate picture.
PANIC:
I will do a whole blog on panic but will address it here briefly. Its awful. I had a client many years ago who had a panic attack in my office. Until that time I had understood panic intellectually but had never experienced or witnessed an attack. Finally the light bulb went on for me and I got it as much as was possible for me. I stopped trying to get her to use her cerebral cortex to stop something that was coming from her amygdala (sometimes called the old brain). We then started to teach her how to survive this experience that made her think she was dying
What kinds of therapy can work?
First I will tell you what does not work. Ignoring anxiety and wishing it would go away does not work well. Drinking it away does not work well nor does smoking weed. If you only rely only external sources such as alcohol or weed then you end up with much bigger problems.
What does work is cognitive behavioural therapy with a heavy dose of mindfulness. When I was younger I forgot that I was trained in Cognitive -Behavioural therapy and put much of the emphasis on thinking your way out of anxiety. That is a good start but it’s not all there is.
I also have learned that how we act and how we think with a strong dose of acknowledgement for your emotional and physical responses work together and that if we bring mindfulness into the everyday and practice we will be able to manage this chronic condition called Anxiety.
Ending our first Session:
I invite you to ask me questions or just tell me what you need to say. Sometimes I invite you to talk by asking this question. What didn’t I ask that I should have? What did I miss? Often that invites you to explain something in more detail that we might have skimmed over or introduce what is really going on for you. But my intention is to make sure you know you have permission to run the show. This is about what you need and my sometimes feeble effort to facilitate you healing.
So after our introductions, questions and a bit of education about anxiety, who it affects and how I want to help you leave our first session with two things.
Skills :
Deep breathing - 4x a day ( We actually practice breathing)
A walking mediation : I will include a link to that in the Endnotes
Alternate nose breathing exercise: This is yogic breathing technique that people find helpful when they are experiencing extreme anxiety or panic : the link is in the endnotes.
Limit the amount of C.A.T.S. you consume. C.A.T.S. stands for caffeine alcohol, tobaccos, sugar and sweeteners . Generally its a good idea not to consume CATS in the first place…just saying.
Homework: (Counsellors love to give homework)
Come back please even though it can be scary
Practice the deep breathing
Journal your responses to food, drink and situations. Notice your emotional responses so that you can begin to identify your triggers for anxiety and know that sometimes .
Thanks for reading this far and next week we will look a bit more at how our brain processes anxiety.
Endnotes:
[i] Anxiety is often accompanied by depression, and the two share many symptoms and involve many of the same brain pathways. Biology can contribute to vulnerability to anxiety, as can childhood experiences such as trauma.
[ii] Frenemies: are two people who spend a lot of time together and need each other to remain in their position of power. They are always together but each wants to be dominant over the other. By themselves we can deal with them but together they are genuine bullies and do everything they can to maintain their power. In my story the two Frenemies are represented by anxiety and depression. You never really feel very good after you interact with a Frenemy.
[iii] Walking Meditation:
https://ggia.berkeley.edu/practice/walking_meditation
[1v] Alternate Nose Breathing Exercise: Its on You tube
https://www.youtube.com/watch?v=sqsxNMoLYKY