Myths About Anxiety
Myth #1 - Labeling, or identifying a particular type of anxiety with a diagnosis, is necessary to treat it.
Labeling is not necessary to treat anxiety as there are several techniques that can treat the symptoms without an opinion of whether you have a specific phobia, panic disorder, or generalized anxieties. Yet, there are times when labeling can be helpful.
Labeling anxious behavior to give it a diagnosis may be helpful if you are a doctor who follows the medical model whose tenets are Assess, Diagnose, and Treat with medication to alleviate the symptoms caused by the problems to which we have just given a diagnosis. If you go into a medical doctor’s office such as your primary care doctor or to the emergency room with shortness of breath, heart palpitations, trembling or shaking, chest pain or discomfort or a fear of dying, you will be checked out and given a finding.
Panic symptoms can mimic heart problems and when you are having a panic attack, you may believe you are having a heart attack. Many people go to a medical facility with panic attacks thinking they are on the verge of dying and instead find out that the symptoms they were having were in fact anxiety related.
Some doctors will prescribe anti-depressants, which can be very helpful and often are used as the first line of medical treatment for anxiety. However, anti-anxiety medication, or benzodiazepines, can be addictive. Without proper guidance, education, and follow up, you can find yourself with an additional problem on your hands. I have had several anxious clients who were fearful of taking any medications because of all the side effects. When you look at the possible problems that can go awry while taking a medication compared with one symptom being anxiety, well, the neurotic within us tells us we would rather have the tried and true familiar anxiety instead of the unknown one.
There are some disorders which may be extremely helpful to diagnose. Post-Traumatic Stress Disorder, or PTSD, is one of those and until the newest diagnostic manual came out, it was under the Anxiety Disorders category. Labeling for PTSD may be helpful for someone who does not experience symptoms of flashbacks, nightmares, startled response, or extreme panic until many months or years after the event. When you are informed that this is what you are experiencing and it is called PTSD due to a war event, abuse, accident, or some other trauma, it is normalized. You can then treat it. It can be helpful for someone to hear how common and understandable their reactions are based on past or recent past incidents. You may feel validated that you are not going crazy but are having symptoms from a very real mental illness.
Depression, which often goes hand in hand with anxiety, can also be very helpful to identify. Many people who experience symptoms of depression—lack of concentration, difficulty sleeping, loss of appetite, feeling overwhelmed, preoccupation with worry, uncontrollable crying, or suicidal thoughts—may be unaware of what is happening to them. They just know they feel helpless or hopeless. Often a family member notices a change in behaviors before the individual experiencing the symptoms does. And once these symptoms are identified as depression, you can start to get the help you need to improve.
Diagnosing a set of symptoms can be helpful if someone is having psychotic symptoms, as in hallucinations or delusional thinking. Yet, once a diagnosis is given, symptoms are often seen within those parameters, which may not always be useful in getting someone the help they need. Sometimes just looking at the possible causes of the symptoms can help.
Well-known psychiatrist Dr. Milton Erickson often treated patients diagnosed with psychotic disorders. Jay Haley, a founding father of both brief and family therapies, wrote in his book, Jay Haley on Milton H. Erickson, about how Dr. Erickson was once asked to see a hospital patient who complained of frequent stomach pains after eating. The staff’s thoughts were that this patient was stuck in some type of delusional thought that would benefit from Dr. Erickson’s wisdom. They hoped the eminent psychiatrist would unravel this schizophrenic’s sick thoughts.
Dr. Erickson talked to this patient, asked him all about his stay in the hospital and went with him to the cafeteria to check out the food. It was determined that the cafeteria food was giving this patient a stomachache. He was not delusional about his stomach pain. Once the food was seen as the culprit, the patient no longer complained of stomach pain.
Situations like this are why I hesitate to specifically label behaviors. As
the Sigmund Freud joke goes, “Sometimes a cigar is just a cigar.”
Physicians and psychiatrists utilize the medical model, which includes labeling or diagnosing a set of symptoms. Again, this can be helpful to eliminate or rule out other problems or disorders. Even for psychological symptoms, some people value learning what is going on with them so that they know they are not alone with it, that it is a real problem and not all in their head. While I don’t think it is necessary to label a type of anxiety before treating it, I will briefly discuss the various anxiety disorders for informational purposes.
Anxiety Diagnoses
Here are the main disorders labeled under the Anxiety Category in the DSM-V, the Diagnostic and Statistical Manuel of Mental Disorders, 5th edition.
Generalized Anxiety Disorder (GAD) – People with generalized anxiety disorder experience unrealistic, excessive, and persistent worry about issues like their health, work, money or family, for six months or longer. They don’t know how to stop the worry cycle, which they feel is beyond their control.
Social Anxiety Disorder (Social Phobia) – The extreme fear of being scrutinized and judged by others in social or performance situations. The anxiety can interfere significantly with daily routines, occupational performance, or social life, making it difficult to complete school, interview and get a job, or have friendships and romantic relationships.
Panic Disorder – Panic disorder is diagnosed in people who experience spontaneous, seemingly out-of-the-blue panic attacks and are preoccupied with the fear of a recurring attack. Panic attacks occur unexpectedly, sometimes even waking you up in the middle of your sleep.
Agoraphobia – This anxiety disorder is characterized as fear of public places, yet can be fear of vast open areas, crowdedness, as in a shopping mall or an outdoor concert, or fear of airports, bridges or other uncontrolled settings.
Phobias – A persistent fear of a circumscribed stimulus whereby the exposure almost invariably provokes an immediate anxiety response. The common ones are exposure to snakes, insects and rodents, heights, flying, closed spaces, needles, or witnessing a blood-related injury.
Selective Mutism – A rare type of anxiety disorder whose main characteristic is the failure to speak in specific social situations where speaking is expected, despite talking in other situations.
And though like PTSD, Obsessive Compulsive Disorder, or OCD, is no longer under the category of Anxiety Disorders, it is often all about anxiety. If you have obsessions or persistent ideas, thoughts or impulses, the way you may prevent any further discomfort, or at least reduce any further anxiety about those thoughts, might be to compulsively repeat certain behaviors. You can think of it like a canceling out of those unrelenting thoughts. Some statistics claim that as many as one in fifty people have OCD. It can be debilitating to sufferers. Yet, there is treatment for it and one very successful treatment is “Tapping”, which I will talk more about later in this chapter and for which there is a demonstration exercise in the appendix.
If you want more information about any of these disorders or if you have other questions you can ask your health provider or go to your health provider’s website. The Internet has a lot of information about each one, but stay away from blogs unless you want to participate in a lot of misinformed chats, which may make you anxious and more nervous.
Myth #2 - You can tell yourself you are not anxious.
When you are experiencing a state of anxiety with negative self-talk, rapid shallow breathing, sweaty palms, shakiness or trembling, you may say, “I am not anxious, I don’t want to be anxious, and I am okay, or I will be okay.” This often makes us more anxious.
One of the ways we deal with our worries is to deny them, or at least deny that we can’t deal with them. We might tell ourselves, “Stop worrying; that will never happen.” Or “I am not anxious about this upcoming surgery. It’s not helpful to be worried; it’s only going to make things worse.” Or “I can handle this. No big deal.”
Actually, studies have shown that people who expressed their anxiety before a surgery did better overall after the surgery than people who said they weren’t afraid. We often deny that we are scared silly of experiencing illness and loss, our own and that of a loved one, our grief over a death, our own loneliness. It can all just become too much to bear.
We can become stoic. We don’t show our feelings, we endure pain, we don’t complain and we do this, we say, for the people around us. If a friend or family member has just received a life-threatening diagnosis, we don’t discuss it. We think if they want to talk about it they will. We think, I can handle this. By not talking about this reality, I maintain my composure.
Yes, until you no longer can.
Myth #3 - If we can deny our anxiety and self-medicate we can circumvent our worries and fears.
We drink excessively, overmedicate, overwork, shop until we drop, become porn, Internet or video game addicts. Fear, worry and apprehension about the future or obsessive thoughts about something painful in our past can scare the heck out of us and we will do anything not to feel it. We are afraid to succumb to the pain of the self-defeating negative thoughts that bring anxiety to the forefront of our minds, which can take over and render us immobilized with fear.
“To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.” - Thich Nhat Hanh
Instead of denying you have any anxiety, if you are nervous or worried about something like an upcoming event, ask yourself, “What is this about? What am I saying to myself that is causing this thought that keeps me in anxious knots?” Talk to your body, acknowledge the worry, fear, self-doubt, and breathe into it. Accept the feeling of nervousness, and breathe.
You may even say out loud, “I am really feeling nervous right now.” It is important to accept the feeling and the tension that goes along with it, without judging it.
Take a deep breath in through the nose, hold for five to six seconds, then exhale deeply through your mouth. Do this for several breaths, though not enough to hyperventilate. Notice what you are saying to yourself along with how nervous you are feeling.
It will probably be something like, “I can’t do this, I am not good enough, I don’t know what I am doing, or I feel worthless, inadequate, or stupid.”
Acknowledge any thoughts you are having—let your body know you get it. When you can do this, you are being in the present moment, and the anxiety dissipates.
Myth #4 - The way to treat it is the same throughout the life stages.
A lot of clinicians and alternative caregivers treating anxiety will offer brief therapies, or solution-focused goals, which can offer symptomatic relief. There is nothing wrong with these methods and often they can be very effective and helpful. In fact, brief therapies are a large part of how I work with anxiety.
Each therapist, clinician, healer, or health worker will use the techniques they believe will rid you of the anxiety you have. In the first stage of life, it might be very helpful to patch someone up with coping skills that can be useful in certain situations.
Yet, when anxiety doesn’t go away, or you continue to have the same fears return, especially in this stage of life, it is time to offer a new perspective on those fears. Most likely, some past event or events are still troubling you, and you must get to the source of your pain and suffering. This is where writing can be so effective to help you get to the core of what is bothering you, shaming you and keeping you stuck with negative thoughts about yourself and your life.
Many of my own anxieties dissipated once I wrote about the times that brought up an insecurity or worry. For instance, I used to have a fear of signing my name in public, either on a credit card receipt or on a business document such as a mortgage or a will. My hand would shake and tremble and the fear of identifying myself to the public would terrify me. Each time I had to sign my name in front of others, I believed that I would be seen as an incompetent fraud. I worried that others were thinking, How can this woman help others with their anxiety when she shakes like a leaf just signing her name?
My understanding of this fear came after writing about how I was punished as a child. Growing up, any type of candy or sweet was my way to soothe and calm my anxiety and worry over any household chaos. If I was caught finding a candy stash and eating some of it, my mother would tell me to wait until my father got home for my punishment. For hours before he arrived home, I was in a state of nerves and anxious apprehension.
Once my father arrived back at our house and after hearing the story of my misdeed from my mother, he would say, “Put out your hand.” I’d cringe and do what I was told but I remember feeling so ashamed that I could do something so bad as to warrant this greeting. Instead of a warm hug, or acknowledgment of my presence, I was scolded for eating candy; that treat that I used to relieve my anxieties that was now causing me further anxiety. Early on I learned not to feel comfortable in my own skin so when I had to present myself to others, I expected harsh consequences. That early form of punishment became a breeding ground for my irrational anxiety.
I may still have the thought at times of, What if I shake while signing my name? When that does occur, I think, well, so be it. My hand is shaking. Because I no longer see myself as incompetent, I don’t perceive that from others and I can separate any negative thoughts from the action.
If you are familiar with anxiety from the first half of life, you may continue to believe that you must consider all the possible computations of “what ifs,” a ruminating, obsessive style of worrying, an inner rant of negative thoughts. What if I fail, fall apart, throw up, have a heart attack, let someone see me shake, or go crazy? You may believe that it is helpful to imagine all the consequences a particular behavior or action may have before you complete it.
If this is you, it is important to ask yourself, “What is the worst that can happen?” These worries that used to seem as though we were doing something about the possibility of something happening by worrying have become useless to us. The worry will not help, and takes you out of the present moment and into a state of fear. If you have these types of worry, you must ask yourself, “What is my worst fear?” Then explore it, write about it, and let it go. If your greatest fear is that you could die, or someone you love could die, and you ruminate over when this fear will happen, it is time to let go. This is not the time of life to spend worrying about “what ifs.”
You can also set aside a worry time. If you find you worry more often than not, set aside twenty minutes at the same time each day to worry. If something comes up which starts to worry you, save it for today’s worry time, or for tomorrow’s. You can then be present for the rest of your day rather than lost in past or future thoughts.
In graduate school another student and I offered a free group on “Fear of Public Speaking.” Because of our own fears about presenting in front of groups, we decided to rid ourselves of those fears while we helped others with it at the same time.
We held this group in a small space off the therapy rooms at a clinic where one of the other social work students had her internship. We placed an ad in the local newspaper and once we found a following of nine other students, we began the group we had hoped would rid us of our fears as well as the fears of the other trusting members.
One of the questions we asked a group member was, “What is the worst thing you fear could happen during a speech?” A young male member said that his greatest fear was that he would throw up. When I asked if that had ever happened he said that it had. He described a talk in which he got up to speak, looked out at the audience, and then walked away to vomit minutes later. I remember that all of us, including the co-facilitator, were silent. We didn’t know what to say.
If his worst fear had come true, then “Now what?” What comfort or help could we offer to convince him that it wouldn’t happen again? He was so frightened that it might reoccur that he would not get up in front of our group to talk further about it. He told us this as we went around the room sharing our worst fears. Sadly, he never returned for any more of our unprofessional assistance. His fear may or may not have actually happened. He was distrustful that we could help, and he may have been testing us to see how we would respond.
Yet, despite whether he was being truthful, now I would offer him different questions, and different options. I had not delved into his background and do not know if something from his past could be involved. A question may be, “So that is no longer your worst fear?” or, “Is your worst fear now that the audience would find that out?” My more trained thoughts are that once we knew that fear about him had come to fruition, if it truly had, he felt shame for exposing himself in front of us. Many people there knew that we were social workers in training, not yet full-fledged clinicians, which led to a high amount of attrition. I think we may have had a better success rate had we just been individuals with a fear of speaking publicly who wanted to start a support group.
Action Plan
Have you ever been labeled as a worrywart? Do you see yourself that way? Have you been given an anxiety diagnosis? Was it helpful to be given this label? If so, how so? If not, why not?
What are some of your most pressing worries? What have you done in the past to help relieve your anxiety? Was it helpful?
Is your anxiety at this time of your life different than in the first half of life? If so, how so?
What story do you tell yourself about your anxiety?
What story would you like to tell yourself about your anxiety?