Ten Steps to Relieve Anxiety. H. Michael Zal

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СКАЧАТЬ everything, even though it sometimes isn’t. This revelation moved Matt to allow me to slowly reduce his antidepressant medication. Matt internalized feelings of anger and guilt and denied his need for support and dependency. All of these issues got in the way in his new relationship with David. As time went by I was able to get him to verbalize these feelings. In any new relationship, we project our early wishes onto the other person just as the client projects them onto the therapist. As we get to know the person better, we start to see flaws and limitations. Gradually, Matt was better able to accept David, “warts and all.”

      Therapy helped Matt with his self-esteem and allowed him to feel better about himself. He had a distorted perception of himself, particularly his body image. Some of this was due to the message that he received in childhood that he was “a cross-eyed fat pig.” I helped him reduce feelings of shame and guilt, stay away from self-pity and begin to like himself more. He started a diet. I also helped him see that he did not have to give others so much power over him. As Eleanor Roosevelt said, “No one can make you feel inferior without your consent.”

      To reduce his need for control and predictability, I pointed out that his life history showed no evidence of loss of control. There was no family history of psychosis. If anything, his problem was too much control. I tried to teach him that his personality probably would never allow him to lose complete control.

      The most significant gain in therapy for Matt was his gradual willingness to travel greater distances, take risks and still feel in control. At first, he traveled to another city to see his lover and visit people in the area. Then, he took another job in a location that was outside of his comfort zone. Finally, with his dependency needs and anxiety in better focus, he was able to leave therapy and take an advanced position in a neighboring state. His anxiety battle had, at last, been partially won.

      After several months had passed since I had last spoken to Matt, I called him to check his progress. He seemed happy and confident; his first words were, “I’m doing well. I just graduated from school with a master’s degree in instructional technology. I gave my dissertation presentation in front of thirty people.”

      Matt told me that he was still working for the same firm: “It’s been rough—a lot of management changes—but I stuck in there. I am doing consulting work on the side with a young firm. I’m handling stressful situations better. It’s been good, especially with driving. You would be proud. I drive all over now, even across bridges. It’s amazing. At first, I did it with my partner and then started to drive myself. Now I’m cruising on the highway. We are still together. If the fears do come up, I do the breathing exercise. I no longer need to be tethered to home. We will see how it goes from here. My anxiety is manageable. If it does present, I have the tools to handle it and it’s just a bump in the road. Sometimes I just say to myself, what is the worst thing that can happen?”

      What surprised me the most was what happened when I read him the first line of his vignette, where he compared his anxiety to a battlefield. Although he remembered writing the words, he could no longer relate to them because so much had changed in his life. I could see that he had come a long way from that insecure, upset and anxious young man whom I had met years ago. I was happy for him.

Chapter 3

       Step 3: Refocus

       Refocus. Concentrate on the here and now. Throw away those underlying negative feelings, particularly those from the past. Don’t play the victim. Leave the past behind. Don’t take it all so seriously. Give yourself permission to lighten up, smile and enjoy the moment. You are allowed to relax and have fun. All those bad things happened a long time ago. This is now. You are older, wiser and more in control.

      Penny and Susan, two of my clients, are as different as night and day. However, they do share two things in common. They both have GAD and they both had an alcoholic parent who affected their lives and intensified their innate anxiety.

      These women are not alone. Alcoholism statistics tell us that seventy-six million people in the United States alone have been exposed to alcohol dependency in the family. More than nine million children live with a parent dependent on alcohol.¹ Alcoholism is a disease involving the body, mind and spirit that often reflects psychological stress. This tension can spill over onto the children in the house, creating feelings of fear and insecurity. Children absorb anxiety like a sponge.

      Gilda Berger calls alcoholism “the family disease” in her book, Alcoholism and the Family.² An alcoholic can create chaos, disrupt family life and cause harmful effects to all of its members that can last a lifetime. Children of alcoholics often show symptoms of anxiety and depression, feelings of shame, resentment, numbness, helplessness, lack of friends and problems with intimacy. They often live in fear and anticipation of danger. They have a low trust level due to a history of a sea of empty promises. Some have difficulties putting their painful childhood and adolescent memories behind them.

      In families such as these, life revolves around the alcoholic. The other members unconsciously give up their own needs and take on roles that are helpful to the family unit in an effort to maintain peace and balance in their dysfunctional world. They can take on the role of caretaker, enabler, responsible one, family hero, cheerleader, mascot or lost child. As they grow older, the children of alcoholics often have trouble giving up these roles. As adults, both Penny and Susan compensated for feelings of inadequacy and helplessness by trying to appear strong. Their anxiety interfered with their enjoyment of life in the present. Both of them needed to learn to refocus, not get lost in the past and realize that they have grown physically and emotionally and have developed many new adult resources since they were entrenched in their threatening childhood world a long time ago.

       Penny’s Story

       “My anxiety is the way that I avoid becoming the monster. I cannot relax. I’m so worried about what might happen next. I wish my mind could rest. I feel so keyed up. When something is upsetting me, I feel shaky inside. My breathing changes and my mind is not clear. The anxiety overtakes me. My heart feels like it skips a beat. I become short winded and have trouble catching my breath.

       “I wake up anxious and afraid. I can’t get enough air. When I make plans and am anticipating a good time at an event, anxiety makes me feel that it won’t happen and even looking forward to something good becomes stressful. Then the negative ‘what ifs’ start. What if something bad happens? What if I lose control?”

      Penny became my client when she was forty. She explained that she had a thirty-year history of psychiatric outpatient treatment for anxiety. In her late teens, she had a history of dependency on medications. She had not taken anything since. She was divorced and had three children. She had a good work history. Her alcoholic father had died of a heart attack ten years before. She still remembered his rage, his cursing and his angry voice. “When I think about it, I feel like my brain is throbbing,” she said. She described her father as being outgoing and friendly to others when he was sober, but in the house, he was cold and distant. He often made promises that he didn’t keep. “It was constant chaos,” she said. “My father could easily blow up and be explosive. He once pulled a knife on me. He was physically abusive to my mother. He often hit me so hard that it left welts on my skin. I was so scared. I often hid under the table. I was always afraid of what would happen next. I had to prepare myself and protect myself. He was a monster.”

      She also told me that her paternal grandfather had molested her when she was four. She described her mother as a woman who was emotionally disconnected, depressed and fearful, shut away in the house and taking medication for her nerves. Penny worried about her mother and felt that she always had to look out for her and protect her from her father. It was an ambivalent relationship. СКАЧАТЬ