Ten Steps to Relieve Anxiety. H. Michael Zal

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СКАЧАТЬ I didn’t stop biting my nails.” In spite of the fact that her mother used her as a confidante, she didn’t feel that her mother loved her: “She would wake me up at night to go out and get pizza and beer for my father. I had weight issues. She would make me go to the tap room carrying the empty beer bottles for rebate. I felt embarrassed and degraded with all the men looking at me. I would retreat to my room. It was my sanctuary where I felt safe.”

      Penny was left with a lot of anger, lack of connection to others, depression and anxiety. “I have a need to look strong but I always feel lonely and have trust issues,” she said. She constantly struggled with how to deal with her own angry feelings: “I feel a lot of anger sometimes to the point of lunacy and rage…I’m afraid I’ll spaz out on the wrong person and tell them what I think. I’m afraid I’ll hurt someone physically. It’s frightening even to me.” Like many people who are anxious, she suppressed negative feelings and anger, because she was fearful that such feelings would cause a loss of control or disapproval from others. Because of their negative thought patterns, anxiety-prone people tend to be pessimistic. They ruminate, brood and stew. They tend to catastrophize and over-generalize. Their constant fretting clouds their perspective. They are sure that their negative reasoning reflects reality, that they are losers and will fail. This attitude often leads to depression.

      Sometimes, Penny became depressed and withdrawn and showed physical symptoms, such as muscle spasms and headaches. She was very sensitive to criticism, yet she would occasionally lose her temper irrationally and push people away. She constantly struggled with wanting to be closer to her children, her boyfriend and her co-workers. However, she had problems with trust and maintaining closeness which interfered with her ability to do this. Her expectations were high and she quickly became frustrated if she felt that others did not respect her. It scared her when people lost their temper at work. Once when a woman screamed at Penny at her job, she said, “I’m afraid of people who talk like that. You never know what’s going to happen. I saw abuse and violence when I was growing up. I can’t deal with it. I have zero tolerance. I’m insecure.”

      Although she seemed to be making progress at times, Penny had difficulty maintaining it and things remained the same. Always feeling like the victim, she just could not seem to find a middle ground between her mother’s and father’s behavior. Either she was depressed, passive, withdrawn, avoidant and suffering from vague physical complaints or she was disappointed and angry at everyone. “I can get ugly,” she said. “I scream and curse at my boyfriend. He is judgmental and critical like my parents. Once when we were in my car I got so angry at him that I hit the steering wheel so hard in a rage that I sprained my hand…I don’t feel peaceful inside. I try one way and if that doesn’t work, I try the other way. Something is missing. I always feel a big void. This big emptiness is always there. I feel that I’m not important to anyone.” In between these two sets of behaviors was a constant feeling of anxiety and tension. “I feel afraid that I’m not going to be able to keep my head and maintain control. I feel alone. I have no allies.” At times, she felt like the vulnerable, powerless, ten-year-old child that she once had been.

       Penny’s Opinion of What Helped Her Anxiety

      “I want the world to see me as strong. Some situations make me feel like when I was ten—emotionally threatened and helpless. I try to remember that I am not ten years old. I am not helpless any more. I try to distract myself and refocus. I take a deep breath and tell myself that I’m okay. I tense my muscles and then relax. No one can see me do this. I tense and relax again, while taking a deep breath and exhaling slowly. My heart rate and breathing will slow. I will feel a sensation of calm, mentally and physically. I relax and realize that I don’t have to be either black or white. I don’t have to be sweet or the monster. I don’t have to retreat to my room to avoid things. I can just be me. My anxiety tells me that I am trying to avoid becoming the monster and trying to stay in control and not lose my temper. I am learning to deal with my resentment differently.”

       My Opinion of What Helped Penny’s Anxiety

      Penny was raised by two limited parents who both had anger issues. She particularly identified with her father’s rage and was anxious that she would one day act like him. Identification is an unconscious mental process whereby an individual becomes like another person in one or several aspects. Your adaptive and defensive reaction patterns are often attributable to identification with either a loved or feared person. Freud would say that Penny identified with the aggressor (her father), whom she feared. In therapy, we deal with the fact that anger is a normal emotion; however, it is how we deal with it that defines us. When we share our anger, we also have to know with whom we are sharing. What is their level of emotional maturity? A mature person can react to your anger constructively. They may apologize and say something along the lines of “I’m sorry. I didn’t know that that bothered you. I will try to deal with it differently next time.” An emotionally immature person may turn it around, throw the anger back at you, blame you and point out your defects.

      Viktor Frankl says that although you cannot control biology or genetics when it comes to resembling your parents, you can control your behavior.³ Whenever Penny got into a situation that irritated her, she began to feel helpless like a ten-year-old again and her anger welled up. Most times, she became anxious as she tried to control her negative emotions. Sometimes she failed and, in her own words, she became like her father, “the monster.” When all else failed, she used avoidance to stay in control. She took time off from work, didn’t see her boyfriend for long periods of time and retreated to her apartment as she had to her room as a child. Henry David Thoreau said, “Things do not change; we change.”⁴ It took a while for Penny to understand her behavior through therapy and start to change.

      Penny suffered from a major depressive disorder as well as GAD. I was reluctant to prescribe an antianxiety agent because of her history of polysubstance dependency. I took a history of all the psychiatric medications that she had been given through the years. The one that seemed to work the best was an antidepressant that also had a calming effect. For sleep, she occasionally took a sedating antidepressant often used for insomnia.

      I taught Penny behavioral relaxation techniques, including progressive muscle relaxation and deep breathing, which she found helpful. I also encouraged lifestyle changes such as caffeine reduction and good sleep habits. She began to keep a diary, which helped drain off some of her negative energy and angry feelings. I pushed her to broaden her world and reconnect with friends and family. One of the best things that happened was that out of the blue, her old boyfriend called her. He wanted to see her. In therapy, she reported: “When he called, I felt cornered and trapped like I always did with dad. With dad, I used to have to take a (pill) before I saw him. I felt hurt and inadequate. In the past, when Ben called and asked me out, I used to have to drink two margaritas to calm down before I saw him.” I had her make a list of how Ben and her dad were the same and how they were different. Apparently, they both had “anger against the world and were judgmental.” However, with Ben, she admitted that she felt safe around him and “he wasn’t a drunk.”

      “I want it to work this time [with Ben]. I want to work on the things that make me irritable about him,” she said. He often overstayed his welcome and didn’t allow her enough privacy. He wasn’t always attentive to her and liked to go off and talk to other people when they went on vacation together. He was obsessed with politics and would talk passionately at length on the topic. We discussed ways that she could make the relationship better. She came up with the idea that she could set limits on his behavior, change the subject when he went on a rant about politics and tell him what she needed from him. Most of all, she had to keep focused on the fact that although he had some of her father’s behaviors, he was different from her father. I told her to look Ben right in the eye and say to herself, You are not my father. If she felt tense prior to seeing Ben, she promised that she would engage in twenty minutes of relaxation exercises rather than having a drink. When her mind drifted back to childhood, perhaps she could refocus and really enjoy being with Ben in the present.

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