Ten Steps to Relieve Anxiety. H. Michael Zal

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СКАЧАТЬ are many things that people can do to help themselves. Educating yourself about anxiety can be a first step in allowing perspective, reducing your feelings of apprehension and helplessness and allowing you to feel more hopeful and more in control of frightening feelings. This book is intended to help you understand stress and anxiety and to familiarize you with the symptoms of GAD and a broad range of possible treatment options. When you find yourself feeling apprehensive, tense and irritable, try the ten self-help techniques in this book that have proven beneficial to a wide variety of people suffering from anxiety. Hopefully, they will help you reduce your own anxiety, relax and enjoy life.

A GAD Case History: Paul’s Story

       “My anxiety is such a gut wrenching, horrible, terrified and scared feeling. It is a feeling of fear—I become a prisoner—scared to make a move—afraid that something bad will happen. I cannot sleep. At one point, I lost weight to the point that I had to drink extra liquid supplements. I feel a constant battle in my head. I get to a point that I just do not care what is wrong or right. I worry that I will never see the light and I will always be in the dark. It brings me to a point that I just want to run and never be found. It took me to such a low feeling that I could not go even one day without tears. I felt like I was in the bowels of hell. I cried unstoppably in the shower. I wound up on my knees just crying and feeling below nothing. I could go on but really didn’t want to. There is so much more.”

      In spite of his gray hair, Paul appeared much younger than his fifty-eight years. He scrunched himself into the curve of the chair, looking timid and vulnerable. He never smiled; instead, he looked scared and apprehensive. Every time I asked him a question that made him feel uncomfortable or he shared a childhood trauma or a negative feeling, he nervously and continuously pulled on the hairs on his arm and rubbed the skin on his forehead. Whenever I felt that we had a particularly good talk where he shared significant material and had an insight, he would get up from his chair and say, “I guess this was a bad session.”

      Paul had obsessive-compulsive overlap symptoms. He needed to double-and triple-check things. For instance, if he didn’t verify that the door of his house was locked when he left, he would become quite anxious. If his wife said that she had locked the door, he doubted it and had to go back and check. He liked things in order. “It gives me a sense of peace,” he said. He sought symmetry. If pictures on the wall were not straight, he had to get up and fix them. He would say, “The purpose of the picture is to be straight.” Paul could also be fidgety, had difficult falling asleep due to “thinking, thinking, thinking” and could become short of breath and hyperventilate when he was “nervous.”

      It took Paul more than ten years to pick up the phone, call a psychiatrist and come for help. He was treated on an outpatient basis for depression for more than twenty-five years by two different psychiatrists. He could become tearful, angry and anxious. He was prescribed various psychiatric medications. On one occasion, he got so upset that he felt he could not function. He was hospitalized at a local psychiatric facility. Six months after his second psychiatrist retired, he called me for an appointment. Initially, he seemed like a GAD client. He had the classic triad of anxiety, worry and avoidance as well as a family history of emotional problems (his mother had a “nervous disorder”). However, he had not told his prior psychiatrists or myself the whole story. It took him many sessions until he shared his secret with me.

      His parents were in their forties when he was born. His sister was fifteen years older and out of the house by the time he was six. Both parents worked, so he was raised by his grandmother. He spoke about never having a childhood and never getting to do anything with his parents. He played ball and hung out but doesn’t have many happy memories of his early days. When Paul was sixteen, his grandmother bled to death accidentally when she tried to cut a bandage off her leg. He vividly described his memory of the paramedics putting her in a rubber bag and his father rolling up the rug that was saturated with blood. “I still hear the zipper in my mind and see her in the bag,” he said.

      His secret took place between the ages of ten and twelve. With much hesitation, he finally related that during this time he had been sexually abused. At first it was by some older kids in his neighborhood, like the eighteen-year-old who seduced him into taking off his clothes because he wanted to see if his new camera worked. When Paul was fourteen, a man in his thirties befriended him and also sexually abused him. Paul still had bad dreams and flashbacks of these incidents and had trouble watching related news on television. “It makes me sick to think about it,” he said. “They stole my childhood. I feel that I have a scarlet letter. I feel subhuman. Even when I go to confession, I do not feel clean. I feel dirty. I didn’t say no. I was scared and wanted to please them. I thought that they would hurt me. It caused me anger and rage. ”

      These experiences left him fearful and timid all his life. He felt that he had to take extra precautions to be safe. He worried constantly and felt like an inadequate failure. He never told anyone about the abuse because he was embarrassed, guilty and shamed, all strong emotions that can be painful.

      In spite of these traumas and the energy he used carrying around his secret for so long, he still graduated from high school and worked for many years at a steel company. He has three children from his first marriage, which lasted ten years, and has been happily married to his second wife for eleven years. Between Paul and his wife, they have eleven grandchildren. Paul still works a few hours each day in a small store, doing paperwork.

       Paul’s Opinion of What Helped His Anxiety

      “Therapy helped me. It made me look at things from a different perspective. I wasn’t always receptive but what you said gradually sunk in and helped me. The medications…were like wonder drugs. They have helped make things better. [They]…took away my negative thoughts and tearfulness. I stopped lying in the bathtub in despair. [They]…took away my edginess and [helped] me relax and not be as jittery. My religion and my spiritual life are very important to me. The Church has been very supportive. I go to Mass every day. I place a lot of faith in God and his always being there for me. No matter what religion you practice, if you pray he will answer you. You will not always get what you want but you will get what you need. Exercise is also helpful. I walk three to four miles a day. I’m constantly running and hiking. Being outdoors takes me out of my state of mind. I feel like I’m free and no longer a prisoner.”

       My Opinion of What Helped Paul’s Anxiety

      In therapy, we dealt with Paul’s feelings of guilt and shame. They initially came to the fore in discussing the situation when he took care of his mother, who had developed Alzheimer’s disease. She was very irritable and uncooperative. He felt upset, because on occasion he lost his patience and yelled at her. He had never spoken to anyone who took care of a relative with Alzheimer’s and did not know how difficult and frustrating that could be. He wasn’t aware that there is no one right way to provide care for an elderly parent and that his negative feelings were not unusual in this stressful situation. He did not realize that you can still love a person although you are angry at his or her behavior. I had him read The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease.¹ This was helpful. He commented, “I missed all the warning signs—the anger, the yelling, that I needed help.”

      His feelings of shame, embarrassment and guilt that he still had about the sexual abuse were more difficult to dissipate. They were intertwined with his sense of identity. Somehow, he believed that these acts had branded him as a homosexual. Even at age fifty-eight, he was fearful that a gay man would try to seduce him, so he felt that he constantly needed to be on guard. In some way, in spite of his heterosexual orientation and lifestyle, he felt that he could still be a sexual victim. He was surprised to learn that those young boys who abused him were not necessarily gay; they were just experimenting sexually and wanted to feel powerful. I also explained to him that being gay had to do with your adult СКАЧАТЬ