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A New Way of Looking at Anxiety
Since I first began working with anxiety-related problems in 1981, there has been an explosion of knowledge in the causes of and treatments for them. Today there's a flood of books and audio and video cassettes that describe programs for overcoming anxiety-related problems, as well as an increasing number of centers and therapists who specialize in treating them. Amid all this good news there is a sour note that is often not heard: Research has shown that the approaches currently being used to treat anxiety-related problems do work and provide relief, but they often fail as long-term solutions.
A tremendous number of people with anxiety-related problems go to a specialist or work through a self-help program and experience good results. However, after a period of time that can range from a few weeks to many years, the symptoms return. For some, the symptoms return in full force with debilitating anxiety and panic attacks and the redevelopment of avoidance behaviors or rituals. For others, the symptoms return at a level that is lower than originally experienced, or take a somewhat different form,which might include excessive worry or nervousness. It might also include avoidance behavior or nervous rituals that are different from those that accompanied the original onset of severe anxiety.
There are also many people who go through programs or read books and never find the relief they are seeking. Their initial intense symptoms may be greatly reduced, but they continue to experience a significant level of anxiety-related symptoms in spite of treatment. When anxiety symptoms return, or are never fully resolved, the sense of failure, anger, confusion, and depression that occurs can be overwhelming.
This book takes the next step in the evolution of solutions for anxiety and shows you how to move beyond what have been found to be short-term fixes to achieve long-term recovery. As you work your way through the chapters, you'll meet three people who have taken this next step, battled the crippling effects of severe anxiety, and won. Their battle was not an easy one nor was it over quickly. However, all three did eventually achieve long-term recovery. As you read about how they accomplished this, you will learn many new things about yourself, gain many new skills, and develop a new way of looking at anxiety.
One of the central themes of this book is that anxiety is simply a "messenger" that is telling you that you have one or more important life issues to address. Sometimes symptoms develop because a person is overwhelmed by too many things going on at the same time, such as problems with health, money, children, or work. However, anxiety can also be connected with problems in relationships (your ability to connect and be intimate with others) as well as with what are often called "existential" issues (how we answer the questions "What is the meaning of life?" and "How do I find happiness?").
The purpose of this book is to help you understand the message your symptoms are sending you. All too often, it is easy to become so focused on the symptoms of anxiety (the messenger) that youfail to understand the message. Learning to identify the message lifts the feeling of shame and demoralization that develops when you're focused on the elimination of symptoms. It's also the key to achieving what I call long-term recovery.
Once this idea is accepted, the goal shifts from the absence of anxiety to the management of anxiety. This is a more reasonable goal. Once the focus becomes the message (the underlying issues generating the anxiety) rather than the messenger (the symptoms), long-term recovery is possible.
What Is Long-Term Recovery?
Long-term recovery is really the final stage of the process that people recovering from anxiety go through. As people move through this process, they achieve progressively higher levels of recovery. For the sake of simplicity, I've divided these into the following three basic levels:
Level One: Basic Symptom Control
At this stage of recovery a person is focused on controlling symptoms. Indeed, this is always my initial focus with new clients.
When they're experiencing intense symptoms, people simply aren't interested in long-term answers. They want relief and they want it now!
By the end of this stage, however, a person has made much improvement. Anxiety symptoms are greatly reduced with only occasional episodes of intense anxiety or panic, and there is usually the ability to function comfortably in at least half of the everyday situations that were formerly uncomfortable.
A person at the end of this stage also has a good understandingof the mechanisms of anxiety, along with a broad range of coping skills for managing symptoms. While no longer hypervigilant (always on guard, watching for symptoms), this person is still moderately on guard. For many, medication continues to play a major role in symptom management.
Level Two: Advanced Symptom Control
A person in this stage of recovery is gaining greater confidence in his skills due to the absence of most, if not all, avoidance behavior. Intense episodes of anxiety are now infrequent. To at least a moderate degree, he has come to terms with those aspects of his personality that can cause problems and, when present, the genetic predisposition that makes him prone to anxiety. He has gotten to the point where he will not let symptoms interfere with his behavior. He knows how to avoid the anxiety-panic cycle and use his various skills effectively. There is some understanding that symptoms are messengers.
A person at this stage who relied heavily on medication while at level one is now no longer using medication, using it at a reduced level, or reserving its use for situations that are especially anxiety provoking.
Although anxiety is still a fearful thing, there is now more awareness of the issues that trigger anxiety. The focus has shifted, at least in part, away from the symptoms to the causes of anxiety. However, because this understanding is incomplete, periodic flare-ups of moderate to intense symptoms still mysteriously occur. When this happens there is a tendency to move back to level one and again become preoccupied with symptoms and develop avoidance behaviors.
Level Three: Long-Term Recovery
A person at this level perceives anxiety in a completely different way from a person at the first two levels. Anxiety is seen as a natural part of life rather than as something to be avoided. A person at this level can easily identify her core issues and understand clearly and fully the various messages anxiety sends. When anxiety is experienced, she realizes that high levels of anxiety are supposed to occur when real-life issues are present, so she focuses on the issues generating her anxiety rather than on the symptoms. This, in turn, allows her to experience high levels of anxiety without the distress or escalating symptoms she experienced when her anxiety-related problems began. A person at this stage who formerly relied on medication for symptom control finds it is no longer needed.
Before proceeding, take a moment to decide which of the above levels best describes you at the moment. If this is the first book you've read on anxiety, you may still be caught in the initial intense symptoms and have yet to experience any relief. If you've been battling anxiety for years, you've probably read many books, been through one or more programs, or seen several therapists in your quest for recovery. In this case, you may have cycled back and forth between levels one and two. In either case, my goal is to give you the tools and the knowledge you need to achieve long-term recovery.
How to Get the Most out of This Program
This book is designed to be used as a workbook. In order to get the most out of it, you need to read through it slowly; I suggest you spend at least one week on each chapter and do as many of the recommended activities as possible. While it's best to work through the book systematically, some people just can't wait to learn what each chapter contains. If you are one of these, go ahead and read through the entire book to get a general idea of what it covers. Once you've done this, read the book all the way through, slowly.
In order to achieve the long-term recovery described in this chapter, you need more than just a general understanding of ideas. Your goal is to internalize the information and skills presented in each chapter, to make them a natural and automatic part of your behavior. The recommended activities play a key role in this process. The more time and energy you spend on them, the more successful you will be.
Beginning with the next chapter, plan to spend at least one week on each chapter before you move on to the next one. Start by reading the headings to get an overview of the material. Then read the whole chapter at your usual reading rate. It is best to read each chapter at least three times, more if you find the information difficult. The second and third readings will increase your understanding of the material and reveal ideas that were missed during the first reading.
There may be times when you could spend more than one week on a chapter. While it is important to be thorough, it is also important to maintain your momentum. Therefore, spend nomore than two weeks on a chapter, and do as many of the recommended activities as possible. After completing the program, you can spend additional time on those areas where you feel more work is needed.
This may sound like a lot of work; it is. But keep in mind that it took you all your life to develop the behaviors and thinking patterns that produced your condition. It will take you time,...
