Mental Health Counseling Articles by Jacksonville, Florida Mental Health Counselor, Alan Lipzin:
Tools for your Toolbox in Managing Generalized Anxiety Disorder from an Expert, Alan Lipzin, Licensed Mental Health Counselor
Hello, and thank you for taking the time to read this article on managing generalized anxiety. I’d like to tell you about some approaches to the treatment of one of the most frequently diagnosed mental health disorders – GAD or Generalized Anxiety Disorder. GAD is diagnosed in people who have at least 6 months of chronic and severe worrying. The worrying occurs throughout the day and generalizes to most areas of their lives. When left unmanaged, it can become severe enough to significantly interfere with a person’s daily life. Some of the basic symptoms of GAD include excessive nervousness and worry, a feeling of being keyed up or on the edge, increased tension, accelerated heart rate, gastro-intestinal problems, difficulty sleeping, irritability, difficulty concentrating and feeling worn out. Someone with GAD usually realizes that their worrying is excessive and counterproductive but is unable to stop. As you might imagine, other mental health problems can surface along with, or because of GAD. Alcohol/substance abuse may occur in an attempt to medically control symptoms of the anxiety. When GAD is not managed, depressive symptoms frequently occur and take their toll on relationships, work and health concerns.
Without going into much physiological detail here, anxiety is a hard wired response we all have. It is adaptive when it prepares us for action, the so-called “fight or flight response.” This is a response that is a part of what is called the sympathetic branch of the autonomic part of our nervous system. Our bodies go into overdrive to “gear us up” for self protection. This kind of response may help us if we are faced with an imminent physical threat such as an attacker, a fire, or other physical threat. The response can become maladaptive and harmful to us when it becomes activated by the way we worry or fear daily life situations related to non physical threats such as troubled relationships, finance stress, health concerns, and work or school challenges. Chronic and prolonged activation of this response makes us susceptible to medical and health problems as well. We have all heard statements such as “he/she is worrying themselves sick,” and sometimes this is true!
When we worry, our brain perceives danger and prepares our bodies to gear up and be on ready alert. Our ability to cope and problem solve is often impaired in states of high arousal. We are ready to act – not problem solve in these states.
One frequently used treatment for dealing with anxiety management is Cognitive-Behavioral Therapy or CBT. It has proven effectiveness and is often cited as the empirically based best practice for the treatment of anxiety disorders. As an experienced therapist, I do not believe that one particular therapy is the answer for all people with anxiety disorders. My clinical experience has taught me that while people are similar in many respects, we are also unique. Anxiety disorders develop from many different and often complex reasons in individuals. Some primary factors include genetics and a predisposition toward anxiety, our environment or what has occurred to us in our lifetime, and social learning or what was taught to us about life and how we have learned to cope.
I have found many helpful strategies that CBT has to offer and tend to view them as helpful tools in the management of anxiety disorders. Keep in mind that if you have a tool but don’t use it, it is not useful. In therapy, it is important to find useful anxiety treatment tools. In order to become proficient in CBT, a willingness to commit to practice these tools and an investment in time is needed.
Many useful cognitive treatment tools focus on the premise of the A-B-C’s or some variation of them. Here we educate ourselves that anxiety symptoms do not happen in a vacuum. An “A” (Activating event or situation) occurs in our life. A “B” (Thought) happens in response to A, and then a “C” (Consequence or outcome, such as anxiety, anger, or depression) happens. We can’t do much about the “A’s” – life happens – but we can develop cognitive (mental) techniques to change our “B” response, which in turn changes our “C” or outcome.
We can refine this skill by becoming observers of our self talk and how we appraise a given situation. Sometimes this is difficult to determine as these “automatic thoughts” can occur faster then we can consciously decode them. In terms of GAD, these thoughts are often called “cognitive distortions.” We tend to believe them without question and that also increases our anxiety level. A few such distortions include Catastrohizing, What IF’s, and Mind Reading. By becoming aware of these distortions (and yes, we ALL have them), and then challenging, questioning, and replacing them with more accurate, realistic and factual self-statements, we can change the outcome of our emotional responses. An important point in using this tool is that anxiety will not always go away, but it will be less intense than if we allowed our cognitive distortions to operate without challenging them. Also, we can try not to focus so much on the “What ifs” in our head but rather the “What is” that is occurring in the moment. The future has yet to be written!
A useful behavioral tool that complements the cognitive ones is relaxation techniques. The ability to calm our mind and body so that we do not get “stressed out” can help us remain focused and undo the physical effects of anxiety. In fact, such “mindfulness” or relaxation approaches to both anxiety and stress management are proving to have encouraging results in the treatment of many medical conditions. You might have noticed many athletes using visualization and relaxation techniques in their warm up routines; they do this to combat worry and anxiety and to improve their athletic performance. There are many different types of relaxation techniques available such as PMR (progressive muscle relaxation, mindfulness meditation, and autogenic phrases). Relaxation strategies can come into play here to help us learn ways to deactivate or limit the anxious arousal. In fact, the combination of cognitive (thought appraising) and behavioral (relaxation response training) can become a powerful tool in anxiety management. Medication can also play a useful and at times an essential part in the management of anxiety disorders, especially to gain temporary calm control while learning how to use cognitive behavior techniques effectively. Exercise and nutrition are other helpful approaches.
Hopefully, you now have a better understanding of the basic theory of anxiety arousal and some useful strategies that are used in the treatment of anxiety. There are many other components and variations of CBT and other useful treatment approaches that can be effective.
So is your worrying adaptive or mal-adaptive? The next time you find yourself worrying to the point that you feel nervous ,ask yourself “Is worrying about this problem helping me deal with this situation or am I getting more anxious without any plan of action?” In becoming aware of our feelings, by asking the question, and then evaluating the answer, you will have used a simple but powerful CBT tool.
I would be happy to assist you in designing a treatment program that fits your needs.
Alan Lipzin, L.M.H.C.
With more than 20 years of counseling and clinical experience, Alan Lipzin, LMHC is a seasoned Licensed Mental Health Counselor. He brings a vast array of clinical experience and expertise to the D’Arienzo Psychological Group. Alan provides individual psychotherapy, counseling and assistance to people who are facing difficult life situations and psychological problems. Alan Lipzin is an expert in the field of treating generalized anxiety disorder as well as other anxiety disorders.