I wanted to write this piece to provide some insight into one possible way a therapist starts treating anxiety. I only included the initial assessment and thought process going into the first few sessions because anxiety treatment is dependent on each person and the responses to the initial assessment, I wouldn’t want to provide a full treatment plan as it varies so much.
Where to Begin:
I have found people, in general, cannot separate themselves from whatever ailment they are suffering from. Consider the following, very common statements people use when describing their conditions: “I am diabetic”, “I am always anxious” or “I am Bipolar.” This is where I start anxiety treatment for most of my new clients. Identify if this pattern exists and help them to break free.
For people with anxiety, this is actually more of an internal dialogue and identification to the effect of “I don’t know what it would be like if I wasn’t anxious” or “I can’t get rid of this anxiety.” Both of these indicate a deep-seeded belief and internalization of anxiety that one can truly not separate anxiety from who they are as a person. Essentially leading to the unspoken belief of “I am my anxiety.” This is one of the more significant barriers to treatment, and yet one of the easier ones to overcome. If one cannot separate themselves from their infliction and believes it is who they are at their core, then treatment is essentially trying to change who you are, or more accurately, who you think you are. I don’t think therapy is about changing who you are, but making you the version of yourself that you were meant to be. Therefore, the goal of anxiety treatment is not to completely remove anxiety from your life, but to help manage it to how your body intended to work.
My belief is that you are not your disease, ailment, infliction etc… but that most people, at their core, are just the opposite. Diseases are inherently destructive that follow a simple path of destruction without regret, guilt, and are devoid of any feeling or thought process. Based on this idea, it would be quite difficult to say you are a disease. To this end, by saying “I am always anxious” or “I am diabetic,” you are essentially saying “I am a disease.” Most people would never outwardly refer to themselves as a disease, yet this is essentially the effect these statements have internally. Even if your thoughts and feelings are always negative and do lead to destruction, their purpose was most likely just the opposite. Most people who experience anxiety, depression, or psychosis are trying to save themselves and protect themselves from the bad things in life. However, they are misguided in how they do that. Specifically, with anxiety, its sole purpose is to protect you from harm, not create it. Thus, you are not your disease as your goal is to protect yourself from harm, not create it. If you are struggling with this concept, as most people do, then my suggestion is to work toward that first and foremost, whether you are in therapy or not.
That being said, how does this relate to which anxiety treatment and what you are experiencing? If you can’t separate yourself from your anxiety then it will be very difficult to have the introspection needed to identify your triggers. The secondary benefit of this, which is as important as the primary one of increased insight, is the immediate relief and increase in self-esteem. When people start to concede to and eventually come to this conclusion, there is can be a realization of inherent goodness at ones core as they separate themselves from that which ails them. Regardless of the diagnosis, I feel it is highly beneficial to understand and start to believe this concept.
The key to identifying the type or types of anxiety you are experiencing is figuring out what triggers your anxiety. Again, this is much easier when you can separate yourself from your anxiety. Unfortunately, sometimes there are multiple forms of anxiety that are present at the same time, which makes separation and identifying the anxiety a bigger challenge. With a thorough evaluation, a therapist can make an accurate preliminary diagnosis to develop an initial treatment plan.
The next step in how I treat anxiety is a thorough assessment of what each person’s anxiety looks like and what are the specific triggers to their anxiety. Although there are many similarities across those with anxiety, there are individual differences that are necessary to identify in deciding which type of anxiety is present, which leads to an effective treatment strategy. For instance, someone with excessive general worries might be confused for having an obsessive compulsive disorder rather than generalized anxiety disorder. As such, exposure therapy might be chosen as the treatment strategy. However, I have found this can be less effective for generalized worry, and prolongs the treatment. This is why it is necessary to complete a thorough evaluation to determine what specific disorder(s) is causing the excessive worry, which could be generalized anxiety, specific phobias, obsessions and compulsions, an atypical anxiety, panic disorder, agoraphobia or even anxiety that is caused by a medical condition. Excessive worry is a sign or symptom of all these areas of anxiety. I have helped a number of people who sought out my services as an anxiety specialist who were stuck in their treatment and not progressing like they knew they should. They often found great relief when I offered a diagnosis, explanation of symptoms and treatment strategy that was different than others had explained and resonated much more with how they felt about their experience.
Here are the basic questions I ask that help to form a diagnosis and anxiety treatment plan.
- In what situations or circumstances do you find your anxiety is the most intense?
- What is the worst your anxiety gets?
- What specific thoughts do you have while you are anxious?
- What does your body do when you get anxious?
- Do you avoid anything as a result of your anxiety?
- Are there any situations or places when you are not anxious?
- What helps your anxiety? How long does it take for your anxiety to reduce?
With these questions and subsequent follow-up questions, I can usually develop a strong preliminary diagnosis. Preliminary because diagnoses can often change depending on new information or changes in the individual. Also, it is very important to understand what a diagnosis really is. In my opinion, it is simply a term that helps to guide treatment protocols. It is a cluster of symptoms and behaviors that tells you and your treatment providers what is going on. It is not meant to label you, judge you, or demean you. I don’t believe in giving any power to a diagnosis to affect your self-esteem, self-concept or any area of your life. Its only purpose is to inform and to empower you to find the help you deserve.
Once I have developed a solid understanding of your process, I then begin to develop a treatment plan, which is shared with you for agreement and consensus. It is very important that the therapist and the client have a similar understanding of the problem and agree on a possible plan of action..Until that consensus, or some assent to treatment occurs, treatment can be slow and stale, leading to drop out. A key point to remember on your search, whether self guided or with assistance from a trained professional, is why are you seeking help.
Instead of asking for help for a vague “I don’t want to be anxious anymore” or seeking a perfect diagnosis, it would help to have a better understanding of what you want or need. I think a good question to start is “I am experiencing anxiety, how do I manage it better” or “What kind of anxiety am I experiencing and how do I deal with it?” Both of these questions imply an inherent separation of symptoms and self, and more importantly, hope for relief. You can use these strategies and questions to guide your own treatment through anxiety. Try to use the answers to these questions to find help through online resources and self-help books. However, if you feel anxiety has taken control over your life, then please reach out for help from someone who knows how to accurately assess, treat and differentiate between all types of anxiety.
Dr. Greg Schwarz, Psy.D is a licensed psychologist and Co-owner of Burbank Therapeutic Centers, A psychological corporation. Dr. Schwarz has been working in the mental health field for more than 20 years. Currently providing individual therapy in Burbank, CA, he specializes in anxiety disorders, panic attacks, OCD and working with older adults. He founded BTC on the principle that therapy should be individualized and specific to the person seeking help. Each therapist at BTC only treats a limited number of problem areas, those they have particular interest in, so that we can individualize the therapy to each person.