Anxiety

We all have worries or feel nervous from time to time. But sometimes a high level of anxiety about future problems can itself become a problem. 

Are you:

• anxious in many different situations
• usually anticipating the worst outcomes
• unable to stop worrying
• afraid of situations that you know pose little actual threat
• tense for no reason you can identify
• unusually irritable 
• losing sleep

These are some of the symptoms of an anxiety problem.

Anxiety — the fear of possible future danger — is actually part of a healthy human survival mechanism. When it’s working well, anxiety helps us stay aware of potential hazards and makes us do something about them. But when anxiety becomes intense, or pervasive, it can overwhelm us and become a major problem all on its own.

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults. The good news is that multiple studies have found Cognitive-Behavioral Therapy to be remarkably effective in lowering both general and situation-specific anxiety.

Cognitive-Behavioral Therapy, or CBT, gives us practical skills that get right to the heart of anxiety. We’ll reduce your symptoms by taking active steps that you can learn and apply in your daily life. We’ll give you new tools for reducing your anxiety when you choose, so that you can deal effectively with concerns about the future without unnecessary suffering. We’ll work in ways that make sense to you, without confusing jargon or unclear goals.

Here’s the basic idea:

Three central elements of human experience are thoughts, feelings and behavior. You don’t need me to tell you that excessive anxiety is a painful feeling, and it’s not hard to notice that when we’re hurting, our thoughts and behaviors change too (for example, ruminating on the worst possible outcome or avoiding uncomfortable situations).

CBT helps us recognize that if you change any one of those three elements, the other two will respond in kind. So we’ll find ways in which you can consciously behave differently and think differently about your life situations, and put these changes into action, because they help reduce the anxiety.

In CBT work, we want you to have the most effective tools accessible whenever you need them. So we’ll go over the techniques in session, and have you concentrate on taking these skills into your life. Then in the next session, we look at which techniques worked best for you, and how to make them part of your regular routine.

As you practice these skills and notice that they work, they become easier — and your ability to reduce anxiety improves.

How do I know whether I need a therapist’s help for anxiety?

I always go with: “It’s only a problem if it’s a problem.” Only you can determine whether the level of anxiety you’re experiencing is acceptable, but you might start by asking yourself these questions when you’re feeling anxiety:

1) Am I anxious for a reason that I can identify?

2) Is the amount of anxiety that I’m feeling proportional to what I’m actually concerned about?

If the answer to either question above is No, then you might find it helpful to do some focused therapy work on anxiety.

If all I’m doing is talking about my anxieties and worries in therapy, doesn’t that just make them worse?

Not if we’re actively working on both the content (the situations that give you anxiety) and the process (how your nervous system responds when it feels a potential threat). In CBT work, you actually get better at tolerating the things you’re fearing by building practical skills, so you’re reducing the discomfort you feel.

Isn’t therapy all about focusing on the past? Is that what helps people with anxiety?

Understanding where a problem came from is often enlightening, but that’s not the same thing as positive change. We might gain some insight into experiences or patterns that led to your anxiety, but we want to prioritize actually reducing it. We’ll identify what’s proven to help you feel better, so that you can experience improvements now and make sure that they endure.

What about medication? People have been telling me that I should take anti-anxiety meds.

We can talk about it. I can’t prescribe medication, but we can discuss whether it might make sense for you to consult with a doctor about a possible prescription. As with any type of treatment, there would be both upsides and downsides to anti-anxiety meds. It’ll be your decision whether you want to explore a medication strategy. Before that, though, we’ll work on tools that lower anxiety in the body and the mind. 

How long does this process take? I don’t want to be in therapy forever.

Right — we want you managing anxiety effectively as soon as possible. I can’t give you an exact prediction, but I can tell you that CBT treatments for anxiety consisting of 8 to 16 weekly one-hour sessions have been shown to be successful in clinical trials for most people. Let’s get you feeling better and skilled at reducing anxiety as efficiently as we can.

I’ve been using Cognitive-Behavioral Therapy for 15 years to achieve positive results for many clients, and I’ve been teaching these techniques to student and early-career therapists. Together, we can help you feel better now, without spending years doing therapy.

Paul Silverman, MFT LPCC

Email me: paul@sfcounseling.net
Call: 415/820-1590

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