Ten Steps to Relieve Anxiety. H. Michael Zal
laugh with the kids.” I suggested to him that perhaps this was the one place that he allowed himself to lighten up, be juvenile and compensate for his lost childhood. I tried to get across to him that he could give himself permission to relax and enjoy life like he did in the theme park in other situations as well. At first, he complained that doing more would be out of his comfort zone and bring him into the unknown, which he found scary. However, he then came up with the phrase “experiment with life” and seemed more comfortable and less threatened by this way of describing his dilemma. He agreed that he would try to experiment more and his wife later said that he was doing so.
Medication helped Paul. He was most recently on an antidepressant. Perspective has helped. Education has helped. Exercising and a religious connection have helped. In an effort to have him share his story of abuse with someone other than myself, I asked him to speak with his priest and see what response he got. He agreed to do this. I hoped that the priest would further reduce Paul’s feelings of guilt, anxiety and shame.
Paul’s vignette illustrates some of the pain anxious people experience. It also highlights various treatment modalities. Next, we’ll look at steps to take and stories of several other special yet representative people as they share the anxiety in their lives with you. I will suggest possible solutions that they and I have used to relieve their anxiety, help them refocus, relax and enjoy life.
Stop the world and the anxiety process for a moment. Give yourself time to recoup. Slow down and gain perspective. There is no danger. You don’t have to race so fast. Perhaps you are putting yourself under time pressure. Give yourself permission to relax. Don’t let the symptoms of anxiety control you. You can take charge of them.
People who are anxious move too fast physically and mentally. They always seem to be busy. Some experience physical symptoms such as heart palpitations and shortness of breath. Sometimes they are not even aware that they are feeling anxious and just feel pressured, tense and irritable. They may act restless and fidget if sitting too long. Often they feel compelled to do things like they were a wound-up clock. Overly perfectionist, they have a determination to get it right and have an exaggerated sense of what they and you “should be doing” and the specific way that tasks “should be done.” They have to do them all on their own, in their own way, and often do not like how others complete a task, yet they complain that they have to do everything themselves. They often have a strong need to please others and therefore have trouble saying no. This puts them under further time pressure and increases their tension. They have difficulty unwinding and relaxing when they should be relaxing. Their to-do list grows longer and longer. By the end of the day they are tired, wiped out and unable to sleep. These behaviors make them more prone to burnout. Judy, one of my clients, has these problems.
Judy’s Story
“My anxiety is my best friend. I guess my anxiety has been with me so long I became inexplicably comfortable with it. I was described as a ‘hyper’ child (although I did well in school), who never wanted to sleep. I think I must have thought that if I relaxed I would lose my energy level. My mother was the same way. She would clean, clean, clean and work, work, work. At one point, I was working full time, dating and going to graduate school. I had so many people I didn’t want to disappoint. I was under stress and the anxiety returned big time. My coworkers described me as a ‘hyper nut.’ (In a good way!) I think that my anxiety worked for me. I could pull all-nighters and study and then go to work the next day. The anxiety or the ‘hyper personality’ became part of me. I lived with it, accepting that ‘this is me.’ I seemed to thrive on pressure but hated it at the same time. Although I did very well, I couldn’t calm down when I wanted to. There were ebbs and flows; some years were worse than others. I am my mother’s daughter.”
Judy bounded into the office and onto a chair. She was forty-three years old. She carried a large red purse that caused her to be somewhat off balance. She talked with her whole body and threw herself into different positions like a rag doll. Judy complained of anxiety, palpitations, sweating, tension headaches, shortness of breath and feeling hot or cold. “Everything is overkill with me. I’m over the top,” she said. Indeed, she did not seem to relax for a minute. My first thought was, Where do I start with this lady?
During the opening session, I took a psychiatric and medical history (a habit I always practice), asked Judy about her family, her education and her job history. I did a mental status examination which confirmed my initial impression that she was suffering from generalized anxiety disorder (GAD). At the end of the hour I said to her, “Judy, I had a job to do today. I had to make a diagnosis and formulate a treatment plan. Now, I have to ask you two things. Did you feel comfortable talking to me today? Did everything that I said to you seem to be relevant to you as a person or did you feel that I was trying to put you into a square hole in which you did not belong?” She answered that she had felt comfortable and that she felt that everything that I had said to her was about her and resonated with her. I stood up, smiled and shook her hand. “Then we have made a start.”
Judy was not wrong in her assumption that she had inherited her anxiety from her mother. Research studies on twins have long hinted that anxiety-related personality traits such as worry, harm avoidance, tension, fear of uncertainty, fatigability and pessimism are 40 to 60 percent inherited. Human genetic studies have proven this premise to be true.1 In 1996, Science Magazine reported evidence of a gene (the functional unit of inheritance) linked to individuals prone to these anxiety traits.2 According to Gregor Mendel’s genetic model of inheritance, two alternative forms of a gene, which carry a delivery system for the brain chemical serotonin, influence human “neuroticism” (anxiety and associated traits). One form results in more protein, more serotonin uptake and more neurotic behavior. The second form results in less protein, less serotonin uptake and fewer neurotic symptoms. An offspring exhibits one or the other of the genes but not a mixture of the two.3
It soon became apparent that Judy definitely also had issues concerning time pressure that added to her tension and stress. She told me that her father was in a long-term care facility and frequently needed to be hospitalized due to falls. In spite of having two sisters, she was the designated caregiver and took care of most of his needs. Her son had dropped out of college, lived at home and was not working. Her live-in boyfriend, although she said that he was emotionally supportive, didn’t seem to do much around the house and was not always there physically or emotionally. She demanded an intense level of performance from herself, at work and everywhere else. These demands meant that she had no time for herself to unwind and relax. She constantly had too much to do and too little control over the time and manner in which things were done. This was aggravated by her inability to establish boundaries between her work and personal life.
Many times during our sessions, I said to myself, I wish that I could just get Judy to learn to relax for a moment. I tried to teach her a breathing exercise to slow her down and allow her to calm down. I illustrated the exercise myself. I took in a deep breath through my nose and let it out very slowly. I placed my hands flat on the top of my chest and moved them down slowly as I exhaled through pursed lips. This took me about fifteen seconds. I asked Judy to try it. She did it in two seconds flat as if she was blowing out birthday candles. I said, “Try it again and do it more slowly.” By the fourth try, she had it up to eight seconds.
Judy often complained of feeling that she was going from one pressure cooker at work into another pressure cooker at home. I asked her to pause for a moment and allow her rational brain to seek a solution rather than responding with anxiety and irritability while under stress. I suggested that she try to think of a way that she could unwind and reduce her tension between the time that she left work and returned home. She answered, “Another therapist