Ten Steps to Relieve Anxiety. H. Michael Zal
over, no more thinking about it.’ This is harder than it sounds. However, with practice, it works.” I suggested she do the same thing before she entered her home, which she agreed was a good idea.
As I have gotten to know people who are anxious, I have noticed that there are certain themes that continually crop up in our conversations during therapy. Like many anxiety-prone people, Judy was also a perfectionist with high expectations of herself and others. Anything less than 100 percent was seen as failure. This is one reason that she hesitated to delegate some of her father’s care to her sisters, because “They don’t do it right.”
She valued control and predictability. Any loss or threatened loss of control made her feel helpless and subsequently anxious. She had a need for too much control to feel secure and calm. Like other anxious people, she was overly concerned with what “should be.” She felt that there was only one “correct” way to do things. She tended to see things as either black or white. This also made her more prone to anxiety. She would often say, “They should have done it this way.” I would counter by saying “According to whom?” She would laugh because she saw my point. The word “should” reflected her need to do things according to her rule book. These rules allowed her to feel more in control but restricted her flexibility and spontaneity.
During one session, Judy went on and on about her mother. She spoke about how her mother had been hard on her and was big on guilt: “She was the disciplinarian in the family and beat the crap out of me. She was very hard to please. She felt that her increased anxious energy was productive but she felt that mine was non-productive. Mom worked all the time and was not there for me. She had a high-pressure job. Like me, she thrived under the pressure but hated it at the same time. I remember saying to her, ‘This is a new generation, mom. I will never do all you do.’”
At this point, I asked her, “Did you like it when your mom acted that way?”
She answered with a loud and emphatic, “No!”
“Then why do you act that way toward your family members?” I asked. I could see the light bulb go on in her head.
She went on to talk about her sisters: “My twin sisters were born when I was two. When my parents brought the baby girls home from the hospital and I saw them for the first time, they told me that I took a bag of oranges and threw them one at a time at the two of them. I don’t know how mom did it. She had to learn to cook, find a babysitter for my two younger sisters and me in the summer and maintain the house. Mom pushed me off to my grandmother, who died when I was twelve years old. My aunts were there for me, but basically I was alone. My father worked full time and belonged to a lot of organizations. He came home at six and expected dinner on the table. He spent time with us only on the weekends.”
Judy’s Opinion of What Helped Her Anxiety
“My mother dropped dead at sixty-eight years old (burst an artery in her brainstem). Stress kills! That’s when I went to therapy for the first time. The rug had been yanked from beneath me. My rock was gone. Dr. Zal is the third therapist I have had. He does ‘talk therapy.’ Sometimes you just can’t see yourself and need that outside professional opinion to point things out to you. He can zero in on what I call my ‘bad behaviors’ in dealing with anxiety. He is honest and direct. He calls me on my crap, as I call it. We are getting to the root of my anxiety. He is helping me deal with the stress caused by taking care of my dad, who is in a long-term care facility. He is teaching me how to say no! I have trouble saying no to anyone who asks me to do something for them (even people I don’t consider close to me) and it just adds to my stress. I get upset if people don’t like me. He helps me by asking easy questions such as, ‘Do you like everyone?’ I answer, ‘Of course not.’ He adds, ‘Then why does everyone have to like you?’ His query stops me dead in my tracks.
“I used to handle stress by eating poorly, drinking too much coffee, smoking more. It didn’t work. I still felt increased pressure, felt overwhelmed and couldn’t get things done. I had trouble concentrating and making decisions. I worried constantly. I had ‘stress eczema,’ headaches, insomnia and muscle tension and spasms. In therapy, we have discussed better ways to handle stress. I have learned new coping skills. I am exercising more, have decreased my caffeine and take time to sit down and eat right. I do meditation and yoga. If I can’t sleep, I get up and do something constructive until I feel tired again. I try to not define my value in life only through my job. I try to enrich my life outside of work by spending more time with my friends, family and boyfriend. (We have a ‘date night’ now every month, for just the two of us.) I try to do things that I like, even if I have to schedule time for fun. I like politics and writing. In fact, I’m a political junkie. I am trying to stop being ‘superwoman.’ I try to pace myself, organize my time and prioritize important activities. I try to be real about what I can and can’t do. I have decided that I will not do any more overtime at work without being paid for it. I am letting my twin sisters help more with my dad. I am trying to stop worrying about the future so much! I am trying to enjoy today.
“Dr. Zal also gave me several anxiety-decreasing exercises, one of which is called ‘deep breathing.’ When he asked me in the office to take a slow, deep breath, he said, ‘That was it? Not even close.’ As simple as it sounds, it takes practice to do this exercise. I have to be constantly reminded that the push that I feel I receive from my anxiety is often a false assumption. I am so used to doing it the old way. So I practice every day. Every night, when I leave work and before I enter the house, I take time to ‘de-stress.’ Visualization techniques that I use are also helpful. I am soon to join Maum Meditation to further help my relaxation. I have a lot of work to do, but with Dr. Zal’s guidance and some relief from the medication that he prescribed, I’ll get there. I’m calmer, but I still freak out a little. I’m a work in progress but I am getting better.”
My Opinion of What Helped Judy’s Anxiety
Treatment for Judy included many aspects. Some of our goals were to help her relax, reduce her time pressures and allow her to feel better about herself. I educated her about her anxiety and gave her reassurance that she was not crazy. From the beginning, the positive therapeutic relationship between us allowed her to feel more secure and calmer. Initially, I fulfilled her unconscious need for an older therapist who was accepting and whom she felt would not hurt or punish her. Judy grew more tolerant of her anxiety as she understood her genetic propensity and realized that it wasn’t her fault.
As you see above, we sometimes used modified cognitive therapy techniques to test out some of her assumptions, challenge her inaccurate thinking and give her perspective. Laughter helped. I often joked with her, which allowed her to relax. She was taught relaxation techniques including deep breathing and visualization. We discussed lifestyle changes, such as exercise, diet and reducing her caffeine intake. She brought yoga and meditation into the equation.
When Judy came to me, she was taking an antianxiety medication twice a day. I switched her to a different medication, because her original prescription only lasted four hours whereas my prescription lasted about eight hours.
In therapy, Judy mentioned that her mom was hard to please and was big on guilt. She worked all the time and was often not home. Judy grew up feeling that she was “bad” and thought that this behavior had caused her mom’s actions. She felt that any female authority figure and sometimes the world would “beat the shit out of her.” This made her feel fearful, angry and inadequate. She was also an “injustice collector” who always fought for the underdog. However, in spite of her childhood, Judy saw her mom as “her rock” and wanted to please her. She became tearful when I first pointed out this dynamic to her and why her verbally abusive female supervisor at work made her so angry and was such a problem for her. Unconsciously, she hoped that her next interaction with her supervisor would be better and that if she could just do her job more efficiently that it would help the process and finally get her the approval and positive feedback that she craved.
Judy described her father as “the best daddy ever. He was calm. He was not a disciplinarian and was always there for us. He took good care of us.” He also made her feel safe in spite of a mother who “beat the crap out of me.” This helps explain why she was so intense in trying to do