Ten Steps to Relieve Anxiety. H. Michael Zal
over frightening symptoms. I decided to go back to basics and taught Matt to do a breathing exercise to see if that would help his symptoms. I told him to take in a deep breath through his nose and then let it out very slowly through pursed lips. Remember, it is the slow letting out of air that lowers the pulse rate and encourages relaxation. Most likely, Matt hyperventilated when he became anxious. This rapid breathing caused a decrease of carbon dioxide (CO2), which upset the body’s acid balance and caused physical symptoms such as muscle spasms and contractures. The deep breathing exercise helped bring this balance back to normal. The same effect can be gained by having the client breath into a paper bag, thus rebreathing CO2. I hoped that this exercise would allow Matt to consider anxiety as a causative factor in his distress, offer him a new coping skill and help us form a therapeutic alliance.
Matt’s biggest challenge was trying something new, particularly if it was geographically outside of his comfort zone. As with many anxiety-prone people, two of his stumbling blocks were his difficulty with change and his fear of the unknown. Change is difficult for anyone; for nervous people, because they value control and predictability, change is a haunted house filled with dark rooms. Any loss or threatened loss of control like a new job, a move to a new location, meeting new people or even trying new things causes them to feel helpless and subsequently anxious. They catastrophize and anticipate a negative outcome. It is difficult for them to relax and just go with the flow.
Anxious inner voices from the past often act as roadblocks to action for these individuals. When they are planning a trip, they may hear an internal voice saying, “That’s awfully far from home.” The inner voice may stem directly from parents, grandparents, teachers or older siblings who may have been anxious themselves and significantly influenced the clients’ lives. Unfortunately, people who are anxious seem to accept these internal warnings as dictums rather than as a sign of the other person’s own anxiety and fear. I try to help my clients step back from these warnings and consider their own desires and choices. I offer encouragement by saying, “Do you really need all that protection? You do not have to listen to the committee in your head. Think it through yourself and use your own judgment to decide what is right for you.”
Matt faced a double problem: There was a history of anxiety on both sides of his family. He described his mother as intelligent, warm and affectionate but also overbearing, anxious and overprotective. She had multiple health issues and often stayed in bed for a week. “Pills and doctors—she had a fix for everything,” Matt said. His maternal grandmother also got attention by complaining about physical things. His mother was the disciplinarian in his childhood home and often threatened him with a wooden spoon. His father, a draftsman, was “cold and unemotional but also anxious and a worrier.” His father could be sarcastic and had a rule book about what was appropriate. He worried constantly about his father’s reaction. At the beginning of therapy, I always ask clients to describe the people who raised them. Looking back at their descriptions often gives me clues to better understand how they became who they are and how they may see other people. Insight often comes from these connections.
These themes all played out in Matt’s life. Anxiety, particularly about being away from home, had been an issue with him for some time. His dream growing up was to go to New York and become a musician. His mother told him, “Go to college. That’s what I need from you.” She told him to be “the best.” Feeling great pressure, he went to a university in New York to study music technology. He became depressed and anxious and often couldn’t stop crying. Feeling worthless, embarrassed and ashamed, he took a semester off, returned home and worked for a title company. Then he attended college in Philadelphia and majored in multi-media. He wrote music and recorded voiceovers. He still speaks of New York as “the scene of my failure.”
Admitting that he needed to seek praise and approval his whole life, Matt was very sensitive to the remarks of others. “I didn’t think I had done a good job unless someone told me.” He easily felt rejected. He hated going to a private school with religious connections. He talked of how a teacher in seventh grade put him down and how he subsequently became depressed, had stomach problems and wet his bed. “She told us we were bad if we didn’t do things perfectly,” he said. His anxiety and stomach problems increased when he started a “real job” and kept him from doing things. He spoke of how his father and grandmother called him “a fat pig.” Once, in his twenties, he dated someone who went to another church and he contemplated converting. His mother said, “You’re giving up your family?” and made him feel guilty, thus putting an end to his religious exploration.
He started to understand how angry he’d been since childhood. He seldom said anything negative or stood up for himself or his thoughts due to his fear that others would not like or approve of him. By talking about his feelings in therapy, he realized that not everyone might be judgmental like his family. He realized that his childhood world was different from the larger outside world that he now inhabited. Gradually, he started to take risks and verbalize his feelings and desires more often outside of the therapy room. Although scared at first, he soon found that the results were positive and liberating.
Matt carried his insecurities and anxieties into his personal relationships. He was emotionally needy, had trust issues and could easily become jealous. He had had several significant relationships since age nineteen. Most recently, Matt had been dating David for several months, whom he described as intelligent, stable and mature. One of the main problems was that David lived one hundred miles from Matt’s home. At first, David drove and they went out in the Philadelphia area. Gradually, as the relationship became more serious, there was pressure on Matt to visit David. There was also the issue of doing new things together, such as attending the theater, seeing family members and going to social functions. This meant driving on strange roads and to new places, which brought his anxieties to the forefront. He often used stomach pains or other physical complaints to avoid going.
Eventually Matt showed improvement with therapy. As he learned things about himself, he felt a little more confident and started taking more risks. He did better with change and the unknown and began to see how his anxiety and avoidance kept him from reaching his goals. At first, he would not drive alone and only drove to Harrisburg when David came to his house and went with him. Therapists call this using a “phobic partner.” Finally, Matt took the chance and drove himself to Harrisburg, sometimes using side roads to avoid the expressway and turnpike. He slowly drove greater distances and tried more new things, much to David’s pleasure.
Several months into therapy, he decided to see an Akashic healer, who told him about “The Book of Life” (a belief in universal memory and interconnection) and taught him meditation. At first Matt told me about the healer as if I wouldn’t approve. When I said that anything he did to help himself was okay with me and that really his healer and I were both trying to help him feel more in control but in different ways, he relaxed and became less defensive. He had found two people whom he respected and who accepted him unconditionally. He started to gain perspective in his relationship. He realized that David’s need for “alone time” was not a sign of rejection. He started to ask for more responsibility at work and looked for new employment. With great trepidation, he went on several job interviews and obtained a much more significant position.
Matt’s Opinion of What Helped His Anxiety
“With the help of Dr. Zal and spiritual practices, I have learned several methods to lessen my anxieties. The best tool for an acute anxiety attack is the breathing exercise. This alleviates the tightness and numbness in my face and hands (and gets rid of the blotches on my face) pretty quickly. It is hard to think of and practice in the moment of stress. But it works.
“I learned a lot about myself in therapy. I understand that I use health issues to feel more in control and avoid things that I am afraid to do. I also learned that part of my anxiety is created by holding back emotions. I used to use crying to release a lot of physical and mental symptoms (particularly feeling upset or angry). I fought crying for a long time as it is not considered “manly.” It is not always appropriate in all situations, but if alone in a safe place, I say let it out. I have learned that my feelings can also be let out safely just by sharing them with someone I trust. I also try to use what I call ‘The Zal Method’ of dealing with my anxiety. I ask myself what anxiety or feeling is underlying