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What is Anxiety?

 

Anxiety is a normal, universal part of human life that we all experience to one degree or another. Its evolutionary function for human beings - uncomfortable as it may be - is to keep us safe and alert, and to motivate us towards action. In other words, anxiety is not inherently a bad thing. At the same time, it is commonly the case that anxiety can be intense enough that it negatively impacts our life and functioning, rather than helping it. Anxiety is highly treatable and workable, and there are many ways that we can approach it from an integrative lens.

 

 

What are Anxiety Disorders?

 

There are various standard symptoms of what we may call “generalized” anxiety. In addition to generalized anxiety, anxiety symptoms can manifest with qualities and traits that can be mapped into distinct categories of anxiety. These categories are most commonly known as “anxiety disorders”.

 

Rather than viewing individuals as having anxiety disorders that represents their whole psychology, I strongly concur with the Internal Family Systems model of understanding anxiety disorders, which is that parts of us carry various symptoms. In addition to being a more accurate understanding of anxiety disorders, as well as a more compassionate one, it leads us to accessing what IFS calls "Self", which is the most important factor we need in healing the parts of us that need attention.   

How do I treat anxiety disorders?

The integrative view of working with anxiety disorders includes any modality that is effective for healing anxiety. As always, there are a wide variety of effective treatment approaches, and a lot to choose from.  Therefore, we must find the approach that best suits your needs and your inner system. Below I will briefly list some - but not all - of the ways of working with anxiety disorders.

Generalized Anxiety Disorder (GAD)

 

Biological: Optimization of our biochemistry (sleep, diet, medication, supplements, exercise, etc.)

 

Cognitive-Behavioral Therapy (CBT): Examine the thoughts that are contributing to anxiety; reality-test them; correct unrealistic thinking; practice and master new skills using CBT workbooks.

 

Behavioral: Morita Therapy: deeply understand Morita philosophy; shift from feeling-centered life to action-centered life; focus on taking constructive action regardless of symptoms of anxiety; establish confidence that anxiety does not ultimately control behavior.

Dialectical Behavior Therapy (DBT): Learn mindfulness techniques to desensitize fear of anxiety, as well as emotional regulation skills to help transform anxiety, or overwhelming emotions, on-the-spot.

 

Internal Family Systems (IFS): Familiarize ourselves with our "parts system" and understand dynamics leading to anxiety symptoms; access Self or Self-energy and its healing resources; unburden parts through new relationship with Self, and other parts.

 

Trauma: Utilizing Somatic Experiencing and Sensorimotor Psychotherapy: assess for underlying trauma in nervous system that is is the root cause of anxiety; establish resources for working with trauma; wisely discover and complete adaptive defensive responses that were thwarted at time of trauma (fight, flight, freeze). 

 

Meaning-Making: Uncover current belief system about self, world, and other as the philosophical, existential, and spirtual context in which anxiety symptoms are taking place; examine how these beliefs shape or relate to experience of anxiety.  

Social Anxiety Disorder:

Biological: Optimization of our biochemistry (sleep, diet, medication, supplements, exercise, etc.)

Cognitive-Behavioral Therapy (CBT): Examine the thoughts that are contributing to social anxiety; reality-test them; correct unrealistic thinking; practice and master new skills using CBT workbooks.

Behavioral: integrate Morita philosophy into life; shift from feeling-centered life (i.e. I must feel a certain way to engage socially) to action-centered life (feeling social anxiety and doing it anyway); establish confidence that social anxiety does not ultimately control social behavior

 

Dialectical Behavior Therapy (DBT): Learn mindfulness techniques to desensitize fear of social anxiety, as well as emotional regulation skills to help transform anxiety, or overwhelming emotions, on-the-spot.

Internal Family Systems (IFS): Familiarize ourselves, and verify the reality of "parts" and "Self". This recognition of the inherent multiplicity of the mind opens up to experience and accessing Self, and its healing resources (the 8 C's of Self); learning how to relate to our parts from Self in order to heal and unburden parts; focus attention on the parts that are involved in social anxiety, including "critic" parts, "protector" parts, "exiles", which are parts of us that carry wounds. These wounds include relational wounds, such as those related to rejection, abandonment, shame, and self-value.  

Relational: Authentic Relating and Acquiring Secure Attachment: Establish safety with therapist, express yourself authentically, exactly as are, and receive acceptance while feeling anxiety; assimilate new and  corrective experiences; naturally develop self-acceptance; realize the safety of being with safe and loving people. 

Trauma: Utilizing Somatic Experiencing and Sensorimotor Psychotherapy: assess for underlying trauma (in-utero, post-natal, attachment, developmental, incidental, etc.) in nervous system that is the root cause of anxiety; establish resources for working with trauma; wisely discover and complete adaptive defensive responses that were thwarted at time of trauma (fight, flight, freeze, submit). 

Meaning-Making: Uncover current belief system about self, world, and other as the philsophical, existential, and spiritual context in which anxiety symptoms are taking place; examine how these beliefs share or relate to experience of anxiety.  

Obsessive-Compulsive Disorder:

Biological: Optimization of our biochemistry (sleep, diet, medication, supplements, exercise, etc.)

Mindfulness-Based Cognitive Therapy: Understand and utilize mindfulness to work with obsessive-compulsive thoughts thoughts, feelings, sensations, and other associated symptoms. This approach slows down our habitual psychological and behavioral processes, so that we can observe, and consequently go beyond, our reactive conditioning. When we allow ourselves to be curious about our experience, and get a knack for feeling feelings, we develop a certain kind of security and trust that obsessive-compulsive behavior seeks to achieve.

Neurological: Individuals who do not meet the diagnosis for OCD have the exact same kinds of intrusive thoughts as individuals who experience intrusive thoughts who do meet the diagnosis for OCD. However, the difference between these two groups is that someone in the OCD group gets "stuck" in a certain "gear" in the brain when intrusive thoughts occur, whereas those in the non-OCD group have those same intrusive thoughts, but can shift more fluidly out of them when they occur.

 

Through this lens, obsessive thoughts as a phenomenon of the brain, rather than being personally related to the individual. Therefore, when intrusive thoughts occur, this approach encourages individuals to attribute their symptoms to the brain, instead of taking personal responsibility for it. When intrusive thoughts arise, it is recommended that the individual re-frame their experience as a brain phenomenon, shed themselves of personal responsibility (i.e. "It's not me - it's my OCD), and then take positive and pleasurable action. This process rewires the neuronal connections in the brain to form a new pattern.       

Internal Family Systems (IFS): Normalizes obsessive-compulsive traits as coming from parts, in what is, in fact, an intelligent protective response which mobilizes in order protect other parts and the Self. It is also important to note that Self, and other parts in our inner system, do not have Obsessive-Compulsive traits. In order to transform into less extreme protective roles, the parts in our inner system that organized around obsessive-compulsive behaviors must feel that it is safe to do so. Even though these parts create suffering, their role is to prevent our system from feeling a different kind of suffering.  

 

Safety is created by accessing the resources of Self, and then developing both Self-to-part, and part-to-part relationships. Self naturally wants to understand and extend compassion to parts, which helps them relax.   

 

Trauma: Utilizing Somatic Experiencing and Sensorimotor Psychotherapy: assess for underlying trauma (in-utero, post-natal, attachment, developmental, incidental, etc.) in nervous system that contributes towards the mobilization of parts of us with obsessive-compulsive behaviors; establish resources for working with trauma; wisely discover and complete adaptive defensive responses that were thwarted at time of trauma (fight, flight, freeze, submit). 

Meaning-Making: Uncover current belief system about self, world, and other as the philosophical, existential, and spiritual context in which anxiety symptoms are taking place; examine how these beliefs share or relate to experience of anxiety.  

Eating Disorders

 

Biological: Optimization of our biochemistry, including medication, if beneficial. Collaborate with doctors and nutritionists, if necessary.

Internal Family Systems (IFS): Normalizes and understands binging and purging behaviors as coming from parts, or subpersonalities, rather than being a condition of our whole self. These parts - called "firefighters" in IFS - are ultimately trying to protect the inner system, and doing so with good intentions, even though binging and purging cause considerable suffering. We attempt to verify the good intentions of these parts, which opens up Self-energy (compassionate, non-judgmental understanding). This helps us gain the trust of parts to reveal more about themselves. In this process, we must understand what the firefighter parts are protecting (i.e. exiles, Self), and see what they need in order to let go of their extreme behaviors.          

Attachment (relational): Look at attachment history with family of origin or caretakers; understand how attachment and dynamics of family system or caretaking system may be related to parts of us with eating disorders. Move towards attachment repair through Self (IFS) as well as the therapeutic relationship.

 

Trauma: Utilizing Somatic Experiencing and Sensorimotor Psychotherapy: assess for underlying trauma (in-utero, post-natal, attachment, developmental, incidental, etc.) in nervous system that contributes towards the mobilization of binging and purging parts; establish resources for working with trauma; wisely discover and complete adaptive defensive responses that were thwarted at time of trauma (fight, flight, freeze, submit).