Anxiety makes mountains out of molehills, and monsters out of moles!
Thanks to evolutionary psychology, we know these days that anxiety is a survival mechanism we’ve inherited from our ancestors.
Of course, in prehistoric times, humans had good reason to feel anxious – they were faced daily with physical threats!
The modern world isn’t quite as dangerous, yet in many ways we do live in anxious times. It’s not so much physical threats that face us, but potential threats presented in news and other media.
How the modern world turned a survival response into a psychiatric disorder
Once upon a time anxiety was critical for keeping us alive, but in today’s less life-threatening world, it piggybacks on the kind of chronic, low-level threats that leave many in a state of constant anxiety.
Right or wrong, the psychological industry has packaged this up under the term ‘generalized anxiety disorder‘ (GAD).
People with GAD feel continually tense and anxious over things that wouldn’t normally bother a person to that extent (1).
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Feeling like this day after day can quickly suck the sense of meaning from life. Every day feels like a struggle to survive, and life becomes an exercise in endurance rather than enjoyment.
Take Kay for example. You can see my session with Kay by signing up to Uncommon Practitioners TV (if you’re not a member).
“My brain is constantly on high alert!” (But knowing it doesn’t help)
When Kay came to see me, she was suffering from general anxiety, and it was making her life so much harder than it needed to be. She told me that even coming to see me that day had caused her a great deal of anxiety.
But here’s the thing. Cognitively, Kay knew there was little to worry about – yet knowing that didn’t help. She didn’t have low self-esteem, or feel she was a bad person. Kay understood her fears and worries weren’t rational, but understanding that hadn’t been any use in overcoming the GAD that had been blighting her life.
As a therapist, treating GAD can feel daunting.
After all, when a client has a simple phobia or Post-Traumatic Stress Disorder (both of which can precipitate GAD), it’s clear what needs to be done.
But in Kay’s case there was no one event, no major trauma or life-squeezing phobia – just a horrible, never-ending sense of dread and worry.
Let me share with you some simple steps that I find useful when helping people with GAD:
Step 1: Find the pattern
It’s easy to assume there isn’t a pattern to a client’s GAD. After all, they do call it generalized anxiety disorder. But trust me, there is a pattern, and you can find it.
As I worked with Kay, we discovered that anxiety over her job was leaking out into many other areas of her life. With time, it became clear that she would feel especially anxious when she had to be responsible for planning an event, such as a holiday.
So if you ask me, the term ‘generalized anxiety disorder’ is too… general.
But perhaps there is something even more fundamental we can do to understand a client’s GAD.
Step 2: Find the missing needs
While I don’t doubt that some people naturally experience fear more readily than others, I think it’s important not to pass off a client’s GAD as some sort of genetically predetermined disease.
Instead, we should interpret GAD as a signal that one or more, or perhaps even many, of the client’s primal emotional needs remain unmet. Or that some past emotional conditioning is still active. It might even be a combination of both.
Of course, having GAD can in turn prevent the completion of needs, just as being weakened by the desperate need to eat can prevent us searching for food.
Just to recap, our primal emotional needs consist of:
- The need to give and receive attention
- The need to heed the mind/body connection (some psychotropic meds may block this need if they have damaging side effects)
- The need for purpose, goals, and meaning
- The need to be part of a community and make a contribution
- The need for challenge and creativity – to be stretched, not stressed
- The need for intimacy
- The need for a sense of control and autonomy
- The need for status
- The need to feel safe and secure (which is missing, of course, when GAD is present).
Missing needs create a signal in the form of a ‘symptom’. For example, missing the need for physical hydration creates the ‘symptom’ of thirst.
Once the client starts to get what they need from life, often the signalling symptom will disappear. So it’s important to find out which needs may be missing and also how the ‘symptom’ of GAD may be further interfering with the completion of those needs.
But we also need to look at how and why GAD may have developed – not just to provide our clients with insight, but to actually help decondition any harmful learnings from the past.
Step 3: Find the origins of the emotional conditioning
Kay told me all about her mother, who died when Kay was in her late teens. She told me how her mum, despite always having Kay’s best interests at heart, was very rigid in her outlook, chock full of ‘shoulds’ and ‘musts’ – a ‘my way is the only way’ attitude. I asked her to tell me about some specific instances.
Kay told me about a time her mother had made her apologise to a neighbour when Kay was very young, over having simply taken a flower from her garden.
What struck me was not the fact that Kay’s mother made her do this, but the way she made her do it.
Kay’s mother had been cold and austere and made her feel as if she had let herself down as a human being, such was the level of disapproval, rather than just being a young, innocent girl delighting in nature.
To quote one of the subtitles from the video of the session:
“The trouble with too many rules as a child is that it can then be hard to live in a more ambiguous reality. Much of adult life doesn’t have ‘rules’ or at least not so sharply defined. Therefore Kay makes her own rules and then worries that details are left unaccounted for when planning or having things to do.”
Kay also told me how her mother had always insisted things should be “just right”. She had always insisted Marks and Spencer, the shopping retailers, “should have changing rooms”.
I played with this phraseology during trancework with Kay, using the double entendre to suggest that, indeed, there “should be room to change”. The change I was referring to, of course, was change within Kay.
So we can begin to help undo the effects of past emotional conditioning, which may in part be fuelling GAD.
Sometimes, this alone is enough to help someone overcome generalized anxiety. But it’s also important to discover what does work in the client’s life, for therein lies the key to a whole host of possible solutions.
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Step 4: Find the exception times
Sometimes by asking a client when the anxiety is worse, we can not only find strategies for them to deal with these times, but also, in a roundabout way, uncover resourceful exception times – times in which anxiety is minimal or even non-existent.
So if I tell you my anxiety is terrible on Mondays, then for sure you should ask me what’s so bad about Mondays – but also ask me what’s better about Tuesdays.
For Kay, the one time she felt she could relax was at the end of a yoga class, during yoga nidra. So of course I used this, by evoking it hypnotically when helping to relax Kay deeply later in the session. Why reinvent the wheel?
But more generally, I discovered that Kay had felt more free and alive, more relaxed and happy, when she went away to university as a young adult and was away from her mother’s influence for the very first time.
By finding when the problem doesn’t happen, or even whole periods of life in which it was much better, we are discovering that somewhere deep down the client already knows how not to have the difficulty. And we are in a position to identify which needs were being met then that perhaps aren’t being met so much now.
But we also need to work on worries directly.
Step 5: Find ways to minimize worry
One commonly reported symptom of GAD is worry about stuff that shouldn’t really be worrying at all.
This happens because when you have strong feelings of anxiety, your mind will seek ways to try to justify that emotion. The body responds to imagined stressors almost exactly the same way as it does to real stressors.
But it needs some kind of subject for that stress. It’s as if your mind has to make a container for the feelings; something tangible to worry about.
What all this means is that free-floating stress can lead our brain into imagining stuff to feel stressed about. And those imaginings (did I switch the gas cooker off?!) can, in turn make us more stressed. There are three steps to treating worry:
- Discover what actually does worry the client.
- Help the client begin to detach from the worry by practising relaxing while thinking the worrying thought (this is an unusual but highly effective therapeutic approach). In this way, we deal with the feeling of the worry so that the thought can more easily change.
- Examine thinking styles that may be making your client prone to worry and encourage awareness of these cognitive biases so your client can more easily inhabit their ‘observing self‘ in future.
The last step is crucial, and in a sense needs to flavour all the other steps too.
Step 6: Relax your client deeply
It never ceases to amaze me when anxiety clients, such as Kay, come to me and tell me they had previous therapy but were never encouraged to experience deep relaxation as part of that therapy.
That’s like going to a watering hole in a desert and not being offered a cup of cool water. Or not being given the means to find your own in the future.
We can show our clients they can relax deeply within the session and use those moments to communicate with their unconscious mind. We can also teach our clients to self-hypnotize in order to relax deeply outside of their therapy time with us. This helps them bring down their general stress levels.
The antidote to anxiety is not insight or analysis or trying to forcibly think differently in the hope of feeling differently. The antidote, when we get down to it, is relaxation. If you know hypnosis or mindfulness techniques, use them to give your client what they need.
For more tips and techniques to free your clients from worry and anxiety, try our Conversational Reframing course.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
(1) The standard psychiatric definition (from the DSM IV manual) states that generalized anxiety disorder means “at least 6 months of ‘excessive anxiety and worry’ about a variety of events and situations. Generally, ‘excessive’ can be interpreted as more than would be expected for a particular situation or event. There is significant difficulty in controlling the anxiety and worry.”
