Reducing Anxiety *

David A. Gershaw, Ph.D.

Recently a reader asked me to write about how to reduce anxiety a general fear that is not necessarily related to a specific cause or object.

Anxiety is a necessary part of everyday life. In small amounts, it keeps us out of danger, sparks us into action and can lead to a longer and more productive life. However, in extreme doses, anxiety cripples us causing us to limit our freedom and flexibility.

Some psychologists view anxiety as related to avoidance learning. When something aversive painful or unpleasant is repeatedly paired with any object, the presence of the object soon causes anxiety. Then avoiding this object reduces anxiety. For example, suppose a father gets drunk and beats his daughter. The pain of the beatings is paired with his drunkenness, until eventually the first sign of drinking causes her anxiety. Avoiding her drunken father then leads to anxiety reduction. In time, her avoidance may generalize to men who drink, men who have authority over her or even men in general.

However, this does not take into account the thoughts related to anxiety. Your pain does not need to be physical to cause anxiety. Mental images and thoughts can cause anxiety just by themselves. You can develop vicarious anxiety by watching others reacting with fear to a given stimulus. Even being told that fearful events have occurred without directly witnessing them can cause anxiety. (Have you ever been anxious while walking though a supposedly "high crime" neighborhood at night?)

This mental viewpoint suggests that both memory and expectations play a major role in anxiety. The best predictor of how you will behave is not the anxiety, but rather your expectations of competence. Based on your past experiences, you have expectations on how well you can deal with various situations. For example, many performers suffer from intense stage fright. They may even vomit before each performance. Even so, they still go on with the show, because they know they are still capable of performing well even with their anxiety.

When expectations of competence are low, this can lead to "fear of fear." With any anxiety, specific physical changes occur muscle tension, pounding heart, trembling, sweating and so on. Even if they occur normally under relatively non-threatening conditions you may see these physical changes as a signal of an oncoming anxiety attack. This activates your fear about how badly you will act, which increases your physical symptoms and your fear finally spiraling into full-blown panic.

Anything you learn can be unlearned.

However, anything you learn can be unlearned. One method of unlearning anxiety is desensitization. First, you are taught relaxation exercises to relax muscles and reduce heart rate and breathing. Once this has been mastered, you are asked to list a "hierarchy of fears." You start you list with mild fears, work up to increasingly anxiety-arousing situations and top it off with things you fear most holding a snake, flying on an airplane or being in a crowded elevator. In the relaxed state, you are asked to imagine your hierarchy situations one by one, starting with the mildest ones. As long as you maintain your relaxation, this is incompatible with the high physical arousal that accompanies anxiety. Once this is completed for the whole hierarchy, your relaxed state is very likely to generalize to real-life situations.

A variation of desensitization deals with hierarchies in real-life situations rather than just imagining them. If you fear dogs, for example, the therapist will accompany you through your hierarchy. First, you will look at pictures of dogs, then listen to a recording of a barking dog, listen to a barking dog in the next room and so on until you can be relaxed with a dog in the room. The therapist is also a model for behaviors that you can imitate, increasing your confidence.

Self-defeating thoughts can also be covered at the same time. The therapist can help you to replace your self-defeating thoughts with more positive coping thoughts. You may say to yourself, "I can't do this. This anxiety has been with me for years, and I can't solve it now." The therapist can give you a coping thought, "If others have done it, so can I. I can deal with my fear of dogs." Effective changes in behavior and thought are also rewarded with praise from the therapist.

Some people use drugs like Valium and Librium to reduce the general tension that accompanies anxiety much like the relaxation exercises mentioned. However, this is only a temporary solution, since these pills do not increase your feelings of self-control over your anxiety. You attribute the power to the pill, rather than to your own ability to relax and deal with the situation.

If your anxiety is so extreme that it is interfering with your work or social adjustment, it is almost impossible to stop it alone. Seek reliable professional help!

* Adapted from Richard R. Bottzin and Joan Ross Acocella's Abnormal Psychology: Current Perspectives, Random House, 1988, pages 170-194.

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