Misunderstood: How To Treat Anxiety

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States or 18% of the population especially young adults, according to the Anxiety and Depression Association of America, but it is often misunderstood.

Therapist Patrick McGrath, Ph.D. McGrath has treated obsessive compulsive disorder and other forms of anxiety for two decades and says the condition can feel like you’re living in a constant state of “what if this really bad thing happened.”

People often mislabel someone who suffers from anxiety, throwing out words like hypochondriac, antisocial, paranoid or weak, but using these labels so loosely can elevate the person’s anxiety. A hypochondriac, for instance, is someone who lives with the fear that they have a serious medical condition, even though diagnostic tests show there is nothing wrong with them.

Anxiety also has a way of spiraling but the technical term is an “anxiety loop” when the fear of anxiety creates more fear and anxiousness. We’re seeing this now during Covid. “People with anxiety are having a harder time with intrusive thoughts these days – there’s a lot of people afraid of being unwell or passing something on to someone else,” says McGrath. He recommends that people get their information from one good source and to stick to it, rather than risk hearing conflicting things from different sources.

Somatic Syndrome

Someone who is constantly checking symptoms may be called paranoid but may also suffer from what’s called somatic symptom disorder, and the more they check the worse they tend to feel and less reassured they actually become. Calling doctors or looking up symptoms on WebMD at best provide short term relief.

McGrath says people with somatic symptom disorder create symptoms by looking for them and think that “no one cares enough” or takes them seriously, and say “why would I have these symptoms if there wasn’t something wrong with me?” The symptoms are linked–a headache must mean a brain tumor or a scratchy throat must mean throat cancer.

Acknowledgement As Treatment

McGrath says he always starts with a medical diagnostic workup with a person with health anxiety disorder, because otherwise you have nothing to stand on and the patient can argue everything away since a therapist is not a “medical” doctor. The patient thinks “why should I trust you?”

The first level of treatment is response prevention, then layering coping skills.  If you are working with someone with anxiety or if you are parent of a child or teen or colleague dealing with these thoughts, try to help the person break the cycle of safety-seeking behaviors by taking these steps:

  • Help them focus on the times that the fear consequence didn’t occur
  • Encourage this mantra: “I accept the fact that I have these thoughts, but it doesn’t mean that I have this illness”
  • Avoid arguments, because it will just lead to resistance
  • Try to say something like, “What you are feeling is real. You’re not crazy. But there may be some influence happening in your head if you’re open to that”
  • Help them acknowledge and own the anxiety: “I might feel anxious for the rest of my life but I can learn that it’s not dangerous”

The point is not to teach the person they are not ill, but to teach them that they can handle what they think is going on, to handle the uncertainty. McGrath believes that cognitive behavioral therapy is what works best to help someone with anxiety. Talk therapy doesn’t work, he says, because you need to help change the person’s behaviors.

What To Do When Thoughts Control

McGrath says intrusive thoughts, images or urges often happen in someone suffering from anxiety. These can be obsessions and even compulsions like in someone dealing with OCD.

“A thought or image or urge is not real and it doesn’t have to be reality,” says McGrath. He advises people suffering from these conditions to do things the things that are uncomfortable because they need to believe they can handle it.

That’s the most important thing is treating anxiety disorder.

For example, take a person who is driving and suddenly has a thought to drive off the road or perhaps a person eating lunch with a friend but a thought pops into their of hurting them. Don’t avoid these thoughts, McGrath warns, because avoiding makes it more scary.  To treat this, McGrath will put the person in that situation. He’ll go driving with them and say, “Okay now drive off the side of the road.”  He says this tactic makes the person realize they won’t actually do the thing they are afraid of. Facing it head on it can be effective at shrinking the thought in their minds.

Confronting Fear

There are some conditions that create frightening images for people with anxiety.

Take post partum OCD. It’s not the same as what’s known as post partum depression for new moms. It’s moreso when a mom is afraid of hurting their newborn while bathing them and an image comes up of the child drowning. McGrath says moms in this situation need to know they can handle this, but telling someone to stop having this thought makes it worse. This is called the paradoxical effect of thought suppression.

PTSD trauma is another condition featuring nightmares and flashbacks. McGrath uses a virtual reality simulator for veterans that puts them directly into the reality of being in war. They watch it over and over again, he says, and while vets don’t enjoy the experience it can work.

“Trying not to think of something makes it bigger,” McGrath says. “As a therapist I think about how do we put people in the situations that they’re afraid of?” -EO

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