Anxiety disorders are very common in our culture. The fast pace of life, multiple roles that we play, and pressure to keep up with multiple demands at the same time can easily result in a diagnosable anxiety disorder.  The most common anxiety diagnosis is called generalized anxiety disorder (GAD), which includes chronic worry about a variety of different topics, feeling on-edge and restless, feeling tense and having trouble relaxing. You also might notice sleep and appetite disturbances, and that your thoughts are sped up with GAD. 

Treatment for anxiety disorders can include either medication or talk therapy, or a combination of both. Many people like to try talk therapy first, to assess whether medication is necessary. Counseling sessions for anxiety are usually focused on identifying the source(s) of your worry, identifying thoughts and beliefs that aren't helpful, and learning mindfulness techniques to notice and redirect your unhelpful thoughts as you go about your daily life.

Counseling sessions can also help you better define your personal goals, and provide a sense of direction. Regular sessions provide accountability for following through with the goals that you've set for yourself. Personal goals can be related to work, intimate relationships, family dynamics, physical health, self-care, friendships, leisure time, or any other aspect of life that is causing worry. By identifying concrete steps that you can take toward your goals and having someone holding you accountable to take those steps, you are more likely to succeed. 

Assessing GAD in our office is quick and easy by answering a few questions in your first session. You may find insight into your thought patterns and daily habits that can turn down the volume on the worried thoughts and turn up the peace and calm. 

I regularly encourage clients to develop a "self-care" plan as a way to manage the challenges and difficulties that life regularly presents to each of us. Self-care can be anything that provides a sense of ease and comfort, and varies depending on each individual. Sometimes we identify things like exercise, meditation, joining social groups, reading, watching movies, aromatherapy, hiking.

​Because my personal and professional experience tells me that yoga is an effective tool for self-care, I often encourage clients to try it and sometimes I teach them yoga during our sessions. Likewise, I often hear clients say that they find a sense of peace in the outdoors, I encourage them to go to natural places as regularly as possible, as much as our urban environment here in Dallas allows. 

​This past week, I came across two articles about these very things. 

This article in Medical News Today outlines three new research findings that support the use of yoga as a supplement to treatment for depression. They each followed patients who scored high on depressive symptoms prior to starting a yoga program (Bikram in one study and Hatha in the other two studies) and found significant symptom reduction at the end of the program. In one of the studies, symptom reduction lasted for at least four months after the end of the program.

​These study results are no surprise for those who have personal experience with the mental benefits of a regular yoga practice. We are learning more and more that empirical research findings support it as well.

The Japanese call it taking a "nature bath", referring to the practice of fully immersing oneself in the sights, sounds, smells and textures of natural places. What a wonderful way to describe the common feeling of peace that many of us experience when hiking, camping, swimming, and discovering beauty in nature.

​This article in Time magazine outlines how connecting to "green space" can improve mood and wellbeing for many of us. It highlights that the quality of greenspace is more important than quantity. For instance, cleanliness, accessibility, and the ease of connecting to others are more important factors than the size of the greenspace. So for those of us that live in urban environments, local parks, walking trails, and tree lined neighborhoods are resources to our mental health.

So... if you're finding your mental health challenged today, if you're feeling down or anxious or stressed or angry... break out that yoga mat and do some downward facing dogs and sun salutations. Take a walk to your local park and circle it a few times. Take some deep breaths of the soft breeze. Watch the birds, and listen to them. Feel your heart beating as you move and know that you are giving yourself a wonderful gift!

Let's give anxiety some consideration today. You've likely experienced it over and over. You may have heard about certain types of anxiety like phobias and panic attacks, or diagnoses like Generalized Anxiety Disorder or Panic Disorder. There are lots of levels and experiences of anxiety, and sometimes even different definitions of anxiety from person to person. Anxiety is essentially worrying, feeling afraid, overthinking, and sometime panicking.

The common thread is that anxiety exists and is real for all of us, because it stems from an innate human emotion...Fear.

The DSM 5 (the manual we look at to classify symptoms and diagnose) draws a distinction between fear and anxiety like this:

 The autonomic nervous system, referenced above, pays a particularly important role in anxiety, and has two distinct parts. It revs us up (courtesy of the sympathetic system), then stabilizes us (thanks to the parasympathetic system), when there is a perceived threat in our environment. Imagine a bear chasing you...your heart rate increases, breathing rate increases, blood flows to limbs, pupils dilate, digestion slows, muscles tense. Sometimes tunnel vision and hearing loss occur, as well as relaxation of the bladder and colon. This very physical response to danger has a purpose. Muscles tense to ready themselves for action, blood flows to limbs to enable us to move quickly away from danger. Then, the nervous system slows and reverses this response once danger has passed, initiating relaxation. Our breathing and heart rate slow down, our muscles relax, our body comes back to homeostasis.

Both humans and animals alike experience this stress response cycle. Animals and humans differ, however, in the ability to reason, classify, predict, and analyze. We humans can thank our bigger brains and cerebral cortex for that. An animal might encounter that same bear, have a fight or flight response, be able to escape from danger, then quickly stabilize and move on. The cerebral nature of our human brains don't allow us to move on in the same way. We would likely have persistent fear or worry after an episode like that. We may feel afraid of bears, the place it happened, what we did right before it happened, that we may not protect ourselves from it happening again, or that it will happen to someone else. You can see how the human mind's ability to analyze gets us in a pickle here. 

We can get stuck with our fear in the "on" position, even in response to more innocuous stimuli like work or school demands, relationships, financial issues, health concerns, parenting, and other aspects of daily life. Our reasoning and predicting minds create future scenarios to worry about, and sometimes with good reason. If you lost a job in the past because you were late, you may be well served to worry about being late in the future. So in this way, anxiety is a helpful and useful tool that reminds us to pay attention to something specific like not being late to work. However, as we know, anxiety can become problematic when it immobilizes us in everyday life, keeps us from making decisions, disengages us in things we'd like to do, or impedes relationships.

Here's how I describe the anxiety continuum. Remember, fear and anxiety are related to paying attention to our environments and paying attention is a good thing.

​It may be helpful to outline the different types of anxiety disorders listed in the DSM 5.

• ​Generalized Anxiety Disorder. This is a general worry that underlies experience and gets in the way of daily functioning. It may be hard to pinpoint exactly what you are worried about, or it may seem like you're worried about everything. You may feel tense quite a lot and find your mind racing, jumping to conclusions, and thinking of the worst case scenarios. 
  • ​Fear is is generalized to everything.
• Social Anxiety Disorder. This is anxiety specific to social situations. You may worry about what others are thinking of you, that you'll embarrass yourself, that others will reject you, and avoid social situations in which you are likely to have to interact. 
  • ​Fear is about social interaction.
• Specific phobia. This is anxiety specific to a particular object, activity, or situation. Common phobias are of heights, flying, insects, blood, animals. You may feel intense immediate anxiety when seeing or thinking about your phobia, and actively avoid it.
  • Fear is related to something very specific.
• Panic Disorder. This occurs when panic attacks perpetuate themselves through anticipation of another attack. Panic attacks can occur with other anxiety disorders, depression, post traumatic stress disorder, and many other mental health conditions. Panic attacks are episodes of terror that occur for no apparent reason, in which one may feel shaky, sweaty, racing or irregular heartbeat, difficulty breathing, the sensation of choking, chills or hot flushes, and/or nausea. (Remember the fear response to the bear described above...a panic attack is almost just like that, minus the actual danger). Most panic attacks involve a fear of passing out, fear of going crazy, and/or fear of dying. Merely having a panic attack doesn't warrant a Panic Disorder diagnosis, however.  Panic Disorder emerges when the anticipation of more attacks and the avoidance of places or situations that may cause another attack interferes with everyday life. 
  • Fear is of having another panic attack. 
• Agoraphobia. This occurs when there is a persistent fear of public places or situations, including using public transportation, being in either open or enclosed spaces, standing in line or being in a crowd, or being outside of home alone.  Usually thoughts accompanying this fear are "I can't get out of here" or "no one will help me."
  • Fear of a particular situation, usually in public. 
• Substance or Medication Induced Anxiety Disorder. This occurs when anxiety is attributable to the effects of a specific drug, legal or illegal. 
  • Fear occurs as a side effect of a drug.

The body's natural ability to balance itself in response to stress is powerful. Just knowing that the nervous system is able to balance chronic anxiety is the first step. Then, learning and practicing tools that enhance our body's natural ability to balance, will help us move beyond fear and anxiety that might be crippling us. 

In counseling, there are many approaches to working with anxiety. I've found three approaches most helpful:

1. awareness of the breath
2. mindful meditation
3. awareness of habitual, unrealistic or unhelpful thought patterns.

For more information on how we incorporate these approaches into therapy, please contact us! We are happy to help you learn more about how counseling can work to manage fear and anxiety.