Anxiety disorders are among the most prevalent mental disorders. In addition, anxiety is often an important component of physical illnesses and other mental disorders, such as depression, eating disorders, and post-traumatic stress disorder. Because of this prevalence, it’s important for counsellors to have a comprehensive understanding of anxiety and practical strategies to assist clients.
Normalizing anxiety is an important starting point for intervention. Many clients feel embarrassment or shame, believing that they are flawed or weak because of their problem with anxiety. It’s helpful to inform them of the prevalence of anxiety and to provide examples of common and disordered anxiety.
Explaining how anxiety works, including its adaptive nature, can be empowering and helpful in reducing and managing anxiety. Clients are often worried about their anxiety symptoms, so connecting their anxiety-related symptoms with the underlying fight/flight/freeze response can help them understand their experience of anxiety and the rationale for treatment.
I find the following five principles key for guiding my work with clients experiencing disordered anxiety:
Use the counselling relationship to activate calm.
A calm, therapeutic approach helps soothe the client’s nervous system, reducing the sense of threat, and allowing for new insight and awareness. Counsellors can use themselves, the counselling environment, and the counselling process to promote connection and calm. A soothing approach activates the parasympathetic nervous system in the client, which regulates the body back into rest and recovery.
It is important for clients to develop an understanding of their anxiety as a malfunctioning protective instinct that they can learn to regulate.
It is important for clients to develop an understanding of their anxiety as a malfunctioning protective instinct that they can learn to regulate. Understanding the biology of anxiety and the fear response is often the first step in reducing distress and avoidant behaviour. It helps to explain that the fear response, triggered by an imagined or future threat, is the same reaction that is triggered by an immediate danger. Stress hormones are released that work to focus attention on the threat and ready physiological processes for fight, flight, or freeze. It can be said that with anxiety, the alarm system is working extremely well, but it’s in the wrong place at the wrong time, like a smoke detector over a toaster, creating a false alarm.
Helping clients understand this process and relating it to their experience of anxiety is extremely effective in reducing distress and addressing behaviours that maintain and reinforce disordered anxiety.
Build physiological awareness.
The physical symptoms of anxiety usually create discomfort and distress. As a result, clients commonly set a goal of never feeling anxious again. However, it is important for clients to understand that it’s normal to feel anxious, just as it’s normal to feel hungry – it’s not always comfortable, but it isn’t dangerous. Anxiety sensations, like hunger pangs, are built-in signalling mechanisms, drawing attention and focus to internal functioning and important external events.
As anxiety increases beyond a moderate level, it becomes less helpful. At high levels of anxiety, the alarm centre of the brain takes precedence over the thinking and planning centre of the brain, sacrificing performance for survival. Symptoms of high anxiety, such as a pounding heart, shaking limbs, and racing thoughts, undermine motivation and performance. Learning to recognize when anxiety is low, moderate, or high increases self-awareness and the ability to self-regulate.
It is important for clients to understand that it’s normal to feel anxious, just as it’s normal to feel hungry – it’s not always comfortable, but it isn’t dangerous.
Expand cognitive flexibility.
The tendency to over-focus on threat is a key factor in the development and maintenance of anxiety. Human beings tend to pay greater attention to negative events and possibilities than positive events, creating a negative cognitive bias. For example, it’s natural for negative comments from a supervisor to have more staying power than the supervisor’s complimentary remarks. When giving a presentation, it’s normal for our attention to be drawn to one scowl, rather than 10 smiling faces.
Although this attention to threat is a natural human instinct, when anxiety patterns take hold, a person’s attention gets stuck on the negative, and we’ll miss positive things that happen. Cognitive flexibility refers to the ability to see things from different perspectives and notice positive experiences alongside the challenges. It is important for clients to understand that how they think about a situation affects how they feel and respond. However, it is also important for clients to understand that helpful thinking doesn’t change a difficult situation; rather, it changes their approach.
Avoidance is the behavioural hallmark of anxiety. It’s normal for people to move away or avoid something that is threatening or scary. However, avoiding anxiety-provoking thoughts or situations can result in higher sensitivity. A person’s internal alarm may go off more quickly in anticipation, making them more rigid in their reactions to try to protect themselves.
Some people believe facing fears directly is the best approach, but it’s important to start with small, incremental steps, rather than jumping right into the deep end. Clients should be encouraged to develop a systematic plan for gradually approaching challenging thoughts or situations. Rather than facing difficult situations in a way that triggers intense anxiety, clients can identify small manageable steps they can take to approach the fear. Building in aids such as social support, self-regulating strategies, and helpful self-talk can make it more manageable for clients to approach a source of fear. In some cases, for unrealistic or exaggerated fears, exposure can be done through imagination. In other situations, real-life exposure is ideal.
While disordered anxiety is distressing and limiting, it also reveals important information about clients’ natural defences and abilities.
While disordered anxiety is distressing and limiting, it also reveals important information about clients’ natural defences and abilities. Anxiety work helps clients make sense of their worries and cultivates their natural coping. When people learn to manage anxiety problems, they often report that they feel stronger and freer than before the difficulties began. In a life dominated by anxiety, a lot of time and energy is spent on being preoccupied with threatening possibilities. With proper support and coping strategies, people experiencing anxiety can better accept uncertainty and develop confidence in their abilities to face the challenges of life.
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