Therapy for Anxiety

Therapy for anxiety Psychologist, Brad Peters, has over 15 years of experience working with anxious clients. Anxiety involves psychological and physiological symptoms that signal the presence of a real, perceived, or anticipated threat (APA, 2000).

Although anxiety is usually an adaptive response, it can create problems outside of the presence of a genuine threat. When this happens, the individual may find themselves restricted, in how they think, feel, and act. Thoughts are plagued with worry, dread, or obsessive planning. Behaviours can become inflexible or rigid, through avoidance of people, places, or anxiety-provoking situations. The body may even associate emotional experience as threatening, thus triggering anxiety in the place of feelings like sadness and anger.

Since avoidance is a key part of what maintains anxiety, nearly every therapy for anxiety involves a combination of graded exposure to a tolerable level of anxiety, in addition to emotion-regulation strategies.

Fears and Phobias

Psychologists often distinguish fear from anxiety. While each can produce similar physiological responses, they can be experienced quite differently, depending on the broader context. With fear, the individual is facing a known or identifiable threat. For example, being mugged in a dark alley or encountering a bear while hiking; we are fearful of the mugger and the bear, respectively.

Most fears are justifiable and adaptive. However, for various reasons, we can develop irrational fears, or, justifiable fears may overgeneralize to other objects or situations. Sometimes even thinking about the feared object can cause distress, leading to avoidance. Unfortunately, the ‘relief’ we experience through avoidance, only reinforces the fear response, and increases the likelihood of developing a genuine phobia. Such patterns can become reflexive and difficult to control, leading to a vicious cycle of anxiety and avoidance. Psychologists work with clients to help them notice avoidance patterns and potential roadblocks, face anxiety and fear, and break the cycle.

Anxiety: Three Kinds

Anxiety, in contrast to fear, involves either an unknown threat, or one that is vague or poorly defined. For instance, a student might experience anxiety about being asked a question in class, even though there seems to be no rational basis for it. After all, they like their teacher and their classmates, and believe themselves mostly capable of answering the kinds of questions that could be asked. In this case the threat is ambiguous. Is it the other students who might judge, the possibility of feeling vulnerable, or something else? It might take some time and effort to help clarify what the anxiety is about. A good therapist should be able to help you do so.

There are, perhaps, a few different categories or ‘types’ of anxiety that are worth distinguishing: Sympathetic Anxiety, Parasympathetic Anxiety, and Grief/Panic.

Sympathetic-Dominant Anxiety

Anxious woman fidgeting

The first, and arguably most well-known kind of anxiety, involves physiological responses driven primarily by dominance of the somatic and sympathetic nervous systems. Somatic signs of anxiety, can include (Frederickson, 2013):

muscle tightness in the hands, arms, legs, shoulders, and neck
tension in the chest (often relieved through frequent sighing)
tight stomach muscles (e.g. stomach knots).

Activation of the sympathetic nervous system is often characterized by:

increased heart-rate & blood-pressure
increased respiration
possible hyperventilation & fainting
dry mouth and eyes, dilated pupils
cold hands, shivering, and blushing

Frequently referred to as the ‘fight-or-flight’ response, this form of activation is arguably the most adaptive or flexible, since it prepares the body to act. It provides the metabolic resources to either engage the threat, or flee from possible harm.

Importantly, the symptom profile of somatic and sympathetic-dominant anxiety, is such that there are usually noticeable signs of anxiety. As a result, others are less likely to doubt whether an individual is anxious, since they might very well see signs of discomfort. This may include fidgety mannerisms, rapid speech, laboured breathing, and so on.

Parasympathetic-Dominant Anxiety

The second, and less known/understood form of anxiety, involves smooth muscle activation and dominance of the parasympathetic nervous system. The parasympathetic nervous system is typically associated with the ‘rest-and-digest’ response (states of relative calm and relaxation). However, neuroscientist and distinguished university researcher, Dr. Stephen Porges, has challenged this simplistic picture with his Polyvagal Theory (2011). As the name suggests, Porges found evidence suggesting that there were two branches of the vagal nerve, serving different functions.

The Ventral Vagal Complex (VVC), roughly corresponds to the ‘rest-and-digest’ response, and works to counterbalance and regulate the sympathetic ‘fight-or-flight’ response. In contrast, the Dorsal Vagal Complex (DVC), is associated with more crude survival strategies, evolving from primitive vertebrates, reptiles, and amphibians (e.g. freezing, death feigning). Parasympathetic anxiety, resulting from DVC activation, may cause the following symptoms (Frederickson, 2013):

therapy for anxiety

decreased heart rate & blood pressure
decreased respiration
salivation, teary eyes, & constricted pupils
increased gastrointestinal motility (nausea, vomiting, diarrhea)
relaxed bladder sphincter (urge to urinate)
migraines (due to vasodilation)
“jelly legs” or unsteady gait
dizziness & foggy thinking

These findings have been supported by trauma researcher and therapist, Peter Levine (2010), and the psychodynamic literature (e.g. Abbass, 2015; Frederickson, 2013).

Unlike the sympathetic-dominant anxiety, this parasympathetic form of anxiety involves symptoms that may have very little outward signs. In fact, someone may look completely calm, while their internal experience is one of nausea, muscle weakness, and difficulty thinking. It can therefore be difficult for supportive others to notice or understand what is happening. Even an attentive therapist can sometimes fail to notice that a client is becoming quickly overwhelmed during a session.

Panic/grief Response

This last ‘category’ is closely connected to the one just described. So much so, that one might consider it a sub-class of the parasympathetically-dominant anxiety response. Despite the overlap, the panic/grief response appears to have a distinct enough ‘feel’ and ‘appearance,’ to warrant saying a few things about it.

Much of the work here, is drawn from the late affective neurobiologist, Jaak Panksepp (Panksepp & Biven, 2012), who characterizes the panic/grief response as one that includes typical parasympathetic symptoms, such as “feelings of weakness and depressive lassitude” (p. 190). However, the most prominent symptoms include “a strong urge to cry, often accompanied by tightness in the chest and the feeling of having a lump in the throat” (p. 190).

Indeed, to an observer, the panic/grief response may appear indistinguishable from a sudden burst of sadness or emotional vulnerability. Still, when one asks the individual about their experience, their first-person reports will often include adjectives such as feeling ‘panicky’ or ‘overwhelmed’ (as opposed to ‘heavy,’ ‘upset,’ or ‘sad’). Panksepp claims that this response will often prompt “thoughts about lost objects of affection,” and hypothesizes it to be intimately connected to attachment-related feelings of interpersonal loss or abandonment.

Summary

Individuals who suffer from anxiety know firsthand how debilitating it can be. Your therapist should be able to distinguish which type of anxiety you are experiencing. It may call for different kinds of intervention. Our psychologists have experience in cognitive-behavioral, interpersonal, mindfulness, psychodynamic, and existential approaches. Each may be helpful in understanding and treating types of anxiety, fears, and phobias.

Things Might go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety (K. Wilson & T. DuFrene)

This is not your typical '10-step' or 'quick-fix' kind of self-help book - and that is in part its greatest strength. Rather than viewing anxiety from a medical model and as something to be superficially managed or avoided at all costs, the authors challenge their readers to begin exploring the meaning of their anxiety while confronting it from a mindfulness and acceptance based perspective. An excellent supplement to individual therapy for anxiety, readers may come away from it will a different way of looking at anxiety, stress, and maybe even life.

Abbass, A. (2015). Reaching through resistance: advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.

Levine, P. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books.

Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neurodevelopmental origins of human emotions. New York, NY: Norton.