Anxiety disorders : the go-to guide for clients and therapists

358 Pages·2011·1.92 MB·English

by  Carolyn Daitch

Anxiety Disorders
The Go-To Guide for
Clients and Therapists
CAROLYN DAITCH
W.W. NORTON & COMPANY
NEWYORK • LONDON
Dedication
This book is dedicated to my clients,
whose courage and perseverance have
taught me so much.
Contents
Cover
Title Page
Dedication
Introduction
CHAPTER 1
Getting Started
CHAPTER 2
What Causes Anxiety
CHAPTER 3
Treatment Approaches for Anxiety Disorders
CHAPTER 4
Relaxation Techniques for Everyone
CHAPTER 5
Generalized Anxiety Disorder
CHAPTER 6
Panic Disorder
CHAPTER 7
Specific Phobias
CHAPTER 8
Social Anxiety Disorder
CHAPTER 9
Obsessive–Compulsive Disorder
CHAPTER 10
Medications and Neutraceuticals
CHAPTER 11
A Healthy Lifestyle: Exercise and Diet
CHAPTER 12
Practice Makes Permanent
Appendix: Resources for Clients and Therapists
References
Acknowledgments
Index
Copyright
Introduction
“W
ould you mind telling them I’ll be right back if they call my name?”
the tall blonde woman in her mid-forties said in a hushed voice to a
fellow client in the waiting room. Just moments later, when I came out to the
waiting room to greet her, Mary Beth was nowhere to be seen. After waiting
about 10 minutes I went to check the women’s restroom. No Mary Beth. Then I
checked the parking lot. Not a single person was sitting in a car. I went back into
my office and called the cell phone number she had written on her intake form.
I was relieved when after only a few rings Mary Beth picked up my call. “I’m
sorry,” a timid voice on the other end of the line began. “I just got so nervous
sitting there in the waiting room. Something came over me and I just had to get
out of there. There was no way I could stay,” Mary Beth continued. “Thanks so
much for your time, though, and sorry for any inconvenience I might have
caused you.” It sounded like she was about to hang up the phone.
“Where are you now?” I asked.
“I’m in my car. I’m just a few minutes away from getting back to my home.”
From the sound of it, Mary Beth had no intention of coming back to my office
to begin therapy. She had managed to make the initial phone call to me and to
come in for a first appointment, but the fear of beginning therapy was too great:
Mary Beth left my office before we had even had a chance to talk.
While the majority of the clients I see come to me because they are struggling
with some type of anxiety, the thought of entering into therapy can be anxiety
provoking in its own right. First of all, as you enter into therapy you are
encountering a new situation. You are beginning a working relationship with
someone (the therapist) you most likely have never met before. Especially if
you’ve never tried therapy before, you have no road map that will tell you in
advance the direction this new relationship will take and how your therapy will
eventually work out.
Second, by its very nature, in therapy you are sitting in the “hot seat.” All the
attention is focused on you. And the attention is not just focused on your
strengths (although identifying and enhancing your strengths is a vital
component of your treatment). If you come into therapy because you are
overwhelmed by the anxiety you experience and want help, you will need to
admit and convey some of your greatest struggles to your therapist. For many of
my clients, this process can be accompanied by feelings of shame,
embarrassment, and even a sense of defeat. All these factors can coalesce to
make entering into therapy seem like an intimidating and daunting task. This
was initially the case for Mary Beth. Yet as the British statesman and
philosopher Edmund Burke once said, “Nobody made a greater mistake than he
who did nothing because he could do only a little.” It takes courage to begin
therapy. With a little coaxing, that’s exactly what Mary Beth agreed to do.
In a firm but caring voice I said to her over the phone: “You need to turn the
car around and come back now. I can’t see you this hour, but I have a break at
2:00. How far away are you now from my office?”
“Umm . . . about 30 minutes,” Mary Beth replied.
“You’ll probably get here about 20 minutes early, so you can go browse in the
book store that’s down the street if you’d rather not sit that whole time in the
waiting room.”
“You want me to turn around now? I’m almost home.”
“Yes. Just take the next U-turn and reverse your direction. You were so close
to walking in the door of my office. Don’t stop now, when you’re so close to
getting the help that you need.”
Mary Beth did turn the car around, and this time when she came to my office,
she made it past the waiting room. She also made it through our hour-long
session, during which we discovered that she was indeed suffering from an
anxiety disorder. Mary Beth had been suffering from panic disorder since she
was in college. She agreed to begin seeing me for weekly sessions.
The next week at Mary Beth’s appointment time, I opened my office door to
find her situated calmly. I smiled at her, yet as her glance met mine, she
appeared a little surprised. As soon as we were both in my office I inquired as to
the thoughts that lay behind her expression.
“It’s funny,” she said with a slight chuckle. “Last week I was so nervous to be
here—even the second time around. My heart was pounding. My hands were
shaking. And when you opened the door, I thought you were really tall. I kept
thinking that during the whole session. You seemed huge. It definitely felt like
you were taller than me. This week, well . . . I’ll just say I don’t think that’s the
case.”
At this point I should say that even when I wear platform heels, I’m not quite
five feet tall. Mary Beth was almost a foot taller than me, yet during our first
meeting she felt that I literally loomed over her. This is the nature of anxiety
disorders: our fears can distort our perceptions, making our challenges seem
larger and more intimidating than they really are. In later sessions, Mary Beth
would refer to this first session with a chuckle, recalling that she initially made a
giant out of a woman who shops in the petite department of clothing stores. The
fears that fuel anxiety disorders subside when we learn to face and challenge
them. You will find the ingredients necessary to do just that within this book.
The Intended Audience for This Book
I wrote this book for both the people who suffer from anxiety disorders and the
therapists who treat them. My philosophy of therapy influenced this decision.
Fundamental to my treatment approach is the principle that clients benefit most
when they are active participants in their therapy. That means that not only do
their therapists need to be knowledgeable about anxiety disorders, the clients do
too. Both clients and therapists need to possess an understanding of the tools and
techniques that, together, they plan to use. While it is up to the therapist to bring
a knowledge of intervention techniques and treatment options, the client’s voice
is an immeasurably important component in creating an integrative treatment
plan. It is important that both participate actively in this process.
So my challenge was to create a book that would interest and inform both of
you: client and therapist. Trying to address the needs of both groups was
daunting, in part because I didn’t have any models. Psychotherapy books tend to
be written either for clients (as self-help manuals) or for clinicians. But there are
limitations to that approach. While books for therapists might present
comprehensive lists of symptom clusters and delineate treatment protocols, they
don’t necessarily provide a vivid understanding of what it feels like for the client
to live with an anxiety disorder, or what it feels like to progress through
treatment. On the other hand, self-help books for clients may give some
techniques and encouragement, but they usually don’t explain the psychology
behind their symptoms or the techniques for recovery. In The Go-To Guide, both
therapists and clients will learn about various treatment modalities and
therapeutic interventions. It is my hope that in this way, both the anxiety
disorders and the treatments that we learn about will have a pulse.
My next challenge was to decide who—therapist or client—would be the
primary audience. In my first book, Affect Regulation Toolbox, I addressed the
psychotherapist as the primary audience. But many of my colleagues told me
that after they read it, they recommended it to their clients because they found
that the tools were also useful guides for their clients’ at-home practice. Given
this feedback, I decided that my primary audience for this book would be the
client. So typically the “you” in the book refers to you, the client. Material that is
of particular interest to the therapist is set apart in boxes within each chapter.
This includes more technical information, such as references to research studies
and recommendations to facilitate therapeutic protocols. However, my belief is
that the entire book could benefit both clients and therapists.
How the Book Is Arranged
The material in the book is presented through a wide-angle lens at first; with
each chapter, the focus gets more finely tuned. Chapter 1 provides an overview
of anxiety disorders, discussing the prevalence of anxiety and introducing you to
the anxiety disorders that we will be covering. Chapter 2 explains the causes of
anxiety disorders, looking at the impact of genetics, perinatal and early
childhood experience, and issues of attachment. Chapter 3 provides an overview
of the different interventions commonly used to treat anxiety disorders, ranging
from cognitive therapy to hypnosis and mindfulness-based modalities. Chapter 4
presents relaxation techniques that can be used by anyone, with or without a
therapist, to reduce stress and promote well-being. Chapters 5–9 explore in depth
each of the anxiety disorders: generalized anxiety disorder, panic disorder,
specific phobias, social anxiety disorder, and obsessive–compulsive disorder.
Clearcut explanations of each disorder are presented, along with vivid stories of
clients with the disorder as they go through treatment. The chapters include
detailed instructions for a range of treatment interventions, and end with the
recovery stories of the clients described earlier.
The next section of the Go-To-Guide focuses on adjunctive approaches that
can enhance your recovery process. Chapter 10 gives you a storehouse of
information about medications and herbal or neutraceutical approaches. Chapter
11 highlights the benefits of incorporating a healthy lifestyle into your recovery
program and provides cutting-edge information on diet and exercise. In Chapter
12, I discuss the critical importance of consistent athome practice, outside the
therapy room, to maintain the benefits of therapy. A large section of this chapter
is addressed to therapists and provides specific strategies to help clients engage
in homework assignments. One category of anxiety disorders is not addressed in
this book: post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder
that can develop after exposure to a traumatic event. I decided that a thorough
examination of such a complex disorder as PTSD would merit a whole book of
its own. (Please see the Appendix for some suggested resources.) However,
many of the techniques suggested in this guide are applicable and helpful to
clients with PTSD and therapists treating them. Regardless of the particular
anxiety disorder, The Go-To Guide demonstrates that recovery is possible and it
doesn’t take years!