Anxiety: What to Know About the Most Common Mental Health Complaint and How Therapy Can Help
Anxiety is the most common complaint in people seeking out mental health support.
It is one of the most searched keywords in search engines and statistically seems to always be the frontrunner when mental health clinics collect data on why clients seek services. Anecdotally, it is expressed as a concern for *most* of my clients even if not the primary issue for coming to therapy. It also comes up all the time in my own social circles among family and friends and yes, even us therapists (believe it or not, we experience things too!). But what is it? And can therapy truly help?
“Anxiety” vs. “Anxiety Disorder”
Whether you subscribe to pathology and diagnostics when it comes to mental health issues or not, it is important to first understand that anxiety is not always problematic. Anxiety, which stems from the root emotion of fear, is something that all human beings (and other mammals) experience. Anxiety as an emotion, allows us to anticipate a future threat or concern which in mild doses, can be healthy. What was once intended for immediate physical threat such as the presence of a predator, has adapted to present day symbols of threat which can include anticipating social, emotional and financial threats. For example, anxiety helps us to set our alarm before going to bed so we can be on time for work in the morning. It might motivate preparation behaviours such as planning, studying, and problem solving in advance. Not all anxiety felt is a problem.
Anxiety becomes disordered when it becomes persistent, excessive and interferes with daily functioning and quality of life. This could come in the form of intense body sensations, fear-based thoughts and worries, avoidance of feared situations or things, just to name a few examples. Anxiety of this level can impact your ability to sleep, eat, engage in relationships, enjoy the things you used to, school or job performance, your ability to parent in the way you wish to and even your physical health.
Anxiety disorders can be treated by a family doctor (or other general practitioner) or psychiatrist through medical interventions such as bloodwork that looks for physical causes (deficiencies, undiagnosed health issues that impact mental health) as well as prescribing anti-anxiety/anti-depressant medications such as SSRIs and SNRIs or “PRN” (take as needed) medications. It can also be treated through psychotherapy, which can be delivered on its own or adjunct to medication.
Anxiety disorders tend to come from what I call the “perfect storm” or at least some level of one or more of these factors: Genetic predisposition and family history to anxiety, biological origins (think thyroid conditions, hormonal conditions, other physical health diagnoses), trauma history and learning through life experiences, and present day stressors. It’s hard to know how much of each of these contribute to your specific presentation without assessment and some trial and error in what seems to work and what doesn’t.
Therapy for Anxiety
Will therapy help your anxiety? Many people wonder how speaking with a therapist could possibly help if we cannot guarantee immunity from the feared outcomes. Some people experience a specific theme to their anxiety. Some people have a variety of worries and generally feel really on edge and like they can’t turn their brain off. Some people experience extreme and somatic expressions of anxiety in the form of panic attacks. Anxiety tends to trick your brain and your body into thinking that the material it is turning your attention to is currently happening AND a threat which makes it feel both real and urgent. Believe it or not, it is not helpful in the long-term for your therapist to offer reassurance anyway. Depending on the presentation of the anxiety, too much reassurance can actually make anxiety worse.
People can have an anxious baseline for as long as they can remember. They may have been described as a more nervous or sensitive kid. Maybe there was history of school avoidance or difficulty connecting with peers. For others, anxiety can seem to come out of nowhere. Pregnancy and postpartum are an example of when anxiety can become a problem for the first time. Postpartum depression is well known but postpartum anxiety is just starting to become recognized. Without treatment, postpartum can become extreme and include “obsessive and compulsive” symptoms that can include disturbing intrusive thoughts related to fears to baby.
Therapy can help to improve anxiety and is considered an evidence based intervention. Normally, the process will start with the therapist providing some psychoeducation and helping the client to gain some self-awareness. Understanding when your anxiety is in the driver’s seat can help you diffuse from the anxiety feeling and observe your thoughts and feelings with curiosity and openness instead of seeing every thought and feeling as a fact. Therapy can give you a variety of tools to manage anxiety that can help with body-based distress, anxious thinking, emotion management and behaviour change. Most relief comes when an individual cultivates a sense of mastery over coping with potential negative outcomes instead of looking for reassurance that the negative outcome won’t happen at all. After some practice in challenging your anxiety, it will start to lose its power and will gradually have less and less impact on your life. It can (and probably will) show up again, but with the awareness and tools you have learned, you will feel equipped to know what to do before it gets too severe.
Often, anxiety can be tied to prior trauma experiences or adversity given that anxiety is felt and held in your nervous system. In this case, there are trauma-informed ways of working with your nervous system including trauma re-processing that can help to resolve anxiety that seems to not be budging much from talk based or cognitive therapy. As a therapist who has been in the field for as long as I have, and has worked in many different places with many different people, I tend to have a tailored approach based on the client’s needs and preferences. In my humble opinion, there are several modalities and a combination of interventions from varying modalities that can all be relevant in treating anxiety. CBT is the “evidence based” therapy currently for anxiety but cognitive therapies are limited (see my future blog post on trauma therapy) and not always enjoyed by clients.
Every client’s journey and what works for them is going to be different. It is important however, that your therapist is establishing clear goals from the outset with you, and returning to re-assess your goals every so often to ensure things stay on track. More importantly, you need to find a therapist that you can build a sense of safety with and who you can (learn to) trust. The therapeutic relationship between therapist and client is the single most important factor of whether psychotherapy is effective or not, not the modality used! Rapport can take several sessions to establish but sometimes you just aren’t vibing with your therapist and need to change and that’s okay. We totally understand the importance of a “good fit” and don’t take it personally.
Take-Aways
In summary, anxiety is not all bad. It has a role and we all benefit from having SOME healthy amount of anxiety in our lives. Anxiety, when a problem, can be treated in many ways depending on its origin and your preferences. Psychotherapy is a tried and true method to treating anxiety and can have a major impact on your ability to understand and cope with anxiety long-term. Pick a therapist that aligns with you and helps you to feel comfortable and heard. This matters more than anything.
Brittany Vincze, MSW, RSW