Recently, I explained to my granddaughter what makes strong relationships. So often, especially in dysfunctional families, people demand love, respect, loyalty. But such demands weaken relationships, not strengthen them.

Strong relationships are the result of a series of choices. Every conflict, every tragedy, every problem in a relationship leads to a moment of choice: “Am I going to solve this? Do I choose to endure it? Or, am I going to allow it to fester, grow, and interfere with my relationship?”

Most of the time this choice is unconscious. However, every time a person decides to solve the problem or to support the other person during a crisis, it is a decision to preserve, renew, and/or affirm the relationship. Read more...

The number one attitude most of my clients have towards anxiety is “I can't stand this! Tell me how to get rid of it!” Then, they think I'm crazy when I tell them, “I can't do that. But I can teach you how to tolerate it.” The last thing in the world they want to hear is they need to learn how to tolerate it: “But I am tolerating it! I have to put up with it every day!”

The concept of tolerating anxiety is frequently misunderstood initially but I would probably be even more misunderstood if I said, “You need to become friends with your anxiety.” If you have read the previous coping statements, a common theme is that the more you focus on anxiety and the more you try to get rid of it or control it, the worse it becomes. So, what is the opposite of that? Accepting the anxiety, listening to it and learning to understand its role and purpose is part of developing a normal relationship with the anxiety.

Think of it like the relationships you have with people. Have you ever met someone you can't stand to be near? Yet, if you take the time to know the person and have compassion for how that person came to be the way s/he is, you find yourself more able to tolerate the annoying behavior? Maybe even able to accept the “quirks” and like the person for other characteristics? Read more...

It's bad enough to have anxiety suddenly seize you and make you miserable without having additional anxiety due to worries and fears about it. You may not have complete control over spontaneous anxiety but living in fear of the anxiety only creates more.

When you are fearful of anxiety and expect it to occur, your brain interprets those feelings as meaning that you are already under attack. As a response, the arousal of the autonomic nervous system (ANS) occurs. As discussed previously, the ANS prepares the body to react to a threat. This preparation creates the symptoms of anxiety.

And thus, the anxiety cycle is created: having anxiety creates expectations of anxiety which leads to more anxiety. By stopping this cycle you can eliminate at least part of the anxiety you experience. The best place to break the cycle is in the thought process of expectation that elicits fear. Read more...

You don't lose touch with reality when you are anxious even though it sometimes feels that way. The two symptoms that are disturbing because they often cause those with high anxiety to feel "crazy" are derealization and depersonalization. Both of these symptoms are aspects of heightened awareness.

As discussed with previous coping statements, the autonomic nervous system (ANS) is preparing the body to do something (fight or flee) when faced with a threat and heightened awareness is part of this preparation. However, when you experience hyper-awareness your perspective is different from your normal experience which makes it seem abnormal.

1) Derealization. Sometimes when people experience high anxiety they feel as if things around them are not real. I was once in a car accident in which I saw the car coming towards us and it seemed for that moment time had slowed down. Many people experience this during emergency situations. The reason is because our brain is speeding up trying to process the incoming information in order to react quickly. When the brain speeds up everything seems different which can seem unreal. Read more...

Demanding to not feel anxious creates anxiety. The more you tell yourself “I don't want to feel anxious” or “I should calm down” or “I can't stand this anxiety!” the more the anxiety is likely to increase. These are demands and anxiety doesn't respond well to demands.

Think of how you feel generally to a demand from others. If someone tells you that you “should” do something, doesn't that increase tension in your body? Most people don't like to be given demands and feel uncertain, reluctant, frustrated, or irritated, all of which cause increased tension.

And what is tension at the basic level? It is an arousal of the autonomic nervous system (ANS) which is the same system of the body that plays a major role in the experience of anxiety. So when you place demands on yourself to get in control of the anxiety, you are arousing the same system of your body that is giving you trouble. Read more...

Natural instinct is to protect your loved ones. However, many people confuse momentary protection with long-term protection which, however, may require different actions. Momentary relief usually causes increased problems in the long run.

Too often parents and spouses of those with anxiety are overprotective and indulgent. I've known entire families who centered their lives around the individual with an anxiety disorder. Sometimes that might be driving them places because they are fearful of having a panic attack while driving while other times it might be showering before coming into the house due to an obsessive fear of germs.

The reason for this is frequently due to having compassion and wanting to help the person with the anxiety disorder. Due to their feelings of helplessness, though, the tendency is to do anything to make their loved one feel better, even if it is temporary. Unfortunately, temporary solutions can sometimes be worse than not doing anything. Coddling fears can increase anxiety. Read more...

Some people with anxiety disorders have increased anxiety because they are fearful of having anxiety or panic in public. This is an aspect of social anxiety combined with the primary anxiety disorder such as panic disorder or generalized anxiety disorder. They are afraid of what others might think. This additional fear adds to the anxiety they already experience, thus making it more difficult to manage.

If you have this type of anxiety, it is important to keep in mind that if other people notice your anxiety most likely they will equate it with normal anxiety that most people experience at times. They are likely to attribute your anxiety to the circumstances and not to a negative critique of you. As a result, they are more likely to identify with you and reassure you: “Oh, yeah, I get anxious when...”

Unfortunately, the other side of this tendency for others to believe that an anxiety disorder is the same thing as normal anxiety is that some may also tend to think that those who have an anxiety disorder are just weak and can't handle normal anxiety. Read more...

The foundation of anxiety for many people is the emotion of fear. Whether it is fear of the anxiety itself or fear of harm coming to them or others, fear drives the anxiety. For some people with anxiety disorders the over-riding emotion might be guilt—feelings of responsibility for events over which they have no control.

Yet, too often people accept emotions as absolute truth. In cognitive therapy, this is referred to as “emotional reasoning.” Our emotions are important messengers but they need to be evaluated for accuracy. Sometimes we feel something because we want it to be true. Other times we feel something because it triggers a memory from the past. For instance, “I'm afraid of driving because I'm afraid I will have a panic attack like I did before.”

Have you ever tried to discuss something with someone who declares “Well, that's how I feel” as if the feeling is evidence itself and makes their opinion valid? Isn't it frustrating because no matter what evidence you have, their feeling trumps all? It shuts down the discussion. Read more...

Anxiety sometimes is a message. Many people who have problems with anxiety are so caught up in their fears of it they don't truly receive the message of the anxiety. As a result they are unable to resolve the problem the anxiety is trying to illustrate.

For instance, I had a client who had a fear of driving long distances, or even riding with someone, due to having panic attacks while traveling on a highway. When we explored this I found that it started when she went to visit her family who lived a couple hours away. Although she didn't want to acknowledge it, she had a tumultuous relationship with her mother who tended to be very critical. Due to the panic attacks she was unable to visit her family. The panic attack was an emotional signal that she didn't want to visit her family and for her to resolve the panic she needed to accept that was okay.

Distinguishing whether anxiety is physical or emotional and the message it is trying to convey can help resolve the anxiety. Some common messages: Read more...

Anxiety is body arousal which can be due to any number of triggers. For many people with anxiety, they become confused about the anxiety when it doesn't manifest in its usual way. Frequently I've had clients I treated for anxiety who were managing their anxiety well but had a sudden flare-up they didn't understand and which caused additional distress: “I don't really feel anxious about anything, why am I having these symptoms?”

When I explore with them recent changes or possible triggers, we often discover there are other reasons for the symptoms. The reason there are many triggers for anxiety symptoms is because the symptoms are due to the arousal of the autonomic nervous system (ANS). The ANS is a natural system of the body when the body feels threatened or in danger--it prepares us to react to the threat. To understand this further, read: A Brief Primer on the Biology of Stress and How CBT Can Help.

Many times when my clients have anxiety symptoms they don't understand they become even more anxious due to the concern about why the symptoms are suddenly occurring. Sometimes just knowing the reason for the symptoms can be reassuring. By understanding your body you can tolerate the symptoms better and/or decrease the symptoms. Some of the possible triggers: Read more...

Some people spend a considerable amount of time focused on “what if” types of worries. “What ifs” are different from worries about an actual event. “What ifs” refer to the constant reviewing in your head of possible negative events or outcomes. These thoughts aren't evaluated for probability or importance or solutions, but only serve to maintain a heightened state of anxiety.

A coping statement such as “worries are not reality” can be useful if your worries meet the following conditions:

1) Unlikely. What is the actual probability? Something “could” happen is true for a 10% chance or for a 90% chance but one is a more realistic concern. Worrying about someone breaking into your home and harming your family when you live in a safe neighborhood and have taken proper precautions is a waste of energy because it is unlikely. Read more...

For those with anxiety disorders, Panic Disorder especially, the anxiety symptoms feel so out-of-control it seems that something must be terribly wrong. As a result, they become fearful of the anxiety symptoms thinking they might be having a heart attack or some other physical ailment, will faint and hurt themselves, or will lose control in some way. The obsessive focus on even minute expression of symptoms due to these beliefs cause increased anxiety and even panic.

Frequently, those with these beliefs are not very in tune with their physical self because such body awareness can trigger the fears. This fear of bodily sensations can cause them to reject useful management tools such as breathing methods or relaxation. Such tools rely on heightened awareness of the body which can be uncomfortable initially. Read more...