Anxiety in one form or another is the most common issue that brings people to therapy. It ranges in severity from a vague but persistent sense of unease to incapacitating panic attacks and many levels in between. Various forms of psychotherapy can be very effective in addressing the pain of anxiety and helping the patient move towards health and well-being. Sometimes in conjunction with medication and sometimes not. Symptoms of anxiety can include specific phobias, excessive worry, heightened fear reactions or vague but persistent sense of unease.
How can effective psychotherapy help ease pain, and promote healing and growth? In many circumstances, the patient seeking help from the painful experience of prolonged anxiety will want to resolve particular problems in their life.... “I am always worried I will lose my job” I am am afraid I will be discovered to be a fraud” “I worry I will get terribly sick or die”Patients may desperately seek reassurance That all will be ok or that their fears are unwarranted. But it is usually NOT the identified problem which is in fact causing the pain. It is the troubled mind which has trained itself by repetition and practice to generate worry and fear. It is the thought process itself and not the identified problem. The patient is tricked to think it is an external problem we must solve when it is in fact internal.
The anxious mind relentlessly seeks a problem to fix upon. It is not the problem that needs resolving, it is the impulse to seek it. The realization that one is not defined by painful anxiety, that they are thoughts and feelings and not descriptors of self, can be a powerfully liberating and transformative experience and a deeply rewarding part of effective psychotherapy. One effective version of Cognitive Therapy involves a mindfulness or present moment approach to therapy. In mindfulness, the patient learns to notice anxious thoughts and feelings without attaching or fusing with them.
To sit with anxious feelings, endure the discomfort and allow them to pass, as does a powerful ocean wave. No need to stop it or avoid it, we sit still in the water, prepare and allow it to pass overhead and move on behind us. In a mindfulness approach , the patient learns to notice the anxious thoughts and feelings without attaching or fusing with them. In mindfulness based therapy treatment of anxiety, the patient is encouraged to develop acute awareness of moment to moment experiences, thoughts and feelings. Being present with bodily sensations and feelings sounds simple, but the destructiveness of anxiety results in most of life being lived in the recent past or in the near future and rarely in the now.
Foreboding, regret, fear and doubt are hallmark sentiments of anxiety. It is the work of the therapist and patient together to loosen this grip, and create space for healthier and more hopeful sentiments. Mindfulness brings the patient back to the now. To breathing and to this very moment in time. To the current sensations of the body and the immediate reflections of the mind. Thoughts and feelings are allowed to come and go without being latched onto and ruminated upon in a churning and repetitive manner which fuels unrest and anxiety.
It is often unpleasant or even painful to sit with unwanted emotions or thoughts. It is counter to the patient’s mindset which seeks to deny these feelings or eschew abandon them as quickly as possible. Why do we do this? Why do we encourage the resolute act of sitting with these feelings? By drawing them close rather than pushing them away? Often the patient learns that even painful and powerful feelings are transient and that we can in fact tolerate them until they slip away. The patient also begins to learn that these negative feelings and thoughts are not defining of the self, of who they are. They are.
As preferred and more pleasant feelings and thoughts emerge, the patient learns to notice them deeply and to mark them as desired states. In this way creating a map. A desired place to return to again and again until it becomes familiar and easily located.
At the heart of any form of effective psychotherapy for anxiety and other psychic pain lies a non-judgemental, caring and curious stance. To be heard and accepted opens the hope for change and a turn towards health.
In Cognitive-Behavioral Therapy we learn of the power of the internalized voice. Powerful and repetitive negative thoughts profoundly influence choices and behaviour and vice versa. Our internal voice can be more cutting than our harshest critic or more comforting than our best friend. It is a powerful energy source. CBT works with the patient to identify and understand troubled patterns of thinking and change them. Thoughts which lead to shame, negativity, helplessness and despair are brought to light and challenged.
The patient is encouraged to identify core beliefs and values and to identify actions which bring them to life. As these are enhanced and promoted in therapy, the negative and destructive choices weaken and dissipate.
Any version of mindfulness based therapy, CBT or any other form of effective therapy will be ineffective unless it is based in deep trust between therapist and patient. Respect, and absolute safety is established within a non-judgemental environment where the patient feels free to take risks in the pursuit of meaningful growth and lasting change.