Can A Psychologist Help You Think Your Way Out Of Anxiety The State Of The Evidence About Cognitive Behavioural Therapy For Anxiety
Cognitive behavioural therapy is a dominant force in psychotherapy and the most common treatment approach for anxiety. It’s how most psychologists will try to help you “think your way out.” And behave your way out.
CBT is widely considered to be a proven therapy for anxiety, and some specific types have firm foundations.15 It seems to work fairly well in a primary care setting,16 and it seems to be great for kids.17 But the benefits compared to placebo are underwhelming, and a technically positive 2018 review showed results that were less than impressive, and concluded that “better treatments are needed.”18 The benefits are especially less clear for older adults,19 and it’s definitely underwhelming when there’s pain and strange symptoms involved.20 In other words, CBT may be the least effective when it matters the most: when anxiety is driving the most disturbing symptoms. ?
Overall I’d call the evidence for CBT as a treatment for anxiety “promising,” but far from settled science or remotely proven. Not so much as a treatment for pain itself.21 For more about that, see Cognitive Behavioural Therapy for Chronic Pain. As an excellent example of the deep, scary complexity, there’s fascinating evidence that CBT may fail to treat chronic pain in some people because they are too inflamed — not because the inflammation is directly painful, but because the inflammation modifies mental state and behaviour and that makes the pain harder to treat.22 That’s a deep rabbit hole there.
Fake It Til You Make It: Make It Harder To Worry With Confident Posture Facial Expressions And Calm Breathing
An anxious mind cannot exist in a relaxed body.
Edmund Jacobson, founder of progressive muscle relaxation and of biofeedback
You can try to treat anxiety indirectly by creating physical circumstances in which it’s harder to remain anxious.
In practicing the Japanese martial art of aikido, you don’t throw a person with brute force, or even with clever leveraging . Instead, you position yourself in such a way that your practice partner finds it difficult to keep his balance. Similarly, in some positions it is harder to keep your worry.
Behaviours associated with calm and confidence will also blunt anxiety in the short term, like breathing slowly and deeply. Just like it’s hard to stay pissy while you’re making silly faces, it’s hard to stay anxious when you act confident in various ways. It’s basically an acting exercise that “contradicts” the typical physical patterns of the anxious state. Act as if you are confident, focusing on specific things that are easy to fake. This gives you a little leverage on your emotional state.
For more about the relationship between mood and posture, see my huge posture article.
Acting confident is not an anxiety “cure” any more than taking a decongestant is a cure for the common cold, but it is probably a way to feel better in the short term. And while you’re feeling a little better, logic and reason might have some more influence. Maybe you’ll have a better shot at “outsmarting” your anxiety when it’s dialed down a notch or two.
Never In The History Of Calming Down Has Anyone Ever Calmed Down By Being Told To Calm Down
That’s not strictly correct, but it is funny because it’s true in a sense. Being told to calm down in the right way, or telling ourselves, can be effective. But that “right way” is maddeningly elusive. Most people feel it’s a tall order for anxiey to yield to persuasion and reassurance. It’s hard to outsmart it, or suppress it by force of will. We don’t feel like we are good at calming down. Here are some of the typical ways that people reflexively try to calm down :
- We tell ourselves to “get over it,” and that really doesn’t work.
- We apply logic and reason, telling ourselves that it doesn’t make sense to be so anxious, and that doesn’t work either.
- We seek out the logic and reason of others, of friends with perspective and experts with authority, and that usually doesn’t work. We still worry, we still feel jittery.
- We try to distract ourselves, and sometimes that sort of works — but only temporarily.
- We try to sweat it out with exercise, and that may be the best solution that many people use. But it can still be unsatisfying. It takes a good chunk of time and energy, it doesn’t always work, and you can’t do it every time you need to blow off steam, and in any case “exercise is stress reducing so long as it is something you actually want to do,”14 and certainly not everyone does.
These aren’t “best practices,” just the easiest and most obvious things that worried people tend to try. That doesn’t mean they are useless, and if you haven’t tried them, you should.
Get A Pet Probably A Dog They Are People Too And Those Relationships Are Never Toxic
And if you can’t care for a dog yourself, seek out a therapy dog, formally or informally. It’s hard to overstate the therapeutic value of pets, and dogs in particular — they aren’t called our “best friends” for nothing. Don’t get me wrong: I am both a cat person and a dog person, and have always had trouble relating to being limited to one or the other. I was blessed with a particularly mellow cat that came with my wife, and I miss her terribly. But even as a cat lover, I have to concede that dogs, on average, are probably the better bet for battling anxiety. They are just so freakishly positive. It is infectious. It’s like being around someone who is always laughing.
I have little to add, because the basics are obvious and the details have already been particularly exhaustively explored by others: “How Dogs Can Help with Mental Health.” That’s a deep dive into the power of human-canine relationships there.
This is “Snug.” She’s the lab I grew up with & she was fantastic.
Why These Conditions Often Occur Together And How To Treat Them When They Do
Everyone experiences pain at some point, but in people with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.
The overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain. For example, about two-thirds of patients with irritable bowel syndrome who are referred for follow-up care have symptoms of psychological distress, most often anxiety. About 65% of patients seeking help for depression also report at least one type of pain symptom. Psychiatric disorders not only contribute to pain intensity but also to increased risk of disability.
Researchers once thought the reciprocal relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
In addition, two neurotransmitters — serotonin and norepinephrine — contribute to pain signaling in the brain and nervous system. They also are implicated in both anxiety and depression.
The Science Of Blowing Off Steam: Why Exercising Is Helpful For Stress
Exercising for stress control is an option that isn’t fully satisfying to many people, and often awkward for people in pain. But it’s still one of the most accessible and effective options, and it is firmly grounded in biology and science. Exercise is startlingly good medicine.52 Anything that can ward off dementia53 or actually help your brain recover from injury54 is probably neurologically relevant to any mood disorder as well. Which is certainly what the data suggests so far.55
But there’s a more specific and fascinating reason that exercise is helpful for anxiety, which is well worth understanding:
Exercise simulates what stress is trying to prepare us for. More exactly, exercise simulates a reaction to a stressful emergency which then also triggers the relaxation and recovery mode that follows. Robert Sapolsky:
The stress-response is about preparing your body for an explosive burst of energy consumption right now; psychological stress is about doing all the same things to your body for no physical reason whatsoever. Exercise finally provides your body with the outlet that it was preparing for.
Why Zebras Don’t Get Ulcers, by Robert M Sapolsky, 255
This is why exercise is an effective outlet for frustration, which is well-known to measurably reduce the stress-response.
How To Tell The Difference Between Anxiety And Neurological Disorders
Unfortunately, there is simply no way to tell the difference between suffering from anxiety and suffering from a more serious neurological disorder. The symptoms can look extremely similar, and while some may have some minor differences , the reality is there are often no differences.
This is why it is important to always see a doctor. Even though anxiety is extremely common, a doctor is the only way to accurately determine if a person does/does not have an underlying neurological disorder. Once a doctor rules out any neurological problems, it is important to begin to take steps towards controlling the anxiety. Unmanaged anxiety will lead to continued neurological symptoms, and ultimately, more anxiety.
In the extremely rare event that a person does have a neurological disorder, controlling anxiety is still important. Anxiety plays a significant role in not only happiness and overall wellbeing, but also in the success of medical treatments. If there is any reason to think that you have anxiety and not a neurological disorder, openly seeking help is incredibly important.
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Numbness And Tingling Are Common Symptoms Of Anxiety Panic And Stress
Many people experience numbness and tingling when they are anxious, having a panic attack, or chronically stressed. It is a common symptom and nothing to worry about.
When this numbness tingling symptom is caused by apprehensive behavior and the accompanying stress response changes, calming yourself down will bring an end to the stress response and its changes. As your body recovers from the active stress response, this numb and tingly feeling will subside and you should return to your normal self. Keep in mind that it can take up to 20 minutes or more for the body to recover from a major stress response. But this is normal and shouldn’t be a cause for concern.
When this numbness tingling symptom is caused by chronic stress , it can take a lot longer for the body to recover and to the point where this symptom is subsides.
Nevertheless, when hyperstimulation has been eliminated and the body has fully recovered, this numbness tingling symptom will completely disappear. Therefore, the numbness tingling symptoms needn’t be a cause for concern.
You can speed up the recovery process by reducing your stress, practicing relaxed breathing, increasing your rest and relaxation, and not worrying about this feeling. Sure, the numbness tingling anxiety symptom can be unsettling and even bothersome. But again, when your body has recovered from the stress response or chronic stress, this symptom will cease.
For a more in-depth explanation, see our .
Physical Anxiety Symptom 4: Skin Tingling And Numbness/ Feeling Weak
It is common for anxiety to cause feelings of numbness and tingling. This can occur almost anywhere on the body but is most commonly felt on the face, hands, arms, feet and legs. This is caused by the blood rushing to the most important parts of the body that can aide fight or flight. This, therefore, leaves the less important areas feeling weak, numb or tingly.
It can also be caused by hyperventilation and increased oxygen intake which is particularly felt in the extremities and the face.
Is There Any Advanced Investigation To Diagnose Anxiety Induced Pain
Event-related functional magnetic resonance imaging – FMRI can indicate the activation responses in certain part of the brain to noxious and thermal stimulation.7 Activation response changes with intensity of pain stimulation. Similar changes of increased response were observed with constant pain stimulation and variable anxiety response. The FMRI is at present research tool and rarely used in clinical practice to diagnose anxiety disorder associated with chronic pain.
Physical Anxiety Symptom 5: Temperature: Hotness Sweating Shivering
“The state of arousal also leads to a rise in temperature. Your body reacts by trying to cool you down – this is why you perspire,” Nicky explains.
Such sweating, in turn, can make you feel cold. Especially after a panic attack, as your body starts to cool down but is still perspiring to prevent overheating, it is common to feel cold and shivery.
If You Do Just One Thing With Breathing: Slow Down Your Exhalations
It doesn’t have to be an “exercise”: just pausing for an extra beat or two at the end of a handful of breaths is a good start. Literally just hold your breath for a count of 1 or 2 at the end of breaths that are completely normal otherwise.
Breathing regularity and overall slowness is a good start, but extending exhalation is even better for a specific biological reason: exhalation is literally more relaxing than inhalation. That is how we are wired.
Whenever you inhale, you turn on the sympathetic nervous system slightly, minutely speeding up your heart. And when you exhale, the parasympathetic half turns on, activating your vagus nerve in order to slow things down .
Robert M Sapolsky, Why Zebras Don’t Get Ulcers, 2004, p. 48.
You could make a simple change to the box breathing method described above: instead of holding after inhalation, you can distribute the breaths around the sides of the box like this: breathe in, breathe out, breathe out, hold it out.
Dry And Cracked Skin Including Conditions Like Eczema And Psoriasis
There are a couple of reasons that stress may lead to dry, itchy, or cracking skin.
One is that stressed people are more likely to be dehydrated or overly reliant on caffeinated beverages. Another is that stress can alter the balance of gut bacteria and increase cortisol production, which can both lead to breakouts on skin.
To reduce your risk of these problems, drinking plenty of water and eating a healthy diet are a good place to start.
Physical Symptoms Of Anxiety: A Physiological Explanation For Each
THE SCIENCE: HOW DOES ANXIETY AFFECT OUR BODIES?
“When you are put into an anxiety-provoking situation, an automatic chain of events begins, often known as the ‘fight or flight’ response. This response happens without us thinking about it because it is triggered by the part of our nervous system whose job it is to control our automatic functions ,” says Nicky. “This part of our nervous system is called the ‘autonomic system’ and is split into two components: the parasympathetic and the sympathetic systems. These work opposite each other and only one can dominate at a time. When we are in any situation that causes us anxiety, our sympathetic system starts to dominate and the ‘fight or flight’ reaction begins . “
It is important to remember that everyone experiences anxiety symptoms differently. An individual may feel all or none of the following physical symptoms of anxiety or a combination of a few. There can also be more unique physical symptoms that may not be listed here.
If Anxiety Causes Pain Does That Mean The Pain Is All In Your Head
Of course not. “Psychosocial factors” refers to the dizzying array of stresses in our lives, all the possible reasons we get anxious, which can also independently lead to pain in many ways .
So, is that just an elaborate way of saying the pain is “all in your head”? No — that phrase implies mental illness or faking it. What we’re talking about here is about stress/anxiety creating fertile ground for a crop of chronic pain. This may occur in so many ways that it’s impossible to say exactly how it happens, just like we can’t possibly know which climate factors lead to a specific storm.
Psychosocial factors in pain are a completely different thing from “all in your head.”
And yet, sadly, some health care professionals may not understand this, and some of them may equate psychosocial factors with mental illness and malingering — all the same thing in their heads. We know many healthcare professionals will take pain less seriously if there’s no obvious biological source of pain to treat, even when there is evidence of serious psychosocial factors.40 For instance, physiotherapists may stigmatize psychosocial factors in back pain, feel unprepared to deal with psychosocial factors, and prefer to grapple with the “more mechanical aspects” of back pain.41
Vagal Stimulation Techniques: How To Take Care Of The Vagus Nerve
The vagal tone is an internal biological process that represents the activity of the vagus nerve. The increase in vagal tone activates the parasympathetic nervous system, which means that we can relax more quickly after a stressful situation and this will have a positive impact on our emotional balance and on health in general.
Exist various vagus nerve stimulation techniques:
1. Exposure to cold
We know that cold exposure activates the vagus nerve because it stimulates the cholinergic neurons crossing these innervations. In fact, an investigation conducted at the University of Oulu has revealed that a regular exposure to cold helps to reduce the fight-flight response that triggers the sympathetic nervous system.
It could be enough a cold shower of 30 seconds a day or a cold towel on the face. There are also those who lie down on the belly putting a cube of ice on the nape. Others prefer to drink quickly a glass of cold water.
2. Diaphragmatic breathing
Most people inhale air between 10 and 14 times per minute, which means they have a superficial breathing. The ideal would be to inhale air 6 times per minute. Therefore, another very effective vagal stimulation technique consists in breathing deeply.
With diaphragmatic breathing, we have a deeper breathing that brings air into the lower part of the chest, using the diaphragm correctly and promoting relaxation.
3. Meditation, yoga and tai-chi
Treatment Options When Pain And Anxiety Or Depression Intersect
In patients with depression or anxiety, various psychotherapies can be used on their own to treat pain or may be combined with drug treatment.
Cognitive behavioral therapy. Pain is demoralizing as well as hurtful. Cognitive behavioral therapy is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain. CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain.
Relaxation training. Various techniques can help people to relax and reduce the stress response. Stress tends to exacerbate pain as well as symptoms of anxiety and depression. Techniques include progressive muscle relaxation, yoga, and mindfulness training.
Hypnosis. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve. Some patients can also learn self-hypnosis. One study showed that hypnosis training reduced both gastrointestinal distress and levels of depression and anxiety in 71% of those studied.
Exercise. There’s an abundance of research that regular physical activity boosts mood and alleviates anxiety, but less evidence about its impact on pain.
How Do You Deal With The Anxiety / Stress / Neuropathy Issues
If you feel that you have new anxiety or stress issues or if there are changes in the anxiety or stress issues from which you have suffered for some time, you should bring this to the attention of your medical doctor.
He will need to do some testing to ascertain a diagnosis and a subsequent treatment plan.
Here are a few treatment options which might be recommended by your medical doctor:
Pain medications – there are some medications which have the ability to treat the pain as well as the anxiety disorder – for example, sometimes fibromyalgia sufferers are treated with a selective serotonin reuptake inhibitor and anxiolytics, tricyclic antidepressants, and monoamine oxidase inhibitors that work well for headache pain.
Cognitive behavioral therapy – this is used to treat anxiety disorders as well as the pain.
Relaxation techniques – these techniques help to teach anxious individuals various methods of coping with the stressors in their lives – the most common techniques include breathing retraining, progressive muscle relaxation, and exercise.
Complementary and alternative treatment – these include YOGA, acupuncture, and massage to relieve the symptoms of anxiety disorders and the discomfort of the chronic pain.
Additionally, there are some lifestyle changes that will help the anxiety disorders which will also help reduce the discomfort of the chronic pain:
If you have issues with getting a good night’s sleep, here are some suggestions which may help:
Physical Anxiety Symptom 1: Chest Pain And Heart Palpitations
You may think it’s a sign of an impending heart attack but it’s not. When you feel anxious or are having a full-blown panic attack, the heart beats faster to pump more blood around the body to prepare for fight or flight.
This action can cause hyperventilation which leads to breathing in too much oxygen. This, in turn, causes a contraction of the blood vessels which can lead to chest pain.
Chest pain caused by anxiety is often felt across different areas of the chest and comes and goes.
It is also important to note that a rush of adrenaline does not damage the heart.
But there’s no need to feel silly if you’ve ever thought you were having a heart attack. Nicky says: “Over the years we have been contacted by many people who have told us that they have had to rush off to casualty because they truly believed they were having a heart attack. Once there, they were told , that their problem was entirely psychological.”
Note: Whenever chest pain is concerned, it is always a good idea to visit the GP once to rule out any other heart conditions.
How Critical Is Anxiety Disorder When Induced By Chronic Pain
Anxiety Disorder is classified into several types. Type of anxiety disorder associated with pain is known as “Generalized Anxiety Disorder”. Symptoms of generalized anxiety disorder are irrational worries, agitation, restlessness and insomnia. Symptoms of anxiety disorder can be troublesome and serious if not treated earlier. Interpersonal relationship and family relationship become demanding and quarrelsome. Emotional responses exhibited out of anxiety are ill-tempered verbal gesture, tantrum, shouting, and unnecessary arguments. Anxiety induced daily symptoms like headache, nausea, numbness, muscle ache, breathing difficulties and swallowing become predominant along with pain in later stages. These symptoms become primary symptoms and leads to unnecessary diagnostic tests.
Theory Vs Practice: Youre Not Always Going To Get Ideal Cbt
It’s easy enough to get optimistic about CBT in the abstract, but in my personal experience with several psychologists over the years, and based on a lot of communication with readers … well, let’s just say not all CBT is created equal. There’s a great range of quality and creativity in its application, a big gap between the best possible CBT and the kind that many people will actually encounter in “the wild” — being sold for a bare minimum of $100/hour.
Good CBT probably gives you a better chance than winging it on your own, but it’s still not an easy road. And its most common weakness in practice seems to be an unfortunate overemphasis on the thinking part — using conscious thought as leverage. Which I cynically assume is an issue simply because that’s what is easiest to do in a therapy session.24
Thinking may be what gets us anxious in the first place, and it may be hard to fight fire with fire, hard to use calming thoughts to subdue or replace worried thoughts. Or, worse, worried thoughts may over time become embodied, so entrenched in our behaviour and biology that they are no longer just thoughts — and fresh attempts to think less worried thoughts may have little impact, especially at first.