I’ve recently finished co-facilitating two rounds of a 12 week therapy group aimed at helping anxiety sufferers conquer their fears. The ‘self help’ group, as it is called, is basically an exposure based 12 week program which encourages members to face their fears by gradually ‘exposing’ themselves to the source of their anxiety bit by bit. It’s called the stepladder approach and is based on basic behaviour therapy.
The aim of the group is to guide members, after explaining what exposure is and how to construct a stepladder, towards conquering specific fears or phobias. It’s not really structured for those who are diagnosed with GAD (generalized anxiety disorder), PSTD or depression for example. There is only so much you can do in a group context. That was the theory behind the group, however, the reality proved quite different. We had a few members that had a specific phobia or fear such as public speaking, or a specific social phobia such as fear of eating in public, but most of the members’ anxiety was not that specific. Most seemed to be suffering from a general malaise and in some cases extreme uneasiness in public, social phobia in general or just a case of debilitating shyness. Some had depression as well.
It soon became clear that the prescribed ‘stepladder’ technique was not going to work with these people. One could still go over the basic idea of the stepladder, that is, expose yourself to your fears, little by little. Take baby steps. But a definitely rigid approach was not going to do. So, I did some research and also, concurrently, I started an online course on ACT (Acceptance and Commitment Therapy) but mostly, I learned from the group members themselves. Hearing their stories week by week, their awkward to embarrassing moments, their small and seemingly tiny triumphs and major breakthroughs…they taught me more about how to manage this thing called anxiety, which we are all faced with to some degree, than any text book or peer reviewed article I have read.
So here’s what I learned about how best to deal with anxiety from my research and from those that know best:
1. Accept anxiety as part of life.
Most people who come to a group such as the one I have just described have been struggling with anxiety for a long time before seeking help. Some for years. What they want most when they first come to the group or seek help is for a ‘cure’ that will somehow make their anxiety ‘go away’. But what is most freeing or a revelation for some is when we explain that anxiety is a normal part of being human, and that it will always be present to some degree. Struggling with it only makes it seem stronger and bigger than it really is, ignoring it doesn’t make it go away either… However, acceptance of anxiety is something altogether different. Acceptance allows for dialogue, it allows for a two-way exchange between the person suffering from anxiety and the message that anxiety is trying to convey. It is the first step towards healing, it signifies a willing to listen, to engage.
2. Face and then embrace your fears.
Whatever it is that makes you most anxious, that is where you need to start. Jumping in head first is not a good idea, however a measured, stepladder if you will, approach really does work if done consciously, with self-awareness and with self-compassion. A step is still a step, no matter how small….however, there is a qualifier and the qualifier is as follows:
2a. Face your fears, only if they serve your greater good. That is, face and accept anxiety only if it serves your values. There is no point putting yourself through all that pain and anxiety for no good reason, if it serves you however, and helps you to achieve your goals or be the person you really want to be, then there is a very good reason.
3. Know your values.
One session, after learning about the importance of values in ACT I asked the group members to share with me their reasons for coming to group in the first place. They looked at me blankly at first, as if it was a silly question but then I explained… Yes, I know it’s because you wanted to get help with managing your anxiety but WHY? Why does that matter to you? Wouldn’t it be easier to just stay home, live with your anxiety to a degree and not push yourself to come here, or go on working through your stepladders each week? There is a reason why you do that, come to group each week, something you want to achieve or a way you’d like to live, and that reason should give you a big hint as to what your values are. Values guided action makes anxiety meaningful. It adds another, very powerful dimension to the how of exposure based therapy. The why.
4. Listen to what your anxiety is trying to tell you.
Anxiety is not always blind fear and anxiety is not a one size fits all broadcast. There are different types of anxiety. There is helpful anxiety and not so helpful anxiety. Sometimes, it is steering you towards something, sometimes it is telling you your off track. There is the anxiety that comes with moving forward, and the anxiety that comes with staying stuck. Only the individual can know what their anxiety means to them, or what it is trying to say. Mindfulness is one way of getting tuned in to what your anxiety is trying to tell you by displacing some of the static that most of us walk around with every day, without realizing it most of the time.
5. You are what you do most.
All the skills and techniques broached in the 12 week course (and in most CBT based therapies including ACT) are all pretty sound, yet none of them will work if we only pay lip-service to them. There is no magic pill or cure for anxiety or any other mental illness. Medication helps to a degree but it really only treats the symptoms, or helps with balancing out chemicals that have become imbalanced in the first place because of what the individual has experienced, reacted to and consequently how they have been behaving for many years. It takes dedication, practice and conscious choice to over-ride what have become automatic behaviours or ways of responding for many anxiety sufferers. The more you practice these new behaviours, thoughts, techniques and ways of being, the more they will seem natural.
So that’s pretty much it. (Well not really it, but a sizeable chunk, and besides, I’m getting sleepy!)
All good things take a little time, but like all good things, they are truly worth it in the end. As has been my journey towards becoming a qualified counsellor…it’s been a long 3 and a half years and in a few weeks I will be done with this first long stretch of road. Yes, in just a few weeks I will be qualified! However, while I feel I have learned so much, it gives me a certain amount of anxiety to realize that I have still sooo much more to learn. But, I’m pretty sure it’s the good sort of anxiety…