Overcoming anxiety and fear is possible. Even without medication. But first, we should understand what’s behind it.
Anxiety and fear are quite normal emotions and common reactions to threatening situations, objects, and stress. These feelings are even important and a helpful warning signal to avoid dangerous situations and problems. Feeling anxious about war, diseases, or being nervous about holding a speech in public are normal reactions.
But when anxiety and fear become overwhelming and a constant feeling that affects social life, daily tasks, or our job, it may need some treatment.
Almost 20 % of the population in the United States suffers from an anxiety disorder, with around a quarter of these cases classified as severe. The prevalence of any anxiety disorder was higher for females (23.4%) than for males (14.3%).
An anxiety disorder is the most common mental health problem for women and the second most common for men. Fewer than 40 % of anxiety sufferers are receiving treatment for their disorder. The reason is that many people don’t acknowledge or recognize their symptoms, and hesitate to talk about their feelings with a professional.
Anxiety is often undetected and untreated because the diagnosis may simply be missed because of other (the anxiety) overlaying medical conditions, or because the person suffers from anxiety since their childhood and perceive their feelings and coping reactions as normal.
Untreated anxiety and fear can lead to
- sense of doom and difficulties concentrating
- panic attacks
- headaches from constant worry and stress
- breathing problems
- loss of libido
- feeling wiped out and fatigue
- increase in blood pressure
- social isolation
- poor quality of life
Fortunately, there is a solution: Fear and anxiety are treatable with medication or professional coaching or therapy. We will focus on anxiety disorder treatment without medication, but with proven techniques adapted from cognitive-behavioral therapy (CBT) which has turned out to be one of the best methods.
What is anxiety?
Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing. It is often accompanied by muscular tension, restlessness, fatigue, and problems in concentration.
Anxiety is closely related to fear, which is a response to a real or perceived immediate threat; anxiety involves the expectation of future threats. People facing anxiety may withdraw from situations that have provoked anxiety or fear in the past.
What are the different types of anxiety disorders?
Specific Phobias ( What are specific phobias?)
Specific phobias are among the most common anxiety disorders. They are an overwhelming and unreasonable fear of objects, places, or situations that pose little real danger but provoke anxiety and avoidance.
Some examples of specific phobias are spiders, elevators, flying, fear of public places (Agoraphobia). Thinking about or facing these situations can cause stress, severe anxiety, or even panic attacks.
Social Anxiety Disorder or Social Phobia (What is Social Anxiety?)
Those who suffer from social anxiety disorder fear being judged by others or embarrassed in public. It’s more than just shyness or being nervous talking in front of a huge audience. People with social phobia are afraid that people think badly about them or that they won’t measure up in comparison to other people.
In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt one’s life. Typical signs of a social phobia could be
- The fear of situations where others might judge you
- Worrying about embarrassing yourself
- Avoiding certain situations, events, and activities
- Typical symptoms are blushing, trembling, sweating, fast heartbeat, or muscle tension.
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder is characterized by persistent and excessive worry about several different events, situations, or things. Those who suffer from GAD may anticipate disasters (catastrophic thinking).
Generalized anxiety disorder causes people to feel anxious about a wide range of situations and issues, rather than one specific event. They may be overly concerned about their life, family, health, or other things. People with GAD feel anxious most of the time and as soon as one anxious thought is resolved another one may appear.
Typical symptoms are the feeling of constant worry and restlessness. That results in having trouble concentrating and sleeping.
Post-traumatic Stress Disorder (PTSD)
Post-traumatic Stress Disorder can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, or other threats on a person’s life.
People with PTSD persistently avoid either trauma-related thoughts and emotions or discussion of the traumatic event, and may even have amnesia of the event.
However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma (“flashbacks”), and nightmares. During a flashback, a person may believe the traumatic event is happening again.
What can cause anxiety?
The reasons for anxiety disorders can be versatile:
- Trauma: People who experience or witness a traumatic event
- Past or childhood experiences
- Constant stress: This could be a constant worry about work or finances or stress in the family
- Personality & family history: Some people are more prone to anxiety disorders than others
- Current life situation (e.g. death of a loved one, being out of work, feeling lonely and isolated)
- Drugs and alcohol
- Chronic grief
- Other mental or medical illnesses
How to overcome fear and anxiety
We will focus on anxiety disorder treatment without medication, but with proven techniques from cognitive-behavioral therapy (CBT). How severe anxiety symptoms are, varies from person to person.
While the following tips and tools are certainly helpful for most people who suffer from anxiety and fear the individual person’s situation should always be considered.
If in doubt a detailed diagnosis should be based upon professional clinical judgment.
Cognitive-behavioral therapy (CBT) – The best way to deal with anxiety
There is a lot of evidence to support the use of cognitive-behavioral therapy and mindfulness to treat anxiety. This knowledge and these techniques have been used to create a toolkit that supports therapists and coaches in the work with clients who suffer from anxiety. The tools and techniques of this toolkit could even be used as self-help for anxiety.
Every person is different and so are their resources, conditions, and the level of worry, fear, or anxiety. There’s no one size fits all and no blueprint. That’s why you should always evaluate which tool or technique suits this particular person you’re working with.
Overcoming anxiety is a step by step process. It starts with exploring the motivation and goals of the person that suffers from anxiety and fear. A clear defined goal such as holding a speech in front of colleagues or being able to enter a plane to go on holiday with the family is a real motivation. If the client has such a „WHY“ the chances of overcoming the anxiety increase a lot.
The next step is to become aware of what causes anxiety, fear, worry, or even panic. Creating an anxiety profile and monitoring anxiety and worry episodes throughout daily life will help to understand the often irrational thoughts and fears in our minds. One big part is also the imaginal exposure (in sensu). It involves a repeated recounting of the feared situation (emotional reliving).
Once this is done we are ready to face certain situations, or objects in vivo (real-world exposure).
A good exposure activity should be uncomfortable but safe. It should lie within the person’s control (Being approached by a stranger is beyond your control, but actively approaching a stranger is). It should be as specific as possible and repeatable so that the person can do it various times.
It’s a step-by-step process that starts with exploring and understanding what causes anxiety.
The first step is to define the goals, motivation, and expectations for overcoming anxiety, fear, and worry. This will be done in tool 1.
Exploring the core fear (Tool 2) prompts people to describe any past experiences that might have led to their fear and anxiety.
The “Discovering my Anxiety and its Symptoms” (Tool 3) worksheet is also designed for the early stages of the process. This exercise will provide your client with an opportunity for them to explore their own experience with anxiety. It helps discover the physical, behavioral, and cognitive symptoms one experiences when anxious.
The anxious mind conducts many dangerous miscalculations about the future and possible outcomes of situations.
The following are some of the most common miscalculations of the anxious mind:
- They overestimate the likelihood of negative future events.
- They underestimate how much power they have over changing negative situations.
- They over-plan to accommodate all possible future scenarios.
The Tool 4 “My Thinking Maze” was designed to give you insight into the often dangerous and helpless thinking profile of an anxious person.
Once you know more about the anxiety and the thoughts behind it, it’s time to take stock and create a profile. Depending on the answers to the earlier exercises you could use the anxiety profile (Tool 5), worry profile (6), panic profile (7), or exploring social anxiety (9).
Another important element to consider is the belief system of the anxious person. Many beliefs we have are not necessarily based on fact, experience, or knowledge.
There are many beliefs about anxiety that can make an anxious person even more anxious. Exercise 8 will help them become aware of their beliefs. One will identify their core beliefs about their anxiety and create a new balanced and helpful belief in this exercise.
Thought Journals / Thought Records are incredibly valuable anxiety exercise for kids and adults
Thought diaries or thought records are a perfect approach to addressing the negative cognitions often associated with anxiety disorders. In the Tools (11-14), clients are asked to write down their thoughts and anxiety periods, the situation in which they had the thought, the symptoms, and emotions associated with the thought or anxiety/worry episode.
They also track and become aware if, and how they attempted to cope, and the actual outcome of the event. Journaling and keeping track is incredibly valuable for helping clients become aware of the specific situations that cause them anxiety or worry. They find out which techniques work to help them calm their worries.
Normal anxiety is intermittent and is expected based on certain events or situations. Problematic anxiety, on the other hand, tends to be chronic and irrational. It often interferes with many life functions. Avoidance behavior, constant worry, and concentration problems may all have their origin in problematic anxiety.
That’s why we designed a tool to let anxious people compare normal anxiety with their problematic anxiety. How do they feel? How do they think? How do they react?
Exercise 15 will help to distinguish normal anxiety from problematic anxiety and help them learn that their anxiety is often irrational.
Countering the anxiety is another useful tool based on techniques from cognitive behavioral therapy. It will help the anxious person to make a cost/benefit analysis that can be used to challenge unhealthy anxiety-provoking thought-patterns, allowing them to be replaced by new, healthier, and more realistic thoughts and beliefs.
Tool 16 prompts to describe an anxiety triggering thought or behavior. One has to write down the short- and long-term costs and benefits of that thought or behavior and come up with a healthier alternative.
How to get over anxiety – Exploring the avoidance and escape profile
Avoidance and escape are behaviors where people suffering from anxiety either do not enter a situation (avoidance) or leave situations after they have entered (escape). Avoidance and escape are common and natural mechanisms for coping with anxiety.
Avoidance coping typically involves doing something, like extensively washing one’s hands to try to get rid of all bacteria to avoid disease. It can also involve “not doing something” like not going to certain social events like parties to avoid awkward conversations and being perceived as stupid.
These behaviors become problematic when used too frequently.
The avoidance instantly decreases anxiety because they have not put themselves in a distressing situation. Avoidance and escape make anxiety better in the short term but will make it worse in the long term.
The reason is we become more and more unwilling to confront the anxiety in the future. As one doesn’t disprove their feared catastrophic outcome the anxiety may increase and also be transferred to similar situations and make the problem even worse.
Becoming aware of one’s avoidance and escape profile is an important step to overcome anxiety. (Tool 17).
Ways to get rid of anxiety:
Decatastrophizing – Challenging Anxious Thoughts
People with anxiety tend to focus on the worst-case scenario. It’s called catastrophic thinking.
Decatastrophizing is a tool well known in the CBT (cognitive-behavioral therapy) and can be used for cognitive restructuring. It promotes the elaboration of balanced responses.
It’s also known as the “what if” technique because the worst-case scenario is confronted by asking: “What if the feared event or object happened, what would occur then?”
Tool 18 confronts the anxious person with a worst-case scenario of a feared event or object, using mental imagery (in sensu) to examine whether the effects of the event or object have been overestimated (magnified or exaggerated) and where the client’s coping skills have been underestimated.
How to get rid of anxiety forever?
The last important step to get over anxiety and fear is exposure.
Exposure is a technique well known in behavior therapy to treat anxiety disorders. It involves exposing the anxious person to the anxiety source or its context (in vivo) without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.
Exposure – The best way to deal with anxiety
In Tool 19 the client will make a list of objects and situations that they fear or usually avoid. The activities are ordered in their ability to provoke anxiety. The most anxiety-provoking situation will be listed at the bottom while the least anxiety-provoking situation should be at the top. The list should contain around 10-15 items and is a great guide for the client’s exposure practices.
Over time the client progresses up the hierarchy to more and more difficult exposures. An exposure hierarchy can also be used as an indicator of the client’s progress and their increasing ability to deal with fearful situations.
Tool 20 and 21 track the single exposure task your clients are going to tackle. They will record their feelings, anxiety, thoughts, and the actual outcome of the task. Clients fill out these questionnaires for each exposure task.
Part 1 should be filled out immediately before doing the task and part 2 afterward. This allows us to compare the expectations before each task with the actual outcome. All thoughts, feelings, reactions, coping behavior, and experiences are tracked.
Once the client successfully worked their way to the top of their exposure hierarchy it’s time to evaluate the journey (Tool 22). How did they feel before the treatment? What have they learned during the journey and how are they feeling now?
It’s also space for them to think about future steps and goals to maintain the gains. The main goal is the lasting success of our clients.
We wish you and your clients all the best along the process to overcome fear and anxiety.