First Steps to Overcoming Anxiety

by Dave Carbonell, PhD

This article is a consumer guide for people who are having anxiety troubles and want to know more about overcoming anxiety.

Step One:
Assess Your Symptoms and Situations

Read my description of the different anxiety disorders and compare your experience with those descriptions. The Association for Behavioral and Cognitive Therapies (ABCT) offers a free set of fact sheets for anxiety disorders and many other problems as well. Do you experience some of the symptoms and troubles described therein? If so, you may find it useful to use a self-screening questionnaire to evaluate your situation in a little more detail.

The Anxiety and Depression Association of America (ADAA) offers good, free screening questionnaires. This is not a substitute for a consultation with a mental health professional, but it's a good start. It will help you better evaluate your concerns, and organize your thoughts for a discussion with a mental health professional if you decide to take that step.

It's common to experience a mix of depression and anxiety symptoms, and this is often a source of confusion to people. If this sounds relevant to you, read a little bit about depression. You can also use the depression screening questionnaire at the ADAA site.

Step Two:
Consult with your primary physician

A consultation with your physician is a good start if you suspect you have an anxiety disorder.

Sometimes, physical symptoms that are often part of an anxiety disorder can be caused by other conditions. For instance, symptoms associated with a thyroid problem, mitral valve prolapse, or diabetes, can sometimes be confused with panic disorder. This is not a common occurrence, but it's useful to rule out the possibility. If you suspect that you have an anxiety disorder and have never been evaluated by a physician, I recommend that you do so as your first step toward overcoming anxiety disorders.

Be aware, however, that most physicians, because they specialize in various aspects of physical health, have very little training in the area of anxiety disorders. What training they do have, with respect to treating anxiety, is often limited to medications. They may be much less familiar with cognitive behavioral treatment (CBT) for anxiety disorders, even though it is widely considered to be the treatment of choice. Once your physician has evaluated your physical health, you will probably need to go elsewhere for help in overcoming anxiety disorders.

Before you call for an appointment, make some written notes of what you want to discuss with your physician. The doctor's staff will probably ask you why you want an appointment; tell them that you've been having some problems and summarize them, briefly. If you have used one or more of the screening questionnaires from ADAA, it might be helpful to bring them with you.

What to Expect from Your Physician

Your physician should listen to your symptoms, review your history, ask questions, and offer feedback and recommendations for overcoming anxiety. Since most physicians are trained principally in physical health and medicine, there is no reason to expect them to be an expert in anxiety disorders. However, your physician should take your complaints seriously, evaluate them, and offer suggestions for finding additional help.

If you are having panic attacks and have never been tested for thyroid malfunction, for instance, you should receive such a test, because thyroid problems can sometimes cause a person to have panic-like symptoms. If your symptoms resemble those associated with mitral valve prolapse, you should probably have an echocardiogram to evaluate that possibility. There are numerous physical conditions which can produce symptoms that resemble panic, and your physician should evaluate you for those possibilities if that has never been done before.

However, if you have had those tests before, and your doctor assured you that you were in good health, do not push for continual retesting! Many people do this because they hate the idea that they may have an anxiety disorder, and instead hope to find a physical problem. You can waste lots of time and money this way.

One set of tests is generally enough. If you need a second opinion for a particular reason, then get one. If you get more than two sets of tests, seriously consider the possibility that you are getting diverted from your task of overcoming anxiety!

Let's suppose that you've had a good consultation with your physician, the appropriate tests have ruled out any physical ailments which could be causing your symptoms, and you want to get professional help with overcoming anxiety. Now you're ready for step three.

Step Three:
Learn about the available treatments

There are two kinds of evidence-based treatment which clinical research has shown to be effective in overcoming anxiety disorders: CBT and certain forms of medication. Other forms of psychotherapy are often helpful in resolving some of the issues associated with anxiety disorders, but are generally not regarded as capable of resolving the primary problem. Which form of treatment should you choose?

My view is that most people with anxiety disorders are best served by trying a cognitive behavioral treatment first, and seeing what kind of results you get from that. You can always try medication later, if the CBT doesn't provide all the results you seek.

There are three principal reasons to try CBT first. First, unlike medication, CBT has no side effects. Second, the use of medications tends to lead a person to believe that he or she is now "protected" from anxiety disorders, and the sense of being protected often leads an anxiety sufferer to feel more vulnerable in the long run. Third, clinical research indicates that the results you get from CBT treatment will generally be much more long lasting than those you get from medications.

Some patients may need medication in addition to CBT, depending on the severity of their condition and their particular diagnosis. Medication is nothing to be avoided if it seems necessary. However, I do believe it's true that in our culture, medications are overprescribed for these problems. This can be avoided if you start with CBT first.

The Anxiety Disorders Association of America website includes an overview of medications used to treat anxiety disorders.

There are newer forms of CBT, often labeled as "Third Wave" therapies, such as Mindfulness and Dialectical Behavior Therapy (DBT). One in particular, Acceptance and Commitment Therapy (ACT) is quite useful in the treatment of Panic Disorder and other anxiety disorders. In my work, I blend methods from both traditional CBT and ACT, and find them both very useful in overcoming anxiety disorders.

To read about CBT and some of its various forms, click here.

Do I Need "Treatment" at All?

You may be wondering if you really need to see a professional, or if you can't just solve this problem on your own. In general, the more difficulty you are having, the more you may need professional help, but only you can decide how urgent your need is. Certainly there are many good sources of self help information you can use in overcoming anxiety disorders. If you choose to try anxiety self help, I suggest you follow a few guidelines.

* Get a "buddy", a coach, or a support person, with whom you can discuss your efforts on a regular basis. They don't have to be an expert. A major benefit is that, by telling someone of your efforts, you will find it easier to monitor your progress and hold yourself accountable. It's easy to forget about all your good intentions when you keep them to yourself.

* Follow an organized plan. Find a good self-help book which pertains to your problem, and make that the basis of your work. If you have panic attacks and like the approach you find on this website, then try my Panic Attacks Workbook. If your problem is more about chronic worry, take a look at my book for chronic worriers, The Worry Trick.

* Evaluate your progress at regular intervals, at least monthly. After three months, re-evaluate your progress. If you're satisfied you're making reasonable progress toward overcoming anxiety, continue on course. If you're not, consider seeking professional help at that time.

What about Group Treatment
for overcoming anxiety?

Among the advantages of group treatment for overcoming anxiety are lower cost and the opportunity to share experiences with others who can relate to your situation. This can be particularly important for people who feel especially ashamed and imagine that they are one of a very few who suffer in this way.

I don't really think there are any disadvantages to a well run group treatment, although many people shy away from it because they believe they would pick up more fears from hearing other people's problems. In my experience in running groups, this has not been a problem and, while people are usually quite nervous before the first meeting, their anxiety is usually much lower by the end of the meeting.

Group treatments are often not available, so consider yourself fortunate if they are offered in your area. Your own personal preference is probably the most important deciding factor in the choice between group and individual treatment.

...And Support Groups?

You may also find it helpful to attend a support group. There are general purpose support groups designed to help people with a variety of psychological problems, and there are anxiety support groups which have a more specific focus - anxiety problems in general, or specific anxiety disorders such as Panic Disorder, Obsessive Compulsive Disorder, etc.

Support groups can be helpful, or not, depending on how they organize themselves and conduct meetings. The article linked above has some suggestions for how to evaluate the usefulness of a support group in helping you with your goal of overcoming anxiety.

Step Four:
Identify Qualified Therapists

If you decide to get professional help, be prepared to do some work to find a good therapist. You can start by getting the names of therapists in your area who offer the kind of treatment you seek. The websites of the Anxiety Disorders Association of America, Association for Behavioral and Cognitive Therapies, and Obsessive Compulsive Foundation all offer therapist directories to help you find a specialist in your area.

You will probably be better off if you can find a therapist who has specialized training and experience with the anxiety disorder for which you seek help. However, be aware that these lists will generally include any therapist who wishes to be included; they are not a licensing or accreditation process, simply a place to start. You still need to be an informed consumer.

If you live in the Chicago area, and want to work with me, I would be happy to schedule an appointment with you

You will also find some listings of therapists and other organizations that may be helpful in my Links section.

Step Five:
Select a Therapist and Begin Treatment

An initial evaluation with a therapist may take anywhere from one to two sessions. It should enable the therapist to learn enough about you to give you some feedback about your situation and how that therapist proposes to help you, and should also give you a chance to ask more questions. One area you should certainly discuss with the therapist is what to expect in treatment, i.e., how will you know it is working? What would be a sign that it is not working?

You will probably also want to know how long treatment will take. What I tell new patients is that, while I can't immediately predict how long their particular situation will require, I do expect that they will have a gut feeling that we are moving in the right direction within the first month of weekly sessions, and that they should see some progress within the first two months. If this doesn't happen, it's a sign that something isn't working right, and we should figure out what's wrong.

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