People often turn to therapy to learn techniques for managing anxiety. While these techniques can be helpful, they often don’t significantly reduce people’s suffering. That’s because they only focus on the symptoms of anxiety, and not on its cause. In this post, Jane Rubin, PhD., talks about how understanding the meaning of your anxiety is the key to reducing it.
Where do you focus when you begin anxiety therapy?
I always begin by working to understand what the patient is worried about. They came into therapy because something was bothering them. What is it?
From there, I like to focus on practical solutions. Is there something in their situation that they can change? Do they need to have a lighter workload or more child care or more help taking care of an elderly parent? I always want to make sure that there’s not a practical solution before thinking about going deeper.
And, finally, I often introduce people to mindfulness meditation techniques that can reduce anxiety, or suggest medications that might be helpful.
In most cases, however, these interventions alone are not enough to significantly reduce a patient’s anxiety. Once that’s become clear to both of us, I begin to explore the deeper sources of their anxiety. There’s usually something underlying the worries they’ve expressed that’s making their anxiety feel intractable. That’s what we want to address.
For example, I had a patient who was an engineer at a tech firm. She was constantly anxious because she felt that her work wasn’t progressing quickly enough. We talked a lot about how her regular evaluations were always very good, and how her boss always seemed pleased with her work, but her anxiety didn’t budge.
At a certain point, this patient started to talk about how she could make much more rapid progress if she could get more equipment, and if she could have one more person working under her. But she felt that she couldn’t ask for these additional resources. Because we had talked about her family background at various points, I knew that her reluctance to ask had its roots in her early experiences.
This patient had an older sister who had a serious, chronic illness. When my patient was young, a lot of the family’s resources and attention went into the sister’s care. My patient could tell how stressful this situation was for her parents. She decided that the only way she could help them feel less burdened was to not ask for anything for herself. That meant, for example, that she didn’t ask for a better computer that could have helped her do better in her high school classes.
As we discussed this, it became evident to my patient that the anxiety she felt about asking for more resources at work was the same anxiety she felt when she thought about asking her parents for something. She felt that she would be taking needed resources from her co-workers, just as she had felt that she would be taking needed resources from her sister.
Once we put this together, it became much easier to address the real sources of my patient’s anxiety–the persistent feeling that she wasn’t entitled to the same things as other people. As we were able to address this fear directly, she became much more confident about asking for what she needed. Her work progressed more quickly, and her anxiety decreased significantly.
Do you feel that exploring the source of anxiety leads to greater insight and healing?
I do. It’s like the difference between treating symptoms and treating an underlying disease. If doctors only treated symptoms, and not the underlying cause of the symptoms, the symptoms would keep recurring. The same thing is true of anxiety. If we can address the cause, we can reduce the symptoms.
So the goal isn’t to identify and change unhelpful behaviors?
It is. But the question is how to do that. Sometimes, addressing the behaviors directly is enough. But, usually, by the time someone comes to therapy, they’re very aware of what their problems are, and they’ve worked hard to address them on their own. What’s missing is an understanding of why they’re doing what they’re doing.
It’s also often the case that, by the time someone comes to therapy, they’re feeling very down on themselves for not being able to solve their problems on their own. They often feel that there’s something wrong with them–that they’re being irrational, or that they must not really want to solve their problems. Coming to understand the real sources of their anxiety then serves two functions. It reduces their anxiety, and it also allows them to be more compassionate towards themselves.
So do you operate on the premise that current anxiety has a way of pointing us toward childhood experiences?
I do. I’m thinking about a patient who developed a disfiguring illness. He was terrified that people would make fun of him when they saw him.
This patient had an acquaintance with the same illness, and he knew that people treated her with kindness. But he was convinced that his illness meant that his life was over.
Eventually, we were able to trace this patient’s anxieties to his early experiences in his family. His father demanded that everyone in the family appear perfect on every occasion. He lined them up for military-like inspections before they went out in public.
My patient grew up with the fear that any imperfection would amount to being shunned by other people. Over time, however, he was able to recognize that his father had an intense fear of being shamed, but that he–my patient– didn’t need to continue to restrict his life by taking on his father’s fear as his own.
So, would you say well-being is tied to understanding how beliefs about ourselves were created?
I would. Not all well-being is tied to this, of course. My patient still suffers from the physical effects of her illness. That’s not something that therapy can treat. But so much of the emotional suffering in the world is caused by our being trapped in a set of meanings that are no longer serving us. It might have made sense for my patient not to ask her parents for a computer when they were completely preoccupied with her sister’s illness. But continuing to fail to advocate for herself because she didn’t want to burden her company wasn’t serving her or the company.
The point is really that people come by their anxiety honestly. They’re not irrational or self-destructive. But the reasons for their anxiety are usually opaque to them until they can develop a relationship with a therapist who can help them understand the causes of their suffering.
Are you struggling with anxiety? Please click to learn more about anxiety treatment with Jane Rubin, Ph.D.
Please click to learn more about anxiety therapy and treatment with Jane Rubin, Ph.D. Jane Rubin, Ph.D., is a clinical psychologist in Berkeley, California. She works with individuals in Berkeley, Oakland, the East Bay, and the greater San Francisco Bay Area who are struggling with depression and anxiety. She also specializes in working with people who are trying to find meaning and direction in their lives.