• July 29, 2015
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When the Cure Makes Anxiety Worse by David Berndt, Ph.D.

LS guestWhen the Cure Makes Anxiety Worse

By David Berndt, Ph.D.

When I was writing Overcoming Anxiety I noticed one glaring omission in most of the current literature, and that was any in depth discussion of whether, when combatting anxiety, to rely on one technique or another. Is medication always a good idea? Should you challenge a negative thought or maybe instead do some deep breathing, or would self-hypnosis be a better strategy? You see, even very useful and proven techniques are more useful in some situations than others.

Escape Techniques: When to use them
One consideration is that when you use a technique as a way of escaping the anxiety, you generally are getting a short term relief, if you chose an effective method, such as a distraction technique or a benzodiazepine medication. But for individuals with phobias, obsessions, and other anxiety-based fears in which running from the anxiety IS the problem, then a quick success at escaping by something outside of you may only serve to reinforce the fear and make the anxiety seem larger and scarier than before.

When you are so anxious that the only thing you can think of is to take a pill, then when the pill works, and you become accustomed to relying on it, you have taught yourself that the anxiety is much more powerful than you are, and you need the medicine to deal with it. The same is true if you successfully use a distraction technique like the 54321 method I discussed in Overcoming Anxiety. If you are convinced that you need a powerful technique, chances are that the reliance on that technique this time, will necessitate that same reliance the next time that severe anxiety shows you the same face. You get away for now, but only to find that the anxiety monster has grown the next time.
Escape techniques like medication, self-hypnosis, distraction and guided imagery are not your best choice in these situations. Consider, as a front line intervention one of the grounding techniques, like deep breathing, cognitive reframing, or an exposure technique, so that you can be mastering and deploying a tool rather than making yourself feel more helpless.
When, then, are these escape techniques best applied? One clear example is when there is no immediate danger, and you are well aware of that fact, such as when you realize that you are having a flashback. A flashback occurs often in Post-Traumatic Stress Disorder (PTSD) but more often than you might think in other anxiety disorders. A flashback is present when something incidental (a noise, a smell, a feeling) triggers a memory of a past situation where there was threat that was beyond your resources at that time. You may well need to eventually deal with a flashback, but often, in the here and now, relief is all that is needed. Effectively distracting yourself and/or medication can be very helpful at a time like this, as can guided imagery or self-hypnosis.
Another time when escape techniques can be helpful is when the real threat is so overwhelming, or so compelling, that anything less than escape, even if short lived, is unthinkable, or at least unnecessarily painful. For example, when I am working with survivors of 911, then I typically do not see much point to mastering a fear of flying, unless job or circumstances make that mastery a necessity. However occasionally, for family or other purposes, a flight is nevertheless required, at those times reliance on same Dramamine, distraction techniques, or a benzodiazepine, are probably a sensible solution.

Drugs vs Therapy

The question of whether someone should use medication or psychotherapy can be a matter of personal prerogative, and the wishes of the person most effected should be a major factor. However, not every person is temperamentally suited to therapy, or perhaps access to a good therapist is limited by financial or geographic barriers. Furthermore, some clients are more or less sensitive to medication effects, or prone to addiction, and the benzodiazepines can be highly habit forming.
Another consideration, however, is the question of what role anxiety medication can play. When anxiety medication is appropriate (and this decision needs to be made in consultation with your physician or psychiatrist) than it works best, in my experience, when it serves a role comparable to a brace when you have a leg injury. You can use a brace to stabilize your leg and help you walk, while you work on getting your leg in shape. Therapy, in this metaphor, is more like the exercise and physical therapy you do when you are trying to regain more or less normal functioning.

About the Author

David BerndtDavid J. Berndt, Ph.D. was an Associate Clinical Professor of Psychiatry at the University of Chicago where he published or presented over 80 papers and articles before establishing a private practice. Dr. Berndt currently lives in Charleston, S.C. where he also teaches in an adjunct capacity at the College of Charleston. He is best known for his psychological tests The Multiscore Depression Inventory, and the Multiscore Depression Inventory for Children, both from Western Psychological Services.

His latest book is the nonfiction self-help, Overcoming Anxiety.

For More Information

About the Book:

Overcoming Anxiety 2The good news is that anxiety can be overcome without relying on medication. Psychologist David Berndt, Ph.D., in Overcoming Anxiety outlines several self-help methods for management of anxiety and worry. In clear simple language and a conversational style, Dr. Berndt shares with the reader powerful step by step proven techniques for anxiety management.

You will learn:

  • A Self-hypnosis grounding technique in the Ericksonian tradition.
  • Box Breathing, Seven Eleven and similar breathing techniques for anxiety relief.
  • How to stop or interrupt toxic thoughts that keep you locked in anxiety.
  • How to harness and utilize your worries, so they work for you.
  • Relief from anxiety through desensitization and exposure therapy.

The book was designed to be used alone as self-help or in conjunction with professional treatment Dr. Berndt draws upon his experience as a clinician and academic researcher to give accessible help to the reader who wants to understand and manage their anxiety.

For More Information

  • Overcoming Anxiety is available at Amazon.
  • Discuss this book at PUYB Virtual Book Club at Goodreads.
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