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Alternatives For Anxiety Treatment

Question:

I am diagnosed with anxiety disorder NOS, and I know I identify most with generalized anxiety, social anxiety, and OCD kinds of symptoms. I am in therapy once a week and I see a psychiatrist once a month. I have been actively pursuing treatment for about a year now. I also work full-time and go to graduate school 2/3-time. My concern is really hard to put a finger on, because of course I have a lot of worries. I guess what concerns me most is that I have suffered from this all my life, and it has become increasingly worse over the years despite getting help. None of the 6 or so meds I’ve tried so far help, in fact I suffered serious weight gain from one of them and am still fighting that 40lb+ battle. My problem is that I am pretty sure that living my life like this will probably send me into an early grave. While I do get panic attacks, I don’t have a fear of dying, but I am very well-read and fully aware that chronic stress, lack of sleep, chronic illness like sinus infections and bronchitis, blood pressure elevations, migraine headaches, menstrual problems, reflux, palpitations, vomiting, and chronic muscle and joint pain simply aren’t good things – both from a current and more importantly a long-term health perspective. I am desperate for some relief from this. It doesn’t seem like I derive any benefit from meds (Xanax helped to take the edge off but I dare not take it long-term… I’m currently on BuSpar, which is pretty ineffectual). Therapy is incredibly slow-going (not to mention my therapist is leaving in a few months and I will need to start over with someone new soon). You have to believe me when I say I do everything within my power to try to create a more gentle way of life for myself. And yet I feel completely AFFLICTED by this disease, and of course the lack of control over feeling better makes me feel even more crazy! My health suffers, my work suffers, my school suffers, my relationships with others suffers… and I just can’t seem to find relief soon enough. I’m generally a very happy person who happens to have severe anxiety, and I’m desperate to feel like the person I know I am on the inside. Do you have any thoughts about what other approaches I can take? I just thought of some other stuff you should know. I grew up with an emotionally unavailable (she suffers from depression) mother and a workaholic father, both of whom I am estranged from. I also have an IQ of about 135 and apparently things like CBT are pretty much ineffective in the “gifted” population, or so I’ve been told.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

It’s very nice to see that you are so dedicated to solving the problem of excess anxiety in your life. Your treatment efforts so far have been fairly productive if you ask me – you’ve identified a number of treatments that don’t work well for you – or which at least do not solve your problem. You are now free to explore other forms of potential relief.

Regarding future directions, I would strongly urge you to explore CBT as your next psychotherapy approach. CBT is simply most probably the most effective form of psychotherapy you could pursue for relief from (or at least lessening of) symptoms of anxiety. Multiple scientific studies support this statement.

Unlike traditional insight-oriented psychodynamic therapy, CBT will have a laser-like focus on addressing your symptoms. It is not at all the case that CBT should be ineffective for highly intelligent people. In fact, I would predict precisely the opposite should occur. The more verbally gifted you are (the more you have a capability to self-examine and reflect on your internal mental processes), the better CBT techniques can work for you. This is because CBT will teach you methods for examining and systematically critiquing the mental processes that contribute to and possibly amplify your symptoms. Being able to intelligently view yourself and your anxiety from a variety of perspectives and to apply rational judgment will be helpful to the process, not harmful. It is the people who don’t do well with language and metaphor who have the hardest time with CBT.

While CBT may be an effective approach for you to look into, it is not in of itself a panacea and I don’t mean to oversell it. You may be well advised to continue with whatever medical/medication approaches you have discovered to be useful, and to continue new explorations within the medical treatment realm. For example, If you haven’t done so already, you might get checked for medical reasons that might be triggering your anxiety (such as hidden heart conditions, etc.).

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p> Also know that CBT methods will fail if you (consciously or unconsciously) sabotage them, or if you work with a therapist who doesn’t know what he or she is doing. Try to get a referral for someone who has a full time CBT practice and is experienced with CBT methods specifically designed for treating anxiety. Also, do what you can to approach the process of CBT with humility and honesty and piercing rationality, attempting to be a good student every step of the way. There will be homework, record keeping, journaling, etc and if you don’t do the work, you won’t benefit. Be open to believing that you can benefit as well; if you are convinced that you are a hopeless case, you will find a way to sabotage your treatment.

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