I recently came across a two year article about the popularity of Xanax, and it reminded me of the number of patients I have worked with who had already been taking medication for months and sometimes years, before they decided to try the therapeutic route. I suspect that most people who stick with their medication, even past the point of diminishing returns are unaware about the specifics of how anxiety and panic attacks are typically addressed in therapy.
When treating anxiety, there are three therapeutic models, I use interchangeably , the cognitive behavioral model, the exposure model and the hidden emotion model.
The cognitive behavioral model approaches anxiety from the idea that it is the beliefs and subsequent actions of the person that is making the person anxious. So when the person holds unto beliefs that create anxiety, that person becomes sensitized to situations that can arose anxious thoughts, with the anxious thoughts being a product of what he believes. Take for example, if a person believes that all dogs are dangerous and vicious. This person then becomes aroused by concerns for his safety whenever he finds himself in the presence of a dog, or when he learns that there is a dog close by. Furthermore this person’s anxiety might become even more amplified if he engages in behavior he believes will keep him safe from the dog. So in this situation, we can say that the person’s anxious thoughts are caused by his beliefs about dogs. So in order to help the person get past his fear of dogs, we have to work on helping him adopt a more healthier belief about dogs. In the short term we will get him to practice healthier behaviors to cope with his anxious thoughts about dogs, when he is in the presence of dogs.
The exposure model approaches anxiety from the idea that the anxiety is being caused by the person’s decision to avoid her identified stimuli for the anxiety. An example would be a fear of negotiating one’s way through a crowd of people. So the person’s anxiety would be triggered every time she encounters what she considers a crowd. Using the exposure model, the person would be encouraged to gradually immerse herself into crowed situations, during which she will go through the process becoming desensitized to crowds.
The hidden emotion model approaches anxiety from the idea that anxiety is caused by a fear of confrontation with others. As a result, people who fear confrontation mask their emotions through a facade of being nice. The hidden emotion model posits that through the chronic process of forcing niceness, people sweep their true feelings “under the rug.” Which leads to the repressed feelings being expressed through chronic anxiety and in worse cases, panic attacks. The hidden emotion model addresses anxiety through a process of helping the person become more aware of his feelings, alongside strategies for helping him become more assertive through the practice of assertive building strategies.
In practice what I have learned is that regardless of which model I use to address a client’s needs, it all comes down to identifying maladaptive beliefs the person holds unto and helping the person adopt and practice healthier beliefs. Anxiety is treatable, and in worse cases such as recurring panic attacks, a person can learn to bring the episodes of panic attacks to an end.
Ugo is a psychotherapist and life coach.