Читать книгу Ten Steps to Relieve Anxiety - H. Michael Zal - Страница 15
ОглавлениеRefocus. Concentrate on the here and now. Throw away those underlying negative feelings, particularly those from the past. Don’t play the victim. Leave the past behind. Don’t take it all so seriously. Give yourself permission to lighten up, smile and enjoy the moment. You are allowed to relax and have fun. All those bad things happened a long time ago. This is now. You are older, wiser and more in control.
Penny and Susan, two of my clients, are as different as night and day. However, they do share two things in common. They both have GAD and they both had an alcoholic parent who affected their lives and intensified their innate anxiety.
These women are not alone. Alcoholism statistics tell us that seventy-six million people in the United States alone have been exposed to alcohol dependency in the family. More than nine million children live with a parent dependent on alcohol.1 Alcoholism is a disease involving the body, mind and spirit that often reflects psychological stress. This tension can spill over onto the children in the house, creating feelings of fear and insecurity. Children absorb anxiety like a sponge.
Gilda Berger calls alcoholism “the family disease” in her book, Alcoholism and the Family.2 An alcoholic can create chaos, disrupt family life and cause harmful effects to all of its members that can last a lifetime. Children of alcoholics often show symptoms of anxiety and depression, feelings of shame, resentment, numbness, helplessness, lack of friends and problems with intimacy. They often live in fear and anticipation of danger. They have a low trust level due to a history of a sea of empty promises. Some have difficulties putting their painful childhood and adolescent memories behind them.
In families such as these, life revolves around the alcoholic. The other members unconsciously give up their own needs and take on roles that are helpful to the family unit in an effort to maintain peace and balance in their dysfunctional world. They can take on the role of caretaker, enabler, responsible one, family hero, cheerleader, mascot or lost child. As they grow older, the children of alcoholics often have trouble giving up these roles. As adults, both Penny and Susan compensated for feelings of inadequacy and helplessness by trying to appear strong. Their anxiety interfered with their enjoyment of life in the present. Both of them needed to learn to refocus, not get lost in the past and realize that they have grown physically and emotionally and have developed many new adult resources since they were entrenched in their threatening childhood world a long time ago.
Penny’s Story
“My anxiety is the way that I avoid becoming the monster. I cannot relax. I’m so worried about what might happen next. I wish my mind could rest. I feel so keyed up. When something is upsetting me, I feel shaky inside. My breathing changes and my mind is not clear. The anxiety overtakes me. My heart feels like it skips a beat. I become short winded and have trouble catching my breath.
“I wake up anxious and afraid. I can’t get enough air. When I make plans and am anticipating a good time at an event, anxiety makes me feel that it won’t happen and even looking forward to something good becomes stressful. Then the negative ‘what ifs’ start. What if something bad happens? What if I lose control?”
Penny became my client when she was forty. She explained that she had a thirty-year history of psychiatric outpatient treatment for anxiety. In her late teens, she had a history of dependency on medications. She had not taken anything since. She was divorced and had three children. She had a good work history. Her alcoholic father had died of a heart attack ten years before. She still remembered his rage, his cursing and his angry voice. “When I think about it, I feel like my brain is throbbing,” she said. She described her father as being outgoing and friendly to others when he was sober, but in the house, he was cold and distant. He often made promises that he didn’t keep. “It was constant chaos,” she said. “My father could easily blow up and be explosive. He once pulled a knife on me. He was physically abusive to my mother. He often hit me so hard that it left welts on my skin. I was so scared. I often hid under the table. I was always afraid of what would happen next. I had to prepare myself and protect myself. He was a monster.”
She also told me that her paternal grandfather had molested her when she was four. She described her mother as a woman who was emotionally disconnected, depressed and fearful, shut away in the house and taking medication for her nerves. Penny worried about her mother and felt that she always had to look out for her and protect her from her father. It was an ambivalent relationship. “She always put me down,” Penny said. “Nothing that I did was good enough. She once threatened to cut my fingers off if I didn’t stop biting my nails.” In spite of the fact that her mother used her as a confidante, she didn’t feel that her mother loved her: “She would wake me up at night to go out and get pizza and beer for my father. I had weight issues. She would make me go to the tap room carrying the empty beer bottles for rebate. I felt embarrassed and degraded with all the men looking at me. I would retreat to my room. It was my sanctuary where I felt safe.”
Penny was left with a lot of anger, lack of connection to others, depression and anxiety. “I have a need to look strong but I always feel lonely and have trust issues,” she said. She constantly struggled with how to deal with her own angry feelings: “I feel a lot of anger sometimes to the point of lunacy and rage…I’m afraid I’ll spaz out on the wrong person and tell them what I think. I’m afraid I’ll hurt someone physically. It’s frightening even to me.” Like many people who are anxious, she suppressed negative feelings and anger, because she was fearful that such feelings would cause a loss of control or disapproval from others. Because of their negative thought patterns, anxiety-prone people tend to be pessimistic. They ruminate, brood and stew. They tend to catastrophize and over-generalize. Their constant fretting clouds their perspective. They are sure that their negative reasoning reflects reality, that they are losers and will fail. This attitude often leads to depression.
Sometimes, Penny became depressed and withdrawn and showed physical symptoms, such as muscle spasms and headaches. She was very sensitive to criticism, yet she would occasionally lose her temper irrationally and push people away. She constantly struggled with wanting to be closer to her children, her boyfriend and her co-workers. However, she had problems with trust and maintaining closeness which interfered with her ability to do this. Her expectations were high and she quickly became frustrated if she felt that others did not respect her. It scared her when people lost their temper at work. Once when a woman screamed at Penny at her job, she said, “I’m afraid of people who talk like that. You never know what’s going to happen. I saw abuse and violence when I was growing up. I can’t deal with it. I have zero tolerance. I’m insecure.”
Although she seemed to be making progress at times, Penny had difficulty maintaining it and things remained the same. Always feeling like the victim, she just could not seem to find a middle ground between her mother’s and father’s behavior. Either she was depressed, passive, withdrawn, avoidant and suffering from vague physical complaints or she was disappointed and angry at everyone. “I can get ugly,” she said. “I scream and curse at my boyfriend. He is judgmental and critical like my parents. Once when we were in my car I got so angry at him that I hit the steering wheel so hard in a rage that I sprained my hand…I don’t feel peaceful inside. I try one way and if that doesn’t work, I try the other way. Something is missing. I always feel a big void. This big emptiness is always there. I feel that I’m not important to anyone.” In between these two sets of behaviors was a constant feeling of anxiety and tension. “I feel afraid that I’m not going to be able to keep my head and maintain control. I feel alone. I have no allies.” At times, she felt like the vulnerable, powerless, ten-year-old child that she once had been.
Penny’s Opinion of What Helped Her Anxiety
“I want the world to see me as strong. Some situations make me feel like when I was ten—emotionally threatened and helpless. I try to remember that I am not ten years old. I am not helpless any more. I try to distract myself and refocus. I take a deep breath and tell myself that I’m okay. I tense my muscles and then relax. No one can see me do this. I tense and relax again, while taking a deep breath and exhaling slowly. My heart rate and breathing will slow. I will feel a sensation of calm, mentally and physically. I relax and realize that I don’t have to be either black or white. I don’t have to be sweet or the monster. I don’t have to retreat to my room to avoid things. I can just be me. My anxiety tells me that I am trying to avoid becoming the monster and trying to stay in control and not lose my temper. I am learning to deal with my resentment differently.”
My Opinion of What Helped Penny’s Anxiety
Penny was raised by two limited parents who both had anger issues. She particularly identified with her father’s rage and was anxious that she would one day act like him. Identification is an unconscious mental process whereby an individual becomes like another person in one or several aspects. Your adaptive and defensive reaction patterns are often attributable to identification with either a loved or feared person. Freud would say that Penny identified with the aggressor (her father), whom she feared. In therapy, we deal with the fact that anger is a normal emotion; however, it is how we deal with it that defines us. When we share our anger, we also have to know with whom we are sharing. What is their level of emotional maturity? A mature person can react to your anger constructively. They may apologize and say something along the lines of “I’m sorry. I didn’t know that that bothered you. I will try to deal with it differently next time.” An emotionally immature person may turn it around, throw the anger back at you, blame you and point out your defects.
Viktor Frankl says that although you cannot control biology or genetics when it comes to resembling your parents, you can control your behavior.3 Whenever Penny got into a situation that irritated her, she began to feel helpless like a ten-year-old again and her anger welled up. Most times, she became anxious as she tried to control her negative emotions. Sometimes she failed and, in her own words, she became like her father, “the monster.” When all else failed, she used avoidance to stay in control. She took time off from work, didn’t see her boyfriend for long periods of time and retreated to her apartment as she had to her room as a child. Henry David Thoreau said, “Things do not change; we change.”4 It took a while for Penny to understand her behavior through therapy and start to change.
Penny suffered from a major depressive disorder as well as GAD. I was reluctant to prescribe an antianxiety agent because of her history of polysubstance dependency. I took a history of all the psychiatric medications that she had been given through the years. The one that seemed to work the best was an antidepressant that also had a calming effect. For sleep, she occasionally took a sedating antidepressant often used for insomnia.
I taught Penny behavioral relaxation techniques, including progressive muscle relaxation and deep breathing, which she found helpful. I also encouraged lifestyle changes such as caffeine reduction and good sleep habits. She began to keep a diary, which helped drain off some of her negative energy and angry feelings. I pushed her to broaden her world and reconnect with friends and family. One of the best things that happened was that out of the blue, her old boyfriend called her. He wanted to see her. In therapy, she reported: “When he called, I felt cornered and trapped like I always did with dad. With dad, I used to have to take a (pill) before I saw him. I felt hurt and inadequate. In the past, when Ben called and asked me out, I used to have to drink two margaritas to calm down before I saw him.” I had her make a list of how Ben and her dad were the same and how they were different. Apparently, they both had “anger against the world and were judgmental.” However, with Ben, she admitted that she felt safe around him and “he wasn’t a drunk.”
“I want it to work this time [with Ben]. I want to work on the things that make me irritable about him,” she said. He often overstayed his welcome and didn’t allow her enough privacy. He wasn’t always attentive to her and liked to go off and talk to other people when they went on vacation together. He was obsessed with politics and would talk passionately at length on the topic. We discussed ways that she could make the relationship better. She came up with the idea that she could set limits on his behavior, change the subject when he went on a rant about politics and tell him what she needed from him. Most of all, she had to keep focused on the fact that although he had some of her father’s behaviors, he was different from her father. I told her to look Ben right in the eye and say to herself, You are not my father. If she felt tense prior to seeing Ben, she promised that she would engage in twenty minutes of relaxation exercises rather than having a drink. When her mind drifted back to childhood, perhaps she could refocus and really enjoy being with Ben in the present.
When she started to feel better she stopped coming to therapy, so I called her after nine months. She picked up the phone on the first ring, sounding pleasant and glad to hear from me. “I’m working a lot,” Penny said. “Things are the same with the family and the anxiety. Not much has changed for me. I talked to Ben when he was in the hospital but I am not seeing him. He calls me from time to time. Too much time has gone by. I can’t go back to seeing him again. I don’t have the energy.
“Therapy did help but I got to the point where I felt that I wasn’t going any further,” she continued. “I was disgusted with myself and I felt that I was dragging you through the mud of my life with me. So I just stopped coming. You tried very hard. I knew that you were trying to tell me things and connect the dots for me. I would get it and then when I left, I couldn’t always make it work.”
I told her that I thought she was being too hard on herself, that perhaps her expectations were too high and that change takes time. I told her that I thought that she had made some progress. I asked her how her temper was. She answered, “Oh, my temper has been better. I don’t let myself get drawn into the chaos at work anymore and I’m not acting out. I guess I did make some progress.” I encouraged her, when she felt ready, to return to therapy and continue to takes steps in a positive direction. We wished each other well and hung up.
Susan’s Story
“My anxiety is a life-long problem. When I began therapy at age seventeen, I learned that I had been having anxiety attacks going back to when I was five. When I was young, it presented itself as a fear that something horrible would happen to my mother, who is an alcoholic. I could not sleep anywhere but at home. She’d have to come to my classroom and stay until they could pry me off of her.
“As I got older [high school], it took a toll on my physical being. I was diagnosed with irritable bowel syndrome. I barely ate because my stomach was in knots all the time. By my senior year, I was having anxiety attacks. I’d be in class and start thinking that I had to get out of there. I’d feel out of breath, my heart would beat fast and my palms would sweat. These attacks increased three years ago when my mom became ill. I’d feel out of control and my limbs would tingle.”
Susan was in her thirties when I first met her. She was a petite woman with green eyes who had been married for thirteen years, with two children and five dogs. Her husband was a salesman who traveled and was away at least one week a month. She described him as “a sarcastic, total hothead,” but she felt that they had a good marriage. Susan suffered at times from Temporomandibular Joint Disease (TMJ), irritable bowel syndrome, headaches and a balance disorder. “These physical things are frightening. I’m afraid I’m going to die,” she said. Susan had an inconsistent work history and had had multiple part-time jobs.
