outside of work by spending more time with my friends, family and boyfriend. (We have a ‘date night’ now every month, for just the two of us.) I try to do things that I like, even if I have to schedule time for fun. I like politics and writing. In fact, I’m a political junkie. I am trying to stop being ‘superwoman.’ I try to pace myself, organize my time and prioritize important activities. I try to be real about what I can and can’t do. I have decided that I will not do any more overtime at work without being paid for it. I am letting my twin sisters help more with my dad. I am trying to stop worrying about the future so much! I am trying to enjoy today.
“Dr. Zal also gave me several anxiety-decreasing exercises, one of which is called ‘deep breathing.’ When he asked me in the office to take a slow, deep breath, he said, ‘That was it? Not even close.’ As simple as it sounds, it takes practice to do this exercise. I have to be constantly reminded that the push that I feel I receive from my anxiety is often a false assumption. I am so used to doing it the old way. So I practice every day. Every night, when I leave work and before I enter the house, I take time to ‘de-stress.’ Visualization techniques that I use are also helpful. I am soon to join Maum Meditation to further help my relaxation. I have a lot of work to do, but with Dr. Zal’s guidance and some relief from the medication that he prescribed, I’ll get there. I’m calmer, but I still freak out a little. I’m a work in progress but I am getting better.”
My Opinion of What Helped Judy’s Anxiety
Treatment for Judy included many aspects. Some of our goals were to help her relax, reduce her time pressures and allow her to feel better about herself. I educated her about her anxiety and gave her reassurance that she was not crazy. From the beginning, the positive therapeutic relationship between us allowed her to feel more secure and calmer. Initially, I fulfilled her unconscious need for an older therapist who was accepting and whom she felt would not hurt or punish her. Judy grew more tolerant of her anxiety as she understood her genetic propensity and realized that it wasn’t her fault.
As you see above, we sometimes used modified cognitive therapy techniques to test out some of her assumptions, challenge her inaccurate thinking and give her perspective. Laughter helped. I often joked with her, which allowed her to relax. She was taught relaxation techniques including deep breathing and visualization. We discussed lifestyle changes, such as exercise, diet and reducing her caffeine intake. She brought yoga and meditation into the equation.
When Judy came to me, she was taking an antianxiety medication twice a day. I switched her to a different medication, because her original prescription only lasted four hours whereas my prescription lasted about eight hours.
In therapy, Judy mentioned that her mom was hard to please and was big on guilt. She worked all the time and was often not home. Judy grew up feeling that she was “bad” and thought that this behavior had caused her mom’s actions. She felt that any female authority figure and sometimes the world would “beat the shit out of her.” This made her feel fearful, angry and inadequate. She was also an “injustice collector” who always fought for the underdog. However, in spite of her childhood, Judy saw her mom as “her rock” and wanted to please her. She became tearful when I first pointed out this dynamic to her and why her verbally abusive female supervisor at work made her so angry and was such a problem for her. Unconsciously, she hoped that her next interaction with her supervisor would be better and that if she could just do her job more efficiently that it would help the process and finally get her the approval and positive feedback that she craved.
Judy described her father as “the best daddy ever. He was calm. He was not a disciplinarian and was always there for us. He took good care of us.” He also made her feel safe in spite of a mother who “beat the crap out of me.” This helps explain why she was so intense in trying to do everything she could to keep her father alive. It also explains why she chose three different older male therapists. I tried to instill in Judy a sense of self-worth, even if she didn’t please everyone. She was smart, had a solid work ethic, was a good friend and really cared about people. I tried to help her to see that she was a capable, strong woman who had been standing on her own two feet since age twelve and had done well on her own. Perhaps she didn’t need a constant safety net. Perhaps she didn’t need a therapist cum father figure in her life to constantly support and protect her. As she gained these new perspectives, she started to realize that there was no danger in her life any longer. She started to give herself credit for being capable and realized that she was not the problem.
Judy’s annoyance with her two sisters went back further than when her father entered the long term care facility. She realized that she was angry at her siblings, not only because they didn’t do things her way, but also because she resented their intrusion into her life when she was a young child. When they were born, she lost her prime position in the household and she was given increased responsibility before she was ready. At first she was afraid to tell them that she was angry that they didn’t do their share for their father. She reluctantly took on the role of designated caregiver. Although she complained a lot, in some ways it fulfilled her needs, particularly to feel in control and therefore safe. As she started to understand these issues, she was better able to insist that her sisters share the workload.
After her twin sisters were born and her grandmother died, she noted, “I was alone.” Judy felt that she needed outside support or she would be helpless, vulnerable and isolated. In her present life, she felt that she could not rely on her son. She was angry at his behavior and had no respect for him because he had dropped out of school and was not working. She could not rely on her boyfriend because, although he was emotionally supportive, he was not always around and “didn’t always get it.” Judy had grown up trying to please people so that they wouldn’t leave her and would be there to protect her so she wouldn’t feel bad or guilty. She had been in therapy with several different counselors for a long time because she felt that she needed this constant support.
Judy felt guilty about her son’s life performance. He didn’t fit the mold that she envisioned and was not a reflection of her way of dealing with the world. He was a child of divorce and she blamed herself for his adolescent behavior. During her therapy, he started working in the same facility where she was employed. He did well and she got positive feedback from her coworkers. This helped Judy feel better about herself as a mother and allowed her to understand that perhaps he did have some potential to be emotionally supportive to her in the future.
I encouraged Judy to spend more quality time with her boyfriend, which helped her feel loved, appreciated and more supported. He had not offered on his own before, because he felt that she did not have the time and was not interested. By being more proactive, she was starting to take charge of her anxiety by saying “Stop” to the anxiety process.
Take a deep breath. Draw air in through your nose and let it out very slowly through pursed lips. Take your time and don’t rush the technique. This breathing exercise can be done one to three times in any situation. People will not even be aware that you are doing it. It will slow your pulse rate and help you calm down and relax.
The way we feel is affected by the way we breathe. When we are upset, we are often told to take a deep breath. But when we are feeling anxious or frightened, we don’t just need to take a deep breath; we need to take a breath and exhale slowly. Breathing out, not breathing in, is associated with relaxation. Deep, slow, diaphragmatic breathing is a behavioral relaxation technique that can be taught to reduce or modify symptoms of anxiety. Watch a baby breathe. You will see its stomach—not just its chest—rise and then fall as the breath is released. Breathing retraining causes arousal reduction. Just as hyperventilation is taken by the nervous system as a sign that the body is under stress, deep diaphragmatic breathing
