Thoughts on anxiety and therapy for anxiety…

The concept of anxiety is complex and multi-faceted. Research indicates that anxious traits are often genetically inherited through family lineage. This claim is based on brain neurochemicals responsible for mood and body moderation somehow operating inefficiently or in an incorrect manner. Certainly, a strong case for understanding the origins of anxiety can also be made in observing it to be a learned response and the outcome of being “situationally overwhelmed”, whether on account of extensive, chronic exposure to stress, or even due to relatively sudden anxiety-triggering experiences. Here, our lived experiences are seen as the root of anxiety, rather than a proclivity of the body to be subject to anxious presentation. Either way, when untreated or unaddressed, anxious symptomology is inclined to worsen over time as it is permitted to settle into one’s life with established patterns and unwanted responses.

Most importantly, anxiety should be considered from a holistic paradigm, that is, in ways that sees thoughts, emotions, and the body all inter-relate in order to produce it. My approach to working with anxiety will be in some ways varied, incorporating factors such as medical history, family of origin exposures and presentations, and available cognitive resources the client may have. However, I’m inclined to conceptually frame anxiety in one of two ways: via either top-down or bottom-up processing.

The former implies that thinking influences feeling, which then affects outcome (some form of body response or anxious symptom). For instance, should a client hold a belief that the world is an unsafe place and come to emphasize apparent “proofs” of this being true over alternate perspectives, they are inclined to experience feelings of being unnerved or fearful. The physical outcome is then likely to be some form of anxious presentation, ie: shakes, tachycardia (racing heart), or agoraphobia (fear of leaving safe or familiar places for concern of experiencing panic elsewhere).

Bottom-up processing infers the reverse: that the body – for whatever reason – is activated in ways such that a person experiences physiological symptoms of panic or anxiety, which in turn lead to an emotion of fear, and ultimately confirming thoughts of being somehow unsafe. The “bottom-up” reference is simply that the core (body or soma) represents the start of the progression, leading to feelings (commonly experienced in our chest), and then “up” to the thinking (in our brain). Bottom line: it is important to understand how both paradigms are inter-connected with the one another, and this results in therapy focusing on evaluating all three factors (thinking, feeling, physical outcome), though the respective emphases may vary contingent on timing and need.

Another important aspect to consider when working with anxiety is that of boundaries . Boundaries are the conceptual notion of a line drawn around us that represent where we end and others begin. Specific to anxiety, boundaries reflect where our responsibilities to ourselves end, and where responsibilities of others begins. Living in social groups, we all generally and rightfully are drawn to be concerned for the welfare and interests of others. All the same, we are individuals residing in these social systems, and as such have needs and run into limitations of what we can provide others when these personal needs are consistently unmet. Therapy involves engaging in grounded exploration about the appropriateness of our personal boundaries, and evaluating the legitimacy of the factors that have “set” them in our life. In other words, we often have been introduced to roles in our families that contribute to our propensity to either overemphasize prioritizing the needs of others at the expense of our mental health, or investing energies in ourselves in ways that reduce our social interest , by which we benefit from communal engagement. The point is, boundaries can reflect whether these competing interests are in balance or not, and the degrees to which there is imbalance will predictably be associated with anxious symptoms.

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