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Anxiety

What is it? What causes it? What can I do about it?

What is it?

Anxiety is a natural response to feeling threatened or unsafe. Consider that early Human beings date back over 2 million years. According to historical data it is generally accepted that advanced civilisation began to flourish around ten to twelve thousand B.C. The relative safety and security we enjoy today is recent. For our ancestors dealing with truly life threatening situations was an everyday occurrence. Historically that might  be predatory animals who see us as a meal, warring tribes, famine, drought, plague, pestilence, ice age....you name it...as a species we've endured it! Why is this relevant? Well, it's simple. The human being has a powerful built in warning system to deal with these very real threats. This warning system is primitive in nature since it has been with us from the very beginning. In many ways one can say it is a part of the "animal body" and indeed the area of the brain that is associated with the warning system response is often referred to as the "mammalian brain". When we feel threatened in some way, then the warning system is activated and we experience fear, anger or depression. 

Fear/Anxiety - Fear is the feeling that tells us to either leave a situation or to not go into that situation in the first place. The assumption by the animal mind is that we are in danger.  By design therefore fear is necessarily extremely uncomfortable because its purpose is to get our attention so we take evasive action! This is fine when the danger is real, but is crippling when the anxiety/fear mechanism is responding inappropriately to every day situations and stimuli which really don't require evasive action. 

We can experience anxiety in response to single stimuli (phobia) or we can experience generalised anxiety too (Generalised Anxiety Disorder). Panic is a form of extreme fear which is caused by a build up of anxiety over a period of time which is suddenly released causing a "panic attack". Panic does not exist in isolation (without anxiety generally being present). If you are experiencing panic attacks, then you can take it as a given that your anxiety generally is far too high. 

What causes it?

Excessive stress is the primary cause of anxiety. We experience stress when we feel overwhelmed and any number of factors can cause us to experience stress. Stress is very subjective, and our individual tolerance to stress also varies greatly.   Here are just a few of the most common forms of stress, but this list is by no means exhaustive. The first bullet point here is perhaps the most important cause of stress. 

  • Disempowerment - A lack of power or influence over one's life.

  • Poor sleep (Also a response to stress as well as a cause).

  • Victimisation (Being bullied).

  • Losing a loved one (Bereavement or the loss of a relationship)

  • Family difficulties (Children, sex, divorce, lovelessness)

  • Boredom/Lack of direction in life.

  • A lack of time or energy to do everything that needs to be done.

  • Poor self-image/Lack of self-worth.

  • Negative Thinking

  • Negative Outlook

  • Guilt, Blame and Shame.

  • Financial difficulties (Debt!)

  • Misuse of drugs/alcohol.

  • Work pressure.

  • Illness

  • Loneliness

  • Failing Relationships

We might have included past stress and trauma here too, but I wish to highlight a very important point here. It is true that past hurt and trauma does affect us in the present, but the assumption that we feel terrible today because of something that happened in the past is often misleading. What happens in fact is that what we think and feel today is based on what we have learned in life through past experiences. We experience stress and anxiety when our lives are not working in the present. If however past experiences have taught us that we are powerless in certain areas, then this sense is carried with us into the future. This is known as "learned helplessness", and it contributes strongly to our sense of stress on a daily basis because if we feel "powerless" in any area of life then it means that at a deep level we also feel vulnerable and if we are feeling vulnerable, then we are feeling "threatened". Follow the logic and you will recognise that this is exactly what the "animal mind" is responding to...feeling threatened. In other words, feeling vulnerable creates anxiety. Further though, if we are feeling anxious the unconscious mind seeks to pin this feeling on something. Since the nature of this mind is to search back through past experience for something which pattern matches to the feeling of anxiety it invariably comes up with an image of the last time we experienced a terrible time. Thus, we can easily then make the erroneous assumption that this memory of a terrible time is the cause of our problem when in fact the true cause is that we are lacking control in the present. So it's really important to recognise that although past experience needs to be acknowledged (and possibly worked through therapeutically), it is just as important to make sure that our lives are functioning well in the present, and what this means in real terms is making changes which will bring about more control.

What can I do about it?

There are really three options available.

1)  Change your circumstances - If your circumstances are such that you are practically unable to manage them (even if you were not stressed), then those circumstances need to be changed. This might be a tough decision since your choices might involve loss or sacrifice in order to gain your peace of mind, but here it is a question of priorities. Personally I always put my peace of mind at the very top of every list of priorities. Money is no good to us if we're too anxious to enjoy spending it. So working a stressful 70 hour week so you can buy that Audi is a poor trade off if you're too ill to enjoy it! In most peoples lives the choices may be more practical, and it is true that many people face extremely difficult practical situations, but the advice here is to put your mental and emotional health FIRST, and then to seek practical solutions to the situation. Pretty much it's always possible to find a solution when we make a commitment to doing so. Remember the principle of constructive selfishness. Sometimes the seemingly selfish thing to do (putting yourself first for once!) is actually the selfless thing to do, because by making sure your needs are met, you are ensuring that you remain healthy and available for others in the future. Often the problem is that we are soldiering on and kidding ourselves that we can cope with the situation as it is, when actually we can't. Courage can help here. It might be uncomfortable to make changes and yes, other people might not like that you're not willing to be a doormat any more, but trust me...they'll adjust and you NEED to do this for yourself! Enlist help if you need to. Delegate tasks. Ask for support from loved ones, friends, or colleagues. Explain you are struggling with circumstances as they are. Someone else might be able to suggest a solution you can't see because you're too enmeshed. Talk it over with someone. Seek solutions. Practical solutions. You might be surprised how much support is available when you ask for it. Don't be too proud to ask for help. Your mental health really is your wealth in life, and it's too important an issue to feel like you shouldn't bother anyone with it. If you are struggling with your circumstances, do something! Even setting the wheels in motion towards a way out often alleviates a great deal of anxiety. We always feel better when we are working towards a solution even if that solution will take time to achieve. The mind can cope with stress when we know the end of the tunnel is in sight, but what it can't cope with is no movement towards solution at all. In other words, things don't have to be perfect for us to be anxiety free, they just need to be moving in the right direction!

2) Change the way you view/feel about yourself and/or your circumstances - If you are sure that your circumstances are practically manageable, but you are just responding to them poorly, then the problem can be addressed internally. This basically means that your emotional mind (animal brain) is overdoing the response. The first thing to do is to consider ways in which you can practically reduce negative emotional arousal in your life generally. So even if you are finding your negative responses are taking place at work, it can still be due to the fact that there is fundamental stress at home. In practice it's probably both, but again it is important to understand that your general levels of emotional arousal will be feeding directly into whatever difficulty you have. In practical terms this means being disciplined with yourself with regards to how much negative thought and introspection you allow to be present in your awareness on a daily basis. If you were for instance to spend all day thinking about how so and so wronged you last week, you are absolutely creating more negative emotional arousal because the animal brain responds to what is imagined in a very similar way as it would to what actually is. So if we repeatedly imagine a confrontation with Mrs S, then the brain tells the body to get ready for a fight. If you do this thirty times a day, then your body has created fight mode thirty times, and all that arousal doesn't just go away...it sits in your nervous system for the rest of the day (and can overflow into the next day too if our sleep mechanism can't cope with it all!). What this means in practical terms is an increase in emotional arousal which means (when the anger has subsided) .....yes...more anxiety! Let's be clear. We can choose whether we will go over and over something or not. So anything you are continually re-running at the mental level which provokes negative feelings has to go! It may take time and practice to become proficient in learning to let things go but it IS the way out of anxiety. If you want out of your anxiety, this step is CRUCIAL!

Sometimes, we feel genuinely blocked with regards to how we are seeing a certain situation. Then it is not only about introspection (the things we are choosing to focus on) but it is instead being generated from the deeper levels of awareness - the unconscious mind. Here we have that principle of past experience impinging on our feelings. The unconscious mind automatically scans current experience against past. If the message it holds from past experience is that the current situation is threatening, then anxiety is produced to create an avoidance mechanism and we have a sense of disempowerment. Changing the way we think and feel about things is really the basis of recovery from anxiety. A very important area to consider when healing anxiety is developing kindness and compassion towards ourselves. If we are at war with ourselves; If we have a fundamental dislike for ourselves, then we have a problem, because disliking oneself causes terrible internal conflict. Being unwilling to forgive oneself for something that has happened or something you have done is a sure fire way of becoming anxious. Having an internal war going on at any given time also creates a feeling of being unsafe, and then to top it all off as a result of all the internal hatred we are experiencing we can have self-punishment thrown in for good measure! Solutions are discussed in the "help" section of this site. This is another area where the help of a good therapist can make all the difference. 

3) What we truly cannot change we must accept- This really needs little explanation as a principle. We have to take our cue here from inspirational people, and remember that people are extremely resilient when they choose to be. There is always a positive perspective available if we choose to open ourselves to it...even if that perspective is purely philosophical. It is a difficult fact of life that there sometimes exist tragic circumstances. We have to find a way through such things. It is our will to accept what we cannot change that will dictate the depth of our suffering and our peace. As difficult as the situation may be we must recognise that non-acceptance will only add to our suffering. Again, commitment to healing is what begins the process. Therapy can help here, and self help is discussed in the "help" section of the website. 

Anxiety - The Science.

Stress Containment

We all have a limit to the amount of stress we can handle at any given time. We can use this model to understand the process. 

 Stress Container

Fig 1, shows a non-anxious person. There is plenty of room available to cope with extra difficulties in life. If this person is challenged they will be able to cope easily. 

Fig 2, shows a person with raised stress levels, but this person has not yet moved into feeling anxious or depressed. This person has less of a buffer zone with which to deal with unexpected difficulties, and is likely to feel more "guarded" than someone with low stress levels. Generally this might manifest in feeling short tempered, easily stressed, and in some cases (depending on personality type) a loss of confidence will be noticeable. 

In Fig 3, we have a person whose stress levels are becoming critical. This person is feeling anxious, tense, overly sensitive, short tempered, and/or depressed. This person is still functioning, but life is difficult and pleasure is limited. There is a clear sense here that a crisis would result in not being able to cope. There is a sense that the container is nearly full to spilling point and there is very little room for extra stress or problems which of course manifests as all of the above mentioned symptoms. 

In Fig 4, we find that stress levels have risen to the point that the container has overflowed. Here there is a clear sense that we cannot cope with problems full stop. We may have stopped coping with life in general. At this level we are overwhelmed, and may be suffering with any manner of anxiety driven difficulties. These could include but are not limited to anxiety, panic, obsessional patterns, suicidal thoughts, irrational fears, compulsions, severe phobias, exhaustion, depression, hopelessness...the list goes on. 

Stress Container Manageable

 

Stress Container overflowing

The Emotional Brain

Okay. I know it looks complicated, but we can simplify here. The diagram shows a cross section of a brain. Think of the whole of the pink shaded area which sits at the core of the brain as the "Emotional Brain" This area is often referred to as the "Limbic System". Think of the rest (the grey squiggly matter) as the "Intellectual Brain". These brains are very different in nature and have very different qualities. 

Brain explanation

 

  • The Emotional Brain (Limbic System) - This brain is primitive. It is an emotional and instinctive brain. It is concerned primarily with ensuring survival. The functions of this brain can be easily summarised and remembered as the four F's. That is fear, feeding, fighting, and "ahem"... procreation. This is the brain therefore which creates anxiety, obsession, panic, mood, emotion, and conversely this is also the brain which creates feelings of pleasure and reward. Sex and food are part of this brains concerns and for most people these are pleasurable pursuits, which are rewarded with a supply of "feel good feeling". This brain seeks therefore to promote pleasure and avoid pain and danger, but it does so in a primitive and instinctive way. In other words it is very black and white. It is essentially an animal brain, often referred to as the "mammalian brain", since mammals share a similar brain structure (minus the better developed cortex). Because this area of the brain is primitive, it is NOT an intellect. What we are involved in (our lives) as far as the emotional mind is concerned is either "good" or it's "bad". "Good" is chased with vigour and "bad" creates instant discomfort or fear! "Very bad" creates panic!" The emotional mind CANNOT assess gambling odds. This is the same brain which can make a 40 a day smoker feel terrified of boarding an aeroplane, but on the same day will promote and encourage that same person to smoke 40 cigarettes. You are statistically five and a half million times more likely to be killed by smoking. Which of these actions do you think the brain should be avoiding? Clearly, the emotional brain does not do logic.  So, for the best will in the world it's easy to see how the emotional brain can get the wrong end of the stick, yes?! We also know that the emotional brain, being primitive and unable to employ logic does not know how to differentiate between past, present, or future or indeed between what is real or imagined. Think about this. Your intellect can, but emotionally, can you get upset about something which happened twenty years  ago? Can you get upset about something which has not yet happened? What happens if you imagine something terrible happening? Does it upset you? Yes, of course. So it's true. This mind really does become aroused emotionally by what is imagined to be so, as well as by what actually is, and this includes of course going over old problems in your mind and repeatedly worrying about new ones.  It is very important to understand this, because what this shows us is that anxiety is caused at least in part by what we imagine to be so, and what we make of what actually happens in life.  If we're in the habit of thinking negatively about everything, we can see that the emotional mind starts to feel very unsafe, and steps up the level of concern. This is anxiety! We also know something else very interesting and very relevant about the emotional brain. It refers to the past for information about how to navigate the future. Since it is not a logical or intellectual mind it must rely on past experience to assess a current or future situation. It will refer to it's library of "what has gone before", all of which is stored unconsciously (memory), and will respond accordingly. The higher the anxiety levels are generally, the more this mind will refer back to the past for information, and the more it will become increasingly sensitive to potential threats. What this means in practice is that the mind finds more and more things to worry about which creates more and more fear which creates more and more sensitivity to possible threats which means more and more to worry about.....and so on the cycle of misery continues. This process also tends to make us focus on past problems and it is then very easy to blame all our current difficulties on past events or people, so we can easily become "obsessed" with the past. So to summarise, the emotional mind is a past-focused mind which cannot work out what's good and what's not on its own, and must refer to past experiences for advice on the current situation. It will respond with negative feelings and emotion to anything perceived to be "not good" and is therefore very sensitive to past negativity which it will seize upon as being central to the danger when stress is high generally. When stress levels are low, it will sit quietly in the background, since low stress=no threat=no need to create responses. Then the intellect takes control.   

  • The Intellectual Brain  - The Human brain is the most highly organised matter found within the known universe. We are not naturally stupid. Anxiety however hijacks our intelligence, because it hands over "control" to the animal brain which IS primitive. It is considered that an instinctive response will serve us better than an intellectual response during times of danger. Put simply, when faced with a pride of hungry lions, do we want an intellectual response or an instinctive one? When the danger passes, control is returned to the intellect. Then we can get on with doing what we naturally do best. Solving problems! The intellect is a problem solving brain.  The intellect is where we do all our higher thinking, and you can think of this as the brain which beholds meaning, art, philosophy, language, aesthetics, mathematics, science, and engineering to list but a few of the qualities central to this brain. A beautiful thing if you ask me, and clearly capable of solving very difficult and abstract problems. This brain CAN understand that it's better to quit smoking and board the plane, because it does logic. It can work stuff out! So we call this the "solution focused, problem solving, forward looking" mind. Unlike the emotional brain this mind does not need to refer back to past experience for information on how to behave or think in a current situation. It can choose to take into consideration a past experience, but further to that, this mind is a problem solver and CAN CHOOSE (we will get to the science of this in a moment) to disregard past experience in favour of experimenting with a new method. In other words it is a future focused mind, capable of assessing each situation rationally and logically. Since it is a problem solving mind, it tends towards hope. It doesn't see problems as insurmountable brick walls; only as challenges to be met. It is naturally pre-disposed to enjoy solving problems, and therefore can actually enjoy being challenged. It's motto's might be "Where there's a will there's a way" and "If at first you don't succeed, try try again!" Problem solving (success) gives this mind a BIG buzz! When this mind is in control, life is much more enjoyable! It is worth understanding that the intellectual brain ultimately always remains the boss. It is possible to override the instincts when necessary. If a loved one was in shark infested waters, most people would jump overboard if it meant saving them. So we can feel fear in the emotional mind and still take action with the rational intellectual mind. It doesn't mean it's easy, but it's important to know that it is possible! And this is important when it comes to overcoming many of the anxiety related disorders because ultimately, it's the intellect that has to do the work in taking back control. This is especially so with difficulties like depression for instance where the emotional mind will argue that change and solution is not worth bothering with. We have to use the executive mind to decide ultimately whether we will engage with life again or not. With persistence we keep saying Yes to life, even if we don't FEEL like doing so initially, and by doing so we create a life for ourselves. Then depression is pushed out to the edges and eventually dissolves. In OCD, certain areas of the primal brain are sending an alarm signal which is in fact a false alarm. Again here, we know that successful treatment involves choosing to not "buy into" the belief that something is wrong and then "DOING" something different. Here, a feedback loop is created and it's the intellectual brains refusal to engage with the false alarms as though they were real which causes the emotional brain to make an adjustment. 

N.B: There are exceptions to the rule of intellectual mind having ultimate control and disregarding past experience. These exception relate to specific areas of disempowerment. Here, we are focusing our attention on the rules of OVERALL control. We are looking at how the brain operates GENERALLY. This is an important distinction to make, because when we focus on certain areas specifically (i.e weight gain, phobic responses, addiction, self-esteem etc), we can clearly see that the emotional mind can make empowerment very difficult for us indeed in certain areas, and will very definitely respond powerfully to past experience. What we can note though, is that even when tackling specific difficulties we will always see an improvement in our ability to take control of a situation, to create solution, when we have the intellectual mind back in control. We do this by reducing stress generally, and reclaiming control in the areas that we CAN reclaim it. Ultimately this leads to being able to reclaim areas we believed we couldn't reclaim. This is actually part of the therapeutic process; helping people to reduce their anxiety generally by helping them to succeed specifically (perhaps where they have felt unable to previously). Successful change is really about conscious versus unconscious. This is a detailed discussion and we will therefore cover this area in a separate article on this website. For now, just take it that we are speaking about control within the brain/mind generally. 

In order to fully understand why it's so important to have the Intellectual (Executive) Brain in control, let's have a look at the true science of this.  

Brain Cortex

  • The Frontal Lobe - The Executive Brain (The Intellect)- We could easily over-complicate matters here. One of the goals I set out with in creating this website was to bring understanding to you in plain English. To make this information understandable and accessible to everybody. So to that end, we are keeping this simple. Therefore, although the above diagram looks complicated, we are going to look at the functions only of the Frontal Lobe here- the area coloured pink in the diagram. The other lobes all have their respective jobs, which largely focus on the processing of sensory information. However, the most interesting lobe of all is the Frontal Lobe because this is the lobe that takes care of the "Executive Function" within the brain. In other words this is the part of the brain we might call "The Boss!" The Frontal Lobe has ultimate jurisdiction. Executive decisions are made here. We borrow from research here to highlight the functions known to take place within the Frontal Lobes. 

In 1868 a physician J M Harlow was working with a patient Phineas Gage who had suffered severe damage to the frontal lobe through a freak accident with some dynamite. Though Gage made a good recovery in every other respect, it was noted that his ability to make executive decisions had been badly impaired. Harlow concluded that the frontal lobes must therefore serve as a kind of executive: making decisions, forming goals, planning, organizing, devising strategies for attaining goals, and changing and devising new strategies when initial plans fail.  These observations have been repeatedly confirmed as study and research has continued through the decades. Welsh and Pennington (1988) defined the executive function  "as the ability to maintain an appropriate problem-solving set for the attainment of a future goal". 

Luria in 1973 and Damasio in 1994 also note importantly that the frontal lobes have greater interconnectivity to the sub-cortical regions of the brain (meaning the brain underneath the cortex, which we have looked at and called the "emotional brain") than any the other lobes of the cortex.  The frontal lobes have extensive and reciprocal (can feedback) connections to the thalamus, basal ganglia, limbic system, and also posterior portions of the cortex. Thus, the neural substrate of the frontal lobes also makes it an ideal candidate as a domain, which has greater access to other domains and functions of the brain than any other domain. 

Okay, that is wordy I know so stay with me and we'll plain English it. What this is saying is that basically, the Frontal Lobes (The Executive Brain) have greater access to the "Emotional Brain" than any of the other Lobes, and furthermore that the Frontal Lobes and the Emotional Brain (thalamus, basal ganglia, and limbic system) are reciprocal, meaning that they can (and do) feedback information to one another. In other words they are closely connected. One affects the other. So, here is the scientific way of saying, then when the emotional brain is called into action (by the perception that there is a threat), it closes down the Frontal lobes, because the two brains are in a loop. They are reciprocal. They are connected, and you can't change one without affecting the other. We also note that the frontal lobe "has greater access to other domains and functions of the brain than any other domain", meaning simply that the way to access the emotional mind is through the Frontal Lobes, by using the intellect. CBT capitalises on this understanding by using intellectual function to adjust emotional responses.

Pennington and Ozonoff (1996) also note that central to the executive function is:

 "..maximal constraint satisfaction in action selection, which requires the integration of constraints from a variety of other domains, such as perception, memory, affect, and motivation. Hence, much complex behavior requires executive function, especially much human social behavior.” 

In plain English then, "maximal constraint satisfaction" is another way of saying "Control". Being able to restrain (control) oneself in selecting an action. They go on here to note that "control" requires the correct use of perception (how we view things), memory (how we remember things), and being properly motivated, and that these factors all affect how we behave. 

So (I hope you're keeping up!), what this means is simply this: The emotional brain is connected with the executive brain (The intellect), and vice versa. When the emotional brain receives messages from the executive brain that there is a problem (threat), then it responds by "stepping in" and taking control of the situation with an emotional (instinctive) response. It is not possible to have both brains in control at once. As explained earlier, nature dictates that an instinctive response is preferable to an intellectual response when we are under attack. So when the emotional brain is called to act through this process (by negative introspection) it literally blocks access to the higher brain functions associated with the Executive brain, and these are, as noted earlier...... making decisions, forming goals, planning, organising, devising strategies for attaining goals, and changing and devising new strategies when initial plans fail. And let's not forget "Control".  The actions that are blocked can be summed up in two words. When the emotional mind has control, we lose access to the part of the mind (brain) that controls our ability to "Create Solutions".

  • Emotional Brain versus Intellectual (Executive) Brain - We could not survive without an emotional brain. The emotional brain is our early warning system. It keeps us safe. It is our friend and protector. Unfortunately however, it can get the wrong idea. It's a primitive mind and not being an intellect, it can easily decide that life or certain situations are much more dangerous or threatening than they really are. In other words it can become easily overly-aroused and when this happens it often causes problems. You can look at pretty much any page on this website to understand what factors create over-arousal within the emotional mind, but the effect is the same. We lose executive control, which means in real terms that we feel "out of control". Along with this of course we have the added difficulty of dealing with whatever response we happen to be suffering with as a result of this process...be it anxiety, depression, anger, panic or obsessional thoughts. What should be clear by now however is that our job is to get the intellect back into the driving seat, and we do this by using every tool available to focus the mind positively, start creating solutions again, and reduce anxiety generally. Once the intellect is back in control then we naturally start to create solutions again and even to enjoy the process of creating solutions. This literally gives back control to the Executive mind. If we are choosing to create solutions again, then to the primal (emotional) mind, this means we are happy that the danger has passed, and it's safe to engage with life again. This is why it is SO important to ACT...and not just think about acting! So what appear as insurmountable obstacles when we are emotionally aroused, are easily re-framed as enjoyable challenges when we are calm generally. It should go without say therefore, that the future also appears to be an infinitely more pleasant place to contemplate!

Anxiety Brain

So what does this matter or mean? Well in understanding these principles we can see clearly that the way out of anxiety is to de-arouse the emotional mind so that the executive intellectual brain can come to the forefront once more and make things comfortable again, because the intellect is the solution creating brain. Life is never a dead end or a trapped place when the intellect is in the driving seat, because this brain is an expert at solving problems. Understanding HOW to create the space to allow this to happen is crucial. 

Since we are primarily concerned with the reduction of anxiety and the increase of hope, the research which is particularly relevant to us is the research carried out on depression, and anxiety. This can be found in Michael Yapko’s “Breaking the patterns of depression”. A large scale US government funded study undertaken by the US Government Agency for Healthcare Research and Quality (AHCPR) into the most effective treatments for mild to moderate depression (and anxiety) found that therapy:

1)                  Should be an active process

2)                  Should be time-limited (and not go on indefinitely)

3)                  Should focus on solving current problems (and not on rehashing old issues)

4)                  Should specifically aim for symptom reduction as a goal (rather than assuming the symptoms will disappear if some deeper abstract personality issue gets resolved).

These are nice clear guidelines for successful therapy. The AHCPR does not go so far as to spell it out explicitly, but we can see that these are essentially the components of what is now commonly known as Solution-Focused Brief Therapy (SFBT).

In the UK, Counselling (a very broad term in itself) and Cognitive Behavioural Therapy (often referred to simply as CBT) are generally the main two interventions recognised by the medical orthodoxy (GP’s and Psychiatry) as valid treatments for emotional disturbance. The overarching reason for their use as far as GP referrals are concerned, is that they are two forms of intervention which have been well researched, and shown in randomised trials to be reasonably effective. This does not indicate however that Counselling and CBT are necessarily the best interventions. They simply are the ones that have produced enough evidence in trials to be considered safe and effective for public (state) use, and worthy of public funding. There are many other therapies which are equally, or perhaps even more effective which have simply not received the funding for formal research to validate them. As we learn more about therapy culturally we may well find a shift in these values but as at time of writing (2007) this is the current state of play. So a few words about these therapies. Counselling can be useful. The fundamental premise of counselling is that people often discover their own solutions when speaking about a difficulty. Traditional counselling involves a counsellor asking a question and then simply listening....creating the space for the client to think. So the idea is that a good counsellor asks the right kind of questions which then lead the client into working out the solution for themselves as they speak. Whilst this can be unquestionably useful, there is a question mark over whether it is helpful to go into counselling on a long term basis if one is not feeling better after a reasonable period of time because what can happen (I'm not saying it always does), is that the client actually doesn't work out their dilemma through talking about it and actually then just spends week after week re-hashing old issues with a sense of growing frustration. Practically this can have the effect of re-arousing the emotional mind and reminding one of how terrible everything has been. This is why point three in the research findings reminds us that we should be focusing on solutions as a strategy for overcoming anxiety. This should make sense now that you understand that our job in therapy is to reinstate the "solution focused" mind. So focusing on the past over and over pretty much does the opposite.  Point two tells us that therapy should be a time limited process. Any therapy that tells you after ten weeks of therapy that you're almost better despite your assertions that you feel no improvement at all from the first day you arrived should be reviewed. There is an old school viewpoint that we will feel worse before we feel better. Just occasionally there will be truth in this, but you as the client will know when that is so. If you were for instance actually emotionally processing the loss of a relationship and finding that the grieving feels positive because you are "getting it out of your system and doing the grieving you didn't do at the time" then this is a clear case of feeling worse before you feel better. If however you are just feeling rotten after ten weeks of therapy because nothing feels any different then you should find another therap/y/ist. There is just one exception to this point and that's if you aren't following the guidance given by your therapist and doing your homework you shouldn't be surprised if nothing changes! 

CBT, or cognitive behavioural therapy is a clear case in point here. CBT is very much a self-directed therapy. Your therapist will explain the process and you will be given assignments to follow in between sessions. Albert Ellis, one of the central contributors to modern CBT said "We need a Protestant work ethic" when approaching CBT. CBT teaches us how distorted and/or inflexible thinking causes us to feel unnecessarily emotionally disturbed and then provides tools for amending these perceptions. CBT then is a brain re-training process and it does take time to work its magic but one of the wonderful things about CBT is that you can use it without the aid of a therapist. 

The rule is...if it's helping, stay with it. If it's not, don't. What I am illustrating is that with a good therapist using good therapy you will feel the difference (I would say as a guideline rule definitely within a maximum of five sessions there should be at least SOME change) and you will know you are making progress. What should be clear in any therapy though is that if your therapy is following more or less the guidelines outlined above in the research findings then you are approaching your difficulty sensibly.

Disclaimer: This article is given for information purposes only. The author cannot be held responsible for any effects arising from the use of the information contained herein, and any use of the information in this article is used entirely at the risk of the user.  Persons with poor mental health should not consider using these exercises but should refer themselves to their GP for assistance.

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