Note:  This post is quite different from my typical posts and was inspired by the media coverage on Whitney Houston’s death.

As a specialist in anxiety, I am all too familiar with Xanax, one of the prescription drugs that Whitney was prescribed.  Xanax is benzodiazepine,  a class of drugs known to be highly addictive.  Xanax is one of the worst “benzos” because it is fast acting and sedating.  It calms anxiety within minutes – unfortunately the benefits are short term and actually negatively reinforce anxiety (see my post Working Past Panic) often making it worse in the long run and thereby requiring more medication to calm the anxiety. It is physically and psychologically addictive and there is a tolerance effect such that people often need more and more to get the same effect.

The media talked a great deal about how Xanax can be dangerous when mixed with alcohol.  However, I’ve heard very little about the fact that her physician prescribed a highly addictive drug to an addict. Just because a drug can be prescribed, doesn’t mean that it is safe and that it isn’t addictive. Much like alcohol – just because it’s legal, doesn’t mean it isn’t addictive.  We would all gasp if a doctor advised a patient to use alcohol to calm their nerves.  We would gasp even louder if the patient were an addict.  In my opinion, if you wouldn’t prescribe heroine to an addict, you shouldn’t prescribe Xanax either. Regardless of whether Xanax contributed to Whitney’s death or not, the prescribing physician was irresponsible (and my guess is it did play a role – even if it was a springboard to using more illicit drugs).  Xanax is used for anxiety and cognitive-behavioral therapy has been proven to be more effective in treating anxiety disorders than any medication. Nonetheless, SSRIs and other medications that are not addictive can be effective in treating anxiety.  Furthermore, exercise, chiropractic, herbs etc. can be very helpful as well. So if one chooses to not engage in therapy – there are better alternatives than giving Xanax to an addict.

Jennifer L. Abel, Ph.D.
author of Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety.

Given that we feel more vulnerable, and therefore more anxious, about our worries after tucked into bed (see previous post) consider addressing the issues you are likely to worry about while you are still up and about. Around 30 min to 2 hours before you go to bed make two columns on a sheet. Under the first column write down what you think you will worry about that night.

In the second column write down what you are going to do about it before you get into bed. In the second column you could write a) “nothing,” b) a specific thing that you are going to do before you go to bed, or c) a plan to do something later. Even when deciding to do nothing, writing it down and thinking about it is giving the worry due diligence. In other words, you have addressed it by thinking about your options before deciding to do nothing about it before bed. When planning to do something, be sure to schedule that plan, or at least write it down somewhere that will allow you to remember.

by Dr. Jennifer L. Abel

author of: Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.

Most people worry because they are trying to increase the likelihood that good things will happen and decrease the likelihood that bad things will happen. Yet, worry does the opposite. Obviously, it leads to useless anxiety and that’s a bad thing. Research by Michel Dugas and his colleagues found that worriers have the ability to problem solve as well as their more relaxed peers. However, anxious people tend to have myopic vision when faced with problems. In other words, their mental focus is limited to the extent that they miss options that might help them to solve their problems better.

Likewise, think about when you have your best ideas and creative insights. How often do they occur when you’re really stressed? If you’re like most people, your best ideas come when you’re relaxed and often when you’re not even trying to find a solution. So, first de-stress, then fix your mess.

Jennifer L. Abel, Ph.D.
author of “Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety.”

Anxiety and Stress occur in a spiral of interactions between thoughts, images, physical sensations, behaviors, and emotions. Not everyone experiences all five, but everyone does experience a similar pattern each time they spiral. Relaxation, Better But Believable Thoughts (see my post dated Feb 3), and most coping strategies are useless once your spiral has gained momentum. In fact, researchers at Penn State found that coping strategies did little more than talk therapy to alleviate worry and anxiety. In a follow up study, they taught anxious individuals to prevent their worry spirals from getting out of control by catching them early and found that most all were able to successfully reduce anxiety and worry substantially and enjoy a more relaxed life.

I suggest that you use mindfulness and other relaxation strategies I’ve covered in previous posts several times/day. Use post-it notes or other reminders because we typically don’t recognize stress until it has gained some momentum. Use the strategies without stopping your flow of activity. So for instance, you can feel the surfaces beneath you and continue to read this post, make phone calls, type, or engage in just about any activity.

Check back soon for other ideas on how to nip your anxiety in the bud.

Dr. Jennifer L. Abel
author of: Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.
www.activerelaxationthebook.com

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That depends. The important thing is that you make an informed choice. Consider the advantages and disadvantages of both. Most of what I present is factual, however, some is my opinion. (Please see my previous post on the differences between psychologists and psychiatrists)

When it comes to anxiety disorders, regardless of the anxiety disorder, cognitive-behavioral therapy is superior to drug therapy. So whether you suffer from OCD, PTSD, Social Anxiety, Panic Disorder, Phobias, or Generalized Anxiety Disorder, the results are likely to be better if you find a therapist who is trained in the cognitive-behavioral treatment (CBT) of anxiety.

Mild to moderate depression fares better with cognitive-behavioral therapy (CBT) as compared to medication. For moderate to severe depression, medication has a slight edge in the short run, but therapy is better in the long run. When depression is severe and significantly hampers motivation to engage in therapy, seeing a psychiatrist for medication is often needed to motivate the person to engage in therapy. I will suggest both therapy and psychiatry when someone is severely depressed as they have a better chance of ending the suffering. This logic does NOT apply to anxiety, however, as medication can interfere with the success of CBT and side-effect can worsen anxiety symptoms (see my previous post on Panic Attacks)

Primary Insomnia (having no medical cause) and issues with anger are often related to anxiety and depression and typically respond best to therapy. (Of course, organic disorders like narcolepsy and sleep apnea should be treated medically). With insomnia, people respond best to medication for 2 weeks ad then the positive effects tend to wane (wear off) and CBT works best after 2 weeks of practicing it.

In my opinion, when it comes to anxiety and depression, medication typically treats the symptoms while CBT can change your habits for life. (It has been proven that low seretonin can result from grief, negative thinking, and sedentary life style – so it is not usually the cause of depression and anxiety). Schema therapy, which includes CBT with experiential and more traditional therapies, gets to the root of the issues.

Psychologists are psychotherapists, but not all psychotherapists are psychologists. Unless grandfathered in, psychologists almost always have a doctoral degree (Usually a Ph.D. or a Psy.D). However, many psychotherapists with master’s degrees are very gifted and often just as good as a psychologist. It is more important that the therapist specializes and has a good reputation for treating the problem that you have.

The main disadvantage to CBT is that it can be time consuming and costly in the short term. However, in the long run it is often more affordable as the positive benefits can last a lifetime. The advantage to medication is that it’s much easier to take a pill than to change your behaviors in therapy. The disadvantages of medication include side-effects (particularly with anxiety, side-effects often make anxiety worse), staying in unhealthy situations because the medications numb healthy feelings, and in the long run, not knowing whether you’re better because of meds or other reasons.

While people suffering from ADHD often respond to therapy, medication is of greater help especially if ADHD is moderate to severe. Bi-Polar disorder and psychotic disorders such as Schizophrenia respond better to medication, so people with these disorders should definitely see a psychiatrist. However, individuals with these disorders can benefit from psychotherapy and may choose to see both.

So, if I were advising a friend or family member on whether to see a psychotherapist or a psychiatrist. I might recommend both in some instances. However, by and large if the person suffers from Bi-Polar Disorder, ADHD, or Schizophrenia I would recommend a psychiatrist. If they are suffering from Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder, Social Anxiety, Panic Disorder, Agoraphobia, Simple Phobia, Insomnia, or Depression without cycles of Mania I would recommend a therapist who specializes in the field. There are individual differences though. So, for instance, some people do respond better to medication for GAD, while some people with ADHD may respond well the therapy, and so forth.

Also, remember that there are alternatives to psychiatry and psychology such as exercise, nutrition, homeopathic medicine, and other life-style changes. It is also very important with all of these disorders to rule out medical factors such as hypo or hyper-thyroid, hypoglycemia, low levels of Vitamin D, hormones, Iron etc. as they can all contribute to depression, anxiety, irritability, and insomnia.

by Dr. Jennifer L. Abel
author of: Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.

There are at least 3 reasons why people worry: 1) worry about the future is easier than thinking about past trauma, 2) a false sense of control (sometimes superstitious), and 3) to try to problem solve or increase the likelihood that things will turn out well. This latter is the main reason that people worry. However, most worriers agree that more than 90% of their anxious thoughts are completely useless.

To manage anxiety caused by a specific worry, brainstorm a list of possible solutions. To exercise your mind, be creative by entertaining ideas that are not really good options as these can introduce humor, or better yet, lead to a more viable solution. When you’re finished, you could ask someone else to do the same without looking at your list. Then rule out those you aren’t willing to entertain. Finally, choose those one or two and make a plan to put them into action. Even if there is no solution, you will probably worry less because you have tried your best to solve the problem.

For a simpler way to worry less subscribe or tune in later in the week.

by Jennifer L. Abel, Ph.D.
author of the book Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety

I decided to experience what this golf excitement was all about and after taking a few lessons went to play 9 holes. After about 4 holes, I said to my brother, “I don’t get it! I don’t see the allure.” Soon thereafter I hit a shot just off the green and took out the wedge. The ball landed a foot or two from the hole. I shrieked with excitement and my brother said: “THAT is why people love golf” and I got it. Even much more experienced golfers hit many average or poor shots for every great shot they hit. They keep going back for that occasional great shot.

Worry isn’t much different. We are trying to solve problems or otherwise prevent bad things from happening when we worry. However, like golf, most of the worry leaves us disappointed and often just causes frustration. But every once in a great while, we find a solution. We worry, worry, worry, worry, worry, worry, get a good idea, worry, worry, worry, worry, worry, worry, get a good idea, and so forth. This kind of intermittent reinforcement creates habits that are the hardest to break. So, don’t worry problem solve. Tune in over the next few weeks or subscribe to get advice on how to problem solve instead of worry.

by Jennifer L. Abel, Ph.D.
Author of the book Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety

Bad Light!  Flourescent lights are harmless for some people.  However, it is very common for them to cause a feeling of derealization and disconnectedness.  For some they can even trigger panic attacks.  Don’t be afraid to ask that the ones above your desk at work be disconnected and bring in a lamp with a more pleasant light source. Also, there are now full spectrum flourescent lights that are less offensive and cost less than $4/bulb.
Dr. Jennifer L. Abel

- author of: “Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.”

If trying to push anxiety and worry away worked, you probably wouldn’t be reading this blog. Research shows that trying to put something out of your mind actually makes you think about it more. Therefore, when applying the relaxation strategies you learned in my previous posts, or elsewhere, rather then using them to try to “get rid of” your anxiety, frustration, or stress move toward them.

For an example, let’s say that you’re worried about something you said in a meeting that you fear was negatively received. You’ve already decided that bringing it up again will not likely help and that there’s nothing else you want to do about it, but you can’t keep it from coming into your mind. The wrong way to approach it: “I’ve gotta get this out of my mind.  I should focus on the feeling of the surfaces beneath me and the colors, shapes, and textures of what I see to stop thinking about it.”

The better way: Observing the thought and even allowing it to be there and then gently shifting your focus to the surfaces beneath you and the colors, shapes, and textures of what you see.

See my previous posts “Don’t Think About it NOT” and “DO Think About Blue Monkeys”

Jennifer L. Abel, Ph.D.

Author of Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety.

Cognitive Therapy is based on the fact that what we think affects our mood.  Thinking negative thoughts can lead to depression, anxiety, guilt, and other unnecessary and uncomfortable emotions such as frustration and embarrassment.

Many psychologists have designed elaborate programs of identifying the type of negative thought, looking up a specific anecdote thought, and writing out the new thought. These methods can be cumbersome enough to cause someone to give up on trying to change their thoughts.

When people try to change their negative thinking, the mistake most make is to think the most positive thing they can imagine. Positive thinking, in and of itself, is often useless, even frustrating.  WHY?  Because the most positive thought typically isn’t true.  Trying to change the thought creates more tension and when it doesn’t work it can cause frustration. So for instance, someone is worried about getting laid-off and then they think “I’m sure I won’t get laid off.” That won’t help them feel better because there is no guarantee that a job is completely safe.

My solution…A method of cognitive therapy that is both simple and effective.  When having negative thoughts, think of something Better But Believable (B3). So in the case of the worried employee this is just one example of a string of thoughts that are better but believable:  “Worrying won’t help me to keep my job and if I am laid off I can collect unemployment and catch up on some personal stuff until I find something else. I will survive. It’s even possible I’ll find a job that’s better.”

by Dr. Jennifer L. Abel

author of: “Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.”