Anxiety is a common problem that people come into therapy to treat. However, what exactly are folks hoping to change by coming into treatment?
This post discusses five goals for anxiety commonly discussed in therapy. The first four relate to overarching goals that most folks with anxiety problems could probably benefit from improving.
The final fifth goal discusses examples of more specific goals (i.e., SMART – Specific, Measurable, Actionable, Relevant, and Time Bound). That is, what could specifically translate to specifically into a person’s life and how their lives can be different after therapy.
For all of these goals, I provide common strategies therapists use to work on these goals.
#1: Reducing hyperarousal
People with anxiety problems are sometimes in a constant fight-or-flight mode. Their body is always on high alert for potential threat– kind of like a sensitive smoke detector that sounds the alarm anytime there is even the smallest evidence of a fire.
This constant feeling of anxiety can significantly impact someone’s lives. For example, it can disrupt sleep, increase irritability, and keep on edge and restless. As a result, folks with anxiety can feel constantly exhausted in their lives.
Therefore, one goal of treatment is to reduce this “hyper”arousal. This can be done primarily through regular relaxation exercises. For example, deep breathing, guided imagery exercises, and muscle relaxation strategies. Picking a regular time for one or more of these activities and doing it for a small period of time every day can be very helpful. Consistency is key!
Another way to increase resilience to anxiety is through nourishing activities. Look for things in your life that makes you feel more resilient to anxiety (kind of like self-care). Here’s a few examples that clients I worked with have done that works well for them.
- Making a cup of tea
- Playing an instrument
- Taking a walk
- Calling a friend
- Eating at your favourite restaurant
- Doing some evening yoga
#2: Reduce worry
Anxiety is typically a response to ‘worry.’ Worries are future-focused ‘what if?’ questions that make us fearful about the future and its consequences. For example, “What if I don’t get childcare for next week?”, “What if I forget my talking points for my job talk?”, or “What if I don’t know what to say at the party tonight?”
These fears paralyze us because we are too busy catastrophizing about everything that can go wrong. It’s hard to stay in the present when we are focused on the future.
When dealing with worries, it is helpful to identify the difference between current and hypothetical worries.
Current worries are things we need to deal with in the here-and-now. For example, needing to get childcare or needing to pass a biology exam.
Hypothetical worries are more distant and cannot be solved right now. For example, worrying about your future child being born with a health problem. Current and hypothetical worry requires different strategies to resolve.
For current worries, we would take a problem-solving approach and find a solution to the problem. If I need to pass a biology exam, then I would need to schedule in time for studying and make a plan for which modules to study on which days.
Hypothetical worries can benefit from thought records (evaluating the thought) or the use of written exposures. Written exposures mean spending some time every day (e.g., 30 minutes) writing out the catastrophic thoughts. For example, writing about your scariest fears around losing a loved one or having a severe mental illness and what that would look like. The idea is that by constantly sitting with this anxiety, it should reduce over time.
Finally, mindfulness can be helpful to stay in the moment (and not think about the future) and reduce how strongly we react to a thought. Here’s a post on practicing mindfulness if interested.
#3 Tolerate uncertainty
Underneath worry and ‘what ifs’ is a general fear of uncertainty. Folks with generalized anxiety have an ‘allergy’ to uncertainty and see it as dangerous or threatening.
As a result, they tend stay with the status quo or do things to avoid uncertainty (like getting reassurance, checking something multiple times, or full on avoiding an unfamiliar situation).
When we run away from uncertainty which does two things that keeps the anxiety alive: 1) we believe that it was a good idea to run away from uncertainty and 2) we don’t learn we can cope.
Behavioural experiments are very helpful to work on a fear of anxiety. It is a way to test anxious predictions and be curious if our worries are actually true. For example, we might have a fear of ordering a new drink at a bubble tea restaurant (prediction: “I’ll hate it”). Then we try out the drink anyways to see what would happen.
here are a few different possible examples of behavioural experiments:
- Trying out a new restaurant
- Studying at a café you have never been to before
- Checking an email only once
- Messaging a friend who you have not spoken to in a while
- Practicing setting boundaries with a partner by saying no
When practicing behavioural experiment, most of my clients have found that their fear does not come true. Even when the outcome is negative, they realize that they can cope with it well. Some clients even begin to see uncertainty as exciting and novel!
#4 Habituate anxious responses
Phobias are commonn in anxiety disorders. Phobias refer to having an intense fear of some sort of object or situation.
A few common examples include:
- social situations
- having panic attacks
- animals
- insects
- flying
- going out of the house alone
- being in planes
- etc.
Exposure therapy is the primary treatment for phobias. Facing our fears allow for habituation to occur. Habituation is noticing a drop in our anxiety when we repeatedly face our fears without hesitation. We usually escape away from phobias (e.g., running away from a social situation or a spider). But we need to gradually face our fear so that our body and brain learns nothing bad will happen.
Here’s a post on doing exposures and creating hierarchies.
Setting specific SMART goals
The above provides some more general goals that many folks with anxiety likely would benefit from. However, specific goals differ from person to person.
Therefore, SMART goals can be a great way to identify what exactly are things you would like to change in your life. Below I provide some examples of SMART goals that you might see in common anxiety disorders (but be creative for yourself or your clients!).
- Panic disorder: spin around for 30 seconds to bring up panic symptoms and sit with it
- Social anxiety: talk to 3 people without looking away or ending conversation quickly
- Generalized anxiety: do 3 behavioural experiments a week
- Specific phobia of spiders: look at picture of spiders
These are just a few examples, but of course the specific goals will depend on what you (or the client if you are therapist) wants out of your lives!
Best wishes,
P
Photo by Ronnie Overgoor on Unsplash
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