Francis, a mule we are rehabilitating for providing animal assisted therapy, has a history of very severe abuse. As a result, she has chronic anxiety. Apparently her previous owners tranquilized her to deal with her anxiety and fear. I see a lot of humans doing this for their anxiety. It's amazing how closely her coping mechanisms mirror those of human trauma survivors.
I see the same issue with human clients. Many times the only solution given to them is medication, typically one of the benzodiazepines like Xanax, Klonopin, Valium, etc. (To read more about these medications see, "Why Doctors Don't Like Xanax".) Medications can be very helpful as a temporary fix, but very crippling if used as a permanent fix. Why? Because people do not learn coping skills for handling the anxiety, they simply take another pill. And pills come with side effects of their own. Again, refer to the article above for problems related to taking Xanax.
What else can you do with anxiety? First, it is important to understand what it is and where it comes from. This is a subject too big to cover in its entirety in this article, but I'll cover the basics.
Look at Your Life
Is there a lot of stress in it? I once had a client who came to the clinic everday to receive his medication. He complained heavily of anxiety and requested more medication. Upon talking to him I discovered that his car he drove to the clinic, everyday, was unregistered, was not insured, the inspection had expired , his driver's license had expired and he had 8 warrants out for unpaid parking tickets. But he never thought to examine this as a possible source of his anxiety. (I can't blame the client for this. Our culture teaches us that when we have a problem - take a pill!)
The psychiatrist refused to medicate his anxiety until he addressed the driving issue. Once his record was cleared and his paperwork brought up to date he had no more anxiety when driving to the clinic everyday. Look at your life. Do you have a lot of anxiety provoking situations in it? Are you in an abusive relationship? A substance abuse problem? Any issue you fear may be discovered? Do you have a mountain of debt and collectors harrassing you everday on the phone? Do you have a spending addiction? Do you have familial stressors beyond what can be considered normal? Do you have too many things to do in the course of a day? Are you constantly swigging coffee and trying to run faster? Look at the external factors first and address those. Anxiety can be environmental.
Look at Your Past
If you have a history of trauma, especially a traumatic childhood, your anxiety may originate there. If this is the case, you may need medication to help you calm down temporarily, but only counseling can heal trauma. Find a counselor who understands trauma and knows how to treat it. The longer I practice the more I come to understand that trauma is at the heart of much of our mental health concerns in this country.
Discover the Holy Trinity
By Holy Trinity I mean your thoughts, your emotions and your body. When I work with survivors of trauma I help them understand that these three things are interconnected. Fearful thoughts can lead to fearful emotions. Fearful emotions can trigger a fear response in your body (increased heart rate, shallow, rapid breathing, increased blood pressure, sweating). But these things are not disconnected. They are all happening in the same body. They are all linked together.
So let''s imagine a panic attack. Your body's panic response is triggered in the amygdala (the red alert center in your brain). Your brain dumps adrenaline into your system in order to prepare you for "Fight or Flight". It's actually trying to protect you by enabling you to outrun the perceived danger or to fight it off. (The fact that the danger is only perceived and not real makes no difference to your brain.) In reaction to the adrenaline your heart rate rises, you sweat more, your blood pressure increases and your breathing becomes rapid and shallow. This triggers a response in the thinking part of your brain. Your thoughts might include, "Oh my gosh! I'm having a heart attack! I'm going to die! I can't take this!" Such thinking provokes a feeling of pure terror in the emotional part of your brain. The thinking part of the brain is now triggering a continued panic response in the red alert center which continues to dump fresh loads of adrenaline into the system. This further exacerbates your panicked thinking and your terrified emotions. And the cycle continues.
Now let's try something different. Getting hold of an emotion is almost impossible. But remember the Holy Trinity. Your body, your thoughts and your emotions all coexist in the same system. If you get control of one you can drag the other two down a bit. If you get control of two, the third will have to come along with the others. So start with what is easiest. I may not be able to control my panic, but I can very easily control my lungs. Do the opposite of what your body is being told to do by the red alert system. Activate a system override. Instead of shallow, rapid breaths make them deep and slow. Try to slow your heart rate. Relax your clenched muscles. Concentrate. Once you get control of the body, grab hold of your thoughts. Imagine screaming to your poor brain, "I'm going to die! I'm going insane!" "I can't take this!" Imagine the effect this has on the red alert center. It keeps the adrenaline pumping. So knock it off and do the opposite. Think, "I'm not going to die. This is just a panic attack. It will be over in 30 minutes. I have survived them before. I will survive this one. I'm not going to die." This sends and anti-panic message back to the red alert center. (Talk to it directly if you like. Use humor if that is your nature. Use your own language. "Hey you, wanna knock it off up there? We're in the grocery store for heaven's sake. What's going to get us here??? Chill out!" Do whatever works best for you and makes sense to you to derail the red alert system and stop the brain from sounding the alarm.
The worst part of panic is feeling helpless and out of control. If you are actively doing something to lower the panic, it eliminates the feelings of being powerless. Once you do this a few times and see that it works you will feel less powerless and realize that you have some control over it and this will lower the anxiety. Notice I said lower, not eliminate. The red alert system is going off for a reason, but that is a topic all it's own.
You don't have to be a victim of your anxiety. Learn what helps - and what doesn't - and respect that. A lot of people say that running helps their anxiety. Personally, running makes mine worse. But hooray for those it helps. Find what works best for you personally. Call someone on the phone. Walk your dog. Take a cool/warm bath. Play music. Dance. Fix an elaborate meal. Clean out your closet. Meditate. Develop your own strategies.
What About Medication?
Medication can be used to keep you sane while you develop your coping strategies, so I don't want to totally discount it. But you want to be working on developing your coping skills. Then what do you do with the medication? Talk to your doctor to determine the best strategy. Allow your therapist and your doctor to talk to each other so they can be on the same page and work together for your best interest. (You have to give your therapist permission to talk to your doctor, in writing. They cannot do this without your written permission.)
The best use of an anxiolytic (anti-anxiety medication) I've seen is with a colleague of mine. He suffered from panic attacks. At first, he was prescribed Klonopin and he took it every time he had an attack. This at least let him know there was something he could do about it and eliminated his feelings of powerlessness. He went to counseling and worked at developing coping mechanisms. For him, lying on the bed, getting really quiet and meditating helped him get through his panic attacks. Years after starting treatment he still kept a fresh prescription of Klonopin. But he never used it. Just knowing it was there helped keep him calm. He would utilize every other calming technique he knew. But if they all failed he knew he could take a Klonopin and get relief in 20 minutes. Just knowing it was there and relying on it as a last ditch measure made all the difference. When the prescription got too old, he flushed the unused meds down the toilet, got a fresh prescription and put it in his medicine cabinet. Thank goodness he had a very wise psychiatrist who supported this!
But What About Frances the Mule?
Frances continues to calm. What we use with her is "desensitization". Therapists use the same techniques with humans. If a person is afraid of elevators or snakes or whatever, that thing is slowly introduced to them until they lose their fear of it.
Since Frances was violently abused she has a very high "startle response": if you make a loud noise or move the water hose she jumps a foot. How do we desensitize her? We do all of this stuff every time we are around her. When we feed her we may "accidentally" drop the bucket. When we fill her water trough we may "accidentally" splash her with water. She has now become oblivious to us. She has learned that we are not scary, just incredibly clumsy! We also work with her to desensitize her to human touch. At first she was terrified of us touching her. Through calmly and gently touching her in kind and respectful ways she is learning to trust humans again and appreciate that human hands can be really, well, "handy"! They can scratch that place where you itch, swish that fly out of your eye or get that stone out of your hoof.
So we begin to work with her.
We started by moving slowing and carefully around her, making sure she had good food and clean water and letting her learn that she is now living in a safe place where she will not be harmed. She can also see how the other animals trust us, especially Abby who also has a very severe abuse history. By observing others she can see that they do not fear us and that we are considered "safe" by her peers.
After she has relaxed some and become comfortable in her new environment, we start to address her anxiety. Every time we feed or water her we drop something, splash the trough or her with the water hose, throw an arm up in the air, fling a lead rope around, etc. She has slowly learned to ignore us. A therapist would say we are "desensitizing" her to things which previously alarmed her.
This same technique is used with humans who have crippling phobias. A client who is terrified of elevators may slowly expose themselves to elevators, with or without the help of a therapist, until they become desensitized to the elevator and can ride one to work.