Updated: May 11, 2021
Anxiety is essentially fear, an activation of the fight or flight response. It can come with a tight chest, racing thoughts, irritability, muscle tension, and a strong urge to avoid whatever is causing the anxiety at all costs. Anxiety is normal, and everyone experiences it. However, for some people anxiety becomes unshakeable and pervasive, impacting daily life and health, resulting in an anxiety disorder. Different therapeutic modalities conceptualize the causes of anxiety disorders differently, and posit different ways of responding to them. I’d like to give you a brief introduction to three different approaches that I have used in my practice to help folks move through their anxiety and into freedom and resolution from the things that are making them stuck.
In EMDR (Eye-Movement Desensitization and Reprocessing), anxiety and other disorders are understood to be the result of dysfunctionally stored information in the brain, which became locked in state-specific forms because of painful life experiences. For example, if a child experiences unhealthy expressions of anger in her home when she is four years old and her body goes into fight or flight mode, her nervous system may not be able to adequately process and resolve the experience at that time. As she ages, the neural network associated with this unprocessed memory, which includes the black and white thinking of a four-year-old, the emotional fear response, and uncomfortable body sensations, becomes isolated and unable to attach to more adaptive and mature neural networks. When the child becomes an adult, this maladaptive neural network and all that is associated with it becomes activated any time she has a conflict, which causes impairment in close relationships. The EMDR
approach includes re-accessing the original memory and processing it in a safe and resourced environment, enabling the isolated neural network to integrate with adaptive networks and healing unhelpful thought patterns, emotional responses, and body sensations. This brings a feeling of resolution, and eliminates the reactivation of all of the “old stuff” (which can often look like an anxiety disorder). EMDR does not include rehashing the past through endless discussion. It does include resolving lingering disturbance from the past (including physical complaints) and reducing the effect on the present.
In ACT (Acceptance and Commitment Therapy), psychological pain is understood as an inevitable and normal part of human life. It is not something that should be pathologized. What psychologists label as an anxiety disorder occurs partially as a result of cognitive fusion, which is when we become entangled in our own internal experiences and controlled by them, allowing them to determine our actions in the world. Experiential avoidance is another “feeder” of anxiety disorders: we shy away from meaningful, life-giving activity because are trying to rid ourselves of painful interior experiences. The ACT approach to anxiety involves developing capacity for cognitive defusion, where we allow our inner experiences to be exactly what they are without either pushing them away or seeking to join ourselves to them too closely (yes, it is a mindfulness-based approach). We do this through having a welcoming and curious relationship toward our inner experiences (acceptance), and being willing to allow pain to be present as a necessary part of a full and meaningful life. In this way, we can move toward action that is guided by our values rather than our avoidances.
Two examples of exposure-based therapies are Exposure and Response Prevention (ERP) and Narrative Exposure Therapy (NET). In exposure-based approaches, avoidance is understood as the fuel that keep an anxiety disorder burning, and exposure is the water that extinguishes it. Anxiety disorders persist because the sufferer continues to avoid the feared or unpleasant stimulus—this means that the brain never gets a chance to learn that the feared thing is not really so bad after all. Let's use Contamination OCD as an example. Someone with this anxiety disorder experiences a high degree of fear associated with the possibility of spreading germs, and may continually avoid any situations in which he would come into contact with surfaces that have not been disinfected. Let's say one particular sufferer does this through using his own bottle of disinfectant everywhere he goes and by staying home all the time. So, in this case, the “stimulus” is a surface that has not been disinfected.
The ERP approach includes slowly “exposing” the sufferer to the feared stimulus in gradual increments. This might include first looking at pictures of dirty, unwashed surfaces, then standing next to a dirty unwashed surface without touching it, then placing his hand on an unwashed surface for thirty seconds before washing his hand, then placing his hand on an unwashed surface and waiting for ten minutes to wash his hand (you get the picture). Eventually, the goal is that unwashed surfaces no longer bother him, or bother him very little. Exposure exercises can also include writing out the thoughts associated with feared situations in their most extreme version and reading them aloud repeatedly until the fear response subsides.
So there you have it! Three different ways of thinking about anxiety disorders and responding to them. In reality, these approaches can be integrated in various ways. Personally, I am a huge fan of EMDR, and I like to weave some elements of ACT into the EMDR work that I do. Exposure-based approaches can also be useful for targeting very specific anxious mental loops. If you have any specific questions about any of these approaches and how they might fit for you, don’t hesitate to reach out to me!
May you be well,
Baer, Lee. The Imp of the Mind. Penguin, 2002.
Shapiro, Francine. Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition. Guilford Publications, 2017.
Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd edition). New York, NY: The Guilford Press.
Hyman, Bruce M., and Cherlene Pedrick. The OCD Workbook. New Harbinger Publications, 2010.