The New Hope Crisis Counseling Center Continuing Education Series
April 2002 Class Outline

William Gaultiere, Ph. D., Director of New Hope & Psychologist with ChristianSoulCare.com
(714) 971-4213, DrBill@CrystalCathedral.org

WELCOME

I'm so glad that you're taking this class with me.  Your efforts to learn and improve as a New Hope Counselor are fantastic!  One very important characteristic of effective counselors is that they are eager to learn.  When we listen to callers and chatters we want to have an attitude of trying to learn about their concern and the help that they need.

This class is on anxiety.  Everyone one of us has talked with anxious callers and chatters before and we've all felt anxious ourselves to some extent at one time or another.  So, here we are, ready to learn and to share in this important class. 

GOALS OF CLASS

1. Grow in your understanding of and compassion for what it's like to struggle with an anxiety problem. 
2. Increase your effectiveness in offering New Hope Counseling for those who are anxious. 
3. Experience more of God's peace personally.  

WHAT IS A-N-X-I-E-T-Y?

Here are seven symptoms of anxiety, in the acronym, a-n-x-i-e-t-y.

A gitated?  Are you easily frustrated or irritated or upset?  Do you lose your temper often? 

N ot sleeping?  Are you having trouble getting to sleep or staying asleep?  Do you often wake up and not feel rested?

X -fears?  Do you have any fears that you accommodate by avoiding situations?  Are you afraid of social situations, interpersonal conflict, rejection, failure, public speaking, leaving home, airplanes, spiders, knives, etc.?

I n your body?  Have you been experiencing shortness of breath, heart palpitations, tightness in your chest, discomfort in your stomach or bowels, twitching, shaking hands, sweaty palms, or tingling?

E scalating worries?  Are you worried about problems you're facing?  Do your thoughts race out of control?

T raumas relived?  Does your mind keep re-experiencing an upsetting event(s)?  Are you having nightmares?

Y es all the time?  Do you feel pressured to say yes to other people, to your perfectionism, or to make troubling thoughts go away?

HOW ANXIETY PROBLEMS DEVELOP

In the diagram the container represents the "self."  When someone is anxious underneath that they are also feeling hurt, fear, anger, sadness/grief, guilt, shame, or needy.  Anxiety is a "secondary emotion" that is the result of pressure from stressors that elicit emotion and repressors that deny that emotion. 

The two competing forces create a friction that we feel as anxiety.  It's like holding the lid down on a pot of boiling water or trying to drive by giving the car gas and breaking at the same time.  If the tension is severe or chronic then the result is an anxiety disorder.

GENERALIZED ANXIETY DISORDER

People with generalized anxiety disorder experience persistent anxiety and worry that focuses on at least two stressful situations.  In other words, they spend a lot of time worrying intensely and their worry is out of proportion to what is realistic for the situation.

I grew up with anxiety.  I think every member of my family has had generalized anxiety.  In my family people worry and worry.  Intense discussions, continually analyzing problems, complaining about what's wrong, and seeking solutions to fix everything are continual.  Looking back, it seemed like problems were everywhere.  Family members, extended family, other people, the church, my dad's job, politics, and many other subjects all had numbers problems to worry about.

It took me a number of years as an adult to learn more helpful ways of dealing with anxiety and to experience inner peace.  I used psychotherapy, educating myself, relaxation exercises, lifestyle changes, prayer and other things to find some relief.  I still struggle some with anxiety at times, but it's so much better.  Now because I have better boundaries and I know how to process my feelings until I experience some peace, I'm able to be with difficult family members and other anxious people without being overcome with anxiety.

PANIC DISORDER

It's frightening to experience a panic disorder.  You feel like you're being smothered and can't hardly breathe.  Your heart pounds and hurts and you're afraid you're having a heart attack.  You tremble or feel tingling or numbness in your hands and feet and you're afraid you're going to faint.  You start sweating or have hot and cold flashes.  You feel like you're not all there; it all feels so unreal.  And worst of all, you're afraid that you're going crazy and that you're going to die.

Once someone has had an anxiety attack they develop "anticipatory anxiety;" they're afraid to have another attack, which in itself creates anxiety.

Once I helped a man I'll call Jon.  Here's how panic disorder developed for him.  He'd catch a cold, get an infection, or have an allergic reaction.  (Initiating circumstance.)  The congestion would make breathing a little more difficult.  (Unpleasant bodily symptoms.)  He'd start worrying that he wouldn't be able to breathe.  Then he'd sniff compulsively.  His sniffing and worrying would keep him from falling asleep.  (Increased focus on symptoms.)  Then he'd tell himself that he'd be up all night, and he wouldn't be able to function at work the next day.  He'd even think that he was going to suffocate.  (Catastrophic interpretation.)  Then he'd have a panic attack.

SOCIAL PHOBIA

This is a common anxiety problem and includes people who avoid social situations out of fear of embarrassment or endure them with overwhelming anxiety.  Fear of public speaking is an example.  So are fear of blushing in public, fear of crowds, fear of using public toilets, and fear of taking exams.

Carrie (not her real name) was afraid of introducing herself in her church small group.  Her anxiety escalated as people were introducing themselves around the circle.  Her heart started racing, her breathing became shallow, and she became sweaty.  She was terrified that people would see her blushing or that she'd stutter and that, in any case, people would laugh at her.  Before it was her turn she got up from her chair and went to the bathroom.  Then she went back to the group when she knew she wouldn't have to introduce herself.

Social phobia is just one example of a phobia.  Another phobia, that is even more common is agoraphobia, which is a fear of being trapped in a situation and having a panic attack with no one safe to help you.  To manage their fear, agoraphobics avoid the public places they're afraid of.  There are many other phobias (intense fear and avoidance of) flying on an airplane, high places, spiders, knives, or other things. 

POST TRAUMATIC STRESS DISODER (PTSD)

Jim (not his real name) was 25 years old on 9-11-2002 when the terrorists attacked the World Trade towers and rocked his world.  For three months three months he busied himself in his work until he found that anxiety was overwhelming him.  He couldn't concentrate.  He was exhausted and yet couldn't sleep.  He was full of fear and felt like he was living outside his body.  He worked near an airport and whenever a plane flew overhead he had frightening flashbacks to being a boy in New York City and watching the planes fly over his head.  Then the image would morph into the planes crashing into the towers and he'd start crying and shaking.  He had PTSD.

LEARNING TO SET LIMITS TO COPE WITH ANXIETY

Most people with anxiety problems expect themselves to be super strong.  They think that they should always be "calm, cool, and collected."  Control is their operative word.  They do too much, take on more responsibility than they can handle, try too hard to please other people, and deny their feelings and needs.  Eventually it catches up to them in bouts of anxiety.  They need to learn to acknowledge their limits and say no sometimes.

This was a big part of my generalized anxiety disorder.  I had to accept that I couldn't do everything I wanted to do, but I need to prioritize more and let some things go.  I learned when I needed to say no to someone's request because I didn't have time or energy or had another commitment to keep.  I spent more time relaxing (I'm still working on that one!) and I gave myself permission to feel, to need, and to struggle.  Limits like these were an important part of helping me to feel more peace.

USING POSITIVE SELF-TALK TO COPE WITH ANXIETY

People with anxiety problems, like in the examples above, experience an escalation of fear.  Their fear feeds on itself, getting worse and worse.  Let's get inside the mind of the anxious person to see how their negative self-talk is a part of this viscous cycle and then let's consider how using positive self-talk can help to stabilize and calm the person who is anxious:

Negative Self-Talk Escalates Fear

Threat >>	Negative Self-Talk >>	Body Symptoms >>	Negative Self-Talk >>	Panic
(1st Fear)	Repression	(2nd Fear)	Catastrophic	(3rd Fear)
. . . . .
Hurt	"I'm too sensitive."	Racing heart	"I can't stand this!"
. . . . .
Conflict	"I can't have needs."	Shallow breathing	"I'm losing control."
. . . . .
Stress	"I've got to be strong."	Sweaty	"What will others think?"
. . . . .
Demand	"I can't show feelings."	Twitches	"I'm going to die!"
. . . . .
Violation		Tingling
. . . . .
Criticism		Dizziness
		Upset stomach

POSITIVE SELF-TALK CALMS FEAR

Threat >>	Positive Self-Talk >>	Body Symptoms >>	Positive Self-Talk >>	Coping
	Affirmation		Accepting
. . . . .
	"It's normal to feel."		"I can handle this."
. . . . .
	"My needs are ok."		"Let it pass.  Ride it out."
. . . . .
	"It's courageous to		"My friend accepts my fears
. . . . .
	"I can share with a friend		"I've survived this before."

Responding to the fear that may accompany stress or hurt with affirming self-talk (instead of denying your feelings) is calming.  Accepting the reality of anxiety symptoms in your body (instead of reacting with catastrophic thinking) is also calming.  In other words, rather than fight against your feelings and your body you seek to understand, validate, and comfort your feelings.  The way we learn to do this is by internalizing caring messages from people (e.g., counselor, friend, support group leader) who listen to our anxiety.

Let me illustrate by referring back to three of the examples we discussed above:

• Jon learned to cope with his panic by saying to himself, "It's scary for me when my breathing is more difficult.  I've survived this before.  I won't suffocate.  I'm just anxious because I have a lot of feelings I need to talk through." 
  
  
• Carrie was able to face her fear of introducing herself to groups of people by thinking, "It's ok for me to be nervous meeting new people.  Blushing doesn't make me a bad person.  Besides, most people like me when they get to know me."
  
  
• Jim went back to his job near the airport with the mindset, "It's natural for me to be scared and saddened by the terrorist attacks.  If I have flashback I can ride it out until it subsides and then talk about my feelings later with my friend."

ENTRUSTING YOUR FEELINGS TO GOD AND OTHERS

This is at the heart of any antidote for anxiety.  Earlier I said that anxiety is a secondary emotion.  We feel anxious when we deny our fear or hurt or anger.  So it makes sense that we feel less anxious when we talk through the underlying feelings with someone we trust.

What's the magic in verbalizing your feelings?  What makes this helpful for people who are anxious?  Sharing feelings with a listener is cathartic or relieving of tension when you "let go" of what's troubling you by letting someone else feel what you feel and help to carry your load.  The turmoil becomes less intense and more manageable.  Putting words to what you're feeling gives you perspective on your struggle, helping you to understand your situation more clearly and to think through any decisions.  It helps you to realize that your feelings are valid, real, and understandable.  Realizing that someone cares enough to listen and to understand and to struggle with you is comfort for your hurt and encouragement for getting through your problem.  In time you realize that you feel more peace.

In the Psalms of the Bible, David, the author of most of the psalms, gives us a model for sharing our troubles with God.  By writing out or simply praying our own psalms we too can experience more of God's peace.  Like David, we tell God just what we're feeling, even if it's anger at Him, and He listens and is concerned and responsive.  David also shows us how to receive God's care by thanking Him for his provisions, starting with the smallest of blessings.  

THE A-B-C'S OF NEW HOPE COUNSELING FOR THE LONELY

The basics of what we do are as easy as A-B-C.  The hardest part is tuning into callers' and chatters' feelings and resisting urges to give advice or reassurance.

1. Actively listen for (ask about and reflect) feelings
2. Brainstorm for (collaborate to develop) an action step
3. Close with a referral and/or prayer

NEW HOPE REFERRALS

1. Anxiety Disorders Association of America, 1-301-231-9350, www.adaa.org
   
   
2. TERRAP treatment programs for anxiety, www.terrap.com
   
   
3. Overcomers Outreach, nationwide Christian support groups, 1-800-301-3001, www.overcomersoutreach.org

FREE NEW HOPE RESOURCES

1. "Do You Have ANXIETY?" (Self-Test)
   
   
2.   "Antidotes for Anxiety," 26 strategies to reduce anxiety,
   
   
3. "How do I Overcome Anxiety?" (Ask Dr. Bill Article),
   
   
4. "How do I Learn to Relax? (Relaxation Exercise, Ask Dr. Bill Article)

LET'S PRACTICE!

To receive CE credit and the satisfaction of accomplishment take the CE Exam, which includes a role-play, and turn it into SheilaS@CrystalCathedral.org.  Complete all 11 classes for 2002 and you'll receive a special award at the end of the year!