We are no strangers to feelings of anxiety – at certain stages of our lives or in particular situations, we would have experienced anxiousness and worry with relation to our careers, studies, relationships and even our environment. However, anxiety levels may go beyond the healthy norm for some people, and may instead develop into anxiety disorders that may have a debilitating effect on their lives. According to the American Psychology Association (APA), an individual who suffers from an anxiety disorder is described to have “recurring intrusive thoughts or concerns”, where the duration and severity in which the individual experiences anxiety could be blown out of proportion to the original stressor, resulting in undesirable tension and other physical alterations. In this article, we will be exploring a few types of anxiety disorders as well as how they can manifest within us.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder is a psychological issue characterised by persistent and pervasive feelings of anxiety without any known external cause. People who are diagnosed with GAD tend to feel anxious on most days for at least six months, and could be plagued by worry over several factors such as social interactions, personal health and wellbeing, and their everyday routine tasks. For example, an individual with GAD may find himself experiencing headaches, cold sweats, increased irritability and frequent feelings of “free-floating” anxiety. Others may also experience muscle tension, sleep disruptions or having difficulty concentrating. Often, the sense of anxiety may seemingly come from nowhere and last for long periods of time, therefore interfering with daily activities and various life circumstances.
In contrast, Panic Disorders are characterised by the random occurrence of panic attacks that have no obvious connection with events that are co-occurring in the person’s present experience. This means that panic attacks could occur at any time, even when someone is casually enjoying a meal. Of course, panic attacks could also be brought on by a particular trigger in the environment, such as a much-feared object or situation. Some individuals have reported that panic attacks feel frighteningly similar to a heart attack, especially with the rapid increase in heart palpitations, and the accompanying shortness of breath. Other symptoms also include trembling, sweating, and feelings of being out of control. With these panic attacks bringing on sudden periods of intense fear and anxiety, it can be exceptionally terrifying when these attacks reach their peak within mere minutes. However, a notable difference between a panic disorder and GAD is that an individual diagnosed with panic disorder is usually free of anxiety in between panic attacks.
Obsessive-Compulsive Disorder is a disorder marked by patterns of persistent and unwanted thoughts and behaviours. Obsessions are recurrent thoughts, urges or mental images that cause anxiety. On the other hand, compulsions are the repetitive behaviours that a person feels the urge to do in response to an obsessive thought or image. One common example often exhibited in films is where an individual has an obsessive fear of germs. This person may avoid shaking hands with strangers, avoid using public restrooms or feel the urge to wash their hands way too frequently. However, OCD isn’t purely limited to feelings of anxiety due to germs. OCD can manifest in other ways as well, such as wanting things to be symmetrical or in perfect order, repeatedly checking on things (“Did I leave my stove on?”), or the compulsive counting of objects or possessions. While everyone double-checks their things and has their own habits, people with OCD generally cannot control their thoughts and behaviours, even if they are recognised to be rather excessive. They can spend at least 1 hour a day on these thoughts and behaviours, and will only feel the much-needed brief sense of relief from their anxiety when they perform their rituals. As such, OCD can be exceptionally debilitating to one’s mental health.
Social Anxiety Disorder
Persons with Social Anxiety Disorder, or SAD, experience high levels of anxiety and fear under particular or all social situations, depending on the severity of their condition. They are often afraid of being subjected to judgement, humiliation or rejection in public, causing them to feel embarrassed. As such, individuals with SAD may feel extra self-conscious and stressed out, and try to avoid social situations where they might be placed at the centre of attention.
A phobia involves a pathological fear of a specific object or a situation. This means that one may experience intense anxiety upon encountering their fears and will take active steps to avoid the feared object. Phobias may centre on heights(acrophobia), birds (ornithophobia), crowds and open spaces(agoraphobia), and many others. People with agoraphobia, in particular, may struggle to be themselves in public spaces, for they think that it would be difficult to leave in the event they have panic-like reactions or other embarrassing symptoms. In severe cases, agoraphobia can cause one to be housebound.
For many individuals, therapy is a rather intense and personal topic, and it could have taken them a lot of courage to finally seek the help that they need. Keeping this in mind, it is exceptionally crucial that one finds the right therapist, for there’s a pre-existing implicit clinical belief that the level of treatment effectiveness is greatly dependent on the therapist-client fit. Of course, every client would love to be able to – ideally – find that one therapist whom they can fully open up to from the very beginning, but in reality, that may not be the case. At times, it is necessary to assess your relationship with your therapist and evaluate if there’s the good rapport you need for your sessions to be a success. Ultimately, it boils down to whether you feel a steady, reliable and safe connection with the therapist, and whether you are making the progress you hope for.
To give you some background, studies over the years have shown that the more similar the therapist and the client, the higher the rate of recovery. As an example, an assessment instrument entitled the “Structural Profile Inventory(SPI)”, which measures seven “independent yet interactive” variables (behaviours, affects, sensory imagery, cognition, interpersonal, drugs/biological factors or BASIC-ID), showed that client-therapist similarity on the SPI predicted a better psychotherapy outcome for the client as measured by differences pre- and post-treatment on the Brief Symptom Inventory. Moreover, the demographic similarity between therapist and client facilitates positive perceptions of the relationship in the beginning stages of treatment, enhances commitment to remaining in treatment, and at times can accelerate the amount of improvement experienced by clients. More precisely, it can be said that age, ethnicity, and gender similarity have been associated with positive client perceptions of the treatment relationship. With gender and cultural similarities appearing the most strongly preferred among clients, these domains generally enhance clients’ perceptions of their therapists’ level of understanding and empathy, and as a result, sessions are judged to be more advantageous and worthwhile. However, besides these, there are also other means to assess your “fit” with your therapist, and we’re here to discuss just that.
First and foremost, consider if you are seeking help in the right place. Does the therapist you are looking at specialise in the area you are seeking help for? Before we can even touch on the topic of interpersonal therapist-client fit, it is important for you to take the time to do some research on various therapists’ profiles – in other words, to sift through and read up on their respective areas of expertise. Typically, therapists would have their area(s) of specialisation up on their online profile directories. It would be clearly indicated if they specialise in areas such as substance abuse, family therapy, or even anger management. It goes without saying that, for example, it would be inappropriate to consult a psychologist who specialises in child psychology when you’re clearly looking for someone who can help you with your substance-use addiction. With that said, it is to no one’s benefit for you to rush into therapy blindly.
Once you have chosen the potential therapist that you are most likely to want to have see you through your road to recovery, another essential question you should ask yourself is whether you are comfortable with their suggested mode of therapy. During consultations, you will have the opportunity to enquire about their recommended techniques or treatment methods that will be explored during your subsequent sessions. If you are uncomfortable with any particular process, giving honest feedback and exploring other methods is always an option. However, at any point, you also have the right to seek other therapists who may be able to help you in other ways that don’t put you in a tight spot. After all, therapy is all about having a safe and comfortable space for you to sort out your difficulties.
When assessing your interpersonal connection with your therapist, make sure to trust your gut. This way, you’ll also be able to track your progress better and to seek alternative help if required. Some questions you can ask yourself are:
Am I satisfied with the current balance of talking and listening with my therapist?
Is my overall therapy experience safe, warm, and validating?
Am I fully assured that I’m in a non-judgemental space where I can be fully honest?
How much has the therapist helped me to gain greater insight into my own behaviour and thoughts so far?
Am I becoming more capable of coping (independently) with stressful or triggering situations over time?
Am I noticing more positive changes in myself, as compared to when I first started therapy?
As mentioned, a major deciding factor should also be on whether you find yourself noticing positive changes in your thought cycles and behaviour after a couple of sessions. At the end of the day, therapy should be about working towards achieving your desired outcome, and should definitely not be limited to weekly venting sessions. Although venting and letting out hard feelings can provide temporary relief, it fosters a client’s dependence on the therapist over time and further reinforces the client’s problems. Therapy should instead help you to feel more confident that you’ve developed the relevant skill sets in order to cope with whatever emotional challenges that brought you to seek therapy in the first place.
Naturally, there’s no guarantee that we will find chemistry with the first therapist we meet. The chemistry between people varies, and sometimes it’s just not possible for us to force it. Thus, it is important to remember that a lack of fit between therapist and client is no one’s fault. However, remember that the ball is in our court, and it is within our control to start looking in the right place for the sake of our own well-being.
1 Herman, S.M. (1998). The relationship between therapist-client modality similarity and psychotherapy outcome. Journal of Psychotherapy Practice and Research, 1998 Winter; 7(1): 56-64.
2 Luborksky, L., Crits-Christoph, P., Alexander, L., Margolis, M., & Cohen, M. (1983). Two Helping alliance methods for predicting outcomes of psychotherapy: A counting signs vs. a global rating method. Journal of Nervous and Mental Disease, 171, 480-491.
3 Jones, E. E., (1978). Effects of race on psychotherapy process and outcome: An exploratory investigation. Psychotherapy: Theory, Research and Practice, 15, 226-236.
4 Blase, J. J. (1979). A study of the effects of sec of the client and sex of the therapist on clients’ satisfaction with psychotherapy. Dissertation Abstracts International, 39, 6107B-6108B.
Beutler, L.E., Clarkin, J., Crago, M. and Bergan, J., 1991. Client-therapist matching. Pergamon general psychology series, 162, pp.699-716. (Accessed 30/08/2020)
For someone who struggles with emotional self-regulation, what does having a “breakthrough” mean? A “breakthrough” could mean coming to a point of realisation and acceptance of one’s mental state, and taking a step forward to change his/her seemingly challenging behaviour. To achieve this, we’ll need to learn the art of self-mastery in order to transform our emotions, attitude and most importantly, our behaviour.
Let’s not beat about the bush – the most pivotal factor to attaining self-mastery is for the person in question to understand that he/she needs to take charge of his/her own thoughts, emotions and actions. The model of self-mastery dictates that we should acknowledge and accept that we are the ones who are responsible for changing our own life experiences. It is often said that we are each the author of our own lives, in which we live in whatever we create. At any point in time, we should always be open to learning life skills to deal with whatever life presents us, instead of resisting or reacting against it. We should learn to control what happens to us by exercising creative control over the circumstances that we throw ourselves into. Without the will to take charge and make the relevant changes, this “breakthrough” would, unfortunately, be a tough feat.
There is a difference between control and self-mastery, and it is crucial that we internalise this. Oftentimes, people with mental health conditions tend to display controlling behaviours of themselves or others.To put it succinctly, controlling behaviour arises when we compel others to change their behaviour to cater to our own experiences of life. On the contrary, self-mastery means transforming our own behaviour in order to change our own experiences of life. Practising self-mastery implies that we adapt to what life presents us, instead of quitting or getting emotionally erratic when things become challenging. This involves learning new life skills that we have yet to master in order to carry us through frustrating tough times and eliminate controlling behaviour. Controlling or manipulative behaviour often emerges from within ourselves whenever things don’t go as we expect. We victimise ourselves and push the blame towards others or life in general for what was presented so as to “correct” the situation. The truth is, when you feel that people aren’t showing you the gratitude or appreciation that you deserve, the fault is not with them. In actual fact, you are exhibiting a need to control – to bring your current life experiences to fit your idealised version of it. For individuals with disruptive emotions and impulses, self-mastery may not come easily to them, as a result of the dysfunction of their self-regulation skills. Yet, this doesn’t mean that it is entirely impossible.
Self-mastery means not allowing our past negative experiences to affect our present and future. It is not easy to undo those past experiences, as they are like deep-seated stains on our clothes that cannot be removed. However, we can choose not to wear those clothes again. It is hard to pick up anything new if our hands are full of burdens. Making peace with our past by letting go, forgiving or even forgetting, will give us space for an untarnished and more objective approach to our present and future. Practising self-mastery also includes being mindful of how you interpret an event in a way that reduces the negative thought or completely replacing it with a positive one. This psychological strategy can be understood by looking at a glass and asking yourself whether it is half full or half empty. Instead of focusing on the dark clouds, we should change our interpretative lens to uncover the silver lining. For example, instead of envying your friend’s success, you should see your own failure as a temporary detour and not a dead end.
Being mindful of our actions and reactions helps us see them for what they are so as to reign in any impulsive controlling, or difficult behaviour. Truth be told, we have all displayed difficult behaviour at times, which as a result, might have caused us to burn a bridge or two. However, the display of fluctuating emotions may be a regular occurrence for some individuals who may not know how to work towards a “breakthrough”. In this case, only if we are mindful of our behaviours can we be less reactive and better able to reframe our perception of our current experience in a less emotional and upsetting manner. With practice, we will slowly become better at creating that space which will then allow us to choose our reactions rather than just reacting out of habit or impulse. Of course, this, in turn, leads to happier and healthier relationships, ultimately improving our mental state of health as well.
Last, but not least, a crucial step in developing self-mastery is to start with self-honesty and truthfulness. Do some self-reflection. That is, have an honest assessment of your own strengths and weaknesses, as well as owning up to your problems. When you are able to identify your weaknesses, you will be able to direct yourself better to what needs to be worked on and the relevant life skills you’ll need to master in order to find a breakthrough. In contrast, focusing on your strengths will also help boost your self-confidence, and act as a motivation for you to work towards making the change you need (i.e., self-improvement). If it helps, attend a peer support group. Peer support groups are built on shared personal experiences and empathy – it focuses on one’s strengths and helps you work towards your mental health and happiness goals. At the same time, it comforts you that you aren’t on the road to mental resilience and self-mastery alone and that there are many out there like you. Don’t be afraid to reach out for professional help too, for it could very well be the push you need to help you achieve the breakthrough you desire.