Elizabeth Lacy, LCSW

Individual, Group and Couples Psychotherapy

Emotions are the body and mind's way of giving us information about our environment and ourselves. In and of themselves, anxiety and fear are perfectly healthy emotions that can help  us to prepare for problems and to protect ourselves. Anxiety and fear become problems when something has happened through some experience, trauma,  and/or childhood  that causes us to fear or worry about things that are really not harmful - or at least not nearly to the degree that we fear. Sometimes a person can also be genetically or biologically more sensitive or more likely to experience anxieties or fears.

Three Components of Anxiety/Chronic Worry/Fears

1) Physical/Feelings 

These are the physiological reactions or the body’s physical reactions to anxiety. If you have anxiety or have had a panic attack, you know them well: 

Heart palpitations or raciness, dizziness, sweating, tightness in the chest, shortness of breath or hyperventilation, tingling in the hands/feet, sometimes a feeling of unreality, nausea, feeling of being hot or cold, flushing, headache, general tension in the body and the like. You may have only one of these physical symptoms or you may sometimes have many of them.

 These are all caused by the body releasing various chemicals related to fear or the “fight or flight syndrome” as it is commonly known. Chemicals like adrenaline, noradrenalin and cortisol.


2) Cognitions/Thoughts 

These are the thoughts that come along with anxiety (worrying) and/or panic. These are usually negative, distorted thoughts (click here for common cognitive distortions) that increase your worry and therefore increase the release of the chemicals that cause the physical reactions we just talked about. They are often what we call "automatic" thoughts.

 For example, “ I’m going to have a heart attack” may be a thought that pops up. Or “ What if something bad happens?” "Something terrible will happen" “They won’t like me because they will see that I am anxious”  or “He is going to take advantage of me” ... and any number of negative thoughts that make you feel worried, unsafe, fearful or panicked.


 3) Behaviors

 These are all the behaviors that you try to bring down your anxiety, worries or fears – many of which may include avoidance.

ExamplesIf you believe that it is dangerous to drive, the behavior may start out as you avoiding driving on the highway. Then after a while, you no longer will even ride in a car with someone else driving; If you fear something happening to a family member, you may call or text them to check on them during the day  and when you don’t hear back, you may start calling their friends; If you have some social anxiety, you may avoid eye contact when asking someone out on a date or talking to someone face to face; You may try to control situations  or people's behavior thinking that if the situation or person doesn't do certain things, awful/feared things will happen to you or someone else; checking the Internet for your "symptoms"; nail biting; bringing certain objects or things with you  to keep you safe; keep certain people with you; any other thing you try to bring down your anxiety or fears in the moment.

How the 3 Components interact:  Each component can trigger the others to become more intense. For example,  if you feel your heart palpitating (physical) and you think to yourself “I am having a heart attack” (thoughts), your body will respond with a higher level of fear and probably increase the heart palpitations, you then think “I’m going to die if I don’t do something” so you finally call 911 or go to an ER (behavior).   - Common during a panic attack


A Word About Avoidance: Avoidance is behavior of many anxiety disorders– and a significant one. This is because in the short run it seems to decrease the anxiety - the problem is that in the long run it increases  and intensifies anxiety Click here for a story that illustrates this concept.


Treatment for Anxiety, Chronic Worry, Fears

Some treatments for anxiety disorders are more effective than others – for example CBT. CBT, Cognitive Behavioral Therapy, is a global term used for a number of different types of evidence-based practices that work on all three components of anxiety. Just like the negative spiraling we discussed – treatment works on stopping the cycle at all three points.  (Note: There is a myth out there that CBT is somehow less emotional therapy than other therapies - but the truth is, when done well with a close relationship with a therapist, it is close, deep, emotionally effective treatment for certain types of difficulties. It is now one of the leading treatments in ending the suffering involved in Post-Traumatic Stress Disorder, Panic Disorder, Agoraphobia, Social Anxiety, and OCD.)

For the Physical: Coping Skills/Grounding Techniques; Specific Breathing Techniques targeted to the calm the nervous system and ease under/over-breathing; Mindfulness; and the like.

For The Thinking/Cognitive: Identifying and changing long-standing thinking patterns by reappraising and challenging; identifying core beliefs that may be limiting you; understanding and changing your schemas or images about life; mindfulness and acceptance techniques.

For the Behaviors/Avoidance: Exposure Therapy (facing your fears in a prepared, supported, graduated, safe way); response prevention (for those that do repetitive behaviors to reduce anxiety/fears); and learning new skills where that's needed.

 click here for Article on Effectiveness of Exposure Therapy for PTSD

This is certainly not an exhaustive list of therapeutic techniques, but it is a good start to let you know that there are a number of evidence-based practices that are very effective. PBS had a special not long ago called "This Emotional Life". In it, it featured several of these techniques - I highly recommend you see it if you are worried that you can't stop your anxiety, panic, OCD or PTSD symptoms. (Click on the title to bring you to PBS)