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Uncommon issues in anxiety treatment [long]

Posted by Phil R. on November 6, 1999, at 23:51:14

Hi. I realize the following two issues are somewhat out of the mainstream of this board, but I've received some encouragement to toss them out anyway. The questions themselves:

1. In psychotherapeutic treatment of anxiety disorders, being able to create and then use a relaxation response is usually essential to the patient in reducing anxiety. But some (generally small) percentage of patients have a paradoxical response when they try to relax: they instead become more anxious! I just found out this is a known phenomenon called relaxation-induced anxiety, and I've looked up a few medical journal articles on it. But actually treating relaxation-induced anxiety appears to be mostly a mystery. I'm curious if anyone here has any experience or knowledge with this problem, and if there are any suggestions as to how to deal with it so that relaxation can then be effectively employed to combat anxiety problems.

2. For PTSD and other trauma-based disorders, psychotherapy is usually considered an important component of treatment. But some (again small?) percentage of people with these disorders are pretty much on the edge already, and it's known that psychotherapy can sometimes, at least initially, be somewhat *destabilizing* to them. I've read first-person stories from people whose black-outs or self-destructive behaviors, etc., got worse when they tried therapy. Given this precarious edge, how can someone in this situation begin the therapy which will hopefully be helpful in the long run, but threatens their stability, or even safety, in the short run?

FYI, I do indeed have a personal interest in these questions. I have a range of emotions, but for years I've had a strong need to remain somewhat emotionally guarded, and avoid just letting feelings (especially warmer feelings) just happen. When I do even begin to relax, let my guard down and let feelings just happen, I'm abruptly hit with varying feelings of anxious distress, usually accompanied by actual behavioral agitation, like I'm losing control. At times, the agitation has escalated to unsafe behaviors. Afterwards, I can be more vulnerable for several days.

I was in therapy for many years, but never got very far with it, despite my best efforts. I could never really let my emotional guard down (it felt too unsafe), and I think that's why therapy usually stayed up in the avoidant intellectual realm without much personal growth.

(Diagnoses have included "anxiety disorder not otherwise specified", and possibly PTSD. I also have recurrent major depression. I've been on a lot of different meds at different times: 12 antidepressants offering occasional help, 3 mood stabilizers, low doses of 6 antipsychotics for agitation, 3 anti-anxiety, and 4 "others". The base agitation problems don't seem to be a side effect of any particular medication.)

So I relate to my first question in that relaxation produces an anxiety/agitation response for me. I relate to the second question in that even though I've been in therapy, I was afraid that facing the stillness and emotions was going to be destabilizing and unsafe for me.

I've looked at this from lots of angles over the years. I've decided that it boils down to that I need to find a way to let my emotional guard down and relax without experiencing the distress and sometimes unsafe behavioral agitation. That's the core of it. Learning that skill should enable me to work on other things more effectively. If anyone has any experience or information related to my 2 questions, I'd be very interested. (I apologize that I'm usually not able to check this board every day, but I can every few days.) Thanks all.

- Phil R. (not the other Phil)




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