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Know thyself.

-The Oracle at Delphi

Monitoring Anxiety

If you are working with a psychologist, psychiatrist or therapist on treatment for your anxiety, one of the most important thing you can do is collect information about how anxiety works for you.  That information can help your psychologist tailor treatment to be most effective for your circumstances.  Of course, we recommend that you check with your health care provider and talk with her or him about if this is the right approach for you.

One of the goals of monitoring is to learn as much as possible about what's going on before, during, and after an event like a panic attack or being confronted with a feared situation.  In order to be as thorough as possible, when doing monitoring it is helpful to look at as many different affected areas as possible.  Also, for the most detailed results it is best to collect information when the symptoms or difficult situations are actually happening.  Sound like fun?  Probably not.  However, it can produce results that may be really important in facilitating treatment.

A common example might be what someone would report if they had panic attacks several times a week, and found it impossible to go the supermarket because it cause panic attacks.  While this example deals with panic and agoraphobia, it can easily be adapted to other forms of anxiety:

In addition to collecting this information, it can also be useful to collect information on:

Dr. Jeff Matranga and Dr. Jon Borkum at Health Psych Maine have an excellent website that offers a thoughtful, succinct outline of ideas on monitoring anxiety.  They point out the importance of also paying attention to caffeine and nicotine use, since those substances can affect your body in a way that increases your vulnerability to panic.  They also stress, correctly, the importance of checking in with your doctor.  There are physical illnesses and drug side effects that can create the symptoms that are very similar to some forms of anxiety.  Checking in with your doc is extremely important in making getting a correct diagnosis and in planning treatment.

Finally, there is one other thing you can do to collect information on your anxiety.  Take a piece of paper and make a scale going from 100 down to 0 along the left margin (usually people make this scale going in increments of 10).  On the scale, rate different situations, thoughts, feelings, ideas, etc. that result in different levels of stress.  For the supermarket example listed above, being in line for check out might be rated as an "80", being in the car in the parking lot might be rated as a "60", being at home and thinking about getting in the car to go shopping might be rated as a "40".

There can be a catch-22 in monitoring anxiety if you are someone for whom panic attacks are a particular difficulty.  The catch-22 is that sometimes the attacks can seem to come out of nowhere.  They can be hard or impossible to predict and feel completely uncontrollable, which makes them even more stressful.  Some interesting research has been done on panic attacks that come out of nowhere.  One finding is that for a significant percentage of people with panic attacks, changing the amount of carbon dioxide they breath can be enough to trigger a panic attack.  Other research has found that people with panic disorder are often better at guessing their own heart rates, hinting that they may be more vigilant about physical cues that their bodies produce.  These areas of research have led some researchers to wonder if, for some, panic might be the result of one's body and brain misunderstanding changes in oxygen and heart rate levels and reacting with the same panic one would feel if one were suffocating.  Although these things might make monitoring a challenge, it also means that astute, detailed monitoring is especially important.

If you don't have the time or energy to do all of the things suggested on this page you are not alone!  It's a lot of work.  However, the more information you can share with your psychologist the better.  

As always, if you have questions or would like to set up an appointment with us please give us a call.

References:

Barlow, D.H., Hayes, S.C., Nelson, R.O. (1984). The Scientist Practitioner.  Boston: Allyn & Bacon.

Barlow, D.H. (1988). Anxiety and Its Disorders. New York: The Guilford Press.

Craske, M.G. & Tsao, J.C.I. (1999) Self-monitoring with panic and anxiety disorders. Psychological Assessment, 11, 466-479.

Falls, W.A. & David, M. (1995). Behavioral and physiological analyis of fear inhibition: Extinction and conditioned inhibition.  In Neurobiological and Clinical Consequences of Stress: From normal adaptation to PTSD. Eds. Friedman, M.J., Charney, D.S., & Deutch, A.Y.  Philadelphia: Lippencott-Raven Puslishers.

McNally, R.J. & Eke, M. (1996). Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge.  Journal of Abnormal Psychology, 105, 146-149.

Rapee, R.M., Brown, T.A., Antony, M.M., & Barlow, D.H. (1992). Response to hyperventilation and inhalation of 5.5% carbon dioxide - enriched air across the DSM-III-R anxiety disorders. Jounral of Abnormal Psychology, 101, 538-552.

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The information posted on this site reflects our understanding of peer-reviewed research and generally accepted principles in psychology.  It is not intended to be used for self-treatment or as a substitute for individualized assessment and treatment by a licensed professional, and should not be construed as professional advice.

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