According to experts, anxiety develops from the combination of three ingredients: genetic traits (such as “biological sensitivity”), family influences, and stress (the “why now” factor). The stress ingredient accounts for the widespread prevalence of anxiety today. Translation? Anxiety is essentially a learned response to stress overload in sensitive people. Based on the author’s years of experience with anxiety, both personally and professionally as a seasoned psychologist, Dancing with Fear uses a recovery approach to treating this widespread problem. Dr. Foxman offers a wide range of self-help strategies from drugs and diet to herbs and yoga for combating panic attacks, phobias, avoidant behavior, worrying, unwanted obsessions, and body symptoms such as racing heart, shaking, breathing problems, sweating, nausea, and weakness. With 20 percent new material in this edition, Dancing with Fear offers a proven plan for reclaiming one’s life by replacing anxiety with peace, optimism, and joy.
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|Edition description:||Second Edition|
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dancing with fearControlling Stress and Creating a Life Beyond Panic and Anxiety
By PAUL FOXMAN
Hunter House Inc., PublishersCopyright © 2007 Paul Foxman, Ph.D.
All right reserved.
Chapter OneMy Anxiety Story
I realize that it requires a tremendous leap of faith to imagine that your childhood-punctuated with pain, loss, and hurt-may, in fact, be a gift. - Wayne Muller, Legacy of the Heart
Fear haunted me since childhood, and as I grew up, I sensed I was more sensitive and anxious than other people. My life story is an example of how an anxiety disorder can develop and how to overcome it.
A number of conditions and traumatic experiences were responsible for my anxiety. One strong influence was exposure to violence in the volatile community in which I was raised. It was the 1950s in New York City, in a neighborhood known as "Hell's Kitchen." The Broadway play, West Side Story, portrays the kind of tension and violence I experienced in this primarily Puerto Rican and black community.
Some sharp images and memories stand out about this aspect of my childhood. Racial tension was high and, as a white boy, I was an easy target for racial hostility. When I dated a Puerto Rican girl, for example, I was threatened and physicallyharassed up by a group of Puerto Rican boys who said, "We don't want you messing around with our women." In high school, a black member of the track team punched me in the face in the locker room, and claimed, "I don't want no white boy hanging out with my friends."
Many other forms of violence surrounded me in Hell's Kitchen. I recall a hunting knife being thrown into the lobby of my apartment building, entering blade first into a wall near me. While bicycling in Central Park, my brother, Marc, was mugged and had his bicycle stolen. One boy pushed another from a pier to his death in the Hudson River. A friend of mine, whom I can still vividly picture, was beaten regularly by a brutal father. He finally ran away from home, and I never saw him again. Although I never witnessed it, there were stories of violent gangs from "uptown," with names such as Viceroys and Marlboros, who fought with pipes and chains. These violent images certainly contributed to my unease and anxiety.
I was myself a victim of violent abuse. On the way to school at the age of twelve, I was raped in an abandoned building by a man who threatened to "smash my head" with the brick he held over me, if I did not do what he said or if I ever told anyone. I was so frightened that I not only complied but was unable to tell anyone about the humiliating and painful trauma for more than ten years. I was always on the lookout for that man, and unbelievably, I did see him on one occasion roaming the neighborhood. There must have been other victims.
There were more subtle incidents that also contributed to my anxiety. I recall, for example, my father telling me he had joined the Army to fight against Hitler. I learned at a young age that because of their beliefs, millions of Jews were systematically exterminated in gas chambers and ovens. Because my father was Jewish, the Holocaust struck even closer to home. As I matured, I learned that racism, war, economic exploitation, and political oppression have occurred throughout history, and that the world is indeed unstable and often dangerous.
A near-death experience I had when I was ten years old added to my anxiety. I had a cold, which developed into croup. During the night, I was awakened by a phlegm obstruction in my windpipe that was blocking my breathing. I tried to scream for help, but could make no sound. Due to oxygen deprivation, I fell unconscious. Waking up the next day, after an emergency tracheotomy operation, I found myself strapped to a hospital bed, breathing through an opening in my throat. I was unable to speak, and my parents were told I might never speak again due to surgical damage to my vocal chords. The only pleasant part of the following two weeks in the hospital was a caring nurse named Peggy, toward whom I felt my first feelings of falling in love. The life-threatening episode was a frightening brush with death, leaving me with a sense of vulnerability and life's fragility.
Another source of anxiety was the separation and divorce of my parents when I was ten years old. From this destabilizing process, I learned relationships can be tense, unstable, and hostile. Avoiding commitment and intimacy became a pattern by which I protected myself in relationships for many years to follow.
How did the traumas of my childhood show up in my personality and in my problem with anxiety? Many of my early experiences naturally evoked fear and anxiety. But I was also ashamed of my fear and anxiety. In Hell's Kitchen (as in the larger society), a sensitive or fearful boy would be considered a chicken, a sissy, or a weakling. To avoid the stigma of anxiety and to cope with shame, I compensated by working hard to be successful in academics and sports. I became a high-achieving student and athlete who could hide anxiety behind visible accomplishments. For example, I was the captain of my high school track team, medaled frequently, and earned a reputation as the "fastest white boy" in New York City. I also became editor of the high school yearbook, and I was accepted as a scholarship student to Yale University, where I became a ranking scholar (top 10 percent of the class) and repeatedly made dean's list. At Yale, I had a research project published in a prestigious psychology journal and went on to earn a Ph.D. in clinical psychology. Although not all high achievers are driven by anxiety, it is a common strategy for counteracting shame, low self-esteem, and self-doubt.
In my relationships, I was hesitant to make commitments, but I was also afraid to be alone. Hiding my fear led to difficulty expressing other feelings. My external accomplishments seemed possible only if there was someone to cheer, admire, and approve. I was too dependent on others for my self-esteem, and I worked overly hard to please them. I was unusually sensitive to criticism and rejection, and I avoided conflict whenever possible. I had intense separation anxiety and fears of abandonment. These traits are common in people who tend to develop anxiety disorders.
I also had difficulty relaxing. I was restless, impatient, and tense, and frequently distracted myself from anxiety by engaging in activity. I was certainly not enjoying life, except for a sense of gratification in my accomplishments. My stress level was high due to my perfectionism and need to "prove myself" through my achievements.
This approach to life was exhausting. However, I did not realize there was a problem until this stressful style took a toll on my energy and I began to feel depressed as a young adult.
Depression, as we will see later in the book, often arises as a response to anxiety, and in some cases, an anxiety disorder is misdiagnosed as depression. The symptoms of depression include low energy, low motivation, and loss of interest in activities that have been associated with joy, pleasure, or satisfaction. Particularly when frequent worry is involved, chronic anxiety can also lead to these symptoms.
In my case, fear of being alone was at the heart of the depression that occurred when I was without a companion. At one point, I found myself without a romantic relationship, and both my anxiety and depression intensified. I began to have panic attacks, with accompanying fears of losing control. The worst period consisted of daily panic attacks for several weeks, during which I thought I was going to die, go crazy, or disintegrate.
After college, I experimented with drugs and experienced some relief. The drugs consisted of marijuana and psychedelics, such as mescaline, peyote, and LSD. Use of mind-altering drugs was both a line of defense against anxiety and depression as well as a source of pleasure. Marijuana, for example, helped me relax and slow down. I was able to "let go" and begin to experience an inner peace previously unknown to me. Relaxation through drugs marked the beginning of my anxiety recovery. However, I paid the price: My social life suffered, my efficiency dropped, and I had some "bad trips" that reinforced my anxiety. For these reasons, I would not recommend hallucinogenic or psychedelic drugs for anxiety. In many cases, the altered state of mind induced by these drugs can directly precipitate an anxiety disorder. In fact, there is a formal diagnosis for this response-Substance-Induced Anxiety Disorder-which I discuss in Chapter 3. Fortunately, I discovered healthier methods for relaxing and experiencing inner peace, which I emphasize in Part II.
My anxiety recovery was an eclectic, trial-and-error process. I experimented with many techniques and methods, concentrating on those I found useful. I share them in greater detail with you in later chapters.
I discovered, for example, that I could relax and find inner peace not only through drugs but also through meditation. I studied meditation with a Sufi group in San Francisco, where I began to understand the role of the mind in anxiety. I received teachings and training in meditation from a variety of sources. Through regular "sitting" practice, which I describe in Chapter 8, I was able to face and let go of my anxiety-producing thoughts. I developed the ability to empty my mind and experience my true nature. I frequently enjoyed a state of inner peace, with a quiet mind and open heart. At first, my mind resisted vigorously because it had served for so long as a vigilant guard against threats and danger. It was necessary to diligently practice the yoga and meditation skills I acquired.
Spiritual studies became part of my recovery from fear and anxiety. I explored many wisdom traditions, including Buddhism, Hinduism, Christianity, Judaism, and Native American teachings. In addition to my yoga and meditation practices, I studied many aspects of health and the healing arts, such as massage, herbology, reflexology, and various forms of body work. As I released my body's tension, I was able to experience deeper trust, peace, and feelings of security. I also resumed regular exercise, and I gradually adopted a vegetarian diet, which enhanced my peacefulness. In addition, I sought psychotherapy, where I could talk openly and safely about my anxiety and other feelings.
Equipped with these tools for relaxing my body, controlling my mind, understanding myself, and tapping into spiritual power, I was able to desensitize myself and recover from anxiety. At one point, I faced my biggest fear by taking a year off and traveling by myself, with no itinerary or plans. During this psychological pilgrimage, I spent considerable time by myself, facing my anxiety about being alone, and letting go of the past. At another point, I relocated by myself from San Francisco, California, to Nashville, Tennessee-where I knew no one-to further my professional training. By taking such risks and testing my skills and faith, I experienced a quantum leap forward in my recovery.
One specific incident stands out as an example of the benefits of my anxiety recovery practices. While asleep one night at home, someone broke into my house. When I awoke to the unusual noise, the intruder threatened to shoot me with what appeared to be a shiny weapon. I was able to keep my presence of mind, negotiate with the intruder, who turned out to be a teenage boy, and overpower him through focused attention to his body language and weapon (which was actually a knife). As he pleaded to be released, a profound feeling of compassion overcame me and I let him go. I am certain my life was saved by the mind-body practices that allowed me to stay focused and calm in this life-threatening situation.
What is the reward for working at recovery from anxiety, apart from sheer relief? Anxiety recovery boosted my self-confidence, energy level, and general enjoyment of life. In the recovery process, I learned how to express my feelings more openly, as well as how to deal with conflict. I learned how to love, forgive, and let go of negativity. Anxiety recovery prepared me for a healthy intimate relationship and the joys of marriage and raising children. Through recovery methods such as meditation and relaxation, I now control my mind, rather than having my mind control me. I do not fear aging, or even dying, although I am in no rush to pass on. While I may plan for the future, I live much more in the present. My hope is that more anxiety sufferers will, through their successful recovery, experience these rewards and blessings. I also hope Dancing with Fear will help.
Chapter TwoWhat Is Anxiety?
Anxiety is a normal part of life for everyone. Taking an exam, meeting with a boss or authority figure, having a near accident, starting a new job, or traveling by airplane can all evoke anxiety. Anxiety can even be helpful in preparing for a challenge or change. However, persistent or intense anxiety is abnormal, especially when it interferes with daily life. In such cases, it can become an anxiety disorder requiring professional help.
Anxiety disorders are surprisingly common, and their incidence appears to be rising due to increasing stress and uncertainty in the world. Approximately thirty-seven million American adults suffer from anxiety severe enough to warrant professional help. It is estimated that one out of every four adults will have some form of severe anxiety at some point in their lifetime. Anxiety is the most common emotional disorder, outranking all others, including depression and substance abuse. Indeed, it is estimated that up to 40 percent of those who are dependent on drugs or alcohol have a severe anxiety disorder they are attempting to "self-medicate" and control.
What Is anxiety and Why Is It So Prevalent Today?
Anxiety is related to our survival instinct. Normally, when we are confronted with danger or a life-threatening situation, our bodies react quickly with an automatic survival mechanism, known as the fight/ flight response. Briefly, this is an energized state that enables us to effectively confront or flee from a life threat. In response to danger, a survival command center in the brain calls for release of activating hormones that organize all body systems for survival. A more detailed description of the fight/flight response is found in the next section, entitled "The Anatomy of Fear."
Many situations can trigger the fight/flight reaction, particularly in sensitive people, even if those situations are not life-threatening. This is precisely what happens in most cases of anxiety: A person reacts as though there is a life-threatening situation when no actual danger exists.
It is normal to fear danger or a threat to our lives. As part of our survival instinct, fear is a natural and adaptive reaction. Anxiety, on the other hand, can be understood as a fear response when there is no actual danger or threat. Anxiety is a maladaptive response because it is a reaction to imagined or perceived threat, or an anticipated threat that is not occurring in the present.
In many cases, anxiety develops as a learned reaction to past fears and extreme stress. For example, if you have a traumatic experience in a particular situation-say, a panic attack while driving a car or a nervous feeling while giving a presentation in front of other people-you may begin to perceive that activity as "dangerous." Thereafter, just thinking about entering the situation-driving a car or giving a presentation-will set the fight/flight survival reaction in motion. In other words, certain situations or places become linked to a negative emotional experience and its associated body reactions, and these situations are then perceived as threatening. Some typical "phobic situations" are traveling away from home, flying, being alone, shopping in crowded stores or malls, meetings, and social gatherings. In these situations, the body reaction itself is normal, but it is triggered by a false alarm.
A common denominator in most anxiety conditions is a fight/flight reaction to a place, thought, feeling, or situation, accompanied by an irrational fear of losing control, "going crazy," embarrassing oneself, having a serious illness, or dying. Worry enters the scene as a form of anticipation of future events in an effort to feel in control. We try to predict what will happen in order to feel prepared. But frequent worry keeps us in a state of anxiety. In the next chapter, we explore the anxiety disorders that develop when this pattern persists.
Excerpted from dancing with fear by PAUL FOXMAN Copyright © 2007 by Paul Foxman, Ph.D.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Preface to the New Edition....................xiv
Part I: Insight: How to Understand Anxiety Chapter 1: My Anxiety Story....................9
Chapter 2: What Is Anxiety?....................15
Chapter 3: The Anxiety Disorders....................25
Chapter 4: The Three Key Ingredients in Anxiety Disorders....................44
Chapter 5: How Anxiety Develops....................64
Part II: Strategies and Skills for Creating a Life Beyond Anxiety Chapter 6: Controlling Stress....................85
Chapter 7: Don't Just Do Something, Sit There....................100
Chapter 8: Take a Deep Breath....................113
Chapter 9: Play Is for Adults, Too....................123
Chapter 10: Food, Eating, and Anxiety....................142
Chapter 11: What If?....................153
Chapter 12: Facing Your Fears and Phobias....................170
Chapter 13: Feeling Safe with Feelings....................181
Chapter 14: Anxiety and Relationships....................202
Chapter 15: Sex and Anxiety....................211
Chapter 16: Spirituality and Anxiety....................224
Chapter 17: Should You Take Medication for Anxiety - or Not?....................242
Chapter 18: Toward a Life Beyond Panic and Anxiety....................260