Why am I anxious? Exploring EMDR as a treatment for anxiety

Anxiety is a natural and often necessary emotional response to stress or perceived danger. It's one of the inevitabilities of life that we will face times that challenge us. Feeling anxious may also motivate us: it's a sign that we care about something and that it needs our attention.

While anxiety can be a normal and adaptive reaction, especially in situations where alertness and caution are required, it can become problematic when it is excessive, persistent, and interferes with daily life. Here's a closer look at anxiety, its types, symptoms, and how it can be managed.

Types of anxiety

Often, clients may need to fit into a set medical criterion. Still, it may be helpful to look at how anxiety is grouped into different types or diagnoses. Examples include:

• Generalised anxiety disorder (GAD): Excessive, uncontrollable worry about various aspects of daily life, such as work, health, and social interactions.
• Panic disorder: Recurrent, unexpected panic attacks, which are sudden periods of intense fear or discomfort; fear of losing control or dying.
• Social anxiety disorder (social phobia): Intense fear of social or performance situations where one might be scrutinized or judged by others.
• Specific phobias: Irrational fear of objects or situations, such as heights, animals, or flying.
• Obsessive compulsive disorder (OCD): Presence of obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviours or mental acts performed to reduce anxiety).
• Post-traumatic stress disorder (PTSD): Anxiety and related symptoms following exposure to a traumatic event. Symptoms include flashbacks, nightmares, severe anxiety, avoidance of reminders of the trauma, and hypervigilance.

Understanding your anxiety

When working with clients, a question often arises: "Why am I anxious?" This question can take many forms:

• Why am I anxious about everything?
• Why am I anxious when I am alone?
• Why am I anxious when I am around my partner?
• Why am I anxious all of a sudden, from nowhere?
• Why am I anxious for no reason?
• Why am I anxious in social situations?
• Why am I anxious in the morning?
• Why am I anxious in the afternoon?
• Why am I anxious when nothing terrible has happened to me, like trauma?

To explore the question, "Why am I anxious?", we may look at your 'window of tolerance' of emotional regulation.

Your 'window of tolerance' and the 'green zone'

We all have a 'window of tolerance' regarding emotional regulation. Understanding and recognising our own window of tolerance can empower us to manage our anxiety. This is a range of emotional states within which we feel comfortable, and our body functions optimally.

Working with a therapist can help you expand your window of tolerance so that there is less risk of being 'triggered' and an increased ability to soothe, self-regulate, and cope when you feel challenged. In this state, we are aware and alert but not anxious. We engage with the environment well, feel calm but not tired, and can feel in touch with emotions and reason. It may help to visualise your window of tolerance as your 'green zone.' The green zone allows us to feel grounded, connected, present, safe, caring, creative, flexible, calm, and curious.

What happens when we leave our window of tolerance?

There may be two responses to leaving your window of tolerance: hyperarousal ('fight or flight') or hypoarousal ('freeze'). Let's look at each in turn:

Hyperarousal: 'Flight or fight'

Visualise this state as a 'red zone' of emotional dysregulation. You may feel panic, a sense of chaos, highly anxious, or angry. Your body may respond with increased heart rate, digestive issues, sweating, and sleeplessness. Your concentration may decline, and you may feel hypervigilant and unable to relax.

In this state, people may become more reactive and prone to outbursts. In a hyperarousal state, you may feel irritable, anxious, agitated, uncomfortable, overwhelmed, out of control, or threatened. Thinking, using reason, or feeling in touch with your thoughts or emotions becomes challenging.

Hypoarousal: 'Freeze'

Visualised as a 'blue zone' of emotional dysregulation, hypoarousal is a state that feels more 'shut down.' Some describe feeling depressed, numb, disconnected, dissociated, detached, lacking energy, or 'meh.' There is a sense of rigidity, flatness, and unavailability in the frozen state, where it may be easy to lose track of time, shut down, and experience poor concentration and poor digestion.

Working with anxiety in therapy

In therapy sessions, we may start exploring anxiety through the lens of emotional regulation and what may be impacting your Window of Tolerance. Some aspects we may look at are:

• What is your anxiety, and how would you like to feel?
• If you think back, is there a time or age that the anxiety emerged? Or a time when you felt within your window of tolerance? What was your relationship with yourself, others, and life at these times?
• Do you notice any thoughts emerging when you feel in 'flight, fright, or freeze' mode? These may be "I am not safe," "I always get things wrong," or "I am out of control."

EMDR for anxiety

One of the treatments I have used with clients is EMDR (Eye Movement Desensitization and Reprocessing). This is a fictionalised account of an EMDR treatment with Ray:

Ray's EMDR treatment

Ray came to therapy at age 36. He had been in a long-term relationship with his partner for eight years. Ray had a career he previously enjoyed but now found himself unable to focus at work. He felt he wasn't enjoying work or life as much as he used to, and everything felt flat and meaningless.

Ray was frustrated, as he had so much to feel grateful for and couldn't pinpoint what didn't feel right to him. Ray described waking up each morning with a sense of doom, as though something terrible would happen, but he couldn't understand why. His sleep had become disrupted.

He noticed that before meetings, his palms were sweaty, and his heart felt as though it was racing, making it difficult to focus and concentrate. He felt anxious that he was missing critical things at work but couldn't pinpoint what they were. At home, his partner wanted to discuss plans like moving home or booking a holiday. He found that his mind 'zoned out'; he felt disconnected and guilty that he couldn't share her excitement.

During the first sessions, we worked to explore how Ray felt, his relationship with himself and others, and his experience of life, including his childhood and adolescence. Using a psychodynamic approach, sessions gave us helpful information about unconscious and conscious thoughts and feelings. Notably, the sessions built a safe space for Ray, as the therapeutic relationship allowed him to explore his mind with another person without fear of judgment or having to be concerned about their reactions.

Nothing was 'off the table,' as it provided valuable clues and information that we could work with. Ray felt curious about EMDR and wanted to experience a different approach to understand better what he now recognised to be anxiety. The session was more structured than Ray's previous sessions and lasted 90 minutes. This is an overview of the session:

Using EMDR to help manage anxiety

What is EMDR?

EMDR is a structured therapy that encourages the patient to briefly focus on what they would like to process while simultaneously experiencing bilateral stimulation (usually eye movements, but can be auditory or tactile), which is associated with a reduction in the vividness and emotion associated with the event, disturbance, feeling, or memories. It was developed by Francine Shapiro in the late 1980s and has since been widely used and researched.

Ray had heard about EMDR and had assumed it was only used to treat post-traumatic stress disorder (PTSD). Although it was initially developed for PTSD, EMDR has been found beneficial for a range of other mental health issues, including:

• anxiety disorders
• panic disorder
• social anxiety
• depression
• phobias
• addictions and substance misuse
• obsessive compulsive disorder (OCD)
• trauma
• chronic pain
• eating disorders
• performance anxiety

EMDR can support coping with significant life changes or stressful events that lead to adjustment disorders by processing the emotional impact of these events and promoting adaptive coping strategies. EMDR helps individuals process the intense emotions and memories associated with the loss of a loved one, reducing prolonged grief symptoms and facilitating healthier grieving processes.

Ray's EMDR sessions

Ray's EMDR treatment took four sessions, each lasting 90 minutes, during which we covered the following stages:

1. History taking and treatment planning

We gathered a detailed history and developed a treatment plan. As Ray had been coming to therapy for two months, we were quickly able to identify specific memories and situations that trigger anxiety. Ray had noticed that he felt very anxious and overwhelmed before meetings, as though he would fail somehow. When his partner discussed plans, a similar reaction occurred, and Ray felt he would let her down or fail.

2. Preparation

We discussed the EMDR process and techniques in detail, supporting Ray in building trust and ensuring that he had adequate coping mechanisms to deal with distressing emotions. Coping mechanisms are essential to EMDR, ensuring that Ray felt in control and could stop the process at any point.

We discussed how Ray would let me know if he wanted to stop, agreeing on a hand signal. Also, we decided on a signal to let me know that he wanted to continue processing. Ray understood that when processing, we can compare what is happening within our brain to that of a car passing through a tunnel. The car is the thought or memory, and the tunnel is the neural pathway. Holding the foot on the accelerator or continuing to process through bilateral stimulation helps reach the other side of the tunnel faster.

3. Assessment

We identified the specific memories, thoughts, feelings, and body sensations Ray wanted to target. For Ray, the initial memory was a particular work presentation where he had felt anxious and self-critical. Ray was encouraged to visualise a 'safe place' or 'resource' memory that could be used for comfort and grounding during distress. He described walking in the mountains, which felt very comforting to him.

4. Desensitisation

We processed the targeted memories using bilateral stimulation and reduced their emotional charge. This part of the treatment involved Ray focusing on the image, thought, feeling, or sensation while experiencing bilateral stimulation. Ray noticed a significant shift in his perception of the memory. Initially, Ray felt very anxious and critical of himself when recalling the presentation. Through the desensitisation phase, he began to feel more detached and objective, viewing it as a learning experience rather than a failure.

5. Installation

We installed positive beliefs and feelings to replace the negative ones. Ray chose to instil the belief, "I can handle it," which gave him a sense of confidence and capability. As we processed the memory of the presentation, Ray began to see himself as capable and resilient, able to manage future challenges effectively.

6. Body scan

Ray was encouraged to scan his body to identify residual tension or distress. This helped ensure that the processing was complete. Ray noticed a significant reduction in physical symptoms such as sweating and heart racing. He felt more relaxed and centred.

7. Closure

We ensured that Ray returned to a state of equilibrium and safety. We practised relaxation techniques and grounding exercises to help him feel calm and centred. Ray felt a sense of accomplishment and relief, having processed a significant source of his anxiety.

8. Revaluation

We reassessed Ray's progress and identified any additional targets for future sessions. Ray reported a significant improvement in his anxiety levels, particularly in work-related situations and interactions with his partner. He felt more confident, relaxed, and in control.

After sessions, Ray reported having more vivid dreams but recalled that processing could carry on after EMDR Sessions, resulting in new memories, feelings, or vivid dreams. Ray made a note when this occurred to bring the material to the next session as soon as possible to process.

EMDR has proven to be a powerful and effective treatment for Ray, helping him manage his anxiety and improve his overall well-being. It is essential to remember that the therapeutic process is unique for each individual, and the experiences and outcomes can vary.

If you are considering EMDR or any other form of therapy, please consult an accredited and qualified mental health professional who can guide you through the process and tailor the treatment to your specific needs, which is crucial.

Conclusion

Anxiety can be a challenging and overwhelming experience, but understanding its roots and exploring effective treatment options can make a significant difference. The journey to managing anxiety is personal and unique. Proper support and strategies make it possible to regain a sense of balance, control, and well-being.