Identifying And Treating Anxiety (Part One),Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC

"I can't take the stress!"

Sometimes we might convince ourselves we just can't handle life's ups and downs, but the truth is, we usually manage. Part of our mission as Jews is to face minor and even major stressful events with faith, hope and trust in a good and just outcome. From a young age, a Jew acquires the knowledge that everything that Hashem causes to happen is for the good.

What happens, however, when emunah and bitachon are no longer capable of keeping worry at bay? What if even trivial problems begin to cause extreme worry? What if we respond to life's stresses with fear, anger or tension?

These responses can indicate that anxiety has taken the place of normal reactions to stress. On a deeper level, all Jews are temporarily living with tremendous stress. We are in galus and we are living like fish in the heat of the desert; thirsting for the soothing waters of Torah to alleviate our agony. True, some of us may have found a desert spring to flop around in. But, in order to thrive, we require the breadth and depth of the ocean; the life-giving waters of Torah; the geulah, the coming of Moshiach Tzidkeinu. At the soul level, modern neuroses, including anxiety, are perhaps the natural response to the spiritual deprivations our Yiddishe neshamahs endure in this galus.

The guidance found in Rabbi Shneur Zalman of Liadi's Tanya offers prescriptions for growth as well as solace. The spiritual work we are doing in this galus, making a dwelling place for the Shechinah here on earth, is an essential part of our growth and release. Tanya tells us, in part, that by correcting ourselves while simultaneously reaching out to others, we will find an authentic sense of purpose. And we will also find simchah, which is bound up with purpose.

Tanya, like most Jewish teachings, tells us that being happy with what Hashem gives us means that we genuinely understand that everything, including suffering and hardships, comes from Him. And, since everything comes from Hashem, and we know Hashem is good, even what appears bad must be good. To believe otherwise is heretical. The stressors that can trigger anxiety and depression are gifts from Hashem - tools for our growth.

King David suffered very real anxiety and fear of his pursuers, but he had faith that Hashem would relieve his agony. "Rescue my soul from the sword; my essence from the grip of the dog." (Tehillim, 22:24)

Virtually everything King David writes about is personally relevant to each one of us today. In our times though, the "pursuers" are predominantly internal; our psyches are besieged by the sword of tension and the grip of depression. King David's love for, and unshakeable faith in Hashem's mercy, love and justice also offer guidance for us today. As we know, saying Tehillim can be comforting during times of worry.

If however we are suffering and feel blocked, unable to find lasting inspiration and relief in the words of our Sages, we may need to get professional help.

Is Help Necessary?

To determine if professional guidance is necessary, it is essential that symptoms and causes be clearly identified. Anxiety is commonly associated with multiple symptoms; some common ones are listed here:

Sleep disturbances, tension; restlessness; distraction; impulsivity; excessive sweating; racing heart rate; chest pain; difficulty thinking about anything except the stress-provoking topic which is indicated by repetitive and intrusive thoughts; constant worrying; changes in appetite; being easily startled; feeling tired, irritable, jittery or unable to relax; trembling; angry outbursts; muscle tension; chills; hot flashes; numbness; stomachache; shortness of breath; poor memory; difficulty concentrating or staying focused; and/or feeling an ever-present sense of impending danger or disaster.

As you can see from this partial list, anxiety can cause quite a confusing array of symptoms. Many of them can actually be symptoms of other emotional disorders. It is also possible that these symptoms can have medical causes. If you suspect this may be the case, you may want to rule this out before you begin treatment for anxiety. Seek the advice of an M.D.

If any of the above symptoms interfere with your ability to sleep, work or enjoy life, or you have already seen a professional who has made a diagnosis of anxiety (sometimes referred to as an "anxiety disorder") it's important to seek treatment. If left untreated, the symptoms may become severe. Addressing anxiety disorders in the early stages can actually prevent the development of phobias and panic attacks.

Untreated, anxiety can negatively affect relationships with family and friends. In extreme cases, an overwhelming need to "calm down" or get some relief is felt and the sufferer may turn to mood-altering substances. The temporary relief provided by alcohol, prescription drugs, over-the-counter drugs, or other substances, actually creates a spiraling effect, which worsens the symptoms of anxiety. In addition, substance abuse can cause serious health problems and foster dependencies. Sometimes extreme self-destructive behavior may result.

*Leo's Story

Leo P. was seeing me for a problem with alcohol. Though ashamed of his behavior, he couldn't control his drinking and was just beginning to admit this to himself. His wife of 22 years demanded that he seek help. We discovered that anxiety related to his work was the initial problem that led to Leo "medicating" himself with alcohol. Some evenings he was so tense from work that he would drink a few glasses of wine before going to bed. The alcohol made his anxiety escalate; it interfered with his natural sleep cycle and he became depressed and tense. He began to drink when he came home from work to alleviate his new symptoms. After the initial relief, the alcohol made him feel even worse. Soon the situation began to spiral out of control.

Together Leo and I worked on treating him for the addiction and the accompanying anxiety and depression. As we progressed and were able to deactivate the addiction, we shifted our focus to Leo's original anxiety and its causes. I taught him to identify the triggers that made him anxious and crave alcohol. I taught him stress-reduction techniques as well. Leo also learned ways to manage on-the-job stress. Because of the shame he and his wife felt about his alcohol problem, they had limited contact with family and friends. Now they participate in family events and are actively looking forward to an upcoming simchah.

(To be continued)

*All names and situational identifiers have been changed to protect anonymity.

Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC is a nationally and internationally licensed addiction specialist and psychotherapist with 25 years of experience and is a recognized expert in the fields of mental health and addictions. He has worked extensively with the Jewish community; New York City and State governments; New York City hospitals; the Federal Government including Homeland Security; airlines and other transportation industries; Wall Street Corporations; the NFL; and many other groups and individuals. He has a private practice in Brooklyn and New York City. For more information please call 888-712-1988 or 917-470-5349.

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Identifying And Treating Anxiety (Part One) , Moshe Zwolinski, LMHC, CASAC, SAP, ADS, ICADC