Liz* was no stranger to anxiety, or therapy, for that matter. She remembers being in elementary school and having trouble leaving home because she worried that her mom would die while she was away. In middle school, she began worrying about her own health and what would happen if she got sick while she was not at home. She also thought constantly that other people were looking at her or talking about her. She worked herself up into a nervous wreck days before a test, thinking that she was going to fail. She tried therapy a couple of times. She found some of the suggestions helpful but overall she became stuck in her anxious beliefs and dropped out of treatment.

Now Liz is in high school and her anxiety continues. She misses social events, refrains from extracurricular activities because of her fears, and she is having trouble sleeping. She came to Outreach to give counseling one more try. Her counselor started by asking about Liz’s previous counseling experiences—what had helped and not helped—and reassured Liz that they would work collaboratively to find the approach that was right for her. Liz said that previous treatment had focused on changing her worried thoughts. However, trying to control her her thoughts made her even more worried. She knew her thoughts were often irrational but felt she could not control them. Her counselor acknowledged that focusing on a symptom, in this case the anxious thoughts, can perpetuate them.

They started on a new course. “The problem with anxiety is not so much the thoughts, as it is the way people allow it to limit their lives,” says the counselor. Liz was given permission to have any kind of thought she wanted, noting that all thoughts are merely mental events or a firing of neurons; they do not make the person. Instead, Liz made a list of her values and worked toward behaviors that reflected her values. For example, because she values friendship, she planned to spend time with her friends at a sleepover. Liz also felt encouraged by the use of metaphors, and “driving the bus” was one of her favorites. She pictured herself driving a bus with the purpose of living out one of her values like going to the sleepover. Her anxious thoughts were the passengers; they could come on the bus or get off at any time, but she was the one driving and in charge of where they were going. Liz also enjoyed practicing mindfulness. She learned how to be aware of her thoughts, emotions, physical sensations, and actions in the present moment without being judgmental or getting swept up in them. This was especially helpful when Liz became anxious about her health. She would become mindful of her body and environment and appreciate that she felt well in that moment.

*Liz represents a typical Outreach client.

This column is made possible in part by the Mt. Lebanon Police Association.