By: Jordan Kurtz, LPCC and Chadley Zobolas, LCSW, MFTC

The DSM-5 (Diagnostic and Statistical Manual for Mental Disorders) defines anxiety as “excessive worry and apprehensive expectations”. The American Psychological Association (APA) further adds anxiety is “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure”. Let’s break down further how anxiety manifests, how we can effectively work with it in therapy, and coping skills you can try on your own.

Anxiety Therapy and The Change Triangle

At CZ Therapy Group, we address anxiety and other concerns using Accelerated Experiential Dynamic Psychotherapy (AEDP). AEDP believes that anxiety is rooted in unprocessed core emotions, as opposed to being the singular emotional experience itself, and uses The Change Triangle as a helpful tool to track our emotional experiences and process through the root in order to find healing.

Understanding The Change Triangle

The change triangle posits that when our core emotions (at the bottom of the triangle) are too intense or new to feel – especially in isolation – we often get stuck at the top of the triangle: in anxiety/shame/guilt and in the defenses that we’ve learned keep us safe. Defenses can look like intellectualizing, avoidance, disordered eating, isolation/pulling away from others, use of substances, and more.

Our work in therapy involves uncovering the core emotions at the bottom of the triangle and co-creating enough safety and nervous system regulation to process through them fully. This allows you to access your core and openhearted state and live free from anxiety and a state of protection.

Identifying Anxiety in the Mind and Body

Anxious Thoughts

“I cannot do this”
“I am a loser”
“This is too much”
“I should be able to do more”
“What if ___ happens”
“Everyone is looking at me”
“This will never get better”
“I am scared”
“I look/I will look stupid”

Anxious Behaviors and Bodily Symptoms

Avoiding a person, place, or situation that provokes anxiety
Procrastinating
Social withdrawal
Numbing with alcohol or other drugs
Fidgeting or excessive, fast, or repetitive movements
Rapid breathing or heart rate
Trembling, shaking or jitteriness
Tightness in the chest
Sweating
Nausea and upset stomach

Anxiety vs. Fear

Oftentimes the terms “anxiety” and “fear” are used interchangeably. Though the symptoms of both can seemingly overlap, we know that fear is a core emotion, while anxiety is a reaction to what’s at the core.

Fear: A core emotion. A present-oriented, short-term, adaptive response to an identifiable, immediate, and specific threat.

Anxiety: An inhibitory emotion. A long-term set of reactions to a future-oriented, broad, and diffuse threat.

Whereas anxiety asks, “What is to come and when?”, fear asks, “How do I respond now?"

Anxiety Terms Breakdown

The DSM classifies types of anxiety depending on how our anxiety presents and what it is primarily directed towards or experienced with. Though we will not define all anxiety disorders here, below are common terms often partnered with anxiety and what they mean.

Social Anxiety

Persistent anxiety or fear about social situations in which the person is exposed to possible evaluation by others, such as giving a speech, meeting strangers, or eating and drinking. The person fears they will behave in a way that will show their anxiety and lead to negative perceptions from others. These situations are avoided or endured with extreme anxiety and cause impairment in social, work, or personal functioning.

Phobias

Intense fear or anxiety about a specific object or situation, such as flying, heights, or animals. This fear is out of proportion to sociocultural norms and the threat the object or situation actually poses. Subtypes include Animal (i.e. spiders), Natural Environment (i.e. storms), Blood-Injection-Injury (i.e. needles), Situational (i.e. tight spaces), and Other (i.e. illness, clowns, etc).

Panic Attacks

An unexpected and abrupt surge of intense fear or discomfort that peaks within minutes and results in physical, emotional and cognitive distress. Symptoms include heart palpitations, shaking, nausea, dizziness, derealization (feelings of unreality), depersonalization (being detached from oneself), fear of “going crazy”, and fear of dying.

Coping with Anxiety

‘Work’ the Change Triangle

Notice where you’re at on the triangle - defense/protection, inhibitory emotion, or core emotion
- If you’re at the top of the triangle, notice what’s happening in your body and behavior/thoughts
- Get curious about what core emotion(s) might be at the bottom of the triangle and how it makes sense that your nervous system is keeping you from feeling them
Bring compassion to yourself and your nervous system for all of the hard work it does to keep you safe

“Triple A” mantra: Awareness, Aloneness, Acceptance

Acknowledge the presence of anxiety by identifying how it is manifesting (i.e. “I am experiencing tightness in my chest right now”, “I feel myself beginning to lose control”
Remind yourself you are not alone in this experience (i.e. “Others feel this way too”, “We all struggle like this at times”)
Practice self-compassion and acceptance the feelings are temporary (i.e. “What do I need to hear right now to express kindness to myself”, “May I be patient”, “May I accept that this feeling is hard and this feeling is short lived”

Box breaths: inhale through the nose, exhale through the mouth

Call a trusted friend, mentor or loved one

Anxiety thrives in a vacuum, and distracting yourself or sharing your worries with another may lessen its intensity.

Visualize your anxiety as an object being contained

Envision: if your anxiety were an object, what color, shape, temperature, sound, and smell would it have? Once you have this image in mind, imagine yourself containing or getting rid of this object (i.e. tossing in trash can, locking in a closet, smashing with a hammer).

Practice the 5 Senses grounding exercise

When you feel your anxiety pulling you away from the present, reorient yourself with the immediate by pausing and identifying within your environment:
- 3 things you see
- 3 things you smell
- 3 things you hear
- 3 things you are touching/can touch
- 3 things you can taste

We shouldn’t have to deal with anxiety alone

Our team of anxiety therapists in Denver, CO specializes in helping clients move through anxiety and regulate their nervous system. Learn more about anxiety therapy with us here or reach out for a free consult with an anxiety therapist on our team!

All About Anxiety: Uncovering Its Roots and Ways to Address It