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How Do I Manage My Anxiety About Going Back to School?


Dear Dr. Goldberg

I have recently been accepted to Law School, which is a dream come true, but ever since getting the admission packet I’ve been having terrible anxiety. I can’t eat, I can’t sleep, and my friends have noticed that I don’t want to hang-out with them as much anymore. I’ve felt anxious before, but never to this degree. It’s like a gut-check every morning when I wake up just to get to work. I’ve always wanted to be a lawyer, but this has got me thinking that maybe I’m making a bad decision. Maybe someone is trying to tell me something. What can I do to help manage these feelings? Is it possible that this is a “sign” telling me not to go to law school?

First of all, I want you to relax and take a deep breath. The anxiety you’re experiencing is not a harbinger for negative things to come. It is not uncommon to worry that a period of intense anxiety surrounding a big decision is a message from the gods – but in reality, it’s just an expression of some deep and unsettling fears. And let’s face it, it’s a frightening thing to think about going to law school, particularly when it represents a dream coming true. You’re probably thinking, “what if this dream becomes a nightmare?” But you should know that everyone experiences heightened levels of anxiety during big, life-altering transitions. This can come in the form of worrisome thoughts, sleep disturbances, difficulty eating, periods of social isolation, loss of concentration, and a multitude of other disturbing symptoms. You can interpret this as your mind and body saying, “Hold on a second, buddy! We were doing just fine without this development!” When we begin to step out of our “comfort zones” and into the vast unknown, our bodies signal us about the impending change. Almost like a reminder in case we missed the important news bulletin. While this can create intense discomfort, it helps to reinterpret what you’re feeling as a positive indication of growth. Remind yourself that you’re feeling this way because you are challenging yourself to develop as a person. You could go on feeling perfectly comfortable by dismissing law school and returning to “business as usual,” – but you would be giving away a tremendous opportunity to realize your life’s potential. And wasn’t the point of applying to law school to shake things up a bit? Remember, anxiety is a hard-wired response that alerts us to changes, particularly meaningful changes, in the world around us. It will make you uncomfortable, but the symptoms are generally harmless and temporary. Avoidance will destroy a life.

Of course, there are many ways to manage the anxiety response and support yourself through this transition. I recommend that you look into Edmund Bourne’s Anxiety & Phobia Workbook for suggestions about deep breathing, muscle relaxation, and visual imagery techniques that will help you tolerate the symptoms of your anxiety while you wait for law school to begin. Also, look towards friends and family to support you through this monumental change. Don’t worry about burdening them with your concerns – that’s what they are there for! A good strategy is to write down all of your fears and worries about law school and read them off to a thoughtful and trustworthy friend. This will infuse more rationality into your thinking, and help you distance yourself from the intense and irrational worries that are swirling around this decision. If things do not improve over the next month, outside support may be warranted. An empathic CBT therapist, trained in relaxation techniques and cognitive restructuring, will help you learn to calm your anxiety now and for years to come.

Good luck! And congratulations on this impressive achievement!

- Dr. Goldberg

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What Does CBT Stand For and How Does it Work?

Dear Dr. Goldberg,

My general practitioner suggested that I consider trying “CBT” before taking medication for my anxiety. What is “CBT” and what types of symptoms does it treat? What makes CBT so different from the various therapies that I’ve tried in the past? I’m really reluctant to take medication, so any information that you can give me would be really helpful. Thank you.

This is one I hear often, so I’m glad you brought up the question. The term “CBT” stands for Cognitive Behavioral Therapy, a specific type of psychotherapy that focuses on the relationship between thoughts, feelings, and behaviors. Whereas “traditional” therapy works to understand the inner, often older and unconscious, conflicts that underlie the formation of psychiatric symptoms, CBT endeavors to challenge and modify the present thoughts and behaviors that perpetuate anxiety, depression, and other mental health conditions. As the stoic philosopher Epictetus once wrote, “men are disturbed not by things, but by the view which they take of them.” The premise of CBT is that our perceptions of ourselves, our future, and the world around us influence our emotions, and that these emotions, in turn, influence our actions. Let me provide some illustration:

A man suffering from social anxiety thinks to himself on a near-daily basis, “if people see me blushing they’ll think that I’m weak and pathetic.” This thought creates great turmoil and discomfort whenever he is called upon to speak in public or participate in groups. As a consequence, he avoids these types of activities like the plague, making excuses whenever they come around. Maybe he calls in sick to work when asked to present, or tells his friends when they invite him out that he has other plans. Really he’s sitting at home alone. This behavior leads to greater and greater anxiety because nothing has come along to invalidate these beliefs. He continues to assume that blushing is an indication of weakness and that others will judge him for it. His life becomes a series of avoidances. On the occasion that he is surprised by a chance social encounter, he gets through the moment with excruciating discomfort, waiting for the first opportunity to escape. The whole time he keeps telling himself, “just don’t blush, just don’t blush…”

As you can see from this example, our thoughts greatly dictate our level of discomfort, whether it be anxiety, depression, or various other psychiatric conditions. The man in the vignette above never stops to question whether his blushing actually indicates weakness to others; and yet, he invests a tremendous amount of emotion in this belief. But what if this is a fruitless investment? CBT helps individuals challenge the validity of their negative beliefs through direct guidance, thoughtful questioning, and helpful outside exercises. As I often frame it for my patients, CBT helps redefine the old operating system that people use to interpret their experiences and installs new software that has greater relevance in their current lives. In doing so, individuals can change the patterns of behavior that ultimately perpetuate their symptoms and limit their full experience of life.

Although cognitive behavioral therapy has been found to be as effective as psychotropic medications for the treatment of anxiety and depression, the combination of CBT and medications produces the best results. Without knowing your history, or the extent of your symptoms, I cannot advise you regarding the choice of CBT versus medication. However, I encourage you to contact a psychiatrist to discuss the pros and cons of both treatment approaches. I can tell you from my experience, and from the vast clinical data available, that CBT is a tremendously effective option and should be seriously considered whether you decide to pursue medication or not.

I wish you the best moving forward!

- Dr. Goldberg

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Is There any Cure for Anxiety?

Dear Dr. Goldberg,

“Is there any cure for anxiety, or are people with anxiety disorders stuck with it forever?”

This is such an excellent question and really gets to the heart of anxiety as an emotional and physiological construct. The simple answer to your question, although it may disappoint you, is “no.” There is no cure for anxiety. But in order to understand this answer, let me emphasize a few points about the origins of anxiety and the adaptive function of the anxiety response. First of all, every human being experiences anxiety, in the same way that every human being breathes, or sweats, or feels their heart pounding during exercise. This is because anxiety, like other human functions, is a hard-wired, adaptive response that is meant to preserve the integrity of the body. In this case, anxiety operates to protect you, and alert your body to potential threats within the environment. In the time of cavemen, with gnarly saber-toothed tigers running about, this was a very useful thing! Without so much as a conscious thought, the caveman’s body recognized an impending threat, and turned on a finite number of systems meant to save him from certain doom. This included increased heart rate, increased respiration, sweating, the release of cortisol, increased adrenaline, and myriad other physiological functions. Today, we talk about this constellation of involuntary physical reactions as the “fight/flight” response. Consider it the physiological equivalent of the catch-phrase, “Let’s get ready to rumble!” More important to our discussion, these responses are inevitable, adaptive, necessary, and to cure you of them would be analogous to removing your skin.

Of course, people don’t like feeling all of these things, and the involuntary nature of anxiety is more than a little discomforting, particularly for those of us who constantly want to be in control. In addition, sometimes it can be hard to interpret what our bodies are doing. After all, there are no more saber-toothed tigers! The modern contrivances of men and women have made our present lives quite safe and comfortable, so why this continued triggering system? Well, in some ways, the fight/flight response is a vestige of our primitive past – an emotional appendix, if you will, that has fewer opportunities to shine. However, we do continue to need occasional warnings that something threatening is looming on the horizon; like when someone cuts us off in traffic. The trick is separating the threatening from non-threatening events so that we don’t needlessly evoke our anxiety response. For instance, in the case of panic disorder, the fight/flight response is often triggered following the misinterpretation of minor physical aches and pains. Someone may feel a sudden twinge in their chest, and begin thinking, “what if I’m having a heart attack?” This thought, in itself, brings on the physical symptoms of anxiety (e.g., racing heart, difficulty breathing, sweating) which appear to support the initial concern. Next thing you know, the person is at the hospital getting an EKG, when in reality, there was nothing wrong with them. When we misinterpret the anxiety response, or tell ourselves that we NEED to control it, CURE ourselves of it, or make it GO AWAY, we are ironically making things much worse.

So, what should you do then? I encourage my patients to change their relationship with anxiety. Rather than focus on curing anxiety, we work toward accepting that, sometimes, we will feel anxious. Everyone does. And when that moment comes, the challenge is to control the negative thoughts and behaviors that accompany anxiety. As I am fond of saying, Anxiety is not your enemy. It is a hard-wired response that everyone experiences. WORRY and AVOIDANCE are the enemies! The goal is to treat anxiety like an unwanted party-crasher. An in-law. An acquaintance that we can uncomfortably tolerate for the time that they’re with us. To say to anxiety, “I don’t like you and you don’t like me, but we’re going to have to live with each other.” And while anxiety is visiting, we need to develop better tools for managing the discomfort it creates.

Of course, when your anxiety begins to interfere with aspects of your daily life, such as relationships, work, and school, you may need professional guidance to learn how to manage the physical and emotional discomfort more effectively. For this I recommend cognitive behavioral therapy which has been shown to be immensely helpful for settling the anxiety response. For a list of CBT providers in your area, check-out the Psychology Today website. Thank you for the wonderful question.

- Dr. Goldberg

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