Interview with Catalina Briñez: psychological therapy in cases of GAD
Psychologist Catalina Briñez talks to us about the keys to Generalized Anxiety Disorder.
Generalized Anxiety Disorder (GAD) is a psychological disorder that affects many people with very different lifestyles; it is an anxiety disorder that is complicated to understand for those who suffer from it, as it is not linked to a specific source of fear or dread, but to various life experiences in general.
Fortunately, decades of mental health research have enabled psychologists specializing in psychotherapy to understand the functioning and dynamics underlying GAD, as well as effective forms of intervention to address it. For this reason, on this occasion we have interviewed one of these experts in emotional well-being, psychologist Catalina Briñez, who will talk to us about generalized anxiety..
Catalina Briñez: GAD, seen from the perspective of a psychologist
Catalina Briñez is a General Health Psychologist and founder and Director of Brilo Psicólogos, a therapy center located in Benalmádena that also offers online services by video call. In this interview she talks to us about the characteristics of Generalized Anxiety Disorder and its treatment, based on her years of professional experience helping patients.
What are the main signs that a person is not experiencing simple anxiety, but is developing or has developed Generalized Anxiety Disorder?
To answer the question, first we must clarify that anxiety is an adaptive mechanism that we humans have to face situations that involve a high emotional demand because they arise before something that we interpret as a risk and we need to have our senses sharpened to be more effective; for this there is a change in the neuronal and visceral biochemistry, which allows us to react quickly depending on the demand.
However, when anxiety begins to be recurrent, constant and causes significant discomfort, we no longer speak of "simple anxiety" as you have formulated your question, we speak of a picture that includes very uncomfortable physiological symptoms (muscle tension, tachycardia, fatigue, headache, difficulty breathing, sleeping), thoughts that make you very afraid, emotions related to helplessness and avoidance behaviors which isolate us from others.
These circumstances are a recurrent reason for consultation and are usually related to a particular aspect or trigger that is mainly expressed as phobias or panic disorder.
In Generalized Anxiety Disorder (GAD), the discomfort is not due to a specific stimulus or life experience, but to many aspects of life that even come to cover all vital areas of a person: concern for the family, health, neighborhood, work, the country's economy, global warming, wars, poverty ... generating a very high intensity and frequency of discomfort that do not allow for moments of relaxation, since the mind always has a concern to deal with. As you can see, it is something that causes a lot of suffering and should be addressed.
The 8 recurrent signs that I observe in people who consult and may present GAD are the following: Intense worry for more than 6 months without a concrete event that produces it, stress, fatigue, irritability, problems concentrating, sleep disturbances, restlessness upon awakening, physiological symptoms (pain in the body, muscle tension etc.).
Is it relatively easy to recognize these cases when people come for consultation? What are usually the reasons why they complain and report discomfort in their daily life?
It is not difficult to recognize cases of GAD, since they present specific characteristics that can be quickly identified; what is true is that they often present in comorbidity or at the same time as other types of problems. For example, depressive states, traumatic experiences, family conflicts, demotivation, insecurity .... to mention a few, which is why a good differential diagnosis must be made in order not to confuse GAD with the sequelae of another underlying disorder.
People who consult usually come encouraged by a member of their family or a friend, who are usually the ones who detect that something is not going well. Their main complaint is a constant worry that oppresses their chest, that they are never calm and they do not know very well why, although when they begin to speak they refer a number of fears. They also comment that this situation affects their interpersonal relationships and work life, they often feel misunderstood.
As a psychologist, have you detected any common pattern in the characteristics of people who tend to develop GAD? Is there any specific profile that is more likely to suffer from this psychological disorder?
They are usually people with a high level of inhibition (what we commonly call shy or withdrawn people), they tend to avoid harm, and therefore do not usually take risks or try new things. They tend to be very aware of their bodily sensations (tachycardia, tension, pain...), dependent people with a need for protection and to protect, as well as difficulty adapting to changes.
A person with a Biological predisposition or vulnerability to states of alertness, which is reflected in high levels of anxiety as a trait, which we measure by means of psychological tests, will be more likely to present GAD. Such people tend to have a more apprehensive interpretation of life since childhood.
What goals do you usually set for these patients once you both recognize that their problem fits the clinical picture of GAD?
On the one hand, to achieve emotional self-regulation. Often we believe that the problem is feeling fear, but the difficulty is not the feeling itself, but the intensity or degree of discomfort it generates. When we learn to regulate the intensity of emotions, we can experience a negative emotion without it causing me significant discomfort and therefore be more decisive.
On the other hand, analyzing our internal dialogue: detecting thoughts that cause us discomfort and proposing alternative ways of thinking that can explain the same concerns but that are more functional.
It is also necessary to learn to deactivate the body's physiological reactions to fear. Negative thoughts are usually produced from a signal of discomfort in the body, and this in turn is given by the biochemistry of our body in relation to stress. Breathing exercises or muscle tension and relaxation exercises, as well as guided relaxations, are often very helpful.
In addition, feared situations have to be confronted. Avoidance is often a component of our behavior that keeps our interpretation of the world apprehensive. For example, if my fear, among many others, is to go to a shopping mall for fear of getting dizzy or nauseous, even if I have to buy something I need, if I go several times and I do not feel bad, or I can manage my anxiety, I am giving effective information to my internal dialogue. This step is usually taken after having developed the previous points.
Finally, it is essential to strengthen emotional ties. Positive and quality interactions with others help us to get out of ourselves, which helps to take the weight off our own sense of apprehension; generous and empathic attitudes, as well as feeling support and affection favor emotional intelligence.
And how does psychotherapy usually develop from the way you work?
For me the most important thing is to know the person beyond the diagnosis, because according to their individual characteristics, strengths and context, an effective therapeutic strategy is proposed.
Thus, the first step is the evaluation where we get to know the person, his or her needs, and analyze the factors that generate the discomfort. Then, in the intervention, techniques are applied that have demonstrated effectiveness in achieving the proposed objectives, but these are adjusted to the time and individual characteristics. Once the objectives are achieved, some follow-up sessions are held.
Within the sessions people usually find relief in feeling that they can express all their thoughts without fear of judgment; it is a deep interaction where empathy is fundamental since it allows you to propose solutions that really fit the client, which is usually very rewarding.
Assuming that psychotherapy is always a personalized process, what advice do you usually give to people with Generalized Anxiety Disorder so that they can apply it in their daily lives and between sessions when they meet with you?
The activities that are performed at a general level in daily life are essential to consolidate the techniques used during the psychological sessions; as you have said, there are several strategies that can only be used according to individual characteristics but also at specific times of therapy and in specific circumstances.
However, at a general level, there are several guidelines that can help to reduce anxiety, and they are the following.
In the first place, to carry out physical exercise: the one that is of preference, to practice pilates, yoga, dance, to take walks especially in contact with the nature or the sea.
Secondly, take care of your diet. By eating properly, our energy and physical well-being will increase, therefore the physiological symptoms of anxiety and our attention to them will be reduced.
It is also necessary to socialize: sharing with positive, affectionate people, doing different activities with them reduces the negative or catastrophic charge of the thoughts.
In the same way, it is important to practice a hobby. Doing something that we really like generates positive affection and helps us to focus on the present. It can be reading, painting, learning an instrument, cooking a dish that we enjoy... there are several ways to focus our mind on relaxing content.
Finally, take time to breathe. Something as simple as breathing, making sure that oxygen reaches the abdomen (diaphragmatic breathing) helps to reduce cortisol levels (a hormone that has a strong influence on stress).