Talk therapy

Rebound Anxiety

Jerry Kennard Health Pro April 02, 2012
  • The term rebound anxiety is nearly always used to refer to the difficulties many people have when attempting to withdraw from certain medications prescribed for anxiety. In this Sharepost I'd like to consider another form of rebound anxiety that can occur as part of the natural recovery process and which has its roots in psychology rather than pharmacology.

     

    The journey to recovery from long term anxiety-related conditions isn't always easy. Some people never fully recover but can feel generally better than they used to, others do recover but their path to recovery is far from straight forward. I think it's important for people who may be suffering with anxiety to know that the recovery process isn't an overnight success story. In some cases the road to recovery is slow, littered with setbacks, and can ultimately take years.

     

    Although my focus is on the psychological aspects of rebound anxiety, I can't ignore the fact that withdrawal from medication can overlap, precede or influence rebound. It is estimated that over 70 percent of people who come off benzodiazepine drugs have some kind of rebound effect. In some cases the sensations of anxiety this can evoke are worse than the original symptoms and can include headaches, insomnia and a range of physical symptoms.

     

    One patient I worked with had become virtually housebound as a result of panic disorder. It took well over a year and much persuasion by her husband before she eventually sought help. During therapy this lady appeared to undergo a kind of spontaneous recovery - not altogether unheard of. She seemed to pick up where her life had left off and threw herself into work and social activities. Then she crashed and all her apparent progress was lost. The symptoms of nausea, palpitations, dizziness and fear of stepping outside all returned in an instant.

     

    During subsequent meetings it became clearer what might be happening. She described herself as having always been socially nervous and of being involved in situations and activities she really didn't like. When the symptoms arrived they were naturally very debilitating but they also had the effect of allowing her to avoid those scenarios that had previously made her uncomfortable. Home life changed too. Her husband had become more attentive and other friends and relatives supportive. In all, her situation was very reinforcing and it appeared to suggest part of the reason why treatment was delayed.

     

    When eventually treatment was sought it was partly as a result of pressure but partly because this lady could see her situation was untenable. Once progress was being made she switched on her own internal ‘well button' only to discover it wasn't that simple. The situations that once made her uncomfortable hadn't changed. The fatigue and exhaustion she felt in dealing with some of them quickly resurfaced as did the anxiety, the panic and the agoraphobia.

     

    Recovery is a process and it is one that can't be rushed. The goals need to quite modest and always attainable. Sometimes there will be days when all progress appears to have been lost, but overall, the two-steps forward and sometimes one-back approach is part of the deal, which people need to be aware of. The motivation to get better however is hugely important. Without this no therapist is able to make progress. With it, the therapist can provide an explanation for emotions and behavior and provide a secure structure for progress to be made.

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    Sources:

    Tsutsui S; Zolipidem Study, Group (2001). "A double-blind comparative study of zolpidem versus zopiclone in the treatment of chronic primary insomnia". J. Int. Med. Res. 29 (3): 163–77. PMID 11471853