Monday, July 21, 2008

Spirituality and Sexual Health

One of the approaches to treating sexual compulsivity is the use of the 12-steps. In my work, I don’t use this method. Nevertheless, I do recognize the importance of spirituality. In many ways, I think spirituality can shape and focus our values, goals and behaviors. The goal for this section is to help you clarify “How consistent with my spiritual values is this behavior?”

It is important to start out the conversation about spirituality by introducing a distinction between spirituality and religiosity. The distinction reflects the different between the individual and the community. Spirituality reflects my faith, values, and experiences of the holy. Religion/religiosity reflects our community’s experience of faith, values and the experiences of the holy. The two are different, but yet related. It is through my experience of spirituality that I connect with a community of faith.

This distinction helps us address a number of religious barriers to spiritual health. The two issues I raise are fundamentalism and lack of education. Fundamentalism occurs in two primary ways: scriptural fundamentalism and dogmatic fundamentalism. This entry isn’t designed to go into great detail of fundamentalism. Essentially, fundamentalism sets up a thinking error that one particular view of scripture or one particular belief is the only right belief. What this creates is a series of judgments about who qualifies as a person of faith, or the one-way that faith can be expressed. In other words, this is the one and only way. In an attempt to help people, the fundamentalist approach usually results in excluding others.

I also think a lack of education is a barrier to spiritual health. Too many people simply have too little education in their faith tradition to begin the process of uncovering the richness of their tradition. In my own experience, not many people can explain many of the dogmas and doctrines. Some of these religious beliefs can provide a rich resource for future growth. From a personal point of view, my religious faith affirms the power of forgiveness, redemption and value of the individual. As a person moves toward increased spiritual health, it might be helpful to increase your education within your tradition. This might be helpful in affirming your sexual health.

The process of developing a sense of spirituality is to recognize the importance of story. Spirituality starts and ends with a theology of story. This is a process where we identify experiences of God (and by “God”, I mean higher power, goddess, spirit, wisdom, the absolute, the “all,” etc. For the sake of brevity, I’m going to use “God.”) A theology of story helps us recognize that scripture is simply a collection of stories of people’s experiences of God. Typically, these oral stories were written down, collected and “canonized” across time. In other words, a person had an experience of God, shared it with another person who was so inspired that they shared it with others. The application of the theology of story to our daily living is important. A theology of story asks “What experiences of God in my life have I encountered?” Experiences of God are not limited to scripture. They happen all the time. It is recognizing the experiences that we begin the process of seeing how God is present in our life.

The difficulty with story is that we have lost the ability to share and add new stories. Many people deny or minimize their experiences of the holy. Furthermore, because of fundamentalism, scriptures have unfortunately become a basis to condemn people instead of being a collection of people’s experience of God. The use of scriptures as a weapon has led to a difficulty sharing our personal stories within the religious traditions. For me, part of the process of developing spirituality is to understand how we experience God in various ways.

To do this, I want to set up a positive position on sexuality by establishing a goal-orientated spirituality. I want to highlight three similar approaches to understanding spirituality. These approaches are positive spirituality, generativity, and creative mythology. Positive Spirituality emphasizes a process of uncovering the values by which I choose to live my life. It is future oriented. It is the process by which we make decisions and express our values as a reflection of our experience of God. Positive Spirituality focuses on goals or values such as wholeness, integrity, fidelity, growth, etc. that a person seeks to express. For those with a religious tradition, these values which we choose to live by can come from our community experience. There is a lot in of values or beliefs identified in the scriptures and various traditions that can be positive. Examples can include love, integrity and responsibility. In the development of a positive spirituality, the individual identifies new ways to express the presence of God’s action in their life. These values are then used to shape their life. A typical example of this is the “WWJD” (What Would Jesus Do) bumper sticker. A person with a WWJD has declared “As a Christian, who believes in Jesus, I use his life to shape my behavior as an expression of by beliefs.”

Whereas positive spirituality is future focused, generativity focuses on the “now.” Generativity is the question/value of how a person involved is being made whole, generated or regenerated in his/her life. Generativity asks the question: “How am I being made whole in the now?” In other words, in this behavior (or with this thought) am I brought to a sense of wholeness/fullness, or am I left distracted and broken. In the realm of sexual health, is this behavior helpful or a hindrance to my well being.

A third approach to developing a person’s spirituality is the concept of Creative Mythology based on research by Joseph Campbell. For him, Creative Mythology focuses on how meaning is created and conveyed in people’s lives. He defines Creative Mythology as “present when an individual has an experience of order, horror, beauty, exhilaration, which seeks to be communicated through signs, images, and words. If this realization has a certain depth and import, touching the heart, his communication will have the value and force of a living myth.”

The part that I like is the experience of something amazing, either good or bad, that shifts your understanding of reality. It is in this experience that you have a connection to God. This experience is then shared with other people. Creative mythology is an attempt to express meaning in a person’s life of something greater. Mythology is a way my heart speaks to your heart. (Notice the similarity between creative mythology and the concept of intimacy as discussed in the intimacy section.)


It may be helpful to review your understanding of scripture and tradition to create a positive approach to morality and higher power: scripture and tradition are not always an enemy to spirituality. Within a tradition, a sense of wholeness and acceptance is possible. A community is created through tradition, whether it be a long-term tradition such as the Catholic tradition or the short-term tradition of fellowship after a 12-step group.

Spirituality also requires a person to make a commitment to take responsibility for his/her life. You need to step forward to identify and claim values toward which you will work in your life. What works for me won’t necessarily work from you. While we may learn from each other, our path is uniquely our own.

Such an approach is not easy, particularly in an American society in which the media emphasizes to get by with the least possible.

For some people, it may not be possible to use scripture or tradition as a way to shape their spirituality. I also recommend a number of other resources. There are some very good authors and/or experiences available. Three examples of these are provided here. I highlight them simply as examples, rather than instructions on activities to complete.

  • Landmark Education or similar programs focus on creating possibility
  • Course in Miracles
  • Power of Intention (Dwyer)
  • 7 Habits of Highly Effective People (Covey)

Finally, another strategy is to start from your personal experience. The following exercise may be helpful.

  • First, name three people who inspire you. These people may be real/fictional, living/dead, someone you know, or simply someone you read about. For each individual, highlight why this person is an inspiration to you. Examine the values that they expressed in their life. As you think about each individual, you may start to identify themes that are important to you.
  • Second, name three times when you’ve experience a sense of timelessness. In this sense, timelessness is the experience of time passing without awareness. Think of a young child playing outside all day. You yell to the child “Come, in for bed.” To the child, the day passed with a sense of timelessness. They simply were completely in the moment. As an example, some individual sessions with clients pass so quickly, I simply didn’t realize the time was gone. Other, as you could guess, drag on. In the moments that they passed quickly, I look for the themes that made the time pass quickly. (I also use the other moments for self-reflection; I can learn from them as well!)
  • Third, as you examine the individuals and experiences in your life that are important, highlight common themes, values, and experiences. These common themes, in my opinion, are expressions of your experience of God in your daily living. In more formal theology, you have experienced the immanence of God in your life connecting you to the transcendence of God.

Final word

It is important to emphasize that spirituality is not an end product. Each of us, as we’ve come to understand our experiences of God in our experiences of a Higher Power, of the holy, of the sacred, have developed images, stories, and ideas that we communicate to other people through our stories. It’s an ongoing process and we take our history with us.

Final-Final Word

He who knows, knows not.
He who knows not, knows.

Joseph Campbell
Power of Myth

Sunday, July 13, 2008

Why have sex

Interrupting the acting out cycle requires awareness of the payoffs for sex. This is essentially answering the question “Why have sex?” The classic scripts/reasons for sex have typically been reduced to three themes: procreation, relational and recreational. In other words, people have sex to “make babies,” to build a relationship, or to have fun. While these reasons for having sex are over-simplified it is important for each individual to uncover some of the reasons they have sex. In some circumstances, the reasons for having sex may highlight clinical issues, patterns of behaviors, high risk situations, thinking errors or feelings that need to be addressed. This is a much more difficult task than you may think. To put this in perspective, a recent journal article identified 237 reasons a person has sex. After analyzing the data, their research identified four groups of reasons of why people have sex. The factors and the identified subfactors are:
  1. Physical Reasons with 4 subfactors: Stress Reduction, Pleasure, Physical Desirability, and Experience Seeking. .
  2. Goal Attainment with 4 subfactors: Resources, Social Status, Revenge, and Utilitarian.
  3. Emotional reasons with 2 subfactors: Love and Commitment and Expression.
  4. Insecurity subfactors with 3 subfactors: Self-Esteem Boost, Duty/Pressure, and Mate Guarding.

Within each factor are a number of subfactors that reflect the various concepts. The subfactors can help you reveal and/or assess various reasons for having sex. For example, if stress reduction is one reason why you’re caught in a compulsive cycle, examining the sources of stress in your life may provide insight into the cycle as well as reduce the possibility of future relapse. As you continue, review your sexual timeline/sexual history. Examine various incidents where you acted out. Examine which reasons for sexual behavior may be relevant. As you reflect on the reasons, examine the thoughts/assumptions that are present. If, as another example, a reason for sexual behavior is getting a self-esteem boost, examine what are the thoughts and feelings associated with the goal seeking behavior.


Meston, C. & Buss, D. (2007) Why Humans Have Sex. Archives of Sexual Behavior) 36:477–507. DOI 10.1007/s10508-007-9175-2

Sunday, July 6, 2008

Topic 16: Intimacy

Topic 16: Intimacy

Perhaps one of the most difficult issues to address in promoting sexual health is the desire for intimacy. Too often intimacy is seen as “sexual intercourse.” The goal of this topic is to expand the understanding of intimacy by looking at different types of intimacy. Without a doubt, many individuals are stuck on a limited view of intimacy and often use sexual behavior to try to get other needs meet. As you review incidents in your sex history and timeline, think about the times when having sexual contact that you may have been searching for something else entirely. By the end of this topic, it is hoped that you will be able to clarify your primary intimacy needs, as well as begin to think about healthy ways to get those needs met.

There are a variety of definitions of intimacy. Perhaps the easiest definition of intimacy is the feeling of connection with another person. One of the best definitions I heard was about 20 years ago. Intimacy is the soul to soul connection between two people. Intimacy is more than simply saying, “Hi,” but a connection with openness and honesty. The need or desire to be connected with others is healthy and normal. Most of our life is about the experience of intimacy. This simple reality is dismissed when intimacy is reduced to sexual contact.

It is important to highlight that intimacy can include sexual contact; but it is equally important to highlight that not all intimacy is about sexual contact. It is possible to be very intimate with another person without any sexual contact. It is also possible to have sexual contact that is lacking in intimacy, and may actually harm intimacy particularly if it is exploitative or abusive.

Types of intimacy

To expand our understanding of intimacy, it is helpful to review different types of intimacy. Two researchers, a husband and wife team (Clinebell and Clinebell, 1970) identified twelve types of intimacy. These are included below. Their focus was on marriage relationships, but I tried to build on their work by expanding their definitions.

Sexual intimacy is more than the bringing together of sexual organs. It is more than the reciprocal sensual arousal of the partners and even than mutual fulfillment in orgasm. It is the experience of sharing and self-abandon in the merging of two persons. There are types of sexual intimacy beyond bodily contact. Sometimes simply talking about sex is very intimate. For some of my clients, I am the first person they have every talked to about sexuality concerns, behaviors or issue. I would argue that talking about the deepest and darkest secrets in the realm of sexuality is a form of sexual intimacy. (And, as a pre-emptive disclaimer, I have never violated any sexual boundaries with any client. Simply highlighting that sexual intimacy may be more than sexual contact with the corresponding fears that it can trigger confirms the very bias of our culture and the assumptions of intimacy that I’m trying to address in this workbook.)

Emotional intimacy is the deep self- awareness and sharing of significant meanings and feelings. Emotional intimacy is the foundation of all other forms of intimacy. It is the ability to talk openly, without fear. And when fear is present, to disclosure that fear in such a way to facilitate a stronger and closer relationship. Emotional intimacy includes the ability to share one’s hopes and dreams.

Intellectual intimacy is the closeness resulting from sharing the world of ideas. This can include addressing similar concerns, or interests. Intellectual intimacy can range from hobbies, topics, or current events. There is a genuine respect for each individual’s opinion. Agreement on the topic isn’t necessarily required for intellectual intimacy. It is the process of sharing, reflection and discussion which highlights the aspects of intellectual intimacy.

Aesthetic intimacy related to experiences of beauty. Various expressions of this can include typical expressions of art, music, plays and movies. Other experiences of this type of intimacy can include natural beauty such as sunrises, listening to a thunderstorm, and taking a day hike through a park.

Creative intimacy is the intimacy of shared creativity. Sometimes this can include aspects of aesthetic intimacy. The key component of creative intimacy is the process of co-creating with the other person in the particular encounter. In the connection, you are experiencing growth and I’m experiencing growth through the movement toward new possibilities.

Recreational intimacy refers to the experience of play. It talks about stepping outside of work and struggles of life, and simply spending time together. The types of play may vary and include sports, outdoor activities, indoor activities, and the like. Sometimes other intimacies are incorporated into recreational activities such as going to a movie (aesthetic) and then talking about it afterward (intellectual).

Work intimacy occurs in the sharing of tasks, either at home or at work. It can include projects, events, or simply the process of long-term commitment regarding work or family. The corresponding feelings of satisfaction when completing a task with another person is an example of work intimacy. These tasks could include completing a project at work, or finishing cleaning up the house at work.

Crisis intimacy is the intimacy that occurs as a result of major and minor tragedies. Personal crises may be illness or accidents. Larger forms of crisis intimacy can be community experiences in response to a natural disaster. In these situations, individuals step outside of their limits and connect. Strangers will go above and beyond typical experience.

Commitment intimacy is the experience of hope and possibility in response to addressing some issue, cause or event that is bigger than one person alone. This can range from a short-term task (completing a social service project at work) to a never ending task such as social justice for the poor. It is the process of transforming the world relative to the task that is the source of intimacy.

Spiritual intimacy is the connection that develops through sharing with others the most important areas of concerns including values, meaning for life, and the core of our being. It is an experience of possibility and transcendence beyond the daily experience of who we are. It can be connected to religious traditions and practices, but ultimately it is about how we connect with God (in whatever way we describe God).

Strategies for building Intimacy in your life.

Now that we have a reviewed the types of intimacy, the next step is to highlight how to build intimacy in your life. The following are simply ideas and suggestions. They are far from the “only way” or the “correct way.” The suggestions are, however, based on research and experience in the field.

Start by identifying which of the types of intimacy above are the most important to you. Which three, for example do you want in your life? How would you know if they were present? Next, who in your life could you start to develop intimacy by being open and honest with? This could be difficult for some people, so a slow start is OK. Where might you find people with similar interests?

Intimate relationships can be brief or long. We are taught to think of intimacy in terms of “Hollywood” or “Disney” movie moments. Yet, if we look to the present moment, there are many types of connection occurring all the time. To limit our ability to see these intimate connections limits our ability to experience intimacy. How am I connected to the person next to me at this time.

Recognize barriers to intimacy.
Barriers to intimacy can be internal and external. Internal barriers reflect issues in our life and how we interact with others. They may be historical (history of abuse) or current (shame or depression) These barriers can be unhealthy thoughts we have of our self or that we have of others. Overcoming, correcting and changing these thoughts is necessary. One example of a barrier is someone who identifies as a gay man, but believes he is sinful. Such a person must address the internal story before healthy intimacy is possible. External barriers may be isolation, or lack of resources to connect with others. In these situations, setting up plans can be a helpful tool. Other times the barrier may be a lack of skills that negatively impacts a person’s ability to share with others. In these cases, therapy and coaching may be helpful.

Take appropriate risks. You will not find intimacy when you shut down and isolate out of fear. Intimacy often requires a bit of pain, either through rejection, failure or simply being betrayed. It is not possible to avoid these risks and try to have intimacy. It is your reaction to the hurts and the fears that can actually facilitate additional opportunities for intimacy. The reality is that the other person is probably just as fearful as you are. The question is which person will be the first to transcend their fear.

As you review your sexual history and your timeline, think about how intimacy, or the lack of intimacy is related to your life. Where you searching for a type of intimacy through sexual contact? How satisfied where you with the contact? Which intimacy needs are the most important? Who in your life can help you get these needs met.

Identify the top three types of intimacy that are the most important for you.
Identify 3-5 people who can help you meet those intimacy needs.
If you aren’t satisfied, identify a plan to increase your level of satisfaction.

Topic 14. Primary Thinking Error

While we might use multiple thinking errors over time, there is a constant theme that is present. This theme I’ve labeled the core thought. This core thought is the foundation of how we make sense of much of the world. Or, to put it more actually, it is the story that we use to first interpret a situation. And the less information we have about what is happening in real time, the more likely we are to base our assessment on the core thought. As integral as this pattern of thinking is in our life, it is very difficult to recognize the core. Two analogies might help explain why it is difficult to recognize. For those who wear glasses, you “forget” that you wear them. Another example is driving yourself home, you don’t “think” about the directions/streets to take, you simply drive. And after you’ve moved, you have to “think” about getting home so you don’t automatically drive to the old residence.

Too often it is this core thought that drives our behavior. As an example, the core thought is “I don’t fit in,” I will do a lot of things to fit in. I might look for ways that I don’t fit in as a way to justify my behaviors. For example, I might not say “no” so I’m not rejected. I might use so I fit in. Or, if something happens such as being rejected, we conclude this as another example of how we don’t fit in. We are always looking for the perfect situation where I will never have to worry about fitting in. We do things to either make it come true, or prevent it from coming true, or in reaction to the fear that it might be true.

Identifying the core thought.

There is no easy way to identify the core thought directly. I typically try to “vector” in and help the client identify the core thought. This is done by approaching the thought from a number of directions. None of them appear to make the process easy, but it is helpful. I’d recommend that you simply list the thoughts that come to mind without trying to analyze them too much at this point.

1. One approach is to review the topic on thinking errors. Which thinking errors stand outs out as having the most intense reaction relative to the other thinking errors? It might be in agreement with the thinking error where you say “I say this a lot.” Or in reaction to that thinking error “That is NOT me…no way.” Of any of the thinking error examples that elicit a reaction, think about why the reaction occurred.

2. Another approach is to look at an incident where you acted out, as you complete a behavioral analysis track the thoughts backward. I like to use an example of dominos. The current thought is based on a preceding thought just like the current domino falling is triggered by the previous domino all the way back to the initial domino. That initial thought might be the core thought.

3. What triggers the strongest anger reaction? Before you “explode,” what is the internal conversation or thought you are having? What is the assumption of what you think the other person said, or your assumption of what happened? As referenced in the power of thinking, the core thought is so automatic that it is difficult to recognize.

4. A fourth approach is to have a few friends who you trust give you feedback. Ask them to answer the following questions. When something happens in y life that I don’t like, what do you see is my first response? When I talk to you for support, what appears to be the pattern of my struggles? What do you see as the issue that I get the most angry about?

5. Look back over times in your life when things didn’t go the way you wanted. It could be “big things,” such as losing a job or getting called into the boss’ office, etc. What is your thought as you first heard about the results? It could also be small things that can help you see the core thought, such as plans with a friend falling through. What do you say to yourself in that internal conversation to make sense of the situation?

6. When you look at the list of thoughts, restate them in a simple way. I encourage my clients to say the thought as a six or seven year old might say the thought.

These are simply six ways that may be helpful in identifying the core thought. It is important to emphasize that we are looking for a “thought” and not a feeling. If you identify a feeling in the process, ask yourself “Why do you feel that? What is the thought that creates that feeling?” Too often people will say my core thought is that “I am bad” or “I’m not good enough.” My response is to ask “why” do you feel that. If this process works, great. If it doesn’t that is OK. It is simply a tool. You might be able to identify the core thought later on as you start to look at incidents as they occur in real time.

Some sample core thoughts

  • It’s my fault
  • I can’t do it.
  • It doesn’t matter.
  • Why try
  • This won’t work
  • You can make me
  • I can do what I want
  • I don’t fit in
  • Nobody wants me

As difficult as to identify the core thought, the reward for identifying/recognizing the core thought is amazing. Consider the reality that you can’t break a bad habit if you don’t know you’re doing a bad habit. In golf, for example, coaches are often helping you “unlearn” bad habits that you picked up along the way. So it is with the core thought. It is a habitual way of thinking. When recognized, new opportunities are possible. Part of freedom is to not to do what I want, but to choose the direction I want to go. As you recognize how present the core thought is, you can make a different choice toward something else that is more important. This will be covered in the future under “goal” theory and “purpose.”

Topic 13: Anxiety

The goal of this topic is to help you identify how your sexual timeline is shaped by your anxiety. As you review your sexual history, think about the following information. How has anxiety increased your sexual behavior? Perhaps you have used sexual behavior to stop or reduce symptoms of anxiety. On the other end, your experience of anxiety may impair your sexual health and sexual behavior. In some cases, a person might have so much anxiety that they use chemicals to feel less anxious in order to engage in sexual behavior. Yet, in other cases, anxiety can lead to sexual functioning issues. As you review this material, think about how anxiety is present in your life and shapes your behavior and your sexual health.

Anxiety, in the simplest sense, is simply a sense of fear or uneasiness. Some anxiety is helpful in that it motivates us to do things. “I’m nervous that my boss will get upset if I don’t complete the project by Friday.” As such, anxiety can motivate us to get something done. In these cases, anxiety is a positive thing. For some people or some situations, anxiety can be a serious problem. In these extreme cases, anxiety disorders can be a serious medical illness.

If anxiety becomes pronounced, it can express itself in various ways. For example, you may have trouble sleeping. You might find you overly dwell on a particular situation and/or find it difficult to think or concentrate on other things. Your appetite or eating behaviors might change. Alternatively, you might have a sense of vigilance or a feeling of impending disaster, as if "something bad is going to happen. In some cases, anxiety can mask other mental health issues such as depression. Below are symptoms and types of anxiety. How do these symptom show up in your life?

Symptoms of anxiety:
• Feelings of apprehension or dread
• Trouble concentrating
• Feeling tense and jumpy
• Anticipating the worst
• Irritability
• Restlessness
• Watching for signs of danger
• Feeling like your mind’s gone blank
• Pounding heart
• Sweating
• Stomach upset or dizziness
• Frequent urination or diarrhea
• Shortness of breath
• Tremors and twitches
• Muscle tension
• Headaches
• Fatigue
• Insomnia

Types of anxiety

There is a range of anxiety disorders, with the most intense type of anxiety on top. Depending on the number and/or severity of symptoms, an individual’s diagnosis may change. It is recommended that if you experience a number of strong symptoms that you seek professional help.

Panic Disorder is an unpredictable attacks of anxiety that in clued a physical component. The physical expression is so intense that it can be consumed with heart attacks. Typical symptoms include some pain and a shortness of breath. Once a person has had this experience, they may change their behavior out of fear of having another similar attach. When this fear of another incident gets so bad, some people get to the point of withdrawing from public interaction. In these cases, a diagnosis of panic disorder with agoraphobia is a possible diagnosis. These individuals typically avoid public spaces out of a fear of losing control. Someone with this level anxiety requires medical attention. It is my opinion that this level of anxiety may have a genetic/biological component that needs to be evaluated by a medical provider. This type of anxiety has the most impairment in a person’s life.

Post Traumatic Stress Disorder (PTSD) is as it sounds, an anxiety reaction after to the fact that is triggered when similar situations appear. The classic example is the war veteran returning home. This diagnosis is highlighted recently in the press as veterans return from Iraq and Afghanistan. Less known events can trigger PTSD such as a car accident, witnessing a death or accident. Some clinicians have suggested that there might be a cumulative experience of trauma such as domestic abuse, physical or sexual abuse that can trigger PTSD.

Obsessive Compulsive Disorder (OCD) - The person suffering from OCD uses ritualistic and repeated behaviors to rid themselves of obsessive thoughts and anxieties. The key is the emphasis on behaviors or thoughts that repeatedly impairs an individual’s ability to function in the world. This might be expressed as perfection, or fear of not doing it write that leads to nothing getting done.

Generalized Anxiety Disorder (GAD) characterized by excessive anxiety and worry that is consistently present, and disproportionate to the event or circumstance that is the focus of the worry. One way this shows up is that if I looked at pornography, the “porn police” will track me down. Or, if someone finds out I’m gay, they will tell everyone else. The key to this type of anxiety is the “over the top” fear. It is not rational to most people. In these cases, it is my opinion that a biological component is often present with this level of anxiety.

Social Anxiety Disorder refers to anxiety is social situations. This can include simply being in public to more specific forms of public speaking. A person then is fearful of situations in which they may be subject to the scrutiny of others. This fear of judgment by others can lead to immobilization at the extreme end to forms of self medication such as alcohol or drug use.

Specific Phobias is the persistent fear of objects or situations. A typical example is a fear of heights, flying, or snakes. When these objects occur, a severe response occurs including feelings of fear, increased heart beat, etc. The experience doesn’t even need to be “real.” For example, someone afraid of snakes can be triggered by a snake on a movie or TV screen.

Adjustment disorder with Anxiety is the least severe. It often has no or only a minimal impact in a person’s life. A classic example is the anxiety associated with starting a new job. Will I be able to do it? Will people like me? This level of anxiety has a short life span.


Treatment for anxiety is varied. Depending on the severity, you might need to use all available treatment tools. In other cases, one or two might be appropriate. In nearly all of the serious cases of anxiety, I recommend some type of medication. Please consult a medical professional. The range, type, and levels of medications are simply too complex to fully document in this blog.

In addition to medications, there are a range of talk therapy approaches to treatment. Some of the most researched forms of treatment for anxiety are forms of cognitive behavioral therapy CBT. This work has as its core theory, a cognitive therapy approach (see Topic 5). The process of treatment is to evaluate the relationships between thoughts, feelings, and behaviors. Once this examination is done, it is important ot identify and implement strategies to address the thoughts, feelings and high risk situations.

Other approaches to treating anxiety include bio feedback, systematic desensitization, flooding, and exposure techniques. Each theory has their approach and should be used under the proper supervision. I recommend that you talk with a clinician regarding their training, experience and treatment plan when you start a treatment approach.

There are also a number of alternative approaches to treating anxiety. They are listed here (based on other resources).

  • Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
  • Stop or reduce your consumption of products that contain nicotine (a stimulant)
  • Review over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
  • Exercise daily
  • Take a nice, long bath. You can use bath oil.
  • Take a walk outside.
  • Tighten the muscles in your toes. Hold for a count of 10. Relax and enjoy the sensation of release from tension.
  • Muscle tension is most commonly experienced in the back of the neck and shoulders. One easy way to get rid of such tension is to tighten the neck and shoulders, holding for 5-10 seconds before releasing.
  • Close your eyes and rest them, take a deep breath through the nose, exhale through your mouth, and repeat a few times. When breathing in, let your stomach expand as much as possible. Concentrate on breathing slowly and calmly, thinking of your slow breathing as calming your entire body as a whole or in parts. Leave your breath out for a relatively long period of time.
  • Mentally scan your body from head to toe. Are there any areas of tension? If so, take a few deep breaths, hold, then release slowly, saying "relax" to these parts. Think of the muscle as being soft and limp.
Meditation Activities
  • Draw
  • Journal
  • Listen to relaxing music
  • Tell yourself "I am relaxed" as you carry out breathing exercises. You can also think about positive words like "peace", "serenity".
  • Visualize a soothing image (e.g. lying on a warm beach).

As you review the material on anxiety, they key is to reflect on how anxiety is related to your sexual behavior. Could anxiety impair your sexual functioning? Might you be using sexual behavior to reduce anxiety? Could anxiety lead to different types of sexual behaviors (such as casual sex out of a fear of getting hurt in a committed relationship?) These are simply questions to start the conversation.