Counseling in Tokyo


Normal Anxiety

Many normal persons and persons under stress may experience anxiety. Most everyone has experienced anxiety triggered by an outside stress when there is the expectation of a feared situation like driving fast in a car or when an angry dog suddenly runs at you.

Anxiety triggered by an internal fear might be that when one is going to make a presentation at work, ask out a person they like, or when one is called to see their boss without knowing what the topic is. These kinds of situations can stimulate minor defects in one’s self esteem that everyone has and that are not usually in conscious awareness. These problems are usually mild and self-limiting and not in need of any intervention such as counseling unless the stress is really great.

Personality Disorder & Anxiety

Persons with deeper or a greater number of deficits in their self identity (i.e., having core issues or mental schemas of feeling unloved, unwanted, belittled, unvalidated, incompetent, etc.), may have a more pervasive nature of anxiety related to these core issues or deficits in the “Self" or personality. This kind of anxiety may be free-floating in the sense that it is always there, and worsened by situations that stimulate these deficits (like being alone or criticized, etc.) so that they may have high anxiety at times.

The anxiety these person’s feel is related to faults in their identity or personality structure, like a software problem, but they are not illnesses of the brain per se, like a hardware problem. Person’s whose personality is affected to a significant degree may fit the criteria for a personality disorder. Intensive psychotherapy aimed at personality reorganization is the preferred treatment for these problems. Usually a mixture of various approaches including Psychodynamic Psychotherapy that uses a Core Issue-Defense paradigm, or that based on Cognitive Therapy will be helpful.

Biologic Anxiety Disorder

There are also persons who have debilitating anxiety unrelated to outside events and without evidence of personality problems. These persons often have a family history of anxiety, depression, or other mental illness. This type of anxiety would be best thought of as a biological illness of anxiety and may likely fit the criteria of an anxiety disorder.

The major types of anxiety disorder are, Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder. While many clinicians, researchers, and the staff at Counseling Tokyo think of these disorders mood disorders, there is still controversy in the field of mental health whether anxiety problems should be subsumed under mood disorders or kept as a separate classification as anxiety disorders.

Persons with anxiety disorders tend to have considerable worry related to their specific illness characteristics, with many people feeling that “if I could just change my way of thinking", or “if I could just settle this issue at work", then they would not be anxious anymore. However, they tend be in an endless spiral of worry, that instead of being the cause of the problem, is really the result of having their tanks full of anxiety (a feeling state) that acts as the fuel for their worry (a cognition). The reason one can make this conclusion is that they did not have this kind of thinking style before they had anxiety and worry, and that medication treatment, if successful, usually clears up both the worry and anxiety, not only the anxiety. To see the types of evidence related to anxiety and biology, you can for example put the search words, “panic disorder and brain scans" or “obsessive compulsive disorder and brain scans" into the Pub Med web site of the U.S. National Library of Medicine to get a feel of the massive amount of work that has been done in this area.

Counseling is also necessary to rehabilitate these persons into a world that does not need worry anymore, to reduce the self-recrimination that comes with one concluding one’s thinking pattern is faulty, and to repair the relationships that have suffered because of the difficulty in relating to a person with these kinds of symptoms. In addition to the psychotherapies described above in the “Personality Disorder & Anxiety paragraphs, medication treatment is also usually necessary because of the intensity and debilitation associated with these disorders. This link also gives a more detailed description on the treatment of anxiety.

Go to anxiety page two.

Summary of the links on this page:

AnxietyPersonality DisorderPsychodynamic PsychotherapyCore Issue-DefenseCognitive TherapyGeneralized Anxiety DisorderPanic DisorderSocial Anxiety Disorder
Obsessive-Compulsive DisorderPost-Traumatic Stress Disordermood disordersmedication treatmentPub Medanxiety medication treatmenttreatment of anxiety

Counseling Tokyo provides counseling, support, and advice, for both the international community in English, as well as the local Japanese community in Japanese.