Bird’s eye overview of anxiety: Dr K’s Guide - Anxiety
Ways of thinking about anxiety, how it relates to the ego and spiritual guide to exploring and dealing with the pain that comes from resisting what is: The Power Of Now - enlightenment
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Outsmart Your Anxious Brain
A person with an anxiety disorder comes to treat anxiety not just as symptoms of nervousness but as a threat. The experience of anxiety and the efforts to not have that experience combine to form a vicious cycle of anticipating anxiety symptoms, fearing them, resisting and avoiding them, experiencing them anyway, dreading them all the more, and actually bringing more anxiety into your life with your efforts to stop worrying.
You can recover from a chronic anxiety disorder by finding ways to interrupt and break that vicious cycle.
During efforts to break free of anxiety, people are likely to observe, with despair, that “the harder I try, the worse it gets!”
Our natural tendency to resist and avoid anxiety takes ordinary anxiety and pumps it up into an anxiety disorder. We get into a counterproductive struggle with our anxiety symptoms: worrisome thoughts, uncomfortable physical sensations, reflexive behaviors, and negative emotions. We treat anxiety, panic, and worry like an external threat, rather than an internal reaction. We resist it when it appears, and we worry about it appearing when it’s not present. We develop an argumentative, confrontational relationship with anxiety, which unfortunately makes it worse rather than better. The path to overcoming chronic anxiety disorders is to develop a more adaptive way of relating to anxiety, and that’s what this book will help you do.
Even the way we describe and label anxiety is often unhelpful and counterproductive. What we call a “panic attack” isn’t an attack at all. It’s a reaction. Sometimes the person experiencing panic doesn’t even know what they’re reacting to, but that still doesn’t make it an attack of any kind. When we think we’re being attacked, we naturally leap to defend ourselves. That effort to defend, when there’s nothing in the present situation to defend against, is what keeps stirring the pot and making life worse.
What we presently call “anxiety disorders” could be more appropriately labeled “disorders of excessive self-protection” because that’s how they actually work.
Counterintuitive Problems & The Worry Trick
Chronic anxiety is a counterintuitive problem. If your puppy gets off the leash and runs down the street, your gut instinct is probably to run after him. But that only makes him run faster, as he enjoys the game of being chased. If you turn around and run away from the puppy, he’ll chase you, and the situation gets resolved.
An anxiety disorder develops, and comes to full bloom, when a person falls into the pattern of treating the discomfort of anxiety as if it were danger. That’s the fundamental “trick” of a chronic anxiety disorder: treating discomfort like danger. The reason people with anxiety disorders have so much trouble overcoming these problems is because they literally get tricked into responding to anxiety in ways they hope will calm it, but that actually make it more difficult and more persistent.
People with panic disorder get tricked into treating their physical symptoms—changes in heart rate, labored breathing, chest tightness, and so on—as a sign of imminent danger. People with generalized anxiety disorder get tricked into treating their worrisome what-if thoughts as a sign of future danger. In each case, they struggle and oppose these symptoms, hoping to feel better, only to discover they feel worse. They will do better with a counterintuitive response, working with the anxiety and worry rather than against them.
Anxiety comes in a variety of symptoms—physical sensations, worried thoughts, fearful emotions, and reflexive behaviors—which all share the same meaning: “I’m nervous and afraid.” They’re different expressions of the same condition of being nervous.
When we get tricked by anxiety and worry, we stop treating it like nervousness and start treating it like danger. That’s what makes things worse rather than better.
How People Get Tricked
People think of anxiety as an enemy, and that’s how they treat it. We only have three kinds of responses for dangerous enemies: fight, flight, and freeze. If it looks weaker than me, I’ll fight it. If it looks stronger than me but slower, I’ll run away from it. And if it looks stronger than me and faster than me, I’ll freeze and hope it doesn’t see well. That’s all we have for enemies: fight, flight, and freeze. These are good responses…when you’re actually in danger.
When you’re not in danger, though, these instinctive responses of fight, flight, and freeze will lead you to feel more anxious over time, rather than less. Running away from or fighting off the attack of a predatory animal is a good thing because it can make you safer. Running away from a grocery store when you feel panicky there or trying to repel scary thoughts, for example, are unhelpful responses. They won’t make you any safer, just more anxious.
“Is it danger or discomfort?” might be the best opportunity you get to immediately set out on a helpful path in response to a moment of high anxiety. If you treat the anxiety like a danger, fighting or fleeing it, that actually produces more anxiety rather than less. Treat the anxiety like discomfort though, and you’ll be on the right track.
Outsmart the Worry Trick
The intuitive choice, treating it like danger, means opposing, resisting, and fleeing the anxiety. The counterintuitive choice means treating it like discomfort. The best way to counter discomfort is with some version of “chill out and give it time to pass.”
“Float” (with or through your anxiety), as opposed to “swim” (against the current of your anxiety). Weekes’s advice, which still compares favorably with the most effective anxiety treatments today, suggests that you make no effort against worry and anxiety; you simply allow the environment to support you, just as one does in floating upon a body of water.
They try so hard to change or remove the thoughts they don’t want, snapping rubber bands on their wrists and trying to distract themselves with another topic, only to get further embroiled with the unwanted thought. This is why they try so hard to “escape” from situations that aren’t dangerous, like long lines at a grocery store or crowded churches or movie theaters. They’re trying to protect themselves from a danger that doesn’t exist at that time and place, and that’s why they’re feeling more afraid! It’s almost as if they’ve literally been sabotaged into acting in ways that will give them the very thoughts and feelings they don’t want.
Instead, if you can come to recognize the fear and anxiety as signs of discomfort, rather than danger, and respond accordingly, that will be the basis of a more helpful way of relating to worry and anxiety. That will truly be the path out.
One of the most striking characteristics of an anxiety disorder is that the terrible outcomes people fear tend not to happen. Has this been your experience?
What Maintains Chronic Worry
This question bedevils the sufferers of chronic anxiety disorders. They fear the answer is that they’re defective in some way—too weak, too cowardly, too stupid, and so on.
The truth is none of those. They don’t get over it because they get blinded by their reliance on safety behaviors and other factors, which prevents them from seeing the problem and its solution clearly.
Safety behaviors are naturally occurring preparations and responses to moments of high anxiety: efforts at protecting ourselves from perceived danger.
Safety behaviors:
- Support people
- Support objects
- Distraction and thought stopping
- Rituals
- Avoidance
Two common types of safety behaviors are “support people” and “support objects.” A person who is accompanied by a support person is usually willing to do more of life’s activities than when they are alone. It’s good that they can get to their activities, but unfortunately, the anxious person who relies on a support person comes to believe even more strongly that they can’t cope on their own, and that’s a bad thing.
Safety behaviors trick you. When you rely on them, you get fooled into believing that something—a person, an object, avoidance, distraction, and a few others—protected you from harm and that, if that safety behavior or object weren’t available, then you would suffer a calamity. The more you rely on safety behaviors, the more vulnerable and dependent you feel because you attribute your safety and well-being to the safety behaviors, as if they were bodyguards, rather than to your own ability to cope with life challenges. Reliance on safety behaviors deprives you of the opportunity to learn from your own experience.
There’s also distraction and thought stopping. Our effort to distract, our self-instruction to “stop thinking about it,” serves to remind us of the exact idea we don’t want to think about. This is why the most likely result of trying to suppress your thoughts is to have more of the thoughts you are trying to suppress. An even bigger problem with relying on distraction is that it contains within it the idea that thoughts can be dangerous. Thoughts aren’t dangerous. Only actions can be dangerous.
Relying on rituals and superstitions is another safety behavior. “Why not?” they reason. “It can’t hurt!” But rituals and superstitions do hurt. They perpetuate the idea that you have to do something to make yourself safer when you’re probably already as safe as you can be. They create more items on a checklist that they think they need to monitor to be okay, rather than simply showing up, taking their seat, and allowing the crew to do their job of safely taking them to their destination.
Avoidance and escape, the pattern of staying away from, and fleeing, the object, activity, situation, or location you fear. The more you avoid the things that trigger your fear, the more persistent and strong the anxiety becomes over time. It’s true that you’ll feel better as you turn away from those cues. When you avoid, you get a few moments of temporary, brief comfort at the price of giving up your long-term freedom, and it’s a terribly bad trade.
“Despite my best efforts, my anxiety keeps getting worse.” They mean this sincerely, but it’s not really true. Here’s what’s true: their anxiety keeps getting worse because of their best efforts. Their best efforts usually include a variety of safety behaviors: actions they hope will protect them but which actually only lead them to feel more vulnerable over time.
This is where the idea of “face your fears” comes from. Safety behaviors and objects offer to “protect” you from your fears but actually strengthen them. Practice, or exposure to what you fear, will gradually remove the fears. But the spirit in which you do the exposure is just as important as the exposure itself. I don’t like the phrase “face your fears.” It sounds too much like a confrontation—a staring contest, a toe-to-toe argument, or a physical struggle with an external opponent. That’s not the spirit that’s best suited for overcoming these fears. Working with, rather than against, your signs and symptoms of anxiety is a much more helpful attitude to take when you do exposure work.
Where Worry Comes From
First and foremost is the experience of anticipatory worry. It will be a big help to become a better observer of your own anticipatory worry, to literally catch it in the act, so you can practice different responses to the worry habit.
Here’s something that will help you catch yourself in the act of automatic worry: the great majority of worrisome anticipatory thoughts start with the words “what if.”
Misattribution is another important element in our thinking style that maintains a chronic anxiety disorder. The problem is that when you attribute your survival to a chance element in the environment, be it luck or the availability of another underpaid cashier, this probably leads you to feel more anxious and insecure about the future, rather than less. It makes it seem like you just survived an incident that could have done something terrible to you, and you made it through only because of the presence of this element.
People who struggle with chronic anxiety disorders often suppose that when they’re experiencing powerful negative emotions and persistent disturbing thoughts, it means they’re out of control. Control isn’t measured by what you think and feel. Control is measured by what you do.
Keeping your fears and anxieties a secret is another way you might try to help yourself, which instead aggravates the problem. People who struggle with chronic anxiety disorders often feel ashamed and embarrassed about their fears. They usually try to hide them and keep them a secret. Secrecy is the flip side of shame. The more shame a person feels, the more they struggle to hide their troubles. And, as you probably know, the more you try to hide your problems, the more shame you’re likely to feel about them.
Rule of Opposites
The Rule of Opposites says this: My gut instinct of how to respond to panic and high anxiety is typically dead wrong and following that instinct makes my troubles worse rather than better. So I will respond with the opposite of my gut instinct.
Your (and my) initial gut instinct of how to respond to a strong anxiety episode is almost always wrong. Not just wrong, but precisely and completely wrong, 180 degrees wrong, like a compass that points north but labels it south. If you have a compass like that, that’s a problem, but there’s an easy workaround. As long as you know that what the compass calls south is actually north, you can still find your way home. And so it is with the signs and symptoms of chronic anxiety disorders. If you can see that your gut instinct of how to respond to panic, worry, and anxiety is usually dead wrong, then that sets the stage for you to do the opposite next time that anxiety comes into play.
When people experience a moment of high anxiety, they tend to either try to fend off a “danger” that probably doesn’t exist at that time and place, or try to oppose and silence their fear. Neither helps them calm down. Instead, they become more afraid and also upset with themselves for once again feeling overcome by fear.
People often worry that this means there’s something wrong with them or with their brain. But this is actually evidence of your brain trying to carry out its job—keeping you safe—rather than any sign of malfunction. Our brains are much more willing to make the error of seeing a lion where there isn’t one than of not seeing a lion where there is one. The first mistake just brings on some discomfort; the second one might lead to danger and death. So our brains will naturally choose to err on the side of seeing dangers that aren’t there. The principal task of your brain is to protect you, not to keep you comfortable.
You’ll be better able to use the Rule of Opposites by turning your powers of observation back to your immediate circumstances. Use the following questions for a start.
What are you doing with:
- your hands?
- your shoulders?
- the muscles of your chest?
- your breathing?
- your posture?
What are you:
- looking at?
- listening to?
- focused on?
- thinking about?
Where is your attention and energy:
- Is it focused inside your head, with all its what-if thoughts?
- Is it focused on your body, hypervigilant to every physical sensation?
Ways to Counter Anxiety
Breathing:
Feeling short of breath is a hallmark of panic attacks. People try so hard to take a deep breath during a panic attack, only to find that their breathing usually feels worse rather than better. Inhaling under these circumstances will make the feelings worse. Here’s where the Rule of Opposites can be so helpful. What’s the opposite of an inhale? An exhale.
Belly breathing:
- Sigh gently, out through your mouth. (There’s no need to fully empty your lungs. A sigh is a smaller version of a full exhale.)
- Pause. A couple of seconds is sufficient, but the precise timing isn’t crucial. Do what feels comfortable.
- Push the muscles of your belly out and forward while you inhale, slowly, through your nose. You’re probably in the habit of holding your stomach in, but let go of that for now. When you’ve taken in as much air as you can with your belly, stop. That’s the end of the inhale. Don’t throw your upper body into it.
- Pause again.
- Exhale, through your mouth, by pulling your belly muscles back in.
- Repeat
Use belly breathing while you’re having a panic attack so you can observe and defuse the symptoms rather than flee the scene. Don’t use belly breathing as a shield! Some anxiety specialists believe that it’s better not to teach clients a breathing technique. They’re concerned that the clients will think the breathing technique is saving them from a terrible fate and that this will make their panic and anxiety persist over time. In other words, they would be using belly breathing as a safety behavior to protect themselves, rather than a simple coping technique to help them stay in place and work with, rather than against, the panic.
Practice, Don’t Protect
When you get tricked into avoiding something that’s not dangerous, you get the immediate, short-term benefit of a reduction in fear. But in the long term, you become more afraid of the object or situation that you avoid. The best way to counter that trick and obtain a better trade is to practice with, rather than protect yourself against, the activities, objects, and locations that trigger those fears.
We’re just as affected by our internal thoughts, emotions, and physical sensations as we are by objects and events in the world around us—maybe even more affected. And simply knowing “It’s only a movie!” doesn’t prevent you from feeling afraid.
Your best way to know which fears to take seriously and which to disregard is to rely on your experience. Whether you’re afraid of dogs, flying, highway driving, mistakenly leaving your door unlocked or your stove on, public speaking, or meeting strangers—whatever you fear—your past experience with those objects and activities will be your best guide.
Work the following questions:
What triggers your fear? It might be something in the world around you: an object, animal, or person; attending an event; participating in an activity; or encountering a distressing situation. Or it might be something within you: a thought, a physical sensation, or an emotion. When you meet the object, person, or animal; participate in the event or activity; encounter the situation; or experience the thought, sensation, or emotion and then become afraid, what are you afraid that the external situation or your internal reaction will do to you?
Has it ever done that to you? (yes or no) If yes, that would indicate there’s some danger associated with your fear or there has been at some point in your life. Maybe your answer isn’t simply yes or no but something like one of these:
- Not yet, but what if it does?
- Not so far, but I’ve just been lucky!
- No, because I had my medication (or my cell phone, water bottle, support person, emotional support animal, or some other aid) to help me. If your answer is a simple no, however, that neither your fear nor your feared object has ever done anything harmful to you then that indicates you know you’re up against discomfort, rather than danger. This is a situation in which you can make immediate use of the Rule of Opposites. What’s the opposite of avoidance? It’s to approach and experience the thing you’ve been avoiding. This is what psychologists usually call “exposure.” I’m going to call it “practice.”
They wish that first they’ll lose their fear, and then they’ll go deal with the situation or object that they used to fear. You can do both: lose your fear and deal with the situations you fear. But usually not in that order.
AWARE Steps:
- Accept - When you notice that you’re feeling afraid, you probably want to resist and stop feeling that way. Of course! You don’t want these symptoms, you don’t deserve them, and they don’t feel good. If you could simply toss them aside, the way you might change your clothes after getting caught in a downpour, that would be helpful. But you can’t. When you try, you’re likely to get caught up in a struggle against your own thoughts, emotions, physical sensations, and automatic responses. The result of this struggle will be more, not less, anxiety. Resistance is not only futile—it makes you feel worse! And the opposite of resistance is…acceptance.
- Watch - Watch the symptoms you experience and your instinctive urge to respond immediately. List or write down: Physical Sensations, Thoughts, Emotions, Behaviors (Use Worksheets at the bottom)
- Act - What action should you choose? Those first two steps function like the old adage of “count to ten before you get mad,” buying yourself some time in order to choose a truly useful course of action. It’s not your job to stop the anxiety because every anxiety episode ends no matter what you do. And the more you can fit yourself into this role—to accept the temporary anxiety and wait, as passively as possible, for it to end—the sooner it will end. What you resist, persists.
- Repeat - R is here to remind you that it’s okay if anxiety finds a new surge, you might experience that, and if you do, just run through the steps again. Take it from the top, as often as you need. If we didn’t have the R here, you might suppose something had gone wrong, that the steps weren’t working.
- End - This last step is another reminder that the anxiety episode will end, all on its own, no matter what you do. The end of an anxiety episode is just as much a part of an anxiety episode as is the start of one. It comes with the package. It’s not something you have to supply.
Catch Worry in the Act
Worries start from “what if … ?”
Exercise to become more aware of the what-ifs: Get yourself some boxes of Tic Tacs, or any mint that comes in a specific quantity to the box or bottle. Tic Tacs come in boxes of sixty. Get into this habit: carry your box of Tic Tacs everywhere you go. Every time you notice yourself thinking (or saying) the words “what if,” open your box and take one out. You can eat it if you like or flick it into the trash if you don’t. Use the Tic Tacs as a simple way to keep count of how many times a day or week you experience a what-if thought.
When you think there might be a useful signal in your worry content, use this two-part question to evaluate it:
- Does the problem I’m worrying about exist in the world around me now, the world outside of my mind and imagination?
- If it does, is there anything I can do to change it now?
If you get two yes answers to these questions, then maybe worry isn’t your main problem. The two yes answers would indicate that you have a worry about an actual problem that exists now, outside of your mind, a problem you can do something about. That’s what ordinary worry is for, to remind you to take action when you can, and that’s probably what you need to do. But if you get any other combination of answers—a no to the first question, a yes and a no, or answers like what if, couldn’t it happen, imagine that, I suppose—then you don’t have a problem you’re worrying about; you have the problem of worrying.
Humor Your Worries
Taking the content of these what-if thoughts seriously causes problems…and so an effective counter might be to take these thoughts more lightly and respond to the anxiety they offer with humor.
When you’re frequently being bothered and interrupted by what-if thoughts of problems that either don’t exist now or can’t be changed if they do, then you’re being heckled, yes heckled, by your own worry thoughts. What’s the best way to handle heckling? A performer who’s being heckled might be tempted to take off his jacket and rush into the audience for a fistfight with the heckler, but that’s not going to help him perform his show. Nor will it help to try to ignore the heckling because he’s still hearing it, and the audience knows that. Probably the best way for a performer to respond to heckling is to work that heckling into his act. That’s an effective way to disarm heckling.
Arguing with your worries usually makes things worse. The opposite of arguing is humoring, agreeing with, and playing with the worries.
Paradoxical Repetition:
- First, pick a time and place where you can have complete privacy
- Select a topic you often worry about, one that fails the Two-Part Test
- Create a worry sentence of about twenty words, one that incorporates all the worst fears you have about this topic
- Repeat your worry out loud twenty-five times, slowly and methodically. Don’t keep count in your head. Rather, use one of these two methods for counting: Make twenty-five marks on a piece of paper and cross one out with each repetition, or put twenty-five coins on a table and move them from one side to the other, one with reach repetition. Repetition drains the upsetting power from the worry sentence.
Other ideas:
- Worry in a foreign language
- Make a poem about current worry
- Make a song
- Walk - Take a walk for somewhere between two and five minutes. While you’re walking, keep this thought in mind: I can’t move; my legs are broken. It’s obviously untrue, but that’s okay; this is an experiment. When you’re done, consider these questions: How do you feel as you walk around with this thought in your mind? What attitude do you have toward the thought as you walk around? Think of other times when you’ve had an untrue or exaggerated worrisome thought in your mind. How did you feel with that thought in mind? What attitude did you have toward that thought?
- Take the worry with you - All too often, people get tricked into thinking that they have to get rid of intrusive worrisome thoughts before they can move on to another activity. What would be the opposite of that? Take the worry thoughts with you as you go to another location or activity with an attitude of acceptance for the experience of having unwanted, unpleasant, worrisome thoughts.
- Use the “Yes, and…” technique of impro theatre.
- Make worry appointments - schedule two ten-minute appointments each day to deal with worries. When the appointed time arrives, worry aloud in front of a mirror. Fill the ten minutes with worry as best you can, and let it be pure, unadulterated worry: no research, no problem solving, no reassuring, just one what-if thought after another. You might find it helpful to set a timer. This enables most people to sweep relatively clear large portions of their day that used to be continually interrupted by worry.
Observe, Don’t Distract
Clinical research on the topic says that when we try to get rid of a thought, it tends to recur.
I’ve used CBT methods throughout my career as a psychologist. What I find most helpful in CBT is the B part, helping people to change their behavior—what they do. That’s been very effective in helping people overcome chronic anxiety disorders. I find that cognitive restructuring is often less helpful to clients struggling with chronic anxiety disorders, particularly when they’re struggling with lots of worrisome thoughts.
I think that’s because this kind of worry doesn’t follow any of our rules of logic and evidence. It’s not based on what’s likely, or even possible. It’s based on what would be scary and terrible. Trying to identify and correct the errors in this kind of thinking is like arguing with a person who offers no logic or evidence, only opinion. It just leads to more arguing.
There are two basic postures from which you can respond to worry, panic, and anxiety. One is the victim posture, in which you respond instinctively as one who is being threatened and in need of immediate protection. This is the posture in which people are motivated to distract themselves from anxious thoughts and symptoms, responses that tend to make the worries more persistent.
The other is the observer posture, in which you take careful note of all the symptoms and circumstances coming to your attention without resistance, protection, distraction, or even any strong judgments. You’re observing your thoughts, as best you can, without evaluating or reacting to their content. This is what Claire Weekes meant by “floating”: observing your thoughts and letting time pass without reacting.
The more you are in the victim role, the less available you are to observe anything because you are struggling with your own thoughts. This is why people have so much trouble describing their first panic attack. So terrorized and victimized did they feel that they were unable to observe the events in a way they could later remember and describe. The reverse is also true. The more you are in the observer role, the less available you are to feel victimized and struggle with your symptoms. This is what makes the role of observer so useful.
I suggest you take notes during your anxious episodes, and I’ll give you a pair of journals you can use for this purpose. Complete the journals during the anxiety episode. Some of the journal items will remind you of helpful responses you can have in a moment of high anxiety, and if you wait until later to use the journal, you won’t benefit from the reminders. You’ll also get a more complete picture when you write the journal entry at the height of an anxiety episode rather than later.
Panic Journal
Symptoms:
- Physical Sensations
- Thoughts
- Emotions
- Behaviors
Type of Panic:
- Anticipatory: Occurs while you are thinking of a feared situation
- Situational: Occurs while you are in a feared situation
- Spontaneous: Appears to come “out of the blue” because you are neither in a feared situation nor thinking of on
Questions:
- Where are you? Are you alone?
- What were you doing before the panic?
- What were you thinking before the panic?
- What do you fear the panic will do to you?
- How is your breathing? Are you practicing belly breathing? Did you remember to start with an exhale?
- What are you doing to soothe yourself?
- Are you using any safety behaviors (distraction, fleeing the scene, safe people or objects, rituals, and so on)?
- How did the panic end?
- What was the worst thing the panic actually did to you?
- If your feared outcome did not happen, to what do you attribute that?
- Describe anything you experienced that you don’t understand, never experienced before, or don’t know how to handle.
- Is there anything you want to do differently next time you experience panic?
Worry Journal
- Complete your worry sentence: What if … ?
- Does the problem exist now in the world around you? (Y/N)
- If yes, can it be changed now? (Y/N)
- If Y and Y, what action can you take now?
- What triggered the worry?
- What physical sensations accompany the worry?
- What images accompany the worry?
- How is your breathing?
- How are the muscles in your neck and shoulders?
- What does your worry thought predict is going to happen?
- What will be the result if that happens?
- Do you believe it will happen?
- What does the worry push you to do or to avoid?
- Do you think that will help? (Y/N)
- Do you want to do that now? (Y/N)
- Are you treating this thought like a worry produced in your mind or like an important prediction of the future?
- Are you paying attention to your surroundings or to the thoughts in your head?
- What are you doing in the external world?
- What are you doing to relieve the worry?
- How effective is your response?
- What does the Rule of Opposites suggest?
- Will you try that now? (Y/N)
Let Your Support People Go!
The opposite of relying on a support person is doing things alone. That’s a scary idea for people who have come to rely heavily on the presence of a support person. For now, be aware that you don’t have to go it alone all at once, without any planning. You can take steps at a pace that works for you. But letting your support people go is the way to counter the trick of feeling so dependent on others and regain your ability to rely on yourself.
If you rely on support people, it probably enables you to engage in some activities you would otherwise avoid and perhaps even to feel a lower level of anxiety as you do. But does it help you to regain your confidence that you can engage in these activities on your own? That’s what’s most important.
Reflect:
- Who is your primary support person? Is there more than one?
- Identify the activities, locations, objects, and so on that your support person helps you cope with.
- Describe what your support person does, if anything, to calm you.
- Describe how your fear, anxiety, and worry have evolved during the time you’ve relied on support people.
- How has your reliance on support people affected your sense of being free, confident, and independent?
- Has your reliance on this support person affected the quality of your relationship?
- If so, has it had a positive or a negative effect?
- Has your reliance on support people given you some benefits, in terms of comfort and convenience that you enjoy?
- Are you willing to make that trade, to give up that extra measure of comfort and convenience, in order to foster your recovery?
Here are some ways you can break this process—of letting go of your reliance on support people—into smaller steps:
- Have a conversation with your support person. Identify the way the two of you work together and the rules of thumb the two of you use, and gradually reduce the number of specific ways the support person helps you.
- Reduce the time the support person spends with you. If they accompany you in the store, perhaps you can have them arrive a few minutes after you enter the store, leave the store a few minutes before you, or step out of the store for a few minutes in the middle of shopping. Gradually increase these intervals over time.
- Reduce the spoken and physical interaction between the two of you. If you’re used to having your support person right next to you as you walk down an aisle, perhaps one of you can change directions. Enter an aisle from opposite ends, walking in opposite directions so you only pass each other in the middle. Do the same in the next aisle.
- Systematically, one step at a time, begin to leave your support person out of your daily activities. Identify all the various situations and activities in which your support person accompanies you, and rank them in terms of which seem the most anxiety provoking to you. Then you can begin to leave your support person behind as you tackle the least anxiety-provoking activity and move up the list over time.
- If you can see that the role of your support person has grown over time, shrink it by reversing that process. First review the history of how your support person has assisted you over the years. It might have started accidentally, when you realized it was a source of comfort for this person to be with you. Maybe initially it included just one or two triggers and came to expand over time. Maybe it became more deliberate and intentional over time. You can trace the way this behavior developed and grew; then reverse the process. Begin shrinking it down in the opposite way it expanded and grew.
- Increase the distance between you, first within the store or other location, gradually keeping the person at a farther and farther distance. Gradually replace the person’s physical presence with phone contact and diminish that as well. A final step here might be to periodically leave your cell phone home entirely. We’ll check that out in the next chapter.
Why am I doing this? I’m feeling more afraid!
That temporary increase in fear is precisely the reason to do this. If you’ve become dependent on a support person, or any other anti-anxiety technique, you feel protected, temporarily, from the fear, rather than genuinely safe. That sets the stage for you to have more anxiety going forward as you wonder if your protection will always be available.
Cope with the fear with techniques like the ones described before, like AWARE.
Your relationship with this person is likely to change as you become more independent. It will be helpful for you to consider how you want the relationship to change and what you value about it.
Honesty and Truth Will Set You Free
Secrecy and shame work hand in hand to strengthen and maintain anxiety and worry troubles. The opposite of secrecy is honesty, what psychologists often call self-disclosure. People who struggle with chronic anxiety and worry often feel so ashamed that the idea of self-disclosure is a nonstarter for them, and it might seem that way to you as well.
Many people get tricked into trying to keep their anxiety problems a secret. They hope that if they hide their troubles from others, they will suffer less embarrassment. That’s probably true, for a very short period of time. Many people get tricked into trying to keep their anxiety problems a secret. They hope that if they hide their troubles from others, they will suffer less embarrassment. That’s probably true, for a very short period of time.
People with panic attacks fear death and terrible loss of control, but when the panic attack actually arises, they typically become afraid and then calm down, with neither death nor loss of control. People with social anxiety fear terrible humiliation and ridicule from others, but when the social anxiety occurs, they feel embarrassed, and then life moves on. In a very similar way, your anticipation about how people would respond if they became aware of your anxiety and worry problems is probably far worse than what would actually occur. Instead of getting the support you might want, you suffer silently in your own self-criticism. You may think you know what family and friends would say if you shared your secret, but those are still your thoughts, not theirs.
The main reason they continued to see themselves as frauds was because they kept their troubles a secret. They remained in their mind, wrestling with their own shame and blame, rather than bringing it out into the open where it could more readily be accepted and dismissed.
It’s often harder, and more anxiety provoking, to try to maintain a fake explanation than it is to simply express the truth as you best know it. The truth will set you free.
Self-disclosure involves revealing some aspects of your anxiety trouble to selected people rather than keeping them a secret from everyone. Most people don’t like the idea of self-disclosure, and maybe you don’t either.
You don’t need to assume that self-disclosure will help you or blindly follow this suggestion. Keep an open mind and do a cost-benefit analysis of the possible benefits of self-disclosure. Here’s how:
- Identify one person in your life who clearly has your best interests at heart, someone who has your back as much as, or more than, anyone else you know. This should be someone with whom you’ve used excuses and deception to hide your anxiety.
- Consider the benefits you get from keeping your anxiety troubles a secret from this person. This usually has to do with sparing you the embarrassment you expect to experience from revealing your troubles and how you expect that person to react. Answer the following questions in your notebook:
- How has this person reacted in the past when you have done or revealed something that you found embarrassing, shameful, or negative? What was the worst thing they did in response? How did that affect you and for how long?
- What is the worst thing you suppose this person might do if you disclosed some of the trouble you have with anxiety and explained how it has affected your relationship (for instance, how it’s led you to avoid certain activities with them)?
- Are there any good ways this person might react to your self-disclosure?
- Review the description of the five negative side effects above. Do you see signs that you have experienced some of these negative effects? If so, how might your life, and your friendship, improve if you could remove them by doing some self-disclosure?
- Throughout your entire life, what was your most embarrassing experience? How did you handle it? What was the ultimate result of feeling so embarrassed? Then:
- Tell your friend that you have something you want to discuss, and set a time to get together in the very near future for this specific purpose. Your friend might be curious, so let them know that you don’t want to borrow money or complain about their behavior, just that you have something on your mind to talk over.
- Recognize that you will probably feel nervous as the time approaches. Don’t try to talk yourself out of feeling nervous or argue with yourself about it. Review some of the tips for handling anticipatory worry in chapter 6 if you feel the need.
- When the time comes, get right to the point. If your friend knows anything about your anxiety, mention that it’s about that. If they know nothing about your anxiety, explain that you don’t know if they recognize it, but that sometimes you have trouble with anxiety and that this is the topic you want to discuss.
- If you want your friend to keep this conversation private and not share it with others, ask for that.
- Give your friend a sample description of how you sometimes experience anxiety in ways that lead you to limit your activities. Tell them that you’re dealing with this as best as you can and you didn’t want to give the impression that you didn’t want to spend time together, because you value the friendship. And, if you’re willing, offer to be more candid in the future when you don’t want to do something due to anxiety, rather than make an excuse.
- Your friend may ask, “How can I help?” Explain that the biggest help would be knowing that you can be candid when the anxiety troubles you and knowing that your friend will understand that your turning down an invitation isn’t a reflection on your friendship, but it’s just you having trouble with anxiety.
Control Actions and Accept Feelings
When you struggle with a chronic anxiety disorder, you probably focus a lot on how you feel. That’s understandable because you want so much to feel better.
We don’t control our feelings. The only thing we can really control is what we do. And you’ll probably be better off by controlling, and focusing on, what you do, rather than how you feel.
Where did you feel better? Which one do you prefer? Better here (when you were actively engaged with the people and objects in your immediate environment)…or better here (when your attention was focused on how you felt inside)?
Most people seem to feel better when they’re involved in the present moment, in their interaction with the people and objects around them, using their hands and feet and voice, when they’re more focused on involvement with their immediate environment than they are with how they feel (and think) inside themselves. We’re much more likely to feel anxious and uncomfortable when we’re focused on changing and resisting our internal sensations, emotions, and thoughts. We’re much less likely to feel anxious and uncomfortable when we’re focused on our activity and involvement with the world around us.
If I run away from something, I probably feel more afraid over time. If I deal with something I’ve been avoiding, I probably feel better.
Feelings follow behavior.
You can get both these things—confidence and a life in which you’re able to do what you want, where you want—but not in that order. You generally need to do this in the opposite order. First, you do the things you fear, and then you come to feel confident. Confidence isn’t a commodity you acquire. It’s something that naturally develops out of the actions you take.
People with fears and phobias often try to control things that are outside of their usual range of control. They try to control events and situations outside of themselves, hoping that this will bring them the internal feelings of comfort they want.
People have phobias because they fail to embrace the particular role in which they’re cast. What’s the role of a passenger on a commercial airline? There’s nothing you need to do but sit there until they tell you that you’ve arrived at your destination and it’s time to disembark. You’re baggage that breathes!
Feel the Fear and Let It Pass
Don’t try to get rid of your fears, or even calm down, while you’re doing exposure practice. When you get tricked into opposing, fleeing, and otherwise trying to get rid of your fears during exposure practice, it undermines the benefits you will get from exposure and makes the problem worse.
Instead, let yourself feel afraid. Allow yourself to experience the scary thoughts, emotions, and physical sensations without trying to get rid of them or distract yourself from them. Practice, a step at a time, with situations that elicit your panic, worry, and anxiety and allow yourself to feel afraid. Do not attempt to oppose or interrupt the anxiety that ensues. Follow these steps:
- Spend time with what you fear: the object, activity, situation, or even thoughts.
- Reduce your use of safety behaviors, people, and objects as much as you are willing. Work toward having none of them during exposure practice.
- Get afraid.
- Allow yourself to experience the fear without trying to get rid of it.
- Stay with it until the fear level comes down some, mostly on its own. Let the fear leave, at least in part, before you do.
- Review your results. What happened as a result of exposure, and what didn’t happen? How does that compare with what you anticipated?
- Repeat as necessary, on a regular basis.
People often misunderstand what exposure therapy is all about. They understand that they’re supposed to go spend time with what scares them, rather than avoid it. But they sometimes think that when they do exposure practice, they’re supposed to go to the feared situation—maybe highway driving, shopping in a crowded mall, or riding an elevator—and try not to be afraid somehow, maybe by distracting themselves, trying to reason with their fears, or doing some other safety behavior. Even when they understand that they’re not supposed to resist the fear, it’s such a natural instinct that they find themselves resisting anyway.
Ways to allow yourself to feel afraid and work with it, rather than against it, include:
- AWARE steps
- Journals
- Symptom Inventory
- Humoring the what-if thoughts
- Belly breathing
Exposure practice
- Work with one fear at a time.
- Prepare yourself with a fire drill, literally pretend you are in your feared situation.
- Don’t combine exposure with daily tasks.
- Break it into small steps.
- Schedule in advance.
- Decide in advance what you’ll do.
- Make sure your exposure is “relevant.”
And remember:
- You can do exposure if you have no specific cues or phobias.
- You can also do exposure with fearful thoughts.
- An anxiety disorder is not a disease.