Anxiety – Frequently asked questions

March 17, 2017 / southislandwellness / Leave a comment

What is anxiety?

Anxiety is a normal reaction to perceiving a threat. When we believe something important to us (our lives, our jobs, our families, etc.) is threatened, our bodies prepare us to deal with this threat. Our muscles tense, our heart beats faster, our breathing may get rapid and shallow, etc. these are the physical symptoms of anxiety.

How does worrying influence anxiety?

There is a lot of research suggesting people who struggle with excessive anxiety have difficulties tolerating uncertainty. In other words they struggle with not knowing what might happen. “Worrying” is attempting to anticipate threats that may occur in the future – trying to figure out what might happen. People tend to believe that if they can just predict everything that could go wrong, they can plan and problem solve, and then they will be safe. However, our brains easily confuse real threats with imagine threats. For example, if you were extremely afraid of spiders, seeing photos of spiders, seeing videos of spiders, or just thinking about spiders might be enough to trigger anxiety – even if you know the spider in the photo is not actually in the room with you. This is important because when you are worrying, you are thinking about “something bad” that could happen, and your brain gets confused and thinks the “something bad” is actually happening right now. So your brain tells your body to get ready to deal with the “something bad” right now, and as described above, we call these preparations “anxiety.” As advanced as our brains are, its responses to “something bad” happening can be overly simplistic. It doesn’t matter if the “something bad” is someone saying something mean to us or having to run away from a tiger in the bush, our brain and bodies tend to react in the same way (fight/run away/freeze). So the more we worry (think about what could go wrong/perceive a threat) the more your brain tells your body to get ready to deal with what could go wrong by becoming “anxious.”

Why do I worry so much?

Researchers Dugas and Robichaud identify five beliefs that keep people stuck in a cycle of excessive worrying. If we believe these things, we are encouraged to worry as much as possible. These beliefs are:

1) “Worrying helps find solutions to problems.” While recognizing the problem is one part of problem solving, it is no longer helpful when we start worrying about problems with a low probability of occurring. For example, if you are going camping it makes sense to recognize that it could rain (anticipate a problem with a reasonable probability of occurring) and plan accordingly by bringing a tarp. However, it is less helpful to plan for a satellite falling from orbit and landing on your campsite. This sounds ridiculous but we often do we worry about all the things that could go wrong as opposed to what is likely to happen.

2) “Worrying helps motivate me to get things done.” Similar to the previous rationalization for worrying, perhaps some worrying does help motivate you. It makes sense to remember you have a test coming up in a couple of weeks, so you can start studying for the test. However, when we excessively worry we can often get overwhelmed by anxiety. If we are worrying about our test in a couple of weeks, about the bus maybe being late, about our partners not actually loving us, about what we are going to get our mother for her birthday, about the assignment due next month, etc. we may experience too much anxiety and being distracting ourselves, procrastinating, using substances to calm down, or use another unhelpful coping mechanism.

3) ‘Worrying prepares me for uncomfortable emotions.” This belief reflects the idea that if we worry about something bad happening, we will be less disappointed, sad, or guilty should that bad thing happen. Unfortunately, this belief will keep us locked in an endless pattern of worrying “just in case.”

4) “Worrying can prevent bad things from happening.” Some people believe that if they just worry enough, “magical thinking” will prevent what we are worried about from happening. If this were true, then we would become stuck in an endless cycle of worrying about all the bad things that could happen.

5) “Worrying is a positive part of my personality.” This is when we believe that worrying shows we are caring, loving, or conscientious. However, worrying too much can actually annoy and frustrate the people in your life, and push them away. Furthermore, there are many ways we can be caring, loving, and conscientious without worrying.

A major theme within these beliefs is the idea that worrying will somehow prevent or reduce our pain and suffering. In other words, people think that if they can just anticipate all the problems, they can create some kind of plan, which “fixes” the “problem”, which will protect us from the pain and suffering we would experience if the problem were to occur. For example, if I worry about my kid using drugs, I can create a plan to talk to them about drug use, so I can avoid the pain and suffering I would experience if my kid were to use drugs.

However, when we anticipate problems, our mind tells our body to prepare to deal with problems, it tells our body to become anxious. Most people find anxiety painful and describe it as suffering. So ironically, by anticipating problems, to avoid pain and suffering, we are actually creating our own pain and suffering.

Many people want to spend a lot of time anticipating the bad things that could happen in their lives (worrying) but don’t want the anxiety. However, our brains are not wired for this and by choosing to worry, we are indirectly choosing to have anxiety.

When is it helpful to worry?

Worrying can be helpful in some situations but we want to limit our worrying because excessive worrying will lead to excessive anxiety. For example, it can be helpful to anticipate and prepare for:

a) Things with a reasonable probability of happening,

b) Things we can reasonably do something about now or in the immediate future,

c) Things that would pose a legitimate threat to our health, safety, or goals.

If a situation meets all three of these criteria, it might be worth your worrying. For example, people often worry about public speaking. If we know we have to give a presentation in class, there is a reasonable probability we will have to speak in public. Perhaps a large portion of your grade is dependent on how you do in your presentation, so it may be important to you to do well, in which case it would be prudent to prepare thoroughly. By anticipating this challenge, we can prepare by doing our research and practicing our presentation thoroughly. If we are thinking about the challenges we may face while giving our presentation during a study session scheduled to work on your presentation, this would be helpful. However, worrying about giving your presentation is no longer helpful when you are lying in bed at 3 am wanting to sleep, because these is nothing you could reasonably do at that time and focusing on the presentation is interfering with your other important life goals (like getting a good night’s sleep). Worrying about being laughed out of the classroom and losing all your friends because you did poorly on a presentation isn’t helpful because, in my opinion, it doesn’t have a reasonable probability of occurring. It is also important to put the consequences of giving an imperfect presentation into perspective. While you might not get the grade you want, you will likely be physically fine – no one will chop your hand off for doing poorly.

How do I experience less anxiety?

This is a very old and complicated question with several different answers. For moderate to severe levels of anxiety medication can help, but medications can have side effects. Taking medication can also be relatively easy, you simply take some pills throughout your day. Other ways to reduce anxiety typically take more work, but they also have some benefits medication does not. In therapy, I usually start by recommending daily exercise, getting 8-9 hours of sleep per night, and eating a balanced diet. While people may not see the connection between these habits and their anxiety, research strongly suggests each of these interventions. These habits also come with a wide array of other benefits as well. Healthy living habits serve as the foundation upon which we can build wellness.

Then there are a number of mental exercises people can practice to reduce worrying and anxiety. One of which is called mindfulness which can be described as practicing non-judgmental awareness and acceptance of the present moment. This is when you pay attention to what is happening right now, in the room where you are, in your body, and in your mind. Then we accept the thoughts, feelings, sensations, and images in the present moment without judgement. So maybe you check-in with your body and notice some sadness, and instead of trying to get rid of the sadness because it is “bad” you accept the sadness without judging it as either good or bad. This can help reduce anxiety because when we are paying attention to the present moment, we cannot be attempting to anticipate the “bad things” that could happen in the future. As we continue to practice directing our attention to the present, this gets easier and we actually change the way our brains work.

The cognitive-behavioral therapy (CBT) approach to reducing anxiety includes changing patterns of thinking and behaving which maintain anxiety. We question the beliefs that maintain our worrying, our unhelpful ways of dealing with problems, the beliefs about our vulnerability to “bad things happening”, and our ability to cope with challenges. We largely do this through a series of activities designed to challenge unhelpful beliefs. For example, a person anxious about being in a public place will create a series of exposure exercises in which they expose themselves to their feared situations so they learn that their fear is irrational and that they can cope with being in public places. CBT is direct, short-term, and it can take a willingness to take some “risks.” There is a lot of research supporting CBT as a front-line treatment for anxiety. In my experience, CBT is most effective when the feared situation is concrete and specific. CBT can be offered in individual therapy, group therapy, self-help books, and online.

I’ve tried everything before and it hasn’t worked, now what do I do?

This question is an overgeneralization – there is no way anyone could try “everything.” Instead, it is likely that you have tried several or many things in the past and have not gotten the desired results. However, there are many different medications, many different activities that promote wellness (yoga, joining a sports team, trying a new hobby, finding a new job, journaling, etc.), and many different kinds of therapy. Even among cognitive-behavioral therapists there is a lot of variation in how therapists actually practice. If we are trying to find a reason to give up (“I’ve tried everything”), this might mean we don’t actually want to put the work in to make changes, and that is okay. There may be a time in your life when you are more ready, willing, and able to try something new. If that time comes, hopefully this article has given you some ideas you could try.

Overcoming Anxiety and Avoidance

October 12, 2016 / southislandwellness / 3 Comments

Although this will likely reduce the number of “likes” I get for this post, I believe it is important to begin with some honesty. Overcoming anxiety is hard work. Most people want a simple and easy answer that can make all of their suffering go away. However, for every complicated and messy problem there are many simple and easy answers that are ineffective. For example, in Canada the use of antidepressants increased over 450% between 1981 and 2000, but the demand for mental health services has never been higher. This post is not an “8 easy steps to being less anxious” kind of post, it is more of a “if you work really hard, stay determined despite set-backs, and keep an open-mind about trying new things you may be able to make some real improvements to your life” kind of post.

Anxiety and Avoidance

Anxiety is a normal reaction to perceived threats. However, when we have a tendency to focus on threatening situations, the problems in our lives, we are fueling excessive amount of anxiety. One way we attempt to reduce the amount of anxiety we experience is by avoiding challenging situations. However, avoidance prevents us from overcoming our fears. Furthermore, as we avoid more and more things, our lives become more and more restricted.

For example, if you had social anxiety and were terrified of talking to authority figures, you would likely experience anticipatory anxiety before you spoke to people of authority, then when you did have to talk to someone of authority (exposing yourself to the feared situation) your anxiety would likely spike. Then when you avoid the situation by promptly leaving, your anxiety will naturally go down. Unfortunately, when we cope with anxiety by avoiding challenging situations we cannot challenge our assumptions that the situation is dangerous, we cannot challenge our assumptions that we cannot handle the stressful situation, nor can we learn how to handle the situation more effectively. So then the next time we exposure ourselves to the stressful situation we experience a similar amount of anxiety.

Overcoming anxiety can be accomplished a number of ways. However, research strongly suggests that one of the most effective strategies for overcoming anxiety is something called “exposure therapy.” Exposure therapy rests on the premise that if we can expose ourselves to our anxiety provoking situations in a certain way, we can learn: the situation isn’t as dangerous as we assume, we can handle the challenging situation, and we can practice skills to better handle similar situations in the future.

Exposure therapy

Begin by creating a list of situations you avoid
Rate how much anxiety you suspect you will experience in each of these situations on a scale from 0-100
Select a situation that will provoke a small amount of anxiety – set yourself up for success
Create a plan to expose yourself to this situation –when? Where?
Expose yourself to the situation
When you are in the situation try and pay attention to what is going on around you as opposed to what is happening in your body or distracting yourself (looking at your phone, talking to a friend, reading a book, etc.)
Stay in the situation until your anxiety has diminished, do not just leave when you feel some anxiety
After your anxiety has gone down, ask yourself what you have learned about how dangerous the situation was, what you have learned about your ability to cope (did you survive?), and some skills you could practice to handle the situation more competently in the future
If you notice yourself going over and over the situation in your mind, distract yourself by doing something engaging
When you are able, expose yourself to the same situation again and again until you do not feel very much anxiety at all in that situation
Once you have completed the first anxiety provoking situation, move on to another situation on your list of anxiety provoking situations and repeat this process

By exposing ourselves to anxiety provoking situations appropriately, we are able to reduce the amount of anxiety experienced when we face similar situations in the future.

Some notes about exposure therapy:

Exposure therapy can be immensely effective for anxiety created by many different situations. Personally, I have seen clients make radical changes in only a small number of sessions when they are committed to their exposure plan. However, it is important to remember than some situations are actually dangerous and we are not always exaggerating the danger in our minds. Therefore, I do not encourage people to behave recklessly, for example standing in a busy highway, going down dark alleys at night, or committing any crimes. Also, this article only describes one type of exposure therapy, something called “in vivo” exposure therapy and this type of exposure therapy cannot be used to overcome some anxiety provoking situations. Obviously, we cannot expose ourselves to our fear of our own death (at least not more than once), to fears of loved ones dying, or to fears of natural disasters. For these types of hypothetical fears, we may need to practice something called “imaginal exposure” which is not described in this article.

Some notes for therapists:

Many clients struggle with creating the motivation to engage with exposure therapy. When we are distressed we often resort to coping mechanisms that are familiar to us, even if they are not helpful. It can be useful to go slow with clients and discuss the costs and benefits of avoidance. Encourage the client to consider what their life may be like if they continue to avoid anxiety provoking situations indefinitely and/or consider the opportunities their avoidance may have already cost them. Remember, it is not our job to convince the client to do anything. Instead we are there to help them make informed decisions. If the client chooses to continue to avoid, while knowing the consequences of this decision, that is their choice and that should be respected.

Processing what the client has learned from exposing themselves is just as important as collaborating with the client to design the exposure activity. “what did you learn from exposing yourself to this situation?”, “what did you learn about your ability to cope with the situation?”, “what did you learn about your anxiety in general?” “what did you learn about your fears?” – Questions like these can be very helpful.

Welcome to mindfulness

August 19, 2016August 19, 2016 / southislandwellness / 1 Comment

You should do breathing exercises. Maybe do yoga a few times a week and you’ll feel better. Go for a walk daily. Start your day off with a 10 minute meditation.

I cannot count the number of times people have given me advice like this to me. These are probably good suggestions and they do indeed have a reasonable amount of research supporting them, but I believe they are insufficient for promoting lasting composure. I do see a lot of value in maintaining a relaxed, composed state of mind while going through my day. When we are calm our brains function differently, we have superior reasoning and problem solving abilities. I think many people can relate to the experience of reacting inappropriately when distressed. How can 10 minutes of meditation in the morning, a walk, or yoga a couple of times a week maintain my composure throughout the day? I do not believe it can. Instead, perhaps I need a tool I can easily use throughout the day to maintain my composure. For me, this tool is practicing mindfulness.

Mindfulness refers to paying attention to the present moment, without judgement. Practicing mindfulness is simple and incredibly effective for regulating my emotions throughout my day. What does practicing mindfulness look like? Take a breath, notice the air filling your lungs, notice your rib cage expanding, notice your heart beat, just notice how it feels. Focus on those things, and without judgment (“It should be deeper”, “it should be slower”, “it should be…”), just notice the way it is. Congratulations, you have just practiced mindfulness. It’s that simple.

Paying attention to your breath can be convenient because we always have our breath, even in a completely dark room, late at night but we do not have to pay attention to our breathing to practice mindfulness. We can be focused on anything in the present moment without judgement to practice mindfulness. By “judgment” I mean assigning interpretations like “good”, “bad”, “better”, “worse”, etc. For instance I often look at a tree outside my office window. I watch how the sun hits each leaf, I look at the shades of green and grey, I watch it move in the wind. Instead of thinking “that is a beautiful tree” or “that tree should be bigger” I just notice and accept how it is in the present moment.

I direct my attention to the present moment hundreds of times a day. As the people in my life can attest (with some frustration occasionally) I do very little worrying about the future. I also try and rarely think about the past, besides considering what I can learn from it and moving on. My paying attention to the present allows me to avoid much of the anxiety and depression that is associated with worrying about the future and regretting the past.

But I need to problem-solve and plan! I can’t just be sitting around looking at trees all day! I agree, that is impractical. However, I would argue that many people do far more worrying and regretting than are truly necessary. How many times have you lay in bed and lost sleep because you were trying to worry your way out of a problem? So we problem solve and plan when we must, and we stay in the present as often as we can. This way when we do have to problem we are composed, and our thinking is productive.

Okay, so what happens when I’m paying attention to the present moment and my mind just naturally thinks about the future or the past? It takes practice to stay in the present moment for any extended amount of time but while we are training our minds we want to be compassionate with ourselves. Like training a puppy, we want to be consistent, reliable, and gentle. So when our minds wander to a place they don’t need to be, we gently guide it back to the present.

I find practicing mindfulness to be most helpful in distressing situations. For example, when talking in-front of people I find it very helpful to just take a deep breath and just for a moment notice the air filling my lungs and my ribs expanding. This relaxes me immediately. Or after a stressful experience I will take a breath and just ask myself “what is going on in my mind right now?”, “what am I feeling?”, and “where are these emotions coming from?” I find this to be much more helpful for regulating my emotions than thinking “stop getting angry”, “I shouldn’t (judgement) worry about this”, or “I’m being too dramatic (judgment).”

Worry – The illusion of action

April 28, 2016April 28, 2016 / southislandwellness / Leave a comment

What if I lose my job? If I lose my job then, I won’t be able to pay rent or afford food. Then I’ll have to move back in with my parents, or worse!- I’ll be homeless. I can’t get fired, oh please god, I need this job or I’m in real trouble. What if I do lose it though? I won’t be able to pay off my debt either, then I’ll get even more interest or I’ll damage my credit, and I’ll be in a financial hole for the rest of my life.

These thoughts may seem a little excessive to some people, but many of us have had worries like this countless times – usually when our guard is down, when we are tired, lying in bed with nothing to distract us. What is it about worry that can be so difficult to control? Researchers Rodebaugh and Heimberg suggest that worry “acts as a trick the person is playing on himself or herself to provide the illusion of action, when useful action seems impossible.” In other words, in our minds, worry resembles problem solving or planning. We convince ourselves that if we just worry enough, we will be better able to prevent “something bad” from happening or we will be better able to cope if this “something bad” does happen.

However, worry is not problem solving or planning. Worry is simply thinking about a problem or fear, it is not a productive attempt to create solutions. Worry typically leads to anxiety, which is a physical reaction priming your body to deal with threats, it is preparing you to run away and/or fight. Now in some situations this is helpful, but in the vast majority of situations in modern society, we do not need to run away or fight. Therefore, this is an inappropriate and unnecessary reaction. Sometimes the first step in overcoming worry is actually accepting that worrying is not helping us. Moreover, in many situations worrying, and the associated anxiety, is actually reducing our ability to cope with challenges. Many clients enter therapy and want to get rid of the suffering cause by anxiety without having to stop worrying, but this is an unrealistic expectation. So long as we keep our pattern of worrying, we will keep our pattern of feeling anxious.

There are several different types of anxiety. One such type is called “generalized anxiety.” People that struggle with generalized anxiety worry more than most people about everyday things, and have trouble controlling it. Generalized anxiety can keep you awake at night or make you feel sick. Sometimes people with generalized anxiety refer to themselves as “worriers.” The Cognitive Model of Generalized Anxiety Disorder, created by Dugas and Robichaud, illustrates the connection between situations, wondering “what if something bad happens?”, worry, anxiety, and demoralization/exhaustion.

So if we accept that worry is not particularly helpful for us, and we want to change this pattern of worrying, what can we do?

According to many CBT therapists, the first step in overcoming anxiety is understanding our worries. We can do this by writing down what we are worried about several times throughout the day. Then you take this list of worries and divide them into actual current problems and hypothetical “what if…?” worries.

Now you might look at this list and think “but I could get sick!” or “but my partner might leave me!” Yes, but in neither of these situations will worrying help problem solve. You might also look at these lists and think “but my worrying helps motivate me! If I quit worrying, won’t I lose my motivation??” Let me answer this question with a question – many, many, many very motivated and successful people do not worry very much, so why do you have to play by different rules? Also, we can problem solve, set goals, and plan all without worrying, don’t get sucked into the tricks worrying is trying to play on you. One huge difference between the things in the “actual problem” category is that the things on that list are current and actionable. You can choose to make something for dinner, choose to write a paper, choose to schedule a time to exercise, and choose to create a resume. The things on the “what if…?” list are uncertain because they are in the future and greatly influenced by forces beyond your control. It would be a beautiful world if we could just choose to not get sick or choose to have everyone like you.

God grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And the wisdom to know the difference.

The Serenity Prayer.

In the sections above, I suggested that worrying is not problem solving, this begs the question “what is problem solving?” In problem solving we first (a) identify the problem, (b) identify possible solutions to a problem, (c) evaluate the pros and cons of each solution, (d) select a reasonably good solution, (e) try it out, (f) evaluate how the solution worked to solve the problem, and (g) repeat this process as necessary. I strongly recommend you write these steps down for your more serious concerns, or chances are when you worry about the problem at 2 in the morning you won’t remember the plan to created yesterday to solve the problem.

The exercise of identifying which worries are actual problems that we can do something about, from those worries that are beyond our control can be a powerful tool for challenging unhelpful thinking patterns. As we become more aware of these unhelpful patterns, we can replace unhelpful thoughts with more helpful ones. When we think “I might lose my job” we can challenge this worry by thinking “yes, it is possible, however I cannot control this. Instead I’m going to focus on things I can do to decrease the probability of this happening – such as improving my performance.”

Unfortunately, there are times where there is nothing we can do to prevent a catastrophe from occurring. In those situations, we are faced with a choice – continue to worry (and suffer) or accept the uncertainty. This can be extremely difficult for some people. One way we can increase our tolerance of the uncertainty is to review the evidence that the catastrophe will take place. What is the evidence the catastrophe has taken place? What are the actual probabilities of the catastrophe occurring? Will your worrying change the probability?

As is usually the case for the topics I choose to write about, this is a huge topic that has been explored in many studies, articles, and books. However, I hope this article helps expand your understanding and will be of some help.

If anyone has any questions or comments, please e-mail!

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