In This Chapter
^ Understanding the nature of anxiety ^ Developing attitudes that help overcome anxiety Designing a programme to face your fears
I\ Nxiety is a bully. And like most bullies, the more you let it shove you Ґ \ around, the pushier it gets. This chapter helps you get to know the nature of anxiety and to identify the ways in which it pushes you about. Fundamentally, you can beat anxiety, like any bully, by standing up to it.
Acquiring Anti-Anxiety Attitudes
Your thoughts are what count, because your feelings are influenced greatly by how you think. Feeling anxious increases the chance of you experiencing anxiety-provoking thoughts (refer to Chapter 6). Anxious thoughts can increase anxious feelings, and so a vicious circle can develop. You can help yourself to face your fears by adopting the attitudes we outline in this section.
Thinking realistically about the probability of bad events
If you have any kind of anxiety problem, you probably spend a lot of time worrying about bad things that May Happen to you or your loved ones. The more you focus your attention on negative events and worry about bad things being just around the corner, the more likely you are to believe that they’ll actually happen.
Proving For sure that bad events won’t happen isn’t that easy without a crystal ball or two, but you can acknowledge that you tend to Overestimate The probability of bad things happening. Adjust your thinking appropriately to Counterbalance For this tendency. Counterbalancing your attitude is a lot like riding a bike with the handlebars offset to the left – to steer straight, you need to turn the handlebars to the right, otherwise you keep veering off to the left. If you tend to always imagine the worst, straighten out your thinking by deliberately assuming that things are going to be okay.
Avoiding extreme thinking
Telling yourself that things are ‘awful’, ‘horrible’, ‘terrible’, or ‘the end of the world’ only turns up the anxiety heat. Remind yourself that few things are really that dreadful, and instead rate events more accurately as ‘bad’, ‘unfortunate’, or ‘unpleasant but not the end of the world’.
Extreme thinking leads to extreme emotional reactions. When you mislabel a negative event as ‘horrible’, you make yourself overly anxious about unpleasant but relatively non-extreme events, such as minor public embarrassment.
Taking the fear out of fear
When people say things like ‘Don’t worry, it’s Just Anxiety’, the word ‘just’ implies – wrongly – that anxiety’s a mild experience. Anxiety can, in fact, be a very profound experience, with strong bodily and mental sensations. Some anxious people misinterpret these intense physical symptoms as dangerous or as signs of impending peril. Common misreadings include, assuming that a nauseous feeling means that you’re about to be sick, or thinking that you’re going crazy because your surroundings feel ‘unreal’.
If you have concerns about your physical sensations you may consider seeing your family doctor prior to deliberately confronting your fears. Your doctor may then be able to advise you as to whether deliberately increasing your anxiety in the short-term, in order to be free of it in the long-term, is safe
Enough for you. It is rare for people to be advised against facing their fears.
Understanding and accepting common sensations of anxiety can help you stop adding to your anxiety by misinterpreting normal sensations as dangerous. Figure 9-1 outlines some of the more common physical aspects of anxiety.
Undoubtedly, anxiety is an unpleasant, sometimes extremely disturbing experience. However, evaluating your anxiety as ‘unbearable’ or saying ‘I can’t stand it’ only turns up the emotional heat. Remind yourself that anxiety is hard to bear but not unbearable.
Attacking Anxiety
The following are some key principles for targeting and destroying anxiety.
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Winning by not fighting
Trying to control your anxiety can lead you to feeling more intensely anxious for longer (for more on this, read through Chapter 7). Many of our clients say to us: ‘It makes sense to face my fears, but what am I supposed to do while I’m feeling anxious?’
The answer is.. . nothing. Well, sort of. Accepting and tolerating your anxiety when you’re deliberately confronting your fears is usually the most effective way of making sure that your anxiety passes quickly.
If you’re convinced that your anxiety won’t diminish by itself, even when you do nothing, test it out. Pick one anxiety-provoking situation that you normally withdraw from – examples include using a lift, travelling on a busy bus, standing in a crowded room, and drinking alone in a bar. Make yourself stay in the situation and just let your anxiety do its thing. Don’t do anything to try and stop the anxiety. Just stay where you are and Do nothing Other than feel anxious. Eventually, your anxiety will begin to ebb away.
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Defeating fear With FEAR
Perhaps the most reliable way of overcoming anxiety is the following maxim: FEAR – Face Everything And Recover. Supported by numerous clinical trials, and used daily all over the world, the principle of facing up to your fears until your anxiety reduces is one of the cornerstones of CBT.
The process of deliberately confronting your fear and staying within the feared situation until your anxiety subsides is known as Exposure Or Desensiti-sation. The process of getting used to something, like cold water in a swimming pool, is called Habituation. The principle is to wait until your anxiety reduces by at least half before ending your session of exposure – usually between twenty minutes and one hour, but sometimes more.
Repeatedly confronting your fears
As Figure 9-2 shows that if you deliberately confront your fears, your anxiety becomes less severe and reduces more quickly with each exposure. The more exposures you experience, the better. When you first confront your fears, aim to repeat your exposures at least daily.
Time
Keeping your exposure challenging but not overwhelming
When confronting your fears, aim for Manageable exposure, So that you can successfully experience facing your fears and mastering them. If your exposures are overwhelming, you may end up resorting to escape, avoidance, or safety behaviours. The flipside of choosing overwhelming exposures is taking things too gently, which can make your progress slow and demoralising. Strive to strike a balance between the two extremes.
If you set yourself only easy, gentle exposures, you risk reinforcing the erroneous idea that anxiety is unbearable and must be avoided. The point of exposure work is to prove to yourself that you Can Bear the discomfort associated with anxious feelings.
Taking it step bg step
Avoid overwhelming or underchallenging yourself by using a Graded hierarchy Of feared or avoided situations. A graded hierarchy is a way of listing your fears from the mildest to the most severe.
If
You want to kill your fear, let it die of its own accord.
You can use Table 9-1 to list people, places, situations, objects, animals, sensations, or whatever triggers your fear. Be sure to include situations that you tend to avoid. Rank these triggers in rough order of difficulty. Alongside each trigger, rate your anticipated level of anxiety on the good old 0-10 scale. Voila! You have a graded hierarchy.
After you have confronted your fear, rate the Actual Level of anxiety or discomfort you experienced. Then, tailor your next exposure session accordingly. Most situations are not as bad as you expect them to be. In the unlikely event that the reality is worse than your expectations, you may need to devise more manageable exposures for the next few steps and work your way up the hierarchy more gradually.
Table 9-1 Graded Hierarchy of Anxiety
Feared or Anticipated Anxiety or Actual Anxiety or
Avoided Trigger Discomfort 0-10 Discomfort 0-10
Jumping in at the deep end
Although we caution about striking a balance between under – and overchal-lenging yourself, jumping in with both feet does have its benefits. The sooner you can face your biggest fears, the sooner you can master them. Consider whether you can climb to the top of your hierarchy straight away.
Graded exposure is a means to an end. Going straight to your worst-feared situation without resorting to safety behaviours (which we talk about in the next section) can help you get rapid results, as long as you stick with the exposure long enough to discover that nothing terrible happens.
Shedding safety behaviours
You can overcome anxiety by turning your anxiety upside-down. The best way to make your anxiety go away is to invite it to do its own thing. As we explain in a bit more detail in Chapter 7, the things you do to reduce your fear in the short-term are very often the very things that keep you feeling anxious in the long term. (Check out Chapter 7 for some common examples of safety behaviours.)
Recording your fear-fighting
Keep a record of your work against fear so you can check out your progress and make further plans. Your record can include:
I The length of your exposure session
I Ratings of your anxiety at the beginning, middle, and end of your exposure session.
A record helps you see whether you’re sticking with your programme long enough for your fear to subside. If your fear doesn’t seem to be reducing, make sure that you’re still trying hard enough to reduce your fear by getting rid of those safety behaviours.
You can use the behavioural experiment record sheet in Chapter 4 to record your exposure and to compare your predicted outcome of confronting your fears with the actual outcome.
Mdinq Common Anxieties
The following sections outline the application of CBT for some common anxiety problems. A full discussion of all of the specific types of anxiety problems lies outside of the scope of this book. However, the CBT principles that we introduce you to here are the very best bet for overcoming most anxiety problems.
First, define what you’re doing to keep your anxiety alive in your thinking (see Chapters 2 and 6), and alive in your behaviour (see Chapters 6 and 7). Then, start to catch your unhelpful thoughts and generate alternatives (Chapter 3), and test them out in reality (Chapter 4). Understanding where you focus your attention, and re-training your attention, can also be hugely helpful (see Chapter 5). We discuss anxiety about health, fears of being ugly, and obsessions in Chapter 11.
Socking it to social anxiety
Attack Social anxiety (excessive fear of negative evaluation by other people) by drawing up a list of your feared and avoided social situations and the safety behaviours you tend to carry out (check out Chapter 7 for more on safety behaviours).
Hang on to the idea that you can accept yourself even if other people don’t like you. Be more flexible about how witty, novel, and entertaining you ‘have’ to be. Systematically test out your predictions about people thinking negatively about you – how do people act when you don’t try so hard to perform? Refocus your attention on the world around you and the people you interact with, rather than on yourself. For more help on retraining your attention, refer to Chapter 5. Once you’ve left the social situation, resist the tendency to play your social encounters back in your mind.
Waging War on Worry
To wage war on your excessive worry, resist the temptation to try to solve every problem in advance of it happening. Try to live with doubt and realise that the most important thing is not what you specifically worry about but How You manage your worrying thoughts. Overcoming worry is the art of allowing thoughts to enter your mind without trying to ‘sort them out’ or push them away.
Pounding on panic
Panic attacks are intense bursts of anxiety in the absence of real danger, and can often seem to come out the blue. Panic attacks often have very strong physical sensations such as nausea, heart palpitations, a feeling of shortness of breath, choking, dizziness, and hot sweats. Panic sets in when people mistake these physical sensations as dangerous and get into a vicious circle because these misinterpretations lead to more anxiety, leading to more physical sensations.
Put panic out of your life by deliberately triggering off panic sensations. Enter situations you’ve been avoiding and resist using safety behaviours. Realise, for example, that feeling dizzy does not cause you to collapse, so you don’t need to sit down, and that other uncomfortable sensations of anxiety will pass without harming you. Carry out a behavioural experiment (see Chapter 4) to specifically test out whether your own feared catastrophes come true as a consequence of a panic attack.
Assaulting agoraphobia
Being afraid to travel far from home, or to venture away from safe or familiar places are common characteristics of Agoraphobia.
To gain confidence and overcome agoraphobia, develop a hierarchy of your avoided situations and begin to face them, and stay in them until your anxiety reduces. This may include driving progressively longer distances alone, using public transport, and walking around in unfamiliar places. At the same time, work hard to drop your safety behaviours so you can discover that nothing terrible happens if you do become anxious or panicky, and ride it out.
Beating With posttraumatic stress disorder
Post-traumatic stress disorder (PTSD) can develop after being involved in (or witnessing) an accident, assault, or other extremely threatening or distressing event. The symptoms of PTSD include being easily startled, feeling irritable and anxious, memories of the event intruding into your waking day, nightmares about the event, or feeling emotionally numb. If you have PTSD you may be sustaining your distress by misunderstanding your normal feelings of distress in response to the event, trying to avoid triggers that activate memories of the event, or trying too hard to keep yourself safe.
To combat PTSD, remind yourself that memories of a traumatic event intruding into your mind, and feelings of distress are normal reactions to trauma. Allowing memories to enter your mind and spending time thinking about them is part of processing traumatic events, and a crucial part of recovery. Many people find that deliberately confronting triggers or writing out a detailed first person account can be helpful. At the same time it’s important to reduce any excessive safety precautions you may have begun to take.
Hitting back at fear of heights
Begin to attack a fear of heights by carrying out a survey among your friends about the kinds of feelings that they have when standing at the edge of a cliff
Or at the top of a tall building (see Chapter 4 for more on conducting surveys). You’ll probably discover that your sensation of being unwillingly drawn over the edge is very common. Most people, however, just interpret this feeling as a normal reaction.
Put this new understanding into action to gain more confidence about being in high places. Work through a hierarchy of entering increasingly tall buildings, looking over bridges, and climbing to the top of high cliffs.
Fascinating phobias
One of the interesting things about anxiety problems is the wide variety of things that human beings fear. In our practise, we still encounter people with fears we’ve never heard of before. Crucially, what matters is notwhatyou’re afraid of but how negatively your fear is affecting your life.
Sometimes people are embarrassed by their phobias because they think others may find them silly or trivial. But extreme fear is never trivial – terror and fear can be very disabling, even if your fear is of something as simple as buttons. We suggest you seek out health professionals who take you seriously so you can get help foryour phobia.
Common phobias include:
Acrophobia: Fear of heights or high levels
Agoraphobia: Fear of open spaces, crowded public places, or being away from a place of safety
Aichmophobia: Fear of pins, needles, and pointed objects
Arachnophobia: Fear of spiders
Claustrophobia: Fear of confined or small spaces
Emetophobia: Fear of vomiting
Haemophobia: Fear of blood and blood injury
Lockiophobia: Fear of childbirth
Noctiphobia: Fear of the night and the dark
Trypanophobia: Fear of injections
Less common phobias include:
Arachibutyrophobia. Fear of peanut butter sticking to the roof of one’s mouth
Automatonophobia; Fear of ventriloquists’ dummies, dolls, animatronic creatures, or wax statues
Barophobia;fear of gravity
Bibliophobia; Fear of books (if you’ve got this one, stick with us-you’re doing well!)
Blennophobia.fear of slime
Lutraphobia.fear of otters
Lyssophobia;fear of going insane
Necrophobia;fear of death or dead things
Ombrophobia;fear of rain or being rained on
Soceraphobia;fear of parents-in-law