Read Free Yourself from Anxiety Online
Authors: Emma Fletcher
Making changes to your lifestyle is only the beginning of your recovery from Anxiety – for some people there will be a huge impact on their Anxiety, although for others there will be very little difference. The only way to find out is to try – and in any case you will benefit from having a healthier lifestyle.
In this section we are going to move on to the next stage of constructing your recovery programme. Keep working on the lifestyle changes as you read through the next few chapters. Start by answering these questions.
1. Do you feel tense or worried all or most of the time? YES/NO
2. Do you have panic attacks? YES/NO
3. Are you afraid to go far from home? Or travel on public transport? YES/NO
4. Do you feel embarrassed in company, dread being the centre of attention, or dislike going to pubs or restaurants? Do you worry about blushing or trembling when speaking to people? YES/NO
5. Do you feel giddy when standing on the edge of a cliff? Or stifled in confined spaces like lifts or tunnels? YES/NO
6. Do you break out in a sweat at the thought of coming in contact with a spider? A mouse? Flying insects? A cat or a dog? Any other creature? YES/NO
7. Does the sight or thought of blood make you feel faint? Do you avoid
the dentist, or dread the thought of an injection? YES/NO
8. Do you feel compelled to wash yourself or your clothes, or clean your house, many times over? Do you have to check again and again that taps or lights are switched off, or doors locked? YES/NO
Look at the questions you answered with a yes. These will help you understand the nature of your Anxiety.
Yes to questions 1 and/or 2 are signs of Generalised Anxiety.
Yes to any of questions 3–7 indicates different types of phobia.
Yes to question 8 refers to OCD.
It is possible to have a combination of these. If your specific difficulty isn’t mentioned, don’t worry. The techniques we describe will still work for you.
We’ve already said that Anxiety affects every aspect of your being. Here is a brief overview:
•
Physical:
whether or not you suffer from panic attacks, the effects of Anxiety always have a physical element. You may feel weak, faint or dizzy from shallow breathing. You may have headaches, neck, shoulder or back pain from muscle tension. Your digestion may be affected, with loss of appetite, dry mouth, nausea, swallowing difficulty. Bowels and bladder may be affected. Almost any part of your body can be affected by Anxiety.
•
Emotional:
as well as the dominant emotion of fear you may also feel shame and lack of self-worth. You may also have underlying emotions, such as anger or grief, that you are not able to express openly.
•
Thinking:
your thoughts may race, be anxious or obsessive. You may be constantly saying negative things to yourself.
•
Behaviour:
you may avoid certain places or situations, or you may have to complete compulsive rituals
•
Whole self:
you may have poor self-esteem, fuelled by underlying beliefs about yourself. You may blame yourself for developing Anxiety.
•
Spiritual:
you may be dissatisfied with life, or feel that life has no meaning.
Now examine each aspect of your life and decide how Anxiety affects it – use your notebook and work through each of the headings on the previous page. Here is an example from someone with severe agoraphobia:
P
hysical:
sick and shaky, lightheaded.
Emotional:
fear, even at the thought of going out, embarrassed when I have to tell people.
Thinking:
supposing I do go out, and I collapse in public.
Behaviour:
avoid going out, even to the dustbin.
Whole self:
feel like giving up.
Spiritual:
hate my life.
And another example from someone with OCD:
Physical:
feel better doing rituals, apart from knot in stomach.
Emotional:
fear, and ashamed of need to keep cleaning toilet.
Thinking:
if I don’t clean it’ll be my fault if someone gets ill.
Behaviour:
clean everything every day and clean toilet at least 10 times, more on bad days.
Whole self:
hate myself.
Spiritual:
I know that I’m responsible.
Understanding the detail of your particular Anxiety problem will help you focus on the changes you can make. As you change some things, you’ll find that others change without you making a conscious effort. The lifestyle changes in section one were aimed at reducing some of the physical effects of Anxiety. This section will concentrate on your behaviour – the things that you do because of your Anxiety.
‘I suppose you could say I’m a checker.’
A
NDREW
‘I thought if I stood up I would fall over and pass out. I phoned my partner and said I was feeling very strange but I didn’t want to tell my mother I was ill.’
B
RIDGET
‘When my anxiety was very bad I didn’t go outside my home at all, in fact I was confined to the bedroom, and to one side of the bed where I felt safe. Even going to the bathroom was difficult.’
J
ULIE
‘I could not go out and even panicked when hanging the washing on the line. I was unsteady on my legs and would often feel as if I was going to fall through the ground. Turning my head or getting up from a sitting position made me dizzy and I would have to grab the nearest object to hang on to.’
M
ARGARET
‘Wash those hands, check that light.
Where’s the energy to win the fight?
Switch the light off, now put it back on.
This O.C.D. has once again won.
Oh no! My hands are dirty again.
It’s back to the sink and count up to Ten.’
N
ORMAN
‘I used to avoid everything.’
P
EN
‘At first I just used to avoid school assembly, then it was the pictures, and towards the end I wouldn’t even go out in the back garden and put washing out.’
W
ENDY
There’s no doubt that Anxiety does affect behaviour, although the details will be different for each person. Here are some of the most common Anxiety behaviours.
The urge to get out, get away, escape from the situation where the Anxiety or panic strikes can be overwhelming. It’s part of the fight-
or-flight
mechanism which fills you full of physical energy and makes you want to
do
something. When you do leave, you find that you start to feel better quite quickly, so you’ll tend to think that escaping makes Anxiety go away. Next time you’ll feel even more keen to escape, and soon a pattern is established.
It’s important to understand that escaping does not make Anxiety go away. The adrenalin surge of fight-or-flight always dies down, even if you stay put.
This usually follows on from escape. If getting out of a certain situation appears to make Anxiety go away, then it seems logical to avoid going into the situation in the first place. The problem with this is that pretty soon you’ve got a whole list of things that you can’t do, life becomes a misery and you still suffer from Anxiety.
As well as avoiding places or situations you might also choose to avoid opening the paper or turning on the TV or radio in case there is an item
about your phobic subject. You might avoid eye contact in social situations, or avoid using the phone or talking to people.
Avoidance is the main factor that keeps Anxiety going for agoraphobics, social phobics and people with panic attacks and single phobias. However it can also be an important factor for someone with OCD. If you know that using a public lavatory sets off a need to do rituals, then clearly you’ll want to avoid public lavatories. This is also why someone with, say, a cleaning ritual might well end up doing no cleaning at all – better not to start in the first place.
The problem with avoidance is that it means you never test out your belief that you will be anxious if you enter the situation or engage with the behaviour.
The physical symptoms of Anxiety can make you feel as if you are physically ill, in fact many people find it hard to believe that their problem is mental rather than physical. You can find yourself doing less and less because you feel so weak, tired and shaky. If you think that your panic attack is actually a heart attack, or that panic will damage your heart, you will retreat to the armchair and behave like an invalid. This is a vicious circle, because the less you do the worse you’ll feel, physically, and the less you’ll feel able to trust that your body will see you through the panic.
Nearly everyone with Anxiety has something they do that they believe keeps them safe. Someone with OCD with rituals, whether physical or mental, is doing that pretty well all the time. The trouble is the effect tends to wear off so that as time goes by you need to keep increasing the number or complexity of rituals to achieve the same feeling of safety.
People with other forms of Anxiety also have safety behaviours – always sitting by the door, always carrying your mobile phone, carrying spare
tranquillisers just in case, are good examples. Again these tend to increase with time.
There are two big problems with all of these behaviours.
1. As we’ve seen already, they tend to get worse with time, so that life becomes more and more restricted.
2. You believe that the behaviours are holding Anxiety in check, but in fact you never get to test that out.
Changing your behaviours will help you halt the increase and prove to yourself that Anxiety does go down in the end whatever you do. All of the behaviours have the same flaw, that is, they provide short-term relief but overall Anxiety increases.
The aim is to change your behaviour very gradually, in small manageable steps.
Make a list of your Anxiety behaviours. Follow the four headings, and add anything that you know you do even if it doesn’t seem to fit any of the headings.
ESCAPE
AVOIDANCE
DOING LESS
SAFETY BEHAVIOURS
OTHERS
‘The only situations I’ve ever really avoided are medical things.’
A
NDREA
‘Checking light switches/power sockets are off, doors are closed and locked, etc.’
A
NDREW
‘It was like I was almost out of my body. I kept thinking “I’m going to die on the number 16 bus”. I phoned my mother who said “don’t worry about me, get yourself to a doctor.”’
B
RIDGET
We had planned to be there early enough to strategically choose our seats, so that we (or rather I!) could easily “escape”, should there be any need. At the time it sounded like a great idea but it meant a long unnerving wait before the start of the show.’
J
ULIE
‘… often I had “jelly legs”. If at all possible I preferred to tread on uneven ground because this made me concentrate on where I was putting my feet. Open areas of floor tiles, like you see in shopping malls, made me uneasy.’
M
ARGARET
But what if I need to use the loo?
That would really put me in a stew.
To touch the flush handle would be foul
As I cover my hands with a thick clean towel.
But it has to be a particular one.
This isn’t pleasant, it isn’t fun.
N
ORMAN
‘Anything that upset me emotionally, even good things, brought on a panic attack.’
P
EN
You are beginning to have a clearer understanding of how your Anxiety problem affects your life. Perhaps you are realising that things aren’t as bad as you thought, or perhaps you’ve had to face up to the full extent of your illness. This is painful but important – anything that you keep in the shadows of your mind is likely to turn into a bogeyman, scaring you because you don’t understand it.
Now it’s time to look at exactly what you want to achieve. You may say impatiently ‘I just want to be alright’ or ‘I just want to be my old self again’ but you need to be more specific than that.
No one is ever entirely anxiety free. Not only does everyday life produce anxiety (Will I find a parking space? Have I got time to dash into the bank?) but there is always the possibility of an unexpected difficulty (How am I going to cope with redundancy? How can I deal with my partner’s anger?).
Anxiety is an essential part of life. It tells you when to be careful, and on the other side of the coin is your ability to feel excited about doing something new or challenging, such as starting a new job, or falling in love. You need both of those abilities.
The real problem is that your normal anxiety has mutated into an Anxiety condition, and it has taken control of your life. Wouldn’t you like to wrest that control out of Anxiety’s hands? Wouldn’t you like to be in control again?
Remember the title of this book –
Free Yourself from Anxiety
. You have the power to do it, and you are the only one who can. However severely restricted you are, starting from where you are now, you can make improvements in your situation.
At first you may feel you aren’t making any progress – but at least you will be preventing Anxiety from adding any more layers. And if you persevere, you will start to improve, however slowly. Finally, you will have learnt a set of lifetime skills that will keep you well, as long as you remember to use them.
Let’s look more closely at those impatient responses. Many people when they come for help will say:
•
I want to get better
•
I just want to be alright
•
I just want to be my old self again
•
I want to live a normal life
•
I just want to be happy.
This is all perfectly understandable, but recovery doesn’t come from aiming at this sort of goal. Remember, goals have to be SMART.
•
I want to get better
– this is too vague. Your goal must be Specific.
•
I just want to be alright
– can you define ‘alright’? ‘Alright’ isn’t Measurable.
•
I just want to be my old self again
– this is not Achievable, because every experience changes you, and so you will always be a different person from the one who fell into the black hole of Anxiety.
•
I want to live a normal life
– is this truly Relevant? Wouldn’t it be better to live the life that’s right for you?
•
I just want to be happy
– achieving happiness isn’t Timeable. It can happen in an instant, or it can take years.
Instead you need to look for concrete, specific goals such as:
•
I want to get back towork
•
I want to have a relationship
•
I want to travel abroad
•
I want to go back to college.
Use your notebook to write down specific long-term goals for you. Don’t let yourself become upset at the thought of how far off they seem. Instead, use the goals as your motivator. One day you will achieve them.
Next, take one of your long-term goals and break it down further, looking at what is stopping you from achieving it right now. For instance, if your goal is to get back to work you might be stopped by:
•
fear of having a panic attack at work
•
fear of being with other people
•
fears relating to the journey
•
fear of a dirty environment
•
fear of not having enough stamina to get through the day
•
fear of being seen doing a ritual.
Your goals will be aimed at removing these fears from your mental agenda. They will be different for each person, because although there are broad categories of Anxiety disorder there are always differences of detail from person to person.
We aim to show you how to achieve your goals using techniques based on Cognitive Behaviour Therapy (CBT). ‘Cognitive’ means ‘relating to thoughts’ – when you filled in the ‘thinking’ section in Chapter 17 you were describing your cognitive approach. ‘Behaviour’ means just that – how you behave.
The therapy aims to help you make changes to both your thoughts and your behaviours so that you can gradually release the grip that Anxiety has on you.
We are going to start with behaviour and move on to thinking in Part Three. This is because most people find it easier to change their behaviour, at first. Sometimes just changing behaviour is all a person needs to do, but most people find that they can get so far with it and then they come to a brick wall – that is when they need to move on to changing their thoughts.
You might say, why not go straight to changing thoughts then? The answer is that behaviour does have to be changed, and starting with thoughts is too challenging for most people. It’s better to make some changes to your behaviour and enjoy the feelings of triumph that successes bring. This will help you to feel confident and motivated to work on your thoughts.
‘Keeping a diary was a great idea, because I felt obliged to tell the truth in it, and the only way I could record improvements in the diary was by doing the work and making the improvements.’
A
NDREW
‘… anxiety is not something that can be turned off like water from a tap.’
M
ARGARET
‘My advice on recovery is to take it one step at a time and don’t rush it. Start from wherever you’re at and take the first step.’
W
ENDY