A quick way to tell if you’re anxious:
| Please read each statement and choose a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement. |
| The rating scale is as follows:
0 Did not apply to me at all |
| I was aware of dryness of my mouth | 0 1 2 3 |
| I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion) |
0 1 2 3 |
| I experienced trembling (eg, in the hands) | 0 1 2 3 |
| I was worried about situations in which I might panic and make a fool of myself |
0 1 2 3 |
| I felt I was close to panic | 0 1 2 3 |
| I was aware of the action of my heart in the absence of physical exertion (e.g, sense of heart rate increase, heart missing a beat) |
0 1 2 3 |
| I felt scared without any good reason | 0 1 2 3 |
(From the DASS 21 Scale)
Score: add up your scores and multiply by 2
under 5 = no anxiety
5-7 mild anxiety
8-13 moderate anxiety
15-20 severe anxiety
21 + extremely severe anxiety
Anxiety
Anxiety is what we experience when the ‘fight or flight’ hormone adrenaline gets triggered in our brains and bodies.
Usually, this reaction would be saved for actual danger, such as being attacked by a wild animal….but our brains are good at learning and will often label something previously un-scarey as terrifying.
A main part of our brain that learns what to be afraid of is called the limbic system. This is a walnut-sized mini-computer in the middle of the brain, specializing in many things including threat perception. For whatever reason, once it has labeled something scarey, that’s it. Fight or flight will happen when we think of or encounter that thing.
Once the mid brain signals the release of adrenaline, this powerful hormone affects our bodies and minds in many ways. It causes heart rate to speed up and breathing to become faster and shallower. Sweating begins and blood flows away from the digestive system towards the muscles, preparing us to attack or run away and perhaps making us feel sick. We may find it difficult to swallow or speak. To top it all, if we don’t use those hyped-up muscles, we may get the shakes in our hands or limbs. So it is a very physical experience.
At the same time, our ‘thinking mind’, the cortex or grey matter, joins in by noticing all these physical and mental changes, and drawing catastrophic conclusions. ‘I’m going mad’ ‘I’m having a heart attack’ ‘I’m going to collapse or faint’ ‘people will notice and think I’m weird’.
These thoughts, of course, are scarey in themselves and often set off a whole new cycle of threat – perception and adrenaline rushes.
Most anxiety thoughts go along the lines of ‘what if?’
What if I mess up the interview?
What if a car hits me?
What if I lose my job?
What if my loved one leaves me?
What if my kids are in an accident?
What if I panic in the supermarket?
What if I have cancer?
What if people notice what an idiot I am?
These thoughts are natural and understandable, often based on real past experiences or on stuff learned from our parents or the media. They lead to conscious or unconscious efforts to avoid whatever disaster our minds are predicting. For example, never going out socially without drinking alcohol first to ‘relax’, or planning one’s escape from a crowded room. Avoidance leads to relief, which leads to more avoidance, which finally leads to a life shrunk to a little dot with no pleasure or joy in it.
Panic Attacks
Panic attacks are a very common problem, though many of us feel embarrassed to talk about them. They are often kept going by thoughts like ‘what if I have a panic attack?’ and avoidance of places/situations where we have learned they may happen. They are such a physical and frightening experience that many people think they are physically ill and may have had several visits to hospital for heart checks and the like.
Treatment for panic attacks includes sharing information about them, such as you are not going to die or come to harm and you are very unlikely to faint. Understanding the physicality of the fight/flight response also helps.
Then we will learn some simple ways to regulate breathing and heart rate and gently embark on a program of widening up your life to include avoided situations and places, as well as working on the thoughts and feelings that are keeping the whole cycle going.
Worry
If panic attacks are acute attacks of anxiety, worry could be said to be the chronic grind of every day anxiety. If severe it can be called ‘generalised anxiety disorder (GAD)’.
Worry has been called the ‘wrong approach to problem solving at the wrong time’. For example, lying awake at 3am trying to come up with a solution to ‘what will I do if I lose my job?’ never works.
Seemingly constant thoughts of potential disasters, especially if there is some real possibility of them coming true, and our attempts to problem-solve these, lead to physical and mental exhaustion. Attention is taken away from the joys of life and loved ones towards internal endless dialogues of what if..what if…
Worry is treated by first understanding what is going on and probably learning to observe thoughts using thought diaries. Then we might work on the thoughts themselves, reviewing how realistic they are, or using mindfulness to train our brains to observe thoughts without being overwhelmed by them. More effective problem solving strategies and schedules will be learned, to replace the ineffective ones. Lastly, avoidance of worried-about situations will be reduced.
Phobias
Worry is about general anxiety, phobias are where it’s focused on a specific object. For example spider phobia is pretty common, fear of dogs, of heights, of enclosed or open spaces, of crowds, of almost any thing or person in the world.
In phobias, anxiety gets focused on one ‘threatening’ thing the brain has decided is intolerably frightening. Avoiding this thing can become the focus of life to such an extent that all the rewards and challenges of a life worth living are lost in the midst of a fog of fear.
Phobias are treated by first getting an understanding of how they work and what keeps them going. Together with your therapist you will observe and review your thoughts and feeling about the feared object and gradually begin to include it in your life. In the course of creating a valued and active life you will increase your willingness to experience fear along with new skills to manage and reduce it.
OCD (obsessional compulsive disorder)
OCD involves feeling compelled to carry out routines or rituals in order to reduce anxiety. Often it involves cleanliness and people feel obliged to wash their hands extensively after visiting the toilet, or to shower excessively. Or there may be anxiety about electrical appliances and a need to check switches are off repeatedly. Some people worry about security and need to check alarms and door and window locks repeatedly. Others may count in their heads or have special ways of walking along the street without stepping on cracks. When these compulsions become out of hand and threaten to take over our lives and those of our loved ones, its time to get treatment.
It may seem strange, but rituals and checking are themselves a sort of avoidance. They offer instant reassurance and relief ‘I feel better now I’ve washed my hands 50 times’ but long term they prevent us learning that we can manage without them. Also, they grow like topsy…whereas one or two checks on the door lock might have done in the past, now I might need ten.
Treatment involves understanding how OCD works in general and how your own personal OCD is kept going. Then learning new skills to help you focus your mind and energy on what really matters in your life and also to manage anxiety provoking thoughts and situations without the need for rituals and checking. Gently your therapist will guide you towards a more balanced approach to life’s challenges while you work hard on your between-session tasks.
Social Anxiety
In social anxiety we tend to see ourselves through the eyes of others…or at least, how we believe others see us! And we believe they see the worst in us, most of the time…or we worry that they might. So we ‘mind read’ other people with whom we are interacting. Instead of focusing on what they are talking about, our brains send us thoughts like ‘she’ll realize I know nothing about anything soon…what a boring person I am’. Even before we go into social situations our minds will be anticipating dreadfully embarrassing possibilities, where we clam up or people laugh at us.
These are very terrifying thoughts and images and understandably lead to attempts to avoid them. We may to and fro about going to that party or date and finally decide not to, missing out on the fun and maybe letting others down. Or we may drink or take drugs to give ourselves ‘Dutch courage’. Or we might prepare long impressive speeches to impress others.
Treatment of social anxiety involves understanding how it works in general and how it works for you in particular. You’ll identify with your therapist how you would like life to be and take steps towards your goals. You might explore your own self image and you’ll probably train your brain’s ‘mindfulness muscle’ to enable you to point the spotlight of your attention where you need it to be (on the other person not yourself).
Our book will show you how to help yourself to Get Your Life Back. It takes you step by step, starting with identifying the problem. Then it helps you understand why you have the problem. You will learn mindfulness skills to begin training your brain. Then get clear about your values: what you really want in your life. Another chapter helps you understand how your problem works for you. Once you’ve done this there is a chapter showing you how to break the links in the chain of your problem behaviour. You can also contact us to work with a therapist skilled in this area by Skype, FaceTime etc., on the phone or face to face.