by Jill Weber
Decrease need for reassurance from partner Learn to tolerate fears of abandonment: positive self-talk, breathing exercises; seek reassurance but decrease it by 25 percent (three times a day instead of four, decrease from there)
Decrease overthinking spiral/rumination Build awareness for rumination by breathing and being mindful; talk to people when upset instead of dealing with the difficulty only in your head, on your own
Be present and participate in life No drug or alcohol use; build awareness of when you’re spacing out or daydreaming; ask questions; be an active listener
STRATEGY: IDENTIFY TARGETS
Based on your goals, identify three or four target behaviors you would like to change because they get in the way of your larger goals.
Rate how hard it will be to work on each of these behaviors. Use a 1 to 10 scale, 1 being not hard at all, and 10 being nearly impossible.
Rate how motivated you are to work on each of these behaviors. Use the same scale.
Start with a behavior that’s not going to be too difficult to eliminate but which is causing enough trouble to motivate you to work on it. So, using the 1 to 10 scale, consider behaviors in the 4 to 6 range for difficulty and at or above 5 on the motivation range. Once you make progress on one target behavior, momentum will develop, and you can work on other items as you wish.
The Great Escape
When we avoid, we work behind the scenes to dodge what we dread. We’re planning ahead to totally eliminate contact with the trigger. Escape is different; it manifests when we experience an acute anxiety surge in the moment we contact the trigger. We then do whatever we have to in order to get away from it. Imagine what you’d do if you touched an appliance and got a sudden electric shock—you’d jerk your hand away immediately. You didn’t manage to avoid the shock but you did escape it, and minimize your contact with the unpleasant feeling.
For example, if you have a phobia of crowded spaces, you may be perfectly fine most of the time living in a bubble that keeps you in your open-space comfort zone. But terror can take over if for whatever reason you miscalculate and suddenly find yourself in a crowded corner at a museum reception. Your heartbeat jumps. Your face flushes. You shake and jitter. You may even think you’re going to pass out or have a heart attack. Similar to a fire alarm sounding, these panic symptoms cause you to immediately make some excuse and flee.
As we’ve seen, an adaptive survival response in a true emergency can, for the person with chronic anxiety, become a self-defeating pattern of avoiding uncomfortable but nonthreatening situations. When that happens, a person may find themselves in total escape mode for situations that are actually benign—shopping malls, movie theaters, driving, parties, family events, work meetings, doctor’s appointments, just to name a few. Giving in to panic and fear through escape means no new learning can occur because you never get a chance to discover if what you fear will actually happen.
STRATEGY: REIN IN FIGHT-OR-FLIGHT
If a lion is attacking, jump off a high wall, run toward oncoming traffic, crash through a sliding glass door—do whatever you must to survive. But only rarely do most of us encounter truly life-threatening situations. In those other circumstances, the ones that feel scary but pose no real threat, you’ll get the best outcomes if you rein in your fight-or-flight response long enough for your “upstairs brain” to kick in, so you can make an accurate risk assessment. Here are three quick and easy strategies for decreasing the physical agitation and arousal—shortness of breath, increased heart rate, sweating, shaking—that accompany panic and anxiety:
1.Take slow, deep breaths, feeling your chest rising fully. Each time you exhale, make the exhalation a little longer than the one before.
2.If you’re too keyed up to breathe freely, count your breaths. Counting helps distract your brain from anxious thoughts. Count 1 when you inhale, 2 when you exhale, and so forth up to 20. Then start again with 1. Repeat this a few times; the arousal will start to decrease.
3.If breathing doesn’t work, place your hand on your heart. Notice the speed. See if you can slow it down with your breathing. Put all your attention into observing the beat . . . beat . . . beat . . . of your heart.
STRATEGY: DO WHAT YOU FEAR (a.k.a. EXPOSURE)
We reinforce escape behavior by never staying in the feared situation long enough to see if our anxious expectations are accurate. The only way to test your fears is to put yourself in the situation(s) that ordinarily make you want to bolt, and see if your expectations are realistic. Initially this is going to bring discomfort, but in the long run, it will lead to less anxiety and less escape behavior.
1.Get out your notebook and write down situations that typically trigger an urge to escape.
Example: Driving
2.Next to each situation write what you believe would happen if you stayed in the situation and did not escape.
Example: “If I keep driving when I have heart palpitations and shortness of breath, I’ll freak out and crash the car.”
3.Rate how likely you believe each of your listed expectations is to happen on a 1 to 10 scale (1 being not at all and 10 being extremely likely).
4.Now pick a situation from your list that is moderately difficult, not painfully difficult, but challenging enough that you feel the burn. You’re going to intentionally put yourself into this situation to see that you can cope better than you imagine.
5.Start with sticking in the situation for a short time and gradually build up from there. Remember to breathe (use the “Rein In Fight-or-Flight” strategy) during this exercise. You can and will come out on the other side of this fear.
6.Write down your goal. (We’ll use the previous example.) Now go and drive the car. Continue driving for 15 minutes after panic symptoms (rapid heartbeat, shallow breathing, feeling shaky) are triggered. Use purposeful breathing to slow down your breathing and heart rate so the “upstairs brain” can tune in and see that you’re actually safe.
7.After you have stuck it out, ask yourself the following:
•Did your expectation happen? (“No.”)
•What is the evidence that it happened or didn’t happen? (“I felt my heart beat fast and I had shortness of breath but continued to drive for 15 minutes,” or “I did not crash the car.”)
•What did you learn from this experience? (“I can feel anxious in my body and still drive safely.”)
Go Deeper
What Would Happen If?
This short writing exercise is a way to shift your focus away from your fear to the positive feelings and strong sense of self that will come as you rely less on escape and more on moving forward in spite of your anxiety or panic.
Write two stories in your notebook:
1.The story of what you expect would happen if you intentionally exposed yourself to something you’ve been escaping. Call to mind your worst-case scenario—all the difficult thoughts, feelings, or behaviors you imagine would happen if you stuck with something that instinctively you want to move away from. Perhaps you believe you would die, have to leave in an ambulance, lose your mind, throw up, humiliate yourself . . . whatever it is, write it down. Be as specific as possible.
2.The second story is your best-case scenario of what could occur if you didn’t use escape to manage your panic. In this story, you effectively cope and manage whatever thoughts, feelings, or behaviors arise. Despite your discomfort you stay. If you pushed through discomfort, what would be the result? How would you feel about yourself then? Imagine feeling good, strong, capable, even proud.
Uncertainty Intolerance
Remember the Magic 8-Ball from childhood? Ask the ball any question you wish, shake it up, and poof! A triangle floating in water delivers an unequivocal answer. If the Magic 8-Ball really worked, we probably wouldn’t have anxiety disorders; because it would always tell us what was coming next, we’d never have to experience uncertainty.
Research shows that people who struggle with chronic anxiety and worry have great difficulty dealing with unc
ertainty—that is, situations with unknown outcomes. Overthinking—about past events or possible future outcomes—is a way to bridge the uncertainty gap. When we don’t know what’s going to happen, our brain gets busy generating a bunch of hypothetical outcomes to make us feel like we know more than we do. Take the person going to the doctor for their yearly blood work. Before the tests, during the appointment, and up until they receive the results, they imagine and replay the possible negative results. They even consider various treatment plans for potential diagnoses and diseases.
The problem with this kind of worry and rumination is that anxious minds aren’t very rational, and tend to generate possible worst-case outcomes that aren’t very likely. So, while worrying about bad outcomes may feel soothing in the short term, it’s actually making you more and more anxious over time.
This happens because when we can’t tolerate uncertainty, we take on more responsibility than is reasonable for a given situation. A kind of superstitious thinking creeps in, telling us that the “work” of worry is somehow keeping us safe from the hypothetical bad things happening. Whether we think about the blood work results every hour of every day or not, the results will be what they are. Curiously, when the results come back indicating all is normal, there is a self-defeating and irrational tendency to believe that all the worrying made the difference. And then the next time uncertainty creeps in, we will be encouraged to worry again to bridge our knowledge gap.
It’s as if we are saying, “If I don’t worry about this, then it’s my fault when the bad stuff happens.” Despite the weight of this pressure, we persevere in our worrying, thinking it will get us somewhere when in reality it’s only increasing our anxious state of mind. So we check our email again and again to ensure we haven’t missed anything. We triple-check that the stove burners are off, or that the doors are locked every time we leave the house. We seek reassurance, asking ourselves and the people around us, “Are you sure you still love me?” “Have I done everything I can?” “Will my child be safe?” “Do they think poorly of me?” “Will I ever find a partner?” “Am I healthy?” “Am I normal?” “Is everything okay??”
Living that way is exhausting, and over time it diminishes quality of life. The idea that we have to worry or remain hypervigilant so bad things won’t happen to us is an illusion. Bad things, including suffering and sorrow, are sadly part of life. It’s not your job to become certain of the uncertain. The only real control we have is to accept reasonable uncertainty so anxiety doesn’t rob us of joy, or of the pleasure of being fully present in this life now.
STRATEGY: MEETING NEW PEOPLE
Before entering a social situation, we can never know with 100 percent accuracy what will happen, how we will feel, or what others may think about us, which is why social situations often involve a lot of uncertainty anxiety. We can get so caught up in fears over possible judgments/criticisms/slights that we become paralyzed at the prospect of hanging out with people.
The more assertive you are, the less likely you are to fear social interaction. This is because when you exchange eye contact, speak out, put down boundaries, share your opinions, people see you and respect you. And, too, speaking up is a way to clear up misconceptions and miscommunications (both of which are inevitable in the social world) so the same distressing social dynamics don’t continue to play out for you over and over again.
List in your notebook what your fears are before entering a specific social situation, and next to each fear write out how you could respond and appropriately handle the situation should it occur.
•What rejections could occur?
Example: “People won’t talk to me at all,” or “People will look away and it will feel like I’m not even there.”
Response: “I’ll volunteer to help the host,” or “I’ll make the plan and initiate the event, so I’ll be an integral factor.”
•What criticisms could occur?
Example: “If I talk about my job, people will think it’s boring and that I’m uninteresting.”
Response: “I’ll talk a bit about my job but will highlight the positive, smile, and maybe even joke about it,” or “I’ll vary my conversation to include my job but also my family or a movie I’ve seen.”
•What things matter to you that cannot be predicted in your social interactions that keeps you avoiding?
Example: “I want to feel like people like me, but I fear they’ll avoid me or won’t pay any attention to me.”
Response: “I’ll make a point to engage people. I’ll ask questions, make eye contact, and make them feel I’m interested in what they say so they’ll enjoy talking to me.”
If possible, role-play with a friend or therapist where they act the part of the critical other and you act the part of being assertive and defending yourself. Or stand in front of a mirror and literally act out the two sides. Get used to hearing yourself clarify thoughts or statements without being defensive. A good formula for this is starting with something validating followed by a clarifying statement: “I understand what you mean, but actually I don’t see it quite the same way as you do.”
After practicing assertiveness, get out in the world and talk to people. You can tolerate the uncertainty of not knowing what people are thinking and still enjoy the social experiences.
STRATEGY: BUILDING UNCERTAINTY TOLERANCE
Learning to tolerate uncertainty, and seeing that it’s possible to live with it, is actually much easier in the long run than overthinking possibilities and imagining terrifying outcomes.
Here are four steps toward increasing your tolerance for uncertainty:
1.Instead of avoiding uncertainty, seek it out.
2.When uncertainty presents itself, courageously welcome it with open arms: “I see you, uncertainty, and I can and I will continue to live fully while you’re by my side.”
3.Reduce behaviors that reinforce your belief that you can’t handle uncertainty. If you compulsively check things, check every few days instead of every day, or every five hours instead of every hour. If you constantly seek reassurance, see if you can self-soothe through positive self-talk, journaling, exercise, deep breathing, before you ask for another dose of reassurance. If you’re ruminating about a what-if scenario, internally label it “can’t be certain of the uncertain.”
4.While strengthening the muscles that will let you manage uncertainty, pay close attention to the parts of your life where you do have control. For example, being present and attentive to children is one way we can impact their future happiness. Exercising and eating well helps with health and feeling good. Building communication skills and positive experiences together helps a range of relationships stand the test of time. You may not be able to predict uncertain outcomes, but those are all things you can do to help ensure things will go well in the long run!
WRAP-UP
•Avoidance feels relieving in the moment but in the long run increases anxiety.
•The desire to avoid/escape fearful situations is part of our brain’s fight-or-flight response.
•The problem is when fight-or-flight is triggered without an actual threat.
•Challenge your instinct to escape or avoid so new learning may occur.
•Uncertainty in life is unavoidable; accepting this truth decreases anxiety.
CHAPTER SIX
Acceptance & Approach
Making Peace with Anxiety
Anxiety serves an important function. Worry and concern enable us to tune in, connect with others, take care of ourselves, and have empathy. Anxiety also motivates us to set goals, take action, and pay attention to what matters. I sometimes see people in my practice who don’t have enough anxiety. That might sound strange, but they come in feeling unmotivated, lost, and without purpose. Chances are, if you live with anxiety, you’re fully invested in your life’s course. You have the drive needed to achieve an enriching and meaningful life. The key, however, is to not squander your precious energy on a struggle against anxiety.
&nb
sp; Many of us have a sense that we aren’t living a “good” or “happy” or “correct” life if we experience even low levels of distress. If you feel this way, you probably expend a lot of energy trying to prevent the unpreventable. Joy, love, and pleasure are magnificent aspects of life. However, in the small print on life’s contract you’ll find that hardship, loss, suffering, setbacks, and, yes, anxiety, are also part of the deal.
Instead of trying to rid yourself of things that can’t be changed, like distress and discomfort, change your relationship with anxiety by accepting it. Give up the futile struggle against your feelings and allow your anxiety to come and go—as feelings always do.
Imagine yourself as a surfer, moving with, not against, your waves of emotion, and accepting those waves as they come. You can’t control the waves, but you can take them as they are, which will help you move through life more smoothly.
Accepting anxiety doesn’t mean you’re a victim of it or that you’re giving up and allowing it to control you. Acceptance doesn’t even mean you like what you’re experiencing. Acceptance is the idea that it is what it is. When you look out the window and see rain you don’t say to yourself, “It’s raining, I have to fix this!” You also don’t say, “I’m a victim of the rain,” or “I’m being abused by the rain,” or “It’s raining, I give up.” Perhaps you don’t love the rain, but you pull out an umbrella, you keep moving forward, and you know that eventually the rain will stop.
STRATEGY: ACCEPTANCE
Try this experiment to experience the change in perception and emotional freedom that true acceptance brings.
For this exercise, get your notebook and also find a bandana or light cloth you can use as a blindfold. I want you to write a few sentences while wearing a blindfold about your understanding of the role of acceptance in managing anxiety. You’re to write as clearly and legibly as possible, making sure to keep the letters and words lined up, even though you won’t be able to see what you’re writing. You can do anything you need to help you with this, except remove the blindfold. Do your best to try to figure out a way to write as straight as you can in spite of not being able to see.
