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How to Worry Less

2009-09-28T11:53:00--10:00

Statistics suggest that approximately one in five adults suffers from an anxiety-based condition of which a prominent feature is some form of worry. Approximately twice that number of people would worry on a regular basis. Therefore, worry is one of the most common forms of psychological distress. Some level of worry may be normal and productive. For example, worry can be productive if we are considering a very important issue where a potentially negative outcome is likely to happen if we do not take action and there is something which we can do about the situation. By this definition of productive worry it may be healthy to reflect on concerns about our environment or our children’s safety or our health if there are signs that these things are under immediate threat. We may then be constructively motivated to do something to improve the situation. It helps if we are focused on a specific situation and are willing to accept imperfect solutions, taking into account what we can and cannot control. By contrast, worry will commonly not be helpful if we are ruminating about relatively minor matters or about situations which are not likely to occur or when facing circumstances which we can do little about. Worry may also be unproductive if we continue to ruminate excessively and expect ourselves to have an unrealistic level of control over our circumstances or expect ourselves to find an ideal solution to complex problems.

What is worry?

We could define worry as:
- a chain of thoughts
- accompanied by feelings of anxiety
- about future events
- where the outcome is uncertain and
- where there is a focus on potential negative consequences
- in the hope of reducing danger

Therefore we can help contain excessive worry by a range of means including disrupting a negative chain of thoughts, focusing more on the present (including on the task at hand), accepting uncertainty about the future, not overly focusing on negatives, having realistic views about the actual danger we face and further developing anxiety management strategies. This blog is focused on a range of strategies to help reduce unproductive worry and its impact on us.

Worry-related stress relates to our perception of

the risk of a negative outcome
how bad that outcome would be

Therefore our worries will be particularly intensified if we have an exaggerated view of the likelihood of a negative outcome or of the potential harm which might result. A realistic view of the actual dangers we face will help contain worry. Therefore it may help to ask ourselves how likely is it that a particular event will happen and if it did, what would be the worst thing about that. We can also ask whether worrying will alter the likelihood of a negative event occurring. We might then test our negative predictions and factor in our experience to our future predictions. Research suggests that approximately 95% of feared outcomes which people worry about do not actually happen.

Commonly, worry is experienced as repetitive concerns about particular circumstances such as worry about the welfare of family or friends, about work or school, about home-related issues, about finances, about health issues or about a forthcoming event. Worry is sometimes compounded by concerns about the worry itself, or worrying about worry. For example, people may view their worry is uncontrollable or as harmful or as indicating a failure to cope. This can create a vicious cycle where worry just leads to more worry.

The single most important strategy in countering worry is shifting from a focus on our worrisome thoughts to taking some productive action. For example, rather than worrying about our health or finances we can think of what we might do to improve our circumstances. If we are concerned about our relationship with a family member, we could think of what we might do, even symbolically, as an action to help improve that relationship.

What makes worry worse

Thoughts which may compound the negative effects of worry include:

Catastrophizing: This commonly involves an escalating pattern of increasingly exaggerated concerns about what negative outcomes may occur.
Overvaluing worry as a coping strategy: we may have an inflated view of the potential of worry to help us cope or be prepared for possible negative outcomes. Worry may commonly be merely adding further to the stress we are experiencing.
Anticipating negative events as a form of control: this may include anticipating the worst in the hope that we will be ready for even the most adverse outcome. In fact this strategy tends to make the lead-up to challenging events extraordinarily stressful.
Misinterpreting worry as a failure to cope: such judgements typically only add to one’s stress.
Intolerance of uncertainty: Much of life involves uncertainty and we will typically experience a greater level of well-being if we are focused on what we can productively or enjoyably do in the present rather than having exaggerated expectations of predicting or controlling an uncertain future. We can nonetheless take constructive action in the present to sensibly reduce future risks.
Other common thinking errors: Apart from catastrophizing, common thinking errors include selectively focusing on negative rather than positive information, jumping to conclusions, overgeneralising from past negative experiences, all-or-nothing thinking or personalising situations whereby we take excessive responsibility for the outcome of situations including events over which we had minimal control. Such distress-inducing thinking patterns can lead us to feel as bad as if our exaggerated negative thoughts were true. This is because our emotional reactions to a particular situation or set of circumstances are affected by our subjective perception of those circumstances, not by the objective situation itself.

Behaviours which may compound the negative effects of worry include:

Overly seeking reassurance: if we do not receive that reassurance we may worry more. If we do receive that reassurance we may think that is the reason that we have managed with a situation. Either way, this can lead us to overly focus on receiving reassurance from others in future rather than finding our own ways of coping with a situation.
Avoiding situations related to worry: If we avoid challenging work or social situations which we are worried about we will typically not be further developing our coping skills and strategies for managing more effectively with such situations. Furthermore, our avoidance of situations may further convince us that they are in fact dangerous as opposed to being merely challenging and potentially uncomfortable.
Overly seeking information as a form of control: For example, if we repeatedly and persistently seek information on the internet to allay a health concern we may be at risk if intensifying unrealistic fears rather than seeking reliable and balanced information in a contained way.
Use of alcohol, drugs or comfort eating: Such means of attempting to reduce intrusive thoughts or anxiety represent another form of unhelpful avoidance which commonly compounds worry and may lead to worsened additional problems.

Attitudes which contribute to worry and ways to address them

Fears of failure or perfectionism: People are more prone to worry if they have harsh expectations of themselves or unrelenting standards related to their performance. Aiming to do one’s absolute best all the time would inevitably lead to anxiety. It is worth comparing our expectations of ourselves to what we would consider to be acceptable in terms of other’s performance. It is worth considering what things are so worth doing that they are worth doing less than perfectly, which also enables us to get more things done. As commonly emphasised by successful entrepreneurs we can learn much from our failures. In general it helps to separate our sense of self-worth from our performance on a task or activity. As Mark Twain suggested, we might treat success and failure as twin imposters.
Fears of disapproval: It is also important to separate our sense of self-worth or self-acceptance from the perceived approval we receive from others. Others will vary in their subjective opinion of us, but that does not mean that our inherent worth changes as a result. When people experience social anxiety or avoidance and worry about others’ potential disapproval it can be helpful to face avoided social situations, to take risks such as venturing alternative opinions and to practise asserting oneself in conflict situations. It can then help to compare one’s experience of such interpersonal situations to what you might have predicted. Whenever facing potentially challenging situations it is worth giving oneself credit for one’s efforts and for any ensuing benefits such as improved social interactions and increased enjoyment.
Exaggerated fears of discomfort: In general, discomfort is uncomfortable as opposed to dangerous. If we have avoided or shied away from situations as a result of anxiety it can be helpful to gradually face such situations and recognize the progress that comes from allowing oneself to experience a degree of discomfort. It generally helps to face challenging situations whilst staying in the moment or “being in our own skin” rather than trying to block out our feelings; we can then develop further emotional strength and resilience. Gaining increased confidence in facing challenging situations and dealing with any ensuing anxiety is commonly the most effective way of reducing worry in the longer term. We can then perceive a wide range of situations as being less threatening and dangerous.

Other attitudes more common amongst those with more disruptive patterns of worry include:

Viewing worry as uncontrollable: Given that worrying is influenced by a conscious desire to improve our future circumstances it involves a degree of will and at least partial control. Perhaps the most effective way of gaining an increased sense of control over worrying is to repeatedly practise disrupting a chain of worrisome thoughts by initiating some other activity which engages our attention. This might include some activity which either practically or symbolically could help improve the circumstances that we are worried about. Otherwise it can involve engaging in any alternative pleasurable task. Disrupting worries in this way has been found to alter our brain functioning in a manner to reduce future worries.
Another way of increasing our sense of partial control over worrying is to postpone our worry to a period later in the day. For example, one may set aside 30 minutes in the evening to sit in a particular “worry chair” and to postpone contemplating one’s concerns about a particular situation to that time. Containing or limiting worry as opposed to attempting to completely block it or stop it can sometimes be a more effective way of gaining a sense of further control over worry.

Viewing worry as dangerous: People may be concerned that worry in itself may lead to some serious harm either mentally or for their physical health. This may be influenced by hearing that there can be long-term physical complications from prolonged stress reactions. Reactions such as intrusive thoughts, reduced energy and increased physical tension are uncomfortable more than dangerous. A person may fear developing debilitating physical ailments or losing their mind from worry. In a therapy context people may be encouraged to challenge such fearful predictions by attempting to lose control and to actually “lose” their mind in a particular way such as deliberately inducing a psychotic state. After a brief experiment people typically abandon their efforts as it becomes evident how unrealistic such fears are. People can consider whether friends or others who have acknowledged tendencies to worry appear to be uncommonly plagued by harmful physical illnesses and conditions.

Additional strategies to counter worry

Prediction testing: Given that worry commonly involves overestimating the risk of danger or likely harm it can help to make a prediction as to how a particular situation will unfold and then face that situation and see what actually happens.
Characterise persistently intrusive thoughts as a visitor: For example, if particular thoughts return you might say to yourself, “There’s Fred again”, and pretend that the thoughts are a visitor who might be invited to sit in the room or to be alongside you whilst you nonetheless engage in another activity.
Convert the worrisome thought to a picture: Rather than thinking over and over the worrying thoughts, it may be helpful to instead form of picture or envisage a scene which involves the challenging situation you are worried about and then imagining yourself dealing with it in some way.
Grieve when facing losses you cannot change: For example, if someone has been diagnosed with a very serious illness which would likely markedly reduce life expectancy, it is natural to allow oneself to grieve whilst contemplating potential or likely losses including a curbing of realistic future hopes and altered plans. Allowing oneself to grieve can help gain greater acceptance of a seriously adverse situation which may in turn help the person to make the most of what opportunities remain.
Gratitude exercise: You may imagine losing absolutely everything which is important to you including family members, your home, your job, and even your senses of sight and hearing. Allow yourself to imagine only regaining these one by one, but only after fully experiencing and expressing gratitude for each thing which is to be returned.
Generating other positive emotions: Given that positive emotions tend to “wash away” residual negative feelings, it can help to do anything which involves the experience or expression of other positive emotions including love, faith, trust, hope, joy, forgiveness, compassion and awe.
Anxiety management strategies: Given that worry is associated with anxiety, any strategies which reduce arousal or tension levels may be helpful including breathing and relaxation strategies or coping self statements (e.g., “I’ll be okay”, “Let it be”, “Focus on now”, “I’ll get through it”, “Breathe”, etc). However, it is important to combine such strategies with other techniques which more directly challenge worry-inducing thoughts and behaviours.

People typically make the greatest progress by repeatedly facing challenging situations whilst allowing themselves to tolerate associated discomfort and testing their predictions about feared outcomes. It seems that progress is more reliable if it is allowed to be gradual and imperfect, but is nonetheless backed up by genuinely appreciating and acknowledging one’s efforts.

The most important strategy

The most important thing to remember when addressing patterns of worry is to repeatedly practise ways of interrupting a chain of worrisome thoughts by taking some alternative action, preferably by doing something which is productive or enjoyable.

Dealing with Panic

2008-08-22T12:51:00--10:00

Panic attacks are not such a problem. That may seem a ridiculous statement when panic reactions can be so exceedingly uncomfortable and disruptive. However, it is commonly not panic symptoms themselves which are the most unsettling aspect of panic attacks. The main problem is panic about the panic. A key goal of dealing with panic attacks is to allow some of the distress to be there. Panic reactions are not dangerous. Panic attacks will pass, usually within a matter of minutes. It may feel as though one is losing ones mind or might have a heart attack, but panic is not dangerous. Panic attacks may be very, very unpleasant, but panic is not dangerous. The goal is to help get this message through to the back of ones mind, even when one is experiencing panic symptoms. That is not easy, and takes practice. Commonly it takes months and months of practice before a person can experience repeated panic reactions and yet feel some confidence that the distressing feelings will soon pass.

Panic attacks represent one of the more common difficulties for which people seek psychological treatment. Panic attacks involve a sudden bout of anxiety or intense fear in the absence of real danger. They typically reach a peak within a few minutes. Panic attacks involve experiencing a number of characteristic symptoms which may include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, feeling dizzy or lightheaded, chills or hot flushes, feelings of unreality or of feeling detached from oneself, numbness or tingling sensations and fears of losing control of either one's mind or one's body. Panic attacks tend to worsen when a person becomes preoccupied about the possibility of further attacks and becomes increasingly sensitive to any physical changes in their body which suggest that such an attack might recur. Again, the key difficulty at that point is not so much the impact of particular panic symptoms themselves, but that people may tend to panic about the panic. This can further interfere with one's brain functioning by leading to further activation of the limbic system, a part of the brain which is important for mobilising a fight or flight response to escape danger. In addition to the person feeling like fleeing the situation, their frontal lobes may become less active which may lead to them feeling a marked loss of control of their reactions and perhaps losing their more usual sense of self.

It may greatly help if the person can manage to stay in the situation rather than flee, perhaps using anxiety management strategies described below, as that helps one learn that panic symptoms will typically pass in a matter of minutes.

Specific anxiety conditions where panic may occur

One common anxiety-related condition, panic disorder, is experienced by approximately 1 in 30 people. This occurs when people have recurrent panic attacks and remain especially fearful that they will experience another such attack. In just under half of such cases this may also lead to agoraphobia when the person comes to avoid situations in which they are fearful that an attack may recur. People may also have a phobia, or excessive fear of such situations as heights, enclosed spaces or encountering spiders, and may experience panic-like reactions when encountering the prospect of entering the feared situation. People can also experience panic reactions in the context of having a post-traumatic stress disorder. This condition involves marked anxiety when somebody is reminded of a past traumatic event, such as a car accident or other life-threatening situation, about which they have ongoing intrusive and painful recollections which they seek to block out of their mind. Obsessive-compulsive disorder involves exaggerated distressing thoughts about potential threatening situations such as a fear of leaving the gas on at home, not properly locking ones front door or excessive concerns about contamination from dirt: people may then engage in unnecessary time-consuming activities to neutralise their anxiety feelings such as compulsive hand-washing or compulsively checking door locks which they have already checked. Social anxiety occurs when a person feels somewhat panicky if they are forced to be the centre of attention or fears consequences of coming under other people's close scrutiny. People may also experience panic-type reactions associated with performance anxiety before or during an event in which they have high expectations of performing well such as before an exam or a competitive event. When such conditions are especially disruptive, it can be worth seeking psychological assistance which in most circumstances can lead to substantial gains in approximately eight to twelve therapy sessions, depending on the severity and chronicity of the condition. Although most anxiety disorders appear to improve somewhat from approximately 55 years of age, there are fewer remissions without treatment.

Strategies for dealing with panic

Mindset

Managing well with anxiety-related reactions has a lot to do with ones mindset. It has a lot more to do with letting go than controlling ones reactions. Dealing constructively with anxiety or panic commonly involves allowing some discomfort to be there, bearing with it, grappling with a situation or muddling through it. It is about coping rather than mastery. Coping means allowing oneself to feel the anxiety, but recognizing that one has ways of handling it. Mastery is about trying to be on top of a situation, trying to succeed in controlling it, or aiming to eliminate bad feelings. Aiming to master anxiety reactions often makes the situation worse. There is no need to Be Positive! so to speak. It is more about hanging in there when you feel bad. When disruptive symptoms pass, that then allows you to get on with whatever you were doing. Such an approach helps reinforce the understanding that panic is not dangerous.

Breathing

Panic symptoms are commonly influenced by disrupted patterns of breathing. In particular, if people are facing ongoing stresses they will tend to be at greater risk of overbreathing. At rest, people generally need no more than about 14 breaths per minute. If people commonly experience dizziness during panic attacks, it is likely that panic symptoms have been induced by overbreathing. Overbreathing can include rapid breathing or frequent sighing or yawning. This may lead to a complicated range of bodily reactions associated with reduced carbon dioxide in the blood and reduced oxygen to the brain. Many panic symptoms can be directly caused by overbreathing. In a psychological therapy session, a client who has had panic attacks may be encouraged to hyperventilate for a minute or so to demonstrate the extent to which panic symptoms can be caused just by changing breathing patterns alone. To help counter overbreathing, it can help to take in 10 to 12 breaths per minute (one breath every five or six seconds), preferably breathing relatively lightly through the nose, and breathing more from the diaphragm (as though breathing through the belly button) than from the chest. Practising an exercise of slowing breathing for a few minutes each day (perhaps counting each breath in and saying, Relax, for each breath out) can help prepare oneself to slow ones breathing when experiencing panic symptoms. This exercise might best be repeated daily for several weeks.

Coping self-statements It can be particularly helpful to draw on coping self-statements to help manage with anxiety. This helps further activate frontal lobe influence on more primitive brain functioning (geared toward escaping danger) which may in turn allow the person to gain greater feelings of partial control. Coping self-statements may be in the form of a mantra, or a word or phrase that a person may repeat to themselves, such as, "Let it pass", Breathe, Ill be OK, or Let it be. People can simultaneously use relaxation or breathing techniques to reduce tension.

Medication

Sometimes it may be helpful to combine psychological strategies incorporating the cognitive-behavioural techniques described above with medication as an adjunct, but often in the first instance it is helpful to address panic reactions without using medication. People may be at increased chance of relapse if they have used medication and then the medication is discontinued. In many cases medication is not necessary. Medication may sometimes be a useful aid to treatment as it can provide some symptom relief whilst the person further applies psychological strategies, but medication is not a complete treatment in itself.

Practising experiencing discomfort as a goal

When people are aiming to further develop their ways of dealing with anxiety and panic it can help to seek to practise experiencing discomfort as a goal rather than as a problem to be overcome. When people gain much greater confidence that they are able to manage with discomfort, then they are much less likely to experience fear about the fear and are less likely to panic in the face of panic. This can help reverse a vicious cycle and may increase the person's confidence that they can deal with whatever situations they may face. This may involve muddling through or grappling with those situations and coming out the other side, perhaps uncomfortable, but relatively unscathed.

Exposing oneself to challenging situations

When dealing with any persistent difficulty related to anxiety it can aid recovery for the person to deliberately enter various challenging situations (a therapy strategy called exposure), perhaps whilst using the aforementioned strategies. The person may then gain confidence or increase their sense of self-efficacy or effectiveness in dealing with such situations, which in turn leads those situations to seem less threatening. People might best vary their exposure to challenging situations, such as by entering different types of situations for varying lengths of time. If a person feels they must leave a situation, it is best to engage in a strategic retreat. This involves briefly withdrawing from a situation, preferably moving slowly rather than rushing, to a point of having regained some further composure, and then re-entering the original situation. It can sometimes help for a person to focus their attention on their planned actions or behaviour as opposed to their feelings in a particular situation. By having the focus outside of oneself, at least temporarily, this may help to distract oneself from internal uncomfortable feelings.

In summary, a key goal for managing with panic is to aim to tolerate anxiety rather than to try to control it or necessarily reduce it. This involves allowing some fear to remain. The aforementioned strategies, especially including the use of a brief coping mantra, are best practised for a period of six months or so to help them become habitual and automatic.

Psychological Reactions to Traumatic Accidents

2007-12-14T00:00:00--10:00

It is common for people to suffer from a range of psychological reactions after a traumatic experience such as a motor vehicle accident or any other life-threatening incident. In the first instance, individuals may feel anxious and apprehensive. They may suffer from such symptoms as sleep disturbance, poor concentration, irritability, and loss of interest in activities. They may experience intrusive thoughts or images related to the traumatic experience. Such recollections are commonly distressing and individuals will often make efforts to block such thoughts or recollections from their mind. People affected by traumatic accidents may feel sad and withdrawn and may be more detached from others. Having an understanding of such reactions can assist people's psychological recovery. The support of other people including friends and family members can be especially important in aiding psychological recovery from accidents.

Sometimes the aforementioned reactions and other forms of psychological distress can be sufficiently debilitating or long-lasting that it can be worth seeking psychological therapy. This would especially be the case if individuals are suffering persistent nightmares related to trauma, if they are resorting to alcohol or illicit drugs to manage with painful feelings, if symptoms are persisting beyond a month or two, or if the person has limited social supports. More disruptive psychological reactions following traumatic accidents include such conditions such as Post-traumatic Stress Disorder or Depression which can further limit people's capacity to work or to interact with others. Clinical psychologists or other psychologists who have received specific additional training have specialized skills and experience in assisting individuals to recover from such conditions. Therapy commonly includes an educational component to help individuals further understand their symptoms. Treatment also typically includes the teaching of strategies to manage anxiety including breathing techniques, relaxation techniques, and other coping skills. Therapy sometimes encourages individuals to deliberately recall aspects of their traumatic experience in a manner that helps to reduce the emotional impact of such recollections. It is not uncommon for people to feel depressed at some stage of their recovery associated with losses such as restrictions from any injuries, the loss of one’s previous sense of wellbeing or a temporary incapacity to continue with work or other interests. Individuals may experience a sense of guilt or shame associated with the accident or their reactions to it. Various therapy techniques can assist individuals to deal with such negative experiences by recognizing and altering any unduly negative patterns of thinking which can contribute to such difficulties. Finally, therapy focuses on other strategies to assist individuals to resume previous routines and interests. Recovery from accidents can be further complicated when individuals suffer from physical injuries and pain. There are a range of pain management strategies which can assist people to cope with such additional difficulties. Individuals sometimes benefit from being involved in a group therapy process where they might meet others who were seeking to cope with similar challenges.

It is important to understand that the vast majority of individuals make a good psychological recovery from traumatic accidents. Even those who have suffered from long-term or severe trauma reactions will commonly recover to the point where their symptomatic distress is relatively mild in the longer term. However, it may take considerable patience to accept slow and gradual progress during the rehabilitation process, especially if physical injuries are involved. Following their recovery from trauma reactions, individuals may have a heightened sense of their own resilience and a deeper understanding of their priorities in life: this commonly includes a heightened recognition of the importance of significant relationships and an appreciation of everyday activities which offer a sense of pleasure and fulfillment.

Turning a Bigger Problem into a Lesser One

2007-11-14T18:35:00--10:00

Many people find it very difficult to make a decision to see a psychologist. Often when they do so, this has already started a process of turning a bigger problem into a lesser one. Because commonly when people see a psychologist for the first time, they have two problems, or layers of problems. The first problem is what they are seeking help for, perhaps a panic or anxiety reaction, a depressive condition, an anger or behavioural problem, or perhaps a relationship issue or a life adjustment problem. But in addition to that, people commonly have a second problem which relates to their reaction to the first - commonly in the form of non-acceptance or shame. And it is this non-acceptance of the first problem which is the bigger stumbling block, or at least a significant barrier to progress. Reactions to the original problem can also include feeling very anxious about having panic reactions, feeling helpless about ones relationship problem, or even being depressed about being depressed.

Acknowledging a problem openly, and particularly acknowledging it to someone who has a very informed understanding of such issues, is perhaps the most important step toward acceptance. Commonly when people reveal such a personal aspect of their experience, they may learn that many others have felt or reacted a similar way. They may learn that many others have successfully addressed such difficulties. They might find themselves sitting opposite someone who has a deep and genuine appreciation of the nature of their difficulties, yet clearly remains optimistic about their prospects of overcoming them. When clients have the experience of being understood and accepted despite revealing something about themselves that they might have found wanting or shameful, they commonly experience greater hope. The experience of standing back from a problem and gaining an increased understanding of it with a therapist's help can shift a burden from feeling potentially insurmountable to a set of circumstances that might be actively addressed in some way, even though the path of recovery may not be clear at first. Once someone is able to accept themselves having a particular problem, and has reduced their sense of shame associated with having it, the practical steps for best addressing the first problem more readily unfold. At that point, the first problem has become a lesser one.