Positive Health Online

Extracted from How to Help Someone with Anxiety: A Practical Handbook

by Dr Rachel M Allan

Published by ‎Welbeck Balance. 2021. Paperback. £7.69. $12.95.  ISBN-10:‏ 178956266X.

Available from Amazon.co.uk and Amazon.com

We know that anxiety is an interaction between thoughts, emotions, physical responses and behavior. We know that anxiety is natural and has a crucial function of keeping us safe. We know that anxiety hurts because it threatens what matters to us, and gets in the way of us living the life we want. And most of all, we know that the best way to support and empower someone living with anxiety is to provide our time, empathy and understanding.

Planning For Change

One of the most important conversations I have with my clients at the start of therapy is about goals. Before we talk about goals, it is interesting to have a conversation about what is not working. Often, it is the frustrations and disappointments that anxiety creates in our lives that points us toward the things that matter most, and that we most want to change.

Identifying what anxiety costs us, and how that hurts us, is a good way to lead in to a conversation about change. Once the person you are supporting has talked through the ways in which anxiety gets in the way of them having the life they want, they may be ready to think about how they do want things to be. Like anything in life, setting goals helps us focus on where we want to get to. Identifying a destination – or at least milestones – on any journey is key to making sure we are heading in the right direction.

Setting Realistic Goals

When I explore with clients who live with anxiety what they want to get out of therapy, I often hear that they want to get rid of anxiety! That is an understandable response.

But think about what would happen if you approached the beginning of a journey by specifying where you do NOT want to end up. It would not provide a great deal of focus. Generally, it is better to identify where you DO want to end up. So when I talk about goals with my clients, I challenge them to think about what they DO want.

If a client says to me their goal is to get rid of anxiety, or to be free of anxiety, my next question is, what would that allow you to have more of? Or what would that let you do that you are not able to do right now?

That can help clarify where we want to end up on our journey, and that serves as a guide for making changes.

Getting clear on values in this way is an excellent foundation for thinking about specific goals. When goals are rooted in an understanding of WHY something hurts us, we are more able to commit to making changes. In other words, establishing the outcome we want puts our eyes on the prize. This galvanizes change, and directs the focus of the work that needs to be done to get there.

Goals give us a useful guide and a reminder of the outcome we are supporting the other person to achieve. When we think of our New Approach, it is useful to bear in mind what goals the person has identified. That way, you can always check in with whether they feel they are moving toward or away from where they want to end up.

Goals provide a brilliant basis for focusing change. When the person is clear on goals, you can both use that clarity to inform the New Approach you build together.

Coping With Worry

Worry and anxiety often go hand-in-hand. When I am working with clients to help them live better with anxiety, we often end up having some interesting conversations about worry.

Many of us carry a belief that worrying is a useful way to keep ourselves safe. I often hear people say things like, ‘If I didn’t worry, I wouldn’t be prepared for when things go wrong’ or ‘If I didn’t worry, I might drop the ball and forget about some important things I need to take care of.’

It is important to recognize that some worry can be useful in making us take action to address important things. For example, worrying about an upcoming interview can make us prepare to a higher standard. Worrying about paperwork we have not yet completed can make us get it done on time. Part of recognizing the seriousness of some situations in life can involve thinking through options, feeling a degree of anxiety about the possibility of a bad outcome, and looking ahead to make contingency plans for worst-case scenarios.

But there is a difference between recognizing the seriousness of a situation, or taking reasonable steps to keep ourselves safe, and becoming consumed with thoughts about worst-case scenarios that tip us into panic, and cause anxiety storms to spiral and escalate. This is what can happen when planning or consideration turns into a repetitive and unproductive mental behavior, focused on potential future outcomes, which is ultimately what worry is.

For many people living with anxiety, worry is an insidious presence that spreads into mental and emotional space like gas filling a room.

Worry is usually triggered by uncertainty. When we are faced with an ambiguous or uncertain situation, rather than sit with the uncertainty, we are likely to go over possible outcomes to try to manufacture a sense of certainty for ourselves. The problem with this is that our mind often jumps to worst-case scenarios, and then we get pulled into an extended anxiety storm, reacting to what our mind has given us as if it were true.

When the mind is focused on an imagined future, not only do we have to deal with the emotional effects of the things we imagine could happen, we also miss out on being fully present and attentive in the here and now.

It is not uncommon for me to hear people who experience anxiety tell me that they also have a bad memory. I ask them to consider this: if your mind is off in the future, how can it attend to information in the present? And if you are not attending to information in the present, how can you expect your mind to take in new information and store it for you?

Broadly speaking, worry can be divided into two categories.

1. The first kind of worry is helpful or productive worry. That is the kind of worry that drives us to do things to keep ourselves safe, and to put sensible precautions in place in the face of a threat. It is the kind of worry that motivates us to address problems, and engage with important tasks;
2. Unhelpful or unproductive worry is the type that can escalate and involves us into going over and over worst- case scenarios in our minds, without leading to positive action. This type of worry tends to be repetitive, and can cause us to feel trapped. This can be accompanied by feelings of anxiety, panic, dread and helplessness.

Breathing

The fight-or-flight response – and the whoosh of physical experiences that go with it – is at the heart of the experience of anxiety. Anxiety happens in the body, and one of the most powerful tools we have to regulate anxiety also involves the body. That tool is breathing.

I am sometimes wary of introducing breathing exercises in therapy, because breathing as an exercise has perhaps become a cliché or a way of brushing off the depth of suffering lived through by people who experience anxiety. It is not enough to direct someone who is at the height of an anxiety storm to ‘just breathe’. Having said that, introduced in the context of the TURN method, breathing has the potential to be one of the most powerful tools you can support the person you are helping to put into practice.

First, let’s have a quick recap of why breathing is so important. Earlier in the book, we looked in detail at how the fight-or- flight response is responsible for the collection of physical experiences that often go with anxiety (see page 54). When the internal fire signal is activated and the whoosh of anxiety takes over, lots of things happen in our bodies, with the function of preparing us to fight a predator or run away from a predator.

Breathing is the key to restoring balance in the body during an anxiety storm and a good tool to use when it is starting to brew, because it can slow the escalation of a storm and keep the body from being taken over with the physical feelings of anxiety.

Getting into the Present Moment

In the grip of an anxiety storm, the mind is rarely focusing on the present. When we face uncertainty or threat, the mind automatically comes up with imagined future scenarios and outcomes, and we engage with those as if they are real and true.

Often, this means that part of anxiety involves our minds being focused on an imagined future.

Our inner threat system does not know the difference between an immediate threat in front of us in real life and the threatening situations our minds think up when we worry and catastrophize.

Our anxious minds tend to live in the future, imagining the worst. This is why using techniques to consciously bring our focus back to the present can be a useful way to manage anxiety. If we can catch our minds before negative thoughts snowball completely, we can use that as an exit strategy in an anxiety storm, or even use it to stop a full storm gathering in the first place.

Acknowledgement Citation

Extracted from How to Help Someone with Anxiety: A Practical Handbook

by Dr Rachel M Allan

Published by ‎Welbeck Balance. 2021. Paperback. £7.69. $12.95.  ISBN-10:‏ 178956266X

Available from Amazon.co.uk and Amazon.com