Overcoming Worry and Anxiety

Jerry Kennard

• Publisher: SPCK
• Year: 2014
• ISBN:
  9781847093233
• Topic: Personal Development
• Subtopic: Self Improvement

Worry is always with us, but, the lived experience of anxiety is often complex, embarrassing and hard to explain. Using clear, down-to-earth language, this book explores its characteristics, available treatments and effective self-help techniques. Topics include: • How the brain and its chemicals work • How anxiety may interact with other states such as stress, fear, panic, and illness • Symptoms and conditions • Work and lifestyle • Practical measures to combat worry • Thinking about treatment • Guided and supportive therapies • The value of assertiveness

1

Worry, anxiety, stress and fear

Illness and responsibilities

If we get into conversation about our worries and the uncomfortable sensations they arouse we can be pretty certain the person listening can sympathize – to a greater or lesser extent – with our experiences. This is because worry and anxiety are universal. We are born with anxiety and without it we would have no internal mechanism to monitor and respond to real or perceived threats.

Anxiety is both normal and necessary, but beyond this are situations and circumstances that evoke high levels of worry and anxiety in the face of proportionately low levels of threat. It is these more extreme levels of anxiety that provoke a wide variety of questions and explanations.

The focus of this book is to explore some of the features of high and often persistent levels of worry and anxiety. In doing so, I attempt to answer your questions about the nature of the beast before considering ways we might reduce its worst effects.

So what’s the difference between worry and anxiety? Well, they are related of course, but technically worry refers to the thought processes that result in anxiety. Thus worry precedes anxiety, which is an important distinction when it comes to managing worry. The way we think leads to the feelings and emotions we describe as anxiety. As the book progresses you will see how certain therapeutic approaches target the way we think and behave in order to reduce anxiety.

Before I press on, a word of caution. Too much focus on the symptoms of anxiety can distort perceptions. Feeling anxious, even for a protracted period of time, may be uncomfortable but it is not necessarily a sign of psychological illness. We have to account for the context in which symptoms occur before being tempted to label ourselves, or others, as having some kind of anxiety disorder.

There is also a basic danger in medicalizing the effect of a problem rather than its cause, which is always something of a dilemma with conventional treatment methods. Giving people pills for anxiety because, for example, we can’t address the poverty and lifestyle issues that cause their symptoms is a case in point. Even so, over the past few years there has been a considerable shift in the way medicine operates (no pun intended). People in my own 50-plus generation were pretty well indoctrinated into the idea that sickness belonged to medicine – you gave yourself over to the doctors and followed their orders. These days the picture is chan-ging and many of our doctor–patient interactions are in the form of information-sharing and agreeing strategies and treatments. Many of these, you may be surprised to learn, are within our own gift and require no medication.

Doctor, doctor …

The medical profession freely acknowledges that, in some areas at least, what they can offer has limitations. This has given rise to more collective forms of therapy in which doctors, other health professionals and sometimes people once considered outside of therapy can provide a more comprehensive range of interventions.

Despite this, many people still place ultimate faith in medicine to provide them with an answer, preferably in the form of a cure. It isn’t easy to be told your faith in medicine is sometimes misplaced. Having your doctor point out, often in the kindest way, that you have to take some responsibility for your anxiety is tough. To be asked to take control of something you feel powerless over may even feel like an act of betrayal. You may feel your symptoms have been misunderstood or you may begin to question the competence of the doctor. Such issues are understandable in the context of beliefs you may hold about medicine but they also reveal a pattern of thinking that is typical of anxiety and therefore something only you can change.

Many people with anxiety come to rely on doctors to tell them, sometimes repeatedly, that nothing is physically wrong with them. Here are people who monitor any minor change in physical symptoms. They worry because they feel sick, nauseous, dizzy and more, and somewhere in the back of their minds is the hope and belief this new symptom will be enough for their doctor to piece the puzzle together and tell them what’s really wrong. So to be told that these physical symptoms actually result from anxiety places them in a situation where to get relief from symptoms they must treat their anxiety.

To be asked to shoulder some responsibility for your worry and anxiety is not the same as being told to go away. It is merely the first and most important step in appreciating that your own thoughts and actions have a profound effect on your well-being.

The types of people who worry and suffer with anxiety vary greatly, but we know that relief can and will come from owning and mastering certain coping skills. Medication may also be useful, but a complex job often requires more than one tool!

Now let’s dig a little deeper into the nature of worry and anxiety, how it applies to us and what we can do about it.

Anxiety and stress

As worry is to anxiety, so is there a relationship between anxiety and stress. It’s worth taking a moment to consider the issues.

Anxiety is an emotional sensation. It’s the uneasy and apprehensive feeling we get when we’re emotionally or physically threatened.

Stress is often thought of as a development of situations that make us feel angry, irritated or frustrated. But stress is also a response to things like viruses, heat, cold, hunger and thirst. Stress is the way the body reacts to situations in which a decision is needed, or an action, threat or some imbalance to its normal functioning occurs. It is a protective mechanism usually, but if constantly triggered it becomes a health issue.

Everyone knows what a stressful day feels like. It leaves you depleted, tired and often with a headache. During stress your body reacts in a certain way – it pushes out adrenaline and various stress hormones and makes your heart work faster. This is excellent for situations in the short term but less good over long periods of time.

Any job is stressful in which the meeting of deadlines is essential or your performance is on display and being judged by others. Even more stressful is having to deal with disgruntled people, take on extra work or having a boss you can’t get on with. The role of long-term caregiver is also stressful, often because of the social isolation, repetitive demands and sleep disruptions that come with it. Despite all this, you may not feel anxious.

Where confusion arises, I think, is that we often talk about stress and anxiety as if they are one and the same thing, much in the way we refer to worry and anxiety. Another reason may be that people often only acknowledge they are stressed once they experience symptoms of acute anxiety. They find they can’t concentrate as well as they used to, sleep may become disrupted and moods more tetchy and irritable. In some situations they may develop anxiety or panic attacks.

Anxiety and stress follow parallel paths. Independently of each other they can present a variety of health issues yet sometimes their paths cross and coincide. As anxiety often develops from stress it is possible to reduce anxiety by reducing stress. The good news is that a number of tried, tested and effective methods exist that allow us all to tackle either our anxiety, our stress or both.

Why do we worry?

We’ve all heard it and we’ve all said it: ‘Don’t worry – it’ll all work out.’ The sentiment is well intentioned but how accurate or useful is it? We often describe our less appealing emotions as negative. Grief, depression, anxiety and worry all fall into this category but it doesn’t mean they are without purpose.

One of the key characteristics of worry is the way concerns just turn over and over in the mind, often with no apparent purpose or resolution. Apart from our insides being chewed up, the effect of worry can be sleepless nights, distraction from other activities and a focus on negative rather than positive outcomes. It is hardly surprising, then, that worry is universally regarded as a negative emotion.

You’re probably reading this book because you see yourself as a person who worries, and perhaps this in itself worries you. It’s much more common than you might think, but to reduce the negative effects of worrying I think it’s helpful to gain some insight into how our own worry processes operate.

I’d like you to spend a few moments thinking about the issues that trigger your own worrying. Are they family related? Maybe they are things you read or see on television. Perhaps they are work issues. Of course they could be all or none of these things.

The chances are that your list includes one or more issues from finances, health issues, personal relationships and/or work. I can certainly relate to every one of these, and this is because they are among the most common worries, whether or not you consider yourself a worrier. But if we contrast this with, say, people with a generalized anxiety disorder (GAD), we begin to see a difference between what’s normal and what isn’t. People with GAD tend to focus a lot more on illness and poor health – their own and others’. They also tend to think that no other person worries the way they worry and that their worry is fully out of control, a process the psychologist Adrian Wells describes as meta-worry.

An obvious question is why we are burdened with worry. Jeremy Coplan, a professor of psychiatry, believes there is an evolutionary link between worry and intelligence. According to Coplan there is a correlation between high IQ and worry. Previous studies have also noted that excessive worry tends to exist in people with higher and lower intelligence and less so in people of average intelligence. Coplan’s view is that this association would have had certain evolutionary benefits. Basically, high IQ worriers would be more likely to weigh up the potential risks of situations and take fewer chances, thus increasing their likelihood of survival. Those who suffer with anxiety and have lower intelligence often achieve less success in life and, in a complex modern world, may have less resilience and fewer personal coping strategies upon which to call.

But does this mean that worrying can actually be good for us today? It seems there’s a balance to be struck. The negative side of excessive worry is that it can be emotionally debilitating. There is also a physical toll, which can include a higher heart rate and sinus arrhythmia – a naturally occurring variation in heart rate during a breathing cycle. Chronic worrying can also trigger the stress response, which is known to have a number of health implications.

On the plus side there is always the possibility that it is our concerns over the consequences of certain activities that keep us safe and healthy. The motivation for many smokers to quit is based around their concerns over cancer, heart problems and general health issues. The same might be said for diet, voluntary screening, breast self-examination and so on. Clearly there is a dividing line between health concerns and chronic worrying, but they are underpinned by the same basic mechanisms. The old saying ‘ig-norance is bliss’ may be true up to a point, but you mustn’t view your capacity to worry as entirely without use or merit.

This may be a good time for you to explore your own beliefs about worrying and whether you regard your own worrying as negative, positive or a mixture of the two. An example of negative beliefs is that your worrying makes you ill, that it might be getting worse and that you’re losing control. By contrast, positive beliefs might be that your worrying keeps you focused, helps you to identify potential problems before they occur and is necessary to keep you sharp and on top of things.

Whether you consider your worrying as negative, positive or both, the fact remains that it is still worry. People who worry about worrying often adopt what is known as a ‘what if’ style of thinking. As the worry progresses it becomes more negative in nature. Here’s an example:

Tom is a well-regarded science teacher with ten years’ experience under his belt. The train on which he commutes to and from work is often stuffy and crowded, and this evening someone kept sniffing and sneezing. A string of worrying thoughts begins to unfold in Tom’s mind: ‘What if I catch a cold, or flu?’ he thinks. ‘I’ll have to take time off work.’

Because he’s a worrier, Tom’s imagination leads him along a path that becomes more catastrophic in nature. Thus ‘I could lose my chances of a promotion’ might build to a crescendo in ‘I could even lose my job.’

Tom’s story is a fiction but it represents a form of extreme and uncontrollable worry that won’t diminish. Persistent worrying like this tells us that Tom’s mood is increasingly negative, and he believes his problems will worsen and can’t be solved. Negative thinking as a feature of worry is something I’ll address a little later.

It’s also clear that Tom’s worry is pointless, but it does demonstrate two common characteristics of worry: first, it is unimportant; second, the outcomes conjured up are unlikely. Tom may or may not catch a cold, but how important is that? Also, how realistic are his thoughts about losing his job? And how did Tom get to such a point where he even thinks like this?

Unlocking anxiety

It’s no understatement to say that most people who experience clinical levels of anxiety or depression have had difficulties in their early lives. It doesn’t necessarily mean one leads to the other, and it doesn’t preclude those with a secure upbringing from having these problems, but the association is noticeable, as is the way early life experiences often occupy a central position in affected people’s memories.

Psychologists continue to gain insights into both the nature and effects of worry and anxiety. We now recognize that childhood disorders can cast long shadows and extend into adulthood. We also know from research following people from birth into adult-hood that most young adults with a mental-health problem had diagnosable problems much earlier in life. How early these problems start and the mechanisms that link childhood adversity and trauma to adult life are more speculative matters. So-called adult disorders may have been set in motion during pre- and/or post-natal stages of development, yet for the most part our system of diagnosis places most weight on current symptoms, while acknowledging that there may be some ‘history’.

One of the most researched areas in child–parent relationships is around attachment and/or separation. The unique bond between a mother and her infant is so universal that it has allowed scientists to study it in everything from rats to primates – the results are remarkably similar to humans. From some of these animal studies we know that baby rats separated from their mothers show a higher stress response rate later in life. We know that monkeys separated at birth from their mothers can develop strong bonds with others in a similar situation but remain more anxious and more vulnerable to anxiety and depression later in life.

The psychiatrist and psychoanalyst John Bowlby identified the huge importance of the parent–child relationship in the early years of life and how this goes on to influence future outcomes. Later developments in the field by Allan Schore showed how Bowlby’s ideas could be proved biologically. Schore made the case that the development of an area of the brain known as the prefrontal cortex depends on a positive emotional experience between parent and child.

The prefrontal cortex is involved with the control of pleasure, pain, anger, panic and other emotions and urges. Unlike other organs, which develop automatically, this part of the brain appears to be strongly affected by anxiety and depression. In a healthy nurturing relationship it will grow and form connect...