How to stop worrying about everything

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Volatile markets, difficult bosses, speed demons on the roads, terrorism threats, dire warnings about the fallout of climate change -- there's plenty of anxiety around for everyone these days.

Some anxiety is a good thing, in fact. It’s, after all, part of that old fight-or-flight syndrome, the adrenalin rush that gears us up for threats or challenges we have to face. Big job interview coming up and you’ve understandably got some butterflies in your stomach, so you spend a little more time and care getting dressed or rehearsing how you’re going to handle difficult questions. Investments going sour and the niggles of worry at the back of your mind prompt you to consider shifting some of your funds into alternative avenues or to engage the services of a financial advisor. At the right time, in the right dose, anxiety certainly has adaptive value. Too little anxiety and you wouldn’t think twice before running across the street, robbing a bank or turning around and yakking to friends in the back-seat while you drive.

But too much anxiety is a different kettle of fish. When everything becomes a potential crisis, when you feel overwhelmed by worry, when you have trouble eating, sleeping and concentrating, then you are no longer dealing with garden-variety anxiety. You’ve crossed over into the weedy territory of the Anxiety Disorders – an area pock-marked with irrational fears and disabling anxiety.

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How much is too much?

How do you know whether your anxiety problem is the plain-vanilla variety or a rather more toxic serving? Here’s a 1-minute snap test that works as a preliminary screening. It is designed to alert you to the presence of anxiety symptoms that indicate the need for evaluation by a medical professional. It does not in any way replace a medical evaluation.

Examine the following statements and indicate how often you feel that way:

1. Do you feel that you worry excessively about many things?

Yes

2. Do you experience sensations of shortness of breath, palpitations or shaking while at rest?

Yes

3. Do you have a fear of losing control of yourself or of "going crazy"?

Yes

4. Do you avoid social situations because of feelings of fear?

Yes

5. Do you have fears of specific objects, e.g., animals or knives?

Yes

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6. Do you feel afraid that you will be in a place or a situation from which you will not be able to

escape?

Yes

7. Does the idea of leaving home frighten you?

Yes

8. Do you have recurrent thoughts or images in your head that refuse to go away?

Yes

9. Do you feel compelled to perform certain behaviours repeatedly -- e.g., checking that you locked the doors or turned off the gas?

Yes

10. Do you persistently re-live an upsetting event from the past?

Yes

The above are anxiety symptoms that might be part of an Anxiety Disorder. If you have answered ‘Yes’ to any of them, it is advisable to seek a professional consultation.

The big six

Anxiety disorders fall into 6 main categories:

» Generalized Anxiety Disorder (GAD)

» Obsessive-Compulsive Disorder (OCD)

» Phobias

» Social Anxiety Disorder

» Panic Disorder

» Post-traumatic stress disorder (PTSD)

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Oh GAD – 24 x 7 anxiety

The biggest group of silently-suffering worriers are those in the grip of Generalized Anxiety Disorder (GAD). Having this disorder is pretty much like having a worry machine in your head. If it’s not one thing, it’s another. People with GAD experience excessive and unrealistic worry about all types of life issues – in particular, health, family, money, work. They are always anticipating disaster, they can’t stay focused, can’t make good decisions, keep putting off action on problems because they feel too anxious about the outcome (procrastination). No matter how well things seem to be going, they remain apprehensive and anxious, constantly feeling that something bad is about to happen. They even worry about the fact that they worry too much. Little wonder that GAD is often described as “free-floating anxiety”. Most sufferers will say they remember having been anxious all their lives.

People with GAD may also suffer physical symptoms, the most prominent one being muscle tension, especially in the neck and upper shoulder. Other symptoms include sleep disturbances, headaches, irritability, trembling, twitching, or sweating. They may startle more easily than other people. They tend to feel tired, and may suffer depression, too.

Even though they usually realize that their anxiety is more intense than the situation warrants, people with GAD can't seem to shake their concerns. When GAD is mild, the sufferer doesn’t feel too restricted in social settings or at work. But, when severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

Although most GAD sufferers do not seek psychological treatment, they do tend to show up in doctors’ clinics fairly frequently with complaints such as fatigue, insomnia, muscle tension.

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What causes GAD?

Many people still labor under the mis-perception that chronic anxiety is a character flaw, a problem that happens because you are weak. They’ll say to a person who’s struggling with distressing anxiety, "Get over it!" or, “Pull yourself together!”. For that matter, most people who suffer from an anxiety disorder typically berate themselves (sometimes more than others do) for not being able to "get over it". However, "getting over it" is easier said than done, because anxiety is mostly a problem of biology and mental mechanisms that are automatic and not conscious.

While the precise causes of anxiety disorders are still being teased apart by researchers, we know for sure that they are not the result of personal weakness, a character flaw or poor upbringing. We know today that both, biochemical factors as well as environmental factors, are involved. Studies show that anxiety disorders may run in families. Also, that severe or long-lasting stress can change the balance of chemicals in the brain that control mood. Moreover, environmental factors -- such as a trauma or having to face major decisions in one's life-- may trigger an anxiety disorder in people who already have an inherited susceptibility to developing it. Gender may also play a small role in that women are diagnosed with GAD rather more often than men are. Your personality can be another contributor: those with fearful or negative inclinations are more at risk for GAD.

Someone who has experienced anxiety in a particular situation begins to anticipate the symptoms of anxiety at the mere thought of facing that situation again; this anticipation of the symptoms may then actually bring on the feared symptoms, such as rapid heartbeat and sweating and – in their wake – further anxiety. This is the vicious “fear of fear” cycle.

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The road to healing

GAD generally doesn’t go away on its own, at least not in most people. The best first step you can take is to recognize that this is a problem you need to deal with. The second step is to get professional help. These two steps may in fact be the hardest part of the healing process. The majority of sufferers do not get the treatment they need. In many cases, people are unaware that they have an anxiety disorder and visit a doctor because of the physical symptoms they are experiencing – headaches, neck pain, palpitations or chest pain.

If you suspect you are suffering from GAD symptoms and visit a physician, the first thing s/he will do is to rule out the possibility of an underlying medical illness, such as heart disease or other heart abnormality (e.g., mitral valve prolapse), or an overactive thyroid. Once other medical conditions have been ruled out, the physician may diagnose an anxiety disorder if certain criteria are present. You may be referred to a mental health professional (such as a psychiatrist or a psychologist) who will use specially-designed assessment tools to determine whether anxiety and / or another emotional disorder such as depression or panic disorder is present.

(If your anxiety is so extreme that it is bringing on suicidal thoughts or behaviors, you need to seek emergency treatment).

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Drugs: A crutch, not a cure

There is no drug that will “cure” anxiety. But, often, medicines can be a beneficial short-term crutch. Given the proper support and guided with effective psychotherapy techniques, an anxiety disorder can be effectively tackled. But medication is definitely indicated if the symptoms are severe and seriously interfere with daily functioning. Psychotherapy can't work well if a person is so overwhelmed by anxiety that (s)he cannot concentrate.

The drugs commonly prescribed for anxiety include not only anti-anxiety drugs but also anti-depressants. Most physicians will start medication at a low dose and then increase it slowly according to your response. You will need a trial of several weeks at full dose to determine the benefits.

Many forces come to bear on anxiety. Research and clinical experience show that the medications are of no benefit to some people and can make matters worse for others. If medications do not benefit you, give your other options a fair trial.

The promise of psychotherapy

“Cognitive behavior therapy” is the technique that has won its spurs in the treatment of GAD. In most cases, used in combination with medication, it can produce lasting improvement with very low relapse rates; indeed, clients often continue to improve after treatment is over.

The approaches used in psychotherapy are targeted at helping the anxious person:

• Understand what is causing the anxiety and what is keeping it going.

• Learn to challenge the thought patterns that bring on the anxiety

• Learn to change the behaviours that reinforce the anxiety

• Learn new coping and problem-solving skills

• Combat the physical symptoms of anxiety through the use of relaxation techniques

Introduce lifestyle changes that can help to control the level of anxiety (e.g., reducing consumption of caffeine, which is known to heighten symptoms of anxiety; getting regular exercise; avoiding coping strategies that are actually stress enhancers -- alcohol, over-work, casual sexual relationships).

Develop a helpful spiritual or philosophical perspective on life’s challenges.

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Can anxiety be self-treated?

Self-help, as a stand-alone approach, has shown limited success in battling moderate to severe anxiety. However, if your symptoms of GAD are mild -- though chronic -- you can try the self-help methods, below. If you don’t improve, do seek professional help.

You need to work on at least four different areas.

1. Understand your anxiety better. By now, you probably have a fairly good idea about what is causing your anxiety. But get down to the nitty-gritty. Analyse your anxiety: Is it related to certain people or situations, is it worse at certain times of the day, does it centre around realistic worries that would make anyone anxious?

In getting at the answers, you may find it helpful to keep an Anxiety Diary. For a period of at least 2 weeks, keep an hourly diary of your anxiety level, rating it from 0 to 10. Note down anything that seems important. Did the anxiety come on when you were at work, or when you were home? Who was (were) with you, what were you doing, what were you thinking about? You will gradually begin to become aware of situations that make you anxious, or situations you may even be avoiding.

2. Challenge negative thoughts. Our thoughts (i.e., the “self-talk” we engage in) play a central role in keeping the vicious circle of anxiety going. It isn’t always easy to catch the thoughts that are bringing on your anxiety or making it worse – these kind of thoughts can come and go in a flash and may become so much of a habit that they are automatic. The way to pin them down so you can examine whether they are rational or not is to put them in writing. So, in your anxiety diary, write down your thoughts in situations where you felt anxious. Any thought counts, even something like, “Oh no, here I go again.”

Step 2: Ask yourself -- Is this thought rational, is it grounded in reason and reality? There are many kinds of faulty thinking that won’t stand up to rational challenge. For instance:

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Am I “catastrophizing”? (“That’s done it – I’m going to be dismissed for this error”).

The Challenge: Is it really a terminal disaster? Is it terrible, horrible, awful, the end? Or is it more on the lines of a faux pas that I can apologize for and take steps to rectify?

Am I jumping to conclusions? (“Something’s bound to go wrong at this interview, I just know it will”).

The Challenge: How do I know it will? What’s the evidence that something’s “bound to” go wrong? Why isn’t it likely that everything will go beautifully right?

Am I focusing on only the bad things? (“Yesterday was a really lousy day”).

The Challenge: But what about the rest of the week gone by which had some really good days?

After you’ve tried challenging the thoughts that are making you feel anxious, ask yourself, “Instead of getting paralysed with anxiety, is there something concrete I can do in this situation?” Which brings us to the next step.

3. Try Some Problem Solving. If you become conscious of a concrete problem that may be causing you anxiety, a problem-solving approach may help. A good way to begin is, once again, by writing down the specifics of the problem. “I’m worried about my health” is too vague. Something like, “I’m feeling a little concerned about the fatty liver condition that showed up on my ultrasound” is more helpful.

Next, write down as many possible solutions as you can. Never mind if some of them sound trite or obvious – write down whatever comes to mind. Possible solutions might include:

Reduce or discontinue my alcohol intake

• Cut down on high-fat foods

• Take up exercise

• Avoid, as far as possible, medications that may affect the liver, such as steroids

• Keep my blood sugar levels under control

• Check my cholesterol levels and follow up with medical treatment if necessary

• Consult a medical specialist for more advice

Choose what seems like the best solution(s), and write down all the steps it might take to achieve that solution. Who might help? What might go wrong? Give yourself a confidence boost by reminding yourself that you have successfully come to grips with other problems before. “I have solved similar (or more difficult) problems”, “I can solve this problem if I try hard enough”, "I can do this", "I'm a survivor".

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Then implement the solution(s) you’ve decided is your best option, or the one you can begin with.

Sometimes, of course, you may need to accept a problem as presently unsolvable. In such cases, it is often helpful to ask yourself: “What is the worst thing that could happen?” You may well find that the worst is not so terrible, after all! And, if you can think of a plan to cope with the worst-case scenario, your anxiety may well abate.

4. Learn to relax. Reducing the intensity of the physical symptoms of anxiety can prevent it from becoming too severe. Some people can relax with a good book, others by listening to music. Still others may find “relaxation exercises” more helpful. These need to be learned and may take time. You may even benefit from "breathing re-training". When you are anxious, you tend to hold your breath. Practising deep diaphragmatic breathing calms your system. Also good to try, depending on your preference: yoga, meditation and / or deep muscle relaxation.

Many people find deep muscle relaxation (also called “progressive relaxation”) very effective in reducing levels of tension and anxiety. But it’s important to learn the correct procedure; also, first consult your doctor if you have a history of serious injuries, muscle spasms or back problems, because the deliberate muscle tensing of the procedure could exacerbate these conditions.

(The author is a former editor of 'Health & Nutrition' magazine, and now works as a counseling therapist)

Read more at: Mind | Heal Thy Self |