Free Yourself from Anxiety (10 page)

We’ve already explained the key skills of relaxation, basic calm breathing and goal setting. Now we need to look at two more skills that relate to your mental attitude to recovery.

This is not the same as the cognitive part of CBT, which we’ll deal with in Part Three. It’s more about finding a mindset that will help your recovery rather than hinder it.

Anxiety has a very limiting effect on a person’s life – they may avoid going out, restrict their social contacts, spend many hours on rituals instead of enjoying life, and so on.

There is a parallel effect on your mind. If you spend most of your time worrying, or working out how to avoid certain things, or how to manage life within the restrictions imposed by Anxiety, then you’ll become mentally stale. Your thought processes will run along the same old grooves.

Then there is the fear factor. If even thinking about certain things brings a spurt of panic then you’ll avoid thinking about them. You’ll stop thinking of yourself as a person who can, for example, have a career, or travel the world, or face the challenges of life. You’ll become
self-protective
and afraid to take on anything new in case it makes your Anxiety worse.

At the beginning of recovery work, people often give the impression that they want desperately to get better but they also want to hang on to their current mindset, even though this mindset is helping to maintain their
Anxiety. Changing your mindset is really important, but like everything else in your recovery programme, it can be done in small controlled steps. As you work through the exercises, you’ll find that your mindset changes, slowly and gradually.

The first key skill is accepting that change is necessary. Change is scary for almost all of us. Just think of the first day at school, or the move to a new house. In fact if you look back at the Holmes-Rahe stress scale in Chapter 7 you’ll see that almost everything on the list represents a change in status quo – someone was married, now they’re divorced; were fit, now they’re injured; were solvent, now they’re in debt, and so on.

If you have experienced massive stressful changes, and have developed Anxiety as a result, it’s no wonder that you don’t want there to be any more change. Even if you haven’t been through stress like this, the effect of Anxiety is to make you fearful of change. If you feel that you’re only just coping with life as it is, you’re bound to want things to stay the same, just in case you can’t cope with anything new.

And yet everything about recovery involves a degree of change. If you were living off caffeine and thin air, you already know that you need to change your diet. If you were breathing badly, you’re now learning to breathe well.

And because you’ve read this far, you know that the key is to make the changes in small controlled steps. You can get used to each step before you move on to the next one, and slowly but surely you will find yourself making the changes you need to make.

There will be more change as you work through this book. If you take it steadily you will manage it.

If change feels too challenging, and you aren’t sure that you want to engage with it, then try this exercise.

In your notebook divide a page into four equal squares. Give each square a heading: Advantages of staying as I am, Disadvantages of staying as I am, Advantages of change, Disadvantages of change.

Next write down as many points as you can think of under each heading. Here’s an example for someone with OCD around causing harm to others.

Advantages of staying as I am
I can be sure that I haven’t hurt anyone as long as I do my checking rituals.

Disadvantages of staying as I am
I am isolated because of the time I spend checking.
My family life is disrupted.
I can’t work so my income is low.
I’m very unhappy with my life.
My OCD is steadily getting worse.

Advantages of change
I could get back in touch with my friends.
My family would be much happier.
I’d be able to get back to work.
I might be happier.

Disadvantages of change.
I’d be very uncomfortable, I might not be able to bear it.
I’d feel like I was taking a huge risk, in case I did harm someone.

The key sentence here is ‘My OCD is steadily getting worse’. This means that change is going to happen anyway, whatever you decide
about undertaking a recovery programme. If you decide to do nothing, then the chances are that your Anxiety will get worse and you’ll find yourself constantly fighting a rearguard action, trying to hold it back. On the other hand, if you take charge and work towards change that you choose, then you can make it happen in a positive way that leads you towards recovery.

Many Anxiety sufferers are naturally cautious people, or they learned caution from their families as they were growing up. Others become fearful of risk as a result of their experience of Anxiety.

When you read about the need for change, did you feel a stab of fear? Does it feel to you as if making changes is just too risky?

There is an element of risk involved in undertaking recovery work. You
may
have a panic attack if you venture out to the shops, you
may
feel worse rather than better if you cut down your rituals, you
may
embarrass yourself in public if you go out into the world.

But you know what we’re going to say to you here – if you take it slowly, and break it down into small steps, then the risk at each stage is very small. If you persevere with the lifestyle changes and set yourself SMART goals, then you’ll make the risk as tiny as possible.

But still, undertaking the programme will feel risky. The first time you step into the place you’ve been avoiding, the first time you walk away without finishing your ritual, will be challenging. At this point you need to ask yourself – do I want to carry on as I am, living in the black hole of Anxiety, or do I want to take a small, carefully structured risk as a step along the road to recovery?

Remember, nothing is without risk of some kind. You may feel that staying indoors or avoiding situations keeps you safe. But by placing such
restrictions on yourself you
risk
losing friends, self-esteem, quality of life – quite a big trade-off for some short-term discomfort.

This exercise will help you to assess risk objectively. In your notebook, divide a page into two columns, one headed Gains and one headed Losses. In the Gains column list all the benefits from taking the risk, and in the Losses column list every disadvantage of taking the risk.

Here is an example for someone with agoraphobia/social phobia who is trying to decide whether to go to a film with friends:

Gains
 
I’d like to see the film, I only see old films on TV now.
I could see my friends without having to make much conversation.
I know I’d feel better for getting out of the house.
I’d get a wonderful feeling of making progress with my recovery.

Losses
I might not enjoy the film.
I might feel too nervous to chat to my friends.
I might say or do something embarrassing.
I might feel so panicky that I can’t go.
Something unforeseen might happen that I can’t cope with.

Next, they look at the Losses list and decide whether they can manage the risks:

I might not enjoy the film –
I can cope with that.
I might feel too nervous to chat to my friends –
they’re used to me being quiet.
I might say or do something embarrassing –
I can’t bear the thought of that.
I might feel so panicky that I can’t go –
I can use relaxation to calm me.
Something unforeseen might happen that I can’t cope with –
my friends will look after me.

Finally, they have to decide whether to take the risk. Clearly in this example they are most worried about embarrassment. They will have to decide whether to take this risk, or whether to aim for a smaller, more manageable goal.

Many Anxiety sufferers have never told anyone about their problem. If you feel ashamed or embarrassed about having Anxiety you might feel quite unable to talk to anyone about it. You may also feel that you’ll be labelled forever as someone who was mentally ill, that you won’t receive any sympathy, or that you’ll be forced to try treatments that you don’t really want.

Even if you haven’t told anyone, your friends and family are being affected by your illness. They may not know why you keep turning down invitations, or refuse to go on holiday with them, but they do know that something is preventing you.

People are naturally curious, and they’ll wonder why you behave as you do. They may decide that you’re just shy, or guess that there’s some sort of problem. They may also come up with explanations that are way off beam – such as thinking you’re unfriendly, or consider yourself too good to mix with them.

Did it upset you to read that? If only people knew what you’re going through, then they’d have more sympathy, surely? Or would they judge you as weak, or pathetic? Struggling to keep your illness a secret adds greatly to the stress of Anxiety, so does worrying about who to tell, and how.

Only you can decide what is right for you, but many people have reported the great relief they felt when they finally confided in someone.

Many sufferers tell only one person, usually their partner or a family member. If they need a lot of support from that person they may then start to feel guilty about it, or perhaps resentful that the person isn’t doing enough to help. It can make more sense to tell a few trusted people so that they can share the helping tasks. You may find that one person has a soothing presence and you enjoy their company, while another is helpful in a practical way.

It’s important not to let your friends and family become part of the problem. If they always do your shopping for you, or check the house for spiders, or let you travel in the front seat of the car, then they are helping to maintain your Anxiety. No doubt they are busy people, and find it easier to go along with your immediate needs rather than take the time to help with recovery. With the best will in the world, they are doing exactly the wrong things. Of course temporary help, while you work on your recovery, is quite a different matter.

People with OCD do often admit to their difficulties, because they need help with their OCD. Sometimes they need help to complete their rituals, and sometimes they have a compulsive need to ask for reassurance. If you have OCD, you may have already involved your friends and family, even if it’s just that they have to tolerate the extra time you need to do everyday tasks. They may also be obliged to live in a certain way (e.g. always wiping door handles after touching them) or may be involved in giving reassurance.

Whatever kind of help you have, you will at some point need to let go of it and take responsibility for yourself. Like every aspect of recovery, it can be planned as a series of goals aimed at gradually reducing your need for other people to support your Anxiety behaviour.

For a few people their Anxiety becomes so extreme that they need to be cared for by another person. This is a tough role and carers often become exhausted, while the person they are caring for has yet another worry – what happens if my carer can’t carry on?

This is an extreme scenario of course, but it does give a tremendous motivation for undertaking recovery. Even someone whose Anxiety has become this bad can start a recovery programme – there is no situation so bad that it can’t be turned round by slow steady repeated steps towards carefully chosen goals.

It’s best to tell your carer what you are planning to do, so that you can work through the programme together. You may need to make changes in your daily routine, or ask for extra patience and understanding while you work on your goals.

The basic tool that is used in CBT for changing behaviour is Exposure or systematic desensitisation. It is based on the understanding that Anxiety decreases the longer you tolerate it. This can be very hard to accept for someone who feels anxious all the time, or whose panics seem to last for ages, but the fact is that fight-or-flight is only designed as a short-term response to deal with immediate danger. Your body is very keen to switch off the fight-or-flight and with a little help from you, it will manage it.

In exposure work you choose to enter the situation that provokes your Anxiety in a controlled way. Someone with OCD will choose not to do their rituals, again in a controlled way.

There are some important aspects to exposure work that you need to understand before you get started.

Anyone with OCD whose obsessions and compulsions are both thought-based still needs to do exposure work, although they will need to design their programme around their compulsive thoughts rather than behaviours.

Continuing our example of someone who wants to get back to work, they have already looked at what is stopping them, and they know which form their Anxiety takes, so they know where to direct their efforts. The next stage is to look at intermediate goals that will take them towards the ultimate goal of returning to work.

It may be that you have more than one problem. An agoraphobic may have problems travelling, and being with other people. Someone with OCD may have problems with what they perceive as a dirty environment both while travelling and while at work.

The only answer is to take the issues one at a time, and the key at all levels of goal setting is to start with the one that you feel will cause you the least stress and be the easiest to achieve.

Your next step is to make a list of five medium-term goals that will help you towards your main goal. Here’s an example for an agoraphobic who wants to get back to work:

Here’s an example for someone with an obsession about dirt who wants to get back to work:

Neither of these lists is in any particular order, because each individual will have their own ideas about what they might find easiest and hardest. It seems likely that the agoraphobic will find the weekend away the hardest to do, and either the bus journey or the corner shop the easiest. The person with OCD might find reducing toilet cleaning to once a day the hardest and the public lavatory the easiest. Or vice versa.

Make your own list of five goals in your notebook. Put the goals in order of difficulty. Remember to make your goals SMART.

There are some goals that fulfil all the SMART requirements that are still not very practical because of the need to keep repeating them. If you live in a village with only one bus a week, then you can’t practise bus travel every day. If you are afraid of flying, you won’t be able to get on a plane every day.

One answer is to look for other situations that imitate the one you fear. If you dislike being shut into a confined space with other people, then you can use lifts, cars, even meetings to practise that as well as getting on the bus or plane.