The basic definition of anxiety is a sense of fear out of proportion to actual threat of danger.
The definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is varied, because anxiety can be a temporary state, a disorder, or a specific subset of symptoms. I'd like to talk about some of those variations and the subsets of symptoms - in other words, the many faces of anxiety.
Eee-GAD! There is a diagnosis called Generalized Anxiety Disorder (GAD for short). In order for this to be your diagnosis, you would need to have a lot of worries in several different situations more often than not in the past 6 months; worries are difficult to control; and they manifest in some physical symptoms such as body tension, restlessness, fatigue, insomnia, or difficulty concentrating. (NOTE: The DSM adds criteria to each diagnosis to say that another more specific diagnosis wouldn't explain it better, symptoms aren't due to a health problem or substance use, and they "cause significant distress or impairment.") GAD and other anxiety disorders are the most common mental health disorders in the U.S. but only about a third of people with anxiety get treatment (source). Treatment usually consists of Cognitive Behavioral Therapy (CBT), or some form of it. Other forms or off-shoots of CBT are REBT, DBT, and ACT. All of these have shown to be effective in treating GAD.
Social Anxiety Disorder. This is one of the specific types of anxiety. It may overlap with GAD and also lasts for at least 6 months, but the symptoms do not equal GAD, because they only occur in social situations and require: a fear of social embarrassment or criticism, recognition that the fear is somewhat irrational, and intense distress and/or avoidance of situations that might include embarrassment, judgment, or criticism. In addition, people may have panic attacks: physical feelings such as racing heartbeat, sweating, dizziness, numbness, and the feeling that one is going to faint or even die.
I see many adolescents with social anxiety. They often avoid going to school. Some parents or teachers think of their behavior as avoidance of school work or bullying, or they may see it as plain shyness. But to have the disorder means that the symptoms and avoidance are out of proportion with the threat - in other words, they may never or rarely have been bullied, and shy people might be shy, but not have social anxiety. I always tell people with this diagnosis, "Your anxiety is lying to you." Anxiety tells you that the best thing to do is to avoid the thing that causes your anxiety. But the treatment for it is actually the opposite: you must go toward the thing that makes you anxious. Avoidance only temporarily causes relief but strengthens the anxiety response in the long run. Treatment is usually (again) CBT, especially challenging faulty thinking by asking yourself:
Agoraphobia. Social anxiety or other anxiety disorders can overlap with agoraphobia, which is now its own anxiety disorder. People - myself included - used to think of agoraphobia as the fear of going outside, but this isn't true. Agoraphobia means that you fear and avoid of places and situations that might cause feelings of panic, entrapment, helplessness, or embarrassment. For some, it is a fear of standing in line at the grocery store, For others, it is going to a class in school where you know the teacher might not let you leave. Agoraphobia often goes hand-in-hand with panic. This makes sense - if you felt unsafe in a situation and like you could not easily escape it, wouldn't you panic?
Treatment for agoraphobia is often in the - you guessed it - realm of CBT or CBT-like therapies. Again, your anxiety is lying to you: the situation you are in is probably not unsafe, and you probably could leave, if you needed to. Therapy might include looking at irrational thoughts and challenging them (as in the example above). For some, such as adolescents in school, it might require a modification of the rules for that person (in Oregon, this is known as a 504 Plan) - within reason, e.g. giving the student permission to take a break from class if needed. Ultimately, in therapy you may be asked to consider working on coping strategies for panic so that you can face those situations that cause the anxiety.
Obsessive Compulsive Disorder. Another specific type of anxiety, OCD involves intrusive thoughts and (often) behaviors in response to certain thoughts or situations. A person with OCD will usually try to neutralize the thought with a behavior - which works briefly. The subtypes of OCD are worries about:
Anxiety has many faces. You can even be diagnosed with "Anxiety, unspecified," by a doctor or therapist if you have significant distress and worry, but it doesn't meet the criteria of any of the above (or they don't know enough yet about your anxiety).
There are medications that can help, in addition to the therapies and strategies above, but many of them are prescribed less and less often these days because they are opiates and addictive. Doctors and psychiatric nurse practitioners will often use SSRIs or SNRIs, which are the very same medicines used to treat depression, and are not opiate-based or addictive. They take time to build up in your system and must be taken daily, rather than as-needed. Some people don't like this.
Some people don't like therapy, either, but if you are in distress and don't want to live that way, doing something is always better than doing nothing. So, I suggest you start by asking someone you trust and who knows you well. Treatment is personal and your situation will be different from others. Get help right away if you need it (see 3 links here). Or, if you don't need immediate intervention or are just looking for some information, I hope you have found something helpful here.
It may seem like there is no "magic" to this exercise. That would be one way to look at it.
Another way to look at it would be that there is magic - magic in its own time, and in your own ability to transform yourself through consciously applied effort. Magic is, in some way, a skill. Do you think David Blaine, David Copperfield, Harry Houdini, Harry Blackstone Jr, Cris Angel, or other magicians were blessed at birth with superhuman powers? Or is it more likely that they learned, honed, and demonstrated a skill?
You can use your conscious mind and its logic to transform itself - which is actually awe-inspiring, if you think about it. Your own brain is able to change at any age (see this post for more on that) because of what you do and think. It comes down to whether you are willing to create that change - over time, through applied effort. In the exercise below, which is adapted by me, very CBT-based, but mostly taken from an old exercise by J Roberts, you will learn, hone, and demonstrate the skill of changing your beliefs about yourself.
Step One. Start with a negative belief (you don't want to change a positive one, right?). Some examples: I'm unworthy, invisible, don't matter, not enough, a problem, unloved, weak, etc. If you really don't know what you believe about yourself, pick one of these that rings true or that you could see believing about yourself.
If you discover that you feel unworthy, for example, you may have tried simply to apply a more positive belief over that one - and found that alone didn't always work. In this exercise, you must first discover the reasons for your stubborn beliefs. You can begin by doing the following: a) Write down your feelings about yourself. attempting to be perfectly honest; b) Examine what you have written; and c) Realize that a set of beliefs is involved, not an objective reality.
Step Two. Then you must challenge these beliefs a little. For example, start by acknowledging that there IS a difference between believing that you are unworthy and being, in fact, an unworthy person. No one is an unworthy person, plain and simple. If a friend came to you with the same list of "defects" (beliefs), you would encourage them to challenge these things. It's only fair to do the same for yourself. See this page for a list of more questions, known as Socratic questions.
Step Three. Now, write a list of your abilities and accomplishments. These should include such things as getting along well with others, taking care of yourself or others when sick, being good with plants or animals, being a good carpenter or cook or poet - any talent of achievement should be noted honestly, as if you were a good friend helping you to write your list. Again, you do not need "objective proof." We're not scientists or lawyers here. Science and facts are necessary in the laboratory or court room, but not here.
That's it! These are all the steps. Remembering how I said it takes time and effort, you may ask, What's next? Good question. Well, you know how the shampoo bottle says: Lather - rinse - repeat - ? Now it's your job to: Identify the negative belief - challenge it (this can be with logic, Socratic questions like some of the examples above, or with positive affirmations) - and repeat . . . and repeat . . . and repeat. After all, this is exactly how those negative thoughts got turned into what you believe to be true - you said them over and over again, until you forgot they were just thoughts you kept thinking, and NOT facts.
There is no human being alive who does not have the ability to control and choose their thoughts in his or her own way. There is no human being who does not have achievements and excellent characteristics. You are a human being, so you are no exception. If you follow these instructions you will find out that you are indeed a worthy individual with many fine and wonderful qualities.
If you allow yourself to be more and more aware of your own beliefs, you can work with them. It is
silly to try to fight what you think of as negative beliefs, or to be frightened of them. They are not
mysterious. They may even be there to help you, as you may find that many served good purposes at one time. They simply became overemphasized, unnecessarily repeated. Now they need you in order to have the light shine on them, so they can be restructured or removed, not denied.
2:27 The "CBT Triangle (no relation to the Bermuda Triangle...)
3:45 Watch me do a magic trick with my dog!
3:46 List of "thinking traps" - click here for more.
I don't know about you, but I've been hearing therapy jokes since I was a kid. That's all well and good, and I get it, I really do. When I would see a character in a movie about to get really mad, take a deep breath, and go to their "happy place," I snickered and phfft'ed. I joked with friends about Al Franken's SNL character "Stuart Smalley" ("I'm good enough, I'm smart enough, and - doggonit - people like me,"), joked about anyone trying to get a sense of peace who dared to sit cross-legged, their thumb and forefingers together, chanting, "Ommm."
As a therapist, I can now see how these jokes minimize the therapeutic effect of some actual coping strategies and really turn people off to simple things that might work for them. For example, in doing a therapy called EMDR (Eye Movement Desensitization and Reprocessing), one of the preparations for trauma processing is a resource called "calm, safe place." Yep, you guessed it: It's going to your happy place. In the EMDR version, however, guided eye movements are involved as the client imagines a place with as many sensations possible that makes them feel calm and safe, and then use this later to counteract many of life's little annoyances.
Should we throw out these simple strategies when they seem like tired cliche`s? I don't think we could, even if we wanted to. There are very practical reasons why things like deep breathing, affirmations, and visualization work.
Deep breathing. I wouldn't advise foregoing a deep breath every now and then. In fact, this article on MindBodyGreen provides five very practical reasons and concrete effects from deep breathing. This includes improving fat loss by oxygenating our cells, helping the lymphatic system remove toxins, and easing pain and increasing relaxation through the release of endorphins. And this article on Selfication talks about how our shallow, tense breathing habits can really mess up our body functions - constricting blood vessels and airways, unbalancing the nervous system, and decreasing our overall energy. It's easy to forget how important breathing is, especially because we mostly rely on doing it unconsciously, but I always appreciate reminders of just how vital it is for mental health, not just, well, life itself.
Affirmations. Bringing it back to our non-therapist friend Stuart Smalley, affirmations are quite helpful - and theatrically portrayed as totally ridiculous. We use negative affirmations all the time via our internal mind's anxious chatter: I'm such an idiot. My life sucks. I hate my body. So we need to be aware of this and counteract these with positive statements, because we get what we concentrate and focus upon. To illustrate this, think about how often you find things you aren't looking for versus finding things you are looking for. Lost your keys in the morning before work? Can't find your wallet? Well, you're probably not going to have a lot of luck finding them if you never try. Same goes for affirmations: if you make a point of naming the positive aspects of yourself and others, even if they are just potential aspects, you're much more likely to find them.
Visualization. This can be more than a "happy place." There are many guided visualizations (or guided imagery) on YouTube that you can follow for many purposes, such as insomnia, quitting smoking, relaxation, or self-esteem. Some I like and have listened to include the following channels: Jason Stephenson, Michael Sealey, and YouAreCreators. Inner Health Studio is a website providing free scripts for meditation on a variety of subjects, mostly for relaxation, but they also include a nightmare reprogramming script which is a very good technique for stopping recurring bad dreams. Read the scripts in your own voice into your phone or computer voice recorder and play whenever needed.
I hope you find something helpful in the above links - if not, keep looking for something that helps you do your thing.
And as always, contact a therapist or helpcenter like this, this or this if you are in crisis and need personal help right away.
The most popular request I hear from people, especially when they're referred to counseling by their doctor at the clinic where I work two days a week, is for coping strategies.
Coping strategies will be different for everyone. Aside from personal preference, it also depends on the diagnosis. For example, if a person has a trauma-related disorder like PTSD, I will recommend ongoing counseling for trauma processing. This might mean cognitive behavioral strategies that ask you to tell your story to the counselor and then work together on desensitizing you to the intensity of the memories; Trauma-Focused-Cognitive Behavioral Therapy or TF-CBT is a recommended best practice for this. Or, it might mean finding a therapist trained in doing Eye Movement Desensitization and Reprocessing (EMDR), another best practice for trauma.
In general, though, all of us should find coping strategies or coping skills that work for us in times of stress or when symptoms of depression or anxiety increase. In order to find the ones that work, we have to try them out. Makes sense, right? Try them not just once, and maybe not even twice or three times, but really give these things a good effort every day for, say, a week. Depression and anxiety symptoms involve patterns or habits that took a while to develop and then got stuck in your mind or in your life. Let's be honest: it probably took much longer than a week. So it's only fair to give new skills and habits a shot to stick in your mind and life, too.
Below is a list of fifteen coping strategies that could be good for a variety of situations: feeling down, depressed, negative, panicked, worried, overwhelmed, betrayed, or grief, for example.
You may like to put these on small index cards - just print, cut out, and glue to a card. Maybe spend some time on the card, such as by giving it some meaningful doodles, decoration or just coloring it in. Spending some time on each card in this way can help you remember it.
And as always, if you are in need of help because you're having thoughts about suicide, please go straight to #1 - reach out to someone near you and ask for help. Or call 1 (800) 273-8255.
I am Lisa and I believe we create our reality. I hope to help empower people to create more mindfully, be kind to oneself and others including animals and the environment, and just generally feel better.