Excerpt from Controlling Anxiety: Self-help Strategies to Conquer Fear and Phobias and Live with Confidence
This book is written primarily as a self-help book. Many people suffer from anxiety, often mild, but sometimes crippling. This is not a textbook on mental illness, although much of what will be discussed does come under the umbrella of mental health. The book is written for the person in the street, and not in technical language.
As Dr Claire Weekes said in her book Self Help for your Nerves: ‘Many of those who suffer from nervousness are persons of fine sensibilities, of delicate regard for honour, endowed with a feeling of duty and obligation. Their nerves have tricked and misled them.’
This is the stance I have taken in dealing with people who suffer from anxiety, and indeed, other mental health problems. The seeds of anxiety, depression, and any other of what we call mental illness, lie within us all. The fact that we can feel jittery about taking an exam, or feel ‘blue’ when things are not going right, or we can’t stop crying when someone dies, or we think someone is getting at us, all indicate that we have the potential to experience full-blown mental illness. None of us is so superior that we are immune from the traumas of life. If to this stage we have not suffered crippling anxiety, or depression that sucks into the depths of despair, or obsessions that torture our waking hours and torment our dreams with terror, then we should count ourselves very fortunate. At the same time, let us not be complacent and think that it will never happen. None of us knows what is round the corner of life. None of us knows how we will cope with, for example, the sudden death of a loved one.
I do not talk about ‘cure,’ but of finding the strength within to rise above whatever is causing the anxiety. My belief is that if we can turn the anxiety indicator down at least one notch, then life will be lived with more pleasure and satisfaction.
‘The strength to recover is within you, once you are shown the way.’ My sincere hope is that Dr Weeke’s words will find an echo in your heart if you are desperately searching for some ways of making sense of what is happening in your life. If you work with people who are suffering, then I hope that this book will help you to help them.
Finally, although I believe that all people who suffer from anxiety will find benefit from reading this book, and from other self-help books, when anxiety is chronic, or when it interferes with normal activity, the sufferer is in need of medical help, which goes beyond the remit of this book.
Feeling anxious, or any of the variations talked about in this book, is nothing to be ashamed of, any more than it would be if you developed pneumonia. Feeling crippled by anxiety is not a sign of weakness. It does not mean that you are immature, nor that you are a hopeless case. You may feel hopeless; you may feel constantly under threat of something you cannot identify, so much so that you fear you are going mad. Take notice of these feelings, for these are what your doctor needs to hear. The more you can tell your GP, the more informed his choices will be when it comes to offering you help.
Above all, when things look the blackest they have ever looked, remember this: you are a very important person. Whatever your life story is, however traumatic or disturbed, you are still important. Someone, somewhere, needs you, and whatever you are passing through right now, think on this: you are passing through, and you will come out at the other side. You have a contribution to make to society which only you can make. That is why you are a very important person.
I am indebted to Neil Morrison of the Institute of Counselling, Glasgow, for permission to use some of the material from two of the Institute’s distance learning courses: Introduction to Stress Management (1996), and Psychology for Counsellors (1996)
ASSESSING YOUR KNOWLEDGE OF ANXIETY
Anxiety is a distressing feeling of uneasiness, apprehension, or dread. Anxiety as a physical and emotional response to a fear may be rational, based on an actual event, or irrational, based on an anticipated event which may, or may not, take place, and when no appropriate action is finally taken.
A certain amount of unrealistic and irrational mild anxiety is part of most people’s experience, and seems to be an unavoidable part of human personality. Indeed, unwelcome and uncomfortable emotions are expected, commonplace experiences in the everyday lives of most people.
Very often these feelings are made worse by dwelling on the fear of what the emotions might mean. Generally the fear is of some terrible illness or disease.
At a deeper level anxiety as a fear of non-being, which may be fear of death, but also of a sense of meaninglessness and a powerful sense of guilt.
Anxious people are in suspense, waiting for something, they know not what. A main source of anxiety is the fear of being separated from other persons who are felt to provide security.
Identifying the characteristics of anxious people:
- ever on the alert
- over-react to noise
- helplessness in the face of actual or imagined danger
- mood that alternates between hope and despair.
Identifying typical indicators of anxiety:
- skin pallor
- sweating, or, less often, flushed
- sweat on the upper lip and forehead
- sweaty palms
- dry mouth
- dilated pupils
- increased pulse/heart rate and breathing
- mild exertion produces undue increase in heart rate
- muscle tension
- dizziness, or light feelings in the head
- tightness in the chest and throat
- stomach feels ‘knotted’
- there may be diarrhoea and/or vomiting
- sinking feelings in the abdomen
- desire to pass water frequently
- limbs feel like jelly
- loss of sexual interest or inability to have sex.
Identifying levels of anxiety
Not all events that produce feelings of anxiety are necessarily unpleasant. Getting married or being presented with an award are two events that could be termed ‘pleasant’; yet they often produce feelings of anxiety. Generally, however, the anxiety associated with such events is not long-lasting, and feelings generally return to normal quite quickly, in much the same way as the heart rate, in a healthy individual, returns to normal after exercise.
Normal anxiety, in small amounts, is biologically necessary for survival. Anxiety in doses too large for us to handle, leads to panic, and panic produces irrational behaviour. Panic is more likely to be caused by ‘free-floating’ anxiety – anxiety that cannot be readily attributed to any specific event or idea. It is there, constantly lurking in the background. When it attacks, the person is once again set a-running on the treadmill. When anxiety is chronic, and not traceable to any specific cause, or when it interferes with normal activity, the sufferer is in need of expert help.
‘Free floating’ anxiety is characterised by ‘trembling, jitteriness, tension, sweating, light-headedness, feelings of apprehension and irritability. It frequently manifests itself as the result of opposing or conflicting wishes, desires, beliefs, life events, or strain resulting from conflict between roles. The more desperate the feeling of helplessness and indecision, and the more difficult the decision between two opposing forces, the more severe the anxiety. Anxiety may show itself in depression, hopelessness, powerlessness, poor self-esteem/self-worth.
Highlighting some typical anxiety-producing situations
- tests, examinations, medical appointments
- meeting deadlines
- meeting important people
- waiting for a baby to be born
- driving test
- being involved in a traffic accident
- hearing bad news
- relationships with:
- spouse (partner)
- work colleagues
- new relationships.
Identifying anxious events
- What incidents in your life do you associate with feeling of any of the above situations? These may be places you have visited; people you have met; events; situations in which you were involved. You may think of others that are not listed.
- Do you feel more anxious about actual or anticipated events?
- Can you remember the first time you experienced these feelings?
- Did you feel like this when you:
- started school?
- were punished for something?
- started your first job?
- were waiting at the wedding altar?
- went to a funeral of a friend/relative?
- took your first aeroplane trip?
- were admitted to hospital?
Understanding the treadmill of anxiety
Anxiety is both a prison and a punishment. Those who experience severe anxiety are trapped within a process over which they seem to have no control, in the same way that a prisoner would be subjected to the treadmill. There the pace was set by a gaoler. If he felt particularly vindictive, a turn on the control lever increased the pace at which the prisoner was forced to run. There was no respite; no escape. Exhaustion was inevitable. This is the picture of the outcome of anxiety; a state from which the victim may not escape unless some influence can be brought to bear on the gaoler to slow the rate at which the mill turns and allow the prisoner to step out onto firm ground.
One of the characteristics of anxiety is that the more severe it is, the more it erodes every aspect of the person’s life. The more this happens, the less able is the person to function effectively. The person’s total psychic energy is swamped with the anxious feelings. Thinking becomes unclear, and problem-solving ability is impaired. The inner struggle, the constant feeling of pressures, coupled with the feeling of not coping, leads to exhaustion and defeat. The prisoner collapses on the floor of the treadmill, while the gaoler laughs. Who is the gaoler? The gaoler is whatever, or whoever, it is that seeks to drive the person on to exhaustion. This may be a punitive conscience, guilt, ambition, fear of failure, or one of a multitude of fears. It is possible that there are multiple gaolers, each of whom may be at war with the others. The resultant conflict increases the tension felt by the victim.
Many people have a single anxiety disorder and nothing else, but it isn’t unusual for an anxiety disorder to be accompanied by another illness, such as depression an eating disorder, alcoholism, drug abuse, or another anxiety disorder. Often people who have panic disorder or social phobia, for example, also experience the intense sadness and hopelessness associated with depression or become dependent on alcohol. In such cases, these problems will need to be treated as well.
Identifying common anxiety and stress-related symptoms
Signs and symptoms of anxiety are heightened during times of stress. This is possibly because stress lowers our resistance, and what would normally not be a problem assumes frightening proportions. During times of stress, for example when someone dies, our normal defence mechanisms are weakened, allowing anxiety to surface. Fatigue often leads to anxiety and is caused by trying to spread ourselves around too thinly.
High blood pressure
Figure 1 summarises the signs and symptoms of anxiety that can occur on each of the three planes
The symptoms marked * are more severe in panic attacks though many may also be present in generalised anxiety.
|Butterflies in stomach
Chest pains or other discomfort *
Dizziness, faintness, unsteady, light-headed, or faint *
Hot flashes or chills *
Feelings of warmth
Heart palpitations *
Light-headedness or dizziness
Muscle tension / aches
Numbness or tingling, especially in the extremities*
Rapid, pounding heartbeat
Shaking or trembling
Shortness of breath or a feeling of smothering or choking *
Tightness of chest
Tingling or numbness
Trembling or shaking *
Weakness all over
|I can’t do it
What if I make a fool of myself?
People are looking
I could faint
It’s a heart attack
Get me out of here
No one will help
I can’t go alone
I can’t breathe
I’m going to die
I’m going crazy
I feel confused a lot
I’m not going out
What if someone is hurt, sick, has an accident
My thoughts are speeded up
Criticised by other people
Fear of dying. *
Fear of going crazy and doing something uncontrolled *
Feelings of doom / gloom
Keyed up / on edge
Trapped-no way out
If you checked 3 or more from each of the three lists in Figure 1, ask yourself:
- How far the fear of an anxiety attack limits your involvement in life.
- How far are you avoiding every day situations.
- How much of the time do you worry and feel tense.
How you answered the questions would influence whether you feel it advisable to seek help from your GP. A simple physical examination and talking over your feelings may be enough to reassure you that nothing serious is wrong. The GP may recommend light medication, or counselling which is likely to include teaching you how to relax. Learning to relax is often the first step to controlling feelings of anxiety.