Anxiety is the combined experience of thoughts, emotions and physical sensations which occur when we experience fear in one form or another. Anxiety can manifest itself in different ways. It is important to recognize that anxiety is a fundamental human emotion that cannot just be willed away. One cannot just say I do not wish to experience anxiety. In some ways the more we try to will away our anxiety the more anxious we become. Coming to terms with anxiety starts with the recognition that anxiety is actually part of our normal human experience and is intended to function as a cue to help us stay safe.

Consider the following examples.  I am about to walk into a dark room which I am unfamiliar with and I experience some anxiety. Now ask yourself if it is okay for me to experience anxiety under this circumstance. I would say - yes it okay for me to feel anxious. The anxiety I would experience would come from the legitimate fear that I could bump into something or find something unexpected or dangerous. Physiologically my mind would respond with heightened attention, my adrenaline system would activate and my body be more prepared to respond to danger. Another example is the anxiety I experience when studying for an exam. My fear of failing an exam would create enough anxiety so that I was more driven to study. These two examples illustrate how anxiety can function as a normal and healthy tool to keep us safe and assist us in reaching our objectives.

In both the above I accept and normalize my anxiety and identify ways of allowing anxiety to steer me in the right direction.

So if anxiety is normal how come it can cause so much suffering. Lets go back and examine what happens if when I experience anxiety I say to myself "something is wrong - I should not be feeling this".  If something is wrong because I feel anxiety then this in itself becomes a danger signal or threat and I will experience even more anxiety. Now I have anxiety because I fear experiencing anxiety. This then becomes a viscious and downward spiralling circle. When I reject  or battle with anxiety at a cognitive, emotional and physical level  then the experience of anxiety makes me dysfunctional as opposed to enabling me as in the the examples I used above. Hopefully you are just begining to see how it is not the anxiety itself but the relationship we have to the experience of anxiety that leads to anxiety disorders / disordered anxiety.   Another way to view disordered anxiety is to see it as anxiety which arises from a fear, intolerance or avoidance of naturally occuring anxiety.

At the begining of this article I spoke about anxiety being an experience made up of thoughts, emotions and phyiscal sensations. Lets look at how anxiety becomes disordered by coming back to the example I used above. If I attempt to supress the anxiety I feel about my exam my thoughts will likely spin about the potential outcome of the exam. My thought might sound like, "What if I fail"-"How am I going to master all this material"-"I don't think I will know enough"- etc. etc. My body will respond to a state of stress and danger due to the fear of failing an exam. Physically I might experience, elevated heart rate, tense muscles, nausea , inability to sit still or sleep. After all my mind is telling my body something bad might happen, I might fail.

Let's break it down.

Anxiety thinking:  I might fail  the exam --> I will be embarrased -->I will have to retake the course--> I will not get a job -->There is too much information to master. etc.  etc.

Analysis of anxiety thinking:  I reject the possiblity that I could fail or not do as well as I want to. I just don't want to allow that as a possibility.  The outcome of failing  becomes catastrophized and  more anxiety arises. The fear is so great my mind keeps the situation in forefront of consiousness, afterall failing has become and ever present threat and I keep thinking about the difficult or anxiety provoking circumstance . It may sound strange but the way we deal with a fear that we just don't want to accept is to keep thinking about it.  A good way to identify or elicit the anxious thoughts is to ask yourself -What fear is it that I do not want to feel or accept.

Outcome: The fear becomes so enormous that I  become paralyzed or  my performance is negatively impacted. My anxiety is unhelpful and I have disordered anxiety.

Solution:  Keep reading, I  talk about solutions later on in this article.

One more example.

Situation: Perhaps I have social anxiety. Leaving my house or my home , meeting others etc. creates so much anxiety that I tend to isolate.

Anxiety thinking:  Remember that you can identify anxiety thoughts by asking the following question.

 What is it that I do not want to feel or fear? 

In this case I don't want to feel judged or evaluated. I think people will think I am inadequate in some way. I hate the anxiety I feel when I think someone is making judgements about me. Its intolerable and if I feel this way I will have to leave........

Analysis of anxiety thinking:  It is possible others will judge me. The fear of being judged is so great that  I am not willing to experience the anxiety of possibly feeling judged and would rather experience. lonliness and isolation.

Outcome: I stay home and feel lonlely and sad but I avoided anything that would create the experience of anxiety.

Solution: Continue reading !

In the next part of this article I will address the following 8 basic steps to working with anxiety.

Step 1: Write down  what is really important to you. What outcome do you want to achieve?

Step 2: Identify which thoughts are  are not helpful in helping achieve your desired outcome.  The plan is to shift your attention away from uhelpful thoughts.

Step 3: . Create helpful thoughts to focus on, in place of the unhelpful thoughts you identified above. Helpful thoughts are one which help you achieve your desired outcome.

Step 4: Ask yourself what actions / behaviors will help you achieve your desired outcome.

Step 5: Make a specific commitment to schedule the new behavior / action at a specific time and date.

Step 6: Learn relaxation or meditation skills.

Step 7 : Try the following crazy techniques for letting go of unhelpful thoughts.

Step 8:  Engage in moderate exercise  for at least 20 to 30  minutes 4 days per week and preferably 7 days per week.

By now you are probably asking how do I change. First and foremost identify your motivation to change. There is little you cannot accomplish if you truly set your sight on success. This applies to anxiety as much as it does to overcoming any challenge in life.

Step 1: Write down  what is really important to you. What outcome do you want to achieve (desired outcome) ?

 Example: If social anxiety and isolation is your problem then a potential desired outcome might be the following. I want to be able to meet people and have a social life. I want things to do on the weekend. etc. etc.

When asked to do this many people will tell me there desired outcome is not to have social anxiety. A desired outcome of this nature is not going to be very helpful.

Desired outcomes are directions which we want our lives to take.

For example I want to feel less lonely or I want to meet new people or I want to be able to  go to school are much more effective desired outcomes.  Another way to think about desired outcome to describe what your day or week or month or life would like if your anxiety did not get in the way.  Another pitfall in identifying desired outcomes is selecting outcomes which are not realistic, achievable or within our control.  

Identify outcomes that are realistcally achievable.

Step 2: Identify which thoughts are  are not helpful.  The plan is to shift your attention away from unhelpful thoughts.

Unhelpful thoughts are ones that move you farther away from your desired outcome.

Being successful with ways of responding to anixety thinking requires that we are able to recognize that our thoughts are often not helpful in allowing us to achieve our needs / healthy life.  Road rage is a great example. A thought tells us to strike out at a driver who may have cut us off and the individual having the thought believes, listens and becomes bound to the thought to strike back with often grave consequences. It may be true that the person who cut us off was rude, inconsiderate or possibly intent on creating difficult circumstances. Perhaps it is also true that the individual who cut us off needs to learn a lesson. Equally likely is the possiblity that the driver was just inattentive for a moment and made an error. More important than whether our anxiety / anger thoughts are true (valid) or untrue (invalid) is wether our anxiety / anger thoughts are helpful in getting us what we need.  In the above example, even if  it is true that the person who cut us off was intent  on  creating difficulty and needs to learn a lesson, it is not helpful to listen or repeat thoughts in this regard. This will fuel our anger and potentially lead to thoughts of retaliation which lie at the root of road rage.  Retaliating is not likely to get anyone what they truly want unless they wish to end up dealing with significant legal consequences.

The example teaches us that even though thoughts maybe true (valid),  giving them atttention can get in the way of what we truly want and lead to undesirable outcomes.

Lets return to the  anxiety provoking examples we discussed above. In the example related to social anxiety  if  my thought tells me I may be judged or evaluated by others I need to acknowledge that this may be true to some degree.  Irrespective of  whether I will be judged or won't be judged its just not helpful to pay attention to  thoughts related to how others will perceive me .  Doing so does not help us to achieve our goals of meeting others and changing our lonliness.  Similarly for the example related to performance anxiety about an exam, thoughts which focus on a negative possible outcome will interfere with our aibility to study and not be helpful to the desired outcome .

It can be helpful to list each thought about an anxiety provoking situation and then then label it as either unhelpful or helpful in achieving your desired outcome.


  EG.   People will judge me.  --> May be true --> unhelpful.
           Some people may like me.  -->Maybe true --> helpful
           I won't be able to tolerate anxiety --> Self fullfilling prophecy -- unhelpful
           I will get better at this if I work at it. --> Self fullfilling prophecy -- helpful

Step 3: . Create helpful thoughts to focus on, in place of the unhelpful thoughts you identified above.

              Helpful thoughts are ones that move you closer to your desired outcome.

Example 1: In the first example I have performance anxiety related to an exam.  I might choose to write down the following repsonse to this fear. "I can't possibly know for sure how I will do on the exam so focusing on this uncertainty is not going to help me pass the exam. Instead of focusing on how much I will be able to master or whether I will do well I will focus my attention on studying and shift away from  thinking about what is beyond my control ( the outcome)."

Example  2: In the second example I  have social anxiety because I fear being judged . I might write down the following response to myfear. "Some people may judge me but then some may not. I don't really know. I can choose to  focus my attention on thoughts that help me achieve my desired outcome."

Step 4: Ask your self what actions / behaviors will help you achieve your desired outcome.

Write down these new behaviors and actions and then consider what you might expect to feel in the short term if you tried them. List the all the possible positive outcomes of trying the new behavior /action. In other words if you engage in these new behaviors / actions what will this buy you.

Example: If someone with social anxiety wanted  to begin meeting people they might identify an art class they wanted to try.   Then they could prepare the following ways of repsonding to their anxiety. "I could go to the painting class I really want to try. If I do go I will feel experience anxiety or feel people are evaluating me  but the joy of fulfilling my wish will make it easier to manage the anxiety.  I might meet people.  I might discover that my anxiety is more tolerable than I thought.  I can recognize "unhelpful" anxiety thinking and choose to focus on art etc ."

When we first change behavior we inevitably experience some anxiety .

Don't expect that any amount of thought or behavior processing or planning will change the initial anxiety. Ask yourself the following question.

Am I willing to experience some anxiety to get the life,  goals or needs  I want?

Step 5: Make a specific commitment to schedule the new behavior at a specific time and date.

The most common pifalls in this step are;

a) Not writing down you commitment.
b) Not scheduling a specific time and date.
c) Listening to the thoughts that say;
           " I don't feel like it"
           " I will do it when I feel like it"
           " I will do it later"
           " I cannot do it"

Recognize that if you are waiting to feel better  before you actually change your behavior it will probably never happen. There is a saying that goes "If you always do what you always did then you always get what you always got". The 4 thoughts I listed above are just procratination thoughts which allow you to once again avoid the experience of anxiety.

If you truly believe that you cannot engage in the new behavior  then ask yourself if you would could engage in it if you were given thirty million dollars. I often ask this question of individuals who tell me they cannot stop smoking or they cannot leave their house. Almost universally their response is that for thirty million dollars they could do it for a short while. The epiphany is that what they thought they could not do, they actually can do if the price is right.

Step 6: Learn relaxation or meditation skills.

These skills can be enourmously helpful in learing to hold the physical sensations of anxiety and help you learn to shift your attention to thoughts and behaviors that will enable your desires for a better life. Over time I will  add some articles to help you acquire these skills.

Step 7 : Try the following crazy techniques for letting go of unhelpful thoughts.

a) Think of a song you really like. Find a quiet place where no one will see your and try singing the dysfunctional thought to the tune of this song for at least 2 minutes. Let your experience tell you if it works.

b) Clapping your hands or using your thighs as a drum ( tapping your hands on your thighs) come up with a rhythm that seems pleasant. Then repeat your troublesome thought to the beat of this rhythm for 2 minutes.

c) Put some music on and dance around to the music repeat your troublesome thought for two minutes.

Step 8:  Engage in moderate exercise  for at least 20 to 30  minutes 4 days per week and preferably 7 days per week.

Take a Yoga class. A discussion on what constitutes moderate exercise is beyond the scope of this article. At some point I will add an article on this topic.  In the interim there is a great deal of literature on the topic. Family physicians can be wondeful resources in this regard.

The above might seem far out and I thought these techniques had little value when I first saw them demonstrated at a workshop. My experience in clinical practice is that they can be enourmously helpful. There are other  techniques which I will review in more detail in future articles.

Learning to live well and managing anxiety can be challenging. There is no one size fits all approach. I have tried to share with you an approach to anxiety that has worked well for  me not only personally but in clinical practice.  If you have a therapist,  psychotherapist or counselor then obtaining help  with ways of responding to anxiety thinking can make a big difference - specially till you get the hang of it. If you are not in therapy  / counseling and have the resources to get therapy / counseling then avail yourself of the option. Proffessional counseling is not an option for everyone so  you could also find a friend to help you with this. Its not rocket science and many people do this quite naturally. Meditation / Mindfulness or yoga classes can also be of enourmous benefit.

Lastly please consider the following two statement when faced with uncertainty.

        It is what it is.

        I will deal with it when I get there.

EASY TO SAY , MAYBE HARD TO DO, IT GETS EASIER WITH PRACTICE !

Life without anxiety is just not humanly possible. Learning to make anxiety work for  us is very possible. When this happen anxiety is no longer a disorder but a normal human emotion that spurs us to action.

Namaste

Mark Weiss