Virginia complains to her friends that she's the most nervous person on the planet and that she's close to a nervous breakdown. Recently, her father had heart surgery and her husband lost his job. Virginia feels completely out of control and says that her anxiety never stops. When her counselor suggests that she start tracking her anxiety, she tells him, "You've got to be kidding. I don't need to do that. I can tell you right now that I'm anxious all the time. There's no letup." He urges her to go ahead and try anyway. Table 4-4 shows what Virginia comes up with in her first week of tracking.
Virginia discovers a few things. First, she notices that her anxiety is routinely less intense in the morning. It also escalates in the afternoon and peaks in the evenings. With only one week's records, she can't discern whether her anxiety level is decreasing, increasing, or remaining stable. However, she notices feeling a little better simply because she feels like she's starting to take charge of her problem. She also realizes that some days are better than others and that her anxiety varies rather than overwhelming her all the time.
Writing about your worries
Millions of people keep a diary at some point in their lives. Some develop daily writing as a lifelong habit. Keeping a journal of life's emotionally significant events has surprising benefits:
Journal writing appears to decrease the number of visits people make to the doctor for physical complaints.
Writing increases the production of T cells that are beneficial to the immune system.
Keeping a journal about emotional events improved the grades of a group of college students compared to those who wrote about trivial matters.
Recently, unemployed workers who wrote about the trauma of losing their jobs found new employment more quickly than those who did not.
The power of positive psychology
The field of psychology focused on negative emotions for most of the 20th century. Psychologists studied depression, anxiety, schizophrenia, behavior disorders, and a slew of other maladies. Only recently has the field looked at the pluses of positive emotions, the characteristics of happy people, and the components of well-being. People who feel grateful usually say they feel happier as well.
A study reported in the Journal of Social and Clinical Psychology (2000, volume 19) assigned people to three groups. The first group wrote only about the hassles of everyday life. The researchers asked the second group to write about emotionally neutral events. The third group journaled about experiences that they were grateful for. All the groups performed this task merely once a week for ten weeks. At the end of the experiment, the group that wrote about gratitude exercised more, had fewer physical complaints, and felt more optimistic than those in the other two groups. That such an easy, simple task could be so beneficial is surprising.
Throwing out the rule book
Journal writing doesn't have rules. You can write about anything, anywhere, anytime. However, if you want the full benefits of writing in a journal, we encourage you to write about feelings and the emotionally important events of your life. Write about anything that troubles you during the day and/or past difficulties. Spend a little time on it.
Writing about past traumas may bring considerable relief. However, if you find that the task floods you with overwhelming grief or anxiety, you'll probably find it helpful to seek professional assistance.
Counting your blessings: An antidote for anxiety
Writing about your distressing feelings makes a great start. However, if you'd like more bang for your buck, take a few extra minutes and write about what you feel grateful for each day. Why? Because positive emotions help counteract negative emotions. Writing about your boons and blessings improves mood, increases optimism, and may benefit your health.
At first blush, you may think that you have little to be grateful for. Anxiety can so easily cloud vision. Did your mother ever urge you to clean your plate because of the "starving kids in China?" As much as we think that pushing kids to eat is a bad idea, her notion to consider those less fortunate has value. Take some time to ponder the positive events and people in your life.
Kindnesses: Think about those who have extended kindness to you.
Education: Obviously, you can read; that's a blessing compared to the millions in the world with no chance for an education.
Nourishment: You probably aren't starving to death, whereas (as your mother may have noted) millions are.
Home: Do you live in a cardboard box or do you have a roof over your head?
Pleasure: Can you smell flowers, hear birds sing, or touch the soft fur of a pet?
Sources of possible gratitude abound — freedom, health, companionship, and so on. Everyone has a different list.
The brain tends to focus on what's wrong or threatening in our lives. Noticing and actively appreciating what's right helps counteract that tendency and will make you feel better.
Getting Help from Others
If your problems with anxiety are significantly interfering with your life, you're probably going to want to work with a mental-health professional in addition to reading this book. In the following two sections, we tell you what kind of treatment to ask for and give you a set of questions to ask a potential therapist before you begin treatment.
Seeking the right therapies
Mental-health professionals offer a wide variety of treatments. We've thoroughly studied the research on what works for anxiety disorders so you don't have to. Studies consistently show that two treatments stand out as the most effective for this type of problem — cognitive therapy and behavior therapy, as well as a combination of the two (known as cognitive behavior therapy or CBT):
Cognitive therapy focuses on teaching you new ways of thinking. People with anxiety often have distortions in the way they perceive events, and this approach helps you correct those distortions. For example, an anxious client may be overestimating the risks involved with flying. A cognitive approach would help her discover that the risks are small enough to warrant tackling her fear. See Chapters 5, 6, and 7 for a thorough discussion about how cognitive therapy can be applied to your problems with anxiety.
Behavior therapy operates on the premise that changing the way you act or behave changes the way you feel about the things that happen in your life. Using the previous example of the woman with a fear of flying, a behavior therapist would likely help the woman go through a series of steps related to flying such as watching movies of flying, going to the airport, and eventually booking and taking a flight. Chapter 8 reviews how to bring behavior therapy principles to bear on your anxiety.
Other therapies work for other types of problems, and some also work for anxiety, too. But nothing has been shown to beat cognitive therapy, behavior therapy, and their combination (CBT) for anxiety disorders.
Medications also play a role in the treatment of some anxiety disorders. We usually don't recommend using them as your sole strategy, however. See Chapter 9 for a discussion of the advantages and disadvantages of medication for anxiety.
Seeking the right therapist
In addition to knowing the right therapy, you need to know whom to look for. Start by making sure that the therapist you seek is licensed to provide mental-health services, whether as a counselor, psychiatrist, psychiatric nurse, psychologist, or social worker. Sources for finding one of these licensed practitioners include local professional associations (such as state psychology associations, state counselor associations, and so forth), your primary healthcare provider, your insurance company, or trusted friends and family who can recommend someone.
After you've found someone who seems to fit the bill, be sure to ask the following questions:
What are your charges for services, and does my insurance cover them?
What are your hours?
How soon can you see me?
What is your experience in treating anxiety disorders?
Do you take a cognitive or behavioral approach in treating anxiety?
Are you willing to collaborat
e with my doctor?
You should feel comfortable talking with your therapist. After a few sessions, you should feel listened to and understood and sense that your therapist has legitimate empathy and concern for your well-being. Don't hesitate to inquire about the nature of your treatment plan — that plan should make sense to you. Most therapists take a few weeks getting to know you before they formulate an entire plan. If you're uncomfortable for any reason, by all means seek a second opinion from another therapist. Research shows that how you feel about the relationship with your therapist makes a big difference in how well the therapy goes.
Part II
Battling Anxiety
In this part . . .
We talk about one of the most effective therapies for anxiety and show you methods for tracking your anxiety-arousing thoughts, along with ways to change anxious thoughts into calmer thinking. Next you see how the very words you use to think about yourself and the world can intensify anxiety. The good news is that you can replace your worry words with more reasonable language. In so doing, your anxiety decreases.
Then we describe the agitating assumptions that underlie many anxious thoughts. You discover which agitating assumptions plague you and how you can do something about them. We also show you how to battle anxiety by changing your behavior. This part concludes with a review of medical and biological strategies for treating anxiety.
Chapter 5: Becoming a Thought Detective
In This Chapter
Understanding the thought/feeling connection
Monitoring your anxious thoughts
Rethinking anxious thoughts
Designing pleasant thoughts
Thoughts powerfully influence your emotions. At the same time, your feelings also influence your thoughts. In order to battle anxiety, you need to be aware of both your thoughts and feelings.
The following true story from our lives illustrates how profoundly thoughts influence the way people feel.
Some time ago, we took a cruise to reward ourselves for completing a major project. One evening, we sat on deck chairs enjoying a fabulous sunset: Brilliant red and orange clouds melted into the deep blue sea. The wind picked up ever so slightly, and the ship rolled gently. We sat relaxed, quietly enjoying the scene and the cradle-like motion. We reflected that in our lifetime, we had rarely felt so at peace.
The captain's weather announcement interrupted our tranquil state of mind. Apologizing for the inconvenience, he informed us that because of a hurricane, he would have to steer a slightly different course, and we may feel some choppy seas. Still, he assured us that the storm presented no threat.
The breeze suddenly felt chilling. The clouds, so spectacular before, appeared ominous. The gentle roll that had relaxed us now generated nervousness. Yet nothing about the sky or the sea had changed from moments earlier.
Our thoughts jerked us from blissful relaxation to mounting anxiety. We pulled our jacket tighter and commented that the weather looked nasty, and perhaps we'd be better off inside.
Clearly, our thoughts, or the way we interpreted the weather, greatly affected the way we felt. A state of relaxed bliss turned into nervous anxiety even though the weather itself had not changed.
In this chapter, we show you how to become aware of your feelings and thoughts as well as the events that connect them. The goal is to become a thought detective, able to uncover the thoughts that contribute to anxious feelings. We show you how to gather evidence and put your thoughts on trial. We help you see how thoughts all too easily trigger your anxiety, and we give you proven techniques for transforming your anxious thoughts into calm thoughts.
Distinguishing Thoughts from Feelings
Psychologists often query their clients to find out how they feel about recent events in their lives. Frequently, clients answer with how they think about the events rather than how they feel. Others know how they feel but are stumped when it comes to what they're thinking. In the next section, we discuss why people often end up out of touch with their feelings, thoughts, or both. Then, we discuss how to tune your thoughts and feelings.
Blocking the blues
People often have trouble identifying and labeling their feelings and emotions, especially negative ones. Actually, the difficulty makes sense for two reasons.
First, emotions often hurt. No one wants to feel profound sadness, grief, anxiety, or fear. One simple solution is to avoid feelings entirely, and many creative ways to avoid emotion are available. Unfortunately, most of these methods can be destructive:
Workaholism: Some folks work all the time rather than think about what's disturbing them.
Alcoholism and drug abuse: When people feel bad, numbing their emotions with drugs and alcohol provides a temporary, artificial emotional lift; of course, habitually doing so can lead to addiction, ill health, and sometimes, even death.
Denial and repression: One strategy for not feeling is to fool yourself by pretending that nothing is wrong. Denial is often thought to be a conscious process whereas repression is done outside of people's awareness, but the result is pretty much the same.
Sensation seeking: High-risk activities, such as sexual promiscuity and compulsive gambling, can all push away distress for a while.
Distraction: Athletics, entertainment, hobbies, television, surfing the Internet, and many other activities can cover up bad feelings. Unlike the preceding strategies, distraction can be a good thing. It's only when distractions are used in excess to cover up and avoid feelings that they become problematic.
The price of ignoring your feelings
In Gone with the Wind, Scarlet O'Hara says time and again, "I'll think about that tomorrow. After all, tomorrow is another day." What a nice, easy solution to tough times — shove the issue out of the way. But we're discovering more about the costs of avoiding and repressing emotions.
According to researchers at Adelphi University and the University of Michigan, people who declare themselves as mentally healthy over the years when other evidence shows they're not have higher heart rates and blood pressure in response to stress than folks who own up to their emotional difficulties or those who truly don't have problems at the time. Studies also show that when people write about their emotions on a daily basis, their immune system improves. Amazing stuff.
The second reason that identifying, expressing, and labeling feelings is such a struggle for people is because they're taught from an early age that they "shouldn't" feel certain feelings. Parents, teachers, friends, and relatives bombard kids with "don't feel" messages. See the following examples of "don't feel" messages that you've probably heard before:
Big boys don't cry; don't be a baby!
You shouldn't feel that way!
Get over it!
It couldn't possibly hurt that bad.
Don't be a scared chicken.
Stop crying or I'll give you something to cry about!
That many people are described as "out of touch with their feelings" is no wonder. The problem with the habitual tendency to avoid feelings is that you don't find out how to cope with or resolve the underlying issue. Chronic avoidance creates a certain kind of low-level stress that builds over time.
Getting in touch with your feelings
Noticing your emotions can help you gain insight and discover how to cope more effectively. If you don't know what your feelings are, when they occur, and what brings them on, you can't do much about changing them.
To illustrate problems with identifying feelings, we turn to Dr. Wolfe and her patient, Jim, who is struggling with his marriage.
Dr. Wolfe: How did you feel when your wife said you were irresponsible?
Jim: I thought she was really out of line.
Dr. Wolfe: I see. But how did you feel about what she said?
Jim: She's at least as irresponsible as I am.
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