The reality is that you probably weren't taught how to best tackle emotional problems such as anxiety, depression and obsessions. We confess that even though we've been trained in the art of emotional problem-solving, when it comes to dealing with our own emotions, we can still manage to get it wrong.
In this chapter, we guide you towards identifying the fact that your coping strategies may make you feel better in the short term but that they're actually counterproductive - and that they can make things worse in the long term.
When Feeling Better Can Make Your Problems Worse
Aaron Beck, founder of CBT and Dennis Greenberger, a well-known CBT therapist, note that, if you can turn a counterproductive strategy on its head, you're well on the way to a real solution. This concept basically means that by doing the complete opposite of your established coping strategies you can recover from your problems. Exposing yourself to feared situations rather than avoiding them is a good example of turning a counterproductive strategy on its head. The more you avoid situations that you fear, the more afraid you become of ever encountering feared situations. Avoidance also undermines your sense of being able to cope with unpleasant or uncomfortable events. For example, never using a lift may temporarily stop your anxious feelings about being in an enclosed space, but avoiding lifts does not help you to overcome your fear of enclosed spaces once and for all.
Windy Dryden, who trained us in CBT, coined the phrase ‘Feel better, get worse; feel worse, get better' when referring to people overcoming emotional problems. Many of the things that you may be doing - but in so doing maintaining your current problems - are driven by a highly understandable goal to reduce your distress. However, when you aim to get short-term relief, you may well be reinforcing the very beliefs and behaviours that underpin your problems.
One of the most powerful ways of changing your emotions in a lasting way, is to act against your unhelpful beliefs and to act on your alternative helpful beliefs (Chapters 3 and 16 contain more information about forming alternative healthy beliefs).
Here are some further examples of what we mean by problem-maintaining solutions:
Avoiding situations that you fear or that provoke anxiety. Avoidance tends to erode rather than boost your confidence. You remain afraid of the situations you avoid, thus you don't give yourself a chance to confront and overcome your fears.
Drinking alcohol or taking drugs to block out uncomfortable feelings. Often, those bad feelings persist in the long term, and you end up with the added problem of the effect of the alcohol or drugs (hangover, comedown). Also, you have the potential to develop a new problem - substance dependence (have a look at Chapter 10 for more information about addiction).
Concealing aspects of yourself that cause you shame. Hiding things about yourself - such as imperfections in your appearance, childhood experiences, mistakes from the past or current psychological difficulties - can make you feel chronically insecure that someone may ‘find you out'. Hiding shameful aspects of your experiences also denies you the opportunity to find out that other people have similar experiences, and that they won't think any less of you for revealing your secrets.
Putting off dealing with problems or tasks until you're in the mood. If you wait to take action until ‘the right time', until you ‘feel like it' or when you feel sufficiently inspired, you may wait a very long time. Putting off essential tasks may save you some discomfort in the short term, but undone tasks also tend to weigh heavily on your mind.
The following sections deal with common counterproductive strategies for coping with common psychological problems. We explain that doing what makes you feel briefly better may be perpetuating your problem.
Getting Over Depression without Getting Yourself Down
If you're feeling depressed, you're likely to be less active and may withdraw from social contact. Inactivity and social withdrawal are often attempts to cope with depressed feelings, but they can reduce the positive reinforcement you get from life, increase isolation, increase fatigue, lead to the build-up of problems or chores, and leave you feeling guilty.
For example, if you've been feeling depressed for some time, you may use a number of ultimately negative strategies to relieve your depression:
To avoid feeling ashamed about being depressed, you may avoid seeing friends. This coping strategy leaves you feeling more isolated and means you don't get the support you need.
To avoid being irritable around your partner or children, you may try to minimise contact with them. Your children may become unruly, your relationship with your partner may suffer, and you may end up feeling guilty about not spending time with any of them.
To avoid the embarrassment of making mistakes at work, you may stop going to work on a regular basis.
To cope with feeling tired and to get some relief from your depression, you may take naps during the day. Unfortunately, napping can disrupt your sleeping pattern, leading to even more fatigue.
To see how your depression is affecting your activity levels, record a typical week on the activity schedule in Chapter 12 (and Appendix B). Then, as we explain in Chapter 12, combat depression by scheduling your activities and rest periods (but not naps because napping during the day can disrupt night time sleeping) for each day, and gradually build up your activity levels over time.
Loosening Your Grip on Control
Letting go of control is an especially relevant skill if you have any sort of anxiety problems, including obsessive-compulsive disorder (OCD), panic disorder and post-traumatic stress disorder (PTSD). But, it also applies to other types of emotional problems, such as anger and jealousy, and to eating disorders like anorexia and bulimia.
Here are some common examples of how you may be gripping the controls too hard:
Trying to limit your body's physical sensations because you believe that certain bodily symptoms will result in harm to yourself. For example, ‘If I don't stop feeling dizzy, I'll pass out.'
Trying to control and monitor your thoughts because you think that if they get out of control, you'll go crazy.
Being very controlling about the types of food you eat, when you eat and how much you eat.
Trying to control your appetite and diminish your need for food.
Suppressing upsetting thoughts, doubts or images because you believe that allowing them to enter your mind will cause harm to yourself or others. (This characteristic is very typical of OCD - check out Chapter 13 for more info.)
Trying to control your body's physical reactions to anxiety, such as trembling hands, blushing or sweating, because you think that others will judge you harshly if they notice your symptoms.
Trying to control the uncontrollable is destined to leave you feeling powerless and ineffective. Instead of striving for control, look to change your attitude about needing control by accepting the discomfort of certain types of thoughts or bodily sensations (head to Chapter 9 for more information).
If you try too hard to gain immediate control, you often end up:
Focusing more on feeling out of control, thus making yourself feel even more powerless than you did to start with.
Trying to control things that go against biology, like the need for food, lead to preoccupation and a further diminished sense of control.
Putting pressure on yourself to control symptoms and thoughts that aren't within your control, thus making yourself feel more anxious.
Concluding that something must be deeply wrong with you because you can't keep symptoms under control, thus making yourself feel more anxious, and experiencing more racing thoughts and unpleasant physical sensations.
The next time you feel anxious in a public place or find yourself blushing, sweating or having disturbing thoughts, put the concepts in this section to the test by trying harder to stop yourself from having those thoughts, blushing or sweating. Chances are that you'll find your efforts produce even more of the thoughts and sensations you're trying so hard to control.
Feeling Secure in an Uncertain W
orld
The need for certainty is a common contributing factor in anxiety, obsessional problems and jealousy.
Unfortunately, the only things you can be 100 per cent sure of, as the saying goes, are birth, death and taxes. Over and above that, humans live in a pretty uncertain universe. Of course, many things are predictable and pretty sure bets, like the sun rising in the morning and setting in the evening. However, other things in life are much more uncertain. ‘Will I be pretty?' ‘Will I be rich?' ‘Will I live to a ripe old age surrounded by grandchildren and a few cats?' Qué será, será. Whatever will be, will be.
Trying to get rid of doubt by seeking unattainable certainty is like trying to put out a fire by throwing more wood on it. If you're intolerant of uncertainty, as soon as you quell one doubt another one's sure to pop up. The trick is to find ways to tolerate doubt and uncertainty - they exist whether you like it or not.
Here are some examples of how your demands for certainty may be reflected in your behaviour:
Frequent requests for reassurance. Constantly asking yourself and other people questions, such as ‘Is it safe to touch the door handle without washing my hands?', ‘Do you find that person more attractive than me?', ‘Are you sure I haven't gained weight?', ‘Do you think I'll pass the exam?' or ‘Are you sure I won't get mugged if I go out?' are all efforts to find some reassurance in an uncertain world. Unfortunately, excessive reassurance-seeking can reduce your confidence in your own judgement.
Repeated checking behaviours. Checking behaviours are actions you perform in an effort to create more certainty in your world. Such actions include checking several times that your doors and windows are locked, frequently asking your partner where they've been, seeing lots of different doctors to ensure that a physical sensation isn't a sign of serious illness, checking that you can still feel your hip bones and not fat, and going over conversations in your mind to be sure that you haven't said anything offensive. The irony is that the more you check, the more uncertain you feel. You may feel temporarily better immediately following your checks, but it's not long before you feel compelled to carry them out again. Excessive checking can be very time-consuming and tiring, and it can lower your mood.
Superstitious rituals. Superstitious rituals are things that you do to try to keep yourself safe or to prevent bad things from happening. Typically, superstitious rituals are not directly related to whatever it is that you fear most. Examples of rituals include touching wood, repeating phrases in your mind, wearing lucky clothes or jewellery, and avoiding unlucky numbers, out of a faulty belief that these rituals will stop unfortunate or tragic events befalling yourself or your loved ones. Engaging in superstitious behaviours can lead you to conclude that the ritual has prevented bad things from happening, rather than help you understand that many bad events are unlikely to occur regardless of whether you perform a ritual or not.
Superstitious thinking also involves making faulty links between your subtle behaviours or thoughts (and even dreams) and what happens in reality. If you think about a loved one coming to harm (due to acute anxiety about their safety), you may assume, falsely, that you caused a subsequent accident by imagining it. If you have a vivid image (or dream) of a young child being abducted, you may conclude ‘If it happens, maybe I made it happen by imagining it!' Pretty disturbing stuff. What we point out to many of our clients is that we don't make superstitious links anywhere near as readily about good stuff. When was the last time you thought ‘It's a beautiful day because I thought about the weather being fine this week' or ‘My aunt's tumour is benign because I imagined it would be' or ‘I've won the lottery because I willed it to happen'? If your superstitious thinking makes any real sense at all (and it really doesn't), then it has to hold true for both good and bad events.
Avoiding risk. Risks - such as global tragedies, becoming ill, having an accident, making poor decisions or committing a social gaffe - are unavoidable and ever-present. You may be trying to eliminate risk by staying home or in ‘safe' places, eating only certain foods, never deviating from set routines, over-planning for trips away, or over-preparing for unlikely events such as war, plague or famine. In fact, risk is a part of life and can only be avoided to a limited extent. The more you try to eliminate all risk from your life, the more you're likely to focus on all the possible things that could go wrong. You're fighting a losing battle and are likely to undermine your sense of security even further. Focusing too much on the risks inherent in every day life will leave you chronically worried and cause you to overestimate the probability of bad things happening to you.
Trying to influence others. Examples of influencing others' behaviour include encouraging your partner to socialise only with members of the same sex, persuading your children to stay at home rather than go out with their friends, coercing family members into letting you eat very little, feeding others in lieu of eating yourself and asking your doctor to send you for yet another test. Demanding that other people act in ways to minimise your intolerance of uncertainty and risk can seriously damage your relationships. People close to you are likely to perceive you as controlling or suspicious.
Try to understand that uncertainty has always been a major feature of the world, and that people still manage to keep themselves safe and secure. You don't need to change the world to feel secure. You simply need to accept uncertainty and live with it. You can happily coexist with uncertainty - it's always been that way. Remind yourself that ordinary people cope with bad events every day and that you're likely to cope as well as others do if something wicked your way comes.
The next section deals with accepting uncertainty and letting go of unhelpful coping strategies.
Surmounting the Side Effects of Excessive Safety-Seeking
One of the main ways in which you maintain emotional problems is by rescuing yourself from your imagined catastrophes. Often, these anticipated disasters are products of your worried mind, rather than real or probable events. People with specific anxiety problems, such as the ones listed in this section, often take measures to reduce their anxiety and increase their sense of safety, but in effect make themselves even more intolerant of the inevitable uncertainty of everyday life.
The actions that people take to prevent their feared catastrophes from occurring are called safety behaviours.
Avoiding, escaping or trying too hard to stop a feared catastrophe prevents you from realising three key things:
Your feared event may never happen.
If your feared event does happen, most likely you'll find ways to cope. For example, other people or organisations may be available to help you out.
The feared event may well be inconvenient, uncomfortable, upsetting and deeply unpleasant, but rarely is it terrible or unbearable.
Anxiety affects your thinking in two key ways: it leads you to overestimate the probability and gravity of danger, and to underestimate your ability to overcome adversity. Of course you want to keep yourself as safe as possible. But sometimes you may try to keep yourself safe from events that really aren't that dangerous.
Additionally, some of the things that you do to eliminate risk and safe-guard yourself may actually result in more discomfort and disturbance than necessary - using ultimately unhelpful strategies to avoid feared outcomes is very prevalent in anxiety disorders. Here are some examples of counterproductive safety behaviours that you might be using to cope with specific anxiety problems:
Panic attacks: Michael's panic attacks are maintained by his fear that feeling dizzy will make him collapse. Whenever he feels dizzy, he takes a sip of water, sits down or holds on to something. In this way, he prevents himself from finding out that he won't collapse simply because he feels dizzy.
Social anxiety: Sally tends to over-prepare what she's going to say before she actually says it. She monitors her speech and body language and reviews in her mind what she did and said when she gets home. In this way, she maintains her excessive self-consciousness.
Post-traumatic stress: Sinc
e she had a car accident, Nina avoids motorways, grips tightly on to the steering wheel when driving in her car, repeatedly checks the rear-view mirror, and avoids being a car passenger. Because she's being so careful, her anxiety about having another accident remains at the forefront of her mind.
Agoraphobia: Georgina's afraid of travelling far from her home or familiar places for fear of losing control of her bowels and soiling herself. She has become almost housebound, and she relies heavily on her husband to drive her around. This means that she doesn't go out on her own and never discovers that her fears are unfounded.
Cognitive Behavioural Therapy For Dummies Page 12