Program 8



  1. Understanding Anxiety
  2. When Anxiety Becomes a Problem
  3. Forms of Anxiety and Coping with the Problem
  4. Conclusion

  1. Understanding Anxiety

We all worry about big occasions but chronic worriers tend to worry about everyday events more often, for longer periods of time and feel their worry is more out of control. Worries are just thoughts and NOT real/facts.

Worries are either about real events or hypothetical events that may happen in the future. The former can be dealt with by problem-solving while the latter needs you to give up avoidance and face your fear. Intolerance of anxiety is fuel for worry and uncertainty in turn is generated by worry – hence a vicious cycle ensues.

Worry occurs when things the worrier values and how they want the world to be ideally, is threatened. We mostly worry in words, not pictures, to escape the much stronger emotions, bodily sensations and experiences triggered by mental images. Excessive worry leads to anxiety. Worry can lead to low mood and eventually exhaustion and demoralization.

You need to accept that 100% certainty is not possible and be satisfied with ‘certain enough’. Increase your tolerance for uncertainty – expose yourself safely to uncertainty and overcome your fears. Identify your maladaptive ‘worry rules’ such as: ‘Worry helps to solve problems’, ‘…motivates  you to get things done’, ‘...protects you by preparing you for the worst’, ‘…prevents something bad from happening’, ‘…shows that you care’.

Challenge these thoughts with more helpful alternatives. Strengthen your conviction in the new beliefs by doing behavioural experiments.

See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.

Problems come with threats and opportunities; to reduce worry focus on the latter. Deal with worry by setting a specified time daily to discuss/contemplate the matter and limiting such discussion/contemplation to only this planned time.

Anxiety can be ‘normal’ or ‘pathological’ – the latter is the case if anxiety is greatly disproportionate to the impending threat and continues even when no danger exists. Anxiety prepares us to cope with stressful and dangerous situations. It is a reasonable and sometimes vital response, unless out of proportion. The greater the severity and probability of possible danger, the more vulnerable the person; the lower their self-confidence; the more impeded their performance.

Anxiety = Unknown x Importance [Larry Michelson and L. Michael Ascher].

The more familiar the situation and the less important, the less the anxiety.

Fear can be defined as the appraisal of a threatening situation; anxiety is the unpleasant feeling state (emotion) that ensues when fear is activated. Worry, fear and anxiety trigger the release of the hormone adrenaline resulting in bodily changes (e.g. increased breathing rate), psychological changes (e.g. change in thought and feeling) and behavioural changes (i.e. ‘fight, flight, freeze or faint’ response of the body to threat).

The stress response is helpful in the short-term to prepare us for physical action but if it becomes chronic or too much, difficulties can ensue. In long-term stress, bodily changes intensify to become unpleasant. Psychological changes, if sustained, result in worrying and negative thinking. Behavioural changes can magnify and become exhausting, cause physical or mental problems and can be detrimental to good health. Anxiety is a biopsychological/environmental process.

Stress leads to the stress response and distress ensues, resulting in increased stress and this causes the stress response again and a vicious cycle is created. People frequently overestimate the threat of a situation and underestimate their ability to cope. When anxious you may experience symptoms such as breathlessness, palpitations, trembling, sweating, dizziness and hot flushes. Your evaluation of the situation may cause you to ‘fight, take flight, freeze or faint’.

Anxious clients tend to focus on the future; they need to be taught to focus on the present.

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                  2. When Anxiety Becomes a Problem

Problems occur when cycles are set up by physical, psychological, behavioural and social factors. You need to identify the cycles, break the pattern and control your distress.

In bodily responses the trigger (an actual or imagined threat) leads to a physical reaction (e.g. chest pain) and you conclude you are having a heart attack. This results in alarm and leads to a physical reaction again and starts a cycle.

In psychological responses, there is an overestimation of danger and an underestimation of coping ability. This can lead to increased distress and biased thinking. Mood changes such as hopelessness, misery and irritability can impair your ability to cope with stress.

In behavioural responses, a person avoids and escapes perceived danger and seeks reassurance. This prevents them from learning to cope.

In social responses, stressful situations and indirect or direct behaviours of others can affect an individual’s stress level.

Common thinking biases are:

Catastrophizing (predicting the very worst); all-or-nothing thinking (black-and-white thinking); exaggerating (amplifying the negative); overgeneralizing (making global conclusions from one or more events); discounting the positives; scanning (searching for what you fear, resulting in needless fear).

See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.

Risk factors make an individual susceptible to anxiety and include:

Personality – such as ‘the worrying type’.

Family history – fears may be encoded in our genes and passed on in families.

Life stresses – stressful events.

Psychological style – biased thinking increases the risk of problems.

Coping skills – unhelpful coping strategies.

Social support – lack of sufficient social support.

Personal and social risk factors lead to the problem of anxiety which is then kept going by maintaining factors such as on-going stress. Low self-esteem can make you susceptible to anxiety.

See Program 1: Coping Strategies Counselling Advice – Assertiveness Training, Neuro-Linguistic Programming (NLP), Building Confidence I, Building Confidence II, Building Confidence III, Building Confidence IV and Program 16: Overcoming Low Self-Esteem.

For further helpful coping strategies:

See Program 1: Coping strategies Counselling Advice – Competitiveness and Perfectionism, Frustration, Procrastination and Persistence.

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            3. Forms of Anxiety and Coping with the Problem

Common diagnoses are:

Phobias - when fears become a problem (e.g. fear of heights, spiders, snakes).

Panic attacks - strong feelings of worry combined with an intense physical reaction.

Generalized anxiety disorder (GAD) - chronic (constantly present) worry.

Obsessive-compulsive disorder (OCD) - uncontrollable thoughts (obsessions) lead to compulsions to carry out reassuring mental or physical activity.

Physical problems - such as sleeping and gastric problems.

Hypochondriasis - perceived symptoms cause distress.

Burn out - stress is ignored until it becomes so severe that it interferes with an individual’s functioning.

Post-traumatic stress disorder (PTSD) - a stress reaction to traumatic events.

Psychological methods and/or medication can be opted for but tranquillizers are unhelpful in the long-term. They may mask the problem, cause dependency and unpleasant side effects. Seek your doctor’s advice before modifying your medication.

It is necessary to think of the coping strategies you will be introduced to as skills which you need to practise. Consider your experience of anxiety and choose appropriate coping strategies to deal with the problems. Enlist the support of others if you find that helpful. This advice is the first step and you may find you require further therapy.

Fear is an appraisal of a perceived threatening stimulus; anxiety is the emotional response to the appraisal. You need to know that each anxiety experience is time limited – it will not go on forever.

When anxious you may withdraw from the threatening situation or seek reassurance from others. You may engage in ‘What if…?’ thinking. Counter this with problem-solving thinking, by asking ‘Then what…?’ for each ‘What if…?’ anxious thought.

You can also use ‘What if…?’ positive questions, for example: ‘What if I maintain control?’ -  to challenge ‘What if…?’ negative thinking.

Decatastrophize your outlook by changing anxiety causing statements such as ‘I can’t stand it’ and ‘It’s awful’ to ‘I can stand it’ and ‘unpleasant’ or ‘uncomfortable’.

Deal with your anxiety while anxious rather than wait until you are comfortable as this may take a long time. Accept your symptoms and in this way lessen them – act in spite of your anxiety.

You can use the ACT formula [Emery 1982] to move from a reactive system to a choice system hence, increase your sense of control:

Accept current reality.

Choose what you want.

Take action to get it.

Cope with anxiety using the AWARE strategy [Aaron Beck]:

Accept your anxiety – do not resist it.

Watch the anxiety by distancing yourself.

Act as if you are not anxious.

Repeat steps 1, 2 and 3 until your anxiety is reduced to a comfortable level.

Expect to successfully handle anxiety in future.

See Program 1: Coping Strategies Counselling Advice – Problem-Solving, Forgiveness, Program 6: Overcoming Anger, Program 12: Overcoming Depression and Program 15: Overcoming Grief And Bereavement.  

Also – See Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.

Be self-reliant and develop a positive body image.

See Program 1: Coping Strategies Counselling Advice – Criticism, Countering Self-Criticism, Coping with the Need for Approval and Improving Your Self-Image and Combating Self-Harm.  

Maintain good physical health.

See Program 1: Coping Strategies Counselling Advice – Nutrition, Exercise, Managing Your Time and Sleep Management.

Learn to relax.

See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Meditation, Creative Visualization, Autogenics and Self-Hypnosis.  

Distracting yourself when anxious can alleviate distress.

See Program 1: Coping Strategies Counselling Advice – Distraction Techniques.

You need to gradually expose yourself to a hierarchy of problem situations to overcome your anxiety.

See Program 1: Coping Strategies Counselling Advice – Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.  

If your anxiety is due to or exacerbated by relationship problems:

See Program 1: Coping Strategies Counselling Advice – Social Skills Training, Communication Training, Negotiation Training, Troublesome Emotions and Program 13: Overcoming Destructive Relationships.

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                  4. Conclusion

Identify future challenges regularly and plan how you will cope. Accept that setbacks will occur and learn from them how to cope in the future. Ensure you include relaxation into your daily routine and as many pleasurable activities as possible.

Deal with stress before it becomes too much to cope. Be organized and assertive at home and at work. Avoid tiring yourself by doing too much. Face your fears in small safe steps. Praise yourself for all your achievements and be forward planning.

See Program 1: Coping Strategies Counselling Advice – Relapse Prevention.

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