Anxiety Mindfulness

Escape the vicious circle
Anxiety has different meanings to different people and various ways of being experienced. Two people might both consider themselves anxious, but have quite distinct experiences. This book is not about telling you what you already know: how you think and feel. Instead, it is about learning and using a set of tools to understand and change this experience.

To do that, we have to use a relatively clumsy tool: language. Bear in mind that language is not precise: do not take it too seriously. That said, though, we can roughly break down the symptoms of anxiety into four different components:

  • Physical — your body has certain reactions to anxiety.
  • Cognitive — some thoughts come to the fore in anxiety.
  • Emotional — feelings usually accompany anxiety.
  • Behavioural — anxiety can make you do, or not do, some things.

Just like the language used to describe them, though, the categories are not precise. In fact, each component feeds through into the others.  Here is an example of the experience of a person with anxiety:

  • Physically I feel sick to the stomach after visiting a restaurant.
  • Think that perhaps I have food poisoning.
  • Feel fearful about future health.
  • Avoid restaurants in future.

In this example it seems like all the problems are being created by the physical symptoms of feeling sick. But, I could just as easily write this another way:

  • Visiting a restaurant prompts thoughts about food poisoning.
  • Physically feel sick to the stomach.
  • Avoid restaurants.
  • Feel ashamed for avoiding restaurants with friends.

The point is that everything is interacting with everything else — thoughts, bodily sensations, feelings and behaviours.

It is important to see these four factors as all influencing each other. It means we have more ways to deal with a common aspect of anxiety: the vicious circle. Vicious circles in anxiety occur because all these four aspects of experience link up to cause problems.

Here is another example of someone who is anxious about social occasions:

Although David does not enjoy social occasions, he is at a party. There he meets an acquaintance whose name he cannot remember. When David’s wife joins the little group, he  has to introduce the  acquaintance. Immediately he is embarrassed and almost paralysed with fear. Before anyone can say anything, he excuses himself to go to the toilet. From there he phones his wife and tells her he is feeling sick and has to go home. He avoids parties even more assiduously in the future.

Anyone reading this calmly can see what David might have done in these circumstances. He could say something like: “I’m terribly sorry but your name has slipped my mind for a moment.” At that exact time, though, with the embarrassment and fear affecting his judgement, David does not see this option; he just wants to escape from the situation as quickly as possible and avoid the possibility of it happening ever again.

The reality is that there are a jumble of thoughts (hating social occasions), feelings (embarrassment, fear) and behaviours (avoid all social occasions) all acting together.

This is one example about someone who dislikes social occasions. It does not mean everyone with a social phobia experiences exactly the same thing. Similarly, different types of anxiety have different mixtures of these components and they interact in different ways. One of the challenges in dealing with anxiety is in identifying some typical patterns that you experience.

This can be hard because of the jumble of everyday experience. It can also be hard because anxiety is difficult to face — it feels better to avoid it rather than analyse it.  The problem with these vicious circles is that they lead to avoidance. People tend to avoid the things that make them feel anxious. Sometimes this is not a problem: all right-thinking people avoid the very edge of cliffs. The problem is when people avoid things which can seriously impact their lives, like social situations, going outside or going to the doctor.

Most different types of anxiety have some common threads. People experiencing anxiety tend to:

  • Over-estimate the danger in a situation.
  • Be constantly on the look-out for sources of potential harm.
  • Do their best to avoid difficult situations, thoughts or emotions.
  • Use short-term strategies which do not help the problem.

This Anxiety Mindfulness page shows ways to tackle each of these areas. Since thoughts, feelings, behaviours and bodily sensations all feed into each other, tackling each area has a knock-on effect. By
working mainly on thoughts and behaviours, we can break down vicious circles and change your experience.

Exercise 1: Identify vicious circles

Have a think about some of the vicious circles that might be operating for you. Generally
speaking, what types of thoughts, feelings, behaviours and situations interact to make you
feel anxious? It is perfectly normal if it is not clear to you how your anxiety is maintained.
Analysing this is the focus of the next section.
Monitor anxious experiences
One of the difficulties with anxiety is that it is habitual. Habits have a number of useful and
some not-so-useful properties. Among their less than useful properties in the context of
anxiety are:
 Anxieties arise automatically, without our consciously being aware of what has
prompted them.
 Anxieties arise in response to situations in which we regularly find ourselves.
The reason these two are problems is that anxieties can arise quickly, without a clear
trigger. The response to anxiety — usually to try and avoid the situation — comes so quick on
the heels of the feeling that we find we have responded before even thinking about it.
The key is to think about the interpretation of particular events. When anxiety arises and
avoidance feels like the only option, there is no time to look at our interpretation of the
situation. Changing the interpretation of an event is one way to reduce the anxiety that it
tends to create. But, if the interpretation whips by too quickly in the rush of habit, emotion
and the moment, then there is no time to think or adjust it.
That is why one of the most important ways of dealing with anxiety is to monitor it.
Monitoring experiences — by writing them down, for example — serves a number of useful
purposes. Apart from anything else, simply becoming more aware of our own thoughts,
feelings and behaviours helps us to understand how our anxiety works. It also helps provide
some psychological distance: as though you were examining the inner workings of a
complex machine. Finally, monitoring thoughts often helps to interrupt the constant flow of
anxieties.
The best way to monitor thoughts related to anxiety is to write them down somewhere.
Included below is an example of the sort of simple recording system you can use. It just
needs to have six columns, which are:
 Date
 Situation
 Thoughts
 Feelings
 Behavior
 Comments
Example sheet for monitoring anxious experiences
Here are some example answers for someone who is anxious about making a telephone call:
 Situation: Preparing to make a phone call.
 Thoughts: What if when I start talking, I cannot think what to say? Will I get
embarrassed and totally clam up?
 Feelings: Impatient, anxious, and ashamed.
 Behaviour: Fail to make the call.
 Comments: I know I need to speak to her about this issue, but it will be an
uncomfortable situation, so maybe it is best avoided.
Ideally, anxious situations, thoughts and feelings should be monitored as they occur. When
trying to remember them later, it can be difficult to reconstruct exactly what we were
thinking and how we felt. Recording anxious moments throughout the day as they happen,
though, can be difficult for many people.
One problem people sometimes have is worrying that others will see them. To get over this,
try going somewhere private like the bathroom when you need to write down an anxious
experience. On the other hand, people now spend so much time typing into their
smartphones, it can probably be passed off as texting.
Another problem people sometimes have is worrying that writing down their anxious
thoughts will make bad things more likely to happen or that it will make them feel worse.
Facing fears on paper can be just as troubling for some as facing them in real life. Both of
these are legitimate concerns, but they can only really be addressed by trying it out and
seeing what happens.
Exercise 2: Monitor anxious experiences
Try recording your anxious experiences for a few days. Treat writing down situations, fears,
thoughts and feelings like an experiment. Let us try it and see what patterns emerge. The
idea of this exercise is to make a start at identifying what is keeping your anxiety going. The
notes you make here will also be useful for many different exercises across this book. I refer
back to this section a lot, so you will have plenty of reminders to try this exercise.
Change self-talk
In our minds we all have a series of images, words, feelings and so on going through our
minds. It is what we call ‘thinking’. Different people think in different ways. Most people
experience something like a kind of internal monologue, or what psychologists call self-talk.
The fractured ideas, jumbles of words and flashes of images that tumble through our minds
are what make consciousness so fascinating — and sometimes so frightening.
Over the years of treating people with anxiety, psychologists have discovered that there are
certain patterns of thoughts that are central to anxiety. Spotting, understanding and then
challenging these thoughts is one very useful strategy for dealing with persistent anxiety.
These ways of thinking are a series of habits of thought that have been learned over the
years. This means they can be unlearned or, better still, replaced with other more helpful
thoughts.
Exercise 3: Identify patterns of thought
As you read through the patterns of thought described below, try to see which ones are
familiar. It may be useful to refer to the results of the exercise to monitor anxious
experiences in the previous section (Exercise 2). Hopefully you will spot some of these
patterns in your own thoughts and be able to use the strategies provided to counter them.
Remember that the aim of changing your thoughts is that it will also help to change your
feelings and, ultimately, your behaviours.
Catastrophising
Catastrophising is one of the most common patterns of thought that anxious people
experience. It is the thought, image or belief that something really bad will happen. For
example, you get on an aeroplane and catastrophise about it crashing and burning. Or, you
go to a restaurant and catastrophise about being killed by food poisoning. Or, you walk to
the shops and catastrophise about having left the cooker on and burning the house to a
cinder.
While all of these are extremely unlikely, they are possible, and they can feel very real at the
time they are experienced. What catastrophising does very effectively is make you worry. It
is jumping to the worst possible conclusions, however unlikely, and seeing the
consequences replayed in the most gruesome detail in the mind.
Exercise 4: Challenge catastrophic thoughts
The way to challenge catastrophising is not by denying it or just trying to push it away.