Is Worry Driving You to Distraction?

Image by Priscilla Du Preez

My clients often tell me that they feel worried. And, while I understand what they mean, I always tell them that worry is not a feeling – it’s a thinking process linked to the feeling of anxiety. So, really, what they are telling me is that they feel anxious about something and have gone into worry mode to try and think their way out of the anxiety.

In schema therapy, the part that feels anxious is your Vulnerable Child mode – Little Jane or James. This is the emotional part of you, which gets triggered whenever you feel sad, anxious, stressed, hurt, upset, down… It’s also the part of you that holds all your painful memories from childhood and can get triggered when you feel threatened by something – especially if that reminds you of a stressful event from childhood.

Worry is a symptom

Let me give you an example. *Helen comes to see me because she can’t stop worrying. It’s driving her crazy, because she worries about every little thing. ‘If I have a meeting at work, I worry beforehand, about what I’ll say, whether my boss is annoyed with me, whether my colleagues like me, what I’m wearing, what I say in the meeting… You name it, I’m worrying about it,’ she tells me.

And this worry is exhausting for Helen. It makes her feel stressed before, during and after the meeting. She just can’t stop thinking about these problems. It’s like her mind is a vice – it grips on to the problems and won’t let go. ‘The other problem is that it’s driving my husband crazy,’ she adds. ‘He tries to reassure me but it doesn’t work, so I go on and on about these petty things until we’re both ratty and exhausted.’

Of course I feel for Helen – her worry is causing huge problems in her life. It maintains her low self-esteem, because she doesn’t believe she will ever do anything well enough, and that people think she’s rubbish at her job, even that she will get fired because her boss doesn’t rate her. But in our first session, I tell her something surprising and counterintuitive – even though it’s driving her nuts, worry is not the problem. It’s a symptom. And the root cause of her worry is anxious Little Helen.

Anxiety warns us about threats

I ask her to tell me more about her boss, to see if he reminds her of anyone from her past. She thinks about it, then has one of those lightbulb moments. ‘Ohhh,’ she says, ‘He is just like my dad!’ Helen goes on to tell me that her dad was highly critical when she as a child, telling her that nothing was ever good enough. If she got a B on a test, he would ask impatiently why it wasn’t an A. If she came second in a cross-country race, he would berate her for not being first. And so on.

So when she goes for a meeting with her boss, Little Helen feels highly anxious – just like she did around her dad as a child. And that’s what anxiety is for – it’s an alarm-bell emotion that warns us about potential threats. Her Worrier part then kicks in, with lots of ‘what if…’ thoughts to try and problem-solve the threats. ‘What if you say the wrong thing?’ ‘What if your boss criticises you?’ ‘What if you get fired?’

Trying to help. Trying to protect her from this nit-picking, critical, perfectionistic boss who is just like her dad. Not mean, or horrible, but trying to help Helen deal with the anxiety-provoking situation.

Comforting your little self

In order to help Helen, in schema therapy we do a few things. First, we work with the Worrier, helping Helen see where it came from, what its function is, the pros and cons of worrying, and so on until we can help it calm down a bit. Second, we help Little Helen feel safe, comforted and genuinely, deep-down reassured (not the temporary fix of reassurance that worry provides). There are many ways to do this – plenty of which are provided in this blog – but a simple first step is to use this self-compassion practice to help your little self feel calmer and more at peace.

Third, we build up Helen’s Healthy Adult, so she feels stronger, more rational, having better perspective – seeing the big picture rather than obsessing about the details. If you are a worrier by nature, you need to do all three things, rather than just focusing on the worry. Otherwise, you’re treating the symptom, not the cause, so the worry will just keep coming back.

Warm wishes,

Dan

*All of the case studies on this blog are composites of actual people – I would never reveal any personal or identifying information about my clients.

Online Therapy Available During the Pandemic

Image by Jud Mackrill

As we all find a way to manage the coronavirus pandemic as well as possible, I have moved all of my therapy sessions online. I now offer sessions via Zoom. This means I can offer help to people all over the UK, as well as those living anywhere in the world. I am offering both short-term therapy, to help people through the current crisis, as well as my usual long-term schema therapy.

This is an anxiety-provoking and stressful time for everyone. But it can be especially hard for people who already struggle with day-to-day anxiety, or have an anxiety disorder like health anxiety or OCD. If you have experienced trauma in your life, it may also be triggering unpleasant memories for you, or you may be struggling to cope with the flood of scary headlines about the outbreak.

Please take all sensible precautions to keep yourself and others safe and well, especially older people or those in high-risk groups.

If you would like to know more about how online sessions with me work, I explain all the details in this post. And if you would like help getting through this difficult time, email dan@danroberts.com or use the contact form to get in touch.

Warm wishes,

Dan

What are Anxiety Disorders?

Image by Nathan Dumlao

In either cognitive or schema therapy we first try to understand exactly what is causing someone’s problems, before going on to help solve them. If someone is struggling with anxiety, part of this understanding is making a diagnosis of exactly which ‘anxiety disorder’ someone is struggling with.

Some people find this idea a little uncomfortable, but it’s just like your GP diagnosing whether you have the common cold or flu, so they can prescribe the right treatment.

There are seven anxiety disorders, which I summarise briefly below – map your symptoms on to the disorder to see whether you might have one. If you are unsure, please get an assessment from a cognitive or schema therapist; and remember that it’s common to suffer from more than one of these disorders at the same time, as well as other problems like depression or low self-esteem.

Panic disorder and agoraphobia

A panic attack involves a sudden increase in anxiety, accompanied by physical symptoms of anxiety, such as a racing heart rate, breathlessness or dizziness. Panic disorder involves recurrent panic attacks and may or may not lead to agoraphobia – anxiety about being in situations in which escape would be embarrassing or help would not be available in the case of a panic attack. People with agoraphobia may struggle to leave the house or be in open or public places, like shopping centres.

Health anxiety

Health anxiety (also called ‘hypochondriasis’) involves a fear of having a serious illness, like cancer or heart disease, and a preoccupation with bodily symptoms. The problem will not go away with medical reassurance and is often extremely distressing – you may be convinced you have a serious health problem but that no-one believes you, which is understandably frustrating and upsetting.

Social phobia

People with social phobia have a fear of social or performance situations, or both; you may feel comfortable with one trusted friend, but become anxious if their friend joins you. You might be fine in small groups, but the bigger the group the more your anxiety grows. And you might struggle in performance situations, like public speaking or university seminars – you may hate being put on the spot or have the feeling that everyone can see how anxious you are and will think badly of you in some way.

Specific phobia

This involves the persistent fear of a particular object of situation – it’s ‘specific’ because you fear that and not a wide range of things. The most common phobias are a fear of heights, public speaking, snakes, spiders, being in enclosed spaces, mice, needles and injections, crowds, clowns, darkness and dogs. Of course, some people struggle with more than one phobia. And it’s worth noting that specific phobias are relatively easy to treat with CBT – in around six sessions or less.

Generalised anxiety disorder (GAD)

GAD is defined as excessive anxiety and worry occurring more days than not for a period of at least six months and about a number of events or activities. The two key features of this disorder are ‘free-floating’ anxiety, which attaches itself to one thing after another; and persistent worry, which is more severe than normal worry, seems hard to control and causes distress and/or makes it difficult to function.

Obsessive-compulsive disorder (OCD)

If you are suffering from OCD, you will experience obsessions (intrusive images, impulses or thoughts) and/or compulsions (repetitive behaviours engaged in to minimise the anxiety or upset caused by the obsessional thought or because of rigid rules). Although the compulsion – which could involve checking, washing, prayers or replacing negative thoughts/images with positive ones – is intended to reduce distress or prevent a feared outcome, like someone you love being harmed. Unfortunately, the compulsion only provides short-term relief and is a key element of what maintains the OCD.

Posttraumatic stress disorder (PTSD)

PTSD occurs as a reaction to a profoundly distressing event that threatened death or serious injury to yourself or other people; a response that involved intense fear, helplessness or horror; and key symptoms of re-experiencing, avoidance and hyperarousal. There is some debate over whether PTSD is an anxiety or stress/trauma disorder, but as it does involve very high levels of anxiety, I have included it here.

Warm wishes,

Dan

Bibliotherapy for Anxiety

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'Bibliotherapy' is an important part of cognitive or schema therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's useful for them to read up about their particular issue and for us to discuss their findings next week. 

And people usually like to understand why they might be having problems and find their own strategies to solve them – another important idea in cognitive therapy, because ultimately I want my clients to be their own CBT therapist.

In this post I will focus on anxiety disorders, an area that includes health anxiety, social anxiety, generalised anxiety disorder, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). The idea is that you can read one or all of these books, depending on which appeal to you. And you can read the whole book or dip into the chapters that seem most relevant to you.

1. Overcoming Anxiety: A Self-help Guide Using Cognitive Behavioral Techniques, by Helen Kennerley. I often recommend books from the Overcoming... series to my clients, because they are excellent introductions to CBT, and can be used either as a self-help workbook or alongside a course of CBT therapy. 

Overcoming Anxiety is packed with useful information about what causes anxiety, how best to deal with and practical, easy-to-use techniques for reducing your anxiety levels. And at £10.99 it's also a good deal cheaper than a course of therapy!

2. The Compassionate Mind Guide to Building Social Confidence: Using Compassion-Focused Therapy to Overcome Shyness and Social Anxiety, by Lynne Henderson. This is one of the first wave of books based on the principles of compassion-focused therapy (CFT), a new form of CBT that helps you treat yourself more kindly and compassionately.

Another book in the series (by Dennis D Tirch) deals with anxiety more generally - this one focuses specifically on shyness and social anxiety. Like Helen Kennerley's book, above, it's full of useful techniques you can use yourself to start feeling more socially confident. Given that social anxiety is often caused by harsh self-criticism and fear of rejection/criticism from others, CFT is uniquely well-suited to softening that criticism, which is usually excessively punitive and self-downing.

3. Overcoming Obsessive Compulsive Disorder: A Self-help Guide Using Cognitive Behavioral Techniques, by David Veale and Rob Willson. Obsessive compulsive disorder (OCD) can be a horrible illness, which may end up completely dominating someone's life. David Veale is one of the world's leading experts in the treatment of OCD, so he's certainly worth listening to.

I have to say that, as someone who specialises in treating anxiety disorders such as OCD, this condition is probably too difficult to overcome on your own, but this book will certainly give you a good idea of why you suffer from OCD and what you need to do to banish it from your life. You will then need to work with a CBT or schema therapist (OCD is one of the conditions that doesn't respond well to other forms of therapy).

Warm wishes,

Dan

What is Thought-Action Fusion?

Image by Roman Bilik

One of the many kinds of unhelpful thinking that can make us stressed, anxious or worried is 'thought-action fusion'. This is especially common in obsessive-compulsive disorder (OCD), but is also found in other anxiety disorders such as generalised anxiety disorder (GAD), health anxiety, panic disorder, phobias and social anxiety.

The problem here is that we can confuse thoughts with actions, believing that one has a direct link with the other. Let me give you an example, commonly found in people with OCD (as with the other case studies on this blog, this is a composite of different people and not about any particular client):

Marie has obsessional thoughts (the O in OCD) about running people over when she is driving. As with most OCD sufferers, she worries about this because she is a nice, caring person – it's precisely because the thoughts are so upsetting that she has become obsessive about them. She worries about hurting people before, during and especially after driving from her home to the office.

She thinks, 'Did I just hit someone? I'm sure I did.' Unsurprisingly, this thought makes her very anxious, so she has to engage in compulsions (the C in OCD), like driving back over her route and double-checking there is nobody injured, to 'neutralise' the upsetting thoughts and calm herself down.

One of the reasons Marie gets upset is because she believes the act of thinking about running people over makes it more likely to actually happen. And after her drive she is convinced that because she keeps worrying about hitting people, and even seeing images of that happening in her mind, it means she has actually hit someone. Such is the logic-defying slipperiness of OCD, which makes it challenging to treat.

Generalised anxiety disorder

Another example, of someone who is prone to excessive worry:

Clare has generalised anxiety disorder (GAD), which means she has 'free-floating' anxiety that attaches itself to one thing after the next; she also struggles with chronic worry, lying awake late into the night worrying about her children's safety, their performance at school and countless other things. As with other worriers, Clare has beliefs related to the act of worrying itself that maintain her worry problem. She thinks:

a) 'It's useful to worry – it helps me stay on top of all the family problems I have to deal with every day.'

b) 'If I don't worry about my kids, who will? Worrying about them helps keep them safe.'

You can see how the latter part of her second belief is an example of thought-action fusion. Like many people, Clare thinks there is a causal relationship between worrying (a type of thinking) and her children coming to harm (an action). Logically, although of course it's good to be careful about your children's safety, constantly worrying about them will not keep them safe, especially when they are not with Clare.

But despite the stress and exhaustion that all this worrying causes her, it helps Clare manage her discomfort with uncertainty – another key feature of GAD. Learning to think in a more rational, balanced and helpful way is key to overcoming any anxiety disorder.

Warm wishes,

Dan