Varieties Of Anxiety

The different types of anxiety that I wrote about also differ in the way that they manifest themselves. Separation anxiety is the consequence of deep distress at being separated from someone, which makes sense. This is why obstetric and paediatric practice these days is to ensure that mum and dad have the maximum possible access to their child when a hospital admission is necessary, so that feelings of abandonment are avoided as far as possible, and there is little or no long term effect in most cases. But separation anxiety is also common in everbody's life; it is a major component of that complex web of emotions which we call grief. A much loved partner, parent, grandparent, child or important other is snatched away by death and there is no hope (in this life) of reuniting. It may also come about as the result of a miscarriage or a marriage or relationship breakdown. The main way in which it is likely to manifest as a continuing problem in adolescent or adult life is in inappropriate behaviour to avoid a repetition of the experience. I'm thinking particularly here of people who have a pattern of breaking off relationships or friendships which to an outside observer seem to be developing well. They are, and therein lies the threat. So, get your retaliation in first; that way the pain is less. I am the eldest of three brothers. Six years ago, not yet sixty, my youngest brother fell ill and very shortly died. It came out of the blue. My other brother, once the funeral was over and we were all setting off for our various homes suddenly looked at me and only half-jokingly said " Right. i'm going to die next. I couldn't go through that again." I suppose I should be touched that my death would hit him that hard. Instead I thought, "typical of the selfish bastard!"

Existential anxiety is different. It hits you out of nowhere coming at you like a Formula 1 car going flat out. Why? Because in your past, probably in your early years something or things happened to you, or more likely, were done to you that were way too big to let go of, but way too big to handle. So your mind - the part Freud labeled the subconscious - stepped in to protect you. It buried them where you couldn't feel them, or only vaguely and tolerably, and you were able to survive. But at a price. That pain, anger, shame, guilt, despair festered and fermented, if you like, a build-up of emotional magma that one day would erupt. In the contemporary world events occur which trigger potentially dangerous memories and emotions; the eruption must be stopped at all costs. The result is blind panic, everything gets bottled up again and life, such as it is continues.

There's a problem here. I like analogies, so I'll turn to one here from my hiking days. You're out in wild country and you come across a river in full spate. It's not that deep but the power of that rushing water is tremendous. Your destination requires you to get to the other side. It's too wide to jump across and then is no bridge for miles in either direction. The hard fact: you can't go over it; you can't go under it; and you can't go round it. You have to go through it to reach your destination. The same is true of those buried traumas. There's no way over, under or round them. The only way to health is to go through them and it's going to be no easier and no more pleasant than wading that ragining torrent.

That's why you need skilled, experienced professionals; they are the walking poles that will allow you to keep your balance and get to the other side. That and a load of friends shouting support and encouragement.

There's more than enough to chew on there, so I'll pause now. Next time I'll say a little bit more about this, and then we'll turn to the easy one, situational anxiety.

Flat Is Good

Every person who suffers from a phobia of flying knows lots of people who really enjoy flying. So they see that as their ultimate goal; to get on a plane and recognise that it's fantastic. You can look out of the window and down below is a patchwork of green fields with cows and sheep, maybe caravans in some fields. And then as you leave England behind there's the beautiful blue of the sea, and the boats and the ships to look at.

You know what? At thirty eight thousand feet you can't see the animals or the boats. Which is no bad thing because probably what you're looking down on is the top of a blanket of cloud that most of the way down to Spain. And anyway, you might have an aisle seat. The welcome truth is that flying is like any other form of transport, tedious and time consuming. Oh there's the exhillaration of actually doing it for the first time, but pretty soon after that it's boring. That is your goal, to be bored by it instead of terrified.

There's another thing, too. My friend Jenasaurus of blog fame discovered that the way to overcome anxiety was to confront it; to say, "Go on then, do your worst!" And when she said that anxiety slunk off into a corner and refused to come out. But that challenging attitude is high maintenance. It burns up enormous amounts of energy and leaves you exhausted. What she hasn't noticed is that she has won - because I don't think she actually expected that. She thought that she had found a way to control anxiety, whereas in fact she had defeated it.

Jen, that battle is over. You've won. No need to go for walks to challenge anxiety any more. Go for exercise, for fun time with K, to get stuff from the shops, or keep appointments or drop in on friends for a cup of tea and a ciggy. There will be other, different things to overcome save uour energy for them.

Oh, and well done.

Distinguishing Between Different Types Of Anxiety

As often happens, it is reading or hearing about other people's experiences that clarifies my own thinking, so once again the credit for this post lies elsewhere. It's several years now since I retired from therapy and my memory needs jogging from time to time. I have been writing about anxiety here as if it is a single, unitary thing and it's not. Just as there are different types of arthritis, diabetes, dementia and autism for example, so there are different types of anxiety. When I was working with clients on a daily basis I was aware of this even if not consciously, and I adjusted my approach according to the apparent source of their anxiety; I had forgotten that, so it's good to be reminded. On reflection I would say that there are three main types of anxiety, which I shall refer to as situational anxiety, existential anxiety and separation anxiety. My posts here have been entirely concerned with situational anxiety and how to deal with it. In the early days of psychology the belief was commonly held that anxiety was the manifestation of a subconscious, unresolved conflict; Freud and his followers developed the psychoanalytic technique of using free association and stream of consciousness to encourage the patient to uncover the trauma that was at the root of their condition. In its own terms it was highly successful; it made an awful lot of psychoanalysts very rich, especially in America. Unfortunately, by the time the money ran out the patient was no better. Then in the 1960s when I was training, along came Behaviourism. In a nutshell this argued that deep seated trauma didn't exist. Anxiety was caused by faulty learning; something unpleasant happened and you associated your reaction with the situation in which it happened and subsequently felt anxious if confronted by a similar situation. What you had learned, you could unlearn. From developmental psychology we learned that a baby or young child will become anxious if separated even briefly from those it looks to for nurture. An example of this is my youngest granddaughter. From time to time her mother has to travel on business and may be away from home for as long as ten days. At nine years old, N finds this hard to cope with. The solution she has found to make life easier is to take an article of Mummy's clothing out of the laundry basket and have it in bed with her; it smells of Mummy and provides some comfort. What I concluded in my own work with clients was that these three types of anxiety were each quite different in origin and required a different approach in treatment. Situational anxiety arises out of wrongly attaching threat to a particular situation or activity and then having to avoid that situation or activity. Or your imagination paints a scary picture for you of a situation you haven't experienced - flying to Florida on holiday, for instance, and you develop a phobia about flying. This type of anxiety fits the Behaviourist model and is best dealt with by learning to react differently towards the focus of your anxiety. I've already written quite a lot about this, so I won't labour the point here. Separation anxiety, which usually has its origin in early experience, can persist in some cases up to and throughout adulthood. A lady in her sixties consulted me because she felt constantly vaguely anxious 'for no reason'. This free floating anxiety was something that went back as far as she could remember; she had somehow never felt quite comfortable in the world. This type of anxiety has a root cause, which is more than faulty learning. Something happened to cause an anxiousness that never went away. I saw her in the 1970s, so we are talking of someone born in the early part of the last century. We used hypnotherapy as an aid to finding the trigger. It went all the way back to birth. Jane was born prematurely and was taken straight from her mother to an incubator where she spent the next several weeks under nursing care which met her physical needs but left her floundering emotionally. There was no skin to skin contact with someone who smelled right, when she moved her limbs they never came into contact with anything, above her only emptiness to look at. We did make some progress, but really it should have been dealt with years before to be successfully resolved. And so that leaves existential anxiety. What is it? It is a terror that has no external object, and is probably the closest to what Freud had in mind. Past experiences generate emotions too dangerous to be expressed - or so it seems. For people with existential anxiety the threat is that something may burst the lock on the door behind which they had put the emotions of those experiences, and their escape threatens that person's continued existence, literally. The floodgates once opened will let everything out and overwhelm them. I'm becoming increasingly convinced that when I see a blog post with a TW flagged up, I am reading the story of someone in the grip of existential anxiety. This is not an area for amateurs; this needs the sustained support of a team of professionals, and it will need a great deal of time to find safe ways of dealing with what has been suppressed. In conclusion, it's probably the case that existential anxiety will be accompanied by situational anxiety where the upsurge of anxious feelings is wrongly associated with the external situation rather than the internal pressure, so whilst professional help, guidance and care are needed to deal with the existential anxiety, the sufferer can safely tackle any problems with situational anxiety, using the kind of things I've written about previously. I apologise for the length of this post, but I felt that it was better to treat the subject in some detail rather than cut corners to keep it brief.

Credit Where It's Due

This blog owes its existence and a great deal of its content - the good parts - to a good friend of mine on Facebook who has to contend with serious mental health problems but does so with amazing fortitude and good humour. She also blogs regularly at jenauruswake.wordpress.com. Whether you have mental health problems of your own or not, this is a blog well worth following.

I mention this because recently she has had to battle her way through a particularly bad patch which, thank goodness, she now seems to have largely overcome. The way she did so taught me something new, and I think it's worth sharing.

I have said already that anxiety's sole power rests in its ability to make you fear fear itself. On the Jenausaurus blog, you can read what happens when you pluck up the courage to call its bluff. I'm not going to paraphrase it here. Go to her blog and read all her recent posts which track the changes she has brought about.

Angela's Story

Very shortly after I shared the previous post on Facebook I received a comment which in essence told me that whilst the bottom rung might be attainable, the next rung was the one at the top of the ladder. There were no in between rungs. The lady who told me this knew from experience; she has drawn up too many two rung ladders in the past to see this as a solution for her. So let me tell you about Angela. I’m going back over thirty years but her experience in therapy taught me a lot. Angela was a single woman in her late forties living at home with her elderly, widowed father. She had always lived with her parents and had long suffered with ‘nerves’. Over time what had started out as vague unfocused anxiety had become stronger, more firmly established and more debilitating, until the point came where she was the victim of severe agoraphobia. Before her mother died, the three of them used to drive out regularly into the surrounding countryside where from the safety of the car Angela could enjoy the views across the fields. After her mother died there was a trusted neighbour who took her mother’s place in the car and the trips continued. Apart from that she never left the house; she couldn’t. I was asked to see her and judge whether I could help. She couldn’t come to me, so it would be necessary for me to go to her. Fortunately this was in the early days of my practice and so I could schedule the time needed to visit her at home. Home was a terraced house in a northern industrial town, and the front door opened directly onto the pavement. Angela could not approach that door if it were open. A ladder was not going to be easy to construct in reality. So we constructed a ladder in the imagination. I used hypnosis quite extensively and so explained what was involved and dispelled the popular myths as best I could. It proved to be a state that she could enter either under my direction or by using a self-hypnosis technique which I taught her. Next we brought into play imagination and visualisation and combined that with another of my tools - practice! I’ve said before, and I repeat, do not try to do something because trying implies the possibility of failing and that provokes anxiety, and anxiety is precisely what we don’t want. Instead, practise doing something without feeling anxious. And so Angela would settle down in her armchair, relax into a hypnotic state and then call up a visual image. She started with the image of her standing, relaxed in the open doorway. The moment her relaxed feeling began to slip she wiped the screen clean and returned to simply relaxing until she felt ready to call up the image and practice a little more. To begin with these practise periods were simply a few seconds. No matter. All practice is practice and all of it is valuable. Soon she found that she was able to watch herself calmly until it got boring. The next step was that instead of watching herself from the outside as it were, she now imagined herself standing in the open doorway looking calmly out into the street. She moved from being an observer to being the person in the doorway, and that too became boring before very long. So then she went in person to the front door, opened it and stood there. At no time did she tolerate even a little anxiety. This was not about coping with anxiety; it was about dispensing with it. Neither did she fall into the temptation of setting a goal of how long she would practise for. That way opens another door, the door to anxiety. Let’s be clear. This was no overnight, miracle cure. This was long repeated practice with tiny improvements to begin with which eventually gathered pace. From standing in the doorway she progressed to standing on the pavement. From standing on the pavement she moved on imagining herself walking along the street and then to actually walking along the street a little way and then returning home, still calm and relaxed. Then she was able to walk to the end of the street and back. Then round the corner and into the passage at the back of the houses (what I knew as an entry, growing up in Salford) towards her own back door. Now another thought had to be adopted. We fondly imagine that as human beings we are logical creatures, but if that were true no one would ever have these problems in the first place. We are ruled primarily by our emotions. If our instinct is that we need to retrace our footsteps to the front door, when logic tells us that the back door is closer, listen to instinct. Go back the way you came. Language can be unwittingly misleading. I’ve used the expression ‘we’ a couple of times. I did not go on these practice walks with Angela; she did them on her own. My interventions were always in her front room on my visits. Some time after she had regained the freedom to go out and about in her own town Angela did two things. She got a part time job serving in the local greengrocers, and then a few months later, knowing that she needed to replace her underwear, but not able to ask that her father do it for her, she spent a fortnight practising walking from the car park in a neighbouring town to Marks & Spencers, walking into the store, selecting what she needed, paying for it and walking back to the car. Then she went and did it. Not only that, but she coped with the fact that they had moved the lingerie department since she was last in the store. I tell you this not to impress you with my skill - all the work was done by Angela - but to demonstrate that there is always a way back from even the most overwhelming anxiety, by practising in your imagination what you cannot yet do in reality, by filling that huge gap between the bottom and top rungs with imaginary rungs and using them to bridge the gap.

Best Friend, Worst Enemy

Imagination is both of these things. It can trap you in overwhelming anxiety, can paralyse you with fear, or it can release you to lead the life that you could and should be leading. And the good news is that you have the power to choose which it shall be. If right now you are prone to acute anxiety - and if you’re not, why on earth would you be reading this? - it feels as if choice is one thing that you don’t have. Anxiety is in control and you just have to submit to it or make the best of a bad job. This is an illusion and one that we must tackle, so let’s look at what imagination is and how it works. Imagination is the capacity to picture something which is not present or not happening right now. And your imagination is a very powerful one.It paints two pictures side by side. It paints a picture of what might happen, and it also paints a picture of how you would react. The trouble comes when you accept the pictures it provides as certain to happen. Let’s take an example. It’s time you went to the dentist for a check-up, but you don’t enjoy trips to the dentist. So what happens? The thought of going to the dentist immediately conjures up for you the dentist’s chair, the masked face of the dentist staring down at you, the feel of fingers, mirrors and other gadgets being inserted into your mouth, …. you get the picture. But as if that wasn’t enough, you get a picture as well of you, sweating, trembling, bursting into tears, panicking, fighting to get out of the chair and escape. What a lethal combination of images! Is it any wonder that you put off the idea of ringing up for an appointment until next week, like you did last week and the week before. And yet none of this is actually real. All of it is simply a figment of your fertile imagination. But it has the power, if allowed to go unchallenged, of bringing about a self-fulfilling prophecy. You begin to feel anxious at the mere thought of making an appointment, and once the appointment is made the anxiety persists and increases until indeed you arrive at the dentist’ surgery a gibbering wreck, and now with the added complication of fearing that you are going to make a fool of yourself; and we all know that, in the words of the saying, “I’d rather die than make a fool of myself.” Where did these powerful images come from? From you. You created them with the help of your imagination. So immediately we have all the proof that we need, that you have a powerful imagination. The problem is that you are using it destructively, when you could be using it constructively. If you can imagine a negative outcome and be convinced by it, then you can equally imagine a positive outcome and be convinced by that. It’s simply a matter of practice. Where people had phobic anxiety it was very popular among therapists a few years ago to use a scaled approach to desensitisation. I don’t know whether it’s still popular, but it can certainly be helpful for many people. It involved drawing up a hierarchy of anxiety, usually consisting of about ten steps. An example would be a fear of spiders. You take a sheet of paper. At the top, you write down the most terrifying thing involving spiders that you can imagine. Then at the bottom of the sheet, you write down the very smallest situation that would involve a spider but cause you little or no anxiety. For instance, it might reading the word ‘spider’ in a book or newspaper. Next, half way up the sheet you write down something that falls roughly half way between these two extremes. Finally you slot in another four in the bottom half and three in the top half, so that you have a list going from one end to the other in order of severity. You begin the desensitisation process down at the bottom, repeatedly reading the word ’spider’ until it causes no anxiety at all. Or put another way, until it gets boring because it’s so easy. Boredom is a great healer! Now, you go up one level and work on that in the same way until you have switched off its capacity to trigger anxiety, and so on and so on until you can confront your worst fear related to spiders and not react to it. At that point, you are no longer arachnophobic. I was going to describe this process as climbing a ladder, but I don’t think that’s helpful because it suggests that the hierarchy is still there, but you have learned to overcome it. The vandal in me prefers to imagine a different scenario. When reading the word ’spider’ no longer has any power, you saw that bit of ladder off and throw it away; the second rung is now at the level previously occupied by the first. You then progressively saw chunks off the ladder until the top has come down to you. No climbing involved. Now you make a bonfire out of all those redundant chunks of ladder and toast a marshmallow or two by way of celebration. There’s only one fly in this particular ointment; sometimes the bottom rung itself generates too much anxiety to get started. That’s where imagination comes in as a helpful friend. That’s what we look at next.

Practice Makes Possible

Whenever someone tells me that they are trying hard to overcome their anxiety, my response is always the same; please don’t. What kind of crazy advice is that to someone fighting a constant battle against crippling anxiety! Actually, not as stupid as it sounds. If you try to do something there are two possible outcomes. You may succeed or you may fail. Whilst we love to succeed, the prospect of failing is not a good feeling. It arouses a degree of anxiety in us as we approach the task, whatever it may be. But isn’t anxiety just what we want to avoid? Look at it another way; if you want to confront your anxiety and overcome it, then you have to use the only mechanism that your body/mind has for the task - the fight or flight mechanism, which is where the physiological sensations of anxiety come from in the first place. Let’s spend a bit more time with the plank. It can teach us a lot. The plank is not a threat in itself, although we may create a threat around it. If you can easily walk along it when it’s on the floor, you could in theory walk along it just as easily when it’s thirty feet off the ground. Except that most people can’t. What stops them is their imagination. They picture themselves falling off and breaking a leg, or worse. That picture in their mind’s eye is what stops them from simply strolling along it. In the same way, what confronts you in particular situations is a self-generated image of you not being able to do it without feeling awful and having to run away from it. So when I say, please don’t try to overcome your anxiety or cope with your anxiety it’s because I want to suggest a better way. Why should you have to live your life with an undercurrent of anxiety that you somehow manage to control? There was a book written a few years ago entitled “Feel The Fear And Do It Anyway”. Wrong!!! Far better to get rid of the anxiety in the first place; you don’t need it. It’s a product of your imagination. Unwittingly, you created it. You can discard it. How? By practice. So you take a walk along a plank on the ground. You are probably a little careful because you’re not sure that you will place your feet absolutely correctly. So walk along it again… and again… and again, until you’re doing it without thinking. Now we’ll put it on two bricks. You show a little caution the first time; you could lose your footing. So do it again, over and over until it’s boring, and it’s time to put it between two chairs and start practising walking along it properly off the ground. Then, if you wish, prop it on two stepladders like painters and decorators often do and practise walking along with confidence. You too could be a steel erector, trotting along girders a hundred feet off the ground. There’s another advantage to practising. It doesn’t involve success and failure - as long as you don’t do something silly like turning it into a challenge. “I’m going to walk this plank fifty times and then I’ll reward myself with a cup of tea and a biscuit.” Do you see that you’ve just reintroduced the possibility of failure - and the fear that that arouses? No, you practice, that’s all. How long you practice is entirely up to you. Because the benefits are cumulative, 30 seconds of practice is just as valuable as half an hour. Take your time and stay comfortable. The object is to erase the anxiety, not put up with it, and that takes as long as it takes, but it’s worth the wait. I mentioned imagination. That’s what I want to come back to next time.