Free Yourself from Anxiety (3 page)

Many people with Anxiety also suffer from clinical depression. For some people the misery of Anxiety is the cause of their depression, but for others the depression comes first, and Anxiety is a secondary effect of the depression.

Depression is not just a case of feeling low, or of needing to cheer yourself up. Clinical depression is an illness. Here is a list of symptoms (you are unlikely to experience all of them): 

Mild depression can be treated through self-help – exercise is particularly helpful. More severe depression will need help from your doctor, in the form of anti-depressant tablets or visits to a counsellor.

If you have depression, whatever has caused it, you will have to decide whether to work on the depression before you turn your attention to your Anxiety. The key is to examine your motivation and your energy levels. Depression saps both, and without them self-help can be very difficult.

This decision is complicated by the fact that you are bound to feel a bit daunted at the start of a self-help programme – the journey seems so long, and the ultimate goal of recovery so very unobtainable.

We suggest that you don’t think at all about the ultimate goal at the moment. Just think about the next step. It will be a small step, because that’s how self-help works – small, steady, well-planned steps. If you think you have the energy and motivation for this, then self-help for your Anxiety is worth trying. If you can’t face even the smallest step, then turn your attention to your depression before you tackle your Anxiety.

This is a brief overview so don’t worry if your particular phobia or obsession isn’t mentioned here. As you work through this book you will learn more about the various types of Anxiety disorder, and you will be able to apply the principles of recovery to your own situation. There are more details in Extra Information 4.

A panic attack is a sudden surge of Anxiety, usually short-lived but very intense. The surge causes physical sensations that increase dramatically as the attack progresses. It is fuelled by a sudden release of adrenalin into the body.

They vary from person to person but doctors use the following list – if you experience four or more of these sensations in the space of a few seconds then you are probably having a panic attack:

After the attack, you are left with feelings of exhaustion, shakiness and bewilderment.

For many people, panic attacks are the foundation that their Anxiety disorder is built on. For them, life becomes a question of doing anything to avoid another panic attack. And yet other Anxiety sufferers have never experienced a panic attack, and never will.

Phobias encompass both a fear of something specific and more generalised, but still focused, fears.

These are both about a fear of being trapped and unable to get help or reach a safe place. They are really a cluster of phobias which can include open spaces, closed spaces, crowded spaces, queues, lifts, public transport, crossing bridges, the hairdresser, restaurants, theatres and cinemas.

This is a fear of being alone.

This is another cluster, connected with other people. It is more than just being shy or self-conscious and can include speaking, eating or drinking in public, using public lavatories, preparing food or drink or writing while being watched. Social phobics often worry that they will give themselves away if they blush, sweat or stammer, and the worry makes it more likely that they will.

These are also known as simple phobias because they focus on just one thing. There are hundreds of these, from fear of thunderstorms to fear of injections.

GAD is different from a phobia in that you feel excessively anxious but without a specific focus. You feel tense and unable to relax. You may feel many of the symptoms of a panic attack but without the climactic rush of panic. You may also be constantly worried about something bad happening to people you care about, and you may feel that your worrying keeps these people safe. The constant worry is very distressing and can make you feel that you’re out of control and might go mad.

Some people describe a strange and scary feeling of being ‘not quite there’, ‘unreal’ or ‘not in my body properly’. This is not in fact an Anxiety disorder in itself, but it is mentioned so often that it needs explaining. It happens when someone breathes in a shallow, fast way, which upsets the balance of oxygen and carbon dioxide in their system. It is frightening but not dangerous.

If you’ve had Anxiety for a long time, and think that you know everything it can throw at you, then it can be very frightening if these feelings of unreality suddenly develop on top of everything else you have to cope with.

OCD starts with obsessive thoughts, which are so upsetting that you search for a way to get rid of them. If your way is to carry out compulsive behaviours then you have OCD. Compulsions often have to be repeated many times before it feels like the thought has been cancelled out.

The obsessive thoughts are often about dirt and disease, or about harming someone, either by accident or by giving way to an impulse. Thoughts about germs may lead to compulsive hand washing or cleaning. Fear of causing harm can lead to checking gas taps, electrical connections or the car.

Other compulsions may involve hoarding (newspapers, food or just rubbish), or a preoccupation with symmetry or arranging things in a particular order.

Sometimes there is an obvious link between the compulsive behaviour and the object of the obsession – e.g. dirt and washing – but in other cases there appears to be no logical connection. For example, someone believed they had to touch every lamp post they passed to prevent something dreadful happening to a member of their family.

Sometimes the compulsions are thoughts rather than actions. Obsessive thoughts about harming someone or doing something immoral or taboo, may lead to compulsive thoughts about prayer to cancel out the obsessive thoughts.

Compulsions tend to increase over time, so that you have to do a longer ritual with more repetitions to achieve the same amount of temporary reduction in Anxiety. This is exhausting of course, and so someone with OCD can eventually get to a point where they avoid as far as possible the things that trigger their compulsions. This can mean, for instance, that someone with a cleanliness obsession actually becomes quite dirty because they can’t face the enormous ritual of taking a shower or washing their hair.

If you have OCD you may well have always been a methodical, accurate and careful person. You may even have had a job that exploited these useful qualities. When you are under stress your useful qualities turn to OCD.

Sometimes it can be difficult to distinguish between OCD and a phobia. There is a sense in which most Anxiety sufferers have an obsession – if you spend all your time worrying about having a panic attack, or finding
a spider, or meeting someone in the street, then you are obsessed to a certain extent. And you could say that behaviours such as constantly checking a room for spiders, or crossing the road to avoid a meeting, have an element of compulsion to them.

But there is an extra dimension to OCD, which is the link between the obsessions and the compulsions. A person with OCD usually has a strong feeling that they need to carry out their compulsions or else some dreadful consequence will ensue, and almost always they also feel that they must do their compulsions in a certain way, like a ritual.

So, if you are afraid of spiders and you need to check each room for them, then you have a phobia. If you feel that letting a spider be in the room is likely to bring bad luck, or harm to yourself or your family, and if you also check the room in the same way each time, then you have OCD. Similarly, someone who is anxious about the security of their home might double check that they have locked the door, whereas someone with OCD might check repeatedly, locking and unlocking.

OCD can exist alongside other Anxiety disorders, for example social and health phobias, and also depression.

This is caused by exposure to danger or abuse. It is classified as an Anxiety disorder although it relates to events that have happened in the past rather than fears about what may happen in the future. Most people who experience traumatic events such as road/rail/air accidents or incidents involving violence can expect to have at least some disturbing physical and emotional reactions associated with shock and horror. Usually these are short-lived. Support from family and friends, with possible short-term professional help is usually enough to help them through it. A very few people go on to develop PTSD, where they continue to have strong reactions over a long period, usually feeling that
PTSD needs professional treatment so we don’t recommend using this book or attempting self-help.

This book is intended for use by adults dealing with their own Anxiety. Where children are concerned, although they may be having problems which show many of the same features as adult Anxiety disorders, we do not recommend trying to adapt a self-help approach without getting advice.

Most children go through phases when they are frightened of particular things – these are part of their normal development and are usually outgrown. If problems do persist way beyond the expected age or cause severe disruption to the child’s everyday life and forming of relationships, some professional help and guidance may be needed.

It is advisable to get a proper assessment which takes into account the child’s general health, overall development and any factors within the family or environment which might be contributing.

It’s time to get out your notebook and start keeping a diary. An Anxiety diary is a simple record of your anxious feelings day by day. It’s important that you write down your Anxiety scores at least twice a day, but there is no need for you to try to account for every minute of the day. But don’t leave it till the end of the week and then try to remember everything, because you won’t remember accurately enough.

Even doing it every day you will find that you tend to record the bad times, and ignore the comparatively good times. The important thing is to learn to assess your Anxiety by scoring it. Be honest, only you will ever see the diary.

If you are concerned about your privacy, then use a code or whatever system you can understand.

Sometimes it helps people to write more about what they are going through. Do this if you wish – maybe in the back of the notebook.