What is anxiety and what can I do about it?

When I started working with anxiety I will be honest, I hated it. I found it to be a slippery little sucker. As soon as I thought we had figured it out it would pop up somewhere else and start again. 

I would get caught up with the client in the belief that we had failed with our first attempt and that it may, actually, be a permanent state of mind. I would try and wrack my brains for reasons why it hadn’t worked and come up with nothing. I believed I was failing as a therapist and started to question whether I should be doing this job at all.

I spoke to other therapists and no one seemed to have a straight answer, they just agreed that it was a difficult issue to work with and there was no one way to figure it out. In short, I fell for the narrative anxiety was selling.
 
Then, as the same thing happened with every client, I started to understand that this was part of the journey of anxiety. I realised that to recover from anxiety there was often a period of dipping in and out, a sense that that you had recovered but only temporarily. But why?

It became apparent that to lose the fear of anxiety you had to befriend it and to befriend it you needed to get to know it, and for some people, this meant meeting it again and again until they stopped ‘resisting’. As long as you are afraid of it, it will return, which feels like an oxymoron, who isn’t afraid of being afraid. Your fear ‘mode’ is your survival mode. Without it, you would not be alive today.

So, to learn to become comfortable with it, and ultimately ignore it, goes against everything you are built to do. It is precisely what it is designed to do, make you alert to threats, focus your attention on the threat and stay focused until it has been removed so to learn to ignore goes against sense.

And this is precisely why recovering from anxiety can be so hard.

Anxiety is the fear that something bad is ‘going’ to happen, which may or may not be true. But how do you tell the difference between which ones may be true and which ones cannot be true at this time? The important thing to notice here is that it hasn’t happened yet, and this is where the anxiety gets its power, from the unrealised consequence, the unknown.
 
By our very design, when our body perceives a threat we tunnel vision our focus on this threat, which if you are faced with a knife-wielding mugger is exactly what you want it to do. The same applies when you have a presentation that you have not prepared for. The anxiety should motivate you to do the work needed to do the presentation.

But when it is a hypothetical anxiety, such as ‘What if everyone laughs at me?’, we still tunnel vision our focus onto it which creates an anxiety loop between our thoughts and our emotions, each one feeding the other. And because it hasn’t happened, and we have no way of knowing if it will, it becomes very hard to step out of the loop. Our bodies are designed to stay focused on the threat until it has passed.

There is no point only starting to run away from a mugger and then becoming distracted by something else, we need to get to safety. And in the same vein, if we have a presentation coming up and we haven’t prepared then worrying is a good idea, it helps remind us that we need to do some work. But when the problem is hypothetical we become stuck, focusing on the hypothetical threat where there is no solution. So, we have the same physiological response to all three scenarios, when the threat is real and in front of us, when there is a chance that our lack of planning will impact a future event and when the threat is purely hypothetical.

Working with anxiety: The Xbox metaphor

I have come up with a metaphor for how anxiety works in the body and mind and how to tell the difference between real and hypothetical threats. I’m calling it the ‘Xbox metaphor’.

If you imagine that everyone has an Xbox built into them, this Xbox has the physiological symptoms of anxiety such as heart palpitations, shortness of breath, sweating, stomach issues such as butterflies or digestive problems, a restriction around the chest and throat area, to name a few.

The purpose of the Xbox is to physically tell you there is a threat and prepare the body for fight, flight or freeze. This physical response is often intense and extremely hard to ignore. As far as we are concerned the only way to stop these physical symptoms is to remove the perceived threat, real or hypothetical.
 
So, what is the threat? Using this metaphor, anxiety is the game that is being played on the Xbox and everyone has their own, personalised version. The game is designed to hook you in and not let you go until you have found a solution. This is great if the threat is real or if you need to prepare or plan but when the threat is hypothetical this game becomes un-winnable. Once you start playing the game is designed to keep you looped in until the problem is solved.  
 
When it is hypothetical it cannot be solved in the here and now, and the here and now is all we have. How do we tell though, if it’s hypothetical? You ask the question, ‘Is this fact or fiction?’ For example, you have a presentation coming up and you are feeling anxious because you feel under-prepared and you are worried that people will notice and think you are incompetent. The ‘fact’ is you have a presentation and you are under-prepared, the ‘fiction’ is people will think you are incompetent. There is nothing you can do about the fiction, but the fact is you can do more preparation to help you feel more prepared.

So, the first thing is to check ‘fact and fiction’. When there is a fact you can figure out a plan but when it is a fiction there is nothing you can do. This is when the game turns from helpful to unhelpful and the only way to stop this is to stop playing the game and turn the Xbox off at source, which is easier said than done.  
 
To turn the Xbox off your focus moves away from the game, the perceived threat, and onto the Xbox, the physical symptoms of anxiety. One of the most powerful weapons to use against anxiety is present-moment awareness. This means focusing on what is actually happening in the present moment, not what is happening in your mind. This can be done in several ways, but the most effective way is using the breath and senses.

Senses can only be activated in the present moment. So, firstly, check your breathing. One of the most common symptoms of panic is the shortening of breath. Our breath becomes focused in the upper part of the chest, increasing our heart rate to prepare us for fight, flight or freeze. You want to try and start to lengthen your breath, especially the out-breath.

A common breathwork exercise I use is the 4-8, counting to four on the breath in and eight on the breath out. You want the breath to go deep into your belly. This slows the heart rate down and activates your parasympathetic nervous system, alternatively known as the calming system.

You can also use all your senses, touch, taste, sight, smell and sound to help ground you in the here and now. You can ask yourself ‘What can I see and hear?’ ‘Are there planes flying over? Can I hear birds? You could try eating something salty or biting into a lemon, something that will wake your taste buds up. Finding ways to ground yourself in the moment will allow the body to calm itself down and, by default, stop or quieten the anxious thoughts.

This is also another good way of checking to see whether the anxiety is hypothetical or whether there is anything you can do about it. Being under-prepared will be true whether you are calm or anxious. 

These are just a few tips on how to recognise and deal with anxious thinking.