Sharpen Your Coping Skills to Better Manage Your Anxiety
Rachel: Welcome to today’s webinar titled ‘Sharpen Your Coping Skills to Better Manage Your Anxiety’! We are very fortunate to have Dr. Samantha O'Connell as our presenter today.
Dr. O’Connell earned her PhD in Clinical Psychology from Suffolk University and she currently performs neuropsychological assessments for the Integrated Center for Child Development and works as an outpatient therapist for families, couples and individuals across the developmental lifespan, where she specializes in cognitive behavioral treatment.
So without further delay, Dr. O’Connell, I will turn things over to you.
Dr. Samantha O’Connell: Hi everyone! Thank you so much for having me! During today’s webinar we will be talking about a part of life that’s unfortunately very well known to all of us.
While most of us have -- we don’t have worries that reach the diagnostic threshold per se, but on the other hand many of us do. The truth is all of us know what anxiety is because of the fact that we are all adaptive creatures. And I will be talking about in a little bit that anxiety is actually part of our natural biological adaptive system. It’s our alarm system.
And as we go through this webinar I really want you all to think about anxiety as having three parts. Usually we just think about those perseverative thoughts or how we feel, but it’s really three parts; it’s what we think, it’s how we feel, and it’s what we do, and that may be different for all people, but there are common threads.
So whether we are worrying about our job performance, we are anxious about learning a new task, we are thinking about our children, our loved ones, their health, out ability to control a situation, most of us know exactly what anxiety feels like. However, for some of us that anxiety can really get to the next level, and that’s the level where we are worrying about worrying, and where we are really getting some disruption in our lives. So all of us feel anxiety, but not all of us have life disruption. So we will talk a little about the difference.
But when we are worrying about worrying often we need intervention, and so I am so happy to be doing this webinar, because the treatment of anxiety is something that I specialize in, I feel very passionate about it, because anxiety is one of the most treatable symptoms of any of the mental health symptoms. And often the methods, they could, but don’t have to include medication, so I am so happy to be here.
So for the next slide you will see that during the course of this talk I do hope to cover a few objectives and then I hope to answer any questions that might come up at the end as we go.
So first, for the next slide, you will see that -- let’s just talk a little bit about what anxiety is. So in brief, anxiety is a reaction to real or imaginative threat, and we all know that feeling, uneasiness, dread. Many of us as we talk about it I am sure can conjure up those feelings right in your gut. And I really would like to reemphasize that anxiety is our normal biological response to danger and threat. It keeps us safe.
For example, we are presented with a threat and then there is a signal that’s sent to our brain, the amygdala specifically, to do something. Many of you may have heard of the fight or flight response; there is actually three Fs there; it’s the fight, the flight or the freeze.
So say we are presented with, we are walking in the woods, we are hiking in the woods and a bear jumps out. Our brain will get a message that says either fight that bear, run away from that bear, or play dead. All of those reactions could keep us safe. Unless you are way stronger than me, I don’t recommend the fight, but in the moment the truth is, we don’t really have much -- our bodies magically know what to do that would keep us the most safe in the situation, so anxiety and stress really is sort of a magical response that we have.
But before moving on, I just want to consider -- let’s consider other types of alarms. So, anxiety is our own alarm system in our body but let’s think about other alarms. So smoke detectors, car alarms, alarm clocks, all of these alarms tell us to do something. The smoke detectors says, go get the fire department or hose down the place. The car alarm will say, get away from the car. The alarm in the morning will say, get up. Basically they tell us to do something. Even fitness gadgets now that tell us to get moving every 30 minutes. But basically alarms tell us to act.
Now, think about for a minute, are those alarms are always accurate? Has your smoke detector ever gone off when it’s not really a fire? Has your neighbor’s annoying car alarm gone off when maybe a toddler just brushes by it on his tricycle? Maybe your alarm has gone off on a Saturday morning and that’s not your typical workday.
But think about, does the alarm sound the same? Yeah. Think of a smoke detector, it sounds exactly the same, if it’s a fire drill or if it’s a regular -- or if it actually signals the fire, maybe or maybe not. I am not so careful when I am cooking and my smoke detector must be very sensitive, because it goes off. No, there is not a fire.
So what do we do, do we hose down the kitchen? No. Do we arrest the toddler? No. Do we get up and go to work on a Saturday if it’s not our workday? Hopefully not. What we do is we have to sit in the moment, we hear the sound, it feels the same, but we stay in the situation and we look for clues.
So what I want to sort of talk about is, okay, when can we not do that? When does our own alarm system become a bit too sensitive, like my smoke detector in my kitchen? So for the next slide let’s sort of consider when the wiring in our systems become overly sensitive.
So let’s consider our anxiety as our own alarm system in our body; yeah, it keeps you safe, but some people are indeed born with wiring that’s more sensitive, and we will talk more about this in a bit. And some people’s wiring becomes more sensitive because of life’s experiences or situations, but in any case, we really have to learn to stop and look for clues to know better if we should act or if we should move on.
Because when the wiring does become overly sensitive, it really can cause that disruption I initially spoke about; it can disrupt our lives, our jobs, our families, it’s on one’s fault; we will talk about the risk factors and the whys, but we really do have to acknowledge the toll.
So for the fourth slide, when the wiring becomes overly sensitive we are at risk for developing an anxiety disorder, such as GAD listed here. And in essence, in a nutshell, it’s characterized by persistent, excessive, and unrealistic worry about everyday thing.
So for the next slide, let’s look at some of the symptoms. Now, note that these are some of the symptoms, and they do differ by person, especially the emotional ones. So we have listed uncontrollable/constant worry; yeah, that’s pretty typical, and we know the feeling of dread or nervousness.
Now, some people will experience excessive or uncontrollable crying; other people will have excessive irritability, that one does differ, but the point is, is that there is a very significant emotional part that is pretty unmistakable when you are going through it.
Behaviorally, these are just some; we will talk about the avoidance behavior in a minute, but let’s also highlight the restlessness or fatigue. So I mentioned that anxiety or stress can keep us safe, but when the alarm system is going off all of the time in the absence of real threat or just perceived threat, our body is absolutely going to fatigue.
That miracle of our stress response system is going off over and over and over again, and it works to keep us safe when there is a real threat, but if there is not, that’s really going to take a toll on us.
Now, there is a huge correlation between stress and illness, we know this, and anxiety disorders are a big player in that domain. So for some of the physical characteristics, beside stress and illness, we know the good old GI issues that some people have when we feel stressed, muscle tightness; this can really lead to migraines and other negative effects, and of course sleep problems. And when sleep is disrupted, and stomach is bothering you, and maybe there is a headache, how in the world are you going to get your job done and really function the way you want to?
So for the next slide, let’s take a minute to just entangle Normal Worry from Generalizing Anxiety Disorder or GAD. So you see in the left-hand column we have here, what’s Normal Worry, all right, we all have it, we all have worry, but it doesn’t get in the way of your daily activities or responsibilities.
On the other hand, with GAD, there is the disruption. It significantly disrupts your job, your activities, your social life, and it has to actually affect you in more than one domain to be considered a diagnosable anxiety disorder.
For Normal Worry, you can control it; with the GAD you really can’t.
Normal Worry, your worries aren’t pleasant, but they don’t cause you significant distress, while on the other hand, with GAD, you are extremely upset by worries, you are worrying about worries. Other people notice.
And you see in the next line, GAD, you are worrying about all kinds of things. You expect the worse, whereas with Normal Worry, your worries are pretty limited, specific, small number of realistic concerns.
And finally, Normal Worry, these bouts last for relatively short time period depending on the circumstance, but to be diagnosed with GAD, you have to have been worrying almost everyday, for at least six months.
So for the next slide, we know what anxiety is. We know it’s our natural alarm system, and it’s normal. We know what GAD is specifically, when it takes it to that next level, where it’s causing the disruption and disturbance in our life. Let’s talk a little bit about causes and risk factors.
So those delineated here on this slide, they are also the risk factor for many anxiety disorders and they really do span the biopsychosocial realm. What do I mean by that?
Okay, bio, our biology, what we are born with, so that’s our genetics. Some people are born with different amounts of neurotransmitters. Some people may have been exposed to toxins in utero, which also can affect your response to your environment.
The psyche in the biopsychosocial is how do we naturally understand things? How do we think about things based on our experiences and our personality? Do we think the glass is always full, do we think it’s always empty plays a big part in determining who will and will not suffer from more anxiety than others.
And then finally in the biopsychosocial, there is social learning; how has our environment contributed to us feeling and thinking this way?
So some things to consider are definitely genetics. We know there is a strong correlation between anxious parents having anxious kids. Of course, there could be biopsychosocial things mixed in there, including parenting and how kids observe their parents. But it's important to note that not all anxious kids come from anxious parents and that not all anxious parents have this perfect mold for anxious kids. We do know there is a stronger correlation if family history is positive for anxiety however, so it’s a good thing to know.
For things like substance abuse and physical health problems, it can be sort of a chicken and an egg question. We do know that people self-medicate, because anxiety is extraordinary. Especially, there is high level of social anxiety and overuse of alcohol, marijuana in social context. It makes sense, you want to calm down, those things calm you down.
The other thing we know though is that withdrawal from some addictive substances, like alcohol and even caffeine and nicotine, those can exacerbate anxiety as well. So it’s tricky.
So just looking through, there are lots of causes and risk factors for developing anxiety, and obviously the more of those you have, the more at risk you are. When we are faced with something that brings us anxiety or stress, the most natural reaction is to move away from it.
Think about pain in general, if something is hurting us, we pull away from it. Anxiety is tricky though, because the answer to avoiding it is that, no, we actually shouldn’t avoid it. We can’t ignore it, but we shouldn’t avoid it, because it could actually make it worse.
Let me clarify this. Many people think that it feels so good to avoid, and then the treatment of some anxiety disorder, such as a posttraumatic stress reaction, yeah, there is a component of trigger avoidance. But in general, we should not. We should really work hard to not completely avoid stress, because let’s talk a bit about the anxiety avoidance cycle, and this is important.
Say you are at work and you are nervous about giving a presentation, or maybe you are nervous about waiting on a customer, if that’s what your job entails, you feel anxious. So you decide, I am not going to do that presentation. The only way I can avoid ridicule is if I don’t do a presentation or if I don’t wait on that customer. So you think about doing it, you get anxious, so you decide, you know what, I am not going to do that. I am not going to wait on the customer. I am not going to do a presentation. Immediately, there it is, that feels great, awesome. Great!
Moving on, but there are two big buts here. The first but is, you gather no new data that could compete against your thought of, I can only avoid ridicule if I don’t present or interface with that customer. No one laughed at you or ridiculed you when you didn’t do it, so it has the potential to stamp in that thought that you can do or survive something.
And second, oh, shoot, maybe you need to do presentations to get that promotion, or maybe you have to wait on customers because, well, it’s your job to wait on customers. So in this way continual avoidance can cause a big disruption in your life.
We know for a fact that avoidance absolutely perpetuates the anxiety avoidance cycle, and the true fact is, the more you avoid, the higher your baseline level of anxiety is going to become.
And what people don’t really understand, I work with so many people who struggle with anxiety, and when I ask them, what do you think will happen if you stay in a situation? The anxiety will get higher and higher and higher, and then what? We will keep going. And many people will say things, they feel embarrassed, but they will say, many of us believe, well, I might go crazy. Or I will have a heart attack, or even I could die.
But what we know is that anxiety goes up to a point and then it comes down naturally. The problem is, is many of us don’t stay in the situation to experience that up and then gradual decline that shows us, you know what, I really can deal with this, and we get stuck in this anxiety avoidance cycle. So it’s something to think about, the more we avoid, the more our anxious thoughts are stamped in, and the higher level our baseline can become.
So good news, I said it was treatable, and it is. There are wonderful treatment options. My bias is definitely cognitive behavioral therapy, what you will see on the slide. And my bias is CBT, because for anxiety there are loads and loads of research that shows that this really works.
Now, many different types of treatments work for a lot of people. I just had a lot of luck with people across the developmental lifespan with cognitive behavioral therapy.
And in essence, it’s short, it’s goal-oriented. It helps people to better understand the relationship between those thoughts, those feelings, and those behaviors, and the goals is to help people develop that awareness that they can change their thinking or their behavior patterns to live a more adaptive life, or live more the life that they want to.
So for the next slide, you will see there are other treatment options; medications, relaxation techniques have been around for a long time. In terms of the breathing relaxation technique, it’s an interesting one.
So there’s two parts of your nervous system; the sympathetic and the parasympathetic, and one revs you up and one calms you down. And if you do deep breathing, you actually trick your body into going into the part of the nervous system that calms you down. You can't be in both at the same time.
So if you are starting to feel really anxious, I do encourage you, put your hand on your stomach, breathe in through your nose. Your stomach should distend a bit, as if there is a balloon in your stomach sort of puffing up, and then as you breathe out your mouth, your stomach should become flatter. I encourage you to try it for a second, breathe in, two, three, hold, now slowly exhale, two, three, hold.
If you do that five or six times, you are tricking your nervous system to go into the part that calms you down. So while it’s difficult to catch your breath, I encourage you to really try. That technique is called diaphragmatic breathing, and it means really breathing with your belly rather than that short chest breathing. So it’s definitely a good technique.
So for this next slide, there’s even some more strategies that we can use to manage anxiety and generalized anxiety, learning about triggers, limiting your alcohol and caffeine, and in general, living that healthy lifestyle. Not getting enough sleep, not eating well, not exercising, these can be vulnerability factors that can help perpetuate or even start anxiety.
Finally, really thinking about, well, we really can’t control everything.
On to the next slide, there’s a few more techniques and things to think about. And one is challenging those anxious thoughts. Now, that might include a practice of considering that those thoughts are only guesses. So we have to act as a detective and find clues about whether or not there’s evidence for or against that guess.
You might even write that thought or the guess. Oh, I can’t avoid ridicule, or for a child, I can only be safe near my mother. Then you sort of write that on the top. That’s your guess. Now, put on your detective hat and start really thinking about, is there evidence for that thought, is there evidence against that thought, and sort of tally up the clues and figure it out. And that way, maybe you are being rationale, but it’s a nice process if you do find yourself having a lot of worry thoughts, or automatic worry thoughts that may or may not be grounded in reality.
Maintaining a positive attitude, that is true, but I also want to acknowledge that when someone says, just look on the bright side, quit worrying so much. You know what, that can make us feel even more alienated. So what I would encourage you to consider is that you have to try on thoughts like you would try on new shoes.
Now, what I mean by that is, how many of you had really comfortable sneakers or maybe skates, if you play hockey or something, how awesome does your broken end gear feel? It feels good. It feels comfortable. You know it.
Now, why don’t we wear old sneakers or old skates forever? Well, they don’t work anymore. They may have holes. The heel breaks. They are too broken and they have no support.
So just as we need to bring in new shoes, that may give us blisters, they just don’t feel good, you know what, the more you wear them, the more yours they become, and I really want to acknowledge that it’s hard to try on new thoughts, they don’t feel like yours, you are not really buying it, but with time, I promise you, they can become more part of you, but you have got to start by pretending.
So for the concluding slide, just know that anxiety is a very, very treatable, treatable disorder. I couldn’t be more emphatic about that. Anyone can develop it. And learning new strategies really take time. You have to practice, practice, practice, just like really wearing in those shoes.