Changing Your Relationship with Anxiety

Most, if not all, of us are familiar with what it feels like to experience anxiety: fear of the unknown, feeling out of control, restlessness, sleeplessness, and physical sensations like a racing heartbeat, shortness of breath, and muscle tension.  Anxiety is mentioned in the news, on social media, in conversations, and it’s the most talked about problem in my counselling sessions; there are not many good things said about anxiety.  Not a lot of people want to experience more anxiety, and rarely ever do they talk about its’ benefits.  Most people want to STOP or ELIMINATE anxiety entirely.
 
I hate to break it to you but we cannot stop or eliminate anxiety!  Anxiety will be part of your life forever.  On the bright side, it doesn’t always have to make you feel badly.  As hard as it might be to believe, anxiety has the potential to change and work with you. It can help motivate you, encourage you to make different life choices, and keep you safe.  This will likely, however, take some time, some patience, and help from a trained professional.
 
I understand how complicated it is to experience the symptoms of anxiety; I sometimes struggle with it, too.  I have had to focus on my own skills that I’ve developed over the years and sometimes I talk to my own therapist.  Lately, it has been more demanding in my sessions with my clients because there has been a significant increase in people seeking help for anxiety.  I have to be honest to myself and everyone I talk to in that coping with anxiety can be very challenging. There are no quick or easy solutions and it truly does take time, effort, and patience.  The good news is that there are helpful strategies and, over time, it does get easier to manage the symptoms of anxiety, but you will have to change your relationship with anxiety rather than try to avoid it.
 
I would like to share some therapeutic tools that can help you learn from, and allow you to have a different type of relationship with, anxiety.  I will provide one example for each of the tools using COVID-19-related concerns as the presenting problem.
 
Cognitive Behavioural Therapy (CBT)
Anxiety serves the purpose of trying to protect you and keep you safe and likes to remind you of past experiences that weren’t very pleasant. CBT is an approach that can help you understand where the negative thoughts and feelings come from.  You can then determine if these thoughts are still helpful and relevant to your current situation. A lot of the time, our current situation might be different from past experiences and it is, therefore, important to remind ourselves, when we experience anxiety, that we are safe and this is a different problem and a different time.
An exercise to try:
Trigger/situation: You are listening to the news and you hear about the increase in COVID-19 cases
Feelings/Thoughts: You feel worried, anxious, concerned, and sad. Your most distressing thought is: What if I contract COVID-19?
CBT strategy: Ask yourself: what is the evidence that supports/gives validity to this thought?
Your answers might be, for example:

• There are so many people getting sick with COVID-19
• It seems easy to catch this virus
• Maybe I have the virus and don’t know about it
• Some people do die from COVID-19

Now, ask yourself how it feels to have these thoughts.  Is it helpful or unhelpful?
Helpful thoughts are those that are accurate and can help us achieve our goals and improve our quality of life whereas unhelpful thoughts are inaccurate and usually have the opposite effect.
In this situation, with COVID-19, some of these concerns and thoughts could be helpful, but lets look at the next question first.
Ask yourself: What is the evidence against the distressing thought?
Your answers might be, for example:

• There are many more people who are not sick with COVID-19
• I can get tested for the virus if I started showing specific symptoms
• I am healthy right now and don’t have any pre-existing medical conditions

Ask yourself: What are some alternative, more helpful thoughts for this situation?
Your answers to this question might be:

• There are options available to keep myself safe and healthy
• There is help available for those who need it right now and safety measures in place to prevent people from getting sick
• I can only focus on what I have control over right now in terms of physical and mental health and I can choose to engage in activities that help me feel better
• If I do get sick, it is more likely that I will get better and survive the illness

The video link below provides more information about CBT.
​https://www.youtube.com/watch?v=0G-UZ321l8M&t=7s
​
Acceptance and Commitment Therapy
This form of behavioural therapy helps you to learn how to create more space for anxiety and other unpleasant emotions while focusing on what matters to you in the present moment. This differs from CBT because it’s not about challenging your thoughts but more about being aware of them and not letting them get in the way of what matters to you. Keep in mind, it doesn’t mean you are avoiding anxiety, rather, recognizing that it doesn’t have to bother you all day in every moment. When we focus and engage in meaningful activities and pay attention to what we value the most, we teach anxiety that things are ok and we are willing to better understand anxiety in terms of what purpose it is trying to serve in a relationship with us.
An exercise you can practice using this method is the following: 
When you are enjoying an activity but you keep thinking about COVID-19 and feel anxious, imagine that the thought or anxiety is someone you can talk back to.  You can say, “Oh, hi, anxious thought.  I didn’t expect you to be here.  I am a little busy and having fun right now painting a picture, so I am going to continue doing this and enjoy myself.  See you later!”
 
This is a very different type of strategy that works very well for some people.  Check out this video below for more information.
https://www.youtube.com/watch?

Dialectical Behavioural therapy (DBT)
This form of therapy has many strategies to offer us in how to have a healthier relationship with our emotions.  One of these tools is called Opposite Action.  When we experience symptoms of anxiety, many of us are tempted to take action to decrease it right away or avoid it altogether.  Sometimes these actions end up being unhealthy for us and can actually create further problems with anxiety later on.
An exercise to try:
Opposite Action is a coping strategy that can help us change a negative behaviour into a healthier, more productive behaviours. Here is just one example:
Let’s say that during this pandemic, a family member you are living with asks you to go outside for a walk but your action is to avoid the outdoors for fear of contracting COVID-19.  The consequences of staying inside and avoiding the walk might be:

• Missing out on quality time with your family member
• Missing out on the opportunity to enjoy the fresh air that has even more benefits to your mental and physical health
• Not getting exercise
• The potential of feeling alone and in a poor mood

The opposite action, of course, would be to go outside!
And the benefits might be:

• Getting exercise
• Connecting and engaging with the family member
• The opportunity to enjoy the outdoors and fresh air
• The increased chance to feel better overall

Please check out this video to see more examples and learn more about opposite action.
https://www.youtube.com/watch?v=7DYbCY-XV3k

Narrative Therapy
Sometimes it is helpful to understand how anxiety is influencing us and to remember the times when we had more influence over anxiety.  When anxiety has more influence it might feel like we have less power and less hope as it can create significant problems in our daily life.
 
Narrative therapy is an approach that helps people to recognize situations where they can resist anxiety’s influence in creating problems. This can be a creative and playful approach to helping oneself and others, as the problems are externalized rather than feeling powerless and out of control.  We can learn that anxiety isn’t as scary as we once believed it to be.
For example:
This can be a very good exercise to use with kids but it can also be fun to use as an adult. If you were to be playful and creative and imagine that your anxiety were a character, say, the Worry Dragon, you can ask yourself the following questions:

• When does the Worry Dragon bother you?  When does it bother you the least?
• What are some things you do that the Worry Dragon doesn’t like?
• Are there some ways in which the Worry Dragon can be helpful?
• Who else has been helpful in dealing with the Worry Dragon?

Take a look at the Worry Dragon video below and remember that some worries are not relevant to you in your current situation while some might help you make important decisions or keep you safe. This is not necessarily a Narrative Therapy related video but a good demonstration of externalizing a problem.
https://www.youtube.com/watch?v=kEVzlnJcfXU

Getting the help you need
It is normal to experience anxiety from time to time. There will always be hard times and set backs; life doesn’t always go as planned. Further, it can be even more difficult when one is tired, hungry, over-stimulated, or under-stimulated.  It is, therefore, very important to engage in self-care practices that reduce your vulnerability to suffering from anxiety.
The symptoms of anxiety can be very serious and cause major problems for many people, which may lead to requiring medical attention and medication, in some cases. 
That being said, the examples above are just a few of the exercises that can help.  Many people have health insurance and Employee Family Assistance Programs (EFAP) that cover the cost of counselling.  There are also a lot of free services available for those who do not have benefits (https://www.cbc.ca/radio/opp/if-you-want-to-talk-to-someone-here-s-a-list-of-resources-that-might-help-1.4603730).  Please talk to your healthcare provider if anxiety is affecting you in a negative way or ask for help from a trained professional.