Reducing Anxiety and Worry

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Note: This article is reproduced with Dr. Campbell’s kind permission from his CFIDS & Fibromyalgia Self-Help website.

Anxiety and worry often accompany CFS and FM. The two conditions often create a loss of control over our bodies and over our ability to plan and predict. They also bring uncertainty about the future. We may be unclear about our prognosis and wonder whether we will improve and, if so, how much. We may worry about how far down we might slide and about becoming dependent or destitute.

Strategies for Anxiety and Worry
Here are eight strategies that are often helpful in counteracting anxiety and worry. For more suggestions, see "Fifty Tips on the Management of Worry Without Using Medication" in the book Worry by Edward Hallowell

  1. Practice Stress Reduction
    Learning relaxation and other stress reduction techniques can help reduce the intensity of your emotional reactions and, by doing so, reduce the echo effect in which emotions and symptoms amplify one another. A regular stress reduction practice can also lower “background worry,” the ongoing anxiety that results from long-term stress. 

  2. Use Problem Solving
    Taking action to solve a problem has a double payoff. You reduce or eliminate a practical concern that is bothering you and the process of taking action reduces anxiety. 

  3. Change Your Thinking
    If you have a tendency to think of the worst that might happen, you can take steps to short-circuit the process in which your thoughts increase your anxiety. One antidote is to retrain yourself to speak soothingly when worried, saying things like “I’ve been here before and survived” or “this is probably not as bad as it seems.”

    Also, you can do “reality checks” by testing your fears against facts and by asking for feedback from others. You can make worry work for you if you learn to distinguish between toxic worry, which is unproductive and paralyzing, and good worry, which helps you plan. For more on changing thinking, see the article Changing Self-Talk.

  4. Write to Reduce Worry
    Write out what you’re worried about. The process of giving words to worry can put them into perspective and may even help you identify potential solutions. If you tend to get stuck in rumination, consider writing a reassuring letter to yourself that you can read when you feel stuck, like the “letter to myself” described in the section on depression.

  5. Connect with Other People
    Feeling that you are part of something larger than yourself counteracts worry. Also, contact soothes worry, distracts you from preoccupation with problems, and provides reassurance. 

  6. Exercise and Pursue Pleasure
    Exercise is one of the best treatments for worry, because it is both relaxing and distracting. Also, other activities in which you can become immersed help change mood. These include reading, listening to or playing music, engaging in hobbies, spending time with pets, and good conversation.

  7. Don’t Worry Alone
    The act of sharing a worry almost always reduces its size and emotional weight. Discussion may help you find solutions and almost always makes the worry feel less threatening. Putting a worry into words translates it from the realm of imagination into something concrete and manageable. Seek out people who can offer support and reassurance. 

  8. Consider Counseling and Medications
    Counseling and therapy can make worries more manageable. Also, just as drugs can help with depression, some people find that medications help them deal with anxiety. A drug will not be a complete solution to problems of anxiety, but it can be part of a comprehensive response.

A Note on Panic
Some people experience an especially severe and frightening form of fear called panic attacks. These are brief episodes of terror in which a person may feel he or she is about to die. Symptoms may include chest pain, heart palpitations and dizziness.

In spite of overwhelming fear, people survive, but they may live a life of dread, apprehensive about when the next attack will occur. This kind of fear is treatable. For more, see Hallowell’s book Worry or Martin Seligman’s What You Can Change and What You Can’t.

My Anti-Anxiety Strategies
All those things applied to me, but I was able to reduce my anxiety greatly over a period of several years, thanks to using ideas I found in Edward Hallowell's book Worry. Using five of his strategies, I reduced my score on the worry scale in his book by 60% and, more importantly, changed the emotional climate of my life.

Learning Mental Relaxation
Probably the most important change was learning how to create a state of mental relaxation.

Fairly early in my time with CFS, I began to take two daily rest breaks. The rests helped me to reduce my symptoms, increase my stamina and bring stability to my life. The physical relaxation was restorative, but sometimes the rests were stressful because my mind was racing, full of anxious and worried thoughts.

In response, I started experimenting with incorporating mental relaxation into the rest periods. I hoped that by quieting my mind, I could achieve a deeper quality of rest than by just lying down.

For the most part, I used a simple procedure that combined keeping my attention on my breath with the Relaxation Response, as described by Dr. Herbert Benson of Harvard. Benson suggests repeating a word or sound over and over for fifteen or twenty minutes. When your mind wanders, you return to your chosen word or sound.

I found that using Benson's approach put me in a state of deep relaxation, in which I was aware of what was going on around me but detached from it at the same time. Benson describes this as a pleasant state similar to the feeling you might have lying on the beach on a warm summer day

Using the combination of Benson's directions and focusing on my breath allowed me to slip into a much deeper state of relaxation, in which I was aware of my surroundings and my thoughts but detached from them.

Over time, I noticed that the calmness I experienced in my twice daily rests carried over into my daily life, reducing the "background worry," the ongoing anxiety that resulted from the long-term stress of living with a chronic condition.
 
Changing My Self-Talk
Relapses were a frequent and usually discouraging part of my life during my first two years with CFS. I often responded by "catastrophizing" or imagining the worst. As I lay in bed for hours and hours, I would say things like as "I'll never get better" or "It's hopeless."

These thoughts made me more anxious, frustrated and helpless, and created a vicious spiral. The negative thoughts intensified my worry. The worry made my symptoms worse, which in turn triggered another round of negative thoughts.

I was able to use the principles of cognitive therapy, which Hallowell outlines in his book, to interrupt this negative spiral. When I caught myself saying things like "you'll never get better" or "you'll be like this the rest of your life," I countered by telling myself "you've bounced back from all your previous setbacks, so just relax" or "remember how things always look hopeless when you're at your worst."

I'm convinced that speaking in a reassuring way to myself reduced the length of my relapses. Replacing my negative thoughts with positive and realistic ones enabled me to relax and thus gave my body more energy for healing.
 
Using Distraction and Immersion
When worry led to obsession with thoughts of bad things that might happen, another solution in addition to changing my thoughts was distraction and immersion. (Hallowell refers to this as changing your mental state by changing your physical state.)

If the worry level was fairly low, it might be dispelled by a minute or so of deep breathing. Breathing was relaxing, and focusing my attention on my body distracted me from worry. Getting out of the house and taking a walk was another strategy.

Exercise relaxed me by stimulating endorphins while the visual stimulation distracted my thoughts. Another favorite was taking a nap. If my fatigue reached a high level, it was a sign that I was outside my energy envelope and all my symptoms were on "high," including brain fog, irritability and worry.

Other strategies that Hallowell suggests are listening to music, reading a book, praying, making a list or planning some activity, writing a letter and, in moderation, eating a snack. In sum, he says, "worry is a physical state of mind as well as a psychological one. One of the best ways to deal with worry is to change your physical state."
 
Talking with Others
Another strategy, connecting with others, also helped me to reduce my worry for several reasons. First, I relearned that basic truth that sharing a worry almost always reduces its size and emotional weight. Just giving verbal form to an anxiety seems to make it smaller.

Also, talking with another person often led me to see my situation differently and consider new options. Putting a worry into words translates it from the realm of imagination into something concrete and manageable.

Calling someone and hearing about their day was effective, too. By immersing myself in their world, I turned my attention away from myself and my worries. And the sense of connection helped reduce my anxiety.
 
Taking Action
Doing something to address the problem causing you to worry is another Hallowell strategy. That's a way to kill two birds with one stone. Taking action reduces or resolves an issue and thereby shrinks the reason to be worried.

One experience stands out, a serious relapse after some dental surgery. The dentist projected a one week recovery period, but two and even three weeks after the surgery, my CFS symptoms were still much higher than before the surgery, leaving me worried that the procedure might have set back my recovery from CFS.

I responded with some reassurance, but also with action. Remembering that one of my rules for living with CFS was "If all else fails, go to bed," I increased my daily rest time to twice, three times, and eventually six times normal. After just two days of three hours of rest, my relapse lifted.


Dr. Bruce Campbell is a recovered ME/CFS patient and former consultant to self-help programs for chronic illness at Stanford Medical School. His nonprofit site (www.cfidsselfhelp.org) offers articles, low-cost online Self Help courses in moderated discussion group format, and free follow-up programs & support.
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