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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Take control of your anxiety--and start living your life Feel like your life is spinning out of control? Not sure how to handle what seems like constant change and chaos? You're not alone--the world has taken some pretty crazy turns recently--but if you suffer from an anxiety disorder, you're likely suffering far more than you need to. Anxiety is our natural reaction to unfamiliar, stressful, and dangerous situations, but for some of us this reaction can become all-consuming and ultimately debilitating. Anxiety For Dummies has the antidote to this, showing you how to manage feelings of uneasiness, distress, and dread--and take back control of your life. In a straightforward and friendly style, clinical psychologists Charles H. Elliot and Laura L. Smith show you how to pinpoint your triggers, use proven techniques and therapies, improve health and eating habits, and make other practical changes to your lifestyle that will have you feeling better fast. * Understand what makes you anxious and learn to let go * Change your thinking to "right-size" your worry * Evaluate self-help as an adjunct to professional therapy * Explore healthy lifestyles and medication options Including updates to the clinical literature and discussions of the impacts of world events--such as COVID-19--this book has everything you need to manage your worries and put you, not them, in charge of your life.
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Seitenzahl: 577
Veröffentlichungsjahr: 2020
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Anxiety For Dummies®
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Copyright © 2021 by John Wiley & Sons, Inc., Hoboken, New Jersey
Published simultaneously in Canada
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Library of Congress Control Number: 2020949876
ISBN 978-1-119-76850-0 (pbk); ISBN 978-1-119-76856-2 (ebk); ISBN 978-1-119-76853-1 (ebk)
Anxiety For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Anxiety For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Detecting and Exposing Anxiety
Chapter 1: Analyzing and Attacking Anxiety
Anxiety: Everybody’s Doing It
Tabulating the Costs of Anxiety
Recognizing the Symptoms of Anxiety
Seeking Help for Your Anxiety
Chapter 2: Examining What Anxiety Is All About
Anxiety: Help or Hindrance?
What Anxiety Looks Like
How Anxiety Differs from Other Emotional Disorders
Chapter 3: Investigating the Brain and Biology
Examining the Anxious Brain
Preparing to Fight or Flee
Mimicking Anxiety: Drugs, Diet, and Diseases
Chapter 4: Clearing the Roadblocks to Change
Digging Out the Roots of Anxiety
Finding Self-Acceptance
Having Second Thoughts about Change
Deciding to Get the Show on the Road
Watching Worries Come and Go
Getting Help from Others
Part 2: Battling Anxiety
Chapter 5: Understanding Feelings
What Do You Feel and Why?
Distinguishing Thoughts from Feelings
Looking at the Feeling Cycle in Action
Chapter 6: Rethinking Your Thoughts
Tackling Your Thoughts
Cultivating Calm Thinking
Watching Out for Worry Words
Refuting and Replacing Your Worry Words
Chapter 7: Busting Up Your Anxious Assumptions
Understanding Anxious Assumptions
Sizing Up Anxious Assumptions
Coming Down with a Case of Anxious Assumptions
Challenging Those Nasty Assumptions: Running a Cost/Benefit Analysis
Designing Calm, Balanced Assumptions
Above All: Be Kind to Yourself!
Chapter 8: Mindful Acceptance
Accepting Anxiety? Hey, That’s a Switch!
Connecting with the Here and Now
Accepting Mindfulness into Your Life
Savoring Spirituality
Chapter 9: Facing Fear
All About Avoidance
Exposure: Coming to Grips with Your Fears
Conquering Different Types of Fears
Expecting the Impossible
Chapter 10: Medications and Other Biological Options
Making Up Your Mind About Medications
Understanding Medication Options
Searching for Vitamins and Supplements
Stimulating the Brain
Part 3: Letting Go of the Battle
Chapter 11: Looking at Lifestyle
Friends and Family — Can’t Live with ’em, Can’t Live without ’em
Ready … Exorcise!
The ABCs of Getting Your Zs
Designing Calm Diets
Chapter 12: Meditating as Part of a Healthy Lifestyle
Meditation Basics
What’s So Good About Meditating?
Meditation Methods
Discovering Other Meditation Resources
Buyer Beware: Meditation Myths
Part 4: Zeroing in on Specific Worries
Chapter 13: Emotional Preparedness During a Pandemic
Pushing Through Pandemic-Related Anxiety and Stress
Figuring out Fact versus Fiction
Chapter 14: Facing a Career Crisis and Financial Woes
Meeting Job Worries Head-On
Taking Stock of Your Resources
Committing to a New Game Plan
Chapter 15: Keeping Steady When the World Is Shaking
Assessing Your Risks
Preparing a Plan for Realistic Worries
Imagining and Dealing with the Worst
Doing Your Part to Improve the World
Chapter 16: Racism and Anxiety
Racism: The Elephant in the Room and the Snake in the Grass
How Racism Leads to Anxiety
Coping with Racism
Fighting Racism
Chapter 17: Keeping Out of Danger
Evaluating Your Actual, Personal Risks
Avoiding Unnecessary Risks
Dealing with Trauma-Related Anxiety
Accepting a Certain Degree of Uncertainty
Part 5: Helping Others with Anxiety
Chapter 18: When a Family Member or Friend Suffers from Anxiety
When Your Loved One Suffers from Anxiety
Talking Together about Anxiety
Guiding the Way
Teaming Up against Anxiety
Accepting Anxiety with Love
Chapter 19: Recognizing Anxiety in Kids
Separating Normal from Abnormal
Reviewing the Most Common Anxieties in Children
Chapter 20: Helping Kids Conquer Anxiety
Nipping Anxiety in the Bud
Helping Already Anxious Children
Getting Help from Others
Part 6: The Part of Tens
Chapter 21: Ten Approaches That Just Don’t Work
Avoiding What Makes You Anxious
Whining and Complaining
Seeking Comfort
Looking for a Quick Fix
Sipping Herbal Tea
Drowning Your Sorrows
Trying Too Hard
Hoping for Miracles
Taking Medication as a Solution
Getting Help on the Couch
Chapter 22: Ten Ways to Deal with Relapse
Expecting Anxiety
Counting the Swallows
Checking Out Why Anxiety Returned
Seeing a Doctor
Revisiting What Worked Before
Doing Something Different
Getting Support
Considering Booster Sessions
Doubling Down on Exposure
Accepting Anxiety
Chapter 23: Ten Signs That You Need Professional Help
Having Suicidal Thoughts or Plans
Feeling Hopeless
Handling Anxiety and Depression
Trying to No Avail
Struggling at Home
Dealing with Major Problems at Work
Suffering from Severe Obsessions or Compulsions
Understanding Post-Traumatic Stress Disorder
Going through Sleepless Nights
Getting High
Finding Help
Appendix: Resources for You
Books about Anxiety
Books about Racism
Resources to Help Anxious Children
Websites to Discover More about Anxiety
Index
About the Authors
Advertisement Page
Connect with Dummies
End User License Agreement
List of Tables
Chapter 3
TABLE 3-1 Angst in the Medicine Cabinet
TABLE 3-2 Medical Imposters
Chapter 4
TABLE 4-1 Gavin’s Anxiety Causes
TABLE 4-2 Miguel’s Excuses versus Arguments Against His Excuses
TABLE 4-3 Alaina’s Baby Steps to Success
TABLE 4-4 Virginia’s Day-by-Day Anxiety Levels
Chapter 5
TABLE 5-1 Feeling Cycle Chart
Chapter 6
TABLE 6-1 Weighing the Evidence
TABLE 6-2 Developing a Reasonable Perspective
TABLE 6-3 Switching to the Present
Chapter 7
TABLE 7-1 The Anxious Assumption Quiz
TABLE 7-2 Cost/Benefit Analysis of Prudence’s Perfectionism
TABLE 7-3 Cost/Benefit Analysis of Daniel’s Dependency
Chapter 8
TABLE 8-1 Appreciating Flawed Friends
Chapter 9
TABLE 9-1 What I’m Afraid Of
TABLE 9-2 Leeann’s Exposure Procedures
TABLE 9-3 Chloe’s Exposure Procedures
Chapter 13
TABLE 13-1 Useful Worries and Actions
Chapter 18
TABLE 18-1 Responding to Reassurance Requests
Chapter 19
TABLE 19-1 Does Your Child Have an Anxiety Problem?
Chapter 20
TABLE 20-1 Modeling a Better Way
List of Illustrations
Chapter 3
FIGURE 3-1: When presented with danger, your body prepares itself to flee or st...
FIGURE 3-2: The chronic effects of anxiety.
Guide
Cover
Title Page
Copyright
Table of Contents
Begin Reading
Appendix: Resources for You
Index
About the Authors
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Introduction
We wrote our first book in the For Dummies series, Overcoming Anxiety For Dummies, shortly after the events of 9-11-2001. People felt rather anxious, especially about terrorism. We wrote the second edition in 2010 as the Great Recession was winding down. At that time, people were feeling particularly anxious about their finances and careers. Today, we present Anxiety For Dummies as the world struggles to cope with a global pandemic, an explosion of civil unrest and racism, climate change, and another potentially massive recession or depression.
So today’s world, just like the previous two decades, gives us plenty to worry about. But as we don’t want to become victims of a pandemic, financial setback, natural disaster, or violence, we can’t let ourselves become victims of anxiety. Anxiety clouds our thinking and weakens our resolve to live life to the fullest. We realize that some anxiety is realistic and inescapable, yet, we can keep it from dominating our lives. Even under duress, we can preserve a degree of serenity; we can hold onto our humanity, vigor, and zest for life. We can love and laugh.
Because we believe in our collective resilience, we take a humorous, and at times irreverent, approach to conquering anxiety. Our message is based on sound, scientifically proven methods. But we don’t bore you with the scientific details. Instead, we present a clear, rapid-fire set of strategies for beating back anxiety and winning the war against worry.
About This Book
We have three goals in writing this book. First, we want you to understand just what anxiety is and some of the different forms it can take. Second, we think that knowing what’s good about anxiety and what’s bad about it is useful for you. Finally, we cover what you’re probably most interested in — discovering the latest techniques for overcoming your anxiety and helping someone you care about who has anxiety.
Unlike most books, you don’t have to start on page 1 and read straight through. Use the extensive table of contents to pick and choose what you want to read. Don’t worry about reading parts in any particular order. For example, if you really don’t want much information about the who, what, when, where, and why of anxiety and whether you have it, go ahead and skip Part 1. However, we encourage you to at least skim Part 1, because it contains fascinating facts and information as well as ideas for getting started.
Scattered throughout this book are case examples and stories that illustrate important principles and techniques. Although these examples are based on composites of real people, they do not represent any actual person. Any similarities to actual cases or people are purely coincidental.
Foolish Assumptions
Who might pick up this book? We assume, probably foolishly, that you or someone you love suffers from some type of problem with anxiety or worry. But, it’s also possible that you simply find the topic of anxiety interesting. We imagine that you may be curious about a variety of helpful strategies to choose from that can fit your lifestyle and personality. Finally, you may be a mental health professional who’s interested in finding a friendly resource for your clients who suffer from anxiety or worry.
Icons Used in This Book
For Dummies books use little pictures, called icons, in the margins to get your attention. Here’s what they mean:
The Remember icon appears when we want your attention. Please read the text associated with it for critical information.
The Tip icon alerts you to important insights, clarifications, or ways to do things better.
Warning icons appear when you need to be careful, avoid potential risks, or seek professional help.
The Technical Stuff icon highlights information that some readers will find interesting but is not necessary for your overall understanding of anxiety.
Beyond the Book
For quick tips about anxiety, go to www.dummies.com, and type “Anxiety For Dummies Cheat Sheet” in the search box. You can get information about how to identify anxious thoughts, behaviors, and feelings. In addition, there are some suggestions for dealing with your anxious symptoms.
Where to Go from Here
Anxiety For Dummies offers you the best, most up-to-date advice based on scientific research on anxiety disorders. If you want help controlling your negative thoughts, turn to Chapters 6 and 7. If you’re concerned about living well during a pandemic, check out Chapter 13. If you’re worried about your job and finances, in Chapter 14 we provide tips for finding your next job and pinching pennies. Chapter 16 is a new chapter about anxiety related to racism.
For some people, this book could be a complete guide to fighting frenzy and fear. However, some stubborn forms of anxiety need more care and attention. If your anxiety and worry significantly get in the way of work or play, get help. Start with your family doctor to rule out physical causes. Then, consult with a mental health professional. Anxiety can be conquered, so don’t give up.
Part 1
Detecting and Exposing Anxiety
IN THIS PART …
Understand the ins and outs of anxiety.
Find out what anxiety does to your body.
Discover when anxiety is good for you.
Take a closer look at the causes of anxiety.
Chapter 1
Analyzing and Attacking Anxiety
IN THIS CHAPTER
Growing by leaps and bounds: Anxiety’s proliferation
Paying the tab for anxiety
Understanding anxiety symptoms
Getting the help you need
Stroll down the street and about one in four of the people you walk by has significant problems with anxiety. And almost half of the people you encounter will struggle with anxiety to one degree or another. The rate of anxiety across the world has climbed for many decades, and no end is in sight.
The whole world watches on edge as disasters, terrorism, financial collapse, pandemics, social unrest, crime, and war threaten the security of home and family. Anxiety creates havoc in the home, destroys relationships, erodes health, causes employees to lose time from work, and prevents people from living full, productive lives.
In this chapter, you find out how to recognize the signs and symptoms of anxiety. We clarify the costs of anxiety — both personal and societal. We provide a brief overview of the treatments presented in greater detail in later chapters. You also get a glimpse of how to help if someone you care about or your child has anxiety. If you worry too much, or care for someone who has serious problems with anxiety, this book is here to help!
Anxiety: Everybody’s Doing It
Anxiety involves feelings of uneasiness, worry, apprehension, and/or fear, and it’s the most common of all the emotional disorders. In other words, you definitely aren’t alone if you have unwanted anxiety. And the numbers have grown over the years. At no time in history has anxiety tormented more people than it does today. Why?
Life has always been menacing. But today people around the world are glued to screens watching the latest horrors in real time. News feeds, blogs, tweets, newsprint, and social media chronicle crime, war, disease, discrimination, and corruption. The media’s portrayal of these modern plagues includes full-color images with unprecedented, graphic clarity.
In addition, recurring financial crises rock the fragile stability of the poor as well as the middle class. The lack of basic necessities like food, shelter, education, healthcare, clean water, and sanitation endanger many lives throughout the world. No wonder anxiety is its own worldwide pandemic.
Unfortunately, as stressful and anxiety-arousing as the world is today, only a minority of those suffering from anxiety seek professional treatment. That’s a problem, because anxiety causes not only emotional pain and distress but also physical strain and even death, given that anxiety extracts a serious toll on the body and sometimes even contributes to suicide. Furthermore, anxiety costs society as a whole, to the tune of billions of dollars.
When people talk about what anxiety feels like, you may hear any or all of the following descriptions:
When my panic attacks begin, I feel tightness in my chest. It’s as though I’m drowning or suffocating, and I begin to sweat; the fear is overwhelming. I feel like I’m going to die, and I have to sit down because I may faint.
I’ve always been painfully shy. I want friends, but I’m too embarrassed to call anyone. I guess I feel like anyone I call will think I’m not worth talking to. I feel really lonely, but I can’t even think about reaching out. It’s just too risky.
I wake with worry every day, even on the weekends. Ever since I lost my job, I worry all the time. Sometimes, when it’s really bad, I feel like I’m going crazy, and I can’t even sleep.
I’m so afraid of everything that I can barely leave the house. I’ve stopped even looking for jobs. My family has to bring me groceries.
As you can see, anxiety results in all sorts of thoughts, behaviors, and feelings. When your anxiety begins to interfere with day-to-day life, you need to find ways to put your fears and worries at ease.
Tabulating the Costs of Anxiety
Anxiety costs. It costs the sufferer in emotional, physical, and financial terms. But it doesn’t stop there. Anxiety also incurs a financial burden for everyone. Stress, worry, and anxiety disrupt relationships, work, and family.
THE HEARTBREAK OF ANXIETY
Cardiovascular disease stands as the number one cause of death throughout the world. And research has demonstrated that chronic anxiety is a major contributor to poor cardiac health. So, early diagnosis and treatment for anxiety may help prevent some heart disease.
When patients are diagnosed with heart disease, anxiety often increases, even among people without a history of anxiety. Numerous studies have shown that untreated anxiety among cardiac patients is linked to poorer outcomes. These poor outcomes include recurrent cardiac events and even higher rates of death.
Therefore, it’s been recommended that all cardiac patients should be assessed for the presence of problems with anxiety. Since anxiety can be successfully treated, it makes sense to include evaluation and treatment for anxiety when it occurs in cardiac patients. Such interventions are likely to alleviate anxiety as well as contribute to improved cardiovascular health, but further research is needed to firmly establish this relationship.
What does anxiety cost you?
Obviously, if you have a problem with anxiety, you experience the cost of distressed, anxious feelings. Anxiety feels lousy. You don’t need to read a book to know that. But did you know that untreated anxiety runs up a tab in other ways as well? These costs include
A physical toll:
Higher blood pressure, tension headaches, and gastrointestinal symptoms can affect your body. In fact, recent research found that certain types of chronic anxiety disorders change the makeup of your brain’s structures.
A toll on your kids:
Parents with anxiety more often have anxious children. This is due in part to genetics, but it’s also because kids learn from observation. Anxious kids may be so stressed that they can’t pay attention in school.
Fat:
Anxiety and stress increase the stress hormone known as cortisol. Cortisol causes fat storage in the abdominal area, thus increasing the risk of heart disease and stroke. Stress also leads to increased eating.
More trips to the doctor:
That’s because those with anxiety frequently experience worrisome physical symptoms. In addition, anxious people often worry a great deal about their health.
Relationship problems:
People with anxiety frequently feel irritable. Sometimes, they withdraw emotionally or do the opposite and dependently cling to their partners.
Downtime:
Those with anxiety disorders miss work more often than other people, usually as an effort to temporarily quell their distress.
The cost to society
Anxiety costs hundreds of billions of dollars worldwide each year. Most of the cost is due to loss of productivity. Decreased productivity is sometimes due to health problems made worse by anxiety. But the financial loss from downtime and healthcare costs doesn’t include the dollars lost to substance abuse, which many of those with anxiety disorders turn to in order to deal with their anxiety. Thus, directly and indirectly, anxiety extracts a colossal toll on both the person who experiences it and society at large.
Recognizing the Symptoms of Anxiety
You may not know if you suffer from problematic anxiety. That’s because anxiety involves a wide range of symptoms. Each person experiences a slightly different constellation of these symptoms. For now, you should know that some signs of anxiety appear in the form of thoughts or beliefs. Other indications of anxiety manifest themselves in bodily sensations. Still other symptoms show up in various kinds of anxious behaviors. Some people experience anxiety signs in all three ways, while others only perceive their anxiety in one or two areas.
Thinking anxiously
Folks with anxiety generally think in ways that differ from the ways that other people think. You’re probably thinking anxiously if you experience:
Approval addiction:
If you’re an approval addict, you worry a great deal about what other people think about you.
Living in the future and predicting the worst:
When you do this, you think about everything that lies ahead and assume the worst possible outcome.
Dependency:
Some people believe they must have help from others and are unable to achieve on their own.
Perfectionism:
If you’re a perfectionist, you assume that any mistake means total failure.
Poor concentration:
Anxious people routinely report that they struggle with focusing their thoughts. Short-term memory sometimes suffers as well.
Racing thoughts:
Thoughts zip through your mind in a stream of almost uncontrollable worry and concern.
We discuss anxious thinking in great detail in Chapters 5, 6, and 7.
Behaving anxiously
We have three words to describe anxious behavior — avoidance, avoidance, and avoidance. Anxious people inevitably attempt to stay away from the things that make them anxious. Whether it’s snakes, heights, crowds, freeways, parties, paying bills, reminders of bad times, or public speaking, anxious people search for ways out.
In the short run, avoidance lowers anxiety. It makes you feel a little better. However, in the long run, avoidance actually maintains and heightens anxiety. We give you ways of confronting avoidance in Chapter 9.
One of the most common and obvious examples of anxiety-induced avoidance is how people react to their phobias. Have you ever seen the response of a spider phobic when confronting one of the critters? Usually, such folks scream, jump, and hastily retreat.
Finding anxiety in your body
Almost all people with severe anxiety experience a range of physical effects. These sensations don’t simply occur in your head; they’re as real as this book you’re holding. The responses to anxiety vary considerably from person to person and include the following:
Accelerated heartbeat
Shallow, rapid breathing
A spike in blood pressure
Dizziness
Fatigue
Gastrointestinal upset
General aches and pains
Muscle tension or spasms
Sweating
These are simply the temporary effects that anxiety exerts on your body. Chronic anxiety left untreated poses serious risks to your health as well. We discuss the general health effects in greater detail in Chapter 2.
NAME THAT PHOBIA!
Phobias are one of the most common types of anxiety, and we discuss them in detail in Chapter 2. A phobia is an excessive, disproportionate fear of a relatively harmless situation or thing. Sometimes, the object of the phobia poses some risk, but the person’s reaction clearly exceeds the danger. Do you know the technical names for phobias? Draw arrows from the common name of each phobia to the corresponding technical name. See how many you get right. The answers are printed upside down at the bottom.
Be careful if you have triskaidekaphobia (fear of the number 13), because we’re giving you 13 phobias to match!
Technical Name
Means a Fear of This
1. Ophidiophobia
A. Growing old
2. Zoophobia
B. Sleep
3. Gerascophobia
C. The mind
4. Acrophobia
D. Imperfection
5. Lachanophobia
E. Snakes
6. Hypnophobia
F. Fear
7. Atealophobia
G. New things
8. Phobophobia
H. Animals
9. Sesquipedalophobia
I. Small things
10. Neophobia
J. Mirrors
11. Psychophobia
K. Heights
12. Microphobia
L. Long words
13. Eisoptrophobia
M. Vegetables
Answers: 1. E, 2. H, 3. A, 4. K, 5. M, 6. B, 7. D, 8. F, 9. L, 10. G, 11. C, 12. I, 13. J
Seeking Help for Your Anxiety
As we say earlier in this chapter, most people simply choose to live with anxiety rather than seek professional help. Some people worry that treatment won’t work. Or they believe that the only effective treatment out there is medication, and they fear the possibility of side effects. Others fret about the costs of getting help. And still others have concerns that tackling their anxiety would cause their fears to increase so much that they wouldn’t be able to stand it.
Well, stop adding worry to worry. You can significantly reduce your anxiety through a variety of interesting strategies. Many of these don’t have to cost a single cent. And if one doesn’t work, you can try another. Most people find that at least a couple of the approaches that we review work for them. The following sections provide an overview of treatment options and give you some guidance on what to do if your self-help efforts fall short.
Untreated anxiety may cause long-term health problems. It doesn’t make sense to avoid doing something about your anxiety.
Matching symptoms and therapies
Anxiety symptoms appear in three different spheres, as follows (see the earlier section “Recognizing the Symptoms of Anxiety” for more details on these symptoms):
Thinking symptoms:
The thoughts that run through your mind
Behaving symptoms:
The things you do in response to anxiety
Feeling symptoms:
How your body reacts to anxiety
Treatment corresponds to each of these three areas, as we discuss in the following three sections.
Thinking therapies
One of the most effective treatments for a wide range of emotional problems, known as cognitive therapy, deals with the way you think about, perceive, and interpret everything that’s important to you, including
Your views about yourself
The events that happen to you in life
Your future
When people feel unusually anxious and worried, they almost inevitably distort the way they think about these things. That distortion actually causes much of their anxiety. In the following example, Luann has both physical symptoms and cognitive symptoms of anxiety. Her therapist chooses a cognitive approach to help her.
Luann, a junior in college, gets physically ill before every exam. She throws up, has diarrhea, and her heart races. She fantasizes that she will fail each and every test she takes and that eventually, the college will dismiss her. Yet, her lowest grade to date has been a B–.
The cognitive approach her therapist uses helps her capture the negative predictions and catastrophic outcomes that run through her mind. It then guides her to search for evidence about her true performance and a more realistic appraisal of the chances of her actually failing.
As simple as this approach sounds, hundreds of studies have found that it works well to reduce anxiety. Part 2 of this book describes various cognitive or thinking therapy techniques.
Behaving therapies
Another highly effective type of therapy is known as behavior therapy. As the name suggests, this approach deals with actions you can take and behaviors you can incorporate to alleviate your anxiety. Some actions are fairly straightforward, like getting more exercise and sleep and managing your responsibilities. You can get good ideas on those actions in Chapter 11.
On the other hand, a more critical type of action targets anxiety directly. It’s called exposure and feels a little scary. Exposure involves breaking your fears down into small steps and facing them one at a time. We cover exposure in Chapter 9.
Some people, with the advice of their doctor, choose to take medications for their anxiety. If you’re considering that option, be sure to see Chapter 10 to help you make an informed decision.
Feeling therapies: Soothing the inner storm
Anxiety sets off a storm of distressing physical symptoms, such as a racing heartbeat, upset stomach, muscle tension, sweating, dizziness, and so on. Making a few tweaks to your lifestyle such as increased exercise, better diet, and adequate sleep help a little. But our primary recommendation is to figure out how to approach distressing physical symptoms with an accepting attitude. Chapter 8 offers guidance on what’s called mindful acceptance.
Finding the right help
We suppose it’s not too presumptuous to assume that because you’re reading this book, you or someone you know suffers from anxiety. And you’d probably like to tackle anxiety. This book is a great place to get started on managing your anxiety.
The good news is that a number of studies support the idea that people can deal with important, difficult problems without seeking the services of a professional. People clearly benefit from self-help. They get better and stay better.
Then again, sometimes self-help efforts fall short, especially when anxiety is moderate to severe in intensity. Chapter 23 provides ten critical signs that indicate a likely need for professional help. See Chapter 4 for information about finding the right professional for you.
If you do need professional consultation, many qualified therapists will work with you on the ideas contained in this book. That’s because most mental health professionals will appreciate the comprehensive nature of the material and the fact that most of the strategies are based on well-proven methods. If research has yet to support the value of a particular approach, we take care to let you know that. We happen to think you’re much better off sticking with strategies known to work and avoiding those that don’t.
In Chapters 18, 19, and 20, we discuss how to help a child or an adult loved one who has anxiety. If you’re working with a friend or family member, you both may want to read Part 5, and probably more, of this book. Sometimes, friends and family can help those who are also working with a professional and making their own efforts.
Whichever sources, techniques, or strategies you select, overcoming anxiety will be one of the most rewarding challenges that you ever undertake. The endeavor may scare you at first, and the going may start slow and have its ups and downs. But if you stick with it, we believe that you’ll find a way out of the quicksand of anxiety and onto the solid ground of acceptance.
Chapter 2
Examining What Anxiety Is All About
IN THIS CHAPTER
Determining whether you have a problem with anxiety
Looking at symptoms of anxiety
Uncovering anxiety companions
Anxious feelings sprout up for most folks here and there and are completely normal. In certain situations, anxiety is a perfectly understandable reaction. For example, if you’re driving in a snowstorm and your car starts to spin out of control, feeling anxious makes sense. Or, if you are in the middle of a pandemic and the numbers of infections keep rising, well, if you didn’t feel a bit anxious, we’d worry about you. But sometimes anxiety signals something more serious. When anxiety is not tightly connected to realistic concerns and interferes with your ability to function day to day, it’s a good time to worry about your anxiety.
To get a feel for the difference between something as serious as an anxiety disorder and a normal reaction, read the following description and imagine ten minutes in the life of Viktoria.
Viktoria feels restless and shifts her weight from foot to foot. Walking forward a little, she notices a slight tightening in her chest. Her breathing quickens. She feels an odd mixture of excitement and mounting tension. She sits down and does her best to relax, but the anxiety continues to intensify. Her body suddenly jerks forward; she grips the sides of her seat and clenches her teeth to choke back a scream. Her stomach feels like it might come up through her throat. She feels her heart race and her face flush. Tiffany’s emotions run wild. Dizziness, fear, and a rushing sensation overtake her. The feelings all come in waves — one after the other.
You may wonder what’s wrong with poor Viktoria. Maybe she has an anxiety disorder. Or possibly she’s suffering a nervous breakdown. Perhaps she’s going crazy. No, Viktoria actually wanted to feel scared and anxious!
You see, she was at an amusement park. She handed her ticket to the attendant and buckled herself into a roller coaster. After that, you probably understand the rest of her experience. Viktoria doesn’t have a problem with anxiety, she isn’t suffering a nervous breakdown, and she isn’t going crazy. As her story illustrates, the symptoms of anxiety can be ordinary and sometimes even desired reactions to life.
In this chapter, we help you figure out whether you’re suffering from problematic anxiety, everyday anxiety, or something else. We take a close look at all the different forms and symptoms of anxiety. Then, we discuss some of the other emotional disorders that often accompany anxiety.
Mental health professionals refer to emotional problems as disorders. For example, instead of saying you’re depressed, they say you have a depressive disorder or some other type of mood disorder. A reasonable case can be made for using the term “disorder.” Although we use the word from time to time, we prefer to think of so-called disorders as normal reactions to a combination of biological, genetic, environmental, and interpersonal factors, as well as learned behaviors and problematic thoughts.
Anxiety: Help or Hindrance?
Imagine a life with no anxiety at all. How wonderful! You wake up every morning anticipating nothing but pleasant experiences. You fear nothing. The future holds only sweet security and joy.
Think again. With no anxiety, when the guy in the car in front of you slams on the brakes, your response will be slower because your body doesn’t react quickly to danger, and you’ll be more likely to crash. With no worries about the future, your retirement may end up bleak because your lack of worry caused you to not save for the future. The total absence of anxiety may cause you to walk into a work presentation unprepared or not bother studying for an important test.
Anxiety is good for you! It prepares you to take action. It mobilizes your body for emergencies. It warns you about danger. Be glad you have some anxiety. Your anxiety helps you stay out of trouble. See the sidebar “Anxiety and driving while Black” for suggestions about how normal anxiety may help protect young Black drivers.
ANXIETY AND DRIVING WHILE BLACK
All parents of teenagers who are learning to drive are anxious. If you’ve ever been in the car with a brand-new driver, you understand what we’re talking about. When the teen finally gets a license, the fear persists for some months. Will my daughter remember to stop at stop signs or make a turn without crashing into the curb? Will my son speed or try to show off while driving with his friends?
But if you are a parent of a Black teen driver (especially males), your worries multiply. Will my son be pulled over and know exactly what to say and do? What do I tell him to help him stay safe? Though it isn’t fair or reasonable, parents of Black teens have to give “the talk.” Usually the talk contains a few important elements that are useful for most people who get pulled over, but essential for persons of color. Here are a few items that usually get covered in the talk:
While the officer approaches the car, roll down the window, turn off the ignition, and place your hands at the top of the steering wheel.Don’t move your hands unless instructed to do so.When asked for license and registration, move slowly and tell the officer what you are doing, especially if you need to access the glove compartment.Be polite and cooperate.Do what the officer asks.It’s not a good idea to argue or be defensive.Do not run or resist arrest.Don’t make statements about what did or did not happen until you can talk to an attorney.Again, it’s unfair that people of color must take greater care during police encounters than others. But statistics tell us that persons of color have a greater chance of being hurt or killed at a traffic stop. This is a time when a good dose of anxiety may save a life.
Anxiety poses a problem for you when
It lasts uncomfortably long or occurs too often.
For example, if you have disturbing levels of anxiety most days for more than a few weeks, you have reason for concern.
It interferes with doing what you want to do.
Thus, if anxiety wakes you up at night, causes you to make mistakes at work, or keeps you from going where you want to go, it’s getting in the way.
It exceeds the level of actual danger or risk.
For example, if your body and mind feel like an avalanche is about to bury you but all you’re doing is taking a test for school, your anxiety has gone too far.
You struggle to control your worries, but they keep on coming.
Even when you’re relaxing at the beach or on your most comfortable recliner, anxious thoughts continually run through your mind.
What Anxiety Looks Like
Anxiety comes in various forms. The word “anxious” is a derivative of the Latin word angere, meaning to strangle or choke. A sense of choking or tightening in the throat or chest is a common symptom of anxiety. However, anxiety also involves other symptoms, such as sweating, trembling, nausea, and a racing heartbeat. Anxiety may also involve fears — fear of losing control and fear of illness or dying. In addition, people with excessive anxiety avoid various situations, people, animals, or objects to an unnecessary degree.
Anxious people tend to be extremely sensitive to danger, rejection, the unknown, and uncertainty. They may pay close attention to unpleasant thoughts, feelings, and physical sensations. They also often dwell on the possibility of future calamities. Anxiety symptoms such as these have a tendency to cluster together. The following sections describe some of these major clusters.
The following subheadings roughly correspond to some of the major diagnoses discussed in DSM-5, but we think it’s more productive to focus on symptoms rather than technical diagnostic categories. (See the sidebar “The Diagnostic and Statistical Manual-5 [DSM-5]” for more information.)
Worrywarts
Most people have heard of the term “worrywart” and immediately conjure up someone who constantly worries. Worrywarts have a chronic state of tension and worry. They often report feeling restless, on edge, and keyed up. They may tire easily and have trouble concentrating or falling asleep. Once asleep, they may wake up at 3 a.m. with racing, worried thoughts. Worriers also often report having achy muscles, especially in the back, shoulders, or neck.
Not everyone experiences chronic worries in exactly the same way. Some worriers complain about other problems — such as twitching, trembling, shortness of breath, sweating, dry mouth, stomach upset, feeling shaky, being easily startled, and having difficulty swallowing. No matter how you experience worry, if it’s keeping you from living life the way you want to, it’s a problem.
The following profile offers an example of what excessive worry looks like.
In a subway,
Brian
taps his foot nervously. He slept only a few hours last night, tossing, turning, and ruminating about the economy. He’s sure that he’s next in line to lose his job. Even though his boss says that he’s safe, Brian can’t stop worrying. He believes that he may end up broke and homeless.
His back is killing him; he shrugs his shoulders trying to loosen up his tight muscles. He struggles to concentrate on the blog that he’s looking at and realizes that he can’t remember what he just read. He notices his shirt feels damp. He thinks he might be sick. He
is
sick — with worry.
Brian has worked steadily at the same company since graduating from college six years ago. His work is highly technical. Most of the senior executives depend on his technology know-how. He has stashed away a nice amount of money for emergencies. Nevertheless, his anxiety has increased over the last year to the point that he notices that he’s making mistakes. He can’t think; he feels horrible and is in a constant state of distress.
The economy can make anyone anxious at times. But Brian’s worries appear to be out of proportion to his real situation. It seems unlikely that he’s in danger of losing his job. However, his extreme anxiety may, in fact, cause him to get in trouble at work. People with overwhelming anxiety often make careless mistakes because of problems with attention and concentration.
Some worries are perfectly normal. If you lose your job, it’s quite natural to worry about money. But if your name is Bill Gates or Jeff Bezos and you’re worried about money, perhaps you have a problem with anxiety.
When we were writing this section, we wondered where the original phrase “worrywart” came from. So, we looked it up. Turns out that Worry Wart was a character in a comic strip from the 1920s. The boy was a constant pest and annoyed his brother who christened him with the name Worry Wart. The meaning evolved into someone who is constantly beset with worries. The reason the word “wart” was used is that warts are an itchy nuisance that can’t be scratched away. In fact, the more you scratch, the worse the wart becomes, a bit like worry.
Avoiding people
People who are socially phobic fear exposure to public scrutiny. These people dread performing, speaking, going to parties, meeting new people, entering groups, using the telephone, writing a check in front of others, eating in public, and/or interacting with those in authority. They see these situations as painful because they expect to receive humiliating or shameful judgments from others.
Social phobics believe they’re somehow defective and inadequate; they assume they’ll bungle their lines, spill their drinks, shake hands with clammy palms, or commit any number of social faux pas and thus embarrass themselves. Ironically, because they are so anxious, they actually do what they fear. Shaky, sweaty hands spill drinks. Lack of eye contact turns people away. They worry about what others are thinking about them — so much that they don’t listen well enough to keep a conversation going.
Everyone feels uncomfortable or nervous from time to time, especially in new situations. For example, if you’ve been experiencing social fears about a challenging new situation, that may be normal. A short-term fear of socializing may be a temporary reaction to a new stress such as moving to a new neighborhood or getting a new job. However, you may have a problem with social anxiety if you experience the following symptoms for a prolonged period:
You fear situations with unfamiliar people or ones where you may be observed or evaluated in some way.
When forced into an uncomfortable social situation, your anxiety increases powerfully. For example, if you fear public speaking, your voice shakes, and your knees tremble the moment that you start your speech.
You realize that your fear is greater than the situation really warrants. For example, if you fear meeting new people, logically you know nothing horrible will happen, but tidal waves of adrenaline and fearful anticipation course through your veins.
You avoid fearful situations as much as you can or endure them only with great distress. Because of your fears, you may miss a variety of events you’d otherwise like to go to (for example, family gatherings, work opportunities, or parties).
Check out the following prime example of a social anxiety and see whether any of it seems familiar.
Maurice,
a 35-year-old bachelor, wants a serious relationship. Women consider him attractive, and he has a well-paying job. Maurice’s friends invite him to parties and other social events in an effort to set him up with women. Unfortunately, he detests the idea of going. Maurice conjures up a number of good excuses for backing out. However, his desire to meet potential dates eventually wins. Whenever he imagines scenes of meeting women, he feels intense, anxious anticipation.
When Maurice arrives at the party, he heads to the bar to quell his mounting anxiety. His hands shake as he picks up his first drink. Quickly downing the drink, he orders another in hopes of numbing his emotions. After an hour of nonstop drinking, he feels much braver. He interrupts a cluster of attractive women and spews out a string of jokes that he has memorized for the occasion. Then he approaches various women throughout the night, sometimes making flirtatious, suggestive comments. His silly, drunken behavior doesn’t get him any dates. The following day, he’s embarrassed and ashamed.
THE DIAGNOSTIC AND STATISTICAL MANUAL-5 (DSM-5)
Every so many years, groups of mental health professionals provide research and clinical experience in order to develop a list of emotional disorders. They publish their findings in a manual referred to as the DSM. Currently, the field is using the fifth edition. The diagnoses allow professionals to communicate with a common language. However, the formal role of diagnoses has its detractors. Many professionals believe it’s more useful to focus on symptoms as opposed to specific disorders. For your information, the DSM-5 currently lists the following major categories of anxiety disorders:
Generalized anxiety disorder (GAD)Social phobiaPanic disorderAgoraphobiaSpecific phobiasSeparation anxiety disorderSelective mutismAnxiety disorder due to another medical conditionThe previous few editions of DSM categorized obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) as anxiety disorders. No longer. Today, OCD has its own section, Obsessive Compulsive Related Disorders, and PTSD is categorized as a Trauma-and Stressor-Related Disorder. The controversies surrounding these changes are complex. And in most people with emotional problems, there are almost always overlapping symptoms. In other words, someone with anxiety is likely to have at least a few symptoms in one diagnostic category and a few others in a different category.
Maurice has social anxiety. Drug and alcohol abuse often accompany social phobia because people with social phobia feel desperate to quell their anxious feelings. And drugs and alcohol offer a quick fix. Unfortunately, that fix often causes additional embarrassment and may lead to an addiction.
Beyond everyday anxiety
Of course, everyone feels a little panicked from time to time. People often say they feel panicked about an upcoming deadline, an impending presentation, or planning for a party. You’re likely to hear the term used to describe concerns about rather mundane events such as these.
But people who suffer with panic are talking about entirely different phenomena. They have periods of stunningly intense fear and anxiety. If you’ve never had a panic attack, trust us, you don’t want one. The attacks usually last about ten minutes, and many people who have them fully believe that they will die during the attack. Not exactly the best ten minutes of their lives. Panic attacks normally include a range of robust, attention-grabbing symptoms, such as
An irregular, rapid, or pounding heartbeat
Perspiring
A sense of choking, suffocation, or shortness of breath
Vertigo or lightheadedness
Pain or other discomfort in the chest
A feeling that events are unreal or a sense of detachment
Numbness or tingling
Hot or cold flashes
A fear of impending death, though without basis in fact
Stomach nausea or upset
Thoughts of going insane or completely losing control
Panic attacks begin with an event that triggers some kind of sensation, such as physical exertion or normal variations in physiological reactions. This triggering event induces physiological responses, such as increased levels of adrenaline. No problem so far.
But the otherwise normal process goes awry at the next step — when the person who suffers from panic attacks misinterprets the meaning of the physical symptoms. Rather than viewing the physical symptoms as normal, the person with panic disorder sees them as a signal that something dangerous is happening, such as a heart attack or stroke. That interpretation causes escalating fear and thus more physical arousal. Fortunately, the body can sustain such heightened physical responses only for a while, so it eventually calms down.
Professionals say that in order to have a formal diagnosis of panic disorder, panic attacks must occur more than once. People with panic disorder worry about when the next panic attack will come and whether they’ll lose control. They often start changing their lives by avoiding certain places or activities.
The good news: Many people have a single panic attack and never have another one. So, don’t panic if you have a panic attack. Maria’s story is a good example of a one-time panic attack.
Maria
resolves to lose 20 pounds by exercising and watching what she eats. On her third visit to the gym, she sets the treadmill to a level six with a steep incline. Almost immediately, her heart rate accelerates. Alarmed, she decreases the level to three. She starts taking rapid, shallow breaths but feels she can’t get enough air. Sweating profusely and feeling nauseous, she stops the machine and staggers to the locker room. She sits down; the symptoms intensify, and her chest tightens. She wants to scream but can’t get enough air. She’s sure that she’ll pass out and hopes someone will find her before she dies of a heart attack. She hears someone and weakly calls for help. An ambulance whisks her to a nearby emergency room.
At the ER, Maria’s symptoms subside, and the doctor explains the results of her examination. He says that she has apparently experienced a panic attack and inquires about what may have set it off. She answers that she was exercising because of concerns about her weight and health.
“Ah, that explains it,” the doctor reassures. “Your concerns about health made you hypersensitive to any bodily symptom. When your heart rate naturally increased on the treadmill, you became alarmed. That fear caused your body to produce more adrenaline, which in turn created more symptoms. The more symptoms you had, the more your fear and adrenaline increased. Knowing how this works may help you; hopefully, in the future, your body’s normal physical variations won’t frighten you. Your heart’s in great shape. Go back to exercising.
“Also, you might try some simple relaxation techniques; I’ll have the nurse come in and tell you about those. I have every reason to believe that you won’t have another episode like this one.”
Maria had one panic attack and may never experience another one. If she believes the doctor and takes his advice, the next time her heart races, she probably won’t get so scared. She may decide to see how things go before seeking treatment for her problem. However, if she has a recurrence, treatment works pretty well for this issue.
HELP! I’M DYING!
Panic attack symptoms, such as chest pain, shortness of breath, nausea, and intense fear, often mimic heart attacks. Alarmed, those who experience these terrifying episodes take off in the direction of the nearest emergency room. Then, after numerous tests come back negative, overworked doctors tell the victim of a panic attack in so many words that “It’s all in your head.” Many patients with panic attacks doubt the judgment of the physician and strongly suspect that something important was missed or wasn’t found.
The next time an attack occurs, panic attack victims are likely to return to the ER for another opinion. Even a second or third visit may not convince those with panic attacks that the feeling wasn’t caused by a heart problem. The repeat visits frustrate people with panic attacks as well as ER staff. However, a simple 20- or 30-minute psychological intervention in the emergency room decreases the repeat visits dramatically. The intervention is pretty simple — just providing education about what the disorder is all about and describing a few deep relaxation techniques to try when panic hits.
Panic’s companion
Approximately half of those who suffer from panic attacks have an accompanying problem: agoraphobia. Unlike most fears or phobias, this anxiety problem usually begins in adulthood. Individuals with agoraphobia symptoms live in terror of being trapped and unable to escape. They desperately avoid situations from which they can’t readily escape, and they also fear places where help may not be readily forthcoming should they need it.
The agoraphobic may start with one fear, such as being in a crowd, but in many cases the feared situations multiply to the point that the person fears even leaving home. As agoraphobia teams up with panic, the double-barreled fears of not getting help and of feeling entombed with no way out can lead to paralyzing isolation.
You or someone you love may struggle with agoraphobia if
You worry about being somewhere where you can’t get out or can’t get help in case something bad happens, like a panic attack.
You tremble over everyday things like leaving home, being in large groups of people, or traveling.
Because of your anxiety, you avoid the places that you fear so much that it takes over your life, and you become a prisoner of your fear.
You may have concerns about feeling trapped or have anxiety about crowds and leaving home. Many people do. But if your life goes on without major changes or constraints, you’re probably not agoraphobic.
For example, imagine that you quake at the thought of entering large sports stadiums. You see images of crowds pushing and shoving, causing you to fall over the railing, landing below, only to be trampled by the mob as you cry out. You may be able to live an entire blissful life avoiding sports stadiums. On the other hand, if you love watching live sports events, or you just got a job as a sports reporter, this fear could be really bad.
Luciana’s story, which follows, demonstrates the overwhelming anxiety that often traps agoraphobics.
Luciana
celebrates her 40th birthday without having experienced significant emotional problems. She has gone through the usual bumps in the road of life like losing a parent, her child having a learning disability, and a divorce ten years earlier. She prides herself in coping with whatever cards life deals her.
