The Book of Angst E-Book

Gwendoline Smith

• Herausgeber: Allen & Unwin
• Kategorie: Ratgeber
• Sprache: Englisch

Veröffentlichungsjahr: 2022

Beschreibung

There's a lot of angst around these days. This heightened sense of fear, concern, insecurity and uncertainty can be overwhelming. Bestselling author of The Book of Overthinking and The Book of Knowing Gwendoline Smith explains what angst is and the ways in which deep anxiety can manifest. Gwendoline then drills down into social anxiety, which is often underdiagnosed but is one of the most common of the anxiety family. Using simple, clear language and humorous illustrations, Gwendoline gives detailed step-by-step advice on how to cope.

Leseprobe

Gwendoline Smith is a clinical psychologist, speaker, blogger and the author of the books The Book of Overthinking, The Book of Knowing, Depression Explained and Sharing the Load. She also goes by the name Dr Know. Born and raised in Chatham, Kent, she now lives in Auckland, New Zealand.

First published in Australia and New Zealand in 2021by Allen & Unwin.

First published in Great Britain in 2022 by Allen & Unwin,an imprint of Atlantic Books Ltd.

Copyright © Gwendoline Smith, 2021

The moral right of Gwendoline Smith to be identified as the authorof this work has been asserted by her in accordance with theCopyright, Designs and Patents Act of 1988.

All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or by anymeans, electronic, mechanical, photocopying, recording, or otherwise,without the prior permission of both the copyright owner and theabove publisher of this book.

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A CIP catalogue record for this book is available fromthe British Library.

Paperback ISBN: 978 1 83895 471 0E-book ISBN: 978 1 83895 472 7

Text design by Megan van StadenIllustrations by Georgia Arnold, Gabrielle Maffey andMegan van Staden

Printed in Great Britain

Allen & UnwinAn imprint of Atlantic Books LtdOrmond House26–27 Boswell StreetLondonWC1N 3JZ

www.allenandunwin.com/uk

DEDICATION

Dr Lorna Breen, chair of the emergency medicine department at NewYork-Presbyterian Hospital, died as a result of self-inflicted injuries on 29 April 2020— the year that Covid-19 began to spread around the world. She had contracted Covid-19, but that was not how she died. She cared so much for her patients and her colleagues that the trauma of the epidemic eventually killed her.

After her death, her father asked that she be remembered and praised as a hero. Hence I dedicate The Book of Angst to Dr Breen, and to all health workers. I hope that you all make it through, and that we, your cousins in mental health, are able to do our best to help heal the psychic wounds of this global trauma.

CONTENTS

AUTHOR’S NOTE

INTRODUCTION: WHAT IS ANGST?

PART 1:

The Anxiety Family

CHAPTER ONE

Generalised anxiety disorder (GAD) AKA worrisome overthinking

CHAPTER TWO

Obsessive-compulsive disorder (OCD)

CHAPTER THREE

Post-traumatic stress disorder (PTSD)

CHAPTER FOUR

Health anxiety (hypochondria)

CHAPTER FIVE

Panic disorder

CHAPTER SIX

The specific phobias

CHAPTER SEVEN

The eating disorders

CHAPTER EIGHT

Sexual response and anxiety

CHAPTER NINE

The anxiety epidemic

PART 2:

Social anxiety: the fear of judgement

CHAPTER TEN

What is social anxiety?

CHAPTER ELEVEN

More on social anxiety

CHAPTER TWELVE

The biology of social anxiety

CHAPTER THIRTEEN

Social anxiety and behaviour

CHAPTER FOURTEEN

Performance, perfectionism, procrastination and celebrity

CHAPTER FIFTEEN

Emotion and thought

PART 3:

Therapy time

CHAPTER SIXTEEN

Therapy session one

CHAPTER SEVENTEEN

Therapy session two

CHAPTER EIGHTEEN

Therapy session three

CHAPTER NINETEEN

Therapy session four

CHAPTER TWENTY

Therapy session five

CHAPTER TWENTY-ONE

Therapy session six

CHAPTER TWENTY-TWO

Therapy session seven

IMPORTANT STUFF TO REMEMBER

APPENDIX: FLASHCARDS

AUTHOR’S NOTE

I began writing The Book of Angst in April 2020 during the nationwide Covid-19 lockdown. When I had initially conceptualised this book, the virus was not yet a part of our lives. However, today we co-exist with a powerful pandemic, with the current leader of the free world suggesting the injection of disinfectant and exposure to UV light as potential remedies for this twenty-first-century plague.

Daily life has become surreal. Human beings, as a species hard-wired to attach and form close emotional bonds, are prohibited from such exchanges in our new and alien world. Millions of people worldwide have lost their jobs, their source of revenue, their ability to feed their families. Our health care workers are exposed to death trauma at a level never before seen during peacetime in living memory.

Our ‘peacetime soldiers’ have been risking their lives every day to keep our basic needs taken care of: farmers, truck drivers, couriers, supermarket workers. As is so often the case, ‘the little people’ are on the front line, while billionaires sit in their mansions pining for their yachts and their Botox.

The current climate of our world is ‘angst’. There is so much fear, so much concern, insecurity and uncertainty, created by life-threatening events of epidemic proportions. At the time this book went to print, there had been well over a million deaths worldwide.

The joyful news was that our magnificent natural kingdom had had a momentary reprieve from the toxicity of pollution caused by our human pursuits. Prior to Covid-19, ‘eco-anxiety’ was already a growing phenomenon in the first world—and it is not that our brothers and sisters in the developing world don’t care, it’s that they can’t afford to care. How can refugees wash their hands twenty times a day when they have no water to drink?

Unfortunately the global environmental crisis has not gone anywhere—this is only a temporary remission. But during lockdown I have loved observing people out walking, admiring natural beauty, because they are forced to take the time to smell the flowers and the pollution-free air. I love seeing fathers out with their children bike-riding and being involved with them, probably in the highest numbers since the industrial revolution.

On social media I am comforted by the acts of ‘coronavirus kindness’, reinforcing that there is still great human altruism (perhaps not quite enough, but it’s a start).

My other favourite posts are the ones of animals, birds and insects displaying their beauty, and watching them return to cleaner, more welcoming habitats.

I hope, with all my fingers and toes crossed, that we can make change and learn from this disaster. I would like to quote Sonya Renee Taylor, an author, poet, word artist, speaker, humanitarian, educator and social justice activator:

We will not go back to normal. Normal never was. Our pre-corona existence was not normal other than we normalized greed, inequity, exhaustion, depletion, extraction, disconnection, confusion, rage, hoarding, hate and lack. We should not long to return, my friends. We are being given the opportunity to stitch a new garment. One that fits all of humanity and nature.

—Sonya Renee Taylor

INTRODUCTION:

WHAT IS ANGST?

The word ‘angst’ has existed since the eighth century. It is defined by the Merriam-Webster online dictionary as:

a strong feeling of being worried or nervous: a feeling of anxiety about your life or situation.

In this, The Book of Angst, I cannot possibly—and it has never been my intention to—address all of the varying forms of anxiety in detail. The focus of this book is on broadening your knowledge of the many manifestations of anxiety, with the intention of providing you with understanding, information and recommended treatment methods. You can dip in and out of the various chapters, paying particular attention to those pages where you think you might recognise a little bit of yourself or your loved one.

I have in the later chapters focused on social anxiety disorder (AKA the fear of judgement). I have chosen this particular form of anxiety because it is so often misunderstood and under-diagnosed. Yet it is by far one of the most powerful and crippling of the many anxiety disorders.

In the section dedicated to social anxiety, I will discuss the many idiosyncratic features of this condition—those characteristics that make it stand apart from the others. I will provide understanding and education as well as treatment strategies.

The strategies in this book are based in cognitive behavioural therapy (CBT), which aims to help you manage your problems by changing how you think and act. These strategies can be utilised across the broad spectrum of anxiety conditions. If you identify with one or more of these conditions, it is vital that you seek professional help—particularly when it comes to the more debilitating of them, such as obsessive-compulsive disorder and post-traumatic stress disorder.

Read, have a laugh, and along the way you will hopefully learn some stuff that is both interesting and helpful. Now, come meet the ‘Anxiety Family’ . . .

PART 1

CHAPTERONE

GENERALISEDANXIETYDISORDER(GAD)

AKA WORRISOMEOVERTHINKING

This common disorder is characterised by persistent and excessive worry about a number of different things. People may anticipate disaster and be overly concerned about money, health, family, work or other issues. Thinking spirals incessantly, activated by the never-to-be-answered question ‘what if?’

In these times of great uncertainty, worry is also at pandemic proportions—a manifestation of Covid-19. People are surrounded by things unknown, and all the elements of life that we once took for granted—safety, job security, financial security—are now uncertain. And uncertainty is fuel on the fire of worry.

I have observed that people diagnosed with generalised anxiety are more badly afflicted by their worrisome overthinking during the age of Covid-19, and others who have never previously been worriers have now become engaged with the practice.

TREATMENT OPTIONS

Medication can be helpful with easing the distressing physical and emotional experiences of anxiety, although it does not offer a treatment per se.

If the long-term effects of the anxiety begin to manifest physically—for example, if your worrying is stopping you from sleeping, or you are experiencing gastrointestinal distress because of it (see page 80)—a pathway into depression can occur. This is where an antidepressant can be very helpful. If the depression has a significant anxiety component, an antidepressant with an anxiolytic (anti-anxiety) agent will most likely be prescribed.

Note: If you do seek medical advice at this stage, make sure that you explain your levels of anxiety to your doctor. Being prescribed the ‘right’ type of medication is essential. This is medication for your most important organ—the brain. It is not a matter of ‘one size fits all’.

The recognised state-of-the-art intervention for worrisome overthinking is cognitive behavioural therapy (CBT). The treatment strategies work for both pre-existing and new converts (because of Covid-19) to the cyclical nature of worry.

If you relate to this condition and think you might need help, have a look at The Book of Overthinking (also written by me).

I would like to add that, in my opinion, worry is at the base of most of the various forms of anxiety. The anorexic worries about being fat, someone with OCD may worry about contamination, people with social anxiety worry about being judged.

I mention this because when treating the anxieties via CBT, therapists essentially take a two-pronged approach: addressing the worrisome overthinking alongside the specific content of the fear/phobia. This is very much the case with social anxiety.

CHAPTERTWO

OBSESSIVE-COMPULSIVEDISORDER(OCD)

Obsessive-compulsive disorder is an anxiety disorder in which sufferers have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). It is another profoundly debilitating anxiety condition. In fact once when I was at a neuroscience conference, one of the professors speaking stated that OCD was the most crippling of all of the anxiety conditions.

OCD is an especially difficult condition to treat, whether with medication, talk therapy or behavioural therapy. As a clinician, just when you think you have it nailed, back it comes—different thoughts, different behaviours, but the same torture.

In my opinion the reason that OCD is the giant of them all is because of its major genetic component. Overall, studies of twins with OCD estimate that genetics contributes 45–65 per cent of the risk of developing the disorder. A number of other factors may play a role in the onset of OCD, including behavioural, cognitive and environmental factors, but genetics is a biggie.

I have watched documentary material of three-and four-year-old children with OCD performing lengthy and complicated rituals that can take them hours to complete, and role-modelling doesn’t appear to me to be a significant contributor.

Whatever you do, don’t blame yourself for your child’s OCD.Even the worst parenting doesn’t cause this disorder.

If you’re a parent, OCD is not a ‘phase’ your child is going through. Nor is your son or daughter deliberately misbehaving or trying to get attention. Your child is not to blame.

Perhaps most importantly, it’s not your fault if your child has OCD. OCD is a neurobiological disorder, which means that the brain of a child with OCD functions differently than the brain of a child who does not have OCD.

I have been practising for many, many years, and there have been phases in the psychological world of blaming parenting for children developing disorders such as OCD. During one such phase, which I recall occurring in the 1970s and beyond, there was very little acknowledgement of the complex relationship between nature and nurture, and that it was not either/or.

OCD manifests in many ways:

•  checking

•  fear of contamination(fear of germs)

•  hand-washing

•  hoarding

•  rumination(thoughts going round in circles)

•  intrusive thoughts.

When you look at this list you can begin to understand the profoundly destructive impact that OCD has on the daily lives of these poor souls and their families. Compulsive checking can go on for hours; extreme hoarding splits families and ruins lives. You can also begin to imagine the havoc that Covid-19 has created in the lives of people who struggle to live with OCD.

You can’t ask an individual who compulsively washes their hands as a result of contamination phobia to stop doing it when the message to the entire globe is ‘wash, wash and wash your hands again’. The difference is that the compulsive handwasher will scrub their hands until they bleed— standing fixated at the basin for hours, paralysed by fear.

The OCD brain demands the behaviour continues. Stopping results in unbearable anxiety for the afflicted. The only way to reduce the anxiety is to begin the ritual and repeat it again and again.

You see, it is the subjective experience of the anxiety that the individual wishes to escape. The worrisome, intrusive thoughts about contamination, or lack of symmetry, or throwing things away, create the anxiety, and then the compulsions are continued in an attempt to provide safety from the distress.

TREATMENT OPTIONS

Medication is almost always an option. However, I don’t know of any medications that can ‘cure’ OCD. The options are SSRIs (selective serotonin reuptake inhibitors) or their new cousin SNRIs (serotonin-noradrenaline reuptake inhibitors), the difference being that the newer SNRIs work on both noradrenaline as well as serotonin in the brain.