Anxiety Management

1- Medication

I have never found medication to be helpful, though I have met people who have benefited from either anti-depressants or anti-psychotics.

2 – Psychological approaches

* Paradoxical Intention (PI). This approach seems to have fallen out of favour.  It was devised by a psychiatrist called Victor Frankl.  There is quite a good explanation of it here but essentially it is about trying to improve anxiety symptoms by consciously trying to make them worse.  This is very counter-intuitive but I think that it works because anxiety is fuelled by frustration and fear.If you try to make anxiety worse you are reducing the frustration because you are no longer wanting desperately not to have anxiety and you are reducing the fear because you are confronting it head-on by making yourself think about it more rather than trying to run away from it.   Sometimes I have had some miraculous results with PI. However, unfortunately when I am in situations when I am feeling anxious it does not work. It works better if I practice it before the situation.  I think that maybe it does not work in the situation because I am using PI as a way of running away from anxiety and so I am losing the benefit of the paradoxical intention.

When I practice PI I find that I start to get bored with the anxious thoughts, and that’s when I can feel the effect working. This implies to me that the received opinion that anxiety is caused by thoughts is false.  If it was simply caused by thoughts then PI should make things worse.  Maybe this is why many people find that CBT doesn’t work because CBT is about addressing and challenging thoughts. I’m not sure exactly why PI is helpful, maybe it’s because in the same way that the more you try to not think about something, including anxiety, the more you end up thinking about it; try now not to think of a pink elephant! conversely the more you try to think about something the less you think about it.

* Positive statements: This may seem like a contradiction to on the one hand be advocating paradoxical intention which involves essentially repeating some quite negative statements to oneself, but also to promote positive statements.  The truth is that I have found both to be helpful and I am experimenting with using both to balance each other out. The positive statements are statements like ‘I can (do whatever the thing is that you feel you cannot do)’, or if I can ….then I can….. – where you base the statement that you can do something on something that you have actually done.

* Procrastination

This is where you delay your response to anxiety, e.g. if you are feeling anxious in a situation where you know it is not rational to be anxious, then you simply say to yourself ‘I will tolerate this for another five minutes’. After all, everyone can tolerate something that is not unbearable for five minutes. Once the first five minutes has passed then you see if you can last another five minutes, and you keep going on like this. This approach causes less stress than forcing yourself to tolerate a situation that is anxiety provoking.  You may find that eventually you forget about the anxiety trigger and this can boost your confidence in dealing with anxiety.

* Meditation

I find it useful to do meditation by using earplugs and then focusing on my breathing. I think that the earplugs make my breathing sound louder which makes it easier to focus on. If this doesn’t work then I just let any thought come into my mind without thinking a follow-up thought.  Sometimes I say to myself ‘let go of desire’ because I think that there is something in the Buddhist idea that our minds are like monkeys that are in a tree always looking for bananas and getting frustrated and tense with this constant quest for pleasure.

* Socialising

I used to find that socialising and talking a lot helped with reducing anxiety. I used to go out almost every night with the aim of socialising for about four hours a day.  When I injured my voice all of this had to stop and I wonder now if this excessive socialising and talking may have contributed to my vocal injury.  However, I think that when done less extremely socialising can make a positive contribution to reducing anxiety. In order to do this properly I would recommend combining it with working on improving social skills so that you reduce the stress that can be generated in social interactions.

* TPs

TP is my own abbreviation for my own word ‘Touch Points’.  This is something that I have stumbled on myself. TPs are points on the right side of my face that I touch when I feel stressed and which relieve tension. In order for them to become sensitive to touch I do some tense/relax exercises, for example tensing the arms and then letting them go and focusing on the difference in sensation between tension and relaxation. After doing the tense relaxation stuff I  gently touch some points around my mouth and this triggers a relaxation response.  I can feel my breathing become deeper, I feel mentally calmer and my body feels relaxed. In the past I have been able to stimulate these points simply through mentally focusing on them.

* Rehearsal

I find that rehearsing anything that I feel nervous about helps. I think that one of the main drivers of anxiety for me is worrying about a physical symptom of anxiety and inadvertently bringing it on because the worry includes an element of visualisation.  This process of visualising these symptoms and then producing them causes a vicious circle of fear of fear. I have so far not found a way to reverse this process by visualising myself not having physical symptoms of anxiety or having feelings of relaxation. However logically it seems likely that if the process can work one way it can work the other way.  When stressed sometimes I sleep walk which I think involves a similar mechanism because sleep walking and acting out physically something that you are dreaming about is another example of the body reproducing something physically after it has been imagined.

* Exposure therapy

I’ve noticed that choosing to deal with stressful situations helps me when these situations are imposed on me. For example, I’ve found that by choosing to speak in front of groups of people has helped me when I have been forced into stressful situations that involve groups of people.

* Electro-acupuncture

I’ve not been using this recently, but many years ago I used the low frequency electro-acupuncture setting on an Interferential machine to relieve headache, which it did. I may try this again. I am just mentioning it because I would like to find a simpler approach than an Interferential machine to achieve the same effect. Anyone got any ideas? I’ve tried the electro-acupuncture setting on TENS machines but never found them to work.

However, my main goal is to break the vicious circle of mentally imagery fueling fear of fear.  I think that the answer to this must involve using my mind and gaining the confidence in not becoming afraid of my own thoughts.  The approaches listed above help with this process but they don’t seem to be completely getting to the source of the problem.

* Sleep

Recently I’ve hit on a new technique to help me with sleep, I play music in my head for a while and then follow that with doing a meditation exercise.  I think this helps because the music reduces feelings of depression, however it also creates stimulation so I need to follow this up with meditating which reduces the stimulation and thereby enables me to sleep.