The Mindful Way through Anxiety
Break Free from Chronic Worry and Reclaim Your Life
By Susan M. Orsillo, Lizabeth Roemer
The Guilford Press Copyright © 2011 The Guilford Press
All rights reserved.
understanding fear and anxiety
TURNING TOWARD YOUR EMOTIONS
Marc had worked hard to create a financially secure and satisfying life. After years of college and law school, working late nights and weekends, he finally secured an enviable position at a Fortune 500 company as in-house counsel. Frequently reflecting on their early days of scrimping and saving, Marc and his wife, Janelle, truly appreciated the comfort of their beautiful suburban home, the high-quality private school education they provided for the children, and the frequent travel they enjoyed. Unfortunately, it all came crashing down on Black Thursday, the day hundreds of layoffs in the legal business were announced around the world. As the financial pressures have mounted, Marc has become increasingly nervous, irritable, and stressed. His mind is constantly busy with worry about the future and regret about the past. What if he can't find another position? Who will hire a middle-aged man in this economy? What if they lose the house? How can he explain everything to the kids? Why didn't he pursue a different career? Why didn't he save more money? All night Marc tosses and turns, his mind working through all the possible consequences of unemployment. He is exhausted from the lack of sleep and the constant tension in his neck, shoulders, and jaw.
* * *
It's Friday night, and the dorm is booming with activity. The hall reverberates with the competing sounds of blaring music, the whirlwind of activity in the bathroom where everyone is jockeying for a better position in front of the mirror, and the general commotion in the common area as the residents finalize their plans for the evening. Nikki turns to face the wall and pulls the covers over her head as she hears her roommate, Alisha, come back in. Alisha pauses for a moment but then, convinced that Nikki is asleep, grabs her bag and bolts out of the room to catch up with a crowd headed for the party. Nikki feels the sting of Alisha's sarcastic comment to the group—"My poor roommate seems to be coming down with the flu for the third time this month"—and she feels herself blush as peals of laughter echo through the hall. Nikki never dreamed that she would spend her weekends at college holed up alone in her room. Sure, she hadn't been a party girl in high school, but she never would have described herself as shy or anxious. Nikki had always done well in her honors classes, and she had a group of close friends who hung out together almost every weekend. But the transition to college had been rocky. Nikki was uncomfortable making new friends, and she kept to herself during orientation. Now everyone had settled into groups of friends, and she was left alone on the outside. Nikki started buying food to eat in her room because she was too embarrassed to sit alone in the cafeteria, where she imagined she would be scrutinized by all the other students. Even her schoolwork was slipping. Being organized and responsible was no longer sufficient. Nikki's professors expected her to participate regularly in class, and she had two presentations coming up. As the thoughts and images of all the possible ways she could fail as a college student flooded her mind, Nikki felt a wave of nausea overcome her. "Maybe I really am sick," she considered.
* * *
Rob carefully balanced a large cup of steaming coffee as he slid across the backseat of the pickup truck to make room for the rest of the guys on his crew. As usual, Bruce was ranting on and on about some story in the paper that had him all fired up, while George just slouched down in the seat next to him, the brim of his baseball cap pulled down low over his eyes, trying to catch a few more minutes of sleep before they arrived at the worksite. The conversation turned to sports, and usually Rob would have joined right in, but today he felt too jumpy to concentrate. He felt his palms start to sweat, and although he briefly thought maybe it was just the heat escaping from his cup, Rob had a sinking feeling that the constant fear he had been fighting for the last month was ramping up. Rob had been working construction for at least 20 years, and as a kid he had thought nothing of climbing up ladders or crossing beams without a safety harness. Sure, he had once seen coworkers take a bad fall, but he was confident in his own ability to stay balanced and secure. But lately Rob noticed he felt shaky and dizzy whenever he was doing roof work. He had trouble holding on to his tools because his hands were so sweaty and his heart felt like it was going to pound right out of his chest. Even though Rob was too embarrassed to refuse the coffee that Bruce brought him each day, he didn't drink it, figuring the caffeine would only make things worse. As the truck turned onto the dirt road leading up to the worksite, Rob was filled with dread. He and Mary could barely make ends meet each month without his paycheck. What would happen if his anxiety got worse and he had to quit? Who was going to hire a 45-year-old roofer who couldn't climb a ladder?
* * *
Joan is a stay-at-home mom with four children ranging in age from 6 to 15. Although all the kids are finally in school, with one in elementary, two in middle school, and a sophomore at the high school, Joan's days are easily filled. Between serving as PTO secretary, volunteering in the school library, and just keeping up with the kids' activities, Joan has little time for herself. The only appointment she always keeps is her check-in with Dr. Sedona, the psychiatrist who has been prescribing Joan medication for panic disorder for more than a decade. Joan has been anxious her whole life. As a teenager she had preferred a quiet night at home with her family to the parties and sporting events popular with her peers. At her older brother's urging Joan tried living away at college, but after only a month in the dorms she had experienced her first panic attack. Joan was reviewing her sociology textbook in preparation for a quiz when she noticed the words begin to blur and felt a wave of dizziness and lightheadedness. When her heart began racing and she couldn't catch her breath, she asked her roommate for help and ended up at the emergency room. Six months later she was diagnosed with panic disorder. Fortunately, Joan hasn't had a panic attack in more than 10 years, but she still lives in fear that her symptoms will return, and as a result she keeps to her comfort zone. But lately Joan has begun to worry about what will happen as her kids get older and expect more of her. Her daughter is always asking to go to the mall, but Joan refuses, knowing she would feel trapped and panicky if they ventured into the middle of such a large and crowded building. And the only thing Joan's son wants for his birthday is to attend a concert. But it would be too risky to try to chaperone a group of teenagers in an unfamiliar setting she knows would set off a panic attack. Joan is worried about how she will adapt to these changes and new demands.
* * *
If you picked up this book, you are undoubtedly struggling with something you identify as anxiety. It may be that you recently experienced an event that has left you incredibly anxious, like the loss of a job. Or maybe you're going through a big life transition such as divorce or graduation from college. Perhaps you just noticed that anxiety has been gradually creeping into different aspects of your life, making it harder for you to live the way you want, leaving you exhausted, stressed, and overwhelmed. Maybe you've battled anxiety your entire life and wonder if significant change is possible. Or maybe you've always experienced a lot of stress and worry but viewed it as integral to your success in life, and only lately have you begun to wonder whether there is another way of being in the world.
Whatever your circumstances, through your personal experiences you likely know a lot about this emotional state—how it feels, what situations are likely to bring it on, and, perhaps most painfully, the toll it can take on your life.
We too have some expertise in understanding fear and anxiety, from our own personal experiences, but also from our extensive research and clinical work in this area. That's why we hope you'll allow yourself to learn from our mistakes as you read this chapter and the rest of the book. The faces of anxiety we just showed you may not fully capture what you're going through. Later in the book we might recommend particular coping strategies that seem counterintuitive or that don't immediately strike you as likely to be effective for you. We know (somewhat painfully) from our own experience that sometimes all of us prematurely judge and dismiss information that doesn't fit with how we typically view ourselves and the world. Even as psychologists who study and practice mindfulness—a special type of awareness that allows us to observe our internal states as well as our environment with gentle curiosity and compassion, through a clear, wide-angle lens—we are constantly amazed by the things we learn about our own reactions and behaviors when we allow ourselves to fully consider new and foreign ideas and options.
So, as we present the scientifically and clinically derived general knowledge about fear and anxiety in this chapter, we ask that you carefully consider each point to determine how it fits with your experience. We've discovered that turning toward your internal emotional experiences and making connections between what is known in the field of psychology about fear and anxiety and your own private struggles is an important step toward easing your suffering and living life more freely and fully. Every reader is unique, and we firmly believe that you're the best expert on what is right for you. Give yourself a chance to identify it.
Although the evidence suggests that bringing this new and deepened awareness called mindfulness to fear and anxiety ultimately reduces distress and provides new opportunities, it may seem like a strange thing to do when you're trying to reduce your anxiety. You're already painfully familiar with your emotions—wouldn't learning to ignore them be much more useful? Anxiety can be extremely uncomfortable, so it's natural to want to turn away from rather than toward it. But as we've said, even people who know a lot about anxiety (including those who study and write books on the topic) are sometimes confused by their reactions or unaware of some of the subtleties. An enhanced understanding and awareness of anxiety alleviates a lot of distress and confusion and can often make anxiety itself less overwhelming. So, even though it may require a leap of faith, we recommend that you give the exercises described in this chapter a try. At first you may find that focusing on anxiety and fear makes you feel somewhat more uncomfortable or nervous. That is a natural and normal part of the process. As you incorporate the strategies we present throughout the book, we hope you'll see a decrease in your discomfort and distress with these emotions.
HOW DO WE KNOW WHEN WE ARE ANXIOUS?
Claire just moved from Oklahoma to Los Angeles to take a job with an advertising firm. The weekend before she was scheduled to start, her boss invited the advertising group to dinner. Claire sat silent and wooden in her chair, surrounded by a group of young, stylish men and women engaged in animated conversation. Her ears rang with the clatter of silverware and plates and the buzz of conversation punctuated by shrieks and peals of laughter. She watched the waiters deftly move among the crowded tables of the trendy restaurant, delivering eclectic dishes to the eager diners. The minutes ticked past as Claire frantically searched for something to add to the conversation. She felt her anxiety escalating. Thoughts such as "They must think I am a total hick," "I am sure they regret hiring me," "I have to stop sitting here like an idiot and say something," and "I will never fit in here" raced through her mind. She felt a blush creep up her neck, reddening her pale skin, beads of sweat moistened her palms, and her mouth was as dry as cotton. In addition to feeling afraid and embarrassed, she felt a wave of sadness as memories of her friends and family back home passed through her mind. Abruptly Claire stood up and weaved through the crowd toward the bathroom. Moments later her boss came through the door and asked in a kind and concerned voice if Claire was ill. From the privacy of the stall, Claire steadied her voice and through her tears responded, "I think something I ate made me ill. Please apologize to everyone, but I think I better slip out of here and head home."
As Claire's story demonstrates, signs and symptoms of fear and anxiety appear across all our response systems. Images or memories pop into our mind, thoughts are generated, physical changes occur, emotions arise, and behavioral habits kick in. The specific response we have to an anxiety-eliciting situation is determined by many factors. Elements of the situation, our basic biology or temperament, and our personal history and learning influence our reactions. Different people approach a feared situation in different ways. For example, imagine a person receives an e-mail Sunday night to report to the boss's office first thing in the morning; a customer has filed a serious complaint. Someone who grew up with a chronically ill parent may cope with his anxious apprehension about the meeting by calling in sick to work. Another person might preemptively quit to avoid harsh criticism. Still another might "white knuckle" her way through the meeting, steeling herself against each wave of anxiety. Becoming aware of your unique signs and symptoms and the situations that elicit them is an important first step toward change.
Although fear and anxiety are expressed through several channels of responding—cognitive, emotional, imaginal, physical, and behavioral—we don't always notice the varied aspects of our responses. Usually we define our anxiety using a few key symptoms. For example, someone might be very aware that his mouth becomes dry every time he is called on in class. Someone else is tuned in to the way her heart races whenever she approaches or drives over a bridge. If our attention becomes focused narrowly on one or two typical or dominant responses, it is easy to miss more subtle reactions. When we are able to identify our more subtle reactions, we can catch our anxiety earlier and choose how to respond to it more effectively. For many people, physical symptoms are the easiest to notice. Stepping back and observing our thoughts when we feel anxious can be more difficult. Most of us are not used to treating thoughts as responses; we simply experience them as part of our identity. Observing emotions can also be challenging. Fear and anxiety easily grab our attention and tend to overshadow other emotions like sadness or shame that may also be present and important to notice. Behavioral responses can be both obvious and subtle. Someone might know that she avoids public speaking to keep her anxiety at bay but be less aware that she drinks three glasses of wine each night to avoid lying awake in bed, caught in a web of worry. A salesman who drives the back roads instead of the freeway to avoid the panicky feeling that comes up when tankers thunder by might convince himself that taking the alternate route is a simple matter of preference. Noticing our subtle signs of avoidance is an important step toward reclaiming our lives.
Another characteristic of anxiety that is not always apparent is how responses in one domain can trigger responses in another. While reviewing notes an hour before a test, a student might have the thought, "I am not prepared for this exam." This thought can set off a chain reaction of physical symptoms like tightness in his chest and rapid, shallow breathing. Increasing his rate of breathing naturally causes his heart to pump faster, which signals to him that he is really getting anxious now. Noticing these physical sensations prompts a cascade of thoughts about how scary and uncomfortable it is to be anxious and how anxiety will surely interfere with his performance on the test. These thoughts prompt the student to close his book abruptly and leave the library in an attempt to escape any cue that might increase the intensity of his fear. In this way, our anxious responses feed one another in an increasing spiral. Often we do not notice the signs until they are already quite intense and overwhelming, making it much harder to respond effectively to our anxiety.
How can we both be aware that we are struggling with anxiety and also miss some of its signs? Moving toward and paying close attention to painful experiences is not something we are naturally inclined to do. Have you ever done something really embarrassing? We certainly have! And when a memory of what we said or did comes up, often we want to scream "NO!" and push that image right out of our mind. It can be really uncomfortable to remember how we put our foot in our mouth, to relive turning red, to recall the look on the other person's face. Part of being human is that we are driven to avoid painful experiences. Although this natural tendency toward avoidance is protective, it makes it difficult to notice subtleties in the cascade of responses that make up anxiety. Also, anxious responses often occur quickly and automatically, like an ingrained habit, outside of our focus of awareness. (Continues...)
Excerpted from The Mindful Way through Anxiety by Susan M. Orsillo, Lizabeth Roemer. Copyright © 2011 The Guilford Press. Excerpted by permission of The Guilford Press.
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