Anxiety

Jeanne Robertson, Ph. D., LMFT, LPC
Director, Center for Counseling and Education
St Paul’s Episcopal Church, New Orleans LA 70124

Anxiety is real. It is painful and a growing percent of Americans suffer with anxiety from mild to severe. Many require medication. However, medication alone does not conquer anxiety. Sometimes small changes in thinking, repeated over and over make an immense difference.

How we look at, interpret things and situations can make an enormous difference. It is often subtle. In fact, so subtle that we may not notice. Our interpretation is known as framing. We put everyone and every situation into a framework, a frame. It is our “frame of mind;” how we are thinking about it. We can view situations from a positive or negative frame. Let’s look at one situation from two different frames.

1. You’re on the way to work. You think, “If the traffic continues like this, I’ll be on time.”
That’s positive framing. Your goal is to arrive at work on time. Your thinking is positive; you’re hoping and trying to achieve a positive outcome. You aren’t anxious. These are just positive thoughts. You are using a positive frame. You’re in a positive frame of mind.

2. You’re on the way to work. You think, “If the traffic continues like this, I won’t be late.”
This is negative framing. Your goal is to avoid being late. You are thinking about a negative—being late; you are trying to avoid a negative outcome. These are actually negative thoughts. Some tension is present. You’re fearful of being late, because late is what you are focused on. You are in a negative frame of mind. You may not even be aware of it!

You may be thinking this is really the same thing. It’s all about traffic and getting to work — but it is not the same! How we think, how we frame situations generate emotions … positive or negative.

Thoughts lead to —-> Emotions, which lead to —-> Actions. The action may be: more thoughts, body tension, death grip on the steering wheel, headache, tight gut, etc. if negative. This can generate circular thoughts, a spiraling. Thoughts generate feelings, which generate thoughts, which generate more feelings … positive or negative.

If you are framing the first thought in a positive way, such as on time, when the traffic stops completely, you may wonder if you will still be on time. You may think through what action to take if it appears that you may not be on time. [Notice this is all still positively framed. Your goal is still to be on time.] You don’t panic. You call work and tell someone about the traffic delay; a delay you cannot control. Now they know the reason, if you don’t arrive on time. You may feel some tension, but not full blown anxiety. You realize you can’t do anything about the traffic. You’re able to tell yourself you can stay calm. That thought generates calm, or at least reduces tension.

If you are framing the first thought in a negative way, not being late, when the traffic stops completely, you may become very tense and anxious about being late. Your thoughts go to negative consequences. “I’ll bet written up. Yelled at! Fired!” Anxiety increases and may lead to panic. Anxiety is generated by thoughts which generate the emotions that generate anxiety. You are now caught in a negative feedback loop wherein all thoughts are negative and generate more negative thoughts and more anxiety.

Traffic starts moving, you will be on time! You arrive fairly relaxed and glad to be on time. Still positive.
Or
Traffic is moving, you won’t be late. You arrive tense and drained, but relieved not to be late. Still negative.

1. Become aware! Be aware of what the situation is. (There is always a situation.) It’s noon; it’s Saturday; the car has a flat tire; the kids are home; it’s Monday; the boss is coming to dinner; I’m running late. These are all situations.

2. Ask yourself, “What’s my goal for the situation?” Figuring out the goal is the key to how you are framing the situation. It tells you about your expectations for outcomes, consequences.

3 – Evaluate your “frame” of mind? Are you framing the situation positively or negatively? Is your goal to achieve or avoid?

It’s raining and you need to leave the house. What is your goal? Do you want to stay dry or avoid getting wet?

The physical outcome may be the same, but the experience is different. The outcome may be better too. It feels better to stay dry than avoid getting wet. Positive framing empowers. It seeks a positive goal. Negative framing just tries to avoid, well, the negative. To avoid getting wet, you may just grab an umbrella and dash to the car.

Positive framing looks for more choices, better solutions. You may do something extra to stay dry. You add a raincoat or jacket and boots because you want to stay dry. Positive framing sometimes means we take more time or put in more effort, but it leads to more positive outcomes.

We humans tend toward the negative more than the positive, so we need to work to increase positive framing which reduces anxiety. Increasing positive framing is the goal. Reducing anxiety is a positive side effect of that process. The thought process that leads to anxiety and panic starts long before we are aware that something is bothering us. Before we realize we are framing one or more situations negatively, the emotions being generated by those unconscious negative thoughts are generating tension. This leads to more negative thoughts, more tension, and anxiety. Awareness occurs once our anxiety reaches a heightened state. Becoming aware earlier and earlier interrupts this process and allows us to reframe the situations, change our thoughts, and reduce or even prevent anxiety.

The following exercise will help get you started. Read the situation, figure out your goal. If it is negative, write a positive reframe (like the rain ex. above – staying dry is positive, avoiding getting wet is negative).

Ask yourself:

1. What is your goal?

2. Is the goal framed positively or negatively? [Reframe to positive if necessary.]

3. How will you handle the situation? Will you handle it differently if it is a positive or negative goal?

There is a deadline coming up you must meet: a project at work or school.

An event is approaching. You are required to attend, but do not have clothes appropriate for the event. It’s a business meeting or family wedding.

The washer is not working, the repairman can’t come until next week and the kids have no clean school clothes or you have no clean work clothes.

Your week is very busy. You are asked to do something else and agree to do it.

As you go through your week, practice evaluating various situations, activities or events by asking yourself, “What is the situation? What is my goal?” Are they more often negative — trying to avoid rather than achieve? As you become more aware of how you frame, you can deliberately, consciously reframe the negatives into positives. It becomes habit with practice. It truly will, because that is how anxiety is maintained – through habit, mainly the unconscious habit of negative thoughts.

See how many things you can reframe in one day to set a positive goal rather than a negative goal.

Have you sprung a leak?

Two Kinds of Water:

Two kinds of water make up our external world, rather than our internal, emotional environment. We can compare these two types of water to two types of food. We can broadly divide it into healthy food and junk food. We need food; it is essential to life. It is something we let inside. Now some junk food – cake, candy, cookies are really only junk food (that which weighs us down) when we consume too much. As my husband maintains, dessert is important. If we don’t combine it with not enough healthy food, we can’t sustain a nourishing balance and it weighs us down.

So what constitutes the healthy and junk food of the world around us, the waters on which our ships float?

1. The media is a large part of our external world. Facebook, Twitter, TV, news, movies….

2. People around us: family, friends, co-workers …

Two Ways for it to get in to Weigh Us Down:

A- The News – most of what is reported is Bad News; bad as in something bad has occurred: weather tragedies, shootings, political issues, war … . Important, informative – yes, much of it, but there is little that uplifts or inspires. How do we respond when we consume large quantities? Does it generate emotional distress, anger, disgust, fear? What do we do with that? How does it weigh us down?

B- Family, friends, co-workers, to name just a few of those we come in contact with on a regular basis. What is each relationship really like? Does the other person tell us their problems, but never seem to listen to us? Are they always on the receiving end and we on the giving? Are we criticized, talked down to, belittled? Such relationships that only take and never give, weigh us down.

How to keep ourselves from being Weighed Down:

A- How much of the media world do we allow in? How much is healthy, life-affirming (good food) and how much is bad news, (junk food)? What do we watch that is life-affirming, calming, fun (healthy food) to balance the “junk food” effect of too much bad news?

How much time is spent with Media? When we spend too much time with media (junk food) that generates anger or emotional distress, it becomes hard to develop balance. We really get weighed down.

We need to become aware of and moderate:

1. What impact does each relationship have on us? Do we feel uplifted by it or weighed down?

2. How much time is really needed with that person and how do we deal with junk food treatment?

3. Which relationships are uplifting, healthy, and enjoyable?

4. Plan more time with those with whom we have positive, nourishing relationships.

5. Recognize that just because someone is family, does not give them the right to be toxic junk food in our lives.

6. Learn new ways to deal more effectively with difficult people to minimize the anger and frustration they tend to generate.

For more ways to keep the junk food out and keep your ship afloat, please call, text or email me.

Do you have cancer OR does Cancer have you?

What’s the difference? Identity. Self-identity and identifying what is happening to you. Are you a cancer patient? Or are you a person, an individual who has cancer? What word comes first in your mind; first in how you think about yourself? Why does it matter?

Research indicates that stress is an important factor in how well the immune system functions which in turn can impact cancer survival rate. While every case is unique, overall findings indicate it’s not simply a medical issue. There are psychological and social factors that complicate things for the group between 15 and 39 known as AYA – adolescent and young adults.

Identity is a psycho-social experience that can significantly interfere with the treatment process. You’ve probably heard the term identity crisis, mid-life crisis or adolescent identity crisis. However, regardless of age, a sudden, significant life change, can generate identity challenges, crises, or struggles in developing and maintaining an identity. A diagnosis of cancer is a huge change factor. It creates unique stress which can interfere with both the physical healing process by suppressing the immune system (Dhabar F.S; McLeod, S. A) The psychosocial stress can generate additional inhibiting factors toward healing. Emotions frequently experienced, such as anger, resentment and depression all too often lead to decreases in treatment compliance, and need to be addressed for better treatment and healing, as well as a better quality of life in the present.

The younger range, teens and early twenties are still forming an identity. Their internal worlds are already pretty chaotic. They have so many choices and decisions to make about their future, struggles trying to figure out what they what to do, who they want to be. But life or death really isn’t on their minds. Teens tend to be psychologically wired to feel invincible. It’s necessary to facilitate an appropriate amount of risk-taking to help learn their own limits. But the death of a young person is outside of what we understand as the natural, normal life-cycle. People are supposed to die when they get old. A teen’s identity focus shifting to life or death is not how things are supposed to be, not the natural way life proceeds. “How do I define, identify myself now? I used to be a teenager. A girl, young woman deciding what’s next, talking to my friends, trying to figure life, stuff, out. Now I see myself as someone else.” “I was a guy with plans, but now what?”

What about those in their mid-20s and 30s who have moved beyond that adolescent identity search? A formed identity is shaken, altered and confused by a cancer diagnosis; identity is inherently challenged.

If I have cancer, I can still be in control of my life. I may not be able to kill cancer, but I can make choices that keep my life alive in the here and now. I have choices. I decide how I will allow myself to be identified. It’s my identity so I can decide, not cancer.

If cancer has me, cancer gains complete control, control I’ve given it. I allow the anger and resentment at having cancer lead me into depression, apathy and non-compliance with treatment. I stop treating myself well because I identify myself as a lost cause. Life stops now. Even though I’m alive, I’ve stopped living.

I can use the energy anger generates to fuel my determination to fight for each and every day I have. I can begin to realize that no one ever knows how many days their life has; I can begin to more clearly understand and believe that life, my life, is truly worth living in spite of all the pain I have to face. I can develop an identity of a fighter, a survivor, someone who faces challenges rather than running from them. I can ask questions about how to get where I want to be. I can ask my family and friends to see me in a new way. I can ask them to identify me as someone who has cancer, not a cancer patient; a person with a challenge they can help me with if they understand, rather than feel sorry for me. I can learn that I’m still me. I can ask others to see me, not cancer.

I can find supportive groups of people fighting my same fight. I can find a faith community to help me with life or death questions; questions about the meaning of my life right now. Even if I wasn’t brought up in any religion or faith tradition, or reject the one I know. I can find one that will be helpful if I keep looking.

I can learn about how to be assertive and realize I really do matter – to myself and others. I can talk to people who are helpful and can limit contact with people who bring me down. I can seek counseling and other resources my treatment facility has available. I can find a lot of valuable resources and new friends online. I can fully participate in my own life. I can stop being simply an observer, a passenger, in my own life. In fact, I am going to check out some of the websites below right now.

References

Dhabhar, F.S. (2009) Enhancing versus suppressive effects of stress on immune function: implications and immunopathology. Neuroimmunomodulation. 16 (5): 300-317.

Emotional, Mental Health, and Mood Changes.

Cancer diagnosis: 11 tips for coping

McLeod, S.A. (2010). Stress, illness and the immune system. Simple Psychology.