Episode #72 

How To Manage Anxiety Successfully

Anxiety and stress are very common and can come from many sources:

- Feeling rejected
- Feeling overwhelmed
- Responsibilities at work or home
- Loneliness
- Losing a job
- Losing a friend

How can you cope with the anxiety you feel?

Is it even possible to manage anxiety?

How do you know if what you are experiencing is an anxiety disorder?

In this episode, Dr Julie looks at seven of the most common anxiety disorders - Generalized Anxiety Disorder, Agoraphobia, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, Social Phobia, Phobias, and Panic Disorder - and examines the telltale signs of each. She also shares very practical tips you can apply immediately using CBT tools to help you alleviate and improve your anxiety.

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Full Episode Transcript

Hi, and welcome to My CBT Podcast!

My name is Dr. Julie Osborn, I'm a Doctor of Psychology and I'm here to bring CBT into your life to create more happiness and contentment into you tools to help manage our day to day issues that go on. So as always, I'm going to get started with an email that was sent by one of my listeners.

Always, I appreciate you guys taking the time. This is from Dave.

He said:

“Dear Doctor Osborn, I want to let you know that I listen to your podcast every day and they are a huge support in a place where I improve my self awareness and develop the skills I need to feel better. I'm currently having CBT here in the UK and combine with your podcast has helped me to feel better every day and be a better husband and father. Thank you so much. You're helping more people than you can imagine. The mantra ‘Do what's good for you, not what you feel like’ has really helped me to think and feel behave in a more positive way. And this has helped to transform my daily experience. After a lifetime of general anxiety disorder and mental health issues, most of which I didn't even realize I was dealing with. I thought it was normal. I'm better equipped to deal with life challenges than ever before. Best of all, now that I'm more present and more balanced, I can be a better support for the people in my life that matter to me, including my autistic daughter. Thank you so much, Doctor Julie. Very best, Dave.”

Thanks, Dave. I'm so happy I hear all the time my mantra about do what's best for how you feel or make decisions. I'm sorry, but what's best for you, not how you feel. It really works.

People come back and they're surprised they've had clients in one session. They tried it during the week and they said it actually started to make a difference. So again, all of us, I believe know what's best for us. And if you can ask yourself that instead of saying I don't feel like it, whatever that it might be, it can get you moving and making better choices for yourself. Right?

So we're thinking differently, which then allows our behavior to change and then our mood improves. That's what we're here for, right? To feel good by changing the way that we think. So. Today I'm going to talk about anxiety.

I know I've had some other podcasts talking about anxiety, but it's the number one health issue, definitely in our country. And I thought it wouldn't hurt to kind of review it and talk about some specific anxiety disorders and give you a little more insight. And we'll talk about how the CPT can help with that as well. So I think it'll be helpful. And overall, it's handling stress in our everyday life, which is what we really want to work on.

Because we all have stress. Stress can be a positive thing. Sometimes it gets us moving and motivated, and sometimes it unmotivates us and kind of gets us in a place where we can't really move or do anything. So we want to be able to handle it better every single day. And normally stress happens when we perceive an event is disturbing or threatening.

So we have this primitive feeling back from our ancestors. When they experience stress, they had to fight off wild animals, invaders, adverse natural events, and other threats to their survival that we don't feel on a daily basis. These days, we're more likely to feel anxiety that comes from stress, and we face overwhelming responsibilities at work at home, experience loneliness, feel rejected, or have the fear of losing things that are important to us, such as our jobs or friends. And when we're exposed to such events, we experience what's been called the fight or flight response.

You probably heard of that before.

So to prepare for fighting or fleeing, your body is going to increase its heart rate and its blood pressure. So this sends more blood to your heart and muscles, and your respiration rate increases as well. And that's when you come to more vigilante and our bodies end up like full alert is when you might have shoulder pain or neck pain. And this allows us to take action. So there is some purpose in this.

When these anxiety inducing conditions continue over a long period of time, however, they have a significant impact on how we live, and then we can start suffering from one of the many anxiety disorders. So there was a purpose in it. But now it's become a problem. Share a little bit of research because it's always good to know what's going on and what the research says. It indicates that anxiety disorders are like I said, the leading emotional health disorder for women and our second only to substance abuse for men within any given year.

It's been estimated that 15% of the population suffers from one of the anxiety disorders, yet only a small portion of you guys who suffer go and get treatment. Fortunately, treatment is available and it's really effective. And why don't people get treatment? People are ashamed. People have their hot thoughts of I should be able to handle this.

It will go away when the research says that it's second only to substance abuse for men, there's a good chance that the men are using it to self medicate the anxiety right? Kind of numb yourself out. So thinking that it's going to go away, but then worrying and having more thoughts of what am I going to do tomorrow? How am I going to handle this? Just feeds the anxiety.

So the sooner you go to get some help and doesn't have to take long. Remember, I always say CBT is not a long term therapy. If you're doing the work, you can really get better quickly. You don't have to suffer for so long. Also, anxiety can be helpful when it prompts us to take action.

Like I was saying regarding solving a problem, and you can use it as a clue, in fact, that there is a problem and that we need to confront it. So public speakers, athletes and entertainers have long known that anxiety can motivate them to perform much better when we don't recognize their anxious feelings or don't have the tools to deal with them. We may continue to expose ourselves to the cause of the anxiety and then this leads to more problems. So we keep exposing ourselves to the things that are making us anxious.

And then that just feeds our anxiety.

And prolonged anxiety is demanding on your body and your life in general. So the constant state of being in fight or flight can cause health habitations. You may feel dizzy, you may have trembling or feel shaky. You can increase your blood pressure, you might sweat, you may feel like you're choking, tired of swallow, you can have high stomach acidity, feel nauseous, chest discomfort and even muscle spasms. It can go on and on.

And you may also feel detached or out of touch with reality or think you're dying or going crazy. Sometimes that's a very uncomfortable feeling that many clients have. And I know it's hard to believe it's anxiety, but it is. And there also is more evidence that prolonged anxiety can lead to heart disease and a compromised immune system. So it's really important to deal with your anxiety and keep your stress low.

It also is going to deplete your energy and it feels interferes with your concentration. You may become abrupt with other people and get irritable easily. You may engage in emotional outbursts or even get physical, sometimes in violence. So our relationships and job security may be jeopardized right? Based on our behavior.

And our behavior is from what how we feel and our feelings are from how we think. So. Again, we want to figure out why am I feeling anxious. What am I scared about? What am I worried about?

And again, people who experience prolonged anxiety are more prone to self destructive behaviors, such as as I mentioned earlier, drug and alcohol use, since they may be using these as a form of self medication and you're fooling yourself. There are some people like, I don't want to take any medicine, but you're drinking every day, right? So medicine has its place doesn't always mean you need it. But sometimes it can help you get to a place where you can really work with the therapy and really use the tools.

So what I've said so far is just some clues for you to assess where you are and is anxiety the problem a lot of people have, say stomach issues, and that's a real issue.

But if you're going to doctors and they can't find anything and they can't find anything, it could be your anxiety, right? If you have a lot of muscle tension, you want to make sure, like, okay, I have good posture. Am I stretching? I'm exercising. Am I doing everything I can if I work on the computer a lot, and if I'm doing everything right, it's not going away.

Maybe it's stress, so at least be open. So you're not suffering again with more physical symptoms longer than you need to. So as I said at the beginning, I'm going to talk about the most common anxiety disorders so you can kind of maybe separate what's going on with yourself and any anxiety disorder to be considered an anxiety disorder lasts longer than normal anxiety. It's more intense. It can lead to fears that interfere with your ability to function in daily life.

So the first one I'm going to talk about is generalized anxiety disorder, which occurs when a person's endured at least six months, a state of excessive worry, feeling on edge continually. You can have sleep difficulty. You can find it hard to experience pleasure and relaxation. You can also have symptoms that cause you to feel restless, irritable difficulty, concentrating, fatigue and muscle tension. This is not accompanied by phobias obsessions with panic attacks.

This is just generalized anxiety, which is super common, but it has to last for, like you said, at least six months. It's not just something I've been anxious for a week, and then you're going to have a disorder. That's not how it works. It has to be over a long period of time. Another very common one that's really prevalent is called the gorphobia.

So people who suffer from Gorphobia are afraid of finding themselves in situations where escape would be difficult or maybe help is not available. They also may suffer from panic disorder in certain situations. And over time they develop a fear of finding themselves in these situations. So common situations would include, like public transportation, right? Like in a subway, in an airplane, on a train, maybe being home alone in crowded public places, such as a restaurant or even grocery store.

I've had a lot of people at grocery stores online, and they said they just had to leave all their stuff and leave because they got a felt a Gor phobic in a panic coming on, or also enclosed and confined places such as maybe a tunnel, going over a bridge, being in a classroom. So what happened with Gorphobia is you'll be somewhere you'll feel panicky and then you'll say, okay, I'm never going to the grocery store again because it happened there. Then you're at a restaurant. It happens.

I'm never going back to that restaurant.

Your world starts becoming very small, and it's not necessarily. And it's probably unlikely that the panic has to do with the place you're at. But now I'm not going here. I'm not going here. And all of a sudden, the Gorphobia now you're home and you don't go anywhere.

There's people that have stayed home for weeks, months, years until they started getting some help. So you don't want to get to that point, so you want to address it as soon as you start feeling like it's really causing problems in your life. Another one which I just did a podcast on probably a couple of months ago, was on post traumatic stress disorder. And that can happen if a person has been through a serious life threatening event, such as natural disaster. If you've been in war, if you've been affected by a terrorist act, a car or plane crash, rape, assault or other horrible violent crimes.

And those with PTSD may for months or years afterwards experience these repetitive thoughts about the event with an attempt to avoid thinking about it. Right? They have nightmares, emotional numbness, where they just don't feel anything, they feel very detached. They could have flashbacks like they're right back in that moment and an attempt to avoid activities associated with the event. So you end up having a loss of interest in pleasurable activities, right?

And other symptoms of increased anxiety. And there's a lot of really effective techniques, including CBT, that are helpful dealing with PTSD. So again, don't allow yourself to suffer another day if this is what's going on. And again, as I always say on my podcast, if this isn't you, if there's someone you know in your life, maybe you could share with them if they're not realizing what's going on. Another anxiety disorder, which I have a podcast on is obsessive.

Compulsive disorder. So that podcast is called It's Not Me. It's my OCD. If you want to look it up, and it happens when stress or chaos in one's world causes the person to think and worry repetitively about something. Those are called obsessions or else to engage in repetitive behaviors like hand washing or checking out things excessively.

And that's called compulsions. So obsessions are recognized by a suffer as irrational, but they still continue to intrude in the person's thoughts for extended periods of time. So to give you some examples of obsessions includes images of violence or doing violence to somebody else, as well as thoughts about leaving the lights on or leaving the door unlocked. Compulsions are the behaviors that perform to reduce the anxiety of the obsessions. So this is like excessive hand washing.

I think we've all heard about checking lights or the stove time and time again, checking, make sure the water is turned off or ritualistic behavior such as counting steps while walking. So OCD can come in many different forms. As I mentioned before, sometimes you have these intrusive thoughts, which I talk more extensively in my podcast about. It's Not Me. It's my OCD.

And people with these intrusive thoughts about violence. I just want to let you know people do not act on them, but it's so disturbing that they even think it like, Why am I even thinking this horrible thought about hurting someone? I care about and they don't understand because they don't know which is okay, that it is OCD and you have to learn to separate what you're thinking from who you are. So again, that's really where the CBT can be really helpful in helping you walk through this and feeling better and you can get rid of those intrusive thoughts.

It's not something that you have to live with.

So another common anxiety disorder, social phobia. So this involves the fear of embarrassment in situations where others might scrutinize or evaluate your behavior. So this usually causes people to suffer because they're avoiding situations which affects their lives. And although many simply endure the anxiety associated with these experiences, it's hard to enjoy what you're doing, right. So the most common social phobia is speaking in public.

And in fact, surveys indicate that some people have a greater fear of public speaking and of death. It is a huge fear that people have other forms of this phobia can be fear of writing in front of others. Fear of crowds, test taking phobia, fear of spilling food or choking in restaurants, fear of blushing in public, fear of using public restrooms. I know some people that just will not use public restrooms so they can go out for hours and hours and not go to the bathroom if they have to, which is not good for your health either.

Right.

So social phobia. Again, that can definitely be help with cognitive therapy and doing some exposure techniques and identifying what's the sphere of what you think is going to happen, which probably doesn't and seeing how it just affects your life in a negative way and then just having phobias. So these are intense fears and avoidances that occur when a person is exposed to a certain type of situation. These are specific to the suffer. Usually they're irrational and sometimes even unexplainable.

So common examples include, like airplane phobia, fear of flying, being in an elevator, fear of Thunder and lightning. Animal phobia, fear of heights, fear of a doctor or dentist phobia. Some people just won't go to doctor dentist, which is not good because they're afraid. Blood injury, phobias and illness phobia. I see a lot of people with the illness anxiety.

We call it worried and worried about their health. Any little thing they feel they think it's a medical problem and it really creates a lot of stress, very fearful of that. So see if you can identify if you have any phobias that are getting in the way. We all can be a little scared of maybe having to go do our blood work or we're uncomfortable going to the dentist. I mean, it's not my favorite place, but I show up because I know it's best for me.

So it's not about being fine and not being worried. That's okay. Again, if we have some stress, it's managing the stress and not letting it get in the way of our daily life. So the last one that I'm going to talk about before I talk about more ways of dealing with handling your stress. And the anxiety is panic attacks, which is super common for a lot of people.

And then some people have never had panic attacks, and some people have panic attacks, and they don't worry about it. Right? But the problem with having panic disorder is when you have a panic attack and you worry about the next one, and it's one of the most debilitating manifestations of anxiety. So these dramatic episodes of anxiety seem to come out of the blue and happened even when there's no real danger going on. They're usually intense for a few minutes and they subside.

But most of us don't know that they're going to subside. So our fear while we're having them just makes them last even longer. And the suffering could have chest pains, feeling of smothering, dizziness, heart pounding, depersonalization, that's feeling detached. It has hot and cold flashes, sweating, numbness, and even feeling nauseous. It can also be accompanied by the fear of dying, thinking you're going crazy and losing control.

And people who experience panic attacks often live in fear of the next one, as I mentioned, and this may prevent them from leaving the house, being alone. Driving and panickycs are not always triggered from a specific phobia. Sometimes, like I said, I've had people that just wake up with panic. So we got to figure out what's going on. Why am I waking up in a panic?

And one of the factors that perpetuates panic attacks is the fear of having another one. Right. So now we're always anxious because we're just like, what if it happens here? When is it going to happen again? And the perception that a panic attack is coming on can also magnify an awareness of the symptoms.

And then the person begins to tense up and Harbor thoughts of doom, just the conditions that drive a panic attack. So if you feel a panic attack is coming on, it's helpful just to let it happen, which I know sounds really hard as a comfortable as it may seem. I have read some research that says it tends to hit its peak in about 90 seconds and then it starts to dissipate. But when you're worrying and you're freaking out in the middle of it, it's going to last longer.

And as is true with any phobia, you have to expose yourself to the fear situation in order for the fear to decrease over time, which is the worst part where I always tell people with anxiety.

The good news is you can get through it. The bad news is you have to go through it to get through it. If you don't tense up, the symptoms will generally subside within a few minutes, tensing up just perpetuates the episode. You may feel faint, but you won't really faint. Blood is still going to your muscles as you tense up and not to your brain, and this may bring on the sensation fainting, but your blood pressure and heart rate have increased, so you're actually less likely to faint just to let you know.

And during a panic attack, you want to recharge your thoughts, challenge your negative thinking, letting yourself know I'm not having a heart attack. I'm not going to suffocate. I'm not going crazy. I'm not going to die. If you can trust that this will end soon.

For example, you could say to yourself, Well, here it is again. I'm going to watch my body respond to this just like I've done before. I'm going to survive. I can handle it. This may be unpleasant, but it's only anxiety, and it will pass and let me just flow through this.

I've told people with panic, a suggestion is happening, maybe on your phone or on a three X five card. Write something out. Like I just said, so when you're in that moment of having panic, you can just take it out and you can read it, because in the moment, it's really hard to think clearly, right? And say, oh, yeah. What were those thoughts I'm supposed to be thinking?

It's just too difficult. You want to be kind of prepared if you suffer from panic disorder. So people that deal with anxiety in a positive way usually have a sense of self determination, of feeling, involvement in their life experiences and have an ability to change their negative thoughts into more balanced thinking. So self determination refers to your ability to control or adapt to the events of everyday living, and a great deal of anxiety is perpetuated by how we think about ourselves and even anxiety itself. Right?

So is anxiety and control of us? Or can we learn to control the anxiety? That's what I tell my clients. You want to learn to manage your anxiety, not let it manage you. And rather than seeing ourselves as helpless and trying to overcome obstacles, we can begin to define ourselves as problem solvers.

We can remember specific times when we've been successful in solving problems and then define ourselves. In those terms, we can learn to trust that we will have success in meeting life's difficulties. When we take this approach, we begin to face problematic situations and challenges which then resolve, can bring new and exciting opportunities into our lives. So that's about being self determined. You want to be involved, and that means opening yourself up to the world around you and defining yourself as active participant in your life.

It means letting friends and family members into your personal life and sharing your private experience with others who can be trusted. You want to cultivate a social network that serves you well when you're dealing with anxiety provoking situations. Talking our way through crisis in the presence of the supportive listener rather than holding it alone is one of our best ways of gaining helpful feedback. Putting the situation in perspective in the sense that you're not alone. So when we lack involvement with others, we often feel vulnerable and isolated and they wonder whether we have the resources to cope with the anxiety because it can be scary when you're doing it by yourself, and the ability to find things positively is one of the main attributes for those who deal with anxiety.

The life process is one of loss and gain, and we can't avoid that. It's as natural as night and day. When we trust that our losses will give us rise to new gains and life experiences. The anxiety and worry associated with loss may not be so devastating. So to give you an example, the loss of the job, which I know a lot of people experienced with Kovid can open the door to more satisfying employment and the opportunity for more fulfilling life experiences.

And I definitely attest to that because I've had that go on in my life. The clue is to change your negative thoughts about the situation into more balanced thoughts and positive feelings will follow. Changing your thinking, right? That's what CBT is all about. So for example, if a close friend moves away rather than thinking negatively about how lonely and devastated you feel, think about the good memories and you will always have how your friendship will leave a positive legacy that will always touch your life, how you can still keep in touch and visit, and how you can now spend your time in new and positive pursuits as well.

There's really no need for own wealth and anxiety in this situation because you can choose to move toward the open doors of your life rather than knocking on the closed ones. So even though it's a loss, your friend left and moved away, it doesn't mean the friendship is over and you can decide how are we going to stay in touch? What are some fun things we can plan so we can keep our relationship going. So the clue to analyze anxiety well is to acquire the skills and use your CPT tools so you feel empowered.

So this requires some good, honest exploration into your life, and you need to explore the strengths that are already there for coping with stress as well as learning new skills.

Obviously, therapy can always have a really great benefit and can teach you a number of specific techniques for anxiety. The CBT getting you to do some exercise and breathing techniques and exposure techniques to treat the anxiety so it can go away as well as the overall life strategy. Plans for dealing with other problems in your life experiences. We're all going to feel anxious time in our life. Nobody goes anxious free.

You don't want it to become such a problem that it interferes to have a happy life. So we need to be able to both comfort ourselves and let others nurture us as well. All of us can learn with some healthy exploration to manage our anxiety successfully. So it doesn't have to be such a problem. Like I said, I've worked with many, many people.

I practice what I preach. I get anxious sometimes. Obviously, I have things in my life and I have to just use my tools and be mindful of what am I thinking? That's causing me to feel so anxious and it works every time. And I'm grateful every day that I have my CBT tool.

So I encourage you to think about and I said a lot and share a lot. But if any of these anxiety disorders stuck out for you, find the courage to reach out for help, whether it's through a friend, finding a therapist, asking someone to help you even find a therapist. If that's kind of scary, take that first step because you don't have to suffer and you can be living a much happier life and you can manage your moods and feelings and not let them manage you so that's it for today.

Again, I hope it was helpful. Thank you for being here with me.

I always encourage you to reach out. You can send me emails at MyCBTPodcast@gmail.com.

You can follow me on Instagram, Facebook, and of course, on my website. MyCognitiveBehavioralTherapy.com. A lot of good information; there's some videos and some different articles on there as well.

So as always, make decisions based on what's best for you, not how you feel.

Have a good week. Until we meet again!

Bye!