A Thinking Man

Sometimes (perhaps especially when on holiday) we often long for an anxiety-free existence.  However, in my book, that would be a bad thing.  Human beings have powerful emotional systems and anxiety is a natural feeling that arises in response to stress.  It is part of the natural flight-or-fight response that have enabled the human race to evolve and survive over millenia.  To have no emotion in the face of threat means that we would either be dead or psychotic.  Some some anxiety can be a good thing and is a sign of mental health.

However, the problem for most of us is when that anxiety grows out of proportion and becomes crippling for us in some way.  The pedestrian who was knocked down while crossing a road and who is now completely unable to cross a street, the nurse who made an understandable (and non-fatal) drug mistake who now has serious OCD checking problems while at work and fears she will lose her job, the manager who now cannot face returning to work after a non-stress-related illness, convinced that he would not be able to cope again, are all extreme examples of anxiety that has become dysfunctional.

Although anxiety is usually primarily felt physically and emotionally, its drivers are often primarily cognitive.  What we think influences how we feel and behave, and even if thoughts do not necessarily cause the problem, they certainly help maintain it.  It is not so much the events themselves, but the interpretation of the events that causes the problems.

And we are all capable of having at least two very different interpretations of situations.  When booking the flight I may tell myself that flying is the safest form of travel and experience little anxiety.  When sitting in the plane before take-off I may be extremely anxious because I am telling myself that I am about to die in a crash.

I recently came across something which has helped me think more clearly about my own anxiety and that of the people that I work with.  It’s called the anxiety equation.  I don’t have the word-processing skills to express it neatly in Wordpress, but basically it says that

the degree of anxiety is a function of:

the probability of an event happening, 

multiplied by the cost of that event (in terms of consequences),

divided by our coping resources and other factors that would lessen the consequences.

If I believe that there is a high probability of me being hit by a car when crossing a road, and if I believed the consequences would be inevitably be fatal or extremely bad, then the top part of the equation would be very high. If I also believed that I had very little in me that would enable me to avoid the accident or cope with it, the bottom part of the equation would be low.  A high number divided by a low number would result in another high number - my anxiety would be very high.

If on the other hand I were able to reduce the number in the top part of the equation, and increase that in the bottom, my anxiety could be reduced.  I could, for example, be more realistic about the probability of an accident.  I could remind myself that I have years of success in crossing roads, as have millions of others.  My previous bad experience would have made me even more careful than before, reducing the likelihood of an accident even further.  The resulting reduction in the size of the top part of the equation could also reduce the anxiety.

Of course, the architecture provided by the theory may be straightforward, but the path to anxiety reduction may not be so easy.  I am very well aware (from my own medical worries, and from working with others) that anxiety is not just a cognitive matter.  However, what we think is a powerful starting point, and it is something positive that we can begin to learn to do about the situation.

Although in many situations there can be no quick fix, it is also wrong to believe that we are powerless victims.  In very broad terms we can begin to choose to challenge our dysfunctional thinking both within our heads, and through our behaviour.  We can start to argue with ourselves: “How realistic is what I am telling myself about the size of the top half of the equation?  Is the probability really that high, or am I just imagining a fantasy?”  And I need try to conduct some ‘behavioural experiments’.  If I am telling myself that I will get killed when I cross the road, I could conduct an experiment to prove or challenge that. Suppose I crossed the road successfully.  Wouldn’t that refute the dysfunctional message I have been telling myself?

The one or two regular readers might remember that I have had a very dysfunctional phobia of blood, needles, and medical procedures generally which have been seriously challenged in the last 15 months.  For nearly 50 years, starting at the age of 7, medical personnel have stuck things into my arms, poked around a bit, complained that they couldn’t get any blood out, sometimes given up, sometimes gone back in, and threatened that if they couldn’t get any out they would have to go into the back of my hands or my wrists.  Needless to say, over the years I developed a very powerful emotional reaction to the words: “We’ll need to get some blood …”

I recently managed to go for a blood test by myself - something small, but important for me.  And I was actually in a fit state to drive myself home afterwards.  After a 50 year phobia, for the first time, nobody to hold my hand and hold me down.  I didn’t like it, but for the first time I felt I had more control.

Two things had enabled me to reach that point.  First, I had seriously been working on the top part of the equation.  Up to this point I had been telling myself something like the following: “It will be awful.  They won’t be able to get any blood out of your arm.  They will poke around for ages.  They will get cross with you.  You have no control over what they do.”  Nursing friends had helped me realize that that was an exaggeration and that (most) nurses these days tend to be more compassionate about phobias than I remembered from earlier in my life.  They helped me work on the top part of the equation to reduce the size.  They also helped me work on the bottom part of the anxiety equation to increase my coping skills.  I learned that I could say: “Look, there’s no point in going into my arm. Nobody, and I do literally mean NOBODY has ever got blood out of there. Use a small cannula, and take it from the back of my hand.”  Knowing that I had the right to insist on this helped avoid some of the preliminary trauma and gave some power back to me.

Secondly, in addition to challenging my thinking, I was also able to challenge my memories and experience behaviourally.  In the last 12 months I have had to have numerous blood tests.  Up until now, all of them had been ’supported’ (in the sense of having people there to hold my hand and hold me down), and all of them have enabled me to practice insisting that the nurse go quickly to the back of the hand straight away.  The experience has taught me that having a blood test doesn’t mean poking around for ages in my arm, not getting any blood, and getting cross with me, and that it can be relatively quick, painless, and successful.  My experience has helped prove my dysfunctional thinking wrong.

Overcoming anxiety is rarely quick or easy, but there are things that we can do, especially if there are people around who can help us.

Tags: anxiety, cannula, CBT, Cognitive Behavioral Therapy, Cognitive Behavioural Therapy, OCD, phobia, probability, stress, worry