Worry, anxiety and dpafu

We’re now going to look at the anxiety and worry associated with DPAFU. These worries can be specific, for example worrying about what caused the DPAFU in the first place or what the end result might be. Or the worries may be more general, for example worrying about your future or the state of the world. Of course, you might also worry about your thoughts and worries. Whatever your concerns, we hope the following pages will help.

This section is only a brief, DPAFU-focused overview of the vast amount of literature on worry and anxiety currently available. If you feel that your anxiety is not specifically related to DPAFU, you may benefit from a self-help guide aimed specifically at managing panic and anxiety. We recommend some of these in the section on further reading at the end of the book. Also have a look at Chapter 7 for other techniques that can be helpful. These include problem-solving skills to help you deal more effectively with decision-making and relaxation and mindfulness techniques.

One of the key ways of managing anxiety is to become aware of what exactly it is that you are worried about. What are the thoughts that go round and round in your head? Are they about the same subject? Psychologists call these repetitive, intrusive and unwanted thoughts ruminations. People often find themselves going over and over the same worries because they believe that eventually they’ll be able to work them through. But going over and over the same thoughts often leaves you feeling as if you’re going to drive yourself mad. Worrying can actually be very unhelpful. Often people worry about things that have happened in the past or dwell on what might have happened if things had been done differently. But of course the past can’t be changed by worrying about it.

People also worry about how to prevent bad things happening in the future. Sometimes it’s helpful to separate out your worries about the past from your anxieties about the future; it’s part of trying to be clear about what’s behind your feelings of anxiety or uneasiness. Events that have happened in the past can’t be changed, as we’ve said, and going over and over them in your mind often leads to further feelings of anxiety and low mood. Clearly this is not a helpful strategy. Likewise when we go over all of the things that could possibly happen to us in the future, we often feel increased anxiety and stress. Again the aim here is to adopt a more balanced viewpoint. Ask yourself how likely it is that something bad will happen, and be careful that you are not using emotional reasoning (one of the cognitive errors) to justify how you feel. Imagine that you believed very strongly that the most likely thing to happen when you left the house that day was that you would be abducted by aliens! It’s not likely that many of us would choose to leave the house – no matter how unlikely it was – if we believed this to be 100 per cent true, but how might we behave if we believed it to be 40 per cent true? Well, we might leave the house but remain vigilant. What if we believed it was 1 per cent likely? Then we would probably not give it a second thought. It’s important to spend some time identifying the types of worries and anxieties you have as they very often have a significant impact on our behavior.

Some of the techniques used by people suffering from general worry and anxiety can help here. First you need to allocate some dedicated worry time. Half an hour per day is usually plenty. Plan this dedicated worry time for a time of day that suits you best, for example when you return from work, after you’ve eaten dinner or when the children are in bed. Stick to the same time every day. When you find yourself starting to worry, say to yourself that you will deal with this later during your worry time and that thinking about it now will not help. Like all of the other suggestions and exercises in this book, this one will take time and practice to master.

For your first worry session you’ll need a sheet of paper and a pen. A postcard will be enough once you’re used to the technique. Make a note of the worry or anxiety that bothers you the most. Then begin to challenge the worry in much the same way as you did with the thought records. Imagine what other people might say. Look at what evidence you have. Are there any alternative ideas, thoughts and beliefs? What can you begin to do to address each worry? Write your responses underneath the worry. Try to fit each worry onto one sheet or card. At the end of the half hour, just stop. You can come back to the worry again the next day. Try to identify and tackle a different worry during each worry time. You’ll be surprised at how similar many of the worries are.

 

EXAMPLE WORRY CARD

My DPAFU can’t be cured and I’ll be like this forever

I don’t know that for a fact. It just feels that way. I’m using emotional reasoning and that is prone to error.

Even if it doesn’t go away completely I can manage it better. Then the impact it has on my life will be minimal.

I’ve read on a website that it does go away for some people when they stop worrying about it.

Going over and over it in my head is not going to help; if anything it’ll make things worse.

I am going to practise attention training as a way of trying to stop me focusing on my symptoms.

 

Eventually you’ll have a set of worry cards that cover all of the issues that cause you worry or anxiety. This means that when you have a specific or general worry you’ll be able to turn to the card and look at what you’ve written. You may wish to add more each time or remove the things that are no longer applicable. Over time you’ll become more practised in your responses to your worries and will begin to know them off by heart. Then when the worry pops into your head you’ll have an automatic response. Gradually, your worries will become fewer as you postpone them until worry time. This will mean you’ll be able to deal with them quickly and effectively. Like many of the exercises in this book, you can ask other people – maybe friends, family or work colleagues – how they might respond to a given worry or anxiety. You can then incorporate their answers into your own to help you generate new ways of thinking. You can also rewrite the cards as your ideas and thoughts change. For example, after reading the section on problem-solving you may wish to draw up a list of the advantages (benefits) and disadvantages (costs) of having such a worry, or what it means to you if you don’t worry.

It may be that your worries are not ruminatory, but instead come out of the blue. These may make you feel much more anxious – even to the extent of provoking what seems like a panic attack. It can be very difficult to tease apart DPAFU from panic. Research has shown that more than half of people who suffer with panic attacks become depersonalized during the attack. In turn, about half of the people who suffer with DPAFU also have panic attacks.

If you suffer from panic attacks on a regular basis, you might want to get some help that’s specifically targeted at that problem. You could use self-help books. Or you might visit your GP and ask for a referral for CBT for panic from your local psychology and counselling service. This treatment is very effective and well-established. If you only suffer with panic rarely, or find yourself getting anxious or worried before a specific event or situation, such as a night out with friends, then this section may be of benefit to you. Many of the symptoms or sensations associated with panic are the same as DPAFU. For example, the usual sensations of panic are:

 

•   increased heart rate

•   increased breathing

•   dry mouth

•   feeling dizzy, faint, hot, or sweaty

•   feeling cut off, detached, or light-headed

•   distorted vision

•   mind racing

•   confusion

•   thoughts of losing control and going mad

•   feeling frightened

Usually with panic, a trigger sets off a chain reaction. The trigger can be a physical sensation, a distressing thought or even the dread of another panic attack. This then leads to the person feeling afraid or anxious or worried. When you feel like this, and you have all of the bodily sensations detailed above, this can lead to thoughts of disaster or a sense that something terrible or sinister is going to happen. These feelings are then taken as further proof that it will definitely happen. Such thoughts usually centre around the fear of losing control, going mad and/or dying.

Once this chain reaction begins and thoughts become ‘catastrophic’, the anxiety continues. This is because of the adrenaline that the body produces. You may feel petrified and your body continues to react as it should under conditions of terror i.e. increased heart rate and the usual sensations of anxiety. Once again a vicious cycle is in action.

Just as you did for the psychological model we outlined in Chapter 4, you’ll need to think how your experiences fit this model of the process of anxiety, worry and panic. This will give you a clearer picture of what happens to you during a panic attack. Once you can predict what sensation, thought or image follows on from another, you’ll probably feel less frightened. This is because your understanding will grow. You’ll need to identify when the panic occurred and what was happening at the time. For example, is there a trigger that is specific to certain places? What were you thinking at the time? It may not be until afterwards that you realize you were thinking about something in particular. Did you become aware of a certain physical sensation, such as a missed heartbeat? (Many people don’t know that our heart doesn’t beat regularly all day. It often speeds up or slows down for no apparent reason. But this can feel really scary.) What were you doing? Record these things as soon as possible after each attack while it’s still fresh in your mind. Concentrate on the worst sensation. What did you think was going to happen? If you thought you were going to die, go mad or collapse, why didn’t it actually happen? What did you do to stop it? Were there things you did or said in your mind to stop the worst case scenario from happening?

It’s likely that over time you have collected evidence to support the worst case scenario i.e. that you are about to lose control, go mad or develop schizophrenia etc. You may feel that you’ve had a narrow escape. But how do you account for the fact that the worst hasn’t happened so far? Think about this as evidence in itself. What alternative explanations might there be for your sensations? Are there people or places you avoid because you believe that they make things worse? How realistic is that belief? It could be that it’s true, or it could simply be that you think it’s true. As we’ve already seen, there’s a difference! Try to be aware too of the mental images or pictures you have when you feel panicky. These images may be particularly awful and upsetting. If you push them away and don’t deal with them at the time, they may make the problem continue. You’d be left with a feeling of something awful, although you may not be sure of what exactly it is.

Panic is no different to DPAFU; the more you worry about it, the more likely you are to notice the sensations that support it. What are the sensations that really bother you? What do they mean? Do you have evidence to support your beliefs? What might a logical argument against your beliefs be like? You may wish to include in your logical arguments some of these facts about panic:

 

•   During a panic attack, it’s virtually impossible to faint because your heart is beating fast and your blood pressure is increased.

•   Panic is caused by fear and kept going by adrenaline.

•   Adrenaline makes your heart beat faster and your lungs breathe harder. It diverts the blood supply to where you may need it for urgent action (e.g. the muscles) and away from where it’s not quite so necessary (e.g. the gut – leading to ‘butterflies in the stomach’). In evolutionary terms, this is called the ‘fight or flight response’. You feel dizzy and faint because you’re breathing too hard and exhaling carbon dioxide. This makes the blood vessels to your brain contract, which makes you light-headed.

•   The more you worry, the more sensations you notice.

•   The more sensations you notice, the more you will worry.

•   Noticing sensations confirms your belief that something is wrong. This is the cognitive error of emotional reasoning. Just because you believe or feel something to be true doesn’t mean that it is.

•   If the worst thing that could happen has not happened by now, that’s because it is not going to.

•   If you do something to stop the panic getting out of hand, such as having a sip of water or sitting down, you’ll believe it’s the sip of water or the act of sitting down that stopped you from suffocating or collapsing. Again, these are safety behaviors and they may stop you seeing that the worst simply would not have happened even if you hadn’t intervened.

Just as you did with the thought records, write down your thoughts, ideas, beliefs and images and challenge the evidence you have to support them. Then start generating alternative or more balanced viewpoints. Once again, rate how strongly you believe the thought using the same scale you used before.

We should also mention anticipatory anxiety, when you become anxious before anything has happened, and social anxiety, when you worry about social situations in which you feel that you may be judged. It may well be that you suffer from these forms of anxiety in addition to DPAFU. If you recognize these feelings, we suggest you ask your GP for help or investigate self-help. Once again, CBT has a good track record in successfully treating these conditions. There are also some useful self-help books available to help you manage social anxiety.