“Worry” Pt. 2

Many treatable conditions are associated with worry. For some people, worry is simply a habit or an entrenched way of dealing with life’s conflicts. But for others, it is a symptom of an underlying condition which may be amendable to psychotherapeutic, medical, and holistic interventions, such as:

 

Depression

Ruminative worry, often with negative thinking, is one of the primary symptoms of depression, along with sleep and appetite changes, lethargy, isolation, and a loss of pleasure in every day life experiences. Fortunately, depression responds well to psychotherapy, sometimes with medical or holistic support.

 

Panic Disorder and Social Phobia

A panic attack is worry taken to the extreme- a feeling of terror accompanied by rapid heartbeat and fast breathing along with a need to run away from the situation. The person senses imminent doom. About 30 to 50 percent of the time, panic attacks are accompanied by agoraphobia, which is a fear of any public place where a dreaded panic attack might occur like crowds, driving, stores, restaurants, or elevators. Social phobia, on the other hand, involves a fear of being the center of attention, like speaking in public. These conditions can be treated with powerful psychotherapeutic tools, and sometimes antidepressant or antianxiety medications and holistic approaches can be a useful adjunct to therapy.

 

Obsessive-Compulsive Disorder

A person with OCD experiences unwanted and intrusive thoughts (obsessions) and may feel a compulsion to engage in rituals as a way of handling these unwanted thoughts. Strange thoughts are fairly common for most people, but when they are pervasive and seem uncontrollable and distressful, psychotherapeutic interventions combined with other therapies may help.

 

Generalized Anxiety Disorder

People with GAD lead fairly normal lives, but they worry about things that most of us can brush off. They find it difficult to let go of their worries and this may have a genetic or biological basis. For the person with GAD, any event can prompt an automatic response to interpret things in a negative and fearful way, and this can lead to a cascade of worry. Psychotherapy is very effective in helping a person learn to think positively and to let go of distressing thoughts, and sometimes an antianxiety medication can be used judiciously as an adjunct to therapy.  Current research is available on the positive aspects of holistic approaches.

 

Post-Traumatic Stress Disorder

Sometimes our old pain associated with tragic experiences is difficult to let go of, especially when these experiences have threatened our sense of integrity and safety. A trauma can set the stage for worry years after the original event. Coming to terms with PTSD in psychotherapy usually involves learning to talk about the trauma, grieving the losses associated with the event, and finding ways to forgive.

“Worry” Part 1

It’s a good thing that almost all of us worry. Think of worry as a built-in alarm device. When it is used wisely, it alerts us to danger and prompts us to navigate our way through a maze of solutions to life’s various problems.We need to think through our options when we are faced with problems, weighing the benefits and pitfalls of each alternative, and then come up with the best solution. From there we take action, which, we hope, solves the problem. Worry is helpful when it is used at the right time and at the right level for resolving our difficulties. Like many things in life, too little worry or too much of it can be harmful.

 

Too little worry can result in impulsive decisions, which may result in unfortunate consequences. Indeed, some people are high risk-takers who may not worry enough about problems, they may win, but just as often, they lose. Others avoid worry through substance abuse or other addictive behaviors and then lack the motivation and insight to deal realistically with life’s expected problems. Similarly, a laid-back, come-what-may approach, while it has some merits, sometimes suggests passivity and a lack of ability to participate in the complexity of life’s experiences.

 

As we all know, some people worry too much. Rather than solving a problem, too much worry becomes the problem. Not only does excessive worry create personal suffering, but it also affects the people around the worrier. Worry is a fairly common, but potentially serious, condition. A recent survey suggests that one-third of all office visits to primary care physicians are associated with some form of anxiety-related diagnosis. The stress that accompanies worry can have serious physical implications, including an increased risk for high blood pressure and heart ailments, immune system deficiencies, and cancer.

 

Most people who worry excessively are well aware of their tendencies, although some simply view it as their normal state of affairs. (Indeed, some people like to worry because they feel that their mind is more active and worry allows them to feel more in touch with their inner experience.) The worrier is one who feels in jeopardy but believes that he or she lacks the ability to take action in the real world to solve the problem. Some people who worry feel that if only they can think the problem through repetitively, sometimes day after day, the problem will magically disappear. And many people worry about things they have no control over anyway. In truth, excessive worry does not solve problems- which are actually cleared up by considering real options and then taking action. Worriers harbor their problems in their imagination and often cannot find a way to break free to the stage of taking action.

“Rumination” Part 3

Overcoming Your Rumination

Rumination is an elusive experience. We get caught in the ruminative pattern without realizing it and then assume that this was the way things are supposed to be- thinking and thinking endlessly. We slip into the pattern automatically and feel that we have no control over it. The experience can feel agonizing, but may also seem familiar and comfortable. It does not solve the problems that we are anxious about, and in fact it ultimately increases our anxiety and may lead to depression.

Let’s look at a few ways of breaking the ruminative pattern that can work in a short time. Working on these strategies with a professional therapist can be highly effective.

 

Realize that rumination is not a healthy resolution to your problems

During a ruminative episode we may feel that we have finally gained insight into what is bothering us. “I deserve to feel angry about what he did to me.” “I have a right to feel depressed over the neglect I’ve suffered in my life.” We need to understand that these negative thoughts simply exacerbate our underlying negative mood. When we ruminate we get caught in tunnel vision. We see the world in only one way. This is not a healthy route to solving our life problems. It simply sets us up for depression, more anxiety, and anger. It helps to understand and accept that there are better ways of dealing with problems.

The use of distraction

Research has found that engaging in a pleasant distraction is a good way to open the way of effective problem solving. The use of distraction from rumination can improve our mood and lead to positive thinking. Even a few minutes of distraction can have long-term effects. Some people use exercise as a distraction. A walk around the block, swimming, gardening, or a workout at the gym are all positive distractions from rumination, as well as a hobby that requires us to pay attention to what is happening in the moment. Reading can be a good distraction. The goal is to break the rumination and to focus on something else. Of course, we need to realize that a distraction is not the same as escaping from a problem. For example, alcohol or other substance abuse, losing oneself in videogames, or binge eating are not healthy distractions.

 The” Stop” technique

When you find yourself caught in the swirl of ruminative thoughts, one short-term technique that may help is simply to tell yourself to stop. While this will not last long, and it is certainly not a permanent way to curb rumination, it will give you a sense of some control and open the way to try out longer lasting methods. You might try putting a rubber band around your wrist and then snapping it when you find yourself overthinking, along with the verbal reminder to “stop”.

 

 

Observe yourself

When rumination takes over, cultivate the ability to observe yourself from a distance. Ask yourself, “What am I doing?” “Isn’t my thinking like this just a way of giving the power to the other person?” “I’m letting the other person control me.” Redefining your overthinking in this way gives you a sense of power over it. Take this method to the next step- come up with different ideas that truly allow you to solve the problem constructively. Try to see the issue from the other person’s point of view. Redefine the problem using more positive thoughts.

Put aside time to ruminate

If you allow yourself to ruminate, it can take up your whole day. From morning to a sleepless night, you ponder your situation endlessly. It takes over your life and you do have other responsibilities. Tell yourself that you will allow yourself only an hour per day to ruminate. Choose an hour when you normally feel good (and this should not be right before going to bed).  When the urge to ruminate appears, tell yourself that you will put it aside and save it for your “thinking hour.” Many people find that because they are not spending most of their days free from ruminating, the problems seem less overwhelming during the hour of thinking.

 Share your thoughts 

Rumination is a private experience and we seldom share the thoughts we harbor with other people. We generate thoughts that may have little basis in the real world. You can break this pattern by sharing your thoughts with a trusted friend, family member, or therapist. This person can ask relevant questions, such as, “What was your mood before you starting thinking about this?” You can listen to their feedback and ask questions- and this will allow you to see your issues in a new light and gain new perspective. Make sure that the person you talk to is stable. If you choose a person who simply fans the flames of your thoughts, you will accomplish nothing and may drift further into your ruminative thoughts.

“Rumination” Part 2

Identifying Rumination 

Rumination is associated with anxiety, depression, anger, and substance abuse. The content of rumination falls into three broad categories:

 

Victimization – When we feel that we have been treated badly by someone, we ruminate about the injustice we have experienced. We review the situation again and again and think of ways we can find retribution. We don’t look at the whole situation or try to understand our part in the interaction. Unfortunately, we may take action on our thoughts that may have negative consequences.

Magnifying– When we feel upset, we start thinking of reasons to explain our feelings. We may come up with a number of causes, all equally plausible, and some may be dramatic and not grounded in reality. We then take rash actions with negative consequences, such as quitting our job, ending a friendship, or acting out our bad mood.

Chaos– Sometimes we feel overwhelmed and our thoughts dart from one focus to another without any clear theme. We end up feeling disoriented- and we may shut down or run away from our problems.

Ruminating should not be confused with other types of thinking. Rumination is not the same as worry, although ruminators do worry. Worry involves “what if’s”- wondering about things that might happen (“What if I say the wrong thing at work?” “What if this date goes wrong?”) Rumination, on the other hand, focuses more on things that have happened in the past- like things you said or things that went wrong.

Rumination is not the same as obsessive-compulsive disorder. OCD involves a preoccupation with thoughts that are external, like germs, and how they might intrude on us. Ruminators can turn these thoughts off easily.

And rumination is not like the thinking that goes on in therapy. One thing that therapy might do is to focus on effective problem –solving, including looking at situations in a different way and finding ways to take action to solve problems. Ruminators focus on one-way of looking at a problem and they seldom get to the point of solving the problem.

“Rumination” Part 1

Thinking about our problems is, without a doubt, part of an effective way of solving them. If we need to deal with one of our life issues, we think it through, review our various options, and then choose a course of action to handle the problem. We can then take action to resolve the issue- and this might include redefining it so that we don’t experience it as a problem any longer.

But sometimes we get stuck at the thinking stage of problem-solving and go no farther. The success of thinking can lead us to engage solely in thought, as if- if we do more and more of it – we can think our way through what seems to be an insolvable issue. We find comfort in thought itself and never move into the problem-solving strategy of taking efficacious action. What we may not understand is that rumination (or overthinking) is driven by anxiety. Letting thoughts swirl in our heads over and over again is one way to soothe our anxiety – but it’s a trap because we get stuck in our thoughts and never move on to take action to solve the problem.

Rumination is more likely to occur when our thoughts are largely negative. Positive thinking encourages us to take effective action. Negative thoughts, on the other hand, because of social constraints and the negative impact they have on our self-image, discourage us from taking action. When we engage in negative thinking most of the time, we feel overwhelmed by the world. We feel stuck. We can’t see our way out of our problems. Negative thinking drives people away from us so that we are unable to share our thoughts with others and benefit from the feedback they might offer. And so, alone, we think and think…

Our emotions of the moment, as they ebb and flow throughout the day, influence our thoughts. If we feel sad, the brain has greater access to sad thoughts and memories. So when things happen in our lives, we interpret these events in a sad way. Similarly, if we feel anxious, our brain responds to memories associated with anxiety- and this may lead to our feeling unsafe or even paranoid, because we filter our interpretations of events in an anxious way. These negative emotions are associated with negative thoughts. And this is where rumination takes hold. Negative moods lead to negative thinking, which subsequently drives our negative mood- and we get caught in the cycle of rumination. Interestingly, if we can change our thinking in a positive way, then positive moods will follow- and then we interpret events positively and can take effective action to solve our problems.

To Be Continued…

“Surviving The Life Crisis” – Part 2

A life crisis can be a blessing in disguise because it forces us to respond to what we really need in our lives. It gets us down to the root of who we really are. The crisis allows us to let go of our old life and to create a new one that can be more fulfilling. Yet we resist the change because it forces us to challenge our definition of who we have always been. We need to let go. But we resist letting go because we feel the need to hold on to the illusion of control.

We must let go of those parts of our lives that are no longer appropriate for us to hold on to. They no longer work for us. But we can hold on to those things that we truly need and that will define who we want to be in the future.

Some Practical Steps for Getting Through a Life Crisis:

  1. Live in the Moment- A life crisis might feel like a permanent condition- a painful and lost existence. Take one step at a time as you go through each day. Try not to focus on the past, which can’t be changed, and let the future unfold, as it will. For now, stay in the present and get your bearings. When your world is in turmoil, it is normal to feel confused. Your old tools for survival may not work any longer, and it is time to explore new ways of dealing with everyday problems.
  2. Find Support in Other People– It’s difficult to endure a crisis alone. Identify your crisis (divorce, grieving, financial loss, a medical issue, etc.) and find other people who have been through a similar crisis. Try not to isolate and work this through by yourself, although this might seem like the most comfortable option. A therapist is trained to help you in a confidential and professional way. A support group of people who have been through a similar experience can understand and accept your feelings. Find a trusted mentor who can help guide you through this period of confusion with practical advice.
  3. Draw On Your Full Range of Strengths– Try to find a good balance between the various components of your personality- your ability to think, your emotions, your intuition, and your spiritual self. You may feel more comfortable as a thinker- but understand that this is limiting. A person cannot usually think their way through a life crisis. You also need your ability to feel, and sometimes your gut feelings give you the best course of action. A crisis is a time of growth and adapting to new situations, and for this tremendous challenge you need to use your whole self.
  4. Define Your Goals– You may feel that your life is in disarray, so it helps to give yourself some direction. Set up a series of goals that you can easily achieve. When they are achieved, you will sense a feeling of success. These goals will constantly change as you wind your way through the crisis. For example, Monday will be the day to go to the grocery store alone. Tuesday you’ll call a therapist. Wednesday you’ll go to the gym or take a long walk. Later on your goals will be loftier- like going on a weekend trip with a new friend, arranging a party at your house, or starting a new job.
  5. Take Care of Business– Your life may be in crisis, but it must go on nevertheless. Pay your bills on time. Go to the doctor and dentist. Do your laundry. Bathe every day. Take your dog for a walk daily. Keep your house clean. Water the plants. These activities give you structure and serve as a good counterbalance to the chaos that characterizes life crisis.
  6. Nurture Yourself– The world may seem cruel when you are in crisis. Find at least one thing that you really enjoy doing- and then do it. Give yourself some pleasurable activities. Take a walk. Enjoy the sunset. Do a jigsaw puzzle. While you engage in these activities, allow yourself to have pleasant thoughts. If negative thinking comes into the picture, observe that you are getting negative, and let it go.

“Surviving the Life Crisis” -Part 1

A life crisis is one of the inevitable features of our lives. Learning how to survive a crisis is a crucial skill, and one that we will probably need more than once throughout our lives. A crisis can occur when things begin to fall apart around us. The things that shape us- our marital status, job title, relationships with family and friends, health, or financial security- have disappeared and we find ourselves adrift without any clear guidelines that tell us what to do next. We feel lost. Do we hide? Do we deny this is happening? Do we rage? Do we fear the world? The answers may not be obvious. Nobody ever told us that the world would turn out this way. But one thing is clear- this is a crisis.

We all experience life transitions, such as the move from childhood into adolescence or the transition from working adulthood into retirement. Both involve substantial changes in the way we and others define us and the way we conduct our everyday lives. While these normal and expected life transitions can cause us some stress, we at least know what to expect when it is time to move into the new life stage. Our culture provides us with ample guidelines. If we fail to make our adaptations to the new stage, then we experience difficulty. Think of the child who has trouble moving into adolescence or the father or mother who cannot accept the responsibilities of parenthood. Another example is the adolescent who cannot make the move into working adulthood. Most of us adapt to new life stages fairly well, however, because we see others around us who have made the move successfully. We know what to do.

A life crisis is different, however, because it usually hits us unexpectedly and we feel unprepared to adapt to a set of circumstances that we never thought would happen. A life crisis can occur when there is a divorce, a financial setback, the loss of a job, the death of a family member or friend (or a pet), a house fire, a serious accident, an illness (including terminal illnesses), violence (including rape), or a natural disaster. The list seems endless. A life crisis can even occur when a problem we have been sitting on for years finally comes to the fore- like, “Am I really happy in the work that I do?” Or, “Do I have the chance to express my spiritual life to the degree that I want to?”

How Do We Define Our “Self”?

Answer a question- “Who are you?”

If you’re like most people, you probably answered in terms of the work you do. You may have answered in terms of who you are in your family or other relationships.

If your answer included your work, what do you do when that work is no longer part of your life? What if you retired or lost your job? What if you have a serious illness and are now disabled? What now is your definition of yourself? You may very well feel utterly lost. If your definition of self includes your work and nothing else, and that work is now gone, you could very well end up in a swirl of a life crisis, feeling that you have no resources for working your way back to normal life again.

If you are in a crisis, answer the, “who are you?” question- but this time list all of your positive personal qualities. Get down to the core of who you really are. For example, your list might say, “I am caring, a good friend, creative, a hard worker, trustworthy, a good spouse, a parent, kind, fun, a good socializer, quiet at times, a dancer”- and the list can be anything at all that describes who you are.

When you know that you are more- much more- than your narrow definition, the crisis becomes more bearable. You know that you have qualities which give you the strength to endure your crisis and define your new self.

Your new sense of self can be whatever you choose it to be. Now ask yourself the question, “Who do you want to be?” The answers to this question can be one of your roadmaps to the future…

…To Be Continued