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2 Specific Anxieties

In this chapter we will be exploring the different types of anxieties that people suffer from. The aim is to increase your awareness of any anxiety that may be affecting you. By becoming more aware, you can be more specific about what you are feeling and hence begin to work on managing or eliminating your anxiety forever.

The anxiety disorders featured are the most prevalent in society today. However, I strongly suggest that you do not give yourself the luxury of a label. Although the anxieties we will be examining are labelled ‘disorders’, suffering from symptoms of one of them does not automatically mean you actually have a disorder. It simply means that you suffer from a certain level of anxiety in that particular area. Remember, an anxiety becomes a disorder when the anxiety is chronic and completely disrupts the sufferer’s life. This is very different from having a mild anxiety about a specific area of life.

Before we look at the various types of anxiety, let’s examine the methods you will be using to measure your anxiety levels.

Measuring Your Level of Anxiety

I have included two methods of measuring anxiety. The first indicates your level of anxiety and is called the SUD (subjective units of distress) scale. This scale is very well known to the therapeutic community and is used to measure levels of anxiety in the moment, as well as to monitor feedback over time. The method measures levels of distress on a scale of 0 to 10: 0–1 indicates no anxiety, 2–3 indicates slight anxiety, 4–6 indicates moderate anxiety, 7–8 indicates marked anxiety and 9–10 indicates extreme anxiety. The scale is used to indicate the intensity of specific symptoms and overall anxiety levels.

As well as measuring your level of anxiety, you will also be recording how often you experience anxiety. This is done simply by noting if you experience the anxiety not at all, a little, some of the time, a lot of the time or all of the time.

These two straightforward measures provide a clear indication of where there is a problem and the depth of the anxiety.

Rather than discard any particular anxieties out of hand, I suggest that you read about each one. You may have a good idea which type of anxiety you are prone to – and, of course, you may feel no anxiety in many of the areas discussed – but reading about them all initially will help clarify what is appropriate to you and may pinpoint a few other areas that you need to pay attention to. I suggest you invest in a note pad or a journal, and, as you work through the sections in this book that are appropriate to you, write down your findings as you go along.

Anxiety/Depression

It is quite common for an anxiety disorder to combine with another disorder, and top of the list and most prevalent in the UK and US is the combination of anxiety and depression. A survey by the charity Mind found that 11.2 per cent of women and 7.2 per cent of men in Britain suffer from this condition. Those who suffer from it generally experience a cocktail of emotions, such as hopelessness, sadness, low energy, an inability to concentrate, anxiety, worry, agitation, irritability and restlessness.

Although this book is mainly about anxiety, depression is such a prevalent condition, and one that is so often combined with anxiety, that it cannot be ignored. It is estimated that one in five people will suffer from depression at some point in their lives, and the World Health Organization estimates that by the year 2020 depression will be the biggest health burden next to heart disease.

Naturally, all of us have the occasional day when we feel fed up and pessimistic, but, rather like having mild bouts of anxiety, such moods pass. With depression, however, these moods don’t pass and there is a tendency to look at the down side of life most of the time – the cup is always seen as being half empty as opposed to half full. The medical profession defines depression as an illness of both mind and body in which the symptoms are mental and physical. There are obviously different levels of depression and, like anxiety, the seriousness of the condition is determined by how much it affects the sufferer and their ability to cope with life.

The Symptoms of Depression

When someone is suffering from mild to moderate depression, they will feel low physically, mentally and emotionally. They experience feelings of hopelessness and persistent sadness and will often feel they are trapped in a vicious circle that they’re unable to escape from. Low energy, tearfulness, a lack of enthusiasm and low motivation are also common symptoms. On the whole, someone who is depressed will view the world negatively and only focus on the bad things in life, and this negative state of mind will be reflected in their body language.

The symptoms of mild to moderate depression are:

Inability to sleep

Sleeping too much

Tears and crying

Low mood

Loss of interest in things that you usually enjoy

Low sex drive

Feelings of pressure

Concentration and memory problems

Feeling muddled

Emotional tiredness and fatigue

Low energy

If you were to experience the feelings outlined above for more than two weeks then a doctor would almost certainly diagnose mild to moderate depression. With this type of depression, people are often not aware that they are suffering until it is pointed out to them. Do be aware, however, that sometimes such depression can come and go.

If you find it extremely difficult to function properly and your thoughts seem so completely dark that you are almost suicidal then you are suffering from a severe depression. In both cases – and particularly the latter – you should see a doctor.

Self-Assessment

– How often do you experience depression?

– Not at all/a little/some of the time/a lot of the time/all of the time.

– Go through the list of symptoms above and, on a level of one to 10, how much do you experience those symptoms today?

(0–1 = no depression, 2–3 = slight depression, 4–6 = moderate depression, 7–8 = marked depression, 9–10 = extremely depressed)

Different Types of Depression

There are a number of different types of depression, and a number of causes. Reactive depression can occur in response to a stressful or traumatic event, such as bereavement, a stressful job or a relationship problem. An endogenous depression, in contrast, appears to come on for no apparent reason, which can create a great deal of anxiety to the individual, as he or she never quite knows when it will come on again. Bi-polar depression is another name for manic depression, which appears in the form of extreme mood swings between mania and its opposite, severe depression. Seasonal affective disorder, or SAD, is a seasonal depression that is caused by lack of daylight in the winter, especially around January and February. Another common depressive illness is postnatal depression, which is caused by imbalanced hormones. However, postnatal depression can be psychological as well as clinical, as the mother has to adapt to lifestyle changes as well as the physical changes brought about by motherhood.

As I mentioned before, a large number of people who experience depression also experience symptoms of anxiety. Anxious feelings make you more alert and jittery, whereas if you suffer from depression you are likely to feel that it is an effort to do anything. Anxiety usually precedes depression. However, when anxiety and depression combine, the symptoms overlap.

Symptoms of Anxiety/Depression

Feelings of helplessness

Feelings of hopelessness

Up and down feelings – one moment anxious the next low and depressed

Loss of interest in things that you enjoy

Low energy and motivation

Worry about the future

Feeling of being stuck in the present, unable to focus on the future

Tiredness

Difficulty sleeping

Inability to concentrate

Self-Assessment

– How often have you experienced anxiety/depression?

– Not at all/a little/some of the time/a lot of the time/all of the time.

– Go through the above symptoms and on a level of one to 10 how strongly do you experience these symptoms today?

CASE STUDY for Anxiety/Depression

Viviane was a beautiful 19-year-old who moved to London to make her mark on the modelling industry. She had won all manner of beauty competitions in her home county and it was expected that she would have no problem finding an agent. However, when she got to London, she discovered that life was much harder than she’d imagined it would be. The agency that had been recommended to her turned her down and she found it very hard to get accepted anywhere. After each rejection she found her self-esteem becoming lower and lower. Viviane also had never lived away from home, and she began making do with fast food rather than home-cooked food. The worry about being rejected by agencies was taking its toll on her health. She slept badly and quickly slipped into an anxious depression.

To counter this, I used the anxiety algorithm and the algorithm for depression (see chapter five), both of which worked very well. Viviane and I also worked on her beliefs about herself and she began to learn not to take agency rejections personally and instead see them as simply part and parcel of being a model.

General Anxiety Disorder

General Anxiety Disorder, or GAD, is an anxiety disorder that is characterized by consistent, chronic worry. The American Psychiatric Association has described the condition as excessive anxiety and worry occurring for a minimum of six months. It is estimated that between 2 and 5 per cent of the population of the UK suffer from GAD, while in the US it is estimated there are around four million sufferers. GAD affects both men and women, although statistics show that a considerably higher percentage of women suffer the disorder. Genetics can play a part in GAD, though childhood and life experiences seem to be the bigger contributor.

GAD is a non-specific anxiety, therefore it is not often possible to pinpoint where its roots lie. Excessive worry seems to be present in relation to absolutely everything in life – health, money, job, relationships and even worry about worry itself. With this kind of worry – often referred to as ‘meta’ worry – life becomes distorted with anxieties about everything. Day-to-day concerns, such as turning up on time for appointments or obsessing over something said or done, are often compounded by daily events on the news and events on a global level, such as the terrorist attack at the world trade centre.

With GAD, worries start internally; the individual starts with negative, limiting and often irrational thoughts about themselves, which develop into an exhausting spiral of negative internal dialogue. Experiences become exaggerated out of all proportion, as the anxiety is always more intense than the situations ever warrant. To make matters worse, not only does the individual with GAD worry about himself or herself, they also worry for their loved ones and anyone else around them.

GAD, at its extreme, escalates to the extent that it causes crippling distress to the sufferer. It can last for weeks or months and seem never ending. To the worrier, it feels as if there are threatening situations and disasters around every corner. If you experience this sort of anxiety excessively then you are likely to suffer other physical symptoms, such as general aches and pains, headaches, light-headedness, nausea, lack of concentration, memory loss and sleeping difficulties, all of which can then create even more anxiety. Like all anxieties, you can suffer from GAD to varying degrees.

Symptoms of GAD

Excessive worry about life circumstances

Feeling constantly on edge, restless and irritable

Inability to disengage with object of anxiety

Difficulty concentrating

Constant tension in the body

Shaking and trembling

Being easily fatigued

Trouble sleeping

Nausea

Dizziness

Pressure on the chest

Sweating, cold clammy hands

Self-Assessment

– How often do you experience general anxiety?

– Not at all/a little/some of the time/a lot of the time/all of the time

– Do you find it difficult to control your anxiety and worry?

– Not at all/a little/some of the time/a lot of the time/all of the time

– On a scale of one to 10, how much do you suffer the symptoms of general anxiety in your life today?

(0–1 = none, 2–3 = slight worry and anxiety, 4–6 = moderate anxiety, 7–8 = marked worry and anxiety, 9–10 = chronic worry and anxiety)

CASE STUDY for GAD

Ross, an attractive 24-year-old Australian, was on a travelling trip around the world. Whilst in London, he found himself suffering from severe bouts of anxiety and worry that appeared to be causing on-going migraines and stomach cramps. Ross had a belief that he couldn’t cope. These disempowering thoughts were the result of consistently failing exams in childhood and the learning disability dyslexia. When he was in Australia, he was supported by his mother and sister and felt able to manage his life. However, when abroad, he found it very difficult to communicate his fears and anxieties for fear of ridicule. He seemed to suffer from worry and anxiety about absolutely everything and the slightest thing would cause a negative spiral. He worried about getting a job then he worried about the people around him. He worried that he couldn’t get a girlfriend; he worried about his health.

Underlying Ross’s worry was a belief that he couldn’t cope, so we worked to change this by using some of the beliefs exercises featured in this book. I also used the TFT algorithm for anxiety (see chapter five), and exercises on worry, which allowed him to put his problems into perspective. Ross returned to Australia feeling a lot better.

Social Anxiety

A large number of people have suffered from social anxiety at some point in their lives. Think back over your own experiences and I’m pretty sure you’ll be able to recall a period when you were shy and anxious with particular people or groups, or in certain social settings.

To a certain extent, we are born with our personality already mapped out and with an ‘emotional’ biology that is thought to determine our temperament. Consider babies for a moment – they all have such different personalities. Children born to the same parents also usually have characters that are completely different: one child may have a placid temperament, while another is more robust.

Of course, there is little doubt we are affected by our environment and social anxiety often has its roots in childhood experiences. However, studies examining whether the temperaments of young children changed in social situations over time found that the robust, confident individuals stayed that way in groups of people. The children who were fearful and nervy at an earlier age were more likely to be anxious in social situations, though some did improve.

It is perhaps during adolescence that social phobias and anxieties really begin to manifest and become most apparent. At this stage, children may be breaking some of the bonds with their parents and becoming more aware of themselves as individuals, but they have a strong need to fit in with their peers. As a result, anxieties emerge about being judged or rejected – or indeed doing anything that might conceivably lead to embarrassment or humiliation.

Social anxiety can occur on many different levels. When it is mild, the sufferer usually experiences discomfort and anxiety in particular situations. In cases of extreme anxiety, the individual is consumed by thoughts of their inadequacies and feels quite overwhelmed and panicky. Following a stressful event they will spend hours obsessing about how they could have behaved differently. It is also possible to have phobic reaction in social situations (see here).

While the lucky ones grow out of their anxiety, others simply learn to manage it. For some, however, it can stick, causing them to become fixated with self-doubts about social situations. Patterns like this can run the whole of a lifespan and can have an incredibly negative effect on a person’s life, making it difficult for them to make friends and get on in social situations. For an unlucky minority, this becomes so fraught with anxiety that they will avoid such situations and hence become reclusive and lonely.

High-tech, Low-value Communication

The computer has patently not helped us to interact with others. Instead of communicating face to face and developing relationships within the family and at work, many of us – kids, teenagers and adults – spend hours in front of the computer, cut off from genuine human contact. Today, you can, if you choose, virtually lead your life via the Internet – you can do your shopping, click on to chat rooms for conversations and even have a relationship over the net. Dating anxiety is very common, as the insecurities we have about ourselves can negatively affect the way we communicate. Using the Internet can make the initial process less stressful, but of course it throws up many other problems, not least of which are the expectations both parties have built up before they meet.

Social anxiety is often based on perception rather than feedback from others. People with social anxiety become very conscious of the signals that they are giving out and can easily find themselves blushing, tongue-tied or unable to eat, drink or talk; or the opposite – eating or drinking too much to cope with the situation. And, not surprisingly, this can often exacerbate an already difficult situation.