NHS CHOICES MOODZONE
I'm Dr Chris Williams,
and I'm here to help you help yourself through common life difficulties.
In this session, we're focusing on worry and anxiety
and looking at how these affect you in five key areas of your life.
Worry and anxiety are more common than you think.
Even more so in today's busy lives,
with challenges and financial stresses and demands.
Some people get confused about the difference
between worry or anxiety and depression.
And one reason for that is understandable,
there's so much overlap between these different problems.
So, the majority of people with depression
also have significant anxiety.
But the main focus in depression is on low mood
or loss of enjoyment in things.
Depression also causes people to start doing less
because they have little energy or talk themselves out of doing things,
as they think they won't enjoy it, or it seems just too hard.
In contrast, in worry and anxiety,
although the person might not enjoy things as much as usual,
there aren't the same strong feelings of depression
or loss of pleasure that's seen in depression.
Instead, in anxiety, we become focused on possible threats around us
and worry about things that have happened or may happen,
or how we'll cope with them.
We tend to overestimate our problems and downplay our ability to cope.
Worry often feels like we're trying to solve a problem,
but in fact we just tend to turn things over and over again in our minds.
So, let's look more closely at this worry and anxiety.
Anxiety begins when we start to feel out of balance.
Either we face one really big stressful event that overwhelms us,
or perhaps it feels like there's just one thing after another
after another that grind us down.
Or perhaps, for whatever reason, we feel our ability to cope drops.
Maybe we lose an important support, like a close friend or relative,
or we move away from home or leave the place we grew up in
and all the supports there.
Or we change how we feel inside, perhaps by feeling depressed and down.
And this all affects our ability to tackle things,
to sort out problems or feel resilient.
Whatever the cause, we feel out of balance, stressed and hassled.
Keeping going and ignoring the problem can often lead to things getting worse,
so that we feel more and more overwhelmed.
But the great news is,
there are so many treatment options available for these problems,
such as Cognitive Behavioural Therapy, CBT,
which is a popular form of talking therapy
that has been found to be very effective by researchers.
This module adopts this same CBT approach,
and I'll use it to help you understand the vicious circle of anxiety
and how your thoughts, feelings and behaviour
all act together to keep you feeling worried.
Let's start by thinking a bit more about this,
by considering how anxiety can affect five key areas of life
when we feel stressed or distressed.
So, here's a typical example of someone who's experiencing anxiety and worry.
Emma's 21 years old,
and is a student who has her end of course exams coming up.
She's been revising for the last two weeks
and is worried she won't be able to pass her exams,
which start in four more weeks.
She's trying to work hard,
but finds that she worries when she sits down to work and just can't focus.
She's been feeling more and more anxious and hasn't been sleeping as a result.
She's also been feeling ratty at her flatmates,
shouting at them when they make too much noise.
She decides to go and see the student counselling service
for help and support.
And the counsellor asks Emma about how she is feeling
in five key areas of her life.
This helps her to think about the people and events around her
and the impact of all this on her thoughts, her feelings,
physical symptoms and behaviour.
And the aim of this so-called five areas assessment
is to help Emma to understand her situation better
and to encourage her to make some small changes
that can have a big impact on how she feels.
There are five different areas.
Firstly, the people and events around Emma.
Secondly, her thinking. Thirdly, her feelings and emotions.
Fourthly, her physical feelings.
And fifthly and finally, her altered behaviour.
All of these areas are present within each of us.
What happens in one area can have a knock-on impact on each of the others.
So, at times of anxiety and stress,
we can end up feeling out of balance in each of these areas.
And what this helps Emma to realise is that she's caught in a vicious circle.
The first of the five areas is the people and events around us.
Let's use Emma's situation to think through how this applies to her.
She's feeling the pressure of revising for exams.
She still has a lot of work to cover,
and although she has a revision timetable,
which shows she is only just behind where she wants to be,
she is very aware of quite how much there's still to do.
She knows there are still a few weeks to go before the exams start,
but some of her flatmates aren't doing exams at the moment
and are coming in late, playing music, making noise,
and all this distracts her as she tries to work well beyond midnight.
What Emma didn't know before seeing the student counsellor
is that the things going on around her can cause a vicious circle
that make her feel out of balance and worse inside.
So, let's move on to look at the second of the five areas, Emma's thinking.
For the past three months, Emma has been worried about the exams.
She realises that she always has been a worrier all her life.
She worried at school about exams and essays and projects.
She also worries in her personal life about dates and trips and courses,
where to live and more.
Now the focus of her worry is firmly on the exams,
which are building up and up in her mind.
She lies in bed saying things like,
"There's not enough time left to learn everything."
"I'm not clever enough to understand this course."
"What if I don't pass? What will my parents say?"
"I'll have let them down."
"I'm not taking anything in."
"I keep looking at the page and it just won't stick."
"I should have worked harder earlier in the term."
"My flatmates are being so rude, so inconsiderate."
"They know I've got exams, but they're being as noisy as usual."
And these thoughts show several of the unhelpful thinking styles
that are common in anxiety.
Including making self-critical comments,
that she isn't clever enough and has taken things easy.
Making predictions that things will go wrong
and second-guessing what others will think of her.
She especially worries that her parents will see her
as failing to make the most of her opportunities on the course.
And these are all unhelpful thoughts.
They're also often not true, and dwelling on them makes her feel worse.
That's one of the key things in worry.
Although it feels like sorting out a problem,
instead worry just involves chewing things over again and again
in a way that doesn't actually help sort things out.
And that leads us on to the third area called "altered feelings".
Have you noticed that what we think can affect how we feel emotionally?
Because Emma's mind is so full of so many worrying thoughts,
she starts to feel worse emotionally. She feels anxious and stressed.
She can still enjoy some things, like seeing her boyfriend,
and isn't depressed.
But she just isn't enjoying things as much as usual
because she's spending so much time revising.
She also feels guilty that she may have let her parents down
and angry at her friends because of the noise they're making.
And how we feel can affect us physically.
And that's area four, altered physical feelings or sensations.
People are often surprised quite how physically exhausting anxiety can be.
Emma can't sleep well and is tossing and turning in bed at night,
thinking about how much she has to learn.
Even when she's up and about during the day, she feels tense and on edge.
Thinking about the exams makes her feel slightly sick,
with a churning stomach and she feels shaky.
These are all symptoms she's noticed before
when she's been in similar stressful situations,
like before interviews for the course three years ago.
They're a pattern that repeats whenever she feels stressed.
Other common symptoms of stress that occur can include a rapid heart,
because feeling emotionally tense makes our muscles feel tense too,
which is a bit like running a marathon each day.
Also, noticing pains like headaches or eye strain and tummy pains,
and being prone to every bug going,
with coughs and colds that seem to go on and on.
And all of these things, the altered thoughts, feelings
and physical symptoms, all add up to affect what Emma does,
affecting her behaviour and activity levels.
And that's the fifth and final area of this five areas assessment.
Emma's found that she's been sitting making excuses not to work
by avoiding revision.
Because she feels angry at her flatmates,
she's been quite rude towards them and avoided them.
But importantly, she hasn't actually explained to them
that she needs quiet, so she can revise.
When she does start to work, she keeps going off on a tangent
and going back to work in areas she feels comfortable with,
rather than tackling the areas she hasn't mastered yet.
Finally, she's drinking a lot more coffee to help wake her up
and overcome her tiredness.
Because Emma's forgotten that coffee contains caffeine,
and that can worsen symptoms of anxiety
when someone takes more than around five strong cups of coffee a day.
And each of the five areas affects each other
to create a vicious circle that can help make Emma feel out of balance.
Other common unhelpful behaviours include drinking too much alcohol,
oversleeping, comfort eating and putting important things off,
like paying the monthly flat rent or doing the housework.
And all of these can worsen how we feel.
The good news is that the vicious circle can spin both ways,
and that by making a positive change in just one area,
things can change in the others as well.
So, for example, Emma and her student counsellor both agree
that her altered behaviour's a good place to start making changes.
As a small first step, she decides to go and work in the library,
where it's quieter and where she can focus.
She also decides she will be more assertive
and ask her friends to cut down the noise in the evenings
when she gets back from the library.
Secondly, she realises that it's quieter in the house in the mornings,
so she plans to wake up a little earlier and work then.
That has the advantage of stopping her pattern of sleeping in
and means that she can stop working earlier in the evening,
say, by 11:00 in the evening.
That allows for a work-free wind-down time before bed, which will also help.
To help with her sleep, she changes her coffee to decaffeinated coffee
and has a milky wind-down drink just before bed.
She tries to tackle the problems of revision by re-writing her timetable,
so that it focuses on revising important topics
that have come up in other exams.
Although she wants to cover everything,
she realises she'll need to prioritise and focus on things
that are likely to be of the most benefit.
She introduces these changes bit by bit over a few days,
so the changes are realistic, small and achievable.
Emma begins to feel more in control of things.
She's got back in balance by gaining new skills
to boost how well she feels she can cope.
Plus, by breaking down the tasks and following a revision timetable,
she has managed to make the demands of revision seem smaller, too.
Did Emma's example help you understand any of your own worries?
Why not complete your own five areas assessment
to see if there are any changes you can make
to help you feel less anxious.
Writing this down can be a good way of helping you to assess your own worries.
So, think first about area one.
What's going on in your own life? Are there any pressures or problems?
In area two, altered thinking,
what worrying thoughts have been going through your mind recently?
And on to the third area, how does this make you feel emotionally?
Anxious, stressed, ashamed, guilty, or irritable?
Remember, if you feel really depressed,
or are no longer enjoying things much at all and feel stuck like that,
then see a health worker, like a GP, to check whether you might be depressed.
And remember that stress can affect us physically, area four.
Have you noticed you've been feeling different physically?
And finally on to the fifth and final area,
altered behaviour or activity levels.
Have you stopped doing things you used to enjoy, avoiding anything?
Or have you started doing new things that are becoming unhelpful,
like drinking or smoking too much, to deal with stress?
And how has all this left you feeling?
Are you trapped in a vicious circle and are out of balance?
Here are some ideas that might help you to tackle your own worries.
Firstly, in your thinking,
watch out for saying things to yourself that add to you feeling out of balance.
Things like worries
that go round and round in your head without sorting out the problem.
Try to take a step back and let the thoughts just be.
Remind yourself of times when you've coped before
and of the resources you can bring to things.
And try and see things in perspective.
Because often, when we get distressed, all we look at is the worry
which gets bigger and bigger in our minds as we look at it.
So take a step back and look at it differently.
These thoughts can paralyse you and stop you getting on.
Secondly, physical symptoms.
The physical responses to worry and anxiety can add to our stress
and be quite exhausting.
These are often the things that people notice first,
and it's your body telling you that you may need to make some changes,
or possibly seek some support.
If you're having trouble sleeping,
the sleep problem session in this Moodzone series may help.
Thirdly, alter your behaviour.
Anxiety says to you, "Don't".
"Don't volunteer, don't answer the phone,
don't visit that person, don't push yourself,"
when we know we really should.
Try to face your fears and keep to the task in hand.
And you'll be surprised that, often, the worst doesn't happen
and your anxiety will fade.
Watch out for avoiding things and doing less and less
and getting stuck in a vicious circle of avoidance,
where our fear causes us to do less. And then doing less adds to our fears.
And watch out for seeking false courage through drinking too much, for example.
And remember, don't suffer in silence.
Speak to someone like Emma did with her student counsellor.
But watch out for becoming too dependent on others,
or regularly seeking their reassurance.
Finally, relaxation can be beneficial,
either as part of a class, or on your own at home.
Perhaps try the Moodzone anxiety control training,
which some people find is good for relaxation.
Making changes in these areas can really help you manage how you feel
and tackle anxiety.
Wonder if this might work for you? Why not give it a go and see.
You've made a great start by completing this session.
Thank you for listening.
Thank you. For more like this visit: www.nhs.uk/moodzone