CBT for Anxiety
by Joel Lewin
Anxiety or worry are experienced at some point by most addicts. Whether that comes in the form of an anxiety disorder, the acute anxiety experienced during withdrawals, or the amorphous and at times overwhelming feelings of worry that come with embarking on a new path in life.
Anxiety disorders are some of the most common conditions that occur alongside addiction.
Anxiety can be debilitating emotionally, mentally and physically. But it doesn’t have to be. When we learn tools to deal with anxiety, we don’t need to be fearful or overwhelmed by it. We will never be free from it entirely, but in time we can learn to see anxiety as a source of energy that can be channeled in positive directions.
Evolutionary alarm system
Anxiety is an evolutionary alarm system designed to alert us to danger and prepare us to deal with that threat.
Let’s imagine I’m a caveman. When I venture out of my cave to go down to the river for some water, there are a multitude of dangers I might face. Snakes, lions, other cavemen who want to rob my designer loin cloth…
As I’m walking down the path I hear a heavy rustling in the bushes. This triggers my anxiety alarm system, and my body jumps into action, preparing itself for fight-or-flight.
My body releases a cascade of hormones, which sparks a number of physical reactions.
My heart starts pumping faster to get blood to the muscles in preparation for action.
My breathing accelerates to get more blood to the muscles. (If I don’t use this extra oxygen through physical exertion I might feel light-headed, a common symptom of anxiety.)
My digestion system shuts down- I don’t need to digest meat if I’m about to become someone else’s. This might manifest in a range of digestive disturbances.
My pupils dilate to let in more light so I can see the threat and potential escape routes. This might result in blurry vision.
The blood moves away from the smaller surface blood vessels to the larger muscles which may result in a chilling feeling.
I start to sweat to cool my body in anticipation of action.
So the function of anxiety is to protect us, rather than harm us.
This is a truly remarkable system that prepares the body to face physical threats. But the problem is, the threats we face today generally aren’t physical. Our body is often preparing us for the wrong type of threat. When we enter a room full of strangers at a party, or contemplate starting a new job, our body is preparing us to face life-threatening physical danger.
It’s like an oversensitive car alarm system. A car alarm system is extremely helpful when it alerts us to a burglar, but it can be frustrating and disruptive if gets triggered by birds or bouncing balls.
But the good news is, these responses pass if we let them. They are completely normal physiological responses and they don’t need to be debilitating. In fact, when we learn to respond to anxiety differently, it can become an asset.
The components of anxiety
There are four main components of anxiety- thoughts, feelings, physical sensations, and behaviours.
I’ll demonstrate how these link up with a hypothetical scenario.
Let’s imagine I’m a donkey breeder. I’m going to the global donkey breeding conference to give a talk about donkey immune systems.
I’m standing back stage and I see hundreds of experts, who have been in the field a long time.
My thoughts: These people know more than me. I’m not good enough.
As a result of these thoughts, I feel: anxious, nervous, stressed
This perceived social threat is interpreted as a physical threat by my body which triggers the fight-or-flight response.
My physical sensations: heart racing, shaky hands, tense muscles, sweating.
My thoughts: People can see I’m shaking and sweating. They think I’m inadequate and weird.
Which then compounds my feelings of anxiety and physical symptoms of racing heart and tension.
My behaviour: I race through the speech as quick as possible, which leads me to stumble over my words, intensifying my thoughts of inadequacy and feelings of anxiety.
I avoid people afterwards and leave the conference early, which affirms my thoughts of not being good enough and means I don’t have chance to change these.
It becomes a vicious spiral, with behaviours that offer short term escape from the anxiety, while actually making it worse in the long run.
Fortunately there are a number of very effective ways we can tackle anxiety.
The first thing we can do is address the physical symptoms of anxiety- to put the brake on the fight-or-flight response.
In fight-or-flight, our sympathetic nervous system is activated. The parasympathetic nervous system restores our body to a calm and balanced state. It is like a parachute that brings us down for a soft landing.
One of the best ways to activate this parachute is using breathing techniques.
When we are anxious we take more shallow breaths into our chest. Shifting to deep breaths into our belly can quickly sooth the symptoms of anxiety.
Practice taking deep breaths down into your belly, expanding your belly as far as possible, then releasing it with a long slow outbreath.
Try placing one hand on your chest and one hand on your belly. Focus on moving the belly hand and not the chest hand.
You will feel noticeably calmer after just a few breaths.
Breathe in for a count of four, hold it for four, breathe out for four, hold that for four. Repeat. You can trace a square with your finger if it helps you initially.
Practice these breathing techniques a few times a day, particularly when you’re not anxious. As you get more proficient, you can apply them more easily and effectively when you’re in a heightened state of anxiety.
Progressive muscle relaxation
Even after we have calmed down following an acute bout of anxiety, our body still holds onto residual tension. This is a technique for relaxing the body and releasing the tension that builds up.
It involves tensing and relaxing muscle groups throughout the body. Here is a link for a guided session.
Challenging unhelpful thoughts
Often we overestimate a threat and underestimate our ability to deal with it. Our thoughts can be very unhelpful, irrational and a long way from reality.
By identifying our unhelpful beliefs and challenging them, we can develop more balanced, less anxiety-provoking perspectives.
We can challenge our thinking with questions such as:
Do I have any evidence for these beliefs?
What’s a different way of looking at this situation?
What would I tell a friend in this situation?
Will I even remember this in a year?
What’s the worst case scenario? What’s the best case scenario? What’s the most likely scenario?
We can also avoid compounding our anxiety (like in the example above), by interpreting the physical sensations differently.
There are thoughts that intensify the anxiety, such as:
“I shouldn’t be feeling this tense.”
“There’s something wrong with me”
“I can’t handle this”
We can replace these with an acceptance that the feelings and sensations of anxiety are normal and natural and will pass if we let them.
Exposure basically means doing the opposite of what your anxiety wants.
Equipped with relaxation techniques and the ability to challenge our unhelpful thoughts, you are ready to begin gradually exposing yourself to the source of your anxiety, whether that’s meeting new people, speaking in front of groups, or specific things such as flying.
You start small and work your way up. For example, if someone is afraid of speaking in front of groups, they might follow this stepped approach:
Introduce themselves at an AA meeting
Do a small reading at an AA meeting
Do a larger reading
Share for a long time
Chair the meeting
When anxious, people tend to overestimate threats and underestimate our ability to deal with them. As such we avoid the source of our anxiety, thereby asserting to ourselves we cannot handle it. And we offer ourselves no opportunities to change this belief.
By gradually exposing ourselves to the source, we grow more confident in our abilities to handle it, and the perceived size of the threat diminishes.
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