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Anxiety

Learning to See My Depression and Anxiety as a Gift

In the depths of depression, my world falls apart around me. Everything is shrouded in a dark fog, and I know I need to find my way out, but I don’t understand how I got there in the first place. The heavy feeling of despair prevents me from feeling anything else.

Thoughts soaked in guilt rear their ugly heads. Maybe I don’t truly love my spouse…my family…my life. Even when I know none of these thoughts are true, I still feel like an imposter in the story of my own life. I still feel as if I don’t deserve this happy existence. 
 
Growing up, I always knew my odds of suffering from depression were almost a guarantee, with the condition running rampant through much of my family. What I didn’t expect was the crippling anxiety that would plague me in my twenties after the birth of my second child.  
 
In the depths of anxiety, I feel like I want to crawl out of my skin. Sights are too bright, sounds are too loud and my skin is overstimulated with every brush of the clothes on my back. I avoid all social situations, barricaded in my house where I feel safest, paralyzed by the fear of experiencing a panic attack. In the event of an unavoidable obligation, I create a game plan for every possible scenario. I map out all exits and bathrooms. I constantly search for any sign of imminent disaster. I watch the clock, counting down every minute until I can return to my safe haven. 
 
Two years ago, my depression was getting worse as my anxiety took away all opportunity to experience happiness. I realized I needed to seek help. Unsure of what to do next, I confided in my father. I was lost, and he had been here before. I will never forget what he told me:
 
“Depression and anxiety are part of you. Wishing them away or blaming them for every problem that arises will only make things worse. You can’t pretend they aren’t there — but you can learn to use them to your advantage. Let these feelings motivate you to do more, to challenge yourself, to open up your world in ways many people miss out on.” 

Accepting And Facing My Fears

It was after this conversation I decided to prevail. I wanted to experience my kids growing up instead of being a passive spectator, fooling myself into thinking I was living.

My first step was facing my anxiety and working through my panic attacks. 
 
I started doing things that scared me. At first, it was as simple as going out for a meal and staying no matter how anxious I felt. After experiencing several panic attacks in public, I eventually realized no one could even tell when they were happening. My struggle for survival only evident within, the physical symptoms were invisible to those around me. 
 
Pushing myself further, I took a trip overseas. Although I was terrified because my first ever panic attack was on an airplane, I knew I had done enough groundwork to be okay with the possibility of an episode this time. 
 
Stepping off the plane, successfully avoiding an anxiety attack, I felt elated. It was my first feeling of pure happiness, without the underlying tone of worry and despair, I had felt in over a year. I had done so much work to get my life back and it paid off.  
 
I began traveling regularly, something I previously feared due to my anxiety but always craved. My depression slowly dissolved. I was beginning to make decisions based on my desires rather than my worries, doing things I never thought possible even before I was hit with mental illness. 

Changing My Perspective 

Now I see what my father meant about using my condition to get more out of life. Due to the threat of depression, I can no longer convince myself to put my goals on hold or that doing things halfway is “good enough.” To be idle is to invite those feelings of despair back in. 
 
As a result, I have achieved much more than I ever thought I could. I have traveled to more countries than I ever dreamed of and set myself on a career path I have always wanted, all because I understand the consequences of giving in to my fears.
 
I still experience setbacks, but now that I view my depression and anxiety as a gift, I use it as an indicator that I need to do more. Whenever I feel the symptoms coming on, I take action. I just move, setting tiny, easily achievable goals, like cleaning the kitchen. If I do something once a day that makes me feel good, I am taking steps toward something greater for myself.
 
I am so grateful that my struggle with mental illness opened up more opportunities for me and my family. If you find yourself in the depths or depression or anxiety, remember that anything you do to get better is an astounding achievement. Your hard work will build up over time into a life you never could have imagined. You may even realize, as I did, that without the dark times, you wouldn’t have much of what you are most proud of today.

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The Invisible Life Of Having High-Functioning Anxiety

Anxiety disorders — PTSD, OCD, and Panic Disorder, to name a few — are the most common mental illnesses in the United States, with about 18% of the population struggling with one. That’s nearly 40 million adults, according to the National Institute of Mental Health. Not to mention the uncounted: young adults with anxiety, people who suffer in silence either out of fear, choice or because of a lack of insurance.

I’m not the kind of person you’d expect to have anxiety.

When you see me, I read as genuinely social, I run a fairly popular online magazine for which I act as a sort of “face,” and any anxieties I feel are generally zipped-up tight. Not prone to sharing incredibly painful feelings.

Not known for needing a trigger warning. Viciously opinionated, yet diplomatic. Capable of good work. Fairly prolific. Capable of travel (alone). Intensely ambitious. Not fearful of anything you’d know about, anyway. 

But the reality isn’t so simple; excessive, irrational rumination plagues my everyday life.

I worry about the things that live in between the lines — what someone said, how they said it, what they didn’t say, what I said, what they feel, what they don’t feel, what I perceive they feel.

Mostly, I worry that my own perceptions are false.

I obsess over my false projections, my limitations. I obsess on my irrational ideas and I obsess on my obsessions. 

Reality is not easily defined for me, because sometimes I feel like I’m wading through a thick, black muck of made-up ideas. And a part of me knows I make myself anxious, but I can’t stop it. So, “getting a grip on reality” is basically very difficult. I can’t step outside the tiny, vicious bubble of this very moment right now — so seeing a future, or a light, or a reality that isn’t this reality right now, is nearly impossible.

I liken it to Instagram personalities whose accounts tell a story of colour and beaches, fabric and healthy food, groups of friends, and amazing experiences. The narrative belies the struggle, which could be anything: an eating disorder, depression, social anxiety, an obsession with perfection, loneliness. 

And while I know where my “worry problem” comes from (PTSD), it’s a Sisyphean task to turn it off.

Our minds are literally wired to think certain ways. In my case, I grew up second-guessing everything.

I was taught to worry like I was taught to eat, to wash my face, to not die. It became as involuntary as breathing. 

This is the silent underbelly of my day: a boiling, raging, exhaustive epicentre.

Magma of constant analysis. Crippling fear of the self getting in the way of the self. And so on. 

I have a family member with panic disorder.

Their disorder is marked by panic attacks at the weirdest times, irrational associations, irritable bowel syndrome, social fears, and the need to disappear from reality.

Their sickness looks different from mine, it takes a different shape. It’s physical, louder, more noticeable.

So when I talk to them about understanding their feelings, they say, “You’re totally fine, I’m the mess!”

They’re not trying to be reductive at all, I know this. Because when they’re hunched over the toilet in seemingly random fear, hiding inside their house, I’m publishing essays or meeting with other writers.

How could we both be suffering? Is there some sort of privilege in suffering silently? I think not.

With everyone consistently proclaiming, “You? Anxiety? But you seem so well-adjusted/put together/inspiring” — which, thank you, you’re so kind! — so continues the spiral of invisibility. 

Mariana*, 35-years-old, says, “Anxiety is something I struggle with every day and affects even basic things like texting friends. When I tell people I deal with social anxiety,

I get a range of reactions from genuine surprise to understanding and compassion.

For everyone else, it’s a vague sense of sympathy, but not something they really understand.

And I do try to hide it as much as possible because I think it makes me look less competent professionally.”

Gabrielle, a college student, agrees, saying that people reduce her deep-seated anxiety issues to being stressed. “It feels like everything (including myself) is moving so fast that I can’t keep up — except I have to.

I don’t have a choice, so I block out as much of the feeling as I can, which is never enough.

And these days so many people seem to use “stress” and “anxiety” interchangeably, especially on a college campus, that it makes me worry that the debilitating panicky feeling that I have all the time is normal, even though I know it isn’t.”

Ashley Bethard, a digital content manager for a national media brand, has high-functioning anxiety and shares the same sentiments I do, hitting on the interesting idea that if you’re not seen as physically sick, your sickness isn’t real. 

Bethard says, “It’s invisible. I’m good at my job. I logically understand what needs to be done, how to prioritize, and how to manage my time. The professional skills I’ve cultivated through the years have served me well, and without them, I probably wouldn’t be doing the quality of work I’m doing.

[But] there’s definitely a stigma around it. When I’ve shared this with people, sometimes the response has been incredulous: ‘Really? But you’ve got it together.’ I think there’s a bias against something you can’t really see, like, if someone is high-functioning or successful, they can’t have anxiety.” 

The reality is: do we really want people to agree with us? Do I really want them to tell me I’m losing it? No.

No one wants to be put on blast for their weaknesses or wiring issues. I wish there was a way to better understand the silent majority — the people who suffer every day.

The people who don’t speak out because everything they’ve ever done right in their lives — their successes, their jobs, their full social circles — makes having anxiety seem like a lie, or worse, like a bandwagon appeal for sympathy. 

For anyone who says we’re “put together,” try something new. Take a simpler approach. Instead of being polite and saying we don’t seem “anxious” or “crazy” or that we’re “good at hiding it,” just acknowledge that it sucks. Because whether we’re consciously hiding it or not, it’s there. Just say, “damn, I’m sorry.” Validate it. 

And while I can complain about the invisibility of it all, I’m of the mindset that complaint can’t be made without any attempt to change. I don’t get to air my grievances without trying to find a solution. I don’t want to. 

For the longest time, scientists thought the brain was a fixed thing — immutable, incapable of change.

But in recent years, scientists have been studying neuroplasticity — the idea that the brain can, according to Stanford.edu, “compensate for injury and adjust their activity in response to new situations or changes in their environment.”

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The physical symptoms of Anxiety we don’t talk about

It’s no secret that the mind can affect our bodies. When we get anxious we often sweat or blush; we might feel our body heat rise uncomfortably and our hearts hammering in our chests; and sometimes our voices might crack, squeak, or sound quieter than intended.

We might also find that our eyes start to water, we start to tremble or shake, and we feel light-headed, to name just a few.

But some physical symptoms aren’t often discussed quite so honestly. For example, anxiety or stress can also affect our digestive systems and toilet habits.

This can mean constipation, diarrhoea, or the nervous wee that we have to have ten times when we’re anxious.

I once was so anxious about a job.

I struggled to eat properly because it felt like my throat was restricting or closing up. It’s a symptom

I experienced a lot throughout my childhood – my Anxiety would often make me gag on food when I tried to physically swallow – but it’s one I rarely hear mentioned.

These physical symptoms can be so frustrating and a huge discomfort.

And when we don’t know how common they are, it can leave us feeling all alone.

I discussed common symptoms l was experiencing, like blushing and sweating, with my therapist.

I would often wear clothes of a neutral colour just in case I got nervous and started to sweat.

My therapist suggested social “experiments” to help.

These included slowly gaining a little more confidence in public, as I suffer from social anxiety and doing anything in public feels nerve-wracking.

I was specifically nervous about being judged, and my social “experiments” included small things like sitting in the middle of a restaurant instead of hiding in a corner and slowly wearing lighter-coloured clothing that would show up any sweat patches.

The idea was to make a note of how Anxious I was on a scale of one to ten before the experiment, to try and complete my task, and then to go back afterwards and write on the scale how anxious I was during and after the test.

The results usually indicated that my anxiety was high before, a little better during and lower after the completion of the experiment. The more I did these little tasks, the more

I realised that my anxiety at the beginning was often triggered by what I worried would happen – but these worried never came true.

 am now much more comfortable wearing what I like in public without the feeling of being judged.

The truth is everyone is so busy and wrapped up in their own lives that what you are wearing or any physical signs of anxiety and distress you are displaying is far more noticeable to you than to anyone else.

The physical effects that anxiety has on our bodies are very much as real as the effects it has on the way we feel and the thoughts we have. Inevitably, these connections all come hand-in-hand and it can be unpleasant when we experience them.

But discussing these physical symptoms more openly might help us tackle and normalise them when it comes to mental illness.

Blushing, sweating, shaking, constipation, diarrhoea, the constant need to pee and the struggle to eat are all part of the package that we didn’t sign up for – and that’s okay.

Where to get help

It’s really common to struggle with anxiety at some point. We have lots of information and advice that can really help if you find that you’re feeling worried more than usual.

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Strategies for Controlling Your Anger

Wrath, fury, rage — whatever you call it, anger is a powerful emotion. Unfortunately, it’s often an unhelpful one.

Anger is a natural human experience, and sometimes there are valid reasons to get mad like feeling hurt by something someone said or did or experiencing frustration over a situation at work or home.

But uncontrolled anger can be problematic for your personal relationships and for your health.

Fortunately, there are tools you can learn to help you keep your anger in check.

Understanding anger

Anger can take different forms. Some people feel angry much of the time, or can’t stop dwelling on an event that made them mad. Others get angry less often, but when they do it comes out as explosive bouts of rage.

Whatever shape it takes, uncontrolled anger can negatively affect physical health and emotional wellbeing. Research shows that anger and hostility can increase people’s chances of developing coronary heart disease, and lead to worse outcomes in people who already have heart disease. Anger can also lead to stress-related problems including insomnia, digestive problems and headaches.

Anger can also contribute to violent and risky behaviors, including drug and alcohol use. And on top of all that, anger can significantly damage relationships with family, friends and colleagues.

Anger can be caused by internal and external events. You might feel mad at a person, an entity like the company you work for, or an event like a traffic jam or a political election. Wherever the feelings come from, you don’t have to let your anger get the better of you. Here are some techniques to help you stay calm.

Check yourself.

It’s hard to make smart choices when you’re in the grips of a powerful negative emotion. Rather than trying to talk yourself down from a cliff, avoid climbing it in the first place. Try to identify warning signs that you’re starting to get annoyed. When you recognize the signs, step away from the situation or try relaxation techniques to prevent your irritation from escalating.

Don’t dwell.

Some people have a tendency to keep rehashing the incident that made them mad. That’s an unproductive strategy, especially if you have already resolved the issue that angered you in the first place. Instead, try to let go of the past incident. One way to do that is to focus instead on things you appreciate about the person or the situation that made you angry.

Change the way you think.

When you’re angry, it’s easy to feel like things are worse than they really are. Through a technique known as cognitive restructuring, you can replace unhelpful negative thoughts with more reasonable ones. Instead of thinking “Everything is ruined,” for example, tell yourself “This is frustrating, but it’s not the end of the world.”

Try these strategies to reframe your thinking:

  • Avoid words like “never” or “always” when talking about yourself or others. Statements like “This never works” or “You’re always forgetting things” make you feel your anger is justified. Such statements also alienate people who might otherwise be willing to work with you on a solution.
  • Use logic. Even when it’s justified, anger can quickly become irrational. Remind yourself that the world is not out to get you. Do this each time you start feeling angry, and you’ll get a more balanced perspective.
  • Translate expectations into desires. Angry people tend to demand things, whether it’s fairness, appreciation, agreement or willingness to do things their way. Try to change your demands into requests. And if things don’t go your way, try not to let your disappointment turn into anger.

Relax.

Simple relaxation strategies, such as deep breathing and relaxing imagery, can help soothe angry feelings. If you practice one or more of these strategies often, it will be easier to apply them when angry feelings strike.

  • Focused breathing. Shallow breathing is angry breathing. Practice taking controlled, slow breaths that you picture coming up from your belly rather than your chest.
  • Use imagery. Visualize a relaxing experience from your memory or your imagination.
  • Progressive muscle relaxation. With this technique, you slowly tense then relax each muscle group one at a time. For example, you might start with your toes and slowly work your way up to your head and neck.

Improve your communication skills.

People often jump to conclusions when they’re angry, and they can say the first (often unkind) thing that pops into their heads. Try to stop and listen before reacting. Then take time to think carefully about how you want to reply. If you need to step away to cool down before continuing the conversation, make a promise to come back later to finish the discussion.

Get active.

Regular physical exercise can help you decompress, burn off extra tension and reduce stress that can fuel angry outbursts.

Recognize (and avoid) your triggers.

Give some thought to the things that make you mad. If you know you always get angry driving downtown at rush hour, take the bus or try to adjust your schedule to make the trip at a less busy time. If you always argue with your spouse at night, avoid bringing up contentious topics when you’re both tired. If you’re constantly annoyed that your child hasn’t cleaned his room, shut the door so you don’t have to look at the mess.

You can’t completely eliminate angry feelings. But you can make changes to the way those events affect you, and the ways in which you respond. By making the effort to keep your anger in check, you and the people close to you will be happier for the long run.

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Does Anxiety Plus Depression Equal Depression Plus Anxiety? How Clinicians Really Think

Imagine that you take your car into the shop because it’s been acting a little funny lately.

The mechanic listens to your concerns and takes a look at your vehicle. He tells you that your car has a dent in the fender and also a failing transmission.

He suggests fixing the fender right away because that’s the first issue you mentioned to him, so he assumes it’s the most important to you. In other words, a fender bender plus a failing transmission is not the same as a failing transmission plus a fender bender.

How would you respond? My guess is that you would ask the mechanic if he’d been spiking his coffee that morning.

A dented fender versus a transmission about to go kaput? Hmmm – although I’m not as knowledgeable as the guys on NPR’s Car Talk, I certainly know that fixing a car’s transmission is more crucial than pounding out a little dent.

Luckily, this silly example is not very similar to how many clinicians approach their work in mental health.

I recently read about a fascinating study exploring how mental health clinicians conceptualize diagnoses, particularly when comorbidity exists. Comor-what? Comorbidity is a fancy word to describe two or more diagnoses existing at once. For instance, a person may experience generalized anxiety disorder as well as an adjustment disorder with depressed mood. Keep in mind that these are formal diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) – the book used by mental health professionals to code diagnoses on client records.

The study looked at whether clinicians used the commutative property implied in the DSM-IV-TR to make diagnostic decisions. The commutative property is an algebraic concept that purports that A + B = B + A.

This works well for concrete subjects – for instance, oranges. Four oranges plus three oranges is the same as three oranges plus four oranges. Either way, you’ve got seven oranges.

But does this really work with phenomena as complex as mental health conditions? For example, if a person has a long-standing depressive disorder and then, after an acute trauma, also develops anxiety, is this person’s experience the same as someone who has a long-standing anxiety disorder and then becomes depressed after the death of a spouse?

I don’t think so – depression plus anxiety does not equal anxiety plus depression. The human spirit is too complicated to submit to the commutative property. Luckily, clinicians seem to feel that way, too.

The study found that most clinicians place emphasis on a primary diagnosis and then also note secondary diagnoses in their case reports. Granted, this is the format often required on client records, but the DSM-IV-TR does not address how to “weigh” comorbid diagnoses or how to translate this equation to practice.

There are pros and cons to the fact that clinicians do not treat clients under the assumption that A + B = B + A.

On the upside, clients are more likely to get the treatment they need for their most pressing conditions first, as long as an accurate diagnosis was made. On the downside, clinicians are subject to a host of judgment errors, such as over-emphasis or under-emphasis of certain conditions, which could result in inappropriate treatment.

The bottom line is that clinicians need to be aware of their values and tendencies when diagnosing comorbid conditions, and that clients need to advocate for themselves if they feel they are not receiving adequate treatment for their most salient mental health needs.

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The Truth About Stress

Stress has a bad rap.

Stress can create problems, to be sure. Some of the more common ones are include difficulty concentrating, trouble with focus and memory, moodiness, frustration and overwhelm.

There are physical symptoms as well – low energy, headaches, trouble with digestion, aches and pains, and trouble with sleep. In fact, up to 80% of doctor visits are for “stress related ailments and complaints”.

These things seem undecidedly bad. But here’s the truth about stress: sometimes, part of the problem is how you think about the problem. Stress isn’t really one thing; it’s two.

We use the word “stress” to describe the difficult and challenging events that are indeed part of life. Your kid wakes up with a sore throat, your client isn’t happy with the drawings, your car gets a flat tire.

These things can be hard, but there’s no avoiding them. They’re part of our experience of life.

We also use the word “stress” to describe how we respond to these events. Many people assume that the way we respond is a given: “Of course I’m stressed out; my boss is asking me to do the job of two people.” Or “Of course I snap sometimes; my partner’s being unreasonable.”

But the truth about stress is that our stressful response to inevitable difficulties is actually the heart of the problem.

Peace in a crisis

I’m reminded of a story by the Vietnamese monk Thich Nhat Hanh. He wrote about a time when he was trying to negotiate a landing for a group of “boat people” – undocumented refugees from the Vietnam War who were trying to land in the Gulf of Siam.

If the authorities agreed, these people would find a safe haven and a new home.

If the authorities objected, the boat would continue to move from port to port, unlikely to find a landing place in any country. It was possible to spend one’s life on the boat without ever setting foot on land.

The stakes were high, and the future of this boat depended on the negotiation.

“How can I be peaceful now?” Nhat Hahn asked himself. And then, in a moment of clarity came another question, “If not now, when?” He knew in that moment that working with his own response came first. Only after that could he attempt to negotiate a solution for the boat.*

A surprising contributor

The relationship between difficult events and your response to them is surprising. There’s a study, for example, that shows that people who experience more stressful events have more health problems. Makes sense, right?

But there’s a catch. This relationship between difficult events and health problems is only true for people who believe that difficult events are bad for you.

Kelley McGonigal, a Stanford health psychologist, describes an 8-year study that investigated how people perceive stress. It turns out that people who believe that stress creates health problems are 2 to 4 times more likely to report health problems. The very belief that “stress is bad” — is bad for your health.

As author Andrew Bernstein says that the truth about stress is that “stress doesn’t come from your boss, your kids, your spouse, traffic jams, health challenges, or other circumstances. It comes from your thoughts about those circumstances.” The good news is that those thoughts can be changed.

Changing your thoughts

When you change the way you think about something, you also change how you feel and how you act. You end up with more energy and more creativity, so you’re more able to solve the real problems you might be facing.

Keep one thing in mind, though. “Changing your thoughts” doesn’t mean ignoring the problem or telling yourself things that you’re experiencing aren’t true. It does mean taking a close look at beliefs and perceptions that automatically rise to the surface on many “stressful” occasions.

With that in mind, here are a few ways to change stress-producing thoughts into energy-producing thoughts:

  • Reinterpret your response. Your rapid heartbeat and stomach flutters are signs that your body is rising to the occasion, getting ready to help you take action. They are signals that your body is working well by providing the energy you need to solve the problem you are facing. Reinterpreting your natural and normal response to stress will help you feel calmer and more focused right away.
  • Do an about-face. Trying to avoid difficult situations actually increases stressful feelings, because it focuses your mind on those events. Instead of trying to get away from a stressful situation, think about moving toward something that you want. Instead of complaining about your colleague because she keeps asking you for favors, decide what kind of relationship you do want with her. Then take one specific action that will help bring that about.
  • Own part of the problem. Getting angry or worried about the injustice of a situation won’t lead to change.
  • However, you can usually change: a) your physiological response; b) your thoughts; c) your feelings; or d) your relationship to the situation (e.g. changing jobs). This is not about self-blame. Instead, it’s simple recognition that in most cases, you’re part of the situation that’s stressing you out. And that part, however small, is something you can change.

Taking a breath.

You can’t eliminate stressful events from your life. But stress, in the form of roadblocks and challenges, isn’t always bad. The truth is that your body is designed to get you through challenges, difficult events, and crises.

Short, manageable bursts of arousal can increase creativity, improve efficiency, and keep you on your toes. The increase in physical arousal gives you the energy you need to change.

The problem lies in how you respond to those events. Fortunately, it is possible to change your response.

You can reduce stressful feelings by changing your thoughts. “Every breath we take, every step we make,” says Nhat Hanh, “can be filled with peace, joy, and serenity.” With this kind of thinking, he was able to negotiate a plan for the boat people to safely disembark.

This doesn’t mean you won’t feel angry, scared, sad, or frustrated when something difficult happens. Those feelings are normal, and temporary. But stress is more than an event. It’s a mindset.

There will always be stressful events. The challenge is in learning how to change the way they affect you.

* I heard this story long ago, and am describing the details from memory.

If you know of a written reference for this story, I would appreciate the reference.

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The Link Between Anger and Stress

Have you ever looked at the role stress has in anger? Many people say that stress is more prevalent today than 20 years ago. Likewise, others say there is more anger (road rage, workplace violence, and so on). Stress can certainly create a variety of problems. If you are prone to anger, then stress will likely increase your angry behaviors.

Stress is healthy when controlled. Healthy stress (Eustress) is what gets us out of bed in the morning and makes us pay attention to the details throughout our day. This type of stress does not cause anger or irritability. For those who do not have enough stress in their lives, they are often referred to as “lazy” or “unmotivated.”

Distress, on the other hand, is a type of stress that causes many people to be irritable and sometimes downright angry. This happens when the stress is too much and is no longer a motivator. You can think of this as when there is a combination of stressors and things just keep piling up.

One day, the person does not know how to handle this anymore and there is an anger outburst.

What feeling is behind stress? I have asked the same question about anger in a previous article.

When you are feeling either stressed or angry, there is some other feeling that is fueling this. Often, it is being overwhelmed, feeling disrespected, helpless, fearful and so on. It is very important to look at the feelings behind the stress to better understand why you are having this reaction.

Once this insight is gained, then steps may be taken to relax and feel much better.

Once you have identified the feelings and thoughts associated with your stress, take a look at your environment. Do you live in a chaotic home environment or perhaps a have a work environment that is adding your stress?

When you identify your environmental stressors, take some time to identify ways to limit these stresses in addition to changing the ways you are thinking.

Substances that often increase stress and anger:

  • Sugar
  • Caffeine
  • Excess food
  • Nicotine
  • Exercise
  • Hobbies
  • Learning communication skills
  • Journaling
  • Engaging in social activities
  • Deep breathing, yoga, Qigong

Here are a few of quick quips for managing stress:

If you allow others to make you stressed, you are allowing them to control you. Do you really want others pulling your strings?

Look at stress as a test. Do you want to fail that test by getting stressed out?

The only person responsible for your stress is you.

Stress is energy. Are you going to use this energy for something productive or destructive?

Will it matter tomorrow? Next week? Next Month?

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Anger Management: Top Tips

Anger is a natural emotion and is something that everyone will experience from time to time. However, if it isn’t handled in the right way, it can be destructive to yourself and others around you. So here are our top tips on how to manage anger and unwanted emotions.

1. Listen to your body

Get to know the signs that anger is building up before you have an outburst. The signs tend to be a faster heartbeat and tension in your body, so if you have a history of losing your temper then take some time out of the situation.

2. Deep breathing and mindfulness

Deep breathing and mindfulness are very beneficial to help ease anger, stress

and tension. You don’t have to consider yourself spiritual to benefit from mindfulness and meditation. Try out the Headspace app free trial or a lesson from the Free Mindfulness Project which will teach you the basics of deep breathing and meditation.   

3. Express yourself safely

If a situation is making you angry, remove yourself from it and allow yourself time to calm down. Allow yourself to cry if you need to. Find a safe way to express your anger, such as punching a punch bag or a pillow. Or it try something as simple as listening to music or writing down your emotions.

4. Look after yourself

You’ve probably heard it time and time again, but it’s worth repeating – taking care of your physical health makes you feel happier. This is particularly important if you’re going through a stressful time in your life.

Eat a balanced diet, drink plenty of water, get around 8 hours sleep per night

and exercise regularly. If you’re feeling angry, allow some time for rest and relaxation in order to give your mind a break. Check out our physical wellbeing pages for some tips on looking after your body.

5. Exercise

Doing exercise releases endorphins, which improve your mood, as well as distracting you from any anger or stress you’re experiencing. Find a sport or activity that you enjoy and try to fit it into your routine. Even a half-hour walk can help to relieve tension.

6. Time to relax 

Be kind to yourself and schedule in some regular time for yourself. Do something that relaxes you, such as reading a book, having a bath or listening to music.

7. Ask for help

If you’re struggling with anger or any other emotions, the best thing to do is ask

for help. This isn’t a sign of weakness – you’re taking positive action towards improving your wellbeing.

If you feel comfortable, have a chat with someone you trust. Talking through a problem can help you gain perspective and may even reveal a solution.

Additionally, if your feelings are having a big impact on your life or have been going on for a while, go and see your GP who may be able to refer you for some specialist support.

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How to overcome Fear and Anxiety

Fear is one of the most powerful emotions. It has a very strong effect on your mind and body.

Fear can create strong signals of response when we’re in emergencies – for instance, if we are caught in a fire or are being attacked.

It can also take effect when you’re faced with non-dangerous events, like exams, public speaking, a new job, a date, or even a party. It’s a natural response to a threat that can be either perceived or real.

Anxiety is a word we use for some types of fear that are usually to do with the thought of a threat or something going wrong in the future, rather than right now.

Fear and anxiety can last for a short time and then pass, but they can also last much longer and you can get stuck with them. In some cases they can take over your life, affecting your ability to eat, sleep, concentrate, travel, enjoy life, or even leave the house or go to work or school.

This can hold you back from doing things you want or need to do, and it also affects your health.

Some people become overwhelmed by fear and want to avoid situations that might make them frightened or anxious. It can be hard to break this cycle, but there are lots of ways to do it. You can learn to feel less fearful and to cope with fear so that it doesn’t stop you from living.

What makes you afraid?

Lots of things make us feel afraid. Being afraid of some things – like fires – can keep you safe. Fearing failure can make you try to do well so that you won’t fail, but it can also stop you doing well if the feeling is too strong.

What you’re afraid of and how you act when you’re afraid of something can vary per person. Just knowing what makes you afraid and why can be the first step to sorting out problems with fear.

What makes you Anxious?

Because anxiety is a type of fear, the things we’ve described about fear above are also true for anxiety.

The word ‘anxiety’ tends to be used to describe worry, or when fear is nagging and persists over time. It is used when the fear is about something in the future rather than what is happening right now.

Anxiety is a word often used by health professionals when they’re describing persistent fear. The ways that you feel when you’re frightened and anxious are very similar, as the basic emotion is the same.

What do fear and anxiety feel like?

When you feel frightened or seriously anxious, your mind and body work very quickly. These are some of the things that might happen:

  • Your heart beats very fast – maybe it feels irregular
  • You breathe very fast
  • Your muscles feel weak
  • You sweat a lot
  • Your stomach churns or your bowels feel loose
  • You find it hard to concentrate on anything else
  • You feel dizzy
  • You feel frozen to the spot
  • You can’t eat
  • You have hot and cold sweats
  • You get a dry mouth
  • You get very tense muscles

These things occur because your body, sensing fear, is preparing you for an emergency, so it makes your blood flow to the muscles, increases blood sugar, and gives you the mental ability to focus on the thing that your body perceives as a threat.

With anxiety, in the longer term, you may have some of the above symptoms as well as a more nagging sense of fear, and you may get irritable, have trouble sleeping, develop headaches, or have trouble getting on with work and planning for the future; you might have problems having sex, and might lose self-confidence.

Why do I feel like this when I’m not in any real danger?

Early humans needed the fast, powerful responses that fear causes, as they were often in situations of physical danger; however, we no longer face the same threats in modern-day living.

Despite this, our minds and bodies still work in the same way as our early ancestors, and we have the same reactions to our modern worries about bills, travel and social situations. But we can’t run away from or physically attack these problems!

The physical feelings of fear can be scary in themselves – especially if you are experiencing them and you don’t know why, or if they seem out of proportion to the situation. Instead of alerting you to a danger and preparing you to respond to it, your fear or anxiety can kick in for any perceived threat, which could be imaginary or minor.

Why won’t my fear go away and leave me feeling normal again?

Fear may be a one-off feeling when you are faced with something unfamiliar.

But it can also be an everyday, long-lasting problem – even if you can’t put your finger on why. Some people feel a constant sense of anxiety all the time, without any particular trigger.

There are plenty of triggers for fear in everyday life, and you can’t always work out exactly why you are frightened or how likely you are to be harmed. Even if you can see how out of proportion a fear is, the emotional part of your brain keeps sending danger signals to your body.

Sometimes you need mental and physical ways of tackling fear.

What is a panic attack?

A panic attack is when you feel overwhelmed by the physical and mental feelings of fear – the signs listed under ‘What do fear and anxiety feel like?’ People who have panic attacks say that they find it hard to breathe, and they may worry that they’re having a heart attack or are going to lose control of their body. See the ‘Support and information’ section at the end of this booklet if you want help with panic attacks.

What is a phobia?

A phobia is an extreme fear of a particular animal, thing, place or situation. People with phobias have an overwhelming need to avoid any contact with the specific cause of the anxiety or fear. The thought of coming into contact with the cause of the phobia makes you anxious or panicky.

How do I know if I need help?

Fear and anxiety can affect all of us every now and then. It is only when it is severe and long-lasting that doctors class it as a mental health problem. If you feel anxious all the time for several weeks, or if it feels like your fears are taking over your life, then it’s a good idea to ask your doctor for help, or try one of the websites or numbers listed at the back of this booklet. The same is true if a phobia is causing problems in your daily life, or if you are experiencing panic attacks.

How can I help myself?

Face your fear if you can

If you always avoid situations that scare you, you might stop doing things you want or need to do. You won’t be able to test out whether the situation is always as bad as you expect, so you miss the chance to work out how to manage your fears and reduce your anxiety. Anxiety problems tend to increase if you get into this pattern. Exposing yourself to your fears can be an effective way of overcoming this anxiety. 

Know yourself

Try to learn more about your fear or anxiety. Keep an anxiety diary or thought record to note down when it happens and what happens. You can try setting yourself small, achievable goals for facing your fears. You could carry with you a list of things that help at times when you are likely to be become frightened or anxious. This can be an effective way of addressing the underlying beliefs that are behind your anxiety.

Try to learn more about your fear or anxiety. Keep a record of when it happens and what happens.

Exercise

Increase the amount of exercise you do. Exercise requires some concentration, and this can take your mind off your fear and anxiety.

Relax

Learning relaxation techniques can help you with the mental and physical feelings of fear. It can help just to drop your shoulders and breathe deeply. Or imagine yourself in a relaxing place. You could also try learning things like yoga, meditation, or massage.

Healthy eating

Eat lots of fruit and vegetables, and try to avoid too much sugar. Resulting dips in your blood sugar can give you anxious feelings. Try to avoid drinking too much tea and coffee, as caffeine can increase anxiety levels.

Avoid alcohol, or drink in moderation

It’s very common for people to drink when they feel nervous. Some people call alcohol ‘Dutch courage’, but the after-effects of alcohol can make you feel even more afraid or anxious.

Complementary therapies

Some people find that complementary therapies or exercises, such as relaxation techniques, meditation, yoga, or t’ai chi, help them to deal with their anxiety.

Faith/spirituality

If you are religious or spiritual, this can give you a way of feeling connected to something bigger than yourself. Faith can provide a way of coping with everyday stress, and attending church and other faith groups can connect you with a valuable support network.

How do I get help?

Talking therapies

Medication

Support groups

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Coping with Anger

Why I have struggled with feelings of Anger

High sensitivity

As someone who is both highly sensitive and who struggles with regulating my emotions, anger is one of the feelings I find hardest to contain. It is something that I have not coped well with in the past and something I must constantly work on in everyday life.

Being highly sensitive is a physical trait which Dr Elaine Aron in her book ‘The Highly Sensitive Person’ says affects about 15-20% of the population. It means you have a higher than average sensitivity to the sights, sounds, emotional cues, and other stimuli around you. This can include external stimuli, like your surroundings and the people you’re with, or internal stimuli, like your own thoughts, emotions and realisations. In everyday life this means you tend to feel things more deeply than others seem to, are easily overwhelmed by loud, crowded spaces and hectic environments, and sometimes need to just withdraw and be alone. There are positives to being highly sensitive, such as intuition, empathy, creativity and awareness of others’ needs, but the negatives are overwhelm, exhaustion and burnout.

In my case this overload can turn to irritation and impulsive angry outbursts, especially when I feel like I am a ‘victim’ of inconsiderate behaviour in public or in my home environment. This has got me in unpleasant situations with neighbours, people on public transport, people at concerts, bars and in other crowded spaces.

Emotion dysregulation

Coupled with my high sensitivity, and perhaps caused in part by it, is my emotion dysregulation, or emotional instability.

Emotion dysregulation is a lack of ability to manage the intensity and duration of negative emotions, like fear, sadness and anger, in a way that is considered acceptable. i.e. you struggle to moderate your emotions, and this can lead to impulsive outbursts and aggression towards yourself or others.

For me, as a child and teenager, it often meant social withdrawal or avoidance, crying, sulking and lack of flexibility around change. It could also manifest as bad or antisocial behaviour – screaming and shouting in an explosive rage to parents, defying teachers and others in authority, answering back, impulsive rudeness and school detentions.

Nowadays, I am a lot more self-aware than I was as a child and young person, more mellow and better at managing my emotional instability and my high sensitivity, but there are still situations where I am negatively triggered, and the emotion that comes out in the most ‘socially unacceptable’ way for me, is anger.

Coping with anger as a sensitive person who struggles with emotional instability is a constant challenge. There are things that I have learnt over the years that have helped me, but I know that this is still my area of weakness.

Emotion dysregulation can feel like having an exposed nerve ending or being in the eye of an emotional storm. Often it feels hopeless trying to manage anger when you seem naturally predisposed to outbursts.

What has helped me to cope with anger

Validation and empathy

Self-awareness and greater understanding about what is going on in my brain and how my life experiences and sensitivity have impacted that has led me towards feeling more compassion towards myself than I did when I was younger.

Therapy has also helped me validate my feelings and thoughts, when perhaps they were dismissed (and not always intentionally) in my younger years by parents, teachers or peers. When thoughts and feelings are ignored, dismissed or even ridiculed this can result in feelings of injustice, shame and self-loathing and this is what may trigger dysregulated emotions like anger.

Having someone validate the way you feel or think in a situation and not make you feel strange or odd about that, can be a positive step in being able to think or act differently in the future. Not having our feelings validated may even lead us to resist changing our behaviour.

When people show empathy, you can be much more likely to be receptive to their suggestions. For me having a therapist say to me, ‘‘I can understand why you would have reacted like that in that situation, that must have been really frustrating for you’’ is the validation I have needed to try to improve my behaviour. It is also realising that every human being is flawed and makes mistakes, and you are not a terrible person.

Expressing and being assertive

One thing that may lead to feelings of invalidation is feeling like you are unable to express your feelings or opinions because you are afraid of how others will react. This may be because there’s been a history of them not validating your views before. I was often afraid of stating my view as a child and young person so I’d let a feeling boil up inside me, which would then come out in a dysregulated way later e.g. in an anger or crying outburst.

To avoid feeling anger and resentment of not being able to express myself when I want to, I see if I can express myself in that moment in a non-angry way. I can be assertive without letting this turn into an argument.

Self-care and breathing space

I know that if I am tired, frustrated, stressed, hungry or upset, I am more like to be easily triggered in an anger provoking situation. I’ve found it helpful to try to prevent angry outbursts by making sure I get enough sleep, nutritious food and regular exercise to regulate my emotions.

As someone who likes to be in control to the extent that I sometimes get involved in things I needn’t be involved in, I can find my capacity is nearly full most of the time – which is why it’s so easy for me to react in outburst. I’ve learnt the importance of making time to relax and enjoy things. You cannot be on the go all the time and stay emotionally regulated – not just in your 9-5 job but also working on side projects, as I often am.

Your body needs space to do nothing and be calm. To play as well as work.

Self-protection and reflection

You could also take the time to think and reflect on what situations may make you more vulnerable to anger and protect yourself from them in the future. For instance, for me I have taken the time to realise that I am triggered by crowded, loud, chaotic places and people who are acting in a way that I find selfish or inconsiderate. I need time alone to recharge and recover after overstimulating situations. I also prefer individual or small group interactions where I feel more secure and validated, so I limit the amount of time I spend in large group situations.

As a child or young person, being overwhelmed in large group situations could lead me to sulk or withdraw. This behaviour on the outside may appear to others to be childish or passive aggressive, but inside I was feeling extremely uncomfortable, upset and sometimes desperate to get out of that situation.

Mindfulness

I used to feel hopeless about my anger and easy irritation with things. Thinking that was just the way I was, and I couldn’t ever change it. I used to feel immense amounts of shame after an episode of emotion dysregulation, almost feeling horrified by the person I had momentarily become.

Mindfulness (meditation) was my saviour in 2014 when I took an eight-week course after work and experienced for the first time, without drugs, a state of complete and utter peace, still and calm. Mindfulness is available to all of us. There are apps for it, there are YouTube videos for it, there are courses for it. I can’t recommend it enough.

People who feel hopelessly trapped in an anger cycle need to feel they can change, and mindfulness can provide that hope for some.

Medication

Something else that helps take the edge off my emotion dysregulation, sensitivity and tendency towards anger, is medication. I take the smallest possible dose of my antidepressant. This allows me to absorb more serotonin, the brain’s happy chemical, and allows me to tend less towards irritation and negative feelings.

When it comes to medication for your mental health it is important to seek advice from a professional, whether it be your GP, psychiatrist, or community pharmacy before you go onto it, change it, or reduce it.

Therapy

I have also been seeing a psychotherapist for many months now, and she has been invaluable for me. She has helped me to understand why I am dysregulated, what steps I can take to become less so, and for the first time ever has allowed me to feel properly validated, self-confident and understood. This has enabled me to remove a lot of the shame, low self-esteem and self-loathing from my life which all contribute to my anger outbursts.

Having someone to talk to who understands you, either a trained therapist, or just an empathetic, non-judgemental friend may help to mitigate the emotional turmoil going on inside if you are someone that tends towards dysregulated angry outbursts. Therapists can help to mentalise what is going on in your life and why you behave a certain way, offer insight and perspective and recommend coping strategies and long-term behavioural change.

Handling difficult conversations

  • Taking a step back and pausing

I’ve realised as I’ve got older that when I’ve got into heated arguments with family members or others close to me, it’s sometimes been because I’ve been too personally involved in the debate and unable to step back and see it from the other person’s perspective. I struggled growing up with assimilating my identity with the thing I was defending, whether a rock band, famous person or political view. I felt offended if people didn’t agree with me about something because I felt my fragile identity was attacked.

In order to avoid heated situations with someone who has opposing views, I’ve learnt the hard way that taking a breath and pausing before reacting and not taking on the role of trying to overprotect the thing you are defending, is key.

  • Stopping before you speak

Rows with people can fracture relationships. If you are unable to calmly state your view, then it may be best to try to ignore what is being said or leave the situation politely until you feel calmer. Debates that start off being about a political view or opinion can soon turn into a personal argument if people feel attacked. This is unpleasant for all involved. I’ve had to swallow my pride and learn some humility.

Anger management courses can often teach people to stop before they speak. This is of course easier said than done for people who are easily triggered but practicing mindfulness (bringing yourself into the present and not running away with your thoughts or feelings) may help.

  • Active listening and resolution

Sometimes people can feel hurt or offended by how we’ve behaved towards them, and we should also be willing to listen to them and try to understand how they feel, not get defensive and invalidate them as this will exacerbate ill-feeling and not lead to a resolution in the relationship.

Art and exercise

So many people find expressing their anger in creative ways or letting off steam through exercise helpful. Doing an activity, whether creative or sporty, can be a way to distract your mind from the anger you feel, and a way of positively channelling and removing the stress hormones that anger generates. For me personally, I use art to regulate my emotions. I love to paint abstract art. My art is simply what comes out of my head and on to a canvas. It is therapeutic and it distracts me. It also gives me a sense of pride and achievement, to replace the negative emotions that anger fills me with.

Music and sound

When you’re emotionally dysregulated, an emotion that most people would feel for a short time period becomes a mood that can last the whole day. Your behaviour can be very mood dependent. When I’m feeling particularly angry or frustrated, there are certain songs I listen to that help me get that anger or frustration out. I love rock and metal; I also love techno and electronic music. Dancing in a club to music or listening to music loudly after a stressful day, can be the medicine that I need.

It’s also essential that I always have access to music in public, to stop me getting angry and irritated by loud sounds. At night when I’m trying to sleep, I also use ear plugs, so I’m not frustrated by a neighbour or street noise.

If I’m feeling down or fed up, sometimes I play the guitar and sing, to express the emotions I need to express. Music is cathartic because the people writing it are often expressing their feelings. Being able to connect to people’s words and songs is powerful and can help you to process your own feelings.

Writing and avoiding online debate

I also like to write to get my frustrations out. I write poems or blogs to express how I feel. But I have to steer clear of getting into angry debates on social media about issues that I care about, as this almost never makes me feel better, and almost always gets me into a horrible conflict situation which makes me feel even worse. If you’re really angry about an issue in the news, then you could consider having some time away from it. You could have a break from TV or / and social media or unfollow accounts or news sources that may trigger feelings of anger in you.

Taking control of what you can, accepting what you can’t

This might seem like an obvious one, but it’s something that has helped me mellow out over the years. Sometimes my anger and frustration are caused by an underlying fear that I can’t control things – humans destroying the environment, the way people feel about me, my relationships, people being selfish and inconsiderate in public, the high cost of living, injustice and inequality in society etc. Sometimes letting go is what you need to do to let the anger dissipate.

  • Becoming more accepting and tolerant

My anger and arguments with others have often stemmed from my ideals not marrying up with reality. My positives are altruism, leadership and reliability, but I can sometimes feel easily let down and disappointed because I can be overly idealistic or too selfless and too sensitive. This can lead me to be angrier with the way things are and more motivated to change things than the average person.

I tend to be someone who wants to sort everything out and can exhaust myself by doing so. I have had to force myself to relax more, not put too much pressure on myself and not expect too much from others. I’ve also had to be more accepting of the fact, with the help of therapy, that there’s only so much I can do to help the causes I care about and not to feel guilty. I’ve also had to accept that a lot of people don’t think or act in the same way as me and I may care more about things.

Being more tolerant in distressing situations, accepting that you can’t change the world on your own, you can just do what you can, and that it’s ok to just do nothing sometimes, has helped me enormously.

  • Planning, preparation and being present

As I’ve grown older, I’ve become more sensible with things like money, accommodation and career choices, lifestyle choices, to feel more in control and less overwhelmed in the world. I’m as organised as I can possibly be as this limits my stress levels, and when something goes wrong now, I try to be present and rational in my response and accept that it will be fine, rather than going to my old default place of anger, fear and irritation.

If you can realise that some of your anger might be down to a fear of losing control, recognise that this is what’s happening and try to teach yourself to put things in perspective more this may help you. You can’t control what happens to you, only how you respond to it.

Choosing how to channel my anger

Ultimately, we all feel anger in our lives. It is normal and nothing to be ashamed of. How we choose to channel our anger is the most important thing. Use your anger to fuel creative expression, lobby for positive change, write words that will inspire people, make changes to your circumstances that would make you happier and avoid trigger situations.

Do you need urgent help?

If your mental or emotional state quickly gets worse, or you’re worried about someone you know. go to your GP

You’re not alone; talk to someone you trust. Sharing a problem is often the first step to recovery.

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