Hello and welcome back to ‘Managing anxiety’ for Week 2, Session 2.

If this is the first time you are reading this, welcome! We’re so happy to have you here. However if you’re just starting out please do head back to the first session. We build on material throughout the weeks, and we don’t want you to miss anything!

The goals for this session are:

• Go over some anxious thought patterns
• Understand anxiety can come from different places for different people
• Get clarity about which kind of anxiety we are experiencing or we are more prone to.

**Today’s first grounding exercise will be…
**Think of a word that makes you calm. (it can be the one you thought to connect with your Safe Place). It could be something like “peaceful,” “safe”, “relax”, or “breathe”. Now, take your index finger as you would a pen and softly trace the letters of your calming word, into the palm of your opposite hand.

Fun question: What is the most surprising fact you know?

In the last session, we identified some of the signs and symptoms of anxiety as it manifests in our bodies and minds, in particular our bodies as we talked about anxiety as a long-term experience of the fear response. We wanted to expand on that work today, and continue uncovering our anxiety layers by looking at some thought patterns that are common in anxiety. Of course, everyone is different, and this is by no means an exhaustive list of the kinds of anxious thinking that you might have experienced. But hopefully it provides a starting point to thinking about, well, how you think! As we go through these examples, try to see if any of them resonate for you personally.

Catastrophizing - catastrophizing means imagining the worst possible outcome to a situation. For example, there is a journey which you are anxious about, and you imagine that every step of this journey will go wrong: the bus will be late so you will miss your train. Or maybe you imagine that something bad will happen, that there will be an accident, even if you know that you are using a safe form of transport. Another example might be that you make one mistake on a task at work, and imagining that you will lose your job immediately, or perhaps that you will continue to make many mistakes to the point that you risk losing your job.

Excessive guilt - feeling guilty is often linked to anxiety. This guilt can come in different forms: one kind of unhelpful or ‘maladaptive’ guilt is that which involves accepting personal responsibility for something that couldn’t be our own fault. For example, feeling guilty when a group picnic in the park is cancelled because it is raining. You might think, ‘oh I should have known it was going to rain, I should have looked at the weather sooner and re-planned’, when in reality the rain is something out of your control, and also you have not done anyone harm that means you ought to feel guilty. Guilt can also manifest in what researchers call ‘generalised guilt’. A recent study described this kind of guilt as ‘a “free-floating” guilt unrelated to specific contexts’. We might feel guilty that we are not closer to certain friends or members of our family, or feel guilty that we are constantly making the ‘wrong’ decisions without reference to any particular decision. These kinds of guilt are related to worry and anxiety: many anxiety researchers have proposed that worrying is used as a protective mechanism, to try and prevent or prepare for future situations that could make you feel guilty. So the anxiety and the guilt can become a difficult cycle, of constantly worrying about situations that might make us feel guilty (even if they are out of our control).

Shame spiral - related to guilt is shame. But these are two different concepts. While guilt is a negative evaluation of one’s own behaviour, shame is a negative evaluation of our self. We feel shame at who we are, as opposed to guilty about what we’ve done. Shame is another concept linked to anxiety. When we enter into a ‘shame spiral’, we take a situation and generalise what happened to a negative property about ourself. So ‘I didn’t get the best mark in this assessment’ becomes the thought ‘I am stupid’. This shame may also be linked to how we feel others will evaluate us: what they will think of us, what our reputation will be, how they will treat us differently, if they could ‘see’ who we really are. Proneness to experience shame has been consistently linked to anxiety in previous research.

As you might have been able to notice, these three types of thought pattern: catastrophizing, excessive guilt, and shame spirals, are related to making broad, negative generalisations in response to specific situations. In other words, reacting to ambiguous or uncertain situations with negative interpretations. In this way, these thought patterns represent something called ‘negative bias’. What is ‘negative bias’? ‘Negative bias’ is the tendency to focus on negative information. This ‘negative bias’ actually is a pretty natural part of our psychology, and has somewhat of a neuroscientific basis: information that comes in from our environment with a negative value is often processed with priority over neutral and positive material. This prioritisation can be carried up from our immediate attention and processing to higher levels of cognitive processing such as decision-making, memory, and our interpretation of new information or events. So this bias is natural, but with anxiety, it may become more deeply ingrained in our thought patterns. (If you’ve also read our Trauma Resilience course, you’ll remember this description of negative bias.)

In addition to the types of thought patterns we describe above, some more examples of thought patterns where we see negative bias are:

• All or nothing thinking: Everything is seen in black and white. For example: “If I’m not perfect, then I’m no good at all.”
• Overgeneralisation: One bad thing becomes an “always” thing. For example: If I do something wrong one time, I will always be wrong.
• Jumping to conclusions: Making an assumption, even with little or no evidence to support it, based on your personal self-doubts.
• Magnification or minimisation: You magnify the negative but minimise the positive.
• Shoulds, oughts, and musts: You criticise yourself for not doing the things you decide you “must”, “should”, or “ought” to do, without leaving space for outside factors that might get in the way.

What can we do about these anxious thought patterns? Noticing them is the first step, and that’s why we encouraged you last week to start tracking your anxious thoughts in your thought diaries. We will be building on this work, so keep it up! And in today’s homework, we’ll introduce another technique for using in the moment.

So, combined with last week, this means we’ve looked at anxiety in many of its different manifestations: at the physical level, in our 3F response; at the behavioural level, in some of our potential anxious avoidant behaviours; and now at the cognitive level, with some anxious thought patterns. These are some of our anxiety layers: hopefully, we have built a base of understanding that will allow you to identify how some of these layers of anxiety might manifest in your own lives and experiences.

But in addition to learning about how one’s own anxiety manifests, which we will continue to do together in the coming weeks, it is also important to be able to identify the nature of the anxiety we are feeling. Last week, we briefly introduced you to some risk factors that are related to the development of anxiety - for example, having a family member with anxiety, or having a chronic physical or mental health condition. Now, though, we would like to look more closely at how anxiety can be related to experiences we have had.

Let’s think about an example: women usually are inherently affected by the patriarchal system. So, when Laura consulted a therapist to work on her anxiety and described that she feels anxious whenever she is walking alone in her neighborhood, her therapist saw the red flag. Looking more into the situation that had made Laura anxious, they were able to identify that there were enough threats and stressors present when she walked in that area. Maybe not every time, but they had been there in the past and it had made her hyper-vigilant and had triggered the 3F response in consequence. This meant that whilst she was perceiving this anxiety as “her problem” and something she needed to “fix” (as she would put it), this anxiety was actually a result of an oppressive and misogynistic system that makes women feel unsafe and at risk just by walking on their own in their neighborhoods. It was important for Laura to be able to see that there was nothing she was doing to cause this and understand that there were many other women feeling the same way. She connected with a community of women that helped her find ways of staying safe, she was able to work on techniques to manage the anxiety, and she was able to relocate the burden she had initially misplaced on herself and her mental health. Her body was telling her she wasn’t safe and it had good reason to do so - being able to see through the systems that are seemingly working their rules around us can allow us to find the source of our relationship with anxiety. This can feel incredibly empowering and enabling.

In this past example, there was a clear reason why the amygdala was triggering the anxiety response. There are other situations where the reasons or the sources or our anxiety are more blurred. You may want to consider if:

You are suffering from isolated situations of anxiety like Laura: in this kind of situation, anxiety might be adaptive and your body might be trying to tell you there is a threat you should pay attention to. Being aware of this feeling and which contexts it presents itself in can help you see if you need to take some measures to keep yourself safe, or work on the levels of hypervigilance you are feeling if this is feeling like too much. We will think about this further in the next session.

Your anxiety has increased after something has happened in your life. It is important to know ourselves and be able to identify if something is changing in the way we feel and act. If anxiety was not something that usually brought you much discomfort and now it is increasingly doing so, then you have a red flag. Take a moment to explore your present: has something changed in my routine/life that could be making me feel more anxious? And also, your past: has something happened in the past that could have triggered the way I am experiencing anxiety now? Maybe we are in presence of the aftermath of a traumatic situation that we have experienced in the past, or we are getting an early warning that something that is happening in our lives does not feel right. For example, “Mark has had a traumatic experience with a sexual partner. Following this, he didn't quite notice it but his friends started to see that he was spending lots of time getting ready and was late to work. He would then be nervous because he was late and would spend a lot of time writing emails making sure every detail of them was perfect before sending them.” In this case, Mark’s anxiety increase was a result of his traumatic experience, and after his friend addressed it with him because he was worried, he was able to open up and talk about what had happened. It's hard to see our behavioral changes sometimes and relying on people that know us well can be of great help to identify where things are going wrong.

You have lived with anxiety for a long time: for many people, anxiety is something that is not new, and they cannot trace back to something happening. For some of us, it is the way we react to things, or we might feel it's part of our personality, something we have experienced from an early age, something we get from our family, etc. This does not mean there aren't things we can do to manage our anxiety. If anything, knowing that this is part of your life can make things a lot easier when it comes to managing anxiety - you probably have a better understanding of the whens and hows, and you will be able to identify triggers and coping mechanisms that work for you a lot faster. For example: “Rohit has suffered from anxiety since he was a little boy. He used to get really nervous before having tests in primary school, so much so that his Mum would need to go in and help him calm down. This has been something Rohit has lived with this entire life and he knows that, in his case, academic stress and extreme work demands can trigger his anxiety. In his early 20s, when he had not yet identified what increased his anxiety levels, he would resort to drinking a couple of beers at night. With time and some help from his family, he realised this was making his anxiety worse so he now watches out for when he feels a high demand from his job as a University lecturer (which many times ticks both boxes: academic and work stress) and tries to balance them out with having a rich personal life outside of work and some techniques he has learnt in therapy. In his case, his triggers were connected to his most valuable passions which is a great example of how both things can cohabitate if we learn to recognise when they are becoming potentially harmful or overwhelming and act on them.

We will look at our relationship with triggers in a future session but for now, we want to leave you with the reflection that these different anxiety routes we have just described are just for you to have an idea of different types of anxiety, and start understanding yourself better. We might have a mix of all of these routes: in fact, we probably all do. The idea is to be able to know ourselves well enough to know where we stand and from there, guide our next steps to make our anxiety feel more under control.

The homework for this week is… three things! Okay, two and a half things. It’s really not so much, you’ll see.

This has been a heavy session. So we want you to balance it out with some relaxing, you-time. This will also help in your journey of managing anxiety. Think about this: what is the most relaxing activity for you? Taking a bath, going for a walk, playing with your children, reading a book, exfoliating your body, cooking: any options that work for you and do not involve an anxious element would do. Try to do 1 for at least 15 mins this week.

Secondly, and related to the first, we want to introduce some tricks for dealing with anxious thoughts as they come. This trick is related to mindfulness techniques for anxiety. If you experience an anxious or negative thought, in particular while you’re doing your relaxing activity: don’t try to fight it. Notice it, acknowledge it, perhaps even say hello to it! Don’t judge yourself for having the thought. Just let the thought roll through your mind, like leaves blowing across the road, without sticking any of these thoughts down in glue. Maybe even talk to it. ‘Hello! I see you, there you are. I don’t have time to speak to you now, we’ll talk later’. Saying this won’t immediately banish the thought, it’s not a magic trick. But acknowledging the thought and allowing it to be present and eventually pass through, over time, can help us disengage from these thoughts long-term.

Finally, we’d like you to continue working on your thought diaries. Specifically, keep doing your anxiety-tracking. But this time, instead of focussing on when the anxiety happens, as we asked you to last week, focus on what the thought is. Do you notice any patterns in these thoughts? Can you relate any of these thoughts to one of the negative thought patterns we introduced today? Noticing patterns in these thoughts is our first step to uncovering the layers of anxiety.

Remember, this is an investment in your own journey to recovery. Give yourself the best chance to build resilience. You can do this.