woman holding lantern at nightFear is something all of us have experienced at some point in our lives. Everyone is scared of something. In fact, there are so many times when fear keeps us from doing what we want. At times, it’s a fear of what others might think. And at other times, it can be a fear of something that we are not willing to face.

There is nothing wrong with being scared; as humans, feeling scared is natural.

Fear is the body’s natural response to a stimulus. A stimulus can be anything that your mind perceives as a threat. Your body prepares itself to deal with fear by activating fight-or-flight response. No matter how much you deny fear, it is part of your survival kit. It is inevitable.

Fear is not just a feeling, but a form of energy. Any energy that is accumulated will require an outlet at some point.

4 Steps to Breaking Free from Fear

1. Face your fears

If you do not address your fears, they can accumulate with time. Fear is not just a feeling, but a form of energy. Any energy that is accumulated will require an outlet at some point. No energy can be contained for too long. When you don’t allow fear to get released, it starts expressing itself as struggle and pain.

In order to liberate yourself from your fears, you may need to put in some effort. It is not easy, but it is not impossible either. It is essential to liberate yourself from the fears that are holding you back.

2. Acknowledge your fears

Most people like to pretend that nothing happened after a frightful experience. They think that by trying to forget or ignore the fact that they felt scared, the fear will disappear. In reality, this is not the case. Whenever you feel sacred, you should acknowledge the emotion and face it. Instead of running away, you should tell yourself that it is okay to experience fear.

3. Communicate with your fears

Whenever you experience fear, learn to communicate with it. Seek to understand what your fear is trying to tell you. In order to communicate with your fear, first observe where exactly the fearful energy has accumulated in your body. Sometimes you may feel tightness in your heart, an uneasy feeling in your stomach, or tension in your limbs. Once you are successful in finding the crux of this energy, you can then communicate with it.

Ask questions like:

A dialogue with your fear can reveal some useful and important pieces of information. You will be able to understand the origin of fear and how to make yourself feel safe.

4. Find a way to release fear

A duck flutters its wings intensely after a quarrel to release the energy of fear. Similarly, you can find ways that help you release negative energy. It can be crying, screaming, shouting, or any vigorous physical movement.

Focus on the part of the body where you feel fear has accumulated and understand what kind of movement your body wants. Once you understand, all you need to do is surrender to the movement, amplify it, and repeat until it comes to an end.

4 Tips for Emotional Healing

Most people today may deal with damaged emotions. Many have been through one thing or another that has left them emotionally devastated. In some cases, people suffer so much that they’re scared if they open up about it, others might see them differently. Some people are scared their emotions will be misjudged. Others are scared that they won’t be able to live up to what is expected of them.

In order to start healing yourself emotionally and liberate yourself from your fears, follow the tips below:

1. Be yourself

It’s important to be yourself and be able to do what you like without being afraid of what anyone thinks. Be your own first priority, and try not to let others tell you how you should be.

2. Invent yourself

All of us mold ourselves according to the environment we live in. Give yourself a break and think about how you can reduce the emotional distress you’re feeling. Become a person you think can handle the distress better. Invent yourself with characteristics that were missing earlier.

3. Love and be loved

It is essential to love yourself and allow yourself to be loved. Try not to look down on yourself. You should feel worthy of love, your own and others’.

4. Flip the anxiety switch off

Promise yourself you will continue to work on addressing fears that contribute to unwanted worry or anxiety.

It can take much emotional strength to liberate yourself from fear. Facing and fighting fear can require courage, which can often come with the ability to emotionally regulate. For support as you work to build courage or face your fears, reach out to a trained and empathetic mental health professional in your area.

Grid of plates, each with a different health foodNutrition is fuel for your body. Choose the right fuel and your body, including your mind, may function better.

Research on the role of nutrition in fighting anxiety is mixed, but studies consistently find people with anxiety may have lower quality diets that are low in fruits and vegetables and high in fats and sugars. Emerging research also suggests some foods may help regulate neurotransmitters, thereby improving brain health and potentially reducing anxiety.

Dietary changes are not magic, and a few nutritional tweaks are unlikely to correct serious anxiety or the lingering effects of trauma. They may, however, supplement the effects of therapy, medication, lifestyle changes, and other strategies. Diet changes may also help alleviate some of the physical effects of anxiety, such as muscle tension and a racing heart.

Experimenting with a different diet can help people with anxiety feel an increased sense of control and self-efficacy. Many people with anxiety struggle with feeling out of control. Proactive measures to fight anxiety may help with this feeling. Be open to experimentation, and know that it can take time to realize the anxiety-fighting benefits of anti-anxiety foods.

The Science Behind Foods That Reduce Anxiety

Nutrition affects anxiety in both direct and indirect ways. Low blood glucose can be an anxiety trigger, so crash diets and prolonged periods without food may make anxiety worse. Sugary foods, caffeine, and alcohol can also trigger or exacerbate anxiety. People struggling with anxiety may wish to cut back on these ingredients or eliminate them altogether.

Experimenting with a different diet can help people with anxiety feel an increased sense of control and self-efficacy.

Certain foods may also reduce anxiety. There’s no single mechanism through which food reduces anxiety. Each anxiety-friendly food boasts its own unique benefits. Some common features include:

8 Best Foods for Anxiety

The best foods for anxiety are rich in nutrients, tasty, and adaptable to a wide range of diets. This ensures that even if they don’t immediately help with anxiety, they offer other health benefits. Try incorporating some of the following anxiety-reducing foods into your diet:

Pieces of salmon sashimiSalmon

Salmon is rich in vitamin D, DHA, and EPA. It’s also a healthy source of protein and an excellent substitute for other meats. A 2014 study weighed the effects of salmon on men seeking inpatient mental health treatment. Men who ate salmon three times a week for 5 months had fewer symptoms of anxiety. Salmon was especially effective at alleviating physical measures of anxiety, such as a rapid pulse.

Nuts and seeds

Nuts and seeds are nutritionally dense foods that are rich in DHA. DHA is linked to improved brain health, including reductions in anxiety and better regulated neurotransmitters. Additionally, most nuts and seeds are high in selenium.

Cup of chamomile tea with chamomile flowersChamomile

Chamomile tea is one of the world’s oldest and most popular folk remedies for insomnia. This may be due in part to its effects on anxiety. A 2009 double-blind, placebo-controlled study found that chamomile could modestly improve symptoms of generalized anxiety.

Eggs

Choline is an essential nutrient that plays a role in numerous functions, including supporting brain health, memory, and concentration. It’s also a precursor to acetylcholine. Preliminary research suggests choline deficiency may increase the risk of anxiety. Many vegetarians are deficient in choline, since the primary sources of this important nutrient are all meats. Eggs offer a viable alternative. Consider incorporating one or two hard-boiled eggs into your diet for a protein-packed source of this important nutrient.

Pieces of dark chocolate with cocoa powderDark chocolate

Dark chocolate is rich in antioxidants that can fight inflammation. It’s also a healthy substitute for milk chocolate and other sugary snacks. A 2012 study found that regular consumption of dark chocolate was associated with a decrease in biochemical measures of stress, such as cortisol production. For some people, dark chocolate can also be a powerful comfort food that eases stress after a difficult day.

Berries and citrus fruits

Inflammation may be a culprit in anxiety. Inflammation can also trigger other health issues, such as chronic pain and autoimmune disorders. These conditions can intensify anxiety. Fruits that contain antioxidants may help reduce chronic inflammation. Berries, especially blueberries, are high in anti-inflammatory ingredients. Citrus fruits are a rich source of the antioxidant vitamin C.

Bowl of turmeric powder with roots in backgroundTurmeric

Turmeric has long been used in herbal medicine. Emerging research suggests it may play a role in general brain health, perhaps by fighting inflammation. A 2015 study found significant reductions in anxiety scores among people who consumed turmeric.

Dairy products

Most dairy products are fortified with vitamin D. For people who do not get enough vitamin D in the diet or who spend little time outdoors, vitamin D supplementation can ease anxiety. Dairy is also a rich source of protein. Particularly for people who do not eat meat, dairy consumption may ensure adequate protein intake. Protein helps the body produce key neurotransmitters, potentially improving mood and reducing anxiety.

Every person is different. The ideal diet for one person can prove catastrophic for another. Foods that ease anxiety in some people may make it worse than others. For example, a 2015 case study details how fish oil supplements made anxiety and insomnia worse following treatment of depression.

It’s important to consult with a doctor or mental health provider who is knowledgeable about nutrition and up-to-date on recent nutritional research.

Even with expert advice, some people find their anxiety makes it difficult to adopt a healthy lifestyle or change their diet. The right therapist can help people overcome anxiety and make healthy diet and lifestyle changes. Therapy also supports people in understanding their anxiety, managing the lingering effects of trauma, and improving their quality of life. To find your therapist, click here.

References:

  1. Amsterdam, J. D., Li, Y., Soeller, I., Rockwell, K., Mao, J. J., & Shults, J. (2009). A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of Clinical Psychopharmacology, 29(4), 378-382. doi: 10.1097/JCP.0b013e3181ac935c
  2. Bjelland, I., Tell, G. S., Vollset, S. E., Konstantinova, S., & Ueland, P. M. (2009). Choline in anxiety and depression: The Hordaland Health Study. The American Journal of Clinical Nutrition, 90(4), 1056-1060. Retrieved from https://academic.oup.com/ajcn/article/90/4/1056/4596992
  3. Blanchard, L. B., & Mccarter, G. C. (2015). Insomnia and exacerbation of anxiety associated with high-EPA fish oil supplements after successful treatment of depression. Oxford Medical Case Reports, 2015(3), 244-245. doi: 10.1093/omcr/omv024
  4. Cui, X., Gooch, H., Groves, N. J., Sah, P., Burne, T. H., Eyles, D. W., & Mcgrath, J. J. (2015). Vitamin D and the brain: Key questions for future research. The Journal of Steroid Biochemistry and Molecular Biology, 148, 305-309. doi: 10.1016/j.jsbmb.2014.11.004
  5. Dyall, S. C. (2015). Long-chain omega-3 fatty acids and the brain: A review of the independent and shared effects of EPA, DPA and DHA. Frontiers in Aging Neuroscience, 7, 52. doi: 10.3389/fnagi.2015.00052
  6. Esmaily, H., Sahebkar, A., Iranshahi, M., Ganjali, S., Mohammadi, A., Ferns, G., & Ghayour-Mobarhan, M. (2015). An investigation of the effects of curcumin on anxiety and depression in obese individuals: A randomized controlled trial. Chinese Journal of Integrative Medicine, 21(5), 332-338. Retrieved from https://link.springer.com/article/10.1007/s11655-015-2160-z
  7. Hansen, A., Olson, G., Dahl, L., Thornton, D., Grung, B., Graff, I., . . . Thayer, J. (2014). Reduced anxiety in forensic inpatients after a long-term intervention with Atlantic salmon. Nutrients, 6(12), 5405-5418. doi: 10.3390/nu6125405
  8. Martin, F. J., Antille, N., Rezzi, S., & Kochhar, S. (2012). Everyday eating experiences of chocolate and non-chocolate snacks impact postprandial anxiety, energy and emotional states. Nutrients, 4(6), 554-567. doi: 10.3390/nu4060554
  9. Murphy, M., & Mercer, J. G. (2013). Diet-regulated anxiety. International Journal of Endocrinology, 2013, 1-9. doi: 10.1155/2013/701967
  10. Naidoo, U. (2018, March 14). Eating well to help manage anxiety: Your questions answered. Retrieved from https://www.health.harvard.edu/blog/eating-well-to-help-manage-anxiety-your-questions-answered-2018031413460
  11. Salim, S., Chugh, G., & Asghar, M. (2012). Inflammation in anxiety. Advances in Protein Chemistry and Structural Biology, 88, 1-25. doi: 10.1016/b978-0-12-398314-5.00001-5

Side view of woman standing in field of tall red poppiesWhile many people are much more aware of anxiety now than in the past, some details and symptoms still aren’t as commonly discussed.

One lesser-known symptom of anxiety is the urge to self-harm. Not all or even most people who experience anxiety will have these urges, and there are people who self-harm who do not struggle with anxiety. Yet, when anxiety and self-harm co-occur, it may be crucial to a person’s well-being and safety to identify the issue in order to connect with help.

Can Anxiety Cause Self-Harm?

It’s very possible for anxiety to spark urges to self-harm. Self-harm is frequently associated with a sense of release from overwhelming emotions or situations in those who engage in the behavior. Since anxiety is characterized by a sense of feeling overwhelmed or worried about not being able to handle life situations, self-harm acts can bring relief from anxious feelings. While anxiety does not always lead to self-harm, studies have shown people who engage in self-harm are more likely to experience anxiety and vice-versa.

Types of Anxiety That May Lead to Self-Harm

Certain types of anxiety may be more likely to lead to self-harm than others:

While obsessive-compulsive disorder (OCD) was once listed as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 lists it as an obsessive-compulsive disorder. Although OCD is now technically in a different category than anxiety, is may frequently co-occur with anxiety and has been known to cause self-harm.

One type of OCD, known as harm OCD, can cause intense fear of hurting oneself or others. While this anxiety about harming oneself may be severe and vivid, those with harm OCD are thought to be no more likely to act on their thoughts of self-harm than someone without harm OCD.

Why Is Anxiety Connected to Self-Harm?

Anxiety is frequently accompanied by overwhelming feelings of worry, racing thoughts, and sometimes panic attacks. This can make people with anxiety feel they’ve completely lost control of their minds and bodies. They may turn to self-harm in order to focus their mind outside of their racing thoughts or worries, or they may use it as a way to regain feeling if they’ve begun to feel numb from long-term anxiety.

Alternatively, self-harm is sometimes used out of anger. People with anxiety may feel frustrated or mad at themselves for not being able to keep their anxious thoughts under control or that they can’t “fix” themselves. In this case, self-harm may not be done for the purpose of relief, but as self-inflicted punishment. Self-harm used in anger can be especially damaging, as it isn’t a coping mechanism, but a sign of deeper emotional struggle.

Self-harming thoughts often lead to self-harming behaviors in an effort to either feel relief, feel pain, or punish oneself.

Angela Avery, MA, LLPC, NCC, a therapist in Clarkston, Michigan, notices that self-harm may tend to occur with social anxiety. She explains,

“In my clinical practice with teenagers, I often see self-harming behaviors co-occur with social anxiety. Those who experience social anxiety are afraid that they will be judged by others and often that belief is validated because they lack social skills and social confidence to create friendships or engage with others.

When you feel like no one is your friend, and you are too afraid to speak to anyone, you tend to feel poorly about yourself. Low self-worth then leads to self-critical, irrational thoughts presuming we are “bad” and “stupid” and “no one likes us.” Self-harming thoughts often lead to self-harming behaviors in an effort to either feel relief, feel pain, or punish oneself.

I tend to view harming behaviors as coping strategies of choice for people who view themselves with a severely critical eye. Add in a sprinkling of social anxiety or limited social skills and we have a combination for continued harm.”

It’s important to note that anxiety can lead to multiple forms of self-harm that aren’t always what people typically think of. The stereotyping around self-harm as a form of “attention seeking” or something people do when they’re into a certain type of music has deeply damaged our society’s ability to recognize self-harming behaviors in some cases.

Anxiety and Personality Disorders As a Cause of Self-Harm

In addition to anxiety, some some studies show that certain personality disorders may have a higher likelihood of leading to self-harm. Some of these disorders are closely linked to anxiety and may co-occur, and some can lead to self-harming behaviors independent of anxious thoughts or feelings.

Some disorders that have been linked to self-harm include:

At the end of the day, regardless of the cause, people who are engage in destructive self-harming behavior should not try to overcome these patterns alone. They’re a maladaptive coping mechanism, and while they can be painful and scary, there is hope. With the help of a licensed mental health professional and plenty of love and encouragement from friends and family, people can learn to manage their anxiety and overcome their self-harm behaviors.

References:

  1. Bhandari, S. (2018, February 21). Mental health and self-injury. Retrieved from https://www.webmd.com/anxiety-panic/guide/self-injuring-hurting#1
  2. Bolton, J., Chartrand, H., Sareen, K., & Toews, M. (2011, September 21). Suicide attempts versus nonsuicidal self‐injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety, 29(3), 172-179. doi: 10.1002/da.20882
  3. Klonsky, E. D., Oltmanns, T., Turkheimer, E. (2003, August 1). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. The American Journal of Psychiatry, 160(8), 1501-1508. Retrieved from https://doi.org/10.1176/appi.ajp.160.8.1501
  4. Living with harm OCD: What’s going on? (n.d.). Retrieved from https://www.intrusivethoughts.org/ocd-symptoms/harm-ocd
  5. O’Connor, R., Rasmussen, S., & Hawton, K. (2009). Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress. Behaviour Research and Therapy, 84(1), 52-59. doi: 10.1016/j.brat.2009.09.008
  6. Pierce, L. (2018, April 21). OCD, Self Injury, and Suicidal Thoughts. Retrieved from https://www.verywellmind.com/ocd-self-injury-and-suicidal-thoughts-2510599
  7. Self-harm. (2018, May 25). Retrieved from https://www.nhs.uk/conditions/self-harm

Couple talking while they take a walk in natureStuttering is a complex speech issue that affects about 1% of adults. People who stutter may become socially anxious, fear public speaking, or worry their stuttering will undermine their performance at work or school.

Research shows that stuttering is not a mental health diagnosis, and anxiety is not the root cause of stuttering. Anxiety can, however, make stuttering worse. This can create a vicious feedback loop in which a person fears stuttering, causing them to stutter more. In some cases, anxiety about stuttering may disrupt a person’s relationships and ability to communicate.

What Causes Stuttering?

The hallmark of stuttering is repeating certain sounds, syllables, or words. It exists on a continuum from mild to severe. In some people, stuttering is so mild that others might not notice it at all. For a minority of people who stutter, the condition can be so severe that it makes it extremely difficult to communicate at all.

Most people who stutter fall somewhere in the middle. They stumble over words and repeat certain syllables. They may feel anxious about speaking, and others may notice their speech is not typical. But they’re able to speak to others, and others are able to understand what they say.

Types of Stuttering

Researchers used to think that stuttering was a mental health problem caused by trauma or fear. While it’s possible for trauma to cause stuttering, it’s rare. Instead, providers divide stuttering into two distinct types:

Developmental stuttering

Developmental stuttering is the most common type of stuttering. Common among children ages 2-6 who are learning to speak, it usually goes away on its own. Five to 10 percent of children stutter at some point, and at least 75% outgrow it. For the remaining 25%, stuttering may continue to be a problem in adulthood.

Developmental stuttering is often much worse when a child is anxious. The speech of children who stutter may improve when they speak for longer periods. This means the first few sentences of a conversation may be slow and halting, but as a child become more relaxed, they may stutter less.

Developmental stuttering runs in families. This suggests a genetic link, and researchers have identified a few genes linked to stuttering. However, the specific causes of and triggers for developmental stuttering are still not fully understood.

Neurogenic stuttering

Neurogenic stuttering is much less common than developmental stuttering. It’s due to a problem with the brain caused by an injury, developmental issue, or disease. For example, some people develop a stutter following a stroke or a traumatic brain injury (TBI).

Although anxiety may make neurogenic stuttering worse, anxiety is more closely tied to developmental stuttering.

Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

The Link Between Anxiety and Stuttering

For many people, verbal communication is an important way to connect with others. Stuttering makes this communication more difficult. This may trigger anxiety, especially abut social relationships. A 2009 study found stuttering increased the odds of being diagnosed with anxiety by six- to seven-fold and increased the likelihood of a diagnosis of social anxiety 16- to 34-fold. Another 2009 study found that 50% of adults who stutter have social anxiety.

Stuttering may change the way people relate to the person who stutters. Children who stutter sometimes experience bullying and isolation. Adults may struggle to feel heard at work or in high-pressure situations, such as speaking publicly at an academic conference. Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

A person who stutters may also have false beliefs about stuttering, such as that stuttering necessarily means others won’t take them seriously or listen to them. This fear may affect major life decisions such as where to go to school and which jobs to seek. For example, a talented researcher might opt not to speak at a conference or accept a professorship because of their fears about public speaking.

Coping with Stuttering-Related Anxiety

People who experience anxiety related to stuttering may find relief in a number of strategies. Those include:

How Parents Can Help With Stuttering-Related Anxiety

Most people who stutter are children. Parents and other family members can do a lot to help. Try the following:

How Therapy Can Help with Anxiety Caused by Stuttering

Stuttering can be treatable. Many people see immense improvements in their speech after seeking help from a speech-language pathologist. A therapist can help with anxiety and other stuttering-related issues, allowing a person who stutters to focus on overcoming their speech difficulties.

A strong therapeutic relationship is the most important factor in therapy’s success. Research also shows specific techniques can help with stuttering-related anxiety. Exposure therapy may help people who have anxiety about stuttering in specific situations, such as on a date or while at a conference for work. Cognitive-behavioral therapy (CBT) can curb social anxiety by helping people identify, correct, and eventually prevent automatic self-defeating thoughts.

Even for people who continue stuttering, therapy can restore a sense of self-worth. Addressing the anxiety stuttering causes may prevent it from getting worse. Stuttering does not have to undermine a person’s quality of life or ability to succeed. It’s just one of many human differences. For many people who stutter, therapy offers a path out of shame and isolation and into confidence and better relationships. With the right support, people who stutter may no longer see their stuttering as a deficit or something to fear.

References:

  1. Büchel, C. & Sommer, M. (2004). What causes stuttering? PLoS Biology, 2(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC340949
  2. Craig, A. & Tran, Y. (2005, January 5). What is the relationship between stuttering and anxiety? Retrieved from https://www.stammering.org/speaking-out/articles/what-relationship-between-stuttering-and-anxiety
  3. Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., . . . Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 7(23), 928-934. doi: 10.1016/j.janxdis.2009.06.003
  4. Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009). Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 3(34), 187-200. doi: 10.1016/j.jfludis.2009.09.002

A man looks at a computer screen, which reflects in his glassesIn 2013, former CIA employee and government contractor Edward Snowden released classified documents revealing the broad scope of U.S. government surveillance. Suddenly, fears that once seemed paranoid were decidedly rooted in reality. Paranoia and anxiety are common. They can be part of the typical range of human experience or signs of a serious mental health diagnosis.

Drawing the line between normal fears, anxiety, and paranoia can be difficult. That’s especially true when a person’s apparently paranoid fears turn out to be true—as was the case for activists targeted by programs such as COINTELPRO, and for Ernest Hemingway, who really did have an FBI file. Knowing where to draw that line, and how to decide whether a fear is reasonable or not, can help people seek appropriate mental health care.

What Is Paranoia?

Paranoia is persistent anxiety about a specific fear. Paranoid anxieties often center around persecution, being watched, or being treated unjustly. The hallmark of paranoia is that it is rooted in a false belief. People with paranoid thoughts may also have false beliefs about their own power or importance. For example, a person who does not occupy a political position or engage in activism might believe in an international conspiracy to monitor and torture them. In some cases, exposure to trauma or severe stress can make people more likely to experience paranoia.

People experiencing paranoid thoughts are often preoccupied by these thoughts. They may be fixated on getting other people to accept their beliefs as true. They may make unusual choices designed to protect themselves from the sources of their anxiety.

Fleeting moments of paranoia are common and don’t necessarily mean a person has a mental health condition. Paranoia is also distinct from anxiety in that:

Delusional vs. Reasonable Paranoia

Delusional paranoia is paranoia due to a false belief. While often a hallmark of schizophrenia, it can also be due to other mental health diagnoses. When a person’s fears are rooted in reality or reasonable, they’re not paranoid. The challenge is determining which beliefs are reasonable and which are not.

A lawyer working with detained immigrants might worry that they are being monitored by the government. A doctor working with infectious diseases may be concerned about becoming infected or spreading the disease. Even if the fear does not come to fruition, it is rooted in reality.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear. For instance, young black Americans may be fearful of the police. To someone who has never had a negative interaction with police, this fear might seem unreasonable, even paranoid. To a person exposed to police violence against young black people, the fear seems reasonable and is unlikely to be due to a mental health diagnosis. Dismissing a person’s reasonable fears can be very harmful, especially when it happens in therapy.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear.

One way to assess whether a person’s anxiety is reasonable or not is to assess how they respond to conflicting evidence. People with schizophrenia, for example, may continue to endorse false beliefs even when given evidence to the contrary. The conflicting evidence may even be viewed as a sign of a larger conspiracy, or as a reason to distrust a mental health provider. A person without schizophrenia who learns their false belief is untrue may be relieved rather than defensive.

People who think someone they love may have schizophrenia should not spend time arguing about false or paranoid beliefs. This can harm the relationship, making it difficult for the person to feel understood or loved. Arguing about false beliefs may inadvertently stigmatize the person or make them feel judged.

Schizophrenia Symptoms: The Link to Paranoia and Anxiety

A person who has paranoid thoughts may have schizophrenia or a related condition. Only a mental health professional can treat and diagnose this condition, so it’s important to seek expert insight.

Schizophrenia usually begins in adolescence or early adulthood. Someone who develops paranoid thoughts later in life might have another mental health condition, such as dementia.

Some schizophrenia symptoms to watch for include:

When to Seek Treatment for Anxiety About Being Watched

Mental health treatment can help anyone experiencing anxiety, whether their anxiety is rooted in a real source or the product of a mental health diagnosis. Activists such as lawyers or protest leaders who have reasonable fears about being monitored may find therapy helps them manage their anxiety, deal with the effects of those fears on their relationships, and separate reasonable fears from unreasonable ones.

People who have a condition linked to unreasonable paranoia may also find immense relief in therapy. Therapy can help a person understand their anxiety, confront false beliefs, and assess the effects that false beliefs have on their life. People with diagnoses linked to delusions often struggle at work, school, and in their relationships. Therapy can help with developing better communication skills and dealing with the challenges of schizophrenia and other diagnoses linked to delusions.

References:

  1. Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M., & Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 8(38), 1121-1132. doi: 10.1017/S0033291708003589
  2. Schizophrenia. (2016, February). Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
  3. Shakeel, M. K., & Docherty, N. M. (2015). Confabulations in schizophrenia. Cognitive Neuropsychiatry, 1(20), 1-13. doi: 10.1080/13546805.2014.940886

Dear GoodTherapy.org,

I have really bad social anxiety. I don’t want to go anywhere or do anything anymore because I’m worried I will say something stupid and people won’t like me. I am not a good speaker, so I tend to say things that sound dumb. Then I spend the rest of the night thinking about what other people were thinking when I said it. I second-guess myself a lot.

It has gotten to the point that even when I am forced to be around people, I stay quiet most of the time. I overheard someone tell their friend that I am “unfriendly” and “aloof” because I don’t involve myself in conversations. It’s like my choices are (1) sound dumb or (2) seem unfriendly.

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I can’t make friends because of my social anxiety and I don’t feel like there is anything I can do about it. Does social anxiety get better or go away in time? Or am I stuck being a socially awkward misfit for the rest of my days? —Outcast

Dear Outcast,

The pain and frustration you are feeling comes through loud and clear. You feel like social interactions are no-win situations—you either remain quiet and risk being perceived as unfriendly or try to participate in conversations and risk being perceived as less intelligent than you are. I also imagine this can become somewhat self-perpetuating. As you become more and more self-conscious about your social interactions, it likely becomes harder for you to engage in a way that feels good.

You pose two questions: one, will your social anxiety diminish in time, and two, are you stuck dealing with social anxiety forever. I suggest tabling those questions in favor of a different question: What can you do to make yourself feel more confident and capable in social situations?

You pose two questions: one, will your social anxiety diminish in time, and two, are you stuck dealing with social anxiety forever. I suggest tabling those questions in favor of a different question: What can you do to make yourself feel more confident and capable in social situations?

Joining a therapy group could be helpful. I know it might sound frightening to willingly put yourself in a group of strangers on a regular basis when doing so is deeply anxiety-provoking, but a therapy group is quite different from a typical social situation. First, it is designed to help group members deal with the issues they face. Second, therapy groups are established with rules that are designed to ensure the safety of group members. A group affords you the safety and security of therapy along with the opportunity to explore social interactions and try on new behaviors. As you do so, inside and outside of the group, you’ll have the support of the group to celebrate your successes and to process the things that don’t go as well as you would have liked.

If starting out with a therapy group sounds like too much, that is okay. You might feel more comfortable partnering with an individual therapist first to explore your social anxiety and develop a deeper understanding of it. You could also work with a therapist to develop some tools for coping with the anxiety so joining a group doesn’t feel so daunting. You could even begin working on developing some social skills that you could begin practicing when you join the group.

There are also public speaking groups, such as Toastmasters, that are designed to teach people how to master public speaking. Even people who feel relatively confident in social situations can have tremendous anxiety when it comes to public speaking. Perhaps if you developed a sense of mastery in public speaking, smaller social situations wouldn’t feel so overwhelming.

However you choose to handle this, I encourage you to take a proactive approach. There is treatment available to help you learn to navigate social situations in a way that feels more comfortable and allows you to form deeper, more satisfying relationships. You deserve that!

Kind regards,

Sarah Noel, MS, LMHC

Woman sits at table in outside cafe, looking thoughtfulMany people who experience anxiety or depression know the symptoms of each are not always well-defined. For instance, they can overlap. Commonly overlapping symptoms of anxiety and depression include difficulty concentrating, sleep issues, tiredness, and loss of interest in previously enjoyed activities.

It is not always easy to tell which condition is causing symptoms. In many cases, people seem to experience aspects of anxiety and depression. They may not know whether they are dealing with anxiety, depression, or even both. One reason for this confusion is each condition’s ability to mimic the other.

Identifying one main cause of symptoms is not always possible or necessary. But knowing the root causes of your symptoms could help you find the best treatment approach. A deeper understanding of your experience may also help you feel more hopeful about seeking help.

Key Differences Between Anxiety and Depression

Anxiety is a constant feeling of worry. It can occur on its own or be triggered by certain events or factors. Physical signs of anxiety often include shortness of breath and tense muscles. People dealing with anxiety sometimes experience panic attacks, heart palpitations, and dizziness.

Depression is prolonged sadness or loss of interest in formerly enjoyable activities. It is characterized by low energy, feelings of low self-worth, and sometimes, suicidal thoughts. [fat_widget_right]

Symptoms that overlap between anxiety and depression often have different origins. For example, anxiety may cause a person to stop doing an activity or withdraw from a social setting. This is often because those things inspire panic. Depression can also cause someone to withdraw in similar ways. In the case of depression, withdrawal may be due to loss of interest in the activity.

Fatigue or loss of energy are other symptoms often linked to depression. But anxiety may also cause a loss of energy, which can stem from a sense of exhaustion. This tiredness is often caused by anxious thought patterns, obsessive thinking, or rumination. In the case of depression, loss of energy may be more likely to occur as a primary symptom.

Both conditions can cause social withdrawal or a change in activity levels. These symptoms can have vastly different causes. Different approaches may be necessary to address these causes.

Signs Anxiety May Be the Cause

If you identify with most of these symptoms, you may be experiencing anxiety:

Being diagnosed with a specific anxiety disorder may also mean anxiety is a root cause. For instance, someone who experiences panic attacks or social anxiety may still have symptoms of depression. These may cause someone to withdraw from life, relationships, or social settings. This behavior can trigger feelings of hopelessness and loneliness, which may mimic depression.

Anxiety may also be a more likely cause if:

People diagnosed with depression may experience feelings of anxiety. The term for this is “anxious distress.” It is characterized by feelings of tension, restlessness, and difficulty focusing. The sense of hopelessness that can come with depression may cause worry about the future. Those who experience depression and anxious distress may be at a higher risk for suicidal thoughts. It is important to seek treatment in these cases.

Signs Depression May Be the Cause

Depression is categorized as major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). One key sign of depression is major depressive episodes. When these occur, symptoms of depression may become severe enough to limit daily functioning. Some other primary signs of depression are:

Some types of depression are easier to identify as such. For example, depression caused by a certain life event may be easy to identify. Postpartum depression, which occurs after childbirth, or seasonal affective disorder (SAD), include symptoms of depression that have distinct triggers.

People who mainly experience anxiety may also be diagnosed with one of these depressive conditions. In these cases, the conditions would be seen as co-occurring, or comorbid. This term is used when two separate conditions are both present.

The experience of swinging to and fro between anxiety and depression can be a frustrating one. It may feel like a negative cycle in which balance is much needed but difficult to attain.

Depression may also be a more likely cause if:

If a person is only diagnosed with anxiety, they may still show signs of depression. People with anxiety may expend much of their energy toward worry. These thoughts can leave people with little energy for performing daily tasks or hobbies. When anxiety causes overwhelm or burnout, it may start to look like depression.

The experience of swinging to and fro between anxiety and depression can be a frustrating one. It may feel like a negative cycle in which balance is much needed but difficult to attain.

Do I Have Both Anxiety and Depression?

It can be difficult to tell if you have both anxiety and depression or if symptoms of one just look like the other. In one study, 72% of people with generalized anxiety had a history of depression. Meanwhile, only 48% of people with depression had a history of anxiety. But research indicates comorbid anxiety and depression may be more common than originally thought.

The study also points out that comorbidity can be cumulative. This means a person may experience anxiety and depression at different life stages. Some experts suggest that anxiety at a young age may increase the likelihood of experiencing depression in the future. But depression may also precede anxiety.

When You Are Confused About Your Symptoms

Questions or concerns about depression and anxiety should be directed to a trusted mental health professional. Therapists are often trained to identify the root causes of issues. Discussing your symptoms in therapy may help you discover the source of the issue that prompted you to seek help. Once you and the therapist identify the issue, you can learn how to overcome or manage it.

Talk therapy can be helpful in identifying the cause of certain symptoms. A trained therapist can help unravel your symptoms and see what may be causing them. Whether you experience anxiety, depression, or both, your therapist can help create a plan for addressing those conditions long-term. This may mean more therapy sessions, a support group, psychoeducation, or medication and treatment with a psychiatrist in conjunction with therapy.

Regardless of what next steps you take, it is important to remember that people experience anxiety and depression differently. It’s not always necessary to know every cause of a mental health issue to treat it. But labeling or identifying an issue, especially a root problem, may help reduce feelings of worry or uncertainty in some people. Remember that you are never alone. Any help and guidance for improving your mental health may only be one question to a trusted therapist away.

References:

  1. Ankrom, S. (2018, February 15). Depression and anxiety. Retrieved from https://www.verywellmind.com/depression-and-anxiety-2584202
  2. Anxiety disorders: Risk factors. (2016). Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145335
  3. Davis, J. (n.d.). Is it really depression? Retrieved from https://www.webmd.com/anxiety-panic/features/is-really-depression#1
  4. Moffitt, T. E., Harrington, H., Caspi, A., et al. (2007). Depression and generalized anxiety disorder cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry, 6(64), 651-660. doi:10.1001/archpsyc.64.6.651
  5. Smith, K. (2018, February 13). Anxiety vs. depression: How to tell the difference. Retrieved from https://www.psycom.net/anxiety-depression-difference
  6. Stressed or depressed? Know the difference. (n.d.). Mental Health America. Retrieved from http://www.mentalhealthamerica.net/stressed-or-depressed-know-difference
  7. Wilcox, M. A., Kent, J., Canuso, C., & Wittenberg, G. (n.d.). The DSM-5 MDD anxious distress specifier: A useful predictor of risk: Suicide, comorbidities, disability, and treatments? Retrieved from https://isctm.org/public_access/Autumn2015/Poster/Abstracts/1-Wilcox.pdf

Rear view of person with short hair in pants and sweater walking in field at sunsetOne of the hardest things about stress and anxiety is that it often leads to overwhelm. Because of this, it is tempting to implement strategies that manage the discomfort but fail to offer lasting change. For example, many people choose to avoid situations that trigger anxiety, but they rarely address the sensations, feelings, and thoughts associated with it. It is natural to want to avoid feeling anxious. However, quick fixes don’t tend to bring long-term recovery. An integrative approach that includes both short- and long-term solutions is usually needed.

There are two main reasons for this:

  1. Overwhelm feels more convincing than your ability to change it.
  2. When you are immersed in overwhelm, short-term strategies become necessary for immediate relief before being able to consider long-term solutions.

While psychotherapy, social support, a nutrient-dense diet, spending time in nature, and exercise are important to prevent overwhelm, three key ingredients are necessary: expanding your window of tolerance, mindfulness, and self-compassion.

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Becoming Aware of Your Window of Tolerance

One of the most important aspects for reducing overwhelm is to become increasingly aware of signals that you are about to “flip out” or “shut down” (known in psychotherapy as hyperarousal and hypoarousal). The space between flipping out and shutting down is the zone in which you function most effectively. In this space, you can think clearly, communicate well, engage respectfully, and work effectively. In other words, you are in your window of tolerance.

As you might imagine, everyone’s window of tolerance is different. Understanding your baseline window of tolerance and how to expand it contributes to long-term well-being because it offers you the chance to change your relationship to difficult emotions.

You might wonder how you can come to know and expand your window of tolerance. One of the more effective ways is through mindfulness and self-compassion.

Expanding the Window of Tolerance with Mindfulness

Expanding your window of tolerance helps you navigate increasingly difficult experiences without becoming so easily overwhelmed. To expand the window, you must learn to notice when you are “triggered” or “hooked” into a negative reaction. Mindfulness helps you to tune into subtle messages in your body/mind, giving you insight about where and when you are triggered.

Mindfulness simultaneously offers immediate relief and long-term benefits. It is often described as the state of being intentionally aware of what is happening, as it is happening, without judgment. Psychiatrist and educator Dr. Dan Siegel describes it as “waking up from a life on automatic and being sensitive to novelty in our everyday experiences. Instead of being on automatic and mindless, mindfulness helps us awaken to moment-by-moment experience.” In other words, mindfulness gives us what psychotherapist Linda Graham calls “choice points” or opportunities where change becomes possible.

Mindfulness teaches you to be an observer of sensations in the body and the feelings associated with them. In this shift from immersion to observation, you can tolerate painful feelings as they arise and access your thinking mind with more clarity.

Change becomes possible because mindfulness prevents over-identification. When you are triggered, you are immersed in the experience and accompanying sensations, feelings, and thoughts. Mindfulness teaches you to be an observer of sensations in the body and the feelings associated with them. In this shift from immersion to observation, you can tolerate painful feelings as they arise and access your thinking mind with more clarity.

According to meditation teacher and psychotherapist Tara Brach, mindful awareness has two qualities: seeing what is true and holding with love what is seen. You can ask two simple questions to create mindful awareness.

Continuing to Expand the Window of Tolerance with Self-Compassion

If there is one thing I’d like you to take away from this article, it is to know every moment of suffering is an opportunity to give yourself love and compassion.

Self-compassion helps transform overwhelm and other difficult feelings by teaching us to cultivate kind, connected presence for ourselves. Kristin Neff, researcher of self-compassion and co-creator of the Mindful Self-Compassion program, says there are three main ways to initiate self-compassion:

  1. Kind words
  2. Caring tone of voice
  3. Soothing gestures

Self-compassion increases oxytocin, a powerful hormone that acts as a neurotransmitter in the brain and, in turn, amplifies feelings of trust, calm, safety, generosity, and connectedness. A key thing to remember, however, is that self-compassion is a practice of goodwill, not good feelings. If you use self-compassion practices only to try to make bad feelings go away, you create the requirement that receiving compassion is valuable only if it removes the pain of life. Continue the practice of giving and receiving loving kindness without conditions, even when the pain doesn’t go away. By doing so, you create the habit of approaching yourself and others with kindness. You may feel more positive emotions as a result, but treat them more like a wonderful side effect than a goal. The long-term goal is to cultivate mindful self-compassion in as many situations as possible, and this takes time.

One of the most important points about this approach is to fully receive the compassion you offer yourself. This means to give yourself permission to get into it! This may be challenging at first because you are likely used to spending your energy on avoiding or managing overwhelm. If you shift your focus from avoidance to being compassionate with the part of you that is overwhelmed, you may be surprised how much you are able to expand your window of tolerance.

Reference:

Neff, K. (2011, June 27). The chemicals of care: How self-compassion manifests in our bodies. Retrieved from https://www.huffingtonpost.com/kristin-neff/self-compassion_b_884665.html

Portrait of author and blogger Sarah WilsonSarah Wilson is a journalist, an entrepreneur, and the New York Times bestselling author of I Quit Sugar. Her newest book, First, We Make the Beast Beautiful: A New Journey Through Anxiety, explores anxiety through a variety of angles and lenses.

In her new book, Sarah analyzes research and published works about anxiety and mental health; tells personal stories about her mental health experiences; and shares advice for managing, living with, and accepting anxiety.

Formerly the editor of Cosmopolitan Australia, Sarah regularly blogs about anxiety, minimalism, philosophy, toxin-free living, and anti-consumerism on her website, SarahWilson.com. For the past 8 years, she has traveled the world as a nomad, which gave her the opportunity to meet a variety of people. You can follow Sarah on Facebook, Twitter, and Instagram.

We spoke with Sarah about her creative processes, her own experiences with anxiety and mental health, writing a book about mental health, and more in this GoodTherapy.org exclusive interview.

Why did you choose to focus your latest book on anxiety?

Well, it was almost like I had no choice. I’d been writing all kinds of other books, and I was at a writer’s festival to talk about sugar and health. All of the questions were about anxiety, because I’d been starting to write about it on my blog. My publisher was in the audience, and she said, “Sarah, it’s time you wrote this book.” I also had been researching the topic for years, trying to investigate different ways to manage my own anxiety. Given that I’m a writer and have access to all of these amazing interviews, I felt a responsibility to do it. Also, I was bored of talking about superficial stuff. I figured we’re all craving a deeper conversation about stuff that matters.[amazon_affiliate]

The book is so thoughtfully crafted with synopses of research and published works about mental health as well as your own personal experiences. Can you take us through your process of researching, writing, and arranging this book?

I started out writing it like a normal memoir, and it didn’t seem to reflect what it was like to be inside the mind of a person with intensity and spirit and anxiety. So the way I did it is mini-chapters that dance between memoir, science, quantum physics, philosophy, [and] spirituality. I think that’s the best snapshot of what it’s like to explore and live with the anxious experience. [fat_widget_right]

I have bipolar, and one of the upsides is that when I research something, I go down the rabbit hole and investigate things deeply. The book was like a patchwork of different ideas that follow a thread, but it follows a journey of explaining, layer by layer, how you can land at a place where anxiety is truly beautiful. In fact, the story comes full circle. The very thing that makes you anxious—what anxiety does is it brings you to a resolution of that very thing.

You open the book by explaining you’re not a health professional, but you had several mental health and general health practitioners read your book to ensure the accuracy of the information you share about anxiety and mental health. Why was this important to you, and how did it help you shape the final drafts of the book?

It was important to me because I’m not a scientist, I’m not a health professional, and I needed to make sure what I was saying was responsible and helpful. It was not just to satisfy my own personal need to make sure I got it right, but also so the mental health community felt included in the process. Because the discussion I have, in some ways, criticizes the way we’ve dealt with mental health. I got various people in Australia, the U.S., and the U.K. to read the book and give it “the tick of approval.”

It also meant I could feel confident putting the book out knowing these might be my private musings and research, but I’m also tapping into something bigger. That was a wonderful thing to have behind me when I released the book.

Why do you prefer to write initial drafts by hand? How does this affect your writing process overall?

I’ve always done that, and perhaps that just reflects my age. I did half of a law degree handwriting my essays. I’ve always found that it assists my creative process. I can visualize what the trajectory of the story is going to be. I can grab vast quantities of information at once, whereas scrolling through a computer screen, you just can’t.

When I went through [my research], I found some reasoning behind it. I quote an Australian philosopher who talks about handwriting and walking. They’re two things I promote as great anxiety modulators. The reason is because they go at the same pace as discerning thought, and a big part of anxiety is not being able to piece out your thoughts. I find handwriting to be a healing process, so the writing of the book was quite healing.

First, We Make the Beast Beautiful book coverHow have you managed your anxiety while maintaining your successful writing and journalistic endeavors?

Well, I rattle off statistics about the number of poets with bipolar, and scientists with OCD [obsessions and compulsions], and this kind of thing. I couldn’t find statistics about journalists and writers, but you only have to cast your mind back through history to see how many prominent writers had bipolar, social anxiety, some kind of crippling anxious disorder. Virginia Woolf, Sylvia Plath, Nietzsche, Charles Darwin—you know? It goes hand in hand, and I think the anxious experience is very much about a desire to reach out and communicate with fellow humans. I think we gravitate towards writing and journalism, it’s just what we do.

How did getting diagnosed with Hashimoto’s disease impact how you care for your mental health? Do you have any recommendations for people trying to care for their mental health while coping with a chronic illness?

It’s almost like they do go hand in hand. It’s like, did I develop an autoimmune disease that lead to mental issues, or the other way around? Or are they just symptoms of the same thing? I think it’s all of the above. There’s no point in trying to work out which came first or what’s the cause and effect.

I find that my management of Hashimoto’s and anxiety is pretty much the same. It’s about inflammation, at the end of the day. A lot of people with anxiety will have an inflammatory disease of some sort. I would say 95% of the things I do to manage my anxiety are also required to manage my Hashimoto’s. Eating-wise, it’s cutting out processed foods and sugar, being moderate with alcohol and coffee. It’s about doing gentle exercise, not hardcore gym work—you’ve got to be gentle. It’s about having routines. Limiting the number of choices you’ve got to make. It’s about meditating. And it balances out both. If my anxiety flares, my Hashimoto’s flares, and vice versa.

Why are meditation and focusing on gratitude such important practices for managing and coping with anxiety?

Meditation brings us closer into ourselves. Part of the book is about how a lot of our anxiety, and a lot of contemporary fixes for anxiety, are about reaching outwards. Our entire culture is about that—the answer is out there somewhere else. It’s in a shopping mall, a new holiday, a new boyfriend, or a new car. That reaching out beyond ourselves is actually an intensification of the anxious experience.

What I talk about throughout the book is coming in closer. Meditation is probably the best practice for doing that. Of course, science shows that it calms our thoughts, slows them down, our fight or flight response is balanced out, all of that stuff. But from an almost spiritual point of view, it’s about being able to sit comfortably with ourselves in this lifetime. And I think that’s the most powerful part of those practices. It retrains your brain to be in that state, as opposed to an anxious state.

You describe a variety of your experiences in therapy over the years. What are some ways you can tell a therapist is a good fit for you? Conversely, what tells you a therapist might not be a good fit?

I don’t necessarily [know] the answer because I’m still on that journey myself. Some people say that for people with bipolar, it can take 5 to 7 years to find a therapist who can diagnose and work with you in a way that’s helpful. I think the best advice I can give is to accept that and realize therapy is an ongoing journey.

I am going through the process, and I’m trying to find someone who can truly challenge me. I’ve read about this; I think I know it all; and I need someone who can challenge me. I think if you’re anxious, you can actually over-research these things—I certainly have. And you think you’re pretty smart with all of this. A lot of our practices, obsessive-compulsive behavior being a prime example, are about trying to protect ourselves from anyone trying to challenge us. It’s like “I’ve got it all under control, go away.” I think you need to find a therapist who can call you [out]. I don’t have advice other than, it’s really normal to struggle and to have your own processes for finding a good therapist.

What are some ways people can help support friends, family, and loved ones in their lives that are affected by anxiety and other mental health conditions?

The book was like a patchwork of different ideas that follow a thread, but it follows a journey of explaining, layer by layer, how you can land at a place where anxiety is truly beautiful.

This has been a surprising part of writing the book—that when it came out, so many people who don’t have anxiety but know someone who does read it and got a lot out of it. I love that they wanted to understand their loved one better. There’re two good techniques I’ve shared with people. One is to understand that often, an anxious person looks like we’re trying to control the people around us. What I say to non-anxious people is, try to understand we’re not trying to control you, we’re trying to control the circumstances that can be a trigger to our anxiety so we don’t ruin the picnic, the dinner party, or our night on the couch watching a movie. When I’ve said that, there’s less defensiveness, and there’s a lot of support and understanding.

The other is helpful—a lot of my friends and family are starting to do this for me, and I’m grateful for it. When you’re anxious, you can’t make decisions, and when you have to make too many decisions, it can make you anxious. It’s because the same part of the brain modulates both behaviors. A lot of panic attacks are about not being able to decide on something, and just being in a state of numb terror. What I say is, if you know somebody who is anxious, and they’re a bit fretty and uncomfortable, make the decisions for them. Don’t say, “What can I do for you?” or “Should we go see this movie?” Say, “Alright, we’re going to have pasta, and then we’re going to see a movie, I’ve booked the tickets for 8:30.” That is probably one of the best things you can do because you feel safe, there’s no decisions to be made, you find yourself correcting your anxious spiral, and you end up having a great night.

How has writing this book helped you understand and manage your own anxiety and mental health in general?

It’s been the most wonderful form of therapy in a way, because it’s forced me to look in the mirror. When I’ve written a book, I’ve had to do the work for my readers and go down a layer deeper, and then another layer deeper. It got me pretty real about it all. Also, it’s a bit like writing a book about not eating sugar—I can’t walk down the street eating a Mars bar. It keeps you vigilant. As I say in the book, vigilance is important. It’s all about the journey, there’s no magic quick fix.

But more importantly, it’s made me feel less lonely. I wanted to have conversations with people, to connect in a better way, and certainly the book has done that. It’s made me feel like there’s people out there with the same condition. That just emphasizes the whole premise of my book, which is, you know what? There is a purpose to this. There’s a reason why we have anxiety. And even if it’s to bring us closer to each other, that’s a pretty good reason.

It is not uncommon to feel anxious or to have anxiety. If you often feel this way, you can reach out to a compassionate counselor.

Rear view of person in suit sitting and looking outside large window with hands behind head with sunspot illuminating areaWhen you make a mistake, how do you react? Are you overly critical? Do you always blame yourself, even for the smallest mistakes? That’s your inner critic talking.

The inner critic is the part of us that wants to point out all of our faults. It expects perfection and won’t accept anything less. It also assumes it knows how others think and feel about us. Listening to this inner critic can often make us feel really bad about ourselves.

Why Do We Believe Our Inner Critic?

The Internal Family Systems (IFS) model of therapy is based on the idea that we all have many different parts inside of us. The expression of these parts differs from person to person. In other words, we all have an inner critic, but for some of us that critical part is much louder and meaner. Our inner critic can make us feel anxious or depressed by telling us we aren’t living up to others’ expectations.

Many people feel like their inner critic reminds them of the things they didn’t do. As a result, they might believe they’d never get anything done without this critical voice. [fat_widget_right]

But in reality, bullying doesn’t make us more productive. Quite the opposite, in fact: research shows bullying in the workplace lowers productivity and increases depressive symptoms. Research has also shown that self-criticism tends to accompany social phobias and depression. Self-criticism has also been shown to increase the severity of combat-related posttraumatic stress (PTSD), eating disorders, and body image issues.

What Does Your Inner Critic Want You to Know?

So if our inner critic leaves us feeling bad about ourselves and increases the risk of some mental health concerns, can we learn anything from listening to that part of us?

Is it possible that it wants to protect us from harm? Does that critical part of us come from a place of good intent?

Many people feel like their inner critic reminds them of the things they didn’t do. As a result, they might believe they’d never get anything done without this critical voice.

When we approach the inner critic from the IFS (parts) model, we can begin to understand that this critical part is actually working hard to protect us. It says all those mean things with the best intentions. It truly believes it is helping us.

But if we were trying to help someone else, like a friend or family member, we wouldn’t be that hard on them, would we? We probably wouldn’t ever be that hard on anyone other than ourselves.

So how do we get the inner critic to quiet down? To be less critical?

How Can We Do Things Differently?

1. Tune in.

The first step we can take is to really tune into the inner critic. Try to draw a mental image (you can actually draw it, if that helps!) that part of you. How old does it feel? What does it look like? Does it sound familiar? Perhaps it sounds like a person from your past, a parent, or an ex-partner. Maybe it sounds like someone currently in your life.

2. Get curious.

As you begin to have a clearer picture of that critical part, the next step is to start noticing how often it shows up. Does it chime in when you make mistakes or when it worries about being judged? Does it tell you to avoid new places and situations? How often is it present? Does it show up once in a while, or does it offer a constant stream of negativity?

3. Ask some questions.

You might notice that the critical part hangs around a lot, especially if you’re feeling anxious or depressed. The next time you hear your inner critic, try asking some questions to find out more about it:

4. Use compassion and curiosity.

As you take time to listen, see if you can be compassionate and curious. Would you like to ask that part some other questions? Try to be kind and curious at the same time. Each time your critical part answers a question, you can let it know that you heard it.

You’ll probably learn that your critical part is reacting from deep-seated fears. It’s trying to protect you from future harm. It wants to keep you safe. When you learn that your part wants to protect you, you may feel less likely to tell it to shut up and leave you alone. You might even begin to feel some compassion for the critical part because it’s always responding from fear.

5. Listen and respond.

As you become more familiar with when and how your critical parts show up, you can start responding differently. You can say something like, “I hear you. I know you’re worried I’ll make a mistake or get hurt by others, but I don’t want to live my life in constant fear. Thank you for worrying about me. Right now I’m going to ask you to step aside while I decide what I’m going to do.” You’re telling that part that you hear it. You are compassionately asking your critical part to let you, not it, decide what’s next.

Talking to your inner critic takes a lot of practice. I’m willing to bet it’s had your ear for a long, long time. But in time, you’ll find it’s easier to notice when it shows up and easier to get it to calm down as you try new things—and hopefully even have fun doing them!  [amazon_affiliate]

If you are struggling to reach your inner critic, consider reaching out to a compassionate therapist or counselor who can help you explore this critical part of you.

References:

  1. McTernan, W. P., Dollard, M. F., & LaMontagne, A. D. (2013, November 7). Depression in the workplace: An economic cost analysis of depression-related productivity loss attributable to job strain and bullying. Work & Stress: An International Journal of Work, Health, & Organization, 27(4), 321-338. doi: 1080/02678373.2013.846948
  2. Neff, K. D., Germer, C. (2017). Self-compassion and psychological well-being. In J. Doty (Ed.) Oxford handbook of compassion science (371-386). New York, NY: Oxford University Press.
  3. Schwartz, R. C. (2001). Introduction to internal family systems model. Oak Park, IL: Trailhead Publications.

anxious dog laying downAs anyone who’s ever lived with a dog can attest, dogs’ emotions are complex and occasionally bewildering. And for some dogs, emotions are overwhelming. Whether they’re tearing up the house in sheer terror because a beloved owner leaves for a few hours, or they’re shamelessly snarling and lunging at every dog who walks by, some dogs struggle to cope with the stresses of everyday life.

The science of dog behavioral pharmacology aims to help exhausted pet owners and their stressed-out four-legged companions. Although it was once controversial to prescribe mental health medications to dogs, the pioneering work of Dr. Nicholas Dodman, a Tufts University veterinarian, has steadily moved dog psychology into the mainstream.

Do Dogs Need Mental Health Medication?

The behaviorism of the early twentieth century would have you believe that dogs are little more than machines reacting to their environment. But dogs have much of the same brain circuitry as humans, and when brain chemistry goes haywire, so too can a dog’s behavior. A recent article in The Atlantic, for example, tells the tales of dogs whose behavior miraculously changed after getting the right prescription medication.

[fat_widget_right]Veterinarians typically rely on human medications rather than special formulations for dogs. An anxious or depressed dog is almost as likely to be prescribed Prozac as an anxious or depressed human. The dosage has to be adjusted to reflect the size difference between dogs and humans, of course, and veterinarians sometimes have to do some tweaking to find a medication that works.

How to Tell If Your Dog Needs Help

Medication isn’t a panacea for everything. You still have to socialize your dog and train him or her to be friendly and obedient. Reward-based training methods often improve the behavior of even the stubbornest dogs. If your dog seems untrainable or does things that put her health and safety in danger, though, she could be struggling with a mental health issue. It’s not safe to give your dog your own medication, but if you see any of the following symptoms, it’s time to consult your veterinarian:

Not all veterinarians embrace pharmacological options for dogs’ mental health. If you want to give medication a try, you’ll need to call vets and ask whether they offer pharmacological solutions for behavioral problems.

References:

  1. Beaver, B. V. (2009). Canine behavior: Insights and answers. St. Louis, MO: Saunders/Elsevier.
  2. Fisher, T. (2014, May 02). Dogs get anxiety, too. Retrieved from http://www.theatlantic.com/health/archive/2014/05/dogs-who-take-prozac/360146/
  3. Psychological disorders. (n.d.). Retrieved from http://dogsnsw.org.au/resources/dogs-nsw-magazine/articles/health/177-psychological-disorders.html

Person with long hair in braid sits looking out window holding hot drink wrapped in sweaterThis year, I chose to stay home over the holidays. I didn’t choose to stay home because I don’t love my family or because I didn’t want to see them. I chose to stay home for the sake of honoring my emotions.

As someone who struggles with mental health issues, being around multiple people at once can have a tremendous effect on me—and not a positive one. My family is aware of my conditions, but they don’t always know how to respond to my emotions, let alone understand why I feel the way I do. So before large gatherings, I tend to become anxious, panicky, and overwhelmed.

This year, I’d already been feeling an increase in my anxiety before the party even began, and that was the only indicator I needed to make my decision. Some guilt arose while I was in the process of deciding to stay home, but I knew I would only benefit in the long run.

Here are the three key things I told myself to help curb the guilt I experienced as a result of choosing to stay home rather than participate in holiday celebrations with my family.

1. I don’t owe anybody anything.

I have always been a people-pleaser. Now, I know there’s nothing wrong with wanting to do something that will make another person happy or looking forward to seeing someone’s face light up with joy when you do something kind. But I’ve learned it’s important to draw a line when we begin to sacrifice our own peace and comfort for the sake of someone else’s happiness. [fat_widget_right]

If you know going to a family function or a party with friends is going to make you an anxious mess, I feel it’s best to practice honoring and acknowledging your body and mental health by making the decision that will be best for you, which might be to just stay home.

When I was in the throes of my people-pleasing days, I was always under the impression that if I said, “No,” or did something when I didn’t really want to do it, it would be rude, unkind, and selfish. But I’m here to tell you that it’s not! It is everything but that. By making the best choice for you, not someone else, you are cultivating self-compassion and being loving and kind to yourself. Your body and your mental health will thank you every time you make a decision that is based on how you truly feel.

2. I can’t take the reactions of others personally. 

I will be honest and say I am still working hard on this particular part. But I am pretty proud of myself that I stuck with my choice to stay home this year without letting fear of my family’s reaction influence me.

If you know that going to a family function or a party with friends is going to make you an anxious mess, I feel it’s best to practice honoring and acknowledging your body and mental health by making the decision that will be best for you, which might be to just stay home.

The reality of life is, no matter what we do or what we say, we cannot make anyone feel or react a certain way. How other people choose to react to our personal decisions is solely on them—not on us. We can only control how we feel and what we say and do. The rest is completely out of our control. And part of truly honoring ourselves is to not take the things we can’t control personally.

Thankfully, my family wasn’t upset with my decision to stay home, but I still had to prepare myself—just in case they were. I told myself over and over again that if they were mad or upset with me, I could not control that. All I could do was what I needed for myself, what was right for me. By choosing to honor my boundaries and stick with them, no matter how others reacted, I was able to support my own well-being.

3. I need to trust my gut. 

As I mentioned, I was already experiencing anticipatory anxiety about having to go to my family’s house. From the moment I woke up, I had the gut feeling that I really didn’t want to go. My body and mind were both telling me it would be a healthy choice to lie low at home and take it easy. I knew it wouldn’t be a good idea to put myself in a situation that would only provoke my anxiety.

All three points have one major theme in common: Honor your thoughts and emotions. Listen to them. Accept them.

I had to learn it was all right to put myself first. In fact, many times when I honored my emotions and said “No” to an obligation, I found that people actually responded with more respect and understanding because I was so truthful!

Learning to honor my emotions, trust my gut, and not take things personally didn’t just come naturally, though. Seeing a therapist regularly has helped me tremendously with all three of those things, and there is no shame in needing one if you feel like you’re having trouble honoring your emotions and/or if you struggle to say “No” to obligations, even when you wish you could. My therapist has supported me as I learned to find my own voice, and my work in therapy has empowered me throughout the years to utilize my voice every chance I get. Your voice is your truth, and no one can take that away from you.

If you aren’t feeling well when you have plans, and deep down, you really do not want to go out and do something, I encourage you to learn to be truthful, with yourself and with others. By doing so, you will likely learn, just as I did, that it’s perfectly all right to say no if you aren’t feeling good about something.

If you are struggling with how to begin, seeking support from a mental health professional might be a good place to start—doing so helped me a great deal. By finding your voice, you may not only find yourself opening up the door to self-empowerment, and you might also encourage others around you to do the same.

Julia is a college student and mental health advocate coping with borderline personality. She is currently studying psychology in order to become a licensed mental health counselor (LMHC). 

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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