Coping With Anxiety Quotes

. . .from their earliest years children live on familiar terms with disrupting emotions, fear and anxiety are an intrinsic part of their everyday lives, they continually cope with frustrations as best they can. And it is through fantasy that children achieve catharsis. It is the best means they have for taming Wild Things.

And finally - FINALLY - after a lifetime of feelings and anxiety and more feelings, I didn't have any feelings left. I had spent my last feeling being disappointed that I couldn't rent Jumanji.

What does your anxiety do? It does not empty tomorrow of its sorrow, but it empties today of its strength. It does not make you escape the evil; it makes you unfit to cope with it if it comes.

See, anxiety doesn’t just stop. You can have nice moments, minutes where it shrinks, but it doesn’t leave. It lurks in the background like a shadow, like that important assignment you have to do but keep putting off or the dull ache that follows a three-day migraine. The best you can hope for is to contain it, make it as small as possible so it stops being intrusive. Am I coping? Yes, but it’s taking a monumental amount of effort to keep the dynamite inside my stomach from exploding. The

Females with ASDs often develop ‘coping mechanisms’ that can cover up the intrinsic difficulties they experience. They may mimic their peers, watch from the sidelines, use their intellect to figure out the best ways to remain undetected, and they will study, practice, and learn appropriate approaches to social situations. Sounds easy enough, but in fact these strategies take a lot of work and can more often than not lead to exhaustion, withdrawal, anxiety, selective mutism, and depression. -Dr. Shana Nichols

Mental health, contemporary psychiatrists tell us, consists of the ability to adapt to the inevitable stresses and misfortunes of life. It does not mean freedom from anxiety and depression, but only the ability to cope with these afflictions in a healthy way.

I’ve found that it’s of some help to think of one’s moods and feelings about the world as being similar to weather. Here are some obvious things about the weather: It's real. You can't change it by wishing it away. If it's dark and rainy, it really is dark and rainy, and you can't alter it. It might be dark and rainy for two weeks in a row. BUT it will be sunny one day. It isn't under one's control when the sun comes out, but come out it will. One day. It really is the same with one's moods, I think. The wrong approach is to believe that they are illusions. Depression, anxiety, listlessness - these are all are real as the weather - AND EQUALLY NOT UNDER ONE'S CONTROL. Not one's fault. BUT They will pass: really they will. In the same way that one really has to accept the weather, one has to accept how one feels about life sometimes, "Today is a really crap day," is a perfectly realistic approach. It's all about finding a kind of mental umbrella. "Hey-ho, it's raining inside; it isn't my fault and there's nothing I can do about it, but sit it out. But the sun may well come out tomorrow, and when it does I shall take full advantage.

Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

You can’t be beaten by something you laugh at.

Certainly we want to protect our children from new and painful experiences that are beyond their emotional comprehension and that intensify anxiety; and to a point we can prevent premature exposure to such experiences. That is obvious. But what is just as obvious — and what is too often overlooked — is the fact that from their earliest years children live on familiar terms with disrupting emotions, fear and anxiety are an intrinsic part of their everyday lives, they continually cope with frustrations as best they can. And it is through fantasy that children achieve catharsis. It is the best means they have for taming Wild Things.

The degree to which a surviving parent copes is the most important indicator of the child's long-term adaptation. Kids whose surviving parents are unable to function effectively in the parenting role show more anxiety and depression, as well as sleep and health problems, than those whose parents have a strong support network and solid inner resources to rely on.

The traditional techniques used in getting sleep aren’t much effective any longer and our sleep techniques need to evolve as rapidly as our life style has, in order to cope with it.

So many office situations show no regard for people with anxiety, yet we’re the bad guys if we can’t cope.

The Stoics can teach you how to find a sense of purpose in life, how to face adversity, how to conquer anger within yourself, moderate your desires, experience healthy sources of joy, endure pain and illness patiently and with dignity, exhibit courage in the face of your anxieties, cope with loss, and perhaps even confront your own mortality while remaining as unperturbed as Socrates.

At first, when a child meets something that scares him, the fear grows, like a wave. But when he goes into the water and swims - gets used to the water - the wave grows small. If we pull the child away when the wave is high, he never sees that, never learns how to swim and remains afraid. If he gets a chance to feel strong, in control, that's called coping. When he copes, he feels better.

Be the good & seek the good. Faith fights anxieties… go after your faith with body, mind & soul.

Procrastination is a mechanism for coping with the anxiety associated with starting or completing any task or decision.

What ever happened to mental hygiene?” he asked rhetorically. “It doesn’t exist—and never did. When you went through high school, you were never taught how to deal with stress, how to deal with trauma, how to deal with tension and anxiety—with the whole list of mood impairments. There’s no preventive maintenance. We know how to prevent cavities. But we don’t teach children how to be resilient, how to cope with stress on a daily basis.

Fear is the vigilance and the need to escape from something real. Anxiety is about dread and foreboding and your imagination running away with you. Much as with depression, anxiety is rooted in a cognitive distortion. In this case, people prone toward anxiety overestimate risks and the likelihood of a bad outcome.

People with Asperger’s or autism expend a huge amount of mental energy each day coping with socializing, anxiety, change, sensory sensitivity, daily living skills and so on.

One way of coping with my anxiety has been to imagine it as a tax. In order to do the things I want to do, in order to go about my life, or to get anything done, I just need to pay the anxiety tax first. The tension and soreness I feel in my shoulders that never goes away; the hour of preparation it takes for me to talk myself into leaving the house; the constant fear that I will say the wrongest thing or write the wrongest thing or do the wrongest thing without ever knowing it—these are all part of the tax.

It’s hard to explain how much that feeling of the bottom potentially falling out at any moment takes its toll. It makes you anxious, of course, and constant anxiety is impossible for the body to handle. So you develop a coping mechanism, and for us that meant shutting down. Everything we liked or wanted or felt joy in had to be hidden or suppressed. I’m sad to say that this method works. If you don’t give as much credence or value to whatever it is that you love, it hurts less when it is inevitably taken from you. I had to pretend I had no joy. It will come as a shock to people who know me now, but being able to express joy was something it took me a long time to be confident enough to do.

When the Time Is Right: December 7 There are times when we simply do not know what to do, or where to go, next. Sometimes these periods are brief, sometimes lingering. We can get through these times. We can rely on our program and the disciplines of recovery. We can cope by using our faith, other people, and our resources. Accept uncertainty. We do not always have to know what to do or where to go next. We do not always have clear direction. Refusing to accept the inaction and limbo makes things worse. It is okay to temporarily be without direction. Say “I don’t know,” and be comfortable with that. We do not have to try to force wisdom, knowledge, or clarity when there is none. While waiting for direction, we do not have to put our life on hold. Let go of anxiety and enjoy life. Relax. Do something fun. Enjoy the love and beauty in your life. Accomplish small tasks. They may have nothing to do with solving the problem, or finding direction, but this is what we can do in the interim. Clarity will come. The next step will present itself. Indecision, inactivity, and lack of direction will not last forever. Today, I will accept my circumstances even if I lack direction and insight. I will remember to do things that make myself and others feel good during those times. I will trust that clarity will come of its own accord.

The heart carries heavy loads when it is being trained to carry weighty blessings.

But she found ways to cope, to tunnel her way out of herself, to climb down. Some people accept that they will never be free of their anxieties, they just learn to carry it.

See, anxiety doesn’t just stop. You can have nice moments, minutes where it shrinks, but it doesn’t leave. It lurks in the background like a shadow, like that important assignment you have to do but keep putting off or the dull ache that follows a three-day migraine. The best you can hope for is to contain it, make it as small as possible so it stops being intrusive. Am I coping? Yes, but it’s taking a monumental amount of effort to keep the dynamite inside my stomach from exploding.

Hayes and his colleagues have distilled these insights into seven skills for coping with loss. In more than a thousand studies over thirty-five years, they’ve found that the acquisition of this skill set predicts whether people facing loss fall into anxiety, depression, trauma, substance abuse—or whether they thrive. The first five skills involve acceptance of the bitter. First, we need to acknowledge that a loss has occurred; second, to embrace the emotions that accompany it. Instead of trying to control the pain, or to distract ourselves with food, alcohol, or work, we should simply feel our hurt, sorrow, shock, anger. Third, we need to accept all our feelings, thoughts, and memories, even the unexpected and seemingly inappropriate ones, such as liberation, laughter, and relief. Fourth, we should expect that sometimes we’ll feel overwhelmed. And fifth, we should watch out for unhelpful thoughts, such as “I should be over this,” “It’s all my fault,” and “Life is unfair.” Indeed, the ability to accept difficult emotions—not just observe them, not just breathe through them, but actually, nonjudgmentally, accept them—has been linked repeatedly to long-term thriving.

It’s hard to explain how much that feeling of the bottom potentially falling out at any moment takes its toll. It makes you anxious, of course, and constant anxiety is impossible for the body to handle. So you develop a coping mechanism, and for us that meant shutting down.

Goldstein's central thesis is that anxiety is the subjective experience of the organism in a catastrophic condition . An organism is thrown into a catastrophic condition when it cannot cope with the demands of its environment and, therefore, feels a threat to its existence or to values it holds essential for its existence.

Wherever the shadow of economic growth touches us, we are left useless unless employed on a job or engaged in consumption...We lose sight of our resources, lose control over the environmental conditions which make these resources applicable, lose taste for self-reliant coping with challenges from without and anxiety from within.

Your current situation fits every one of the criteria for this disorder:   Exposure to a traumatic event. Yes, relationship abuse from someone you love is traumatic and life-altering. Persistent re-experiencing. Yes, through the mean and sweet cycle, you were repeatedly subjected to their abuse. Persistent avoidance and emotional numbing. Yes, this is the coping mechanism you adopted to excuse their behavior. Persistent symptoms of increased arousal not present before. Yes, you begin to feel these during the delayed emotions stage, ultimately manifesting as anxiety and fear. Duration of symptoms for more than 1 month. Yes, most survivors will require anywhere from 12-24 months of recovery before they begin to trust & love again. Significant impairment. You tell me—how do you feel right about now? I’d say impaired is an understatement.

Running is not magic beans and I now know that I can’t expect it to inure me to the genuine sadness of life. But throughout tough periods in my life, and without realising it, I had finally acquired a coping skill, one that has helped me every day since I found myself on that floor, wondering how I’d ever get up. It’s something that has taken me out of my self-made cage, propelled me towards new jobs, new experiences, real love and a sense of optimism and confidence that I can be more than just a woman with crippling anxiety. It has given me a new identity, one which no longer sees danger and fear first. It’s not an exaggeration to say that I ran myself out of misery. It has transformed my life.

When one removes this factor by surgical repair, the patient is cast adrift from the more or less acceptable emotional protection it has offered and soon he finds, to his surprise and discomfort, that life is not all smooth sailing even for those with unblemished, “ordinary” faces. He is unprepared to cope with this situation without the support of a “handicap,” and he may turn to the less simple, but similar, protection of the behavior patterns of neurasthenia, hysterical conversion, hypochondriasis or the acute anxiety states.17

Of course sometimes she couldn’t help thinking about the reasons why she had wanted to jump, all the things she thought were missing from her reflection. Her loneliness at the dinner table. But she found ways to cope, to tunnel her way out of herself, to climb down. Some people accept that they will never be free of their anxiety, they just learn to carry it.

Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality). Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned: 1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully. 2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time. 3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.

Living in the land of, "What if....?" leads to emotional paralysis. It sets the stage for doom and gloom thinking. It prevents us from experiencing the beauty of the present moment. Happiness resides in the here and now. It can not thrive in a prison of the past or in the worry of future outcomes that may or may not, happen. We need to trust that we have the divine wisdom within ourselves and through the support of others, to climb the treacherous terrain this human existence brings. It is worth the struggle. The view from the top is extraordinary. Onward and upward!

Possible Problems with Journal Writing Be careful not to get too involved with your journal. In many published journals, writers such as Anais Nin worried that they found writing in a journal so satisfying that they were trapped into spending their lives writing about events, rather than living them. Don’t let writing about feelings replace speaking with others. Journal writing should be a tool to help you become more confident, not a crutch that increases your isolation. If you find yourself becoming too dependent on your journal, take a break from writing for a week or two.

The act of consciously and purposefully paying attention to symptoms and their antecedents and consequences makes the symptoms more an objective target for thoughtful observation than an intolerable source of subjective anxiety, dysphoria, and frustration. In ACT, the act of accepting the symptoms as an expectable feature of a disorder or illness, has been shown to be associated with relief rather than increased distress (Hayes et al., 2006). From a traumatic stress perspective, any symptom can be reframed as an understandable, albeit unpleasant and difficult to cope with, reaction or survival skill (Ford, 2009b, 2009c). In this way, monitoring symptoms and their environmental or experiential/body state "triggers" can enhance client's willingness and ability to reflectively observe them without feeling overwhelmed, terrified, or powerless. This is not only beneficial for personal and life stabilization but is also essential to the successful processing of traumatic events and reactions that occur in the next phase of therapy (Ford & Russo, 2006).

Even if we do manage to get our act together, the goalposts for what counts as “good enough” seem always to remain frustratingly out of reach. We must be smart and fit and fashionable and interesting and successful and sexy. Oh, and spiritual, too. And no matter how well we do, someone else always seems to be doing it better. The result of this line of thinking is sobering: millions of people need to take pharmaceuticals every day just to cope with daily life. Insecurity, anxiety, and depression are incredibly common in our society, and much of this is due to self-judgment, to beating ourselves up when we feel we aren’t winning in the game of life.

Nature’s ultimate goal is to foster the growth of the individual from absolute dependence to independence — or, more exactly, to the interdependence of mature adults living in community. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival. Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and ageappropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other. With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy — for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices — in other words, when autonomy is undermined. Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others—employers, fellow workers, social authority figures. The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence. To minimize the stress from threatened relationships, a person may give up some part of his autonomy. However, this is not a formula for health, since the loss of autonomy is itself a cause of stress. The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of “security” in a relationship, and even if we subjectively feel relief when we gain “security” in this manner. If I chronically repress my emotional needs in order to make myself “acceptable” to other people, I increase my risks of having to pay the price in the form of illness. The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style may avoid anxiety and block the subjective experience of stress but not the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.

There must be quite a few things a hot bath won’t cure, but I don’t know many of them. Whenever I’m sad I’m going to die, or so nervous I can’t sleep, or in love with somebody I won’t be seeing for a week, I slump down just so far and then I say: 'I’ll go take a hot bath.' I meditate in the bath.The water needs to be very hot, so hot you can barely stand putting your foot in it. Then you lower yourself, inch by inch, till the water’s up to your neck.

Mental health, contemporary psychiatrists tell us, consists of the ability to adapt to the inevitable stresses and misfortunes of life. It does not mean freedom from anxiety and depression, but only the ability to cope with these afflictions in a healthy way. “An outstanding feature of successful adaptation,” writes George Vaillant, “is that it leaves the way open for future growth.” Of course, Abraham Lincoln’s capacity for growth would prove enormous.

Fear of Dating Dating is a big part of the teenage years. Dances, parties, and other social events can make you long for a significant other. However, if you have social anxiety, you may be terrified of getting close to someone of the opposite sex. You may be afraid of saying something silly or acting inappropriately. Flirting, a playful way of getting noticed and letting someone know you like him or her, may seem impossible when you feel awkward and insecure.

...it is often reported that women with autism are more likely to internalise the anxiety and stress they feel around change, not wanting to draw attention to their inability to cope with the situation. This leads other people to believe they are coping, when in fact they are not. Repression of emotions and the effort involved in hiding them from others can cause long-term mental health problems, and eventually the facade crashes as the curtailed stress has to come out.

Physiological stress, then, is the link between personality traits and disease. Certain traits — otherwise known as coping styles — magnify the risk for illness by increasing the likelihood of chronic stress. Common to them all is a diminished capacity for emotional communication. Emotional experiences are translated into potentially damaging biological events when human beings are prevented from learning how to express their feelings effectively. That learning occurs — or fails to occur — during childhood. The way people grow up shapes their relationship with their own bodies and psyches. The emotional contexts of childhood interact with inborn temperament to give rise to personality traits. Much of what we call personality is not a fixed set of traits, only coping mechanisms a person acquired in childhood. There is an important distinction between an inherent characteristic, rooted in an individual without regard to his environment, and a response to the environment, a pattern of behaviours developed to ensure survival. What we see as indelible traits may be no more than habitual defensive techniques, unconsciously adopted. People often identify with these habituated patterns, believing them to be an indispensable part of the self. They may even harbour self-loathing for certain traits — for example, when a person describes herself as “a control freak.” In reality, there is no innate human inclination to be controlling. What there is in a “controlling” personality is deep anxiety. The infant and child who perceives that his needs are unmet may develop an obsessive coping style, anxious about each detail. When such a person fears that he is unable to control events, he experiences great stress. Unconsciously he believes that only by controlling every aspect of his life and environment will he be able to ensure the satisfaction of his needs. As he grows older, others will resent him and he will come to dislike himself for what was originally a desperate response to emotional deprivation. The drive to control is not an innate trait but a coping style. Emotional repression is also a coping style rather than a personality trait set in stone. Not one of the many adults interviewed for this book could answer in the affirmative when asked the following: When, as a child, you felt sad, upset or angry, was there anyone you could talk to — even when he or she was the one who had triggered your negative emotions? In a quarter century of clinical practice, including a decade of palliative work, I have never heard anyone with cancer or with any chronic illness or condition say yes to that question. Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child — or are simply too busy or too harassed themselves to pay attention. “My mother or father needed me to be happy” is the simple formula that trained many a child — later a stressed and depressed or physically ill adult — into lifelong patterns of repression.

Once a habit has been encoded, the urge to act follows whenever the environmental cues reappear. This is one reason behavior change techniques can backfire. Shaming obese people with weight-loss presentations can make them feel stressed, and as a result many people return to their favorite coping strategy: overeating. Showing pictures of blackened lungs to smokers leads to higher levels of anxiety, which drives many people to reach for a cigarette. If you’re not careful about cues, you can cause the very behavior you want to stop.

Overcoming panic attacks has left me humbled. It’s taught me how to be brave. It’s left me compassionate to the fears and sufferings of other people. It’s given me the wisdom that my thoughts and feelings are simply subjective responses, and don’t need to be taken as true reflections of reality. But the most important thing I’ve learnt from coping with panic is this: No matter what happens in life, no matter how hard things seem, no matter how painful things are, moments always pass like fluffy clouds in a blue sky, and I will be fine.

Cognitive Therapy Instead of behavior, cognitive therapy emphasizes changing thoughts and beliefs. Cognitive therapists believe that irrational beliefs or distorted thinking patterns lead to social anxiety so they teach patients to think in more rational, constructive ways.

Visualization One way to calm your mind is to replace your maladaptive thoughts with a relaxing, happy scene. You probably can remember a place where the scenery completely relaxed you--maybe it was at the beach or in your backyard, lying in a hammock. In visualization, you focus on this calming memory.

To suggest that someone requires a hug is to say something potentially, but only potentially, demeaning. It’s suggesting that they are, at least for the moment, rather like a child. They have the same kinds of emotional needs that we come to think of as essentially childlike. To need a hug is to admit that one is incapable of coping on one’s own, that one requires protection, guidance, the help of someone wiser and more capable, that one needs to have one’s troubles and anxieties reinterpreted by a more mature mind. It is to say, in shorthand, ‘I am at the moment like a child and I need someone else to be, for a while, like a parent.’ Yet even if we don’t usually like to admit it, there are in fact many times when we should be able to revert to a childlike position. There are moments of adult life when one seems petulant, scared, shy and sure that everything suddenly feels totally unfair. One’s ability to look after oneself is terribly depleted. At such times, to get ourselves back together, we need someone else to take the burden from us. We require the equivalent of what the parent does for the child. We are in need of someone to pat us on the head, to put us to bed early, tuck us in and hold us tight.

This feeling of stress triggers a cascade of physiological consequences. The hypothalamus and pituitary gland in the brain release hormones that cause the release of cortisol from the adrenal glands located on the kidneys. Cortisol increases heart rate, among other things, readying the body for “fight” or “flight.” Acutely, the release of cortisol is beneficial and helps you cope with whatever is urgently being demanded of you. But if the stress becomes chronic, maladaptive things begin to happen. Normally, the release of cortisol turns the hypothalamus and pituitary off, stopping the release of hormone, which in turn stops the further release of cortisol from the adrenal glands. It’s a nice, clean, negative feedback loop. But in the chronically stressed, the loop breaks. The brain stops reacting to cortisol. Our natural, automatic shutoff valve stops working. The brain keeps releasing hormone, and the adrenal glands keep dumping cortisol into the bloodstream, even when the stressful thing that initially triggered the stress response is no longer around. Chronic, elevated levels of cortisol have been associated with a weakened immune system, deficits in short-term memory, chronic fatigue syndrome, anxiety disorders, and depression.

anxiety, with its concomitant feelings of helplessness, isolation, and conflict, is an exceedingly painful experience. One tends to be angry and resentful toward those responsible for placing him in such a situation of pain. Clinical experience yields many examples like the following: A dependent person, finding himself in a situation of responsibility with which he feels he cannot cope, reacts with hostility both toward those who have placed him in the situation and toward those (usually parents) who caused him to be unable to cope with it. Or he feels hostility toward his therapist, whom he believes should bail him out

And what about this. When we’re thrust into it, we anxious folk can often deal with the present really rather well. It’s worth remembering this. As real, present-moment disasters occur, we invariably cope, and often better than others. The day after no sleep, I get on with things. At funerals, or when I’ve fallen off my bike, or the time I had to attend to my grandmother when she stopped breathing, or whenever a major work disaster plays out leaving my team in a panic, I’m a picture of calm. Dad used to call me “the tower of strength” in such moments. I also don’t tend to have a lot of bog-standard fear (as opposed to anxiety). In fact, I relish real, present-moment fear and actively seek it out.

These are the three false assumptions of the monkey mind-set. As long as I am certain, as long as I am perfect, and as long as others are okay I will be safe, able to relax, and happy. Each of these assumptions overestimates the threat and underestimates our ability to cope. Each of them treats the perception of threat as accurate, a problem to be fixed.

Mental health, contemporary psychiatrists tell us, consists of the ability to adapt to the inevitable stresses and misfortunes of life. It does not mean freedom from anxiety and depression, but only the ability to cope with these afflictions in a healthy way. “An outstanding feature of successful adaptation,” writes George Vaillant, “is that it leaves the way open for future growth.

Behavioral Therapy Behavioral therapy differs dramatically from classical psychoanalysis. Instead of dealing with an individual’s thoughts, feelings, and past experiences, it focuses solely on the specific behaviors that are causing problems. Behavioral therapists believe that all behaviors are learned and that you can relearn and replace maladaptive behaviors with more appropriate ones.

morning, be aware of My Presence with you. You may not be thinking clearly yet, but I am. Your early morning thoughts tend to be anxious ones until you get connected with Me. Invite Me into your thoughts by whispering My Name. Suddenly your day brightens and feels more user-friendly. You cannot dread a day that is vibrant with My Presence. You gain confidence through knowing that I am with you—that you face nothing alone. Anxiety stems from asking the wrong question: “If such and such happens, can I handle it?” The true question is not whether you can cope with whatever happens, but whether you and I together can handle anything that occurs. It is this you-and-I-together factor that gives you confidence to face the day cheerfully. PSALM 5:3; PSALM 63:1 NKJV; PHILIPPIANS 4:13

Most of us do not like not being able to see what others see or make sense of something new. We do not like it when things do not come together and fit nicely for us. That is why most popular movies have Hollywood endings. The public prefers a tidy finale. And we especially do not like it when things are contradictory, because then it is much harder to reconcile them (this is particularly true for Westerners). This sense of confusion triggers in a us a feeling of noxious anxiety. It generates tension. So we feel compelled to reduce it, solve it, complete it, reconcile it, make it make sense. And when we do solve these puzzles, there's relief. It feels good. We REALLY like it when things come together. What I am describing is a very basic human psychological process, captured by the second Gestalt principle. It is what we call the 'press for coherence.' It has been called many different things in psychology: consonance, need for closure, congruity, harmony, need for meaning, the consistency principle. At its core it is the drive to reduce the tension, disorientation, and dissonance that come from complexity, incoherence, and contradiction. In the 1930s, Bluma Zeigarnik, a student of Lewin's in Berlin, designed a famous study to test the impact of this idea of tension and coherence. Lewin had noticed that waiters in his local cafe seemed to have better recollections of unpaid orders than of those already settled. A lab study was run to examine this phenomenon, and it showed that people tend to remember uncompleted tasks, like half-finished math or word problems, better than completed tasks. This is because the unfinished task triggers a feeling of tension, which gets associated with the task and keeps it lingering in our minds. The completed problems are, well, complete, so we forget them and move on. They later called this the 'Zeigarnik effect,' and it has influenced the study of many things, from advertising campaigns to coping with the suicide of loved ones to dysphoric rumination of past conflicts.

Acting in New Ways Social anxiety also has a strong impact on how you act. As explained before, when people experience anxiety they usually either freeze or completely avoid the situation. These maladaptive coping mechanisms may protect you in the present, but will probably cause you to lose confidence and lower your self-esteem over time. The final part of coping with social anxiety is to practice new ways to behave.

[B]eyond hiding our need and neurotically pursuing self-esteem, there is a third way our neurotic anxiety about death interferes with love. And this is the darkest manifestation of all, as it makes us violent. Because our worldview is the source of our significance and self-esteem, we want to defend it from the criticisms of out-group members. Those who are different from us implicitly or explicitly call into question the things we hold most dear, the cultural values that ground and shape the contours of our identity and self-esteem in the face of death. In this, out-group members become a source of anxiety, an existential threat. To cope with the anxiety, we rush to defend our worldview and become dogmatic, fundamentalist, and ideological in regard to our values, culture, and way of life. We embrace our worldview as unique and exceptional, as superior to other worldviews, which we deem inferior, mistaken, and even dangerous. This mindset begins the process in which out-group members are denigrated and eventually demonized, sowing the seeds of violence. The point to note here is how this violence is fueled by an underlying neurotic fear that the cultural projects that we’ve invested in and sacrificed for are not actually immortal, eternal, timeless, or immune to death.

Freud had been the first to point out that these [driving forces in neurosis] were compulsive drives. He regarded these drives as instinctual in nature, aimed at satisfaction and intolerant of frustration. Consequently he believed that they were not confined to neuroses per se but operated in all human beings. If, however, neuroses were an outgrowth of disturbed human relationships, this postulation could not possibly be valid. The concepts I arrived at on this score were, briefly, these. Compulsive drives are specifically neurotic; they are born of feelings of isolation, helplessness, fear and hostility, and represent ways of coping with the world despite these feelings; they aim primarily not at satisfaction but at safety; their compulsive character is due to the anxiety lurking behind them. Two of these drives—neurotic cravings for affection and for power—stood out at first in clear relief

Writing on Paper A benefit of writing in a paper journal is that the only limitation is the size of the page. Be creative and make the book a reflection of your personality. Besides writing, you can draw or paint, glue in mementos like ticket stubs or photos, use different-colored pens and pencils, and insert letters and notes. You can write sideways or upside down on the page, and doodle in the margins. Writing in the journal can be fun. Your journal can be an expression of your individuality.

Problems in Your Social Life Social anxiety can make you feel empty and alone. You may feel as though you go through each day like a robot--simply doing only what you need to without drawing attention to yourself. You may feel trapped in an unfulfilling and unsatisfying life. When you suffer from anxiety, it is difficult to have the courage to change your situation. However, trying to get through life without the support of others is tough. The longer you live without creating fulfilling relationships, the more difficult it will be to make them in the future.

Problems in the Workplace This section shows how the problems you have in school carry over into the workplace. If you have a part-time job, you may already experience some of the following problems. If so, you should feel good that you are working on solving them now. They probably will not get better on their own. Many people who have suffered from social anxiety for years finally ask for help when they recognize that their careers are suffering. They realize that they will never reach the level of success they want if they do not overcome their social fears.

The psychological condition of fear is divorced from any concrete and true immediate danger. It comes in many forms: unease, worry, anxiety, nervousness, tension, dread, phobia, and so on. This kind of psychological fear is always of something that might happen, not of something that is happening now. You are in the here and now, while your mind is in the future. This creates an anxiety gap. And if you are identified with your mind and have lost touch with the power and simplicity of the Now, that anxiety gap will be your constant companion. You can always cope with the present moment, but you cannot cope with something that is only a mind projection — you cannot cope with the future. Moreover, as long as you are identified with your mind, the ego runs your life, as I pointed out earlier. Because of its phantom nature, and despite elaborate defense mechanisms, the ego is very vulnerable and insecure, and it sees itself as constantly under threat. This, by the way, is the case even if the ego is outwardly very confident. Now remember that an emotion is the body’s reaction to your mind. What message is the body receiving continuously from the ego, the false, mind-made self? Danger, I am under threat. And what is the emotion generated by this continuous message? Fear, of course.

EMOTIONAL INTENSITY DEFINED Emotional intensity can typically be described as strong and intense emotional reactions to various situations. Explosive outbursts, crying jags, paralyzing anxiety, or fear are all features of the negative aspects of emotional intensity (Sword, 2006a). But not all emotional reactions are negative or sad. Sometimes the extreme emotions include giddiness, highly frenetic energy, laughter, and general happiness. Most often, emotional intensity features the frequent vacillation between happiness and anxiety. That’s right, mood swings. Gifted children are prone to intense and somewhat erratic mood swings; it is the very nature of their giftedness.

and confused if someone does not appreciate their niceness. Others often sense this and avoid giving them feedback not only, effectively blocking the nice person’s emotional growth, but preventing risks from being taken. You never know with a nice person if the relationship would survive a conflict or angry confrontation. This greatly limits the depths of intimacy. And would you really trust a nice person to back you up if confrontation were needed? 3. With nice people you never know where you really stand. The nice person allows others to accidentally oppress him. The “nice” person might be resenting you just for talking to him, because really he is needing to pee. But instead of saying so he stands there nodding and smiling, with legs tightly crossed, pretending to listen. 4. Often people in relationship with nice people turn their irritation toward themselves, because they are puzzled as to how they could be so upset with someone so nice. In intimate relationships this leads to guilt, self-hate and depression. 5. Nice people frequently keep all their anger inside until they find a safe place to dump it. This might be by screaming at a child, blowing up a federal building, or hitting a helpless, dependent mate. (Timothy McVeigh, executed for the Oklahoma City bombing, was described by acquaintances as a very, very nice guy, one who would give you the shirt off his back.) Success in keeping the anger in will often manifest as psychosomatic illnesses, including arthritis, ulcers, back problems, and heart disease. Proper Peachy Parents In my work as a psychotherapist, I have found that those who had peachy keen “Nice Parents” or proper “Rigidly Religious Parents” (as opposed to spiritual parents), are often the most stuck in chronic, lowgrade depression. They have a difficult time accessing or expressing any negative feelings towards their parents. They sometimes say to me “After all my parents did for me, seldom saying a harsh word to me, I would feel terribly guilty complaining. Besides, it would break their hearts.” Psychologist Rollo May suggested that it is less crazy-making to a child to cope with overt withdrawal or harshness than to try to understand the facade of the always-nice parent. When everyone agrees that your parents are so nice and giving, and you still feel dissatisfied, then a child may conclude that there must be something wrong with his or her ability to receive love. -§ Emotionally starving children are easier to control, well fed children don’t need to be. -§ I remember a family of fundamentalists who came to my office to help little Matthew with his anger problem. The parents wanted me to teach little Matthew how to “express his anger nicely.” Now if that is not a formula making someone crazy I do not know what would be. Another woman told me that after her stinking drunk husband tore the house up after a Christmas party, breaking most of the dishes in the kitchen, she meekly told him, “Dear, I think you need a breath mint.” Many families I work with go through great anxiety around the holidays because they are going to be forced to be with each other and are scared of resuming their covert war. They are scared that they might not keep the nice garbage can lid on, and all the rotting resentments and hopeless hurts will be exposed. In the words to the following song, artist David Wilcox explains to his parents why he will not be coming home this Thanksgiving: Covert War by David Wilcox

Journal Writing Keeping a journal is an extremely valuable practice. Right now, your mind may be racing with anxious thoughts and worries. Writing them down helps you sort through your problems and come to a deeper understanding of the issues in your life. The benefits of journal writing may be more than just psychological. Dr. James Pennebaker, a researcher in Texas, discovered that when people write about difficult experiences for twenty minutes at a time over a period of three to four days, their immune system functioning increases. This indicates that the simple act of writing about emotions has a direct impact on your body’s ability to withstand stress and fight infection and disease.

Shyness is not necessarily a problem. It can be a very nice aspect of your personality. Many introverted celebrities, such as Chelsea Clinton and the late Princess Diana, are considered sophisticated and classy because of their reserved personalities. Shyness can make you appear intelligent, discreet, and circumspect. Shy people are valued as good listeners and are more likely to be considered kindhearted, conscientious, and trustworthy. They rarely are overaggressive or obnoxious and usually try not to act in ways that hurt others. A degree of shyness also allows you to be cautious and judge situations before jumping into them. You can stand back, observe, make careful decisions, and then act deliberately. With all of these positive qualities, it is no surprise that between 10 and 20 percent of those who consider themselves shy like their personalities and don’t want to change. They are comfortable with being quiet and are confident that when they do have something to say others will pay attention. Distinguishing social anxiety from normal shyness is sometimes difficult. It has to do with the level of distress and impairment associated with social fears. If you prefer being quiet and listening to others and you feel comfortable with that role, you probably don’t have social anxiety. On the other hand, if you don’t speak up because you are afraid others won’t like what you say or you are terrified of sounding foolish, you most likely have a degree of social anxiety.

When Does Social Anxiety Appear? Social anxiety can develop at any age. Many people remember feeling afraid during social situations as early as kindergarten. Others don’t develop symptoms until they are adults. However, social anxiety most commonly appears in adolescence, between the ages of 15 and 20. When you think about the changes that are taking place in your life at this time, this fact makes a lot of sense. As a teenager, you are expected to act more like an adult than a child. You are beginning to take on adult responsibilities and see yourself as a part of society. Meeting the expectations of others and making a good impression are very important. As a result, you may worry about what others think of you and be afraid of acting incorrectly.

Replace Maladaptive Thoughts with Coping Statements When you feel anxious in social situations, you probably have many false beliefs and maladaptive thoughts, such as “I don’t fit in” or “I’m so awkward.” An important part of coping with social anxiety is to be able to recognize when your thinking is clouded. Use your journal to record events that make you feel anxious, and examine what you were thinking at the time and why. It may help to refer to the list of maladaptive thinking patterns on pages 25 and 26 to help you see when your thinking is faulty. Remember that figuring out your faulty thoughts requires that you be totally honest with yourself. Once you have identified your maladaptive thoughts, you can work to replace them with more constructive thoughts, called coping statements.

How to Perform Paced Breathing Paced breathing is a slow, regular rate of deep breathing. There are three main points to keep in mind when practicing: 1. Breathe slowly. Concentrate on slowing the rate of your breathing to eight or ten breaths per minute. 2. Inhale and exhale through your nose. It is more difficult to take shallow breaths from the upper chest when you breathe through your nose. This keeps you from hyperventilating. 3. Choose a neutral word to focus on while practicing paced breathing. The words “one,” “calm,” and “relax” work well. Each time you exhale, say the word in your mind. This will assist in keeping your breathing evenly paced, and will help to reduce the chances of interfering thoughts. During the day, when you are not practicing paced breathing, alternate paced and normal breathing. Every single breath you take does not have to come from the diaphragm. There should be a natural rhythm between chest breathing and diaphragm breathing. Find a comfortable balance but do more diaphragmatic breathing than you usually do. Tony is at a local law office to interview for an internship. He wants to become a trial lawyer. He is very excited by the thought of working professionally, but is so anxious about the interview that he feels lightheaded and numb. He is afraid he won’t be able to say what he wants to, and that his answers will be incorrect. As he waits for the interviewer, Tony starts to concentrate on slowing the rate of his breathing. With only a few deep breaths, his mind clears and his racing heart calms. He feels more relaxed and is confident.

Easing Your Mind’s Responses to Anxiety When you are in social situations, your mind might race with negative thoughts about yourself, expectations about what is going to happen, or fears about what others are thinking. Often, these thoughts develop into a vicious cycle: Because you believe you don’t have anything worthwhile to express, you expect to have difficulty speaking. When you have difficulty speaking, you believe that people think you’re stupid. Because you believe people think you are stupid, you have even more difficulties with conversation. With your mind in such a tizzy, it is difficult to relax and be yourself. Your imagination is a very powerful tool to help combat negative self-talk and reduce stress, tension, and anxiety. This section will help you learn to think your way out of this mental trap.

Kelly McGonigal, a health psychologist at Stanford University, warned about the dangers of stress for a full decade before she realized that maybe it was her advice, rather than stress itself, that was sending people to their graves faster. “I’m converting a stimulus [stress] that could be strengthening people into a source of disease.” With a breakthrough in her thinking, and some powerful new research, McGonigal made a complete turnaround. Turns out, stress might just be our friend. Just as you put stress on a muscle to make it stronger (by lifting weights or running), emotional stress can make us physically and psychologically stronger too. McGonigal now highlights new research showing that when you change your mind about stress, you can literally change your body’s physical reaction to it. In an eight-year study, adults who experienced a “lot of stress” and who believed stress was harmful to their health had a 43% increase in their risk of dying. (That sure stressed me out.) However, people who experienced an equal amount of stress but did not view stress as harmful were no more likely to die! McGonigal says that physical signs of stress (a pounding heart, faster breathing, breaking out in a sweat) aren’t necessarily physical evidence of anxiety or signs that we aren’t coping well with pressure. Instead, we can interpret them as indications that our body is energized and preparing us to meet the next challenge. The bottom line is, science has now proven that how you think about stress matters—the story you attach to stress. Telling yourself it’s good for you instead of harmful could mean the difference between a stress-induced heart attack at 50 or living well into your 90s.

Paced Breathing People who experience anxiety often breathe improperly. They take shallow breaths from their chests instead of deep breaths from their diaphragms. (The diaphragm is the muscle that separates your chest cavity from your abdominal cavity and that makes it possible for you to inhale and exhale.) Breathing from the chest can cause you to hyperventilate, which has a negative effect on your body’s chemistry. Hyperventilation does not only mean panting or gasping for air; it also includes yawning, holding your breath, and sighing. The symptoms of hyperventilation are similar to those associated with anxiety: shortness of breath, lightheadedness, faintness, tingling or numbness in your fingers and toes, and the feeling that you are walking around in a dream. If you deal with anxiety and begin to hyperventilate, it will make the situation even worse.

How Journal Writing Helps Because of your social anxiety, you may be so afraid that any opinions you have are wrong that you remain neutral on most subjects. Or, you might feel like a chameleon who changes opinions depending on the situation. Not expressing your opinions can make you feel empty and unsure of what you really believe. Writing your thoughts and feelings in a journal can help you figure out your likes and dislikes, your opinions on tough issues, and what you stand for. Once you have your true beliefs down on paper, they will seem more concrete and you will be able to remember them during social situations. Although you probably are aware of what causes you the most anxiety, you also may have worries that are more difficult to identify. People often use various mental tricks to bury problems that are painful or difficult. As you write in your journal, you will become more aware of hidden fears and worries. Once they are brought into the open, you can begin to cope with them more effectively. Writing about events also makes it easier to be objective. While a belief, such as “Everyone thinks I’m stupid,” may cross your mind unconsciously, writing it down makes you realize how false and exaggerated it is. Once you see how maladaptive some of your thoughts are, it is easier to change them. In addition, a journal is valuable whenever you feel discouraged. Reviewing past entries will remind you how much you have improved over time. This insight will help you stay motivated and will make you want to keep working on the problem. Past entries are also helpful in figuring out how to deal with events in the present. You can look back at various situations, discover what actions worked (or didn’t), and feel confident in repeating them (or not).

Social Skills Training Social skills training is based on the belief that socially anxious people lack certain social skills, such as how to make small talk or introduce themselves to strangers. Therapists think that anxiety would lessen for people if they knew the correct way to behave. In social skills training, you practice techniques such as rehearsal (practicing a certain skill until it becomes comfortable), modeling (imitating others in social situations until the behavior feels natural), and role playing. You also receive homework assignments, such as “This week, talk about the weather with three strangers.” A problem with this type of therapy is that even though many people know how they should act, they can’t do it because of fear, negative thoughts, and avoidance. Although practicing social skills may take away some of the uncertainty, it doesn’t address the deeper issues.

How to Perform Progressive Muscle Relaxation Make sure you are wearing loose clothing and that you remove your shoes. Sit in a comfortable chair with your body fully supported. First, tense all the muscles in the area you are targeting. Concentrate on how tight they feel. Next, relax the muscles that were just tensed. Imagine they have turned to jelly and concentrate on how limp and loose they feel. When that muscle group is completely relaxed, move on to the next area. It is recommended that you work all the major muscle groups in your body, listed as follows. When you have finished, keep your eyes closed for a few seconds, then get up slowly. -Right foot -Right calf and foot -Entire right leg -Left foot -Left calf and foot -Entire left leg -Right hand -Right forearm and hand -Entire right arm -Left hand -Left forearm and hand -Entire left arm -Face -Neck and shoulders -Abdomen -Chest

Who Suffers? If you have social anxiety, you are not alone. The National Comorbidity Study found social phobia to be the third most common psychiatric disorder, after major depression and alcohol dependence. Experts believe that millions of people suffer from it. It is difficult to get exact numbers because the nature of social anxiety often makes it difficult for people to seek help. Many people who appear confident and strong suffer silently for years before telling anyone how they feel. In the general population, social anxiety appears to affect more women than men. This may be due in part to the social norms that determine that women should be less aggressive and more reserved than men. However, more men seek treatment, possibly because social anxiety has more of an impact on the jobs traditionally held by men. As gender roles in society continue to shift, these statistics will probably change.

Ideas for Journal Entries You may find the following ideas useful in beginning your journal or keeping the entries varied. If you are not used to expressing your thoughts on paper, it may seem awkward at first. The longer you do it, the easier it will become. You’ll be amazed at the insight you gain into your life. -Write about your most memorable experience with social anxiety. How did you feel? What did you think? How did others react? Why do you think the event happened? -Write about situations that make you anxious every day. Record your thoughts, feelings, and actions. You may want to divide the page into columns with the headings: situation or event; negative thoughts; physical reactions; and actions. Following is an example of how this may look: Situation or Event Should I attend the first art class after school. Negative Thoughts I thought about skipping out. I was afraid of what people would think. I wanted to do a good job. Physical Reactions I felt a shortness of breath. In general, I was nervous and in a bad mood. Actions I took some deep breaths and visualized the class going well. Later, I became engrossed in my drawing. -Write about a time when you were pleased with how you acted in a social situation. -Identify times when anxiety symptoms kept you from doing something that you really wanted to do. How did you feel? What might have happened if you had not been afraid? -Write a letter to someone who made you feel bad about yourself. You aren’t going to show the letter to anyone, so feel free to write whatever you want. -Write out a conversation with your inner voice. Begin the entry with a question directed to yourself, then write your mental response. It may help to label the different voices A and B. Dialogue writing is a very effective way to get to the heart of the matter.

Group Therapy Group therapy has been very successful for treating social anxiety, and there are many benefits to it. Members are a source of support for each other and the group allows you to address your fears in a safe environment. Listening to others’ experiences helps you realize the ways in which social anxiety affects you. Group therapy also helps you become more comfortable speaking in front of people and sharing your thoughts. Moreover, it is typically less expensive than one-on-one therapy because group members share the cost. There are also disadvantages to group therapy. You’ll spend less time talking about your own problems than in one-on-one therapy. You might also worry about confidentiality. It is often difficult to trust that strangers aren’t going to talk about your problems outside of the group. If you have this fear, it can be difficult to open up, thus lessening the effectiveness of group therapy.

Loneliness A recent study showed that 13.5 percent of college students are severely lonely. Overall, they felt that they were to blame for their loneliness. Characteristics of social anxiety, such as shyness, fear of rejection, and lack of social knowledge and experience, often were listed as reasons. Loneliness is not the same thing as being alone. Many people enjoy solitude and find it a good time to be creative. They use time alone to write, read, listen to music, work on a hobby, or exercise. Often, sensitive people feel recharged after spending time alone. They make private time part of their schedules. Loneliness is a problem when you find it unpleasant and distressing. Social bonds are considered necessary to psychological well-being. When it is difficult to develop and maintain relationships, you may find yourself vulnerable to increased stress, depression, other emotional disorders, and impaired physical health.

Easing Your Body’s Response to Anxiety As explained earlier, anxiety has a strong impact on your body. When you feel anxious, your heart races, breathing becomes difficult, your face gets red, and you tremble. When your body deals with anxiety over long periods of time, you may develop stomachaches, headaches, depression, and sore muscles. To combat these negative effects, you need to learn how to relax physically. Once your muscles relax, then the other components of a relaxed state follow: Your breathing pattern slows and deepens, your heart rate and blood pressure decline, your hands and feet feel warm, changes in mood occur, and you feel calmer. There are many ways to relax your body. Some techniques focus on your muscles. Others center on breathing patterns. Relaxation techniques are most beneficial if you practice them on a regular basis. Your body must have these responses “memorized” for them to be helpful in a time of anxiety.

A Final Word Now that you have become familiar with social anxiety, you know that it is a common problem, especially for teenagers. You’ve learned that it affects you physically, mentally, and behaviorally, and that it can have a tremendous impact on all aspects of your life. Most important, you’ve learned ways to cope with social anxiety. Now, make the techniques presented in this book part of your daily life. With practice you will be able to calm anxious feelings and develop self-confidence in social situations. Remember that change does not happen overnight. There will be tough times mixed in with the good. It may be necessary to see a professional therapist or to take medication. There is no reason social anxiety needs to remain a part of your life. If you are committed to lessening your anxiety, you will see great results. With time and hard work, you can become the person you want to be and live a healthy, happy, and productive life.

The History of Social Anxiety The fact that some people are shyer than others has been observed since ancient times. However, the medical community didn’t become interested in this condition until the 1970s, when Philip Zimbardo founded the Stanford Shyness Clinic. At the time, many professionals believed that shyness was a natural state that children eventually outgrew. Zimbardo showed that shyness actually is a widespread psychological problem that has deep and lasting effects on those who suffer from it. This new awareness led to a great deal of research into the causes and treatment of social anxiety. Today, the condition is in the spotlight. Ads in magazines and commercials on television tell about social anxiety and advertise medications to treat it. People are becoming more open about discussing when they feel anxious and feel less ashamed about asking for help. The time has never been better for you to try to overcome your social anxiety.

How to Create Coping Statements Coping statements should be brief and simple so you can easily remember them when you feel anxious. They should apply directly to the situation you fear--if you are worried about your hand shaking while you eat, a statement about public speaking won’t help. They should also be realistic. You might try to counter anxious feelings with a statement like, “I won’t be nervous.” That statement is too unrealistic to help; everyone feels nervous at times. Your statements should help you cope with the nervousness. Some examples of effective coping statements include: -Relax. I’m in control. -My friends will still accept me if I say something silly. -It’s not that bad. I can do it. You may want to write your coping statement on a piece of paper to carry with you. You can also write other helpful comments on it. Then, when you become anxious, you can read the coping card and can remind yourself that you can change the way you think. Often, simply having the card with you is calming whether you refer to it or not.

Journaling Tips -Try to write every day. Set aside a special time--perhaps right before you go to bed--to reflect on what happened during that day. Writing things down soon after they happen will help you to be honest and objective. If you wait, you may not remember the details as well, and maladaptive thinking patterns may cloud your interpretations. -Record the date and time for every entry. Also, give each entry a title that reflects what you wrote about. This will help when you search for old entries about a particular day or topic. -Don’t worry about spelling, grammar, and punctuation, or organization. Being a perfectionist will lead to frustration. You aren’t going to be graded on your journal--just write whatever comes to mind. -Leave blank space for future comments. Reflecting on entries weeks, months, or even years after you wrote them will help you record your progress. -Keep the journal in a safe place. Journal writing is most effective when you are completely honest. This may be hard if you are afraid your parents or siblings might read it.

Behavior Rehearsal Behavior rehearsal is practicing your actions until you feel confident about them. The first step is to visualize the ideal situation. Imagine the scenario and see yourself feeling relaxed and comfortable. Imagine others reacting positively and think about what you will say and do. It may also help to write out the scenario in your journal. Sometimes writing down what you want to say “cements” it in your mind. Next, practice what you imagined. It may help to do this with a friend or family member acting as the other characters. For instance, if you are afraid to call about a job opening, rehearse what you want to say with your mom or dad playing the role of the employer. Or, if you are going to an event where you do not know many people, practice with a sibling introducing yourself to a stranger. Pay special attention to the various maladaptive thoughts and expectations you may have regarding the situation. Analyze them and explore how realistic they are. Once you feel you have a handle on the situation, develop a few coping statements for extra support.

Avoiding School or Dropping Out Unfortunately, school sometimes becomes so difficult for people with social anxiety that they start avoiding it as much as they can. This has a serious effect on a person’s future. It is difficult to get a good job with a decent salary if you do not have a high school diploma. If you drop out, you are setting yourself up for a difficult time. Cedric has always had a hard time in school because of his extreme social anxiety. He feels uncomfortable with his classmates and avoids speaking with them. During classes, he always sits in the back and never participates. When teachers call on him, he usually mumbles “I don’t know.” As a result of his social anxiety, he has low self-esteem and suffers from depression. One day, he decided that it didn’t matter if he went to school or not. Some mornings, he hides in the yard until his mother leaves for work, and then he stays in his room all day. Other times, he wanders around the woods. Cedric has no idea what he wants to do with his life. He knows it is only a matter of time before his mother finds out he has been missing school. He wishes he could just hide and hibernate. Deep down, he knows he has a problem, but he doesn’t know what to do about it. Secretly, he hopes his mother forces him to see a therapist because he is afraid of what the rest of his life is going to be like.

Modeling Modeling is the process of watching how others act in certain situations, then copying their behavior. For example, if you are worried about the first impression you make, pay attention to how others present themselves. What traits give a good first impression? What do people say? How do confident people carry themselves? Also examine people who give a bad first impression and try to determine why. Imitate the actions that impressed you. With time, you will feel more comfortable with modeling and begin to own the traits you admire in others. Modeling works very well when you are in an unfamiliar situation. If you are not sure how to act, watching others will give you clues. Sam’s best friend’s father passed away and Sam attended the service. He had never been to a funeral before and felt very uncomfortable. As he stood in the receiving line, he felt anxious about what to say and how to act. He was terrified of saying the wrong thing and hurting his friend’s family. Sam stepped out of line and stood to the side for a moment. He observed what other people did as he breathed deeply and practiced relaxation techniques. After a few minutes, he figured out what to do and returned to the line. When he reached his friend’s mother, he gave her a hug and said, “I’m so sorry for your loss.” She hugged him back and thanked him for coming. Sam felt confident that he had acted appropriately.

Choosing Careers Many people with social anxiety do not have the job they would like the most because of fear. They hold jobs in which their duties are clear and repetitive. They let other people make decisions because they do not want to be responsible. Social anxiety often causes people to find careers in which they can work alone. Many women with social anxiety immerse themselves in family to avoid the workplace altogether. People suffering from social anxiety often remain at the same position for a long time because they are not seen as leaders. They avoid managerial roles and usually have a hard time communicating. As a result, work becomes boring, uninspired, and unfulfilling. Debra has worked at the Boston Public Library for five years, returning books to the shelves. It is a very peaceful job and the only time she has to speak with people is when they ask her where to find certain books. She has always been a big reader, and the job seems like the perfect fit. Lately, however, she has been feeling dissatisfied with her life. The library job doesn’t pay very much so she still lives with her parents, at age twenty-seven. Most people she went to school with have exciting jobs and are getting married. Often, Debra feels like life is passing her by. However, when she thinks about applying for a new job, Debra becomes very anxious. She is embarrassed that she has limited work experience and fears people will not take her seriously. She reads the Help Wanted section of the paper every day but is too scared to call for more information or to send out her résumé.

Generalized Social Anxiety In contrast to people with specific social anxieties, you may be afraid in a wide variety of situations. You might feel that people are judging everything you do and you might set unreasonable standards of perfection for yourself. This condition is called generalized (or discrete) social anxiety. Generalized social anxiety accounts for 80 percent of all cases of social anxiety. Often, people with generalized social anxiety get caught in a vicious cycle. Because they are overly anxious in many situations, they act in clumsy and awkward ways, which in turn makes them feel even more discouraged and anxious. This cycle often results in depression and chronic stress. Generalized social anxiety can affect almost every aspect of your life. This has been the case for Toni, a college senior. In high school, I hardly had any friends. I didn’t participate in any extracurricular activities and managed to get by with average grades. Because I attend a large state university, I am even more invisible. So far, I have avoided any class that has any interaction with my peers, such as discussion groups or labs. As graduation approaches, I need to decide what type of career I want. The thought of job interviews terrifies me. I am considering grad school but would need recommendations to apply. I haven’t even spoken to most of my professors, and the ones who know me probably can’t say anything good about me. As a result, I’m really depressed. When I imagine the future, I can’t see myself being happy. I’ll probably move back to my parents’ house after graduation. I know they are disappointed in me, and that makes me feel like a complete failure.

The first step in retracing our way to health is to abandon our attachment to what is called positive thinking. Too many times in the course of palliative care work I sat with dejected people who expressed their bewilderment at having developed cancer. “I have always been a positive thinker,” one man in his late forties told me. “I have never given in to pessimistic thoughts. Why should I get cancer?” As an antidote to terminal optimism, I have recommended the power of negative thinking. “Tongue in cheek, of course,” I quickly add. “What I really believe in is the power of thinking.” As soon as we qualify the word thinking with the adjective positive, we exclude those parts of reality that strike us as “negative.” That is how most people who espouse positive thinking seem to operate. Genuine positive thinking begins by including all our reality. It is guided by the confidence that we can trust ourselves to face the full truth, whatever that full truth may turn out to be. As Dr. Michael Kerr points out, compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defence of the child into a life principle. The onset of symptoms or the diagnosis of a disease should prompt a two-pronged inquiry: what is this illness saying about the past and present, and what will help in the future? Many approaches focus only on the second half of that healing dyad without considering fully what led to the manifestation of illness in the first place. Such “positive” methods fill the bookshelves and the airwaves. In order to heal, it is essential to gather the strength to think negatively. Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden. Even more fundamentally, not posing those questions is itself a source of stress. First, “positive thinking” is based on an unconscious belief that we are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. Whether or not the apprehension is conscious, it is a state of stress. Second, lack of essential information about ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamicpituitary-adrenal (HPA) stress response. Third, stress wanes as independent, autonomous control increases. One cannot be autonomous as long as one is driven by relationship dynamics, by guilt or attachment needs, by hunger for success, by the fear of the boss or by the fear of boredom. The reason is simple: autonomy is impossible as long as one is driven by anything. Like a leaf blown by the wind, the driven person is controlled by forces more powerful than he is. His autonomous will is not engaged, even if he believes that he has “chosen” his stressed lifestyle and even if he enjoys his activities. The choices he makes are attached to invisible strings. He is still unable to say no, even if it is only to his own drivenness. When he finally wakes up, he shakes his head, Pinocchio-like, and says, “How foolish I was when I was a puppet.

Cognitive-Behavioral Therapy There are almost no pure cognitive or behavioral therapists. Instead, most therapists use a combination of both techniques. This is known as cognitive-behavioral therapy. It is generally recognized as the best therapy for social anxiety. In cognitive-behavioral therapy, a therapist helps you identity maladaptive thinking patterns and replace them with new ways of thinking. He or she also teaches you relaxation techniques and new behaviors that make you feel more comfortable in social situations. Cognitive-behavioral therapy uses many of the same techniques that we explored in the previous chapter. Although you might make great strides on your own, sometimes it is easier and faster to have someone guide you. Often it is difficult for people to explore hidden beliefs about themselves. A professional therapist is experienced in working with people who are trying to change. Often a therapist will see connections in your situation that you cannot. Carlos was terrified of speaking in class. Whenever the teacher called on him, his heart raced, he blushed, and his stomach felt upset. His therapist first had him focus on his thoughts during class. As an experiment, she had him purposely answer a question incorrectly during biology class. To his surprise, the teacher didn’t make a big deal out of it, and the other students didn’t laugh. As a result, Carlos realized that his imagined consequences for making errors were greatly exaggerated. He also realized that he held himself to a higher standard than other people, including the teacher, did. Next, his therapist showed him various relaxation techniques to lessen the physical symptoms of anxiety. Soon, he felt more comfortable and even volunteered to lead a discussion group.

This linking of bullying to mental illness and the idea that it causes 'life-long damage' really concerns me. I fear it is the anti-bullying industry that is the real threat to young people's state of mind. Rather than reassure, it adamantly stresses, indeed exaggerates, the harmful effects of bullying. Such scaremongering is impacting on young people's coping mechanisms and possibly exacerbating the problem. As such, it actually contributes to the young feeling overly anxious, and ironically creates an atmosphere likely to encourage symptoms of mental ill health. The headline should be 'anti-bullying causes mental illness'. The anti-bullying industry has made a virtue of catastrophizing, always arguing things are getting worse. With the advent of social media, bullying experts are quick to point out there is now no escape: 'Bullying doesn't stop when school ends; it continues twenty-four hours a day'. Children's charities continually ratchet up the fear factor. Surely it is irresponsible when Sarah Brennan, CEO of YoungMinds, declares that 'if devastating and life-changing' bullying isn't dealt with 'it can lead to years of pain and suffering that go on long into adulthood'. Maybe I am being over-cynical about the anti-bullying bandwagon, and there is a danger that such a critique will cause me to be labelled callous and hardhearted. Certainly, when you read of some young people's heartbreaking experiences, there is no doubt that it can be a genuinely harrowing experience to go through. But when we hear these sad stories, surely our job as adults should be to help children and young people put these types of unpleasant experience[s] behind them, to at least put them in perspective, rather than stoking up their anxieties and telling them they may face 'years of pain and suffering'.

How to Perform Visualization To practice visualization, sit in a comfortable position and relax any muscle tension. Once you feel relaxed, begin to visualize a pleasant scene. Imagine every aspect of the scene, using all of your senses. For instance, if you visualize sitting on a beach watching the ocean waves lapping against the shore, imagine first what the scene looks like, then imagine how the sand feels on your bare feet. Take a deep breath and imagine how the clean ocean air smells and tastes. Next, listen for the sounds of the waves and seagulls. As you become more involved with your mental picture, your body will relax and you will be able to let go of your worrisome thoughts. It often helps to make positive, affirmative statements, such as “I feel calm and relaxed,” while practicing to block negative thoughts more effectively. You could picture also an image that represents the tension you feel when you begin, such as a kite that is stuck in a tree getting more and more tangled. As you become relaxed, imagine the string loosening and the kite becoming free and soaring in the sky. With practice, you will be able to use this technique to help yourself relax whenever you feel distressed. Lori spent last Thanksgiving at her best friend Haley’s house. Most of the members of Haley’s large, extended family were there. Everyone was talking at once, the children were running around, and Lori felt completely overwhelmed. It was so different from her quiet house. As she felt herself getting more agitated and anxious, she went upstairs to the bathroom and began to visualize herself at her family’s quiet cabin. She heard the wind rustling through the leaves and the chirping of birds. She smelled the soil and felt the coolness of the air. Soon, she felt calm and relaxed and was able to return downstairs.

I heard the fear in the first music I ever knew, the music that pumped from boom boxes full of grand boast and bluster. The boys who stood out on Garrison and Liberty up on Park Heights loved this music because it told them, against all evidence and odds, that they were masters of their own lives, their own streets, and their own bodies. I saw it in the girls, in their loud laughter, in their gilded bamboo earrings that announced their names thrice over. And I saw it in their brutal language and hard gaze, how they would cut you with their eyes and destroy you with their words for the sin of playing too much. “Keep my name out your mouth,” they would say. I would watch them after school, how they squared off like boxers, vaselined up, earrings off, Reeboks on, and leaped at each other. I felt the fear in the visits to my Nana’s home in Philadelphia. You never knew her. I barely knew her, but what I remember is her hard manner, her rough voice. And I knew that my father’s father was dead and that my uncle Oscar was dead and that my uncle David was dead and that each of these instances was unnatural. And I saw it in my own father, who loves you, who counsels you, who slipped me money to care for you. My father was so very afraid. I felt it in the sting of his black leather belt, which he applied with more anxiety than anger, my father who beat me as if someone might steal me away, because that is exactly what was happening all around us. Everyone had lost a child, somehow, to the streets, to jail, to drugs, to guns. It was said that these lost girls were sweet as honey and would not hurt a fly. It was said that these lost boys had just received a GED and had begun to turn their lives around. And now they were gone, and their legacy was a great fear. Have they told you this story? When your grandmother was sixteen years old a young man knocked on her door. The young man was your Nana Jo’s boyfriend. No one else was home. Ma allowed this young man to sit and wait until your Nana Jo returned. But your great-grandmother got there first. She asked the young man to leave. Then she beat your grandmother terrifically, one last time, so that she might remember how easily she could lose her body. Ma never forgot. I remember her clutching my small hand tightly as we crossed the street. She would tell me that if I ever let go and were killed by an onrushing car, she would beat me back to life. When I was six, Ma and Dad took me to a local park. I slipped from their gaze and found a playground. Your grandparents spent anxious minutes looking for me. When they found me, Dad did what every parent I knew would have done—he reached for his belt. I remember watching him in a kind of daze, awed at the distance between punishment and offense. Later, I would hear it in Dad’s voice—“Either I can beat him, or the police.” Maybe that saved me. Maybe it didn’t. All I know is, the violence rose from the fear like smoke from a fire, and I cannot say whether that violence, even administered in fear and love, sounded the alarm or choked us at the exit. What I know is that fathers who slammed their teenage boys for sass would then release them to streets where their boys employed, and were subject to, the same justice. And I knew mothers who belted their girls, but the belt could not save these girls from drug dealers twice their age. We, the children, employed our darkest humor to cope. We stood in the alley where we shot basketballs through hollowed crates and cracked jokes on the boy whose mother wore him out with a beating in front of his entire fifth-grade class. We sat on the number five bus, headed downtown, laughing at some girl whose mother was known to reach for anything—cable wires, extension cords, pots, pans. We were laughing, but I know that we were afraid of those who loved us most. Our parents resorted to the lash the way flagellants in the plague years resorted to the scourge.

Central to any understanding of stress, health and disease is the concept of adaptiveness. Adaptiveness is the capacity to respond to external stressors without rigidity, with flexibility and creativity, without excessive anxiety and without being overwhelmed by emotion. People who are not adaptive may seem to function well as long as nothing is disturbing them, but they will react with various levels of frustration and helplessness when confronted by loss or by difficulty. They will blame themselves or blame others. A person’s adaptiveness depends very much on the degree of differentiation and adaptiveness of previous generations in his family and also on what external stressors may have acted on the family. The Great Depression, for example, was a difficult time for millions of people. The multigenerational history of particular families enabled some to adapt and cope, while other families, facing the same economic scarcities, were psychologically devastated. “Highly adaptive people and families, on the average, have fewer physical illnesses, and those illnesses that do occur tend to be mild to moderate in severity,” writes Dr. Michael Kerr. Since one important variable in the development of physical illness is the degree of adaptiveness of an individual, and since the degree of adaptiveness is determined by the multigenerational emotional process, physical illness, like emotional illness, is a symptom of a relationship process that extends beyond the boundaries of the individual “patient.” Physical illness, in other words, is a disorder of the family emotional system [which includes] present and past generations. Children who become their parents’ caregivers are prepared for a lifetime of repression. And these roles children are assigned have to do with the parents’ own unmet childhood needs — and so on down the generations. “Children do not need to be beaten to be compromised,” researchers at McGill University have pointed out. Inappropriate symbiosis between parent and child is the source of much pathology.

-Write out a conversation with your inner voice. Begin the entry with a question directed to yourself, then write your mental response. It may help to label the different voices A and B. Dialogue writing is a very effective way to get to the heart of the matter. The following passage is an example of typical dialogue writing: A: Tomorrow is a big day. You have an interview at a college. How do you feel? B: I am really nervous. This is the first interview and I don’t know what it is going to be like. A: What are you afraid of? B: I’m afraid I’ll stutter and say something stupid. I’m worried the person will ask a question and I won’t know what to say. A: What do you want to discuss? B: I think it is good that I was on the basketball team for four years. That shows commitment and dedication. I also got decent grades and earned a blue ribbon at the science fair. A: What about your hobbies outside of school? B: I really like to read. I could mention that. I could talk also about the vacations my family has taken. They are pretty interesting. I enjoy my part-time retail job. A: It sounds like you do a lot. B: I guess I am good at organizing my life and accomplishing what needs to be done. Hey, that would sound good in an interview! -Try focused “freewriting.” Pick one topic, such as school, friends, or family, and write everything that comes to mind about that topic. Write for at least ten minutes or until you’re certain that you have run out of things to write. -Write your belief system. Start by writing “I believe…” at the top of a clean page. Then write whatever comes to mind. It may help to ask yourself questions when you get stuck such as “What do I believe about friendship?” “What is my personal style?” or “What are my gifts and abilities?” -Write about an event from your perspective, then write about the same event from someone else’s point of view. For example, if you had a hard time answering a question during class, write about how you felt, what you thought, and how you behaved. Next, pretend you are the teacher writing about the same event. What do you think he or she was thinking? How did he or she act? This exercise is a great way to show that there are multiple ways of seeing the same situation.

Hypnotherapy You may have seen scenes on television in which hypnotists make people act like chickens or take off their clothes. In reality, hypnotherapy is nothing like that. You actually might experience a hypnotic state many times every week, or possibly every day. It is essentially no different than being engrossed in a book or movie, or being in the meditative state you may reach while exercising. During hypnosis you are highly focused and are not distracted by random thoughts. At the same time, you are aware of outside events, such as the telephone ringing or a door slamming. When you see a hypnotherapist, he or she is simply a guide helping you reach a deeply relaxed state. The therapist may begin by having you picture a pleasant and safe environment. Or, he or she might ask you to focus on an object in your line of vision until your eyes become heavy. Once you are in the hypnotized state, it is easier to focus on your anxiety. You can talk about past experiences, can work on your self-esteem, and can prepare for upcoming social events. You won’t have distracting thoughts or be monitoring everything you say. You may remember events you had forgotten, or may come up with new ways to help yourself cope with the symptoms of anxiety. Adriana was really nervous when her therapist suggested they use hypnosis to work on her fear of meeting new people, but she decided to try it. First, the therapist asked her to visualize a quiet place where she felt completely relaxed and comfortable. When Adriana’s body felt heavy and warm, the therapist asked her to describe how she feels when she speaks with strangers. Adriana discussed how she feels embarrassed and worried, how her face gets red and hot, and how her mind is distracted by negative thoughts. Next, the therapist asked Adriana to visualize being introduced to a stranger. She imagined herself feeling calm and relaxed and looking the person in the eyes. She rehearsed what she would say about herself and said it over and over, sounding more confident each time. The therapist then asked her to think of three things that could help her in those situations. Adriana decided to try relaxing, making sure she is breathing properly, and focusing on the other person instead of on her negative thoughts. Later that week, she dined with a friend and his cousin, whom she had never met before. She was able to take deep breaths and remain relaxed. Once initial introductions went well, Adriana felt more confident and was able to maintain conversations for the entire evening.