22 minute read

CHAPTER 1: What is Worry?

from Creating Calm: 3A Toolkit for Managing Stress and Anxiety- Adult Edition

from Creating Calm: 3A Toolkit for Managing Stress and Anxiety- Adult Edition, page 60

CHAPTER 7: From Avoidance to A...

“Worrying is carrying tomorrow’s load with today’s strength—carrying two days at once. It is moving into tomorrow ahead of time. Worrying doesn’t empty tomorrow of its sorrow, it empties today of its strength.” — Corrie Ten Boom

You know this presentation is important and you have put a lot of time into preparing well. None of that matters now though. Just like last time, your thoughts are all jumbled up, your heart is racing, you are having a hard time catching your breath, your palms are sweaty, you know that soon you will start to feel nauseous. That unpleasant voice in your head snaps “I’m such an idiot, what is wrong with me, why am I the only one who can’t do this, this is going to be a disaster”. Even when your friend tells you “you’re going to do a great job” you barely hear them and know they don’t really mean it, they are just trying to be nice.

If you have ever faced stress or anxiety (which is pretty much everybody), you’ll notice that the example above captures some of the most recognizable aspects of anxiety including changes in your thinking, the emotions you feel, the sensations in your body, and how you relate to others. Anxiety is an all too common mental health struggle that affects people no matter their age, gender, financial background, culture, geographic location, and more. Anxiety interferes with how you want to live, with how well you perform, and with how you think and feel about yourself. Imagine how you and your life would be different if anxiety was not there, lurking and threatening, reminding you of everything out there in the world you should be afraid of, including yourself.

There’s a lot of information out there about anxiety, what it is, what causes it, what to do about it. For some, this mountain of information can add to feeling overwhelmed instead of helping find the solution. Part of the challenge is much of available the information is missing the rationale of why to use a particular strategy and when to use it. In this workbook, an integrative framework will be used to provide you with a clear understanding of what anxiety is and what to do about it. You will learn how and when to use a range of strategies that will shift anxious thinking, help you to calm your body, and consider how you relate to others and yourself. We will be working together to help you build a personal toolkit to help you shrink stress and anxiety in your life.

Defining Stress and Anxiety

In very simple terms, a stressor is anything that requires us to burn energy in order to keep internal systems running smoothly. The experience of stress can be both positive and negative, overt or hidden, physiological and psychological, internal or external, self-imposed, or forced upon us. When we are talking about stress in our everyday lives though, we usually think about only the negative experience of stress.

How we relate to that stress, the meaning we assign to it, will be a focus of the 3A Toolkit STRESS approach. As I won’t actually meet with you and talk to you about the circumstances in your life that can contribute to stress, the focus in this workbook will only be on your response to stress and anxiety. Sometimes you can also really benefit from changes to your circumstances, I just won’t have enough information about your life to advise you about that here. In this workbook, we will consider stress and A stressor is anything that requires us to burn energy in order to keep internal systems running smoothly. The experience of stress can be both positive and negative, overt or hidden, physiological and psychological, internal or external, self-imposed, or forced upon us. Stress is typically in response to a specific circumstance. anxiety on a continuum and may even use the terms interchangeably. Stress is typically ANXIETY in response to a specific circumstance while A full body, cognitive and emotional anxiety is a full body, cognitive and emotional response to perceptions of threat or danger response to perceptions of threat or danger in in the internal or external environment the internal or external environment that causes that causes disturbance in several domains disturbance in several domains. While stress is including: behaviour, emotion, cognition, challenging to manage, it is often short term social, and physiological. and dissipates when the situation changes or the stressor is removed. WORRY Another term to describe anxious feelings

Anxiety represents your experience when that is typically milder than anxiety. Worry is you no longer feel like you can manage easily. usually characterized by ruminating thoughts You may notice negative changes in various about something that is anticipated. aspects of your life such as work, school, relationships, and other activities. Also, it is always not clear what is the cause of the anxiety. Whether we are talking about stress or anxiety, you will notice similar thinking patterns and similar physical sensations. This workbook will help you with both. Worry is another term you have likely heard of and can also be used alongside stress and anxiety. Worry is typically milder than anxiety and is usually characterized by ruminating thoughts about something that is anticipated. In this workbook, I refer mostly to stress and anxiety but the information here applies to worry also.

It is important to note that anxiety is a diagnostic label that typically follows an assessment by a qualified helping professional such as a psychiatrist, psychologist, or doctor. It is a good idea to seek professional support if you are wondering if you have anxiety. You may still experience anxiety even if you have not had a formal diagnosis. In this workbook, I will use the words worry and anxiety interchangeably as I don’t know if you have a diagnosis of anxiety or not. In any case, the material will help you manage better whether you are dealing with stress, worry, or anxiety. I’m really looking forward to you learning more about yourself and gaining confidence to shrink your stress or anxiety!

For more information regarding anxiety see https://anxietycanada.com

Have a look at the table below and write down the changes you experience in response to stress, worry, or anxiety in the following categories:

Changes That Occur When You Experience Stress, Worry, or Anxiety

BEHAVIOUR

EMOTION

COGNITION

SOCIAL/ RELATIONAL

PHYSIOLOGY (BODY)

PHYSIOLOGY (BRAIN)

Keeping in mind that everyone will have different answers in the table above, here are some examples of changes you might notice in response to stress, worry, or anxiety:

Examples of Changes That Occur When You Experience Stress, Worry, or Anxiety

BEHAVIOUR

EMOTION

COGNITION

SOCIAL/ RELATIONAL

PHYSIOLOGY (BODY)

PHYSIOLOGY (BRAIN)

Avoidance of tasks, people, internal experience Withdrawal from activities Jumpy body Excess energy

Fear Worry Frustration Panic Overwhelmed Dread Self-doubt

Negative thoughts Rumination Fixated on ‘what if’ and ‘why’ Over-identification with perceptions of threat

Withdrawal from relationships Negative view of self

Increased heart rate Breathing is shallow and fast

Activated brainstem Activated amygdala Lack of neural integration Change in blood flow Increased cortisol Stomach discomfort

The above examples may not be exactly what happens when you are worried, or some of the things might happen to you but not others. While there are similar things that happen when all of us get worried, each of us has our own unique experience of worry. What is important is that you are aware of how worry impacts you in each of the categories listed in the table above.

From filling in the chart, you can see all the different ways anxiety impacts you. Although everyone is unique, there are many common elements when we are talking about anxiety. Now let’s discover more about anxiety by learning about what happens in your brain and your body.

Feelings of stress or anxiety don’t tend to go away without you making some kind of change either by changing the situation or by changing how you respond to the situation. As I don’t have the details of your life and the situations that are contributing to your anxiety, the focus of this workbook is on changing how you respond to the situation. Even if you are not able to influence the situation itself, there is always something you can do to respond differently.

THE 3A TOOLKIT APPROACH

It helps to know a bit about the ideas that have shaped this workbook and the 3A Toolkit approach. The 3A Toolkit approach to managing stress and anxiety draws mostly from the field of Interpersonal Neurobiology (IPNB) (Siegel, 2014). This approach extracts wisdom for many different disciplines of science to weave a picture of human experience and the process of change across the lifespan. The IPNB perspective incorporates objective scientific inquiry and more subjective reflections regarding human knowing with the intention of alleviating suffering and supporting well-being. The IPNB approach is really helpful, especially when we want to answer questions that are important in the understanding of anxiety such as how we define the mind and wellness.

What is the Mind?

You may not have started this workbook with a burning desire to contemplate is the nature of the mind before you address your anxiety, but I will explain why it is helpful to do so. ‘Mind’ is a term that’s used often and in many contexts, but often without a clear meaning. Think about times you might have said “I’m losing my mind”, “are you out of your mind?”, “keep that in mind” and of course all the times we talk about shaping young minds at school, and all the times we talk about wanting a healthy mind. Considering these examples, how do you define the mind?

MY DEFINITION OF THE MIND

Not to worry if you had a hard time coming up with a definition, you’re not the only one who found this hard. In his book Mind, researcher Daniel Siegel talks about gathering many experts from a whole range of different areas of study. He found that there was no clear definition of mind. It is hard to recover from stress and anxiety and work towards a healthy mind when you are not sure what it is! From Daniel Siegel (2012) and the field of IPNB, the definition of the mind that emerged was that the mind is a “process that regulates the flow of energy and information within our bodies and within our relationships, an emergent and self-organizing process that gives rise to our mental processes such as emotion, thinking, and memory. Subjective experience, awareness, and an embodied and relational process that regulates the flow of energy and information are fundamental and interdependent facets of mind.” (page 1).

At first glance, this definition may seem hard to wrap your “mind’ around, but it highlights key ideas that are important for us here in our quest to manage anxiety. This definition shows that the mind is not an object, but is rather a process of energy and information flow. In addition, the definition includes not just the brain but also the body, and situates the mind within relationships. These ideas will help us to create a toolbox for managing stress and anxiety and moving towards having a healthy mind, especially now that you know what it is!

What is Wellness?

Challenges with stress, worry, and anxiety interfere with wellness. A goal of this workbook is to help improve your wellness. We defined mind above and now we will address wellness, another very ambiguous term. It’s challenging to arrive at wellness when we are not sure what it is. For the purpose of this workbook and our focus on anxiety, I am defining wellness as a state that is experienced when you are integrated and regulated.

Integration

Integration refers to the differentiation and linkage of differentiated parts. In other words, we need to know how the different parts of our brains and bodies work and attempt to link these together. In the 3A Toolkit approach, we will focus on integration between the main areas of the brain, between the brain and the body, and in relationships. Among other things, an integrated brain is more receptive to learning and appropriate behaviour. Thus, a key goal in the 3A Toolkit approach is to foster integration. We will look at how to create better integration in the brain and the body.

Regulation

Regulation refers to being able to manage or ‘regulate’ thinking, emotions, and physiological reactions. Developing the capacity to regulate your responses in these different areas is a main focus of the 3A Toolkit approach. Consider the example from the beginning of the workbook about someone who is anxious about public speaking. For the person in this example, they will need to learn to regulate their thinking so they can shift from negative to more positive thinking. They will learn to regulate their emotional response so they can grow positive emotion such as confidence.They will also need to regulate their physiological arousal, such as breathing and heart rate, so they can feel more calm. And they will learn to regulate their behaviour so they don’t avoid public speaking altogether. Through improving ‘regulation’ of thinking, emotions, physiological responses, and behavior, the person will be able to manage their anxiety about public speaking and likely feel much better as a result!

What Happens in Your Brain When You are Worried?

It is helpful to have some information about how your brain works so you can better understand what is going on when you are worried and also know what to do in order to feel better. The brain is really complex, so we will only talk about the parts that are important to understanding worry. The three main parts of the brain we will talk about are the reptile, mammal, and human brain. Together these are called the triune brain and all three of these parts play a role in anxiety. This a very simplified version of the brain, my apologies to all the neuroscientists out there. In reality, the brain is far more complex and interconnected but the triune brain is a really great model to help us understand worry and develop strategies for managing it (Paul McLean, 1960).

THE TRIUNE BRAIN:

HUMAN

MAMMAL

REPTILE

REPTILIAN BRAIN (Brainstem and Cerebellum)

The first part of the triune brain we will talk about is the reptilian brain. This is also the most ancient part of the brain in terms of evolution and the only part of the brain to be fully developed when you are born. It is responsible for all the functions we don’t think about (or automatic functions) such as breathing, digestion, heart rate and reflexes. This part of the brain also plays a big role in your alarm response when you are afraid, worried or anxious. This response is often called fight, flight, or freeze. When activated, this part of your brain signals your body to be ready for danger; more about how the body responds later.

When your alarm response and reptilian brain is activated, you are primed to respond as if you are dealing with physical danger, even if there is no actual danger. This part of the brain reacts to every worry as if there is a tiger jumping out at you and you need to fight for your life. This is why stress and anxiety make us feel so terrible, like something really bad is going to happen.

For example, if you are worried about speaking in public, you won’t be physically harmed from doing that, but it sure feels like you will from how your body responds! This is because the reptilian part of the brain does not differentiate between what is actually going to hurt you and something that is merely uncomfortable.

In fact, the main job of the reptile brain is survival; it is in charge of everything that keeps you alive. This response is often called fight, flight, or freeze. When turned on, this part of your brain signals your body to be ready for danger also, but more about what happens in your body later.

FIGHT FLIGHT FREEZE

This part of the brain also works without you actually being aware that it is working and it works rapidly, even taking over from other parts of the brain such as logic and thinking. Think of a time when you jumped out the way of something or reacted before you knew what happened. This is a good thing because you stay away from something dangerous (like a hot stove or an approaching vehicle). So, we don’t want to get rid of the alarm system altogether, we just want to understand and manage it a bit better. Along with sending and receiving information from the body, the reptilian brain also sends and receives information from the next part of the brain we will talk about, the mammalian brain.

MAMMALIAN BRAIN (Limbic System)

The mammalian brain or limbic system is very complex and has many different parts. Functions such as memory and emotion are also found in mammals hence the term mammalian brain. This brain region is newer to develop in terms of evolution than the reptile brain. For understanding stress and anxiety, we are most interested in two parts of the limbic system, the amygdala and the hippocampus. Overall, the limbic system is responsible for our emotions, which includes the responses in our body when we experience emotions. Think about how different your body feels when you are scared, mad, sad, happy, or anxious. When activated, the limbic system sends feedback to the reptilian brain which then sends feedback to the body.

Hippocampus

The hippocampus is very important for learning as this is where memories are consolidated and stored so you can retrieve them later. When you are calm and alert, the hippocampus does its job well and stores memories for retrieval later. The hippocampus also connects the emotion fear to the context when a threatening event occurs. Higher levels of cortisol from stress can affect growth and performance as well as memory. When you are anxious or scared, often another part of the limbic system will take over, the amygdala.

Amygdala

The amygdala triggers emotional responses such as anxiety or fear. The amygdala is essentially your security guard. Its job is constantly scanning within you as well as the world around you in order to be on the lookout for potential threats. Your amygdala collects information from three main sources:

Senses: This information is helpful when actual physical danger is present. For example, you can remove your hand from a hot stove or jump out of the way of an approaching car without thinking. It is an excellent system and keeps you safe. Thinking is much slower so by the time you think about something you would be hurt or worse, it is much better that you just react. If you are someone who has a lot of worry, your amygdala might be labelling information coming through one of your senses (or from your thinking) as a threat when it is not. For example, you might be afraid of something you see like a dog or the audience of a presentation and feel anxious, even though you know most dogs and most audiences will not hurt you. The sensory information can bypass your thinking and be assessed by the amygdala as a threat. An important part of learning to manage stress and anxiety is learning to give the amygdala correct sensory information that you are physically safe, no tigers are jumping out at you right now. The amygdala is often not correct about what it labels as a threat. And once something is labeled as a threat, the rest of the defense system is turned on, even if there is no actual danger around.

TASTE HEARING SMELL TOUCH VISION

Body: The body refers to our internal systems like the sympathetic nervous system that may include sensations like rate of breathing, muscle tension, heart rate, stomach discomfort and more. These sensations are part of the automatic response to perceptions of threat that the amygdala is in charge of. These body sensations become part of the feedback loop that contribute to our internal sense of safety, which is called neuroception. Our brain is constantly scanning for this information and how we interpret this contributes to escalation of stress or anxiety or down regulation. For example, when we sense our heart pounding, does that contribute to feeling unsafe and out of control or do you experience this as excitement. This will likely change depending on the context also. Body sensations can also be generated by implicit memories (see chapter 9 for more about implicit memories) which explains how past experiences which my show up in the present moment as body sensations and contribute to our current experience of stress or anxiety. For many people, the whole body – brain feedback loop is typically occurring beneath our awareness and highlights the importance of developing our awareness so we can improve how we manage these sensations.

Thinking: The limbic system and amygdala also get information from the human brain, the final part of the brain that we will talk about. We will talk more about thinking later on, just know for now that what you are thinking can have an immediate impact on the whether your alarm system is turned on or turned up. So if you are thinking really negative thoughts, this can be perceived as a threat and turn on or turn up your defense system, even if there is no physical danger. It is very important to remember that your amygdala is scanning for not just actual threats, things that will

actually cause you physical harm, it also processes perceived threats (e.g. negative thoughts). Once a threat is identified, real or perceived, this information activates the rest of your survival or alarm system regardless of how real (or physically threatening) the threat is. Thus, you can have an alarm response or anxiety whether delivering a public presentation or facing down an attack from a tiger. Learning to manage anxiety will involve working with this alarm response so it is not ready to fight tigers that do not actually exist.

Human Brain (Cortex)

The cortex is sometimes called the human brain, the thinking brain or the professor brain, as it is the ‘smart part’ and the newest part to develop in terms of evolution. We share this part of the brain with other humans and it is the last part to develop. It really only starts to develop and connect to other brain systems around age 5 to 7, major changes happen during adolescence, and development continues well into the twenties. The cortex is also a complex system than processes a lot of information and includes what we call executive functions. These allow you to plan and set goals and most importantly for us, begin to influence and ‘train’ the amygdala and the whole alarm system in your brain and body to be a bit less reactive. We will learn later how thinking will be an important element of this process.

BRAIN BASICS: TRIUNE AND HIERARCHICAL BRAIN

REPTILIAN MAMMALIAN HUMAN/PRIMATE

• Attends to survival and safety, automatic functions • Regulates heartrate, breathing, digestion • Ancient system • Develops first • Attends to emotions, memory consolidation, motivation and reward • Content when needs met and frustrated when not • Develops second • Attends to executive functioning, connection and attachment • Regulates attention, emotions, complex thought, language, empathy, etc... • Develops last, into mid 20’s • Most recent

HUMAN AND PRIMATE

(Cortex)

MAMMALIAN

(Subcortical Region, Limbic)

REPTILIAN

(Brainstem and Cerebellum)

There is a lot to learn about the brain so let’s review some of the information here:

HUMAN - Main Job: Thinking

MAMMAL - Main Job: Security Guard Emotion and Memory REPTILE - Main Job: Survival (Flight, Fight, Freeze)

Something else you should know about your brain is that we feel good when all three parts of the brain are connected and communicating -- in other words, integrated. When we are worried, the bottom two parts of the brain (reptile and mammal) are too busy or excited and causes a break in the connection with the top part of the brain (human).

Another way to think about this is that the mammal and reptile brain can be called the downstairs brain and the thinking brain is the upstairs brain (this way of describing the brain is from the book The Whole Brain Child by Daniel Siegel and Tina Payne Bryson, 2012). When you are calm, it is like there are stairs between the upstairs and downstairs brain so these two parts are connected and can communicate. When you are worried, your downstairs brain takes over and focuses on fighting tigers and saving you from danger. When this happens, there is no connection to the upstairs brain. This is why when you are worried, you feel like you do not have control and can’t think very well. When you are worried, the downstairs brain is in charge and its whole job is to focus on survival, like fighting tigers even when they are not there. To shrink the worry, we will learn how to get the upstairs brain back in charge, to connect the upstairs and downstairs brain again. We will use your very own toolkit to do this.