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We have established already that anxiety is essentially a physical state with physical symptoms known as ‘arousal’. That’s what we call the symptoms of racing heart, rapid and shallow breathing, muscle tension, sweating, trembling and churning stomach. But there’s more to anxiety than just physical stuff. There are psychological symptoms and characteristics of anxiety too. That’s what today’s episode is all about.

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The first thing to say about the psychology of anxiety is that it’s always based upon ‘fortune telling’. That is to say – anxiety is always about a prediction that something will happen in the future that we believe we will not be able to cope with. Nobody is ever truly anxious about the past. They may regret it, they may even become depressed about it but true freeze, flight or fight anxiety is only ever concerned with what we think might be about to happen – not what has already occurred.

This single understanding – that anxiety is about predicting the future – gives us a huge clue about how to help people to cope with their anxiety. There are two approaches that immediately result from it…

Firstly we can work with people to be more objective, more realistic about their expectations. The more sophisticated techniques we use to do this will be covered much later in the series when we cover things like socratic dialogue. In this episode we’ll confine ourselves to some more basic principles. For example ….

• Help people to understand that the vast majority of things they have ever worried about didn’t actually happen;
• Help people to harness their nervous energies into positive action rather than performing aimless ‘headless chicken’ impressions;
• Offer practical assistance when you can (and when it’s appropriate to do so);
• Avoid meaningless reassurances unless you can actually back them up with facts or with actions.

This issue of reassurance is more important than many people realise. It’s true that reassurance can be very helpful when people are anxious but it must be realistic. It’s also worth bearing in mind that the anxious person may have no reason to believe you so don’t assume an authority you don’t have. Surprisingly your reassurances are more likely to be believed if you don’t claim to know everything.

It’s better to say “I think it will be OK” than to say “It will be OK”.

However it’s meaningless, patronising and obvious to tell people e everything will be alright if that’s not actually true. Far from reassuring anxious people it simply demonstrates to them that you cannot be trusted or that you don’t understand the seriousness of their situation.

It’s better to acknowledge real dangers and then start work on making them safe.

Remember also that none of this stuff will really work until you can get the anxious person to calm down a bit. In the last episode we saw that mounting anxiety reduces blood flow to the most rational parts of the brain – the thinking parts. Before you can get any anxious person to join you in problem solving you need to get them calm enough to turn the problem solving parts of the brain back on again.

One good way to do this is by encouraging them to learn and practice relaxation techniques (before they have an anxiety attack) but if that’s not possible, if it’s too late for that then there are still some things that you can do ….

•  Encourage them to breathe slowly and deeply;
• Get them to count their breathing (this gives them something non-threatening to focus upon);
• Remain calm and move/speak slowly yourself. Create in yourself an island of calm that the anxious person can cling on to rather, like a shipwrecked sailor seeking refuge from a stormy sea;
• Use short, concrete sentences that a panicked mind can understand;
•  Control your own anxiety;
• Keep firm behavioural boundaries yourself and don’t accept inappropriate behaviour from the other person without pointing out that such behaviour is unacceptable. You may need to wait until the person is calmer before you point out their unacceptable behaviours (shouting etc) but that’s OK – they’ll remember the boundaries next time.

Secondly we can help people to plan, both should the worst happen and also how to prevent it. This becomes a fairly straightforward three-point process:

1.       What’s the worst that could happen?

2.       If it does happen how can you survive it?

3.       Now we know you can survive the worst what can you (or we) do to make sure it doesn’t happen?

Whatever else you do – be honest, be rational and be objective. Only then can you understand whether or not the anxiety, the perception of threat is justified. If it is then you can begin to work on making the situation safe with all the facts that you need. If it isn’t justified (if it’s what Freud called inappropriate anxiety) then you can have the confidence to work on behavioural strategies designed to help the person to face the thing they fear.

This must be a gradual process – sudden exposure to feared situations (flooding) is dangerous, unethical and can even cause post traumatic stress disorder (PTSD).

The trick though in cases of inappropriate anxiety is, however gradually to help the person to lay down recent positive memories about facing the thing they fear.

I cannot overestimate the importance of that single insight.

Help the anxious person to lay down recent,

positive memories of facing the thing they fear.