The danger of destructive behaviour. Never make things worse than what the stress calls for. In other words, do not punch the bonnet of the car. Violent reactions to stress are uncalled for and are normally regretted afterwards. This is the number one rule. Stress itself is bad enough; there is no need to make it worse.

The rule of exaggeration. Albert Ellis called this ‘catastrophization’. We all magnify stress and this is a normal psychological reaction. This is useful as we want to examine the details of the stress so as to resolve it. However, catastrophization is dangerous, as it blows things out of perspective. A small incident becomes a big incident, and our reaction is consequently out of proportion to what is called for.

Inability to sleep. Insomnia is useful in stressful situations, as it allows us to stay awake and search for a solution to resolve the situation. However, insomnia is useless if we just stay awake, feeling all distressed and sorry for ourselves, wishing the stress would go away. This kind of insomnia is not constructive, and perhaps some mild sleeping pills may help. If you are awake at night because of stress, tell yourself this is only useful if your thinking is constructively helping you sort out the issue so that you eventually resolve it Sometimes, when it is quiet and you are all alone, thoughts and intuition may come which may help you to tackle the challenge better. Of course, good sleep hygiene demands that you do all the thinking in another room and leave your bed for sleep and sex. The best way is, once you are in bed, to dissociate yourself from the stress you are experiencing. Practice self-relaxation, and be confident that you will sleep. Let tomorrow look after tomorrow.

Change irrational thoughts to rational ones. Along the lines of the rational emotive theory developed by Albert Ellis, some of our irrational thoughts are: ‘I must be loved and approved by every person in my life, I must achieve at all times, and it is the end of the world if things are not how I expect them to be’. We have to reconstruct a more logical and rational way of thinking. Cars break down everyday, although it is inconvenient, and this is an everyday ordinary stress. A car has to break down now and then; even a Rolls Royce has its hiccup.

Correct appropriate action. This is not easy, but, if you keep your head cool and follow the logical steps to resolve or minimize the impact of the stress in question, you will turn distress into success and become proud of how you handled yourself under stress. This is why astronauts need to practice all possible mishaps and emergencies, so that when they are under stress they know exactly what are the logical steps to take to avoid catastrophy and they can handle emergencies with ‘military precision’.

How? Look at the alternatives, use your imagination, spend all your time in constructive activity, use your head, solve the problem. If your boss misunderstands you, do not feel distressed. Use your magnifying glass and examine why. Explain to him, assert yourself, or change your behaviour so that the same misunderstanding will never happen again. If the car breaks down, use your head, not your fist. Use your magnifying glass to examine what is wrong with the car, and take appropriate action. If the car cannot be fixed, just bad luck, call a tow truck, and arrange alternative transportation.

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pain-relieving procedures.

The Biological Purpose of Pain-Pain and Evil-We are likely to think of pain as something bad—something evil—that would not be present in a more perfect world. The ancients thought of pain as the tool of the devil, and a burden from which God would relieve them. All this, of course, is fanciful thinking. Pain Is a Warning of Injury. Pain serves as much of a purpose as do our other sensations. Without hunger and thirst we would soon die of starvation; without a sex appetite our race would disintegrate; without feelings of hot and cold our bodies would be burnt and chilled. Similarly, pain is a warning that our body is suffering some harm. Without such a warning we would be unable to preserve ourselves from physical injury. So the sensation of pain is a helpful and necessary guide to us in our everyday living. If we remember this, and abandon any thoughts that pain is wrong or wicked or evil, it will help us in our exercises to control pain.

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The starting point is to accept: ‘This is me and I have an anxiety disorder’. We need to totally accept the disorder and ourselves, not with fear and not with shame or humiliation, but with understanding and compassion. When we can fully accept ourselves as we are at the moment, we can begin to work towards the future when we won’t have an anxiety disorder.

Even when we have accepted the anxiety disorder it can still dominate our life. Through our fear we remain passive. If we feel angry or frustrated we take it out on ourselves. Why? Why aren’t we angry at the disorder? It is destroying our lives. We need to take the power back. We need to dominate it. Everyone wants to recover, but we need to reach a point where enough is enough. The power of our anger and frustration can motivate us in developing an attitude of, ‘I will recover no matter what!’

‘No matter what’ means our recovery is number one priority. We become disciplined in our approach to meditation or relaxation and our other management strategies.

As our power and confidence develop, ‘no matter what’ means we challenge our thoughts. We challenge our fear. We challenge the anxiety and our attacks. How dare they do this to us?

Have you ever tried to have an attack? Have you ever tried to be anxious? Try. See what happens.

As I mentioned in chapter four, our anger can be the ‘rocketship’ to recovery. We can use our anger and frustration against the disorder, instead of against ourselves. Our anger and frustration can help break its dominance. Our anger at this level of acceptance is stronger than our fear. We take back the power. The dominance of the disorder is broken permanently.

The disorders do feel as if they push us to our limits, physically, mentally, emotionally and in some cases spiritually. We survive—but we can do more than just survive, we can recover. We can take back the power.

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We continually add to our fear by the way we think. In other words we are continually scaring ourselves with our thoughts.

CBT is a series of strategies specifically targeted to our particular disorder. For panic disorder these strategies can include relaxation, breathing techniques and ‘interoceptive exposure’ and cognitive therapy. This is usually conducted by a trained cognitive behavioural therapist and is usually done in the therapist’s office. This is called in vivo.

Interoceptive exposure is designed to produce a number of the most common symptoms, including accelerated heart rate, dizziness and the effects of hyperventilation. Combined with cognitive techniques we can begin to change our fearful interpretation of the symptoms and break the anxiety producing thoughts. Armed with cognitive behavioural strategies we go into situations and/or places and ‘test’ our ability to manage our anxiety and panic attacks.

People who have overlapping symptoms of other anxiety disorders need to be taught the various cognitive behavioural strategies related to each symptom group. Studies indicate that short-term CBT can have lasting beneficial effects (Otto et al. 1994). Unfortunately CBT has not been readily available, although this situation is beginning to change.

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The development of avoidance behaviour means everyday normal situations and/or places can become associated with anxiety and panic attacks. Although we are not frightened of the particular situation or place, we avoid them as an ongoing defence or control of anxiety and panic attacks.

We begin to become restricted in where we can and can’t go. We may find we can travel within a certain radius of a few kilometres of home, and do everything we normally do in relative comfort and safety. Once outside these invisible boundaries our anxiety soars. As an overall control of the disorder, we stay within these invisible boundaries. This may mean becoming restricted not only to the house, but to one room. Even then the anxiety and panic attacks can still remain.

Avoidance behaviour can be very subtle and gradual, as the area of relative safety diminishes over time. We are able to do some things one day, only to find ourselves unable to do them the next. Although it appears illogical to others, this defence against panic attacks and anxiety can mean a possible reduction in them. The cost of this defence is high, as it can mean a total breakdown of our previous lifestyle.

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In an attempt to reduce the anxiety or to ease the fears, people often develop compulsive rituals which may take up the

ANXIETY D SORDERS

entire day. People may wash their hands or brush their teeth until their hands or mouth bleed. Others may have to have everything arranged in a particular way, or the person may have to re-do certain jobs a number of times. They may feel the need to repeat a name or a phrase constantly. Others may continually check to see if they have locked their house or car, or if they have turned off their domestic appliances. Some people begin to hoard unwanted or useless items. These compulsions can be so severe that the-person becomes totally restricted by them and is unable to lead a normal life.

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