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Unhelpfully
altered behaviour in panic and phobias
by Chris Williams, MD
Altered
behaviour may add to anxiety in two key ways - avoidance and unhelpful
behaviours.
Altered behaviour 1: Avoidance.
When somebody develops anxiety, it is normal for him or her to try to
avoid difficult situations, people or places. This avoidance can make
matters worse by making the person lose even more confidence.
The result is often an increasingly restricted lifestyle and additional
distress. A Vicious Circle of Avoidance may result.
For example, someone who has panic attacks in shops may begin to avoid
going there, or will only go into smaller shops when they are likely to
be empty. To help you see if this applies to you, ask yourself “What
have I stopped doing because of my anxiety?”
Question:
You may find yourself avoiding certain situations, people or places
because of how you feel. Try to identify ways in which you might be
avoiding things as a result of anxiety. For example, do you avoid going
out or mixing with others? Consider what you are avoiding because of
anxiety.
What situations at home, work or in my relationships with others am I
avoiding tackling / putting off?
If I didn’t have this anxiety, what things would I like to be able to
do?
What have I stopped/reduced doing that I used to enjoy because of my
anxiety?
Remember, sometimes avoidance can be quite subtle. For example,
choosing a time or place when you think the anxiety-provoking situation
will be easier to deal with, or choosing the easiest option when making
decisions.
The following checklist will help you consider any areas of avoidance
in your life.
Checklist: Identifying the
vicious circle of avoidance.
As a result of feeling anxious am I :
Avoiding dealing with important practical problems (both large and
small)?
Not really being honest with others. For example saying yes when I
really mean no?
Trying hard to avoid situations that bring about upsetting
thoughts/memories?
Brooding over things and therefore not longer living life to the full?
Avoiding opening or replying to letters or bills?
Sleeping in to avoid doing things or meeting people?
Avoiding answering the phone, or the door when people visit?
Avoiding sex?
Avoiding talking to others face to face?
Avoiding being with others in crowded or hot places?
Avoiding busy or large shops, or finding that I have to think about
where and when I go shopping etc.?
Avoiding going on buses, in cars, taxis etc., or any places where it is
difficult to escape?
Avoiding walking alone far from home?
Avoiding situations, objects, places or people because of fears about
what harm might result?
Avoiding physical activity or exercise as a result of concerns about my
physical health?
Q. Am I avoiding things in other ways?
Write in here how you are doing this if this is applicable to you.
Having completed these questions, reflect on your answers using the
three questions below:
1). Am I avoiding doing things as a result of anxiety?
Yes__ No__
2). Has this reduced my confidence in things and led to an increasingly
restricted life? Yes__ No__
3). Overall, has this worsened how I feel? Yes__ No__
If you have answered Yes to all three questions, you are experiencing
the vicious circle of avoidance.
Before moving on, think back on what you have learned and think about
how avoidance may be affecting your life. Take time to think this
through and take a break now if you wish to.
Altered behaviour 2: Unhelpful
behaviours.
When somebody becomes anxious or depressed, it is normal to try to do
things that make him or her feel better. This altered behaviour may be
helpful or unhelpful. The purpose of both types of activity is to
reduce anxiety - at least in the short-term.
Helpful activities may include:
* Talking with friends or relatives and receiving helpful support.
* Reading or using self-help materials to find out more about the
causes and treatment of the problems.
* Doing activities that provide pleasure or support such as meeting
friends, playing sport, and attending religious activities.
* Challenging anxious thoughts by stopping, thinking and reflecting
rather than accepting them as true.
* Going to see your doctor or health care practitioner or attending a
self-help support group.
Write down any helpful things you have done here.
You should aim to try to maximise the number of helpful activities you
do as part of your recovery plan. Sometimes however, the person may try
to block how they feel with a number of unhelpful behaviours.
Unhelpful actions designed to
make you feel safer.
Unhelpful behaviours include leaving situations where you feel anxious,
or rushing through things as quickly as possible so as to minimise the
amount of time spent there.
Sometimes the person may carry
out a mental task such as counting things a set number of times,
repeating positive statements such as “I won’t panic”, or saying a
prayer again and again.
These are sometimes called distraction techniques -- because the person
is trying to distract from how they feel. They may also try to do this
by clenching their muscles tightly, digging their nails hard into their
hands, or gripping onto things such as a shopping trolley as tightly as
they possibly can to distract from how they feel.
Other ways that we block how we feel may include over-eating, using
illegal drugs or mis-using prescription medication by taking tablets at
times when they are not prescribed to try to relax.
Alcohol misuse is very common in
anxiety. This may start out as just having an extra drink to help us
get off to sleep. The danger is of escalating amounts being taken more
and more frequently. The risk is alcohol or drug dependency.
Reassurance-seeking and asking others to accompany you whenever you do
anything that causes anxiety also commonly occurs. This is a good
example of an action that in moderation can be helpful and a source of
support, but which can become unhelpful when taken to excess.
The result is a feeling of
dependency on others and a further loss of confidence in yourself.
It can sometimes be tempting to throw yourself into excessive activity
at home or at work. The intention is to “work through” the distress. By
filling every part of the day with non-stop activity the hope is to
avoid noticing how bad you feel.
This may involve other ways of
avoiding emotional distress such as deliberately staying up late
watching films, or sleeping in during the day to avoid seeing others.
It also could include spending hours on computer games or watching
television.
Other common activities are
listening to music, chatting/surfing on the Internet or texting others
all the time. This is not to say that such activities are all unhelpful
-- more about why they are done.
Doing these things because they
can help us to avoid life is a very different motivation than doing
them because they are fun.
The purpose of all the unhelpful behaviours is to feel safer/better at
least in the short-term. They are sometimes therefore called safety
behaviours as a result. Although they lead to a short-term relief in
symptoms, this doesn’t last.
The anxiety returns to the same or even higher level. For example, if
we rely on alcohol or sedative drugs to give us false courage, we may
find they cause us additional problems of their own.
A Vicious circle of unhelpful behaviour can occur. This can further
worsen how you feel by increasing self-blame and confirming negative
beliefs about you or others as a result.
A useful question to identify unhelpful behaviours is to ask yourself
"What am I doing differently to cope with how I feel?"
The following checklists will help you to identify any unhelpful
behaviour in your life. At times these actions can be quite subtle and
often revolve around avoidance of people, places or events.
Unhelpful behaviours leading to
avoidance of anxiety-provoking situations.
Am I :
Quickly leaving anxiety-provoking situations?
Rushing though a task as quickly as possible? (E.g. walking or talking
faster).
Trying very hard not to think about upsetting thoughts/memories? Trying
to distract myself to improve how I feel?
Only going out and doing things when others are there to help?
Taking the easiest option (for example joining the shortest queue in
the shop as a result of anxiety, or turning down opportunities that
seem scary)?
Deliberately looking away during conversations and avoiding eye contact?
Bringing conversations to a close quickly because of not knowing what
to say?
Q. Am I avoiding things in other subtle ways?
Write in what you are doing here if this applies to you.
In addition, a number of other unhelpful behaviours may occur as a
means of blocking or improving how you feel.
Checklist: Identifying the vicious circle of unhelpful behaviour.
As a result of how I feel, am I :
Tick here if you have noticed this.
Misusing drink/illegal drugs or prescribed medication to block how I
feel in general or improve how I sleep etc.?
Eating too much to block how I feel (“comfort eating”), or over-eating
so much that this becomes a “binge”?
Trying to spend my way out of how I feel by going shopping (“retail
therapy”)?
Becoming very demanding or excessively seeking reassurance from others?
Looking to others to make decisions or sort out problems for me?
Throwing myself into doing things so there are no opportunities to
stop, think and reflect?
Pushing others away and being verbally or physically threatening/rude
to them?
Deliberately harming myself in an attempt to block how I feel?
Taking part in risk-taking actions for example crossing the road
without looking, or gambling using money I don’t really have?
Compulsively checking, cleaning, or doing things a set number of times =
or in exactly the “correct” order so as to make things “right”
Carrying out mental rituals such as counting or deliberately thinking
“good” thoughts / saying prayers to make things feel “right”
Being overly aware and excessive checking for symptoms of ill health?
Excessively changing the way I sit or walk to reduce symptoms of
physical discomfort? The altered posture then creates or worsens the
physical problem.
Sleeping with a number of people as a means of blocking how I feel or
to feel needed, attractive or relaxed?
Having completed these questions, reflect on your answers using the
three questions below:
1). Am I doing certain activities or behaviours that are designed to
improve how I feel? Yes__ No__
2). Are some of these activities unhelpful in the short or longer-term
either for me or for others? Yes__ No__
3). Overall has this worsened how I feel? Yes__ No__
If you have answered Yes to all three questions, you are experiencing
the vicious circle of unhelpful behaviour.
Key point. The purpose of
both the avoidance and unhelpful behaviours is to feel safer/better at
least in the short-term. Although they lead to a short-term relief in
symptoms, this doesn’t last.
The anxiety quickly returns to
the same or an even higher level. These actions also teach an unhelpful
lesson - that it is only by avoiding/leaving the situation/harming
yourself/drinking too much/seeking reassurance etc. that you managed to
cope.
In the longer-term this
behaviour therefore backfires and adds to your problems. This can
further worsen how you feel by increasing self-condemnation and
confirming negative beliefs about you or others.
Summary for Area 5: Altered behaviour (avoidance or unhelpful
behaviours).
Having answered these questions:
Q. Overall, do I have any problems in this area? Yes__ No__
These difficulties are potential targets for change. You will find out
more about what steps to take to tackle these in section 5 of the book
Overcoming Anxiety.
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article source: Living Life to
The Full site by Dr. Williams
Chris Williams, MD is a Psychiatrist and Cognitive Therapist, and
author of the books:
Overcoming
Depression: A Five Areas Approach
Overcoming
Anxiety: A Five Areas Approach
I'm
not supposed to feel like this: A Christian self-help approach to
depression and anxiety.
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