Robert London M.D.

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Managing Anxiety in Stressful Times

Cognitive therapeutic tools to help ease modern day stressors.

Posted Apr 13, 2010

At the height of the H1N1 flu scare, I was reminded of a gentleman I once knew. This person became anxious over any mention of an impending flu season or epidemic as the winter approached. He also collected any information he could on the flu---where it hits, what its symptoms are, and how serious it is, for example---and he made sure to follow any precautions he could to make sure he did not get sick. After hearing of a flu death or serious complication, this person's mind would race, and his autonomic responses of headache and gastrointestinal/urinary tract symptoms would dominate a good part of his day.

Such symptoms of autonomic hyperactivity, anxiety, and a cognitive vigilance are consistent with generalized anxiety disorder, or GAD. Survey data on the prevalence of GAD suggest that 5% of the population suffers from this disorder.

I prefer to view anxiety disorders as a spectrum set of disorders with subthreshold and subclinical forms. Therefore, far more people actually suffer from a form of GAD than are officially documented. These people would benefit from treatment. A large number of people with confirmed GAD and subthreshold and subclinical variants of GAD are profoundly affected mentally and physically by their disorder.

One of the triggers is media-generated messages about events, such as the recent swine flu "pandemic." In our information-infused culture, a large-scale event is likely to generate frightening daily updates, analysis, commentary, and anxiety-stimulating doom-and-gloom perspectives---even for individuals who do not have GAD. These media messages offer little reassurance and hope, but frequently lay the groundwork for increased anxiety and stress in the entire population.

When an extremely serious issue such as swine flu threatens the general public, and the media is used around the clock to broadcast information, the result can be an unintended spread of negative cognitive challenges for everyone, but particularly for those who suffer from GAD.

So how would one go about helping a person with GAD whose anxiety is persistently restimulated by the news and by living in stressful times? Cognitive therapy, which is aimed at using thinking to challenge and alter thoughts and behaviors, can provide some relief.

I would offer therapeutically alternative perspectives in a structured manner, sometimes using a hierarchy of ideas and concepts to offer such a person a different or modified way to change thoughts and behaviors. A person who is fearful of crossing a bridge or going through a tunnel, for example, can be offered various ways to rethink and therefore restructure her behavior surrounding this type of phobia.

So, too, can personality styles be modified or changed using cognitive processes. One of the methods I use in cognitive therapy or cognitive challenges is the concept of possibilities and probabilities.

My approach has been to have a person begin to think of an absurd idea that the world might end the next day as possibility (usually getting a good laugh at the unreality of that possibility vs. the probability of the world ending). To use the example of the gentleman mentioned earlier, we established a series of challenges using possibilities vs. probabilities regarding many of his GAD-related worries, which included concerns about catching the flu.

We took the least of his worries, fears, and anxiety, and created cognitive challenges that avoided his all-or-nothing thinking, leading him to adopt more a moderate type of thinking as he continued to learn the concept of possibilities and probabilities and practice a new way of thinking and behaving. His thought patterns and behavior changed over a period of time, giving him more options and greater latitude in his thinking.

If you're someone who suffers from the symptoms of generalized anxiety disorder and find that the news fills you with worry, know that there are proven, effective ways to ease your anxiety and calm your mind. And it couldn't hurt to take a break from the media!

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

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