Hello and welcome back to ‘Managing anxiety’ for Week 2, Session 1. 

If this is the first time you are reading this, welcome! We’re so happy to have you here. However if you’re just starting out please do head back to the first session. We build on material throughout the weeks, and we don’t want you to miss anything!

The goals for this session are:

• Learn about anxious avoidance
• Build up tools for managing anxious avoidance

And as always, we start with a grounding exercise! Remember, grounding exercises are a set of strategies that help us when pain or difficult memories become overwhelming, so whenever you feel uncomfortable, you can use a grounding exercise to bring yourself back and away from hard emotions or physical sensations.

**Today’s grounding exercise is…
**We are going to try and imagine a place or scene that makes us feel safe. It can be somewhere you’ve been before, a place you remember, maybe from a holiday; or it could be somewhere you’ve heard about, maybe in a story, or it could be somewhere that you invent and make up yourself.

Then take a few deep breaths....notice the feelings and sensations that come up in your body when you imagine this space. Notice if you are feeling positive emotions. Have another look around and take a mental picture of this place, save that image. This is your Safe Place and you can come here whenever you want to feel calm and secure. 

Fun question: What colour combination do you love, that other people might not enjoy?

In the previous session, we went over some of the signs and symptoms of anxiety. We talked about how many of these signs are related to our body’s fear response, and how the sympathetic nervous system prepares us for the 3Fs - fight, fight, or freeze. However, in addition to these mental, physical, and behavioural patterns, there is another way anxiety presents itself in a masked way. This is through what we know as ‘anxious avoidance’. 

What does ‘anxious avoidance’ involve? Anxious avoidance involves any actions we might take to avoid feelings, thoughts or situations that we anticipate can make us anxious. This does not mean just ‘not doing’ things to not feel certain emotions, but also a lot of ‘doing’ to be able to escape them. In order to avoid walking past that alley that makes you anxious, you might be walking 5 extra blocks, leaving a lot earlier, holding tight to your phone in case something happens and having to change clothes when you get to the office because all the nervous sweating you did along the way there. This can create a vicious cycle where in your attempt to avoid feeling anxious, the process becomes anxiety-inducing too.

As with most things, it's a balancing game. It's absolutely understandable to want to keep an eye on your anxiety levels and avoid certain things in order to do that. And the immediate relief from avoiding certain things can be overpowering at the beginning. But in the long term, if we incorporate these avoidance patterns into our lives, this can result in increased anxiety- which is what we were trying to avoid in the very beginning.

So at a behavioral level we might try to avoid certain places, people or situations in an attempt to keep our anxiety at bay. If we continuously do this, this is a way of telling our brain that the world is a dangerous place, and this will affect the way we engage with activities we have been trying to avoid in the future.

For example, if your avoidance behavior becomes connected with social situations at work, it might become more and more difficult to consider going to a social gathering with colleagues even if it's a new job with new people that do not connect with your previous experiences. You might be wondering, “but how do I know if I am being avoidant or I just don't feel like going?”. The key is in learning to self-scan. You know yourself better than anyone and if you learn to focus on how your body and mind feel when you are making the decision, you will be able to tell if it's coming from a place of trying to anticipate anxiety. This is why it's key to learn how anxiety feels for each person and in their own body-through homework. Another way of identifying avoidant behavior is by paying attention to people around you: our loved ones usually tell us when they start seeing changes in us. Many times, we try to ignore their comments - that sneaky avoidance again! - because we were not ready to address our anxious behavior. If you have people you trust around you, consulting them can be a good idea, they might help you gain some insight on the things you have been trying to do to actively avoid anxiety situations.

We know it sounds easier said than done so getting a helping hand in all this can have a massive impact. Consider letting your friends know that a certain situation you are about to step into is usually a source of anxiety for you, this might help you face that thing you have been avoiding and having support in case you feel uncomfortable when you do it. You can tell your loved ones about how you may react and ask them to give you some time and space if you want to be left alone to manage your anxiety for instance. Or perhaps you want to let your friend that is organizing that event, that you might need to leave if you feel you cannot manage. This way, you can feel more prepared to face some of the things and situations you have been avoiding and you can get the support you need in the way you need it if your anxiety arises. 

At a cognitive level, we might resort to avoiding some feelings or thoughts by overthinking/ruminating, over-concentrating on something new and also, by distracting ourselves. We will be talking more about anxious thought patterns next session, but for the moment let's focus on distraction, as this is one of the most prevalent ways in which we tend to be avoidant nowadays, and it’s where the line with healthy coping mechanisms can become blurred. 

As we learned earlier, our bodies and minds learn to react to our environments to keep us safe and healthy. This involves connecting certain places, things and behaviors with physical and emotional reactions. And this doesn't only apply to danger. You might have heard about Pavlov's dog experiment, in which a dog was presented with food after ringing a bell. He already knew that presenting food on its own would trigger an unconditioned response of salivation for the dog. After repeating this experiment with the use of the bell several times, Pavlov found that the dog would start salivating when the bell rang even if no food was presented. He called this a conditioned response, and this can help us think about the link between anxiety and distraction.

We can very much learn to associate a particular action with a particular outcome. For example: you might be coming home from work, and start thinking about resting on the sofa and putting on your favorite TV show. Even just while thinking about sitting down on the sofa, before you’ve had the chance to take off your coat and shoes or put down your bag, your body already feels excited and relaxed by the idea - like a conditioned Pavlov response.

This might start to look a bit different if we feel like we get an urge to eat something, go on social media, put a show on Netflix when we are bored or anxious. Do you relate to this feeling? It usually comes after feeling restless and reading your body’s reactions with a necessity of “change gears, do something now!” and for a little while, your action might make you feel better. We might be able to, now, rationalize it, and understand it as a potential avoidance reaction - at this point we don't yet know if this reaction is healthy or maladaptive - but in the moment your brain is TOTALLY going for it regardless of its long-term function, because it brings immediate relief and that's what we are looking for.

But here is the problem. A lot of the time, these actions that can feel like coping mechanisms, even healthy coping mechanisms, can turn into distractions. When they become distractions as opposed to real pleasures, they do not help us or serve our need to reduce anxiety in the long-term. It's not sustainable to binge watch shows on Netflix, scroll down your Instagram or eat snacks forever - and it can become a real problem too, as our brains get used to these behaviors and start asking us for more and more to get the initial outcome. For example, as a long-term behaviour, work procrastination can be thought of as an accumulation of avoidance techniques - we are hooked to the reward of the distractions, and the anxiety of facing the difficult situation or work increases as a deadline approaches, which makes the reward more satisfying. It’s a difficult cycle!

So what can we do? In addition to the techniques we mentioned earlier - doing regular self-scans, and checking in with trusted loved ones - we’ve outlined some steps here to help you first notice the behaviour, then monitor it, then identify the need it is addressing, and ultimately work out a coping mechanism that will serve your needs better in the long run.

1. As usual, noticing this is happening is the first step. Understanding how your mind works can get you 10 steps ahead and here you are, so well done!
2. If you realize you might be using distraction as a way of coping with anxiety and you are getting into the loop, then the key is to break it down to understand the following components at the moment of distraction so you can break the unwanted habits.
   • Trigger: where is the anxiety coming from? 
   • Behavior: what are you using as a distraction? 
   • Reward process: are you feeling better as a result of the distraction? 
3. Once you have done this, you can do an “anxiety tracking” exercise, as seen in homework, and identify when this process happens for you: is it at a specific time of the day/week?
4. After this, try to reflect on how rewarding these distractions actually are - are they really helping you feel less anxious? What do I get from this? As in, physically and emotionally how much better have I felt after having done this activity?
5. Re-evaluate. Maybe you do not need to remove your habits altogether. Maybe just reducing the number of episodes you are watching helps you get the relief and comfort your mind needs after a long day without leading to an anxious avoidant behavior. You could keep notes after completing your activity and if you are feeling content and satisfied then you know it’s a helpful coping mechanism on the right dose. If instead, it's making you feel rested and nervous - you might be in the presence of an unhelpful anxious distraction.

Or, maybe throughout the process of tracking something you notice a pattern. For example, maybe you get very anxious when a work email notification comes in; you see the text of the email on your phone or computer, start worrying about how to respond or what it means, and turn to an anxious distraction at that moment. If we notice this pattern, it could be an indication that we’re not taking care of ourselves in a way that would allow us to experience real nourishment, as opposed to just distraction.

Maybe we need a more fulfilling moment of real relaxation, not just distraction, during our working day, such as a walk with some music, or calling a friend while we’re having lunch. Or, it could be that we need to change the way we receive work emails on our phone, so that we aren’t confronted with or distracted by the notifications throughout the whole day. And then we could establish a schedule of only responding to work emails at certain times of the day, so that we’re not constantly feeling anxious throughout the day about potentially having to see a stressful work email at an unplanned time.

What this last suggestion achieves is not actually stopping the anxiety we may feel when a work email comes up. What it does is stops us from constantly living in a state of anticipating the anxiety-inducing thing - this state is itself anxiety-inducing, as our sympathetic nervous system is constantly fired up. What is more, this state of constant expectant anxiety is exhausting! We need to give our bodies and our minds a break - that is why we are turning to the distraction in the first place, but we will more effectively manage our anxiety and create space for rest and peace if we also try to address the underlying need - the need to not constantly be ‘switched on’

The solution of course to any situation of anxious avoidance, such as the one that we have just described, is personal. But crucially, it’s not about telling ourselves to immediately stop the distraction or that we aren’t allowed to feel anxiety in situations that trigger our anxiety. It’s about addressing our needs in more holistic, fulfilling ways.

And as with anything in this course, the point of noticing our behaviours, in this case anxious distraction, is NEVER to judge ourselves for them. Like we say anxiety, both the physical and mental manifestations, can be exhausting, and it makes sense to want to distract ourselves. And REMEMBER! Distracting ourselves is not a BAD thing. We have encouraged you to turn to things that make you happy, like TV shows or texting with friends, as and when those things make you happy and take you out of a moment of panic. If you do this and it works, that is great! Many of the activities we might be distracting ourselves with when we’re showing signs of anxious avoidance are activities that we find fulfilling and meaningful, when we do them at the right time. 

It's just when the experience or activity stops being rewarding that we might have a problem. If you pay attention, you might already be able to recognize which activities that you initially thought were helping your anxiety are actually making your anxiety worse.  

The trickiest part about avoidance is that it's not as easy to spot as other manifestations of anxiety. We need to pay special attention to it so we can work on it, otherwise our anxious avoidance can lead to us missing out on important things in life that could bring us joy. You are doing so much of that process right here and you'd be surprised of how much of an impact learning about these things can have!

With the previous homeworks and the content of the first week, you’ve already started to think about how anxiety feels for you, and hopefully with your thought diary you might have identified some anxiety ‘triggers’ or situations that cause your anxiety to flare up. This is important work, because as we identified in our steps to deal with anxious avoidance, it’s the effects of these triggers that we are using anxious avoidance for. Next session, we’ll get more into another aspect of our anxiety that we might be distracting ourselves from: anxious thought patterns.

The homework for this week is… We want to give you a genuinely soothing technique to turn to in times of stress. So we want you to make some time to practice your Safe Place. 

Find a moment to bring up the image of your safe place, that mental photograph you took. Bring up the sensations in your body and the feelings you feel there. Now we want you to add a word to this image. A word that connects you with this feeling of safety and calmness.

This might sound like a very simple task and, in some ways, it is. At the same time, learning to evoke your Safe Place in times of anxiety can really help you reduce your body’s response to stress and relax. If you want to enhance your visual experience, why not drawing/painting your safe place or writing it down?

If you cannot identify a Safe Place, or negative sensations or feelings come up when you are trying this, please stop. For some people, it's easier to work with a positive sensation - for example, feeling the grass in your feet for example - than an image of a place. This is also an option if you are struggling to visualize your safe place. 

Remember, this is an investment in your own journey to recovery. Give yourself the best chance to build resilience. You can do this.