Hello and welcome to ‘Managing anxiety’, Week 3 Session 1.

We’re halfway through the course! You should be very proud of yourselves for making it this far, whenever you are reading this content. We are halfway through this journey and we are really impressed with your work and commitment. 

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!

In this session we’re looking at some of the clues for how and when we experience anxiety, in the form of triggers and redflags. So today, we’ll be looking at what triggers our anxiety, and how to build a relationship with this. So, the goals for this session are:

• Recognise the importance of triggers in the management of anxiety
• Connect with your own triggers and understand the importance of our relationship with triggers

We always recommend doing a grounding exercise before diving into the content. As you might remember, grounding exercises are a set of strategies that help us when difficult sensations or memories become overwhelming. They’re designed as techniques to stay “present” when we feel ourselves “dissociating” or as though we’re outside our own bodies. If, at any point, you feel uncomfortable during this session or at any time, you can use one of our grounding exercises to bring yourself back and away from hard emotions or physical sensations.

 **Today’s grounding exercise is…
**Sometimes moving our bodies is the best way of grounding ourselves. If you can, stand up; if not, sit straight in your chair. Think about a fruit that grows from a tree. Do you have it? Here, we are going to go with bananas. Now think about a fruit or vegetable that grows from the ground. We are going to go with potatoes. Ok ready? We are now going to stretch to pick those bananas by taking our arms up to the sky and trying to reach them. And now let's collect our potatoes from the ground. 

These kinds of exercises get our blood flowing and allow our brain and body to concentrate on something else. 

Fun question: What secret talent or ability do you have that might surprise the people who know you?

Today we want to talk about triggers. You may have heard about triggers in the past; they are used a lot in the field of trauma as ways of describing the elements that can bring back bad memories or emotions. While trauma is indeed often linked to triggers, triggers aren’t just experienced by people who have PTSD. In the case of anxiety, we are also going to think about triggers. And, if you are experiencing both trauma and anxiety - don´t worry, you’ll see the link between them and this will help you understand both a little bit better.

When it comes to anxiety, triggers are the things that can initiate the anxiety response. If we go back to our fortress metaphor, think about the amygdala sitting up there looking for threats. If it thinks it sees, smells, or hears a ship - it will action the response. But sometimes, the amygdala might see a bird floating far away in the ocean, confuse it with a ship and trigger it anyways. This is what usually happens after we have experienced a traumatic situation; our amygdala starts to read danger even when we are safe. This amygdala reactivity is linked to the hypervigilance state we introduced in the first week: through exposure to trauma, or through anxiety, we may be spending a lot of time in this state: our amygdala scanning our environment for potential threats, and interpreting certain neutral stimuli as threats. It also links to the homework from the second session, where we asked you to track the times of day when you experience anxiety. This is a useful exercise, as it lets you know just how much time everyday you are spending in this anxious state; this is the first step in identifying when and why our anxiety is triggered.

We will learn to work more on putting on the breaks to this amygdala response next week, but the other good news is that we can also learn to identify what feels triggering for us WAY before we are confronted with the situation. Knowing this will allow us to learn tricks to teach our minds how to manage them when they do appear. 

So, there are some things that tend to trigger anxiety in lots of people. Some of these are:

Physical: 

• Caffeine
• Alcohol and other substances
• Skipping meals
• Health issues

Social:

• Parties or social events
• Interpersonal conflict - with friends, a partner, or family

Professional:

• Exams
• Deadlines
• Financial problems

There are also daily stressors like traffic, missing your train, having to do school runs for your kids, that can be anxiety inducing. In essence, everything can be a trigger. It depends on who you are and where your limits are. For someone that likes things tidy and neat, a cup without a coaster on a wooden table can be anxiety inducing. Identifying your triggers and learning to handle that relationship is the key to managing anxiety. And of course, approaching this whole process without self-judgment, blame, or shame. This will be the most important learning we will do in this course! 

We talk about having a “relationship” with our triggers because it won't be enough just to learn where and what they are. We need to learn how to manage them, long-term. We might be feeling some dread or negative anticipation at this point, about discovering something we don’t want to. Maybe there is a difficult behavioural pattern we are avoiding thinking about, and we’re worried about exposing ourselves to it and being confronted with those difficult memories or feelings. This is a normal reaction. And it’s why we’re here with you: to be by your side as you look at some of your own anxiety layers. And this process is all about preparation, not confrontation: we need to acknowledge how and when triggers appear in our lives every now and then. If we learn how to be prepared for them, then we will know what to do when they are here. It’s as simple as that.

Let's look at some examples. Let's start with a simple one: let’s say you get anxious when you are running late. In your mind, maybe you’re thinking that if you are late, people will change their opinion of you, you will change your opinion of yourself, you will be too embarrassed to arrive and going won't even be worth it. Remember those anxious negative thoughts we introduced in Week 2? Or, as we called them; ‘our automatic negative thoughts’ or ANTs? This might be a moment where some of those ANTs start spiralling: a feeling of excessive guilt, or even a shame spiral: ‘I’m a terrible friend’, ‘I always do this’, ‘I’m a bad person’. Maybe you’re reminded of previous times you’ve been late, which enforces this feeling. As we said last week, these negative thoughts can turn into a vicious cycle.

So, what can we do? How do we manage this trigger, of the stress of being late? Well, one thing is to try and be prepared early so you avoid that difficult sensation. Another option is that if you leave with others that take longer than you, you can meet them there. However,  sometimes you can plan and do everything to avoid delays and still find yourself being late. Here's when having a good relationship with your trigger becomes important. You might need to spend some time - maybe during this course - coming to terms with the possibility of being late, as this is beyond your control. We will be giving you a homework later this week that helps address this type of anxiety: how to manage the uncertainty of situations that we can control, as well as recognise the ones we can control in more productive ways. 

Effectively managing the lateness trigger by accepting what we cannot control also relates to our anxiety-tracking exercises: in this case, if you write down the situations in which these ANTs arise, you will not only be able to notice that the possibility of being late triggers your anxiety, but will also uncover the thoughts that being late uncovers: ‘people will have less respect for me if I’m late to this’, ‘I’m a bad friend’ - whatever those ANTs that come up are. This will make you better able to challenge some of those ideas about yourself and of what people may think of you ahead of time. It may show you that some of your worries about people will think of you are unlikely to be true, so you feel calmer if the situation arises. 

But firstly, a note that these ANTs are very real fears! We may internalise a sense that our anxiety is less ‘real’ if it derives from people’s perceptions of us. So many explanations of anxiety, including the one we recapped just now, revolve around the brain’s response to fear when faced with physical threat. But most of us are no longer running away from tigers and snakes in our environments, or at least, this isn’t the main source of our anxiety. Our anxiety may be rooted in what we call ‘social fears’: worry that is focussed around interpersonal relationships, what other people will think of us, the consequences of certain actions on our social standing within our communities, etc. This can be why parties and social gatherings are so anxiety-inducing for some people. Think of that shame we addressed with our anxious thought spirals: so much of that shame is linked to how we evaluate ourselves negatively, and what we fear would happen were others to discover the true nature of our very self. 

A perspective from evolutionary social psychology posits that these social fears trigger the body’s fear response because of the importance of social belonging to survival in earlier periods of human history. Inclusion in a social group, including things like social status and perceptions of other group members, meant access to resources - food, childcare, medicine. A recent review of guilt and shame as psychological factors from Babeş-Bolyai University wrote that ‘the role of shame is to alert the individual about his/her damaged reputation and compromised social standing’. Given the historical importance of social communities to survival, as well as their importance today in supporting and nourishing us, it’s not inexplicable that our anxiety can be linked to social situations and interpersonal bonds. 

Now building on this example to a slightly more complex situation, let’s say that you find your anxiety is connected to someone giving certain opinions of you or something or someone you really care about in social situations. For example, your parent shares a negative opinion about your partner, or your kids. This maybe makes you feel angry, frustrated, insecure. Maybe it results in you going home feeling anxious for days and it affects your self-esteem. You may want to reconsider the role this person has in your life first. If it's someone you are prepared to keep, learning some ways of calming yourself beforehand and practicing deep breathing can be helpful to be in the presence of someone that you find challenging. Speaking to them or others about what you find difficult can also make the situation better. You may want to stop attending social situations when this might happen or have an exit plan to leave the conversation if it goes where you don't want it to go. Connecting to what feels triggering to you and listening to your needs is what is going to nurture your relationship with your triggers and yourself.

As a last example, let's think about how to measure the intake of food and drinks to manage our anxiety. Here is an example from Paula, our therapist who wrote the course. She says: “I personally love coffee! I think it tastes great and it gives me just the right boost when I need to work. However, there was a time in my life when I was working looooong hours and drinking lots of coffee to be able to keep going. I then started to notice that on weekends I would feel slightly anxious and restless and I realized it went away when I gave my body caffeine. I made a plan to only drink 1 coffee a day to have my body cleanse as I was worried I was becoming dependent on it to feel well and concentrate! As I realized later on, in my case, the trigger wasn't coffee - it was overworking. So now, whenever I see that I am starting to work long hours: 1. I question why that is and try to make a plan to change my situation, if possible; and 2. I make sure I have other sources of hot drinks that do not include caffeine at hand so I can treat myself to a break with a hot drink a couple of times a day. Increasing the amount of coffee I drink would have made me more anxious, which would have made my life a lot more difficult at a time where I was already prone to anxiety.” 

At this point you might be thinking: at the beginning of the session we said that caffeine can trigger anxiety, and it’s true! It’s a stimulant. But, in Paula’s case, tracking her coffee intake helped her realise what was really triggering her anxiety: not the coffee, but the work stress. For you, maybe it’s not drinking coffee, but something else, for example eating. Using eating as a coping mechanism also has a physical basis: eating is usually an inherently rewarding experience, not just at an emotional level, but at a physiological level. And this behaviour is not something to be ashamed of! Eating a sugary treat as a reward can be a fantastic way of incentivising ourselves, and also affirming that we deserve pleasure. But if we know we are using eating as a coping mechanism, tracking when we use this coping mechanism and when this behaviour increases is an incredibly important tool in uncovering what is really triggering our anxiety, whether it’s a work situation, a relationship conflict, or some other source of anxiety. It’s just like what we were talking about last week with anxious avoidance: noticing the behaviour allows us to recognise the need that it is addressing. Once we’ve recognised that need, without self-judgment or blame, we can look for ways to address that need in a more nourishing way. It’s not about stopping the triggered behaviour immediately, and it’s certainly not about depriving ourselves from experiencing pleasure. It’s about building long-term strategies for addressing our needs in ways that are more fulfilling.

So tracking our relationship with coping behaviours, such as coffee or food, is our first step in finding our anxiety triggers. There are a lot of ways that our behaviours can be ‘clues’ to our anxiety, and like we were saying last week, these may be behaviours that trusted loved ones can help us in noticing as well. Once you have identified your triggers, it's not about avoiding them altogether. It's about knowing they are around us and working with them when we feel they are approaching. Acknowledging they exist and giving them some attention is the preventative measure that can help us stay well. If anxiety is a part of our lives, we need to work on our relationship with our triggers to be able to stay ahead of them. 

Finally, there will be times when we cannot manage to work with our triggers and anxiety hits us, and that's okay. Managing anxiety does NOT require perfection. This is when our positive coping mechanisms will come into play. We will think about this more next week.

The homework for this week is… Make a list of triggers and make a column next to it. If you already have tools that you use to manage your triggers, write them down in the other column. As we keep moving along with the course, you will be able to complete this table with more resources. It might help to go through each of the categories of triggers as you make this list: physical, social, professional, and personal.

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