Hello and welcome to ‘Managing anxiety’, Week 3, Session 2.

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:

• Understand when anxiety becomes harmful. 
• Learn about different anxiety disorders. 
• Reflect on the weight of a diagnosis.

But let’s start with a grounding exercise. We’re going to do another foot-related grounding exercise, but it’s different to the one we did the first week, we promise. 

**Today’s grounding exercise is…
**Place your feet on the ground and in your imagination pick your favorite color to draw an outline around each foot. Start at the heel and using your imaginary pencil slowly go up the side of your foot to your pinky toe and then make sure you draw around each toe and then go back towards the heel. Repeat on the other foot.
Fun question: What is the worst dish that you have ever made?

So far in the course, we have looked at the many ways anxiety can be present in our lives, and we are in the process of identifying how we personally experience anxiety: in other words, uncovering our anxiety layers. Now that we’ve uncovered some of those anxiety layers, in today’s session we’re going to be looking more broadly at why anxiety management is so important. Or rather, what are some of the broader implications for our mental and physical health in terms of anxiety management. 

One of the things that usually comes up when discussing this subject is the idea that we don’t know how much anxiety is “manageable”. That is, how much anxiety should we or can we be expected to “manage”, before our anxiety management strategies should include external people or services. First off, it’s worth saying that there are no outright ‘shoulds’ in this process: you know your anxiety best, and should have the agency to manage it in ways that you would feel the most nourishing. However, whilst how much anxiety is ‘manageable’ depends strongly on our own experiences and strategies, if anxiety persists over a long period of time, on a regular basis and/or is getting in the way of our normal functioning, we might be seeing the more harmful side of anxiety. If this is the case, we might seek out the advice of medical services, and it’s possible that our doctor might diagnose us with an anxiety disorder. 

We will talk about some of the most common anxiety disorders in a minute, so you can have important information about the different forms anxiety can take. But, before we start, we want to make sure you know that it’s important to not self-diagnose. We’re giving you this list of diagnoses in the hopes that you will feel better informed about the different kinds of anxiety. Plus, when talking about anxiety as we have been for the last 3 weeks, it’s important to recognise that anxiety can be its own illness or disorder. And we believe that it’s important to recognise the validity of anxiety as a health condition. You might have heard mental health activists talking about how mental health is as important as physical health: we of course believe this too. We shouldn’t shy away from talking about anxiety as its own pathology, as though there is something wrong with having a mental health disorder. Let’s fight stigma and inform ourselves. Also, you might meet someone at some point in your life with an anxiety disorder, so being aware of how anxiety can manifest is important to build awareness and empathy.

So again, we don’t want anyone to come away from this session having self-diagnosed, but if you are worried about your situation, make sure to contact your doctor, speak to a friend or family member, or get in touch with a therapist.

Generalized Anxiety Disorder: those with Generalised Anxiety Disorder feel constant worry and anxiety on a regular basis. This a broad diagnosis that involves many ways of experiencing anxiety, but the main characteristic is the feeling of having uncontrollable worries. Nevertheless, someone with Generalised Anxiety Disorder may still experience specific triggers for their anxiety, for example performance anxiety related to performing activities under pressure and assessment like exams.

Social Anxiety Disorder: people who experience this disorder will fear tremendous amounts of fear and anxiety when confronted with social situations. Some people refer to this as social phobia.

Panic disorder: people with panic disorder experience regular panic attacks without a clear cause. The most difficult part about a panic disorder is that we might feel panicky about getting another panic attack, a feeling which itself can be extremely distressing and cause another panic attack.

Phobias: this is the fear of certain situations or objects. Some of the most common ones are fear of spiders (arachnophobia) and fear of entering crowded and open spaces (agoraphobia).

Post Traumatic Stress Disorder: PTSD is considered an anxiety disorder because of the anxiety symptoms that can arise after being exposed to a traumatic situation. Intrusive thoughts and flashbacks can make us feel very anxious and hyperalert.

Obsessive Compulsive Disorder: people with OCD suffer anxiety through repetitive thoughts, intrusive images and distressing worries, and may experience the compulsion to perform behaviors to manage these distressing thoughts, which causes worry if these behaviours are not followed strictly.

Body Dysmorphic Disorder: the anxiety here is connected to compulsively and obsessively focusing on our bodies, and experiencing chronic dissatisfaction with how our body looks.

Perinatal anxiety: some people develop a specific kind of anxiety when pregnant or in the first year after becoming mothers.

So, these are some of the types of anxiety diagnosis people can receive. Whether or not you’ve received an anxiety diagnosis, let’s think for a moment about what a diagnosis means. Having such a diagnosis can mean different things for different people; some people feel they benefit from having a diagnosis because it helps them have clarity, feel reassured, and/or able to follow an action plan. 

But this might not be the case for everyone. You might not feel like you need, have or want a diagnosis and this is completely okay. Like we said before, this information is just so you can know how anxiety can present in different people. Hopefully, it can help you think about how anxiety is affecting you, and consider options for support if you feel you need them. Either way, please always keep in mind that a diagnosis does not define us. We are not our difficulties, we are a combination of our character, story, relationship, passions, values and struggles, all amalgamated into our sense of self. A diagnosis is just part of that, but most certainly not the whole. We can decide how much power we give it. We can continue to make positive changes in our lives and improve the ways we feel with it.

We wanted to take a moment now to talk about the relationship between anxiety and physical health. That is, we are aware, by this point, of how anxiety can take its toll on our mental health. But understanding the physical impact anxiety can have is also very important to be able to consider the source of our physical discomfort and take appropriate action. 

Let's backtrack for a second to understand how this works. Has it ever happened to you, that at a time of increased stress, you came down with something? Here’s a comment from our therapist and course writer Paula, on this. She says: “I remember it well, first week at my first professional job and after months of interviews, tests, checks and lots of arrangements - I became ill in my first week at the job. It was the flu at its strongest”. Bad luck? You guessed it, no. It turns out that our mind can affect our physical health too. 

Back in the 1980s, some researchers were curious about why so many students at University got sick in the same week. Once they investigated it, they found that this happened in a week where students had 3 days of exams in a row and so they ran some tests on them and discovered their immunity went down during that week.  They had fewer natural killer cells, which are the cells that help us fight viral infections and tumors via the immune response. Many other studies followed, showing that sustained long-term stress can decrease the responsiveness of the immune system. But along with the first study, they also found quite an interesting observation: second year students did not have their immune systems as compromised during the 3-day exams as the first years had. Can you guess why this happened? It turns out students in their second year had made friends and had stronger social networks and this, scientists found, was a protective factor that reduces the extent to which the immune response is compromised by stress. Having a support system around us and that can relate to the kind of stress we are going through can be of incredible help. Loneliness, on the other hand, can lead to more mental and physical health difficulties.

Now, how does this all connect with anxiety? Well, every-day stressors such as the exams that the students in the study had, can trigger our anxiety. And if we are constantly reacting to stressors, which is usually the case for people that experience anxiety on a regular basis, over time our immune system can become compromised, meaning that we are more prone to viral infections and frequent illnesses. 

Another manifestation of anxiety in our physical health is gastrointestinal problems, which are also common amongst people that suffer from anxiety. This is because our regulation of digestion can get disrupted by anxiety, and it's very normal to suffer from abdominal pain and bloating, as well as diarrhea and constipation, as common symptoms. Many of us suffer from this when we are faced with a stressful situation and whilst that’s very common, it's not good for our body to feel this discomfort all the time. Researchers are still investigating other connections between anxiety and our physical health, for example in our body weight, blood pressure, and cholesterol. So, overall, it's important to learn to manage our anxiety so both our physical and mental conditions are in a healthy state. 

There are many different ways in which anxiety interacts with our physical health, which we don’t have time to go over here (as much as we would like to!). It’s important to know, though, that this doesn’t mean that having anxiety is going to make you more ill, or that if you have anxiety and a physical health problem that there is necessarily a connection between them. Or that you are to blame for not managing your anxiety ‘well enough’ to the extent that it impacts your physical health. No. Not at all. We just wanted to highlight the connection between anxiety and physical health, in order to strengthen our understanding of the relationship between anxiety and our BODIES. Remember talking about the body and brain’s fear response in Week 1? It’s all connected to that: anxiety has physical manifestations in our body, in the ways our body responds to stress, for example through the immune response. Taking care of our minds means also taking care of our bodies, and vice versa. The more we understand that connection, the more holistically we will be able to address our own needs. It’s as simple as that.

So finally we just want to reiterate: If you feel you are suffering from anxiety regularly, please do consult a medical or mental health professional. And remember, our loved ones can have a wonderful impact on our immune system, so keep your social networks alive!

The homework for this week is… This week, we’ve been uncovering more anxiety layers: looking at our anxiety triggers and how to manage them, and now looking at how anxiety can be linked to both our physical and mental health. When examining all these things that might make us anxious - being late, financial problems, our physical health - it’s easy to feel frustrated and out of control. And indeed, a fear of uncertainty is one of our key components of anxiety, so being confronted with situations we can’t control is not only frustrating but can make us feel very anxious. And part of that frustration might be frustration at ourselves: why are we anxious over things that we can’t control? It’s a difficult question that we want to respond to with care and without self-blame.

So, for today’s homework, as one of our tools for managing this uncertainty and frustration, we want to think about exactly that: control. What do we have control over in our lives, that we can use to manage our anxiety? And what don’t we have control over, that we should be aware of as we plan and practice the behaviours that are going to make our lives easier?

So, for the homework, we’d like you to draw a rectangle. Imagine this is a room that represents your mind. Divide it into three sections.

Section 1:

Make a list of things that you cannot control, that make you anxious. 

Section 2: 

Make a list of things related to the things in the first column, but that you can control. So for example, if you wrote ‘the train being late and me getting to work late’ in the first column, you could write ‘texting my boss to warn them that I will be there late’, ‘having an external phone battery with me to make sure I can get in touch with work if I’m running late’, ‘sending back-up presentation slides to my co-worker so they can present instead of me if I’m running late’, etc. 

Section 3: 

Finally, in the last column, make a list of things you can control to make your life happier and safer, and the lives of the ones you love happier and safer. 

The first two columns, as you can probably tell: are anxiety management. Sorting the difference between things you can and cannot control in situations that make you anxious, to make your anxiety management the most effective. But why that last column? The things in the last column: those are the things that are going to help you cope with anxiety. Those are your social networks and investments in resilience that make life worth living. When the things in the first column feel like they’re becoming too much, why not make a deposit in that third column. 

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