Is the fear of seeing a therapist and the fear of getting upset related?
Is it possible to be okay about getting upset, rather than have to distract and avoid it?
Why are we wary of seeing a therapist? What do we think it means we are weak, or crazy if we seek help?
These are the main themes of my new book where I explore these two related issues and how we can learn a different way of managing our emotions so that we do not have to fear getting upset any more. I’ve also put together an appendix full of helpful information about finding a therapist and the different therapies that you can choose from.
The book was published in paperback and ebook on 22nd May 2021 by Hero Press (Legend Times Ltd) and in audiobook by Bolinda Digital August 2022. You can get your copy at any of the stores below or at your local library. If you have a library card you can get the Bolinda App for free!
The first thing is to accept that it is normal that we are feeling anxious and afraid. The events happening at the moment will be triggering the fear centre of our brain and our survival instincts are activated.
Why are we feeling so anxious?
If we already have reason to fear death and illness (from previous past experiences), then we will have these experiences and feelings triggered as well. This can be very unpleasant, but it is normal. It is our brain telling us that this danger happened before and it feels like it is happening again. We will be in fight/flight/freeze mode as a result.
The other reason is because there is very little certainty over exactly who/when/how or even if we will be personally affected. We don’t know. Uncertainty is uncomfortable and can make us feel very anxious because it triggers a sense of powerlessness and helplessness.
What is anxiety?
We are anxious because something bad might happen, and we might not be able to do anything about it. These are the central two themes of anxiety:
Something bad might happen, and
I won’t be able to cope with it.
It is a state of mind where we are future-focused on what ‘might happen’ and underestimating our ability to cope. Our brain and body then work to activate us to deal with this potential threat. We are likely to feel many different sensations: tension, hot, nauseous, headache, tight stomach, wobbly legs, dry mouth, short, shallow breathing, irritable with those around us, maybe even more angry.
How can I cope with this?
First remind yourself that you have coped with things before and you can cope again. Find people around you who help you feel supported and safe. Spend time NOW with those people you care about, and bring yourself into the PRESENT moment, and away from future-focused worry. Actively check in with your body to notice the tension, and breathe slowly to bring yourself down a notch or two.
Accept that you or people around you might be more nervous/on-edge, and be compassionate with yourself and others if you can. Imagine that you are all just trying to do the best you can.
Bring your mind back to the present if it races too far ahead to what ‘might’ happen. When we are anxious our thoughts go straight to ‘worse case scenario’ thoughts. Notice this and bring your mind back to the present and what you can deal with right now.
The Worry Tree can help
There is a technique called The Worry Tree which can help bring our minds back to problem solving and away from anxiety-inducing future-focused worry. Here’s a link to it, but it essentially asks you to ask yourself one question: “Can I do anything about this RIGHT NOW?” If you can’t do anything right now, let it go, or tell your brain when you are going to do something about it. I find my brain needs a schedule and needs to know ‘when’ I will deal with it before it will let me let it go.
One of the things that can help keep us in a state of anxiety is constant checking. This is a normal behaviour that our brain does, to ‘scan’ for any threats. Unfortunately though, it can keep us in a cycle of anxiety – checking – reassurance – anxiety – checking – reassurance. Social media notifications and news reports can feed this. Each check is like putting another log on the fire.
Reduce this checking behaviour and balance out your social media and news consumption with stories and information that is not connected to corona virus. If you can seek out people and stories that help you feel connected and safe.
We can get through this
Be compassionate and understanding. Do what you can to encourage a sense of safety and connection with the people in your life who matter. And if you can, try to give people the benefit of the doubt that they are doing the best they can as well. Let’s all use this as a way to practice the coping strategies that we all have inside us.
This article was written as a follow-up to an interview with BBC Radio Shropshire Monday 16th March 2020 9.45am with Jim Hawkins. You can listen to Jim Hawkins and check out the BBC Radio Shropshire website here.
This article by Neuroscience news discusses the difficult to accept point that perhaps we are not designed to be happy. I think this makes a lot of sense to me and certainly seems to explain why we struggle to be happy.
From a survival point of view it makes more sense for us to be vigilant and on guard most of the time, and have moments where we are able to feel safe with certain people and in certain environments. Maybe the moments of safety, contentment and companionship are ‘happiness’, and all we can ever really have are these moments.
If we stop trying to be happy, stop asking ourselves if something is wrong because we aren’t as happy as we ‘should’ be, and instead take small comfort in the moments of contentment we do have. Perhaps this can take some of the pressure and expectation off of us?
The following article by Olivia Remes discusses ‘smiling depression’. In clinical practice this term would not be used diagnostically, however I do think that it is a helpful way of describing a certain depressive coping style.
‘Smiling depression’: it’s possible to be depressed while appearing happy – here’s why that’s particularly dangerous
The term “smiling depression” – appearing happy to others while internally suffering depressive symptoms – has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.
While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.
It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.
Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.
Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.
Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.
Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations and tending to ruminate or excessively think about negative situations that have taken place.
Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts.
Burden and treatment
It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown and feeling as if your life doesn’t have purpose and meaning.
If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalise that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.
So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalising away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.
Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40% in their depression levels only eight weeks into the study. Cognitive behavioural therapy, learning to change your thinking patterns and behaviour, is another option for those affected by this condition.
And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state”, free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.
We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member or even an animal.
Feeling that our lives matter is ultimately what gives us purpose and meaning – and this can make a significant difference for our mental health and well-being.
In the UK, Samaritans can be contacted on 116 123 or by email – firstname.lastname@example.org. Other similar international helplines can be found here.
What should I do if I’m struggling, worried, or trapped in behaviours I don’t know how to get out of?
Physical and mental health should be considered equally, and we are, I believe, getting much better at understanding this. But it can be difficult to know when and how to seek help, particularly if the problem doesn’t seem to be an obvious medical condition.
Ideally your GP should be your first port of call as there are some difficulties which show emotional symptoms but can have an underlying medical cause that needs treating (e.g., thyroid and menopausal issues). But it can be hard to know what to say and how to talk about feelings.
It used to be the case that your GP would mainly offer medication, but there is much better access to psychological therapy now. There can be a waiting list unfortunately but if you are offered help from your local NHS service do put yourself on the waiting list. In the meantime, there are lots of self-help resources out there (books, websites and apps), as well as private psychological therapists. Nowadays therapy sessions can be carried out by telephone, or online video as well as face to face so there are options out there if you want to see someone privately. Therapy doesn’t have to mean endless weekly sessions either. You may just need a short course to get you back on track again.
You could start by saying that you don’t feel good, and then say how things used to be for you before you felt like this. Are there any thoughts that you have been having that feel overly negative, or worries that keep going around in your mind and making you feel anxious? Are you having flashes of distressing images – of something that has happened or something you fear might happen? Intrusive thoughts are common, especially when we are worried or anxious so please don’t feel that you will be judged for having them. Or maybe you are feeling that you just don’t have the motivation that you used to have, or you feel a bit lost or caught in patterns that you can’t seem to get out of.
Try using this quick table to jot down how you feel, it can help to see it written down, and it gives you a format to give to a GP or to the therapist that you see.
When we feel bad, our thoughts match what we feel. This isn’t helpful when it makes us think and believe that things will never get better. They will, and they can. I know it is hard but give therapy a try. Do it for you. You do deserve better. You don’t have to travel, although being in a different physical environment can make you see things from a different perspective, which can sometimes be helpful.
The Physical and the Psychological – inextricably linked!