Table Of ContentGet relief from
your fears and control
over your life!
Living with anxiety can be debilitating—
Overcoming
especially when you don’t know where it’s
coming from or why. And when you’re in a
panic, knowing what’s bothering you often
B O
still doesn’t help you deal with it. Packed
o with valuable information on diagnosing many
v
types of anxiety disorders, this helpful guide
o e Anxiety
gives you techniques for coping with and
k overcoming your symptoms. In it, you get: r
c
T • Confident reassurance from a clinical o
psychologist who’s been there herself.
i m
t • Diagnostic descriptions of different SECOND EDITION
l anxiety disorders.
e i
• Help for gaining perspective on past n
trauma and future concerns.
g
• A holistic approach to relieving anxiety
with exercise, relaxation, and nutrition.
A
• Guidance on seeking professional
counsel and deciding if medication n
would benefit you.
x
i
AS EASY AS IT GETS! idiotsguides.com
e
t
y
Joni E. Johnston, PsyD, is a clinical psychologist O. Joseph Bienvenu, MD, PhD, is an associate
and CEO of WorkRelationships. She writes a professor and director of the Johns Hopkins Anxiety
monthly column for LexisNexis, is a noted public Disorders Clinic and the Johns Hopkins Residents’
speaker, and is the author of Idiot’s Guides®: Outpatient Clinic. He is co-director of the Johns A look at the roots Useful worksheets Calming strategies
Psychology as well as Appearance Obsession. She Hopkins Hospital General Hospital Psychiatry
of anxiety, panic, for self-evaluation and to help you handle
has won numerous media awards. Consultation-Liaison Service. SECOND
phobias, and more ways to fi nd help fears and anxieties
EDITION
ISBN 978-1-61564-633-3
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9 781615 646333 JoJnoin Ei E. J. oJhonhsntsotno,n P, sPysDyD, a &nd O O. J. oJsoespephh B Bieinevnevnenuu, M, MDD, P, PhhDD
No one likes a know-it-all. Most of us realize there’s no such thing— About the Authors
how could there be? The world is far too complicated for someone
to understand everything there is to know. So when you come across Joni E. Johnston, Psy.D., is a clinical psychologist in Del Mar, California,
a know-it-all, you smile to yourself as they ramble on because you and CEO of WorkRelationships, which helps companies build healthy
know better. work relationships. She writes a monthly column for LexisNexis and is a
noted public speaker. She is the author of Idiot’s Guides: Psychology and
You understand that the quest for knowledge is a never-ending one,
Appearance Obsession: Learning to Love the Way You Look, and winner of
and you’re okay with that. You have no desire to know everything, just
numerous media awards for her translation of psychological research into
the next thing. You know what you don’t know, you’re confident enough
consumer-friendly television and print information.
to admit it, and you’re motivated to do something about it.
O. Joseph Bienvenu, MD, PhD, is an associate professor and Director of the
At Idiot’s Guides, we, too, know what we don’t know, and we make
Johns Hopkins Anxiety Disorders Clinic and the Johns Hopkins Residents’
it our business to find out. We find really smart people who are
Outpatient Clinic. He is Co-Director of the Johns Hopkins Hospital General
experts in their fields and then we roll up our sleeves and get to work,
Hospital Psychiatry Consultation-Liaison Service. Dr. Bienvenu’s research has
asking lots of questions and thinking long and hard about how best
focused on the relationship between general personality traits and anxiety
to pass along their knowledge to you in the easiest, most-accessible
and depressive disorders.
way possible.
After all, that’s our promise—to make whatever you want to learn “As
Easy as It Gets.” That means giving you a well-organized design that
seamlessly and effortlessly guides you from page to page, topic to topic.
It means controlling the pace you’re asked to absorb new information—
not too much at once but just what you need to know right now. It
means giving you a clear progression from easy to more difficult. It
means giving you more instructional steps wherever necessary to really
explain the details. And it means giving you fewer words and more
illustrations wherever it’s better to show rather than tell.
So here you are, at the start of something new. The next chapter in
your quest. It can be an intimidating place to be, but you’ve been here
before and so have we. Clear your mind and turn the page. By the end
of this book, you won’t be a know-it-all, but your world will be a little
less complicated than it was before. And we’ll be sure your journey is
as easy as it gets.
Mike Sanders
Publisher, Idiot’s Guides
Overcoming
Anxiety
Second Edition
by Joni E. Johnston, PsyD, and O. Joseph Bienvenu, MD, PhD
A member of Penguin Group (USA) Inc.
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Contents
Part 1: Exploring Anxiety .......................................................1
1 Just the Jitters? .............................................................3
What Is Anxiety? ...................................................................................................................4
Physical Symptoms: From Butterflies to Insomnia ..................................................4
Emotional Symptoms: Fear ...............................................................................................5
Cognitive Symptoms: Thoughts ......................................................................................6
Behavioral Symptoms: Either Take Charge or Run Away! ..................................7
Donny Osmond: A Familiar Face with Anxiety ................................................8
Cautious, Nervous, or Dealing with a Disorder? ..............................................8
Context and Continuum ...................................................................................................9
States and Traits ..............................................................................................................10
How Bad Is It? .......................................................................................................................11
Assess Yourself: How Much Is Too Much? .........................................................12
Primary Anxiety or Something Else? ....................................................................13
What’s the Difference? .....................................................................................................15
2 The Anxiety Disorders ...............................................17
What’s the Diagnosis? .......................................................................................................18
The Pros and Cons of Labels........................................................................................18
Co-occurrence .....................................................................................................................19
Difficulty with Objectivity .............................................................................................19
Cultural Differences .........................................................................................................20
The Anxiety Disorders ...................................................................................................21
Generalized Anxiety Disorder: Chronic Worry .....................................................21
Social Anxiety Disorder: Beyond Butterflies...........................................................23
Panic Disorder: The Tsunami of Anxiety ...............................................................24
Agoraphobia: Fear of the Marketplace .......................................................................27
Specific Phobia: Targeted Fear .....................................................................................28
Related Conditions............................................................................................................28
Obsessive Compulsive Disorder: The Broken Record ...........................................29
Post-Traumatic Stress Disorder: The Endless Movie .........................................30
Depression: Churchill’s Black Dog ..........................................................................32
Anxiety’s Effects on Others ............................................................................................33
iv Idiot’s Guides: Overcoming Anxiety, Second Edition
3 Why Me? .......................................................................35
Who Gets Anxiety Disorders? ...................................................................................36
Psychology and Anxiety .................................................................................................37
Behavior ...............................................................................................................................37
When Twisted Thinking Leads to Anxiety ............................................................39
Biology .......................................................................................................................................41
The Fear Pathway ............................................................................................................42
Life Experience and Anxiety ........................................................................................42
What’s the Cause—Genes or Environment? ...........................................................43
What Triggers Your Anxiety? ....................................................................................44
4 What to Expect on the Path to Recovery ............47
Values .........................................................................................................................................48
Anxiety’s Costs ....................................................................................................................49
Developing the Right Attitude ...................................................................................51
I Am Not Ashamed of Myself or My Symptoms .....................................................51
Anxiety Is My Teacher; What Can I Learn? ..........................................................51
Symptoms Are an Opportunity to Practice—Not a Test ...................................52
Anxiety Is Uncomfortable, but It’s Not Dangerous ...............................................53
I Can’t Stand It. I’ve Got to Get Out of Here. What If It Gets Worse? .........53
Remaining Motivated ......................................................................................................54
Part 2: Fighting Your Way Through the Fright ................57
5 Getting in Tune with Your Emotions .....................59
Feelings.....................................................................................................................................60
Temperament ......................................................................................................................60
Parenting and Response Styles .....................................................................................61
Acknowledge Feelings .......................................................................................................62
Managing Emotions ..........................................................................................................63
Vicious Cycles .....................................................................................................................63
Emotional Intelligence .....................................................................................................64
Pitfalls on the Way to Better Emotion Management ..................................68
Feelings Are Faster—and Stronger—Than Thoughts .......................................68
Feelings and Thoughts Can Get Tangled Up .........................................................69
Self-Medication for Bad Feelings Can Backfire ....................................................70
Judging Your Feelings Doesn’t Help ..........................................................................70
Worry ....................................................................................................................................70
Fine-Tuning Your Alarm System ..............................................................................71
Contents v
6 Understanding and Managing Anger.....................73
Anxiety and Anger .............................................................................................................74
What Is Anger? .....................................................................................................................75
Recognizing Anger ............................................................................................................77
Misdirected Anger ............................................................................................................78
The Personal Cost of Anger ........................................................................................78
Remaining Balanced ........................................................................................................79
What to Do with Anger .................................................................................................80
Anger Diary ........................................................................................................................81
Pause Before Acting ..........................................................................................................83
7 Assertiveness ...............................................................85
Doing Good—and Doing Yourself In...................................................................86
Conflict Avoidance and Anxiety ..............................................................................86
Saying “No” ...........................................................................................................................87
An Assertive Attitude ......................................................................................................89
Dealing with a Pet Peeve ...............................................................................................89
What an Assertive Attitude Includes .........................................................................89
The Many Benefits of Assertiveness ......................................................................90
Acquiring Assertiveness Skills ....................................................................................91
Taking Responsibility ......................................................................................................91
Practicing How to Say No .............................................................................................92
When You Have a Request ............................................................................................93
Delegation ...............................................................................................................................94
The Cost of Not Delegating ...........................................................................................94
Delegation Guidelines .....................................................................................................94
Procrastination......................................................................................................................95
What Procrastinators Fear ...........................................................................................96
Overcoming Procrastination .........................................................................................96
Mental Space ......................................................................................................................97
Time Management ...........................................................................................................98
Part 3: Taming Those Alarming Ideas...............................101
8 Taming Your Thoughts ............................................103
Thinking About Thoughts .........................................................................................104
Thinking Errors .............................................................................................................105
Restructuring Thoughts ...............................................................................................107
vi Idiot’s Guides: Overcoming Anxiety, Second Edition
Defensive Pessimism: Preparing for the Sky to Fall ..................................110
Putting Worries to Good Use ......................................................................................111
Are You a Defensive Pessimist? ................................................................................112
Optimism...............................................................................................................................112
The Pros and Cons of Optimism ...............................................................................113
Guidelines for Balancing Optimism and Pessimism ..........................................114
9 Understanding Core Beliefs and Their Impact ...117
Beliefs ......................................................................................................................................118
Core Beliefs .........................................................................................................................119
Common Beliefs for Anxiety Sufferers ....................................................................120
Common Dysfunctional Beliefs About Emotions .................................................120
Effects of Core Beliefs ....................................................................................................121
Beliefs About Others ......................................................................................................122
The Need for Control ...................................................................................................123
Core Beliefs Are Persistent ........................................................................................124
They’re Only Thoughts ...............................................................................................125
Correcting Core Beliefs ...............................................................................................125
10 Personality Traits and Anxiety ..............................127
Personality Traits .............................................................................................................128
Context ...............................................................................................................................128
The Anxiety-Prone Personality .............................................................................129
High Sensitivity ................................................................................................................131
Perfectionism ......................................................................................................................133
The Need to Please ........................................................................................................135
Owning Your Self-Esteem ..........................................................................................136
Part 4: Boosting the Mind-Body Connection .................139
11 Getting Help from Exercise and Breathing .........141
The Mental Health Benefits of Exercise ...........................................................142
How Does Exercise Help? ..........................................................................................142
Exercise Is Rewarded by Your Body........................................................................144
Motivation to Exercise ..................................................................................................144
Try an Exercise You Enjoy ........................................................................................145
Long-Term Motivation for Exercise .......................................................................146
If It Seems Impossible ....................................................................................................146
The Benefits of Breathing ...........................................................................................147
Contents vii
12 Eating and Sleeping ..................................................151
Foods and Anxiety ..........................................................................................................152
Foods and Substances That Can Make Anxiety Worse ...................................152
Foods That May Improve Mood ..............................................................................154
Thinking About How You Eat ...................................................................................155
Supplements and Herbal Remedies ......................................................................155
Herbal Supplements ......................................................................................................156
Trouble Sleeping ..............................................................................................................156
Sleep Stages ......................................................................................................................157
Improving Sleep ..............................................................................................................158
When Sleep Is Disrupted ............................................................................................159
13 Reducing Stress .........................................................161
What Is Stress? ...................................................................................................................162
Symptoms of Stress ........................................................................................................163
The Right Amount of Stress .......................................................................................164
A Coping Inventory ........................................................................................................164
Buffers Against Stress ....................................................................................................165
Taking Action .................................................................................................................166
Dealing with Uncomfortable Feelings .....................................................................166
Developing Resources ....................................................................................................167
Create a Stress Journal ...............................................................................................168
Communication Under Stress ..................................................................................169
Keeping Cool Under Pressure .................................................................................170
Responses to Severe Trauma ....................................................................................172
Part 5: Survive-and-Thrive Strategies for Diagnosed
Diagnosed Distress .................................................175
14 Self-Help for Panic Disorder ..................................177
Emotional Hijacking ......................................................................................................178
Panic Attacks and Panic Disorder .........................................................................179
Others May Not “Get It” .............................................................................................180
Panic, Phobias, and Other Problems .......................................................................180
Preparing for a Panic Attack .....................................................................................182
Relaxation..........................................................................................................................183
Distraction ........................................................................................................................185
Approach Panic Differently .......................................................................................186
Refusing to Give In .......................................................................................................186
Advanced Training .......................................................................................................187
Practice ...................................................................................................................................188
viii Idiot’s Guides: Overcoming Anxiety, Second Edition
15 Self-Help for Phobias ................................................191
Phobias Are Common ...................................................................................................192
Complex Phobias ..............................................................................................................193
What Causes Phobias? ...................................................................................................194
A Frightening Experience ...........................................................................................194
Observation ......................................................................................................................194
Other Problems Linked to the Feared Object/Event ..........................................195
A Stressful Time.............................................................................................................195
Reinforcement by Physical Symptoms ................................................................195
Reversing the Vicious Cycle .....................................................................................196
Let Anxiety Come ...........................................................................................................198
Allow Yourself to Relax ...............................................................................................198
Calming Counts ..............................................................................................................199
The Ten-Second Grip ..................................................................................................199
Arrange Your Fears in Order ....................................................................................200
The Three R’s: Reintroduce, Refocus, and Repeat ....................................203
16 Self-Help for Social Anxiety ..................................207
Feeling Scrutinized ........................................................................................................208
Risk Factors for Social Anxiety ..............................................................................209
Social Fears ..........................................................................................................................211
Fear of Negative Evaluation ......................................................................................213
The Spotlight Effect .......................................................................................................215
Changing Behavior ........................................................................................................216
Practice ...............................................................................................................................218
Virtual Help or Avoidance .........................................................................................219
17 Getting Professional Help ......................................223
Sarah’s Story ........................................................................................................................224
Evidenced-Based Treatments ...................................................................................225
Cognitive Therapy ........................................................................................................225
Behavioral Therapy ......................................................................................................226
Cognitive Behavioral Therapy (CBT)...................................................................227
Medication............................................................................................................................228
SSRIs and SNRIs ..........................................................................................................228
Benzodiazepines .............................................................................................................229
Azipirones .........................................................................................................................229
Virtual Reality ...................................................................................................................231
Alternative Therapies ....................................................................................................232
Finding a Clinician .........................................................................................................233
When to Say Enough Is Enough ...............................................................................234
