Your Better Mental Wellbeing Podcast

Do you spend time worrying about things, wishing that you weren't worrying or feeling anxious? Finding helpful ways to manage your worries will reduce your stress and give you time back to focus on things meaningful to you.

That's what we're going to talk about today on Your Better Mental Wellbeing. Helping you to manage stress and build resilience with easy evidence based tools. Hello, and a very warm welcome to you. You're listening to Episode 6, Taming Your Worries in Today's World.

I'm Dr. Neera Dholakia. I'm a GP for Boots Online Doctor and the NHS and my expertise is in mental health and wellbeing. I'm really pleased to be hosting the show, focusing on improving your mental wellbeing.

Today, we're joined by Ben Cronin, who is a high intensity cognitive behavioural therapist.

He works in an NHS talking therapy service in Surrey for an organisation called We Are With You, which specialises in mental health treatment. So thank you for joining us today, Ben.

Ben: Thanks so much for having me on.

Just before we get into it, I wanted to let you know that Boots Online Doctor has lots of great information on lifestyle and wellbeing. You'll find this on the website at onlinedoctor.boots.com.

Today we're going to be talking about worry and anxiety. Why we worry and what we worry about, how we can reduce our worries or stop worrying, and if we do worry, how we can worry better and cope. So before I start worrying about getting this podcast out on time, let's get straight into it.

Soen, I know you worry about many things, but what would be something you worry about a lot?

And Ben, do you think that's come to the fore because of us being online a lot as well with people having to actually speak directly into a camera, for example?

Ben: Definitely, I think there's a lot of, you know, impact of that on our lives. The fact that so much of our lives is now broadcasted. We're always often being recorded and watched. And that leaves us open then potentially to judgments of other people. These worries that come up for us about it.

And we often, a bit like stress, think of worry as being unhelpful. So, let's talk about why we feel anxious and why we actually worry. What is the benefit in that?

Ben: If we think about the fact that 200, 000 years ago, human beings were just evolving. And we were living in very uncertain times, where around us there could have been marauding tribes, there could have been saber-toothed tigers, there could have been lots of threats to our life. And our brain evolved in this environment essentially to keep us safe. So we're constantly on the lookout for what a particular threat could be. We have evolved it to be a helpful part of our functioning indeed. In fact, if we didn't have any anxiety at all, we might be inclined to walk out into a road without having looked left and right. And then we get squished. So we do need to have a certain level of anxiety.

Also, we have to remember that we are social creatures. So we grew up in tribes. So it was very important for us to be accepted, to be part of the tribe. If we were ever kind of kicked out of it or the possibility we could be ostracised, separated from the tribe, would result in death essentially. So we have evolved abilities to look out for practical threats in our lives, but also these social threats as well.

I mentioned social media earlier. There is this now direct comparison that not only to our tribe, this small group of people that we live with, but to any number of other human beings. This constant comparison with other human beings that we are constantly ranking and judging ourselves against. If anything, it makes perfect sense that so many of us are feeling anxious and are very prone to worry.

Ben, what's the difference between worrying and anxiety? We use those words almost interchangeably, but there is a difference, isn't there?

Ben: There is, absolutely. The anxiety, it's similar to the stress response. It's a physiological response, more an emotional response to a perceived threat. Worry, we would probably categorise that more as a cognitive process. So that's something that happens in the prefrontal cortex at the front of the brain, that gives us the ability to think in words or often images as well. And worrying is this way of trying to predict in the future what is going to happen, essentially making a plan.

The difficulty is sometimes that we might maybe engage in this process a little bit too much and it becomes excessive. That's potentially when worry becomes something that's a little bit more unhelpful.

So what you're saying is that worry is a process. So the process of worrying and the thinking behind it. And anxiety is the feeling or the response to stress. So the kind of emotional side of it.

Ben: Yes, very much so.

Okay, what about when we seem to worry about something that's happened in the past? I'm thinking about a conversation I had with a friend which ended badly and we've not spoken since. I go over and over it in my mind thinking of the different ways it could have played out if I'd responded differently.

Ben: It's a similar process to worry where we're trying to get this answer. We're trying to resolve a situation. And it can be really helpful, similar to worry, but this is obviously focused in the past, where we're going over and over events, trying to find a lesson to be learned from it, to maybe not do it again in the future, or maybe we're trying to correct the past in some way. We tend to call this process rumination. And it keeps us locked in this cycle of going over and over again, and once again, similar to worrying, if we maybe do that a bit excessively, that can then have unhelpful consequences for us.

I think it's really helpful to be able to refocus, come back to the moment a lot of the time, especially when maybe we're devoting a lot of time thinking about it until we really kind of lose track of any perspective of things and what's going on around us. And instead of engaging with those things that are important to us. So maybe living in more of a valued direction, something that's going to be really encouraging and something meaningful to us. Spending all of this time worrying, which then takes us out of that, means we're not living our lives, not being present.

I know sometimes we worry as a reaction to not having certainty. So a classic example is worrying about medical test results or exam results. We have this intolerance of uncertainty.

Ben: So this basically means this fear of the unknown, essentially this inability to sit with that, that not knowing and that being really scary, really anxiety provoking to not know how things are. So potentially one thing that we can do to help give us a bit more kind of certainty potentially is to worry. However, even by worrying, that's not going to give us that certainty.

So what you're saying is that we often use worry as a way to help us feel better about something that we are not sure about or something that we are not able to be certain about. And so we find that by worrying, we're doing something. So that helps us feel better.

Ben: Exactly, Neera. That kind of active kind of belief around worry. That we think that worry is going to be helping us in some kind of way, and because we believe it's going to be helping us, that maybe we're more inclined to do it, and what we can notice by worrying more is that we're actually then more likely to feel anxious.

There's a quote by Bombeck which says that, you know, worrying is like a rocking chair. It gives you something to do, but doesn't get you anywhere.

And so how can we tell the difference between worrying that's helpful and worrying that's unhelpful?

Ben: Well, there's a simple question that if we are worrying about a particular situation, if we ask ourselves, can I do something about this? That then gives us two potential answers. One of them is, yes, that means that I can do something about this. Great. Brilliant. Go and do something about it, for then you'll be able to focus on things that are going to be more life enhancing. If we answer that question, can I do something about this, and the answer is no, then potentially it's what we would refer to as a hypothetical worry. It's about something that hasn't happened, might never happen. What happens if my train's late? Well, it's not happened yet, so we can't do anything about it. But if my train's late, I'll be late for the meeting, and if I'm late for the meeting, then I might lose my job, and if I lose my job, I might lose my house. Well, that's alright, none of those things have happened yet, so we can't do anything about them. They are all hypothetical worries.

I often like to compare this to the hungry hamster. You imagine a hamster in a cage. On one side of the cage is a piece of cheese. To get to that piece of cheese, it can go through a maze. Solve the maze, I've got some cheese, fantastic. Potentially the other option on the other side of the cage was a wheel. The hamster could easily have got on the wheel and just gone round and round and round. It would have just got more tired, more stressed, and then gone, ah, can't do this anymore. That's how we can tell the difference between what's going to be a helpful worry and what's not.

By asking the question, can I do something about this?

For the first six months of my son's life, I constantly worried about if he was still alive when he was asleep, and I would check his breathing multiple times. Initially, it was something helpful as I did all the things in the safer sleeping advice, but then after that it became unhelpful and I had to learn to let go by accepting the likelihood that he would remain alive.

Yes, I think so.

Ben, you mentioned at the start that many people have public speaking as their top worry. So for example, imagine that you are having to give a presentation tomorrow and you're going through it in your head and you're worried that you'll start to speak and nothing will come out. What can you do to think through your worst case scenario and how you could cope with this?

Ben: It's a good question because one of the central features or cognitive feature around anxiety is often double pronged. We often tend to overestimate the downside of something, how dangerous and how bad and how serious the outcome could be. At the same time, we also underestimate our ability to cope with it. I suppose it's just trying to be realistic. So we have this understanding around what is the worst case scenario we think is going to happen, and in that moment we think we're not going to be able to cope at all. Well let's maybe ask ourselves in that moment, realistically, what do we think is actually going to happen?

Is there any evidence for this at all? Indeed, is there any kind of evidence in the past that maybe we have coped?

You mentioned this idea of not being good enough. It seems to be a common theme that people worry about.

The one technique I was taught in relation to the what if question was to put a 'so' at the beginning of it. So I would ask myself, 'so what if'? And I find that really helps actually when I'm thinking too far into the future and worrying about things that haven't happened yet. It's just to put some perspective on it. So what if I didn't make that meeting? So what if I only gave my son spaghetti bolognese from a packet for his dinner? And actually then it starts to feel okay. Because, generally speaking, the consequence of my what if is actually something I can deal with.

Ben: Sounds like you can really take the sting out of some of those worrisome thoughts by simply putting so in the front.

Ben, we've already touched on a couple of tools that we can use, but are there some specific techniques that will really help us to cope with worry and ensure that we are dealing with it in the most effective way?

Ben: There are definitely some things that we can do. I've got three possible little techniques just for people to try. But before I come to them, just maybe something to do, uh, in terms of better understanding worry itself. Sometimes we call this metacognition. It's a very simple activity of sitting down and doing a cost benefit analysis. So getting a piece of paper and a pen, putting a line down the middle, one side writing all of the benefits of worry. What are the real kind of benefits you get out of worrying? How does it help your life? How does it enrich you? And then on the other side. What does it cost? What is worry? Taking away from your life means you don't get to engage in fully and maybe understanding and learning that actually, worry itself it's maybe costing us more than it is benefiting.

And join us in our next Impactful 10 episode, which is focusing on mindfulness.

Okay, so we have looked at doing a cost benefit analysis and also writing those worries down and getting them out of your head. What do we do after that?

Ben: So the three techniques I wanted to introduce today, the first one is called worry postponement. If we're still finding it really hard to stop worrying, if we still notice that we're spending quite a lot of time doing it, then what we can do is dedicate a portion of the day specifically for worrying. Be that half an hour, maybe that 45 minutes, that hour, however long you want it to be, that is worry time. So whenever you find yourself worrying in the day before that, you're maybe noticing that you're in the middle of writing an email and you're worrying about something else. Ah, catch that worry, put it on your worry list, and then re engage with what it is you're actually doing. So that when you come to that particular time, later in the day or the next morning, you can say, great, these are my worries. I'm now going to sit here for an hour and I'm going to worry about these. And the idea is that you just worry about that in that specific worry time.

I like that idea. I can visualise the train and actually I think I'm more somebody who would pull the emergency cord rather than choo choo, but you know, each to their own. But that really works in terms of drawing attention to the thought and the worry that you've got to stop it, and then you can think about something else, either a different worry or something that is more helpful for you.

Ben, thank you so much for joining us today to talk about worries and anxieties. It's certainly been revealing what our own worries and anxieties are, but also what we can do about them. You've given us some excellent straightforward techniques. We can turn what if into so what if. We can do a cost benefit analysis to understand our worries. And then we have worry postponement, two minute rule, and finally spot, stop, and switch to help us cope with our worries better.

So this week I'm going to think about what I read about other people online, and how I can consider the way that I compare myself with them, and think about not worrying about that as much.

And Ben, any final words of wisdom for us?

Ben: Maybe look at things differently. Maybe start questioning things and just interrogating it a little bit to see what's actually going on, what's actually the realistic story.

Thank you so much for listening to this episode of Your Better Mental Wellbeing.

Join us next week for our next Impactful 10 episode, Being Present and Becoming Mindful. And remember to live your values, accept yourself and let go.