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Development of Your Anxious Lifestyle — Why Me?

Development of Your Anxious Lifestyle  Why Me? 

This chapter applies to you if have ongoing problems with stress, anxiety or depression, or simply want to understand how your past continues to have a negative effect upon your present.

If you suffer from severe anxiety, like more than forty million other Americans, (this material also applies to chronic stress, depression, or simply general unhappiness), you probably have a desperate desire to know why. Disturbing bodily sensations may have led you to think there is something terribly wrong with you physically. On the other hand, high anxiety may have caused you to fear being seen as impaired, debilitated, or “mentally ill.” Many of our clients, out of shame or embarrassment, have kept quiet for years about their anxiety, experiencing increasing social isolation, self-doubt, self-criticism, and difficulty with self-acceptance and self-esteem. Not surprisingly, anxiety is usually accompanied by depression as an anxious lifestyle undermines life satisfactions, confidence, adventure, risk taking, and simply the ability to slow down, relax, and savor life.

Additionally, anxiety and an anxious lifestyle diminish the quality of resilience so vital to finding happiness. You might find yourself in a downward spiral, feeling bad and responding to life in ways that increase what we refer to as “dis-ease,” a cluster of psychological difficulties we view as symptomatic of a life out of balance. In our work we place an emphasis on the natural state of “ease” being unbalanced or disrupted. Life experiences, and things we have been taught and things we have learned, have created a disruption of what was supposed to be, a loss of balance in one’s life, and a loss of the resiliency, self-acceptance, and optimism that determine happiness and well-being.

For all who struggle with anxiety problems, and “dis-ease,” the two most pressing questions are: “Why Me?” and “How do I get better?”

This chapter addresses the question of “Why me?” and will help you understand how you might have developed an anxiety-prone personality or lifestyle, and how you continue to be distressed as long as you remain overly influenced and controlled by early learning and experiences, or current beliefs and self-talk.

You’ll be able to see a clear pathway from earlier life experiences and learning to a present high anxiety, high stress lifestyle, a progression that can be understood with such awareness forming a basis for new choices.

Most of us would agree that modern life has become increasingly stressful. Some studies have shown that 75 to 90 percent of all visits to primary care physicians are for stress-related conditions. In an increasingly complex world of information overload, time pressures, new technology, and problematic relationships, stress is a given. There will be stress!

The focus of this chapter is not so much on coping with external factors, but with developing internal resiliency based on a solid understanding that we basically disturb ourselves by holding on to learned erroneous beliefs and by continuously re-indoctrinating ourselves with learned disturbing self-talk. Epictetus, a first century philosopher stated: “Man is troubled, not by events themselves, but by the views he takes of them.” We learn to disturb ourselves. It’s not our fault. The good news is that having learned to tell ourselves “stories” that don’t serve us particularly well, we can learn to approach life in very different ways.

This chapter is about the evolution of an anxious way of being, and the effect an evolved anxious lifestyle has on the way we deal with a stressful world, greatly limiting our happiness and well-being. Clearly seeing where your anxious lifestyle, or dis-ease, comes from, and understanding how such a lifestyle is supported and perpetuated, is a starting point in learning to make transformational choices.

Although our treatment focus for many years has been stress and anxiety disorders, we believe this material will also serve those who don’t identify themselves as being anxious, but simply feel dissatisfaction with life, or experience general unhappiness or depression. Read on, check the boxes, and you will probably discover things that relate to you, leading to a basis for choices that can greatly and positively affect your happiness and well-being. If nothing applies – congratulations! You are doing well. If none of this material applies to you, this will have simply been a psychological well-being check-up and confirmation of well-being.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          The second question: “How do I get better?” is the central question addressed by our program, Mindful Choices, a system for achieving well-being through being guided in making conscious choices. Our assessment-based program is designed to facilitate awareness of choices, making choices, and following through to personal transformation, balance, and deep satisfaction with life.

We believe small choices, frequently and consistently applied, result in major transformation over time, and a dramatic improvement in psychological well-being. Our program addresses a number of factors identified as possible problems in “Why Me,” and continues on with much more in depth self-assessment and guided exploration of conscious or unconscious choices you may be making.

Included in this chapter is a shorter self-assessment that provides a foundation for a ready-made anxious lifestyle recovery plan. You will be able to identify specific ways of being that sustain an anxious lifestyle, pointing the way to identifying a variety of “Choices” that will facilitate major positive changes in your level of anxiety, or “dis-ease.”

To explain “Why Me?,” we will take you step-by-step through causes of an anxiety disorder as well as factors that result in ongoing and worsening distress.

First, a reminder that the initial step in understanding and overcoming an anxiety problem is ruling out possible medical causes. Your physician, during a complete medical examination can rule out a number of medical conditions that often cause anxiety symptoms, conditions such as asthma, cardiovascular problems, seizure disorders, diabetes, hyperthyroidism, and inner ear problems.

Medications, such as thyroid supplements, stimulants, cold medications, sleeping pills, tranquilizers, some blood pressure medications, and even antidepressants, have been known to trigger anxiety symptoms. In some cases, misuse or withdrawal from medication or use of alcohol or marijuana may produce anxiety. And let's not forget caffeine, often overlooked as a contributor to high levels of anxiety. See your doctor to rule out these problems. You will have less to worry about and more peace of mind.

Getting medical advice is important and is essential whenever there are physical symptoms. At the same time, you should be aware that anxiety has been known to mimic almost every known medical condition. Most of our clients are understandably apprehensive about symptoms that have been so unsettling they came to believe that something was wrong with their bodies. Even when medical conditions are ruled out, our clients tend to persist in worrying. Gradually they come to accept the idea that their problem is anxiety.

In particular, distressed people having panic attacks, the most extreme manifestation of anxiety, need a great deal of reassurance. We tell them at the outset they need to be moving toward firmly believe six things:

1. It’s only anxiety, nothing more. Anxious people tend toward worrisome rumination that their symptoms surely are an indication of serious, perhaps life-threatening physical problems, such as a heart condition or cancer.

2. It can’t hurt you. Panic attacks, although extremely unpleasant, don’t really hurt anyone. Anxious people can’t imagine how such disturbing, physical sensations are in reality harmless.

3. You can handle it. You always have. And you always will. Anxious people are prone to thinking their symptoms will never go away, or will even get worse.

4. It will pass quickly enough if you let it. Fighting it, or struggling against it only prolongs it. A Buddhist idea is that it is futile to attempt to “push the river.” The panicky feelings are physiological in origin, such as an increase in adrenaline, and will quickly resolve themselves if you breathe, think self-calming thoughts, and let them pass.

5. You can learn everything you need to know about effectively managing your anxiety.

6. You don’t have to worry about panic attacks in advance (the “anticipatory anxiety” is a principal contributing factor to bringing on new anxiety attacks).

Of course, it’s hard for panic disorder sufferers to believe these things, but in time, they come to fully accept these beliefs, and their changed beliefs are central to recovery.

Now, turn your attention to the chart The Development of an Anxiety Disorder, focusing first on the box at the top of the page.


                                                    Individual Characteristics 


 Individual Characteristics are all those characteristics you started off with. These personal factors result in either an anxiety prone personality or an anxiety resistant personality.


We vary greatly in our response to stress. Some people are more reactive than others genetically. Some are more ready to react to a flickering light or a loud noise. You may love roller coaster rides; you may feel terrified on a Ferris wheel.


If you are anxiety prone, you may actually be more intelligent, more creative, and have more power of imagination than those people who might be less afflicted. Like all of us, you started off with the same basic needs for safety, security, love, and acceptance, but there were also differences. You were more or less prone to develop an anxiety disorder based on how well these basic needs were met or frustrated in your childhood.


Childhood Circumstances 


 Move next to the cluster of boxes labeled Childhood Circumstances. Now that you have moved beyond childhood these factors are of course historical and unchangeable. Understanding them however is still important. Childhood circumstances often constitute the key ingredients for your adult anxiety.


For the remainder of this article, we recommend you put a number by the boxes that apply to you as we take you step-by-step through “The Development of Your Anxious Lifestyle.” Read each statement, and the accompanying description and example, and decide the degree to which you agree with the statement or believe that the statement typifies your experience. Your choice is to select one of five descriptors, each with different point value. The choices are virtually never true (0 points), rarely true (1 point), sometimes true (2 points), often true (3 points), or consistently true (4 points). 


Check and rate a box even if it applies only to a small degree. If a box does not apply, do not worry about it. Simply move on to the next box.


When you've finished, look back over how you've rated all boxes. You will not only have an understanding of how you arrived at an anxious lifestyle, but also have clear goals for change efforts and skill development, for the “Choices” you will be making toward overcoming your “dis-ease” and becoming a calm, peaceful person.


You will have a solid foundation for an excellent treatment plan. If you're working with a therapist, the two of you will find this material invaluable in your recovery work.



The first box relates to you if your parents often seemed worried about you and communicated their anxiety to you in a variety of subtle or not-so-subtle ways. It may be that your parents were themselves anxious and constantly worrisome about events that might happen, but probably never did.


If your parents were anxious and worrisome about their own lives, it would be quite natural for you to have learned to share their anxieties or be prone to develop an abundance of worries of your own. For example, mothers who get on and off the bathroom scale frequently, and with obvious distress, usually have daughters with fears and insecurities about food and weight.



If you experienced excessive criticism, you may have learned to think far too much about what you did wrong and far too little about what you did right. The result might be that you learned to be pessimistic about your own abilities, expecting defeat and lack of success. You may have learned to be quite anxious about making mistakes or taking risks. You may also have developed deep resentment that you were unable to express. Such resentments, if kept deep inside, often contribute to the development of an anxiety disorder.



Extremely high standards and expectations may have presented you with impossible hurdles and blocked the development of confidence and self-esteem. You may have come to believe that you had to meet parental expectations in order to be loved and accepted. Those perceived expectations may have been quite unrealistic, leaving you either very fearful of falling short or convinced that you simply could not measure up.



Like many families, your family may have been quite good at generating rules for every situation, rules that may not have been particularly consistent or meaningful but were certainly plentiful. Your need, like that of all other children, was not for thousands of rules, but for a few rules or limits that were fair, consistently applied, sensible, and meaningful. If rules were too numerous and confusing, the result may have been a growing sense of insecurity and the need to always be vigilant so as not to incur the wrath of parents. Or perhaps you were one of those children who rebelliously refused to follow any rules. Either way, substantial anxiety was generated, as well as doubts about your own competence and worthiness.



Family mythology refers to the need within some families for members to appear perfect to everyone, including themselves. It may not have been okay to talk about problems or have certain kinds of problems. You may have lived in dread of disappointing your family by having a difficulty that family members were not supposed to have. As a result, problems were not discussed, feelings were avoided, and communication may have been quite superficial. The stage was set for adult difficulties and anxieties.


Janice grew up thinking she could never please her father. No matter how hard she tried, it didn't seem to be enough and he pointed out so many of her flaws that she could never quite remember everything that he said. Father seemed obsessively rule-bound and never happy with his own or anyone else’s efforts. He constantly instructed Janice on “the right way” to do everything. So many rules! Usually confused and feeling inadequate, Janice bought into each and every one of her father’s countless rules in a desperate but futile effort to win his approval. Adding to her pressure were expectations of how family members were supposed to conduct themselves, particularly when others were observing. As an adult, Janice is incessantly worrisome about doing the right thing, always fearful of making a mistake, never feeling safe.  




Suppression of feelings goes hand in hand with the previous box. Feelings such as anger may not have been allowed in your family. Women in particular have often been taught as young girls that anger is not a “nice” feeling and must be suppressed. “Good little girls” were not supposed to get angry.


For many of our adult clients suffering from severe anxiety, a key question we ask is, “What do you do with anger?” Sometimes the initial response is a question, "What does anger have to do with it?" Often the response is, “I don't get angry,” “I don't express anger,” “I was taught anger is wrong and dangerous,” or “I am wrong if I hurt others with my anger.”


Suppression of anger over time often leads to intense generalized anxiety and an extreme whole body response, such as an anxiety attack. If you learned to bottle up feelings early, you may have been an anxious child. It may come as a surprise to many but children also have intense anxiety and anxiety attacks and tend to become anxious adults if untreated. This is something that is only lately being recognized and addressed by mental health professionals.



Suppression of assertiveness is a related problem. You may have been taught that expressing your feelings too openly was dangerous and would be punished. Many children, especially girls, are taught they should not be selfish, should not ask for what they want, and should instead focus on the needs of others.


You may have learned to confuse assertiveness with aggressiveness and feared if you voiced your feelings, you would be perceived as aggressive and hurtful. Suppression of feelings goes hand in hand with a learned inability to assertively go for what you want. The result may have been a growing resentment and a reservoir of anger that was seldom expressed. Sometimes the anger may have bubbled up to the surface and caused an explosion.


We call this the “Mt. St. Helen’s Syndrome” where a non-assertive person finally explodes and then feels overwhelmed with guilt and remorse, convinced once again that anger is dangerous and hurtful, returning once again to anger avoidance and a continued buildup of anger. If this applies to you, you may recall that following an angry outburst you renewed your determination to keep everything “under control.” This took enormous energy and generated enormous stress. A pattern may have been set in childhood for adult non-assertiveness and adult anxiety.


J ill is typical of many of our anxiety disorder clients. She cannot recall ever having told anyone of her anger. Anger was not allowed in her family, at least not from children. Jill remembers being punished severely for any sign of disagreement or any resistance to her parents’ wishes. Still f earful years later that her anger will bubble to the surface and cause problems, she works hard at staying in control, outwardly appearing pleasant and cooperative. Sometimes it is easier to avoid others than to risk conflict. She can accept feeling bored and lonely far more easily than risking conflict and rejection. Filled with the resulting generalized anxiety, often to the point of panic attacks, Jill cannot see a connection between her distress and the absence of any overt sign of anger.



In many cases, only one of these boxes needs to be checked to reveal how seeds of adult anxiety were planted. Alcoholism in the family is often quite sufficient as a predisposing condition, as millions of members of ACA (Adult Children of Alcoholics) can attest. If not alcoholism, there are other family dysfunctions that can also distort a child’s development. Mental illness, drug abuse, family violence, or sexual abuse will so distress a child that a lifelong struggle with anxiety may follow.


“Secrets” refers to what everyone knows, yet no one is allowed to acknowledge. It could be alcoholism, drug abuse, mental illness, criminal behavior, or many other sources of family guilt and shame. It is like having an elephant in the living room with everyone expected to pretend it is not there.



This is about a loss of connection with a parent and may have come about in a variety of ways. You may have felt neglected, rejected, abandoned by your family. You may have come from a large family where you felt lost in the crowd and invisible. Perhaps you were seen as the family problem and actively persecuted. In other cases, a parent may have been lost through death or divorce. Even when mother or father were physically present, you may have feared the loss of a parent. Perhaps you had already lost one emotionally or physically and feared the loss of the other. The threat of loss may have been real or imagined. In any event, it was the perception that counted. You may desperately have wanted to be close to a parent, validated, and acknowledged. You may have either not believed you could get close or were constantly in fear of losing contact.



Like many children, you may have grown up feeling unsafe and emotionally insecure. This was particularly true if your home was characterized by alcoholism, dysfunction, or abuse. You may have learned nothing was certain or predictable. Anything could happen and you always had to be on guard, hypervigilant. It was not okay to relax. You may not have fully trusted your parents would be there for you, capably protecting, guiding, and nurturing.



Nothing more powerfully sets you up for future bouts with anxiety than not feeling fully loved or accepted by your parents and other family members. Self-love and self-acceptance begin in a family setting. If you felt loved and accepted, consistently and convincingly, you were given a powerful antidote against being overwhelmed by future life stresses. If not, the result may be chronic self-doubt, relationship insecurities, and lack of resilience in the face of adversity.



You may have rarely gotten a chance to make a decision on your own. Your parents may have intervened in every potential decision, large or small, often out of the concern you might make a costly mistake. The reality is that mistakes are valuable. Mistakes are how we learn. Mistakes teach us and help us grow. Mistakes are vital in the development of your “struggle muscle.”


If you were not allowed to make mistakes, you were deprived of a most valuable learning opportunity. You may have been robbed of the confidence that comes with knowing that problems can be confronted directly and overcome by your own resources. If you grew up without this valuable learning, the result may be often feeling paralyzed by problems or being chronically indecisive and worrisome.



Many of our clients over the years have reported to us that they felt responsible for their parents from an early age. They worried about their parents’ well-being. They also worried their actions might be hurtful to their parents. They often felt they had to foresee any possible harm to the parents and prevent that occurrence. This is particularly true of many of our anorexic and bulimic clients who tell us they have long been worried about their parents well-being and, in some instances, saw their parents as incapable of adequately caring for themselves and much in need of the child’s protection. This is a terrible position to put a child in. A child needs the security that comes with knowing parents are on the job and fully capable. Thrusting a child into the position of caretaker to the parent imposes a burden that blocks development. How are you going to be adequately self-nurturing if you grew up being totally absorbed in taking care of other family members?



Finally, “Human doings” refers to a powerfully self-destructive idea you may have grown up with if you learned to think your worth came totally from what you did or what you achieved. This is in contrast to being raised as a “human being,” where an individual learns to believe he/she is valuable just because he/she is here, just because he/she exists. If your parents, with the best of intentions, reinforced not your intrinsic worth, but rather your accomplishments, they may have unwittingly instilled the idea that accomplishments were what counted and not you as a person. A most unfortunate learning experience!


If you grew up thinking you had worth only as long as you were accomplishing something, then you probably came to expect that your accomplishments must be increasingly impressive. You may not have learned a basic life skill -- to pat yourself on the back and simply feel good about yourself as an okay person, resting when you needed to, nurturing yourself in healthy ways, and generally enjoying life. Instead, you might have learned to incessantly drive yourself to accomplish and excel. You may have come to feel guilty for relaxing, always feeling the pressure to be doing something more, forever worried that what you are doing is not enough. The lack of self nurturing skill opens the door not only to extreme anxiety but to countless excesses and addictions as a way of trying to find relief externally.


Molly is a professional in her mid thirties. Friends see her as an extraordinary woman with unusually impressive accomplishments. Her job involves supervising a score of other professionals, answering any and all technical questions, solving daily personnel problems, and serving on numerous advisory boards and committees. Already possessing two graduate degrees, she now feels driven to complete her doctorate. Those who know her would be shocked to discover that this “human dynamo” has a deep sense of inadequacy and is terrified of not measuring up. She is convinced everyone will not long be fooled, that she may soon be revealed as a fraud, a phony who only pretends to be competent and secure. She has never been without the anxiety that daily threatens to overwhelm her, anxiety that grows out of a childhood where pushing harder and doing more was the only way that seemed to insure ongoing love and acceptance. 


 Before we move on to contributing factors that are ongoing, changeable, and exist in adult years, take a moment to look over the boxes you have checked and rated under childhood circumstances. As we mentioned earlier, if only one box is checked, it could still indicate something that significantly predisposed you to anxiety in adult life. If many boxes are checked, it is a virtual certainty that you learned in childhood to be an anxious adult.


The good news is that if you learned to be anxious, you can also learn to be more relaxed and worry-free. It should be reassuring to see where your anxiety comes from and to know there is new learning that can help you overcome your anxiety problem. You can learn to be free of excess fear and worry. You can learn to relax and have fun.


Contributing Factors




Our anxiety groups are quite diverse. We have members who are suffering from generalized anxiety disorder, phobias, social anxiety, agoraphobia, panic disorder, post traumatic stress disorder, obsessive-compulsive disorder, and eating disorders. They have different backgrounds and vary in their symptoms. A common factor for many is a critical attitude toward self accompanied by guilt, shame, and self-doubt. Typically, our group members are very hard on themselves. In a constant inner dialogue, they remind themselves of mistakes they have made, consequences they will have to pay, ways in which they do not measure up. They compare themselves with others and feel they have somehow not been as well equipped to deal with life. For many, self-talk is consistently negative, as they put themselves down and “catastrophize” and “awfulize” about their lives.



If you have an anxiety disorder, it is certain you have Distorted thinking, although this is something that is not unique to those with anxiety. All of us deny, falsify, and distort reality. That is because we are all human. None of us is a pure rational “Mr. Spock” (not the pediatrician, but the Star Trek officer).


Because you are human, you tend to put your own particular slant on things. You perceive and process information in accordance with your own set of beliefs. Many of these beliefs are “taught” beliefs learned in your childhood from those closest to you in helping you meet your needs. At times, these beliefs are destructive to your self-esteem and to your relationships. You may be quite unaware of these beliefs, yet, all too frequently feel overwhelmed by the unpleasant emotions that stem from them. It may come as a surprise that external events are not nearly so much of the problem as the fact that you disturb yourself with ongoing and automatic self-talk and false beliefs learned early in life.


Having only one of these beliefs might be sufficient to generate extreme anxiety. Suppose you are one of those people who tell yourself (and absolutely believe it is true) “I must please everyone in all I do all of the time. If I do not please them, it is terrible; I failed and I cannot stand it.” This is an impossible expectation. No one can please everyone. There is bound to be someone you disappoint in some way. In fact, there are many situations where a healthy person is bound to disappoint those around them if only to assert their boundaries and rights in a psychologically healthy way. You simply cannot be a person of good self-esteem, have a good sense of your own identity and boundaries, and be a people pleaser believing that you “must” perfectly and consistently please those around you.


If you have such a belief and you are having a week in which everyone seems to be pleased, you are not off the hook. You are going to be preoccupied with the worry that someone might be displeased, that you might have failed to meet the needs of a family member, friend, or coworker. Talk about pressure! It's like having to take a thousand tests a day and needing a perfect score at each one.


And then if you do find yourself displeasing someone, it will be grounds for depression and a sense of failure. Either way, you cannot win. By virtue of only this one belief, you are destined to be anxious or depressed all the time. There are no other options.


It gets worse. Others are quick to pick up on the fact that you are a people pleaser who is prone to guilt and therefore quite vulnerable to their manipulations. Because a corollary of the belief that you must please everyone is that you cannot express anger, for that would displease others for sure, you are going to be someone who tends to stuff and stack anger while incongruently wearing a smile on the outside.


You might find yourself saying “yes” when you would like to say “no.” Others are often quick to take advantage. You will find yourself resenting other people and seeing relationships with others as problematic and a source of anxiety. In the extreme, others will be perceived as so threatening that the only solution is to avoid then, leaving you isolated and alone. Having just this one belief can leave you feeling powerless, with lowered self-esteem, and full of anxiety.


In reality, we do not have only one irrational belief. We have many and these beliefs overlap and occur in teams. People with anxiety disorders tend to have a particular set of harsh, perfectionistic, and otherwise self-defeating beliefs, which serve to keep them stuck in their disorder. These thoughts are automatic, acting like a high speed computer. We are scarcely aware of them at all.


Much of our therapy is aimed at helping clients slow down their thinking and become mindful of their distortions. Once this new skill is formed, they can begin to participate in their reality in a different way, challenging anxiety producing beliefs, and plugging in more realistic ways of viewing themselves and the world around them. These skills of mindfulness and corrective self- talk are vital to recovery from an anxiety disorder.


It would be impossible to have an anxiety disorder without having frightening self-talk, or “scare-talk.” An anxiety disorder is by definition a set of obsessive thoughts and compulsive behaviors centered on fear and worry. Those with an anxiety disorder are constantly caught up in “what if” thinking as well as “awfulizing” and “catastrophizing.” Distorted thinking and anxiety provoking self-talk are at the core of anxiety disorders.


C arol sat in one of our eating disorder groups listening to a discussion about negative self-talk. Finally, she joined in, saying, “That may be true for the rest of you, but I do not have any self-talk.” Unaware of self-talk, she had never realized she had been disturbing herself with a steady stream of automatic messages. Upon further discussion, she began to see the childhood messages that influenced the course of her life. She had learned to see mistakes as unpardonable and a guarantee of rejection by others. Always vigilant, she had dedicated her life to making sure no one was disappointed and no one saw her make a mistake. By the end of the group session, Carol was a believer. If she was to recover from her anxiety disorder, it meant learned negative self-talk had to be replaced by more rational and compassionate inner dialogue. 



Many of our clients tell us they cannot be satisfied with what they have already accomplished. There is always more that needs to be done and with better results. Often they tell us they cannot possibly be perfectionists, as they make far too many mistakes. We point out to them that a perfectionist is not someone who does a perfect job, but rather someone who thinks he or she must perform perfectly in order to be acceptable. You are a perfectionist if you are someone who constantly places higher and higher hurdles in front of yourself, never able to rest on your laurels, never feeling like you quite measure up.


We ask our clients if they can comfortably and confidently say, “I am not perfect, but I am enough.” Those who can say it and believe it are on the right track. Those who cannot or will not are already stress casualties.


Shoulds” and “musts” involve inflexible rules about how you and other people “should” act. These rules become sacred commandments, guiding every aspect of your behavior. They are seen as right and indisputable with no deviation allowed. Any departure from strict adherence to the rules is accompanied with extreme guilt and anxiety.


One of our groups brainstormed a list of “shoulds” and “musts” they believed applied to them. Their group generated list follows:


1. I should always put others first.
2. I should never express anger.
3. I should not have conspicuous needs or wants.
4. I should not make waves.
5. I should not take time for myself.
6. I should not waste time relaxing.
7. I should not have fun.
8. I should not have expectations from others.
9. I should not get too close to others or they will discover my flaws.
10. I should not be a burden to others.
11. I should not trust.
12. I should not ask for help.
13. I should not make mistakes or fail in any way.
14. I should be perfect.
15. I should stay in control, always be on guard.
16. I should not say no. I should always be there for others.
17. I should please everyone.
18. I should be what others want me to be.
19. I should not be too visible.
20. I should not be comfortable with compliments.
21. I should accept criticism.
22. I should not be overly optimistic or hopeful.
23. I should not be assertive.
24. I should not have strong opinions.
25. I should not love myself or even like myself.
26. I should not act as though I have rights.


Years ago, the famous psychiatrist Karen Horney called this kind of thinking the “tyranny of the shoulds.” Anxious people tend to have extremely high stress levels generated by many such unreasonable demands on self. For the most part, the anxiety and stress is generated by such self- talk or at least amplified by your own perfectionistic messages to self.


Some of these “shoulds” have especially destructive and far reaching results. For example, if you believe you should not express anger, the result will be much free floating anxiety, lowered self-esteem, and relationship problems. Other shoulds have similar widely extending negative consequences.



The central theme of Either-or thinking is the belief that the world consists of black or white choices. Things have to be either one way or the other. There is very little room for middle ground. People and things are good or bad, wonderful or horrible, successful or miserable failures. This polarized thinking leads to an either/or world where reactions to events swing from one emotional extreme to its opposite. Perhaps the worst problem with polarized thinking is the effect upon self-image and self-esteem. If you are not perfect or wonderful in every respect, then you are surely the worst kind of reject, a “worm” of a person beneath contempt. There is no room for mistakes. Each new day brings with it a thousand more tests. Anything other than a perfect score is ultimate failure.


Catastrophizing means that wherever bad things can possibly happen, surely they will occur. We are reminded of a Woody Allen movie in which his headache is certain evidence he has brain cancer. For anxious people, catastrophizing means that if bad things are possible, then they are not only likely to happen but need to be endlessly worried over. This "anticipatory anxiety" is a hallmark feature of an anxiety disorder.


Catastrophizing self-talk often starts with the words “what if.” What if this happened or that happened? If it can happen, then it probably will. The list of possible calamities is endless. Many anxious individuals tend to be chronic worriers. In particular, they may worry about being out of control with fear itself, as is often the case with anxiety attacks. Fearing a panic attack is often the way to generate one.


Phyllis thinks she learned to worry from her mother. Like mom, she is on guard against anything that could potentially cause distress, pain, or illness. “What if” thinking keeps her stirred up and robs her of any life enjoyment. She is not much fun to be around. Anxiety attacks are frequently fueled by the fear of another attack and the constant scanning of her body for signs of something wrong. As physical symptoms are found, Phyllis goes into a full body reaction. Rising anxiety combines with panic filled thoughts, leading rapidly to a full blown panic attack. 



Self-talk is the main way we distress ourselves, but that self-talk stems in turn from underlying core beliefs. Some beliefs are more important than others and more central to our thinking, emotions, and behaviors. These “core beliefs” influence everything we do and can generate enormous anxiety.


The most basic and distressing “core belief” is the belief that “there is something really wrong with me” or “I am basically a bad, unworthy person.” You may have concluded from your family experiences that you are not good enough or worthy enough. As a result, feelings of inadequacy and failure predominate. You may be working hard to create a façade to hide a deep sense of inadequacy.



The second “core belief” is “No one would love me as I am.” You may believe everyone would abandon you if the truth were known. You may have a fear of being too visible or getting too close to others. Surely, others will discover serious flaws if they get close enough. Outwardly, you may be projecting an image of being in charge of life, not needing help, of being unaffected by problems.


A third “core belief” is: “My needs for love and acceptance are never going to be met if I am truly myself, if I do not transform myself into a more acceptable version. I must be what others expect me to be if I am to get their love and acceptance.” This belief erodes away self-esteem and generates much hidden resentment, which in turn damages relationships. Of course, true intimacy is unattainable as long as your true self is kept hidden.


Larry feels hopeless. He cannot remember ever feeling adequate. As a teen, he avoided others, choosing loneliness and boredom over risking rejection. He was always positive that rejection would follow if others got close. Sure enough, Larry finished high school with only one friend, another social outcast like himself. Larry took this as evidence of his unacceptability, unaware of the existence of a self-fulfilling prophecy, the tendency to find evidence to support a dysfunctional belief. As a young adult, Larry alternates between withdrawing from social risks out of fear and trying too hard to please others. This strategy almost always backfires. Either way, he is unfulfilled, lonely, and convinced that life cannot be any different for him.




Are you able to express your feelings honestly and directly, without guilt? Do you believe you have a perfect right to tell others what you are thinking and feeling? If you are uncomfortable expressing anger or other feelings, you may be transforming buried anger into surface tension and anxiety. If you fear conflict or hurting others to the point that you carry hidden resentment, you may instead feel stressed and unable to enjoy life. As mentioned previously, the key ingredient in anxiety states and attacks is often suppressed anger.



At the same time, you may find yourself very reactive to perceived criticism (with emphasis on “perceived”). If you are already self-critical and fearful of not measuring up, you are probably alert to any sign of disapproval from others. You may be so sensitive to this possibility you perceive criticism even when none is intended. As a result, others may seem to be a constant source of anxiety.



Many of our clients, particularly those whose anxiety is manifested as an eating disorder, feel a need to project a calm, unruffled image. Inwardly, a threatening storm is gathering strength and there is no relief in the forecast. If this description applies to you, recognize that you are a perpetual anxiety machine. You exert a lot of energy looking as though you are in control, while actually doing nothing to calm the inner storm. You are operating like a pressure cooker without a valve to vent the steam.



If at the same time, you need always to be in control, you are probably already a stress casualty. Being in control means always being on duty, always hypervigilant. Everything is important. Everything must get your full attention. Besides, you can imagine someone watching, waiting for you to mess up. Can you conceive of anyone needing this kind of control and not being highly anxious? As we often tell our clients, “Over control is out of control.”


Jack prides himself on being invaluable to his organization. He arrives early, leaves late, and always brings work home. He believes he must fulfill all requests and keep everyone happy. Beneath his professional image he is fearful of falling short. He does not know how to relax and cannot recall relaxing in the past. He often feels he cannot keep up the pace. Others must not see his distress. He must keep going. He must maintain his image. Lately, he has begun to have anxiety attacks. 



A word used repeatedly in our anxiety groups is “avoidance.” Ongoing anxiety generally means a lot of energy is being used to avoid whatever is perceived as scary, dangerous, or uncomfortable. At the top of the list of things to be avoided is conflict and angry feelings. Sometimes people are avoided out of fear of rejection or abuse. Perhaps the most consequential avoidance is avoiding finding out who you truly are. All forms of avoidance leave you stuck in your anxiety. If you don't deal with it, you can't heal it.



Fear of failure lies behind much avoidance behavior, particularly avoidance of taking risks. You might be so concerned about possible failure that you resist making the effort or even attempting something new. You may be so preoccupied with the fear of failure that there is no enjoyment of day-to-day life and family. Past successes count for nothing, as the possibility of a humiliating failure always seems to loom on your horizon, if not just outside your door. Think for a moment. How many of the things you worried about last year actually came true?


Fear of failure breeds paralysis, lack of fun, inability to relax, and severely limits success in life. Real satisfaction and real growth come to those who worry little about possible failures, and instead courageously take calculated risks that may get them much of what they want.



If we talk to you about your anxiety, we will ask you questions such as “What do you do for fun? How do you nurture you? Can you tell those closest to you what you need, what you feel?” If you are typical of our anxiety clients, your answers reveal someone who rarely takes time to relax and enjoy life, someone who does not act on needs and feelings directly. You might be someone who places everyone else’s needs first, feeling selfish if you focus on your own agenda. You may not take time to do things for you, often claiming you do not have the time or that other things are more important. In short, you may not be very good at taking care of you, or even believing you deserve it. You might be getting a low grade in carrying out your most basic mission in life, to simply take good care of yourself.



If you checked several of the previous boxes, it is very likely that you have relationship problems. Holding feelings in or denying your own needs and feelings is sure to get in the way of intimacy. Lack of assertiveness or fear of conflict results in hidden resentments and withholding of your complete emotional truth. If you cannot be fully honest with others out of fear of conflict, fear of hurting them, fear of their anger, or simply fear of being wrong, your relationship is blocked. It cannot grow. If you do not believe in your rights as a person and fear being seen as aggressive or selfish, you are likely to be manipulated by others, dislike yourself, and be full of anxiety.



Stress of unmet needs is also a predictable result if you found yourself checking several boxes. This is particularly true if, for a long time, you have felt unsatisfied in your need for love and acceptance. You may feel perpetually lonely, tense, and worrisome, fearful of not being good enough for others to be there for you.


If you checked still other boxes, you may be someone who holds back from direct action aimed at getting you what you want. You may be paralyzed by the possibility of failure, or by a deep sense of not deserving to have your needs met. You may spend so much time focusing on the needs of others that you are out of touch with your own needs. This is the meaning of the much used (and misused) term “codependency.” In short, if you are not feeling fully empowered to guiltlessly and fearlessly take care of yourself, you are no doubt feeling the constant stress and anxiety of unmet needs.


Jane has had a series of failed relationships. Eager to please and fearful of rejection, she has given up herself in an attempt to get love and acceptance. Afraid to complain or say no, always focused on the needs of others, she has often felt victimized. Inwardly angry and resentful, she has not believed she could ever express such feelings and still be accepted. Increasingly, she has either avoided relationships or found ways to sabotage them before they got going. Now she finds herself dreading new encounters while feeling alone and unfulfilled.



We really like the term “uptight.” It is very graphic and very accurate. If you are like most anxious people, you carry your tension in your upper chest, shoulders, neck, and head. You may be breathing shallowly and tensing upper body muscles when feeling stressed. In the extreme, you may have what is known as “hyperventilation syndrome,” breathing shallowly and rapidly, getting rid of too much carbon dioxide and upsetting your body chemistry. The result may be nerves and muscles feeling overly stimulated along with lightheadedness and an “unreal feeling.” These symptoms are so close to the feeling of an anxiety attack or panic attack that they may trigger an actual attack.


Anxious people breathe from their upper chest and often feel as though there is not enough air. If you imagine the shape of your lungs you'll quickly see that the least room is at the top. This is the area of lungs anxious people perpetually struggle to breathe from. Learning to breathe diaphragmatically is a key skill. Ongoing awareness of breathing that comes from breathing retraining puts you in touch with your level of anxiety and also presents you with the cues necessary to plug-in a learned relaxation response, effectively short-circuiting your anxiety reaction.


Muscle tension often results in chest pain, neck pain, and headaches. Worry over all these bodily sensations may lead to concerns over having a heart attack or losing control. As a result, more stress is experienced and an ever escalating cycle of anxiety takes over.



Some disregard emotional and physical signs when they should not. Physical signs can help alert you to take care of business. You may be someone who pushes on no matter what you feel. If you are physically worn down, you redouble your efforts instead of resting. Your favorite motto may be, “When the going gets tough, the tough get going,” or, “If at first you do not succeed, try, try, and try again.” For the first motto, we would like to add, “When the tough keep going, and going, and going, and going without listening to their bodies, they begin to break down.” As to the second motto, perseverance is a great quality if balanced by knowing when to reassess the situation, when to rest, and when its is healthier to quit.


Perhaps you are someone who overreacts or misinterprets emotional and physical signals. Typically, those with panic attacks fear they are going to die, go crazy, or do something embarrassing. These things don't happen.


Chest pain, although commonly stemming from anxiety, does need to be taken seriously. See your physician and rule out a medical problem. Most likely, it's a stress symptom and you'll get good news -- and one less thing to worry about. Once you know you are not dying, start using your symptoms to help guide you to deal with real issues.


L inda is terrified. She is convinced that her panic attacks are going to kill her. Surely, the next one will be worse and will probably be “the big one.” Other body sensations are equally scary. “There must be something terribly wrong.” When asked to demonstrate deep slow breathing, she complies with a mighty breath, but one that is quick and shallow. Like many others, Linda needs to be instructed in the use of abdominal breathing for self-calming and she needs practice. She will also benefit from relaxation training and learning how to relax tense muscles. She is literally “up tight,” carrying all her tension in her upper torso, neck, shoulders, and head, unaware that tense muscles and shallow breathing generate frightening sensations and more anxiety. 



 We have been involved with drug and alcohol intervention and counseling for many years. For many, getting “clean and sober” is only the beginning. Often, they were anxious as teens, worried about fitting in or being good enough. Life may have seemed unpredictable and stressful until the discovery of alcohol and drugs. Finally, there was something that worked every time, bringing control and predictability. After years of using such a crutch to cope and feel in control, facing old anxieties cold sober can be overwhelming.


Using drugs and alcohol often generates more troubles and results in increased anxiety and depression. Many come to hate their drug of choice, but they hate facing life without it even more. They feel trapped and hopeless. Many feel suicidal.


We have been struck by how many of our clients with panic attacks report having had their first attack while using a drug such as marijuana or speed. They got more than they bargained for. Instead of a better feeling, they felt out of control and terrified. A new cycle of anxiety was created.


Stimulants include not only amphetamines and cocaine, but also caffeine. You may be someone who cannot seem to get going without jump starting your heart with several cups of coffee. One of the first things we ask anxiety clients is “Do you drink coffee?” and, “How much?” We frequently encounter high anxiety people with enough caffeine intake to wake up Minneapolis. Seem like an obvious connection? Cutting down on or eliminating caffeine may not entirely solve your anxiety problem, but it is a step in the right direction.


A high stress lifestyle speaks for itself. Are you able to relax and recharge your batteries? Do you have freedom from fear and worry? Can you calm down, rest, relax, and have fun? Are you able to rest on your laurels, put ambition on the back burner for a while, and believe you are “enough?” If the answer is “no” to any of the above questions, you may have become a perpetual anxiety machine. That's right, you’re doing it to yourself.


Type A behavior fits in here. That's the pattern where you feel intense competition with others, there is never enough time, and you must do better (the pack might be gaining on you). That description has long applied to many men and now increasingly applies to many women who often add the quality of having to be everything to everybody.



We all suffer losses. Change is inevitable. Your losses may be overwhelming or so numerous that you feel unbalanced. Changes, even positive changes, like getting a promotion or getting married, are stressful. If change has been very frequent, you are likely to feel stressed and very anxious.


Some changes require major adjustments: taking a job far from your support system or marrying someone with teenage children when you have never been a parent. Many of our clients come to us, not for a lifelong pattern of anxiety, but because they have found themselves caught in a very difficult situation.


Trauma is usually from something that forces a sudden and abrupt change, shocking and life altering. You find that you or someone close to you has a major illness. You are involved in a carjacking or lose your life savings. Some of our clients are Vietnam veterans whose trauma occurred many years ago. For them, change was the abrupt transition from high school and dating to the unrelenting horrors or war. The sheer magnitude of what they endured was so outside the normal experience that it can be fully understood only if you've been there. For many, the result has been a life of constant and extreme anxiety.



Other questions we ask are, “What are your goals?” “What really matters?” These questions refer to a dimension of life know as “existential.” Often a major source of anxiety is the feeling that your life is empty and without meaning. Is there something in your life that gives you a real sense of purpose? Are you feeling involved with life and looking forward to what life may offer? Do you continuously create new and interesting goals for yourself, goals that give your life zest and meaning? Perhaps the most important questions are: “What is it that is really important to you anyway?” and “Is that what your life is about?” Existential anxiety is often at the core of long-term anxious and uneasy feelings.


Again, look back at the boxes checked and rated. If several were checked, you have a clear picture of what keeps your anxiety going and what needs to be worked on. If you checked only one box, it is likely to be a very important box. If no boxes were checked, you have either exceptionally good mental health (in which case, your problem with anxiety is likely to be physiological) or you are in denial.



Deepening Distress 


 Many of our clients erroneously conclude that being anxious is their lot in life. They tell us this is the way it has always been, so this is surely the way it will always be. Besides, they tell us, their family was an anxious family. That is just the way it is with the Johnsons, the Smiths, or (fill in your family name). Many delay seeking treatment for years, thinking there is nothing that can be done.


This thinking is most unfortunate. Anxiety disorders are highly treatable. You learned to be anxious. Learned behavior keeps it going, generating more anxiety. That’s good news! If you learned it, you can learn how to free yourself from excess fear and worry. You can learn to be free, to relax, and have fun.


We get satisfaction from working with our anxiety groups. It is a pleasure to see so much growth, often in a short period of time. It is the proof of everything we are saying.



If you have a stress overload, you want relief. You feel intensely uncomfortable. There does not seem to be much pleasure in life. Physical and psychological symptoms have put a damper on quality of life. You have become a stress casualty headed for burnout, breakdown, or major illness.



Many seek a quick fix through drugs or alcohol, but this kind of help is an illusion. Not only is your life still a mess when you are not using, but using complicates things and creates more stress, anxiety and depression. Other addictions and compulsions, such as gambling, sex, or excessive spending, only distract you from your worries and fears temporarily. In reality, all addictions are deepening your distress.


For years we have specialized in the treatment of eating disorders. In working with these very difficult problems, we have found it most useful to think of them as anxiety disorders. Anorexia nervosa, bulimia, and compulsive eating are not about food and weight. They exist as ways of mindlessly coping with extreme psychological distress through a numbing and distracting avoidance and a shift to obsessing about substitute problems. Food and weight are merely smokescreen issues. The real underlying issues are identity, self-esteem, relationships, rage, and raw fear. Perhaps the biggest anxiety these clients have is the anxiety that comes with avoiding a relationship with self. As is the case with other addictions and compulsions, a defense against anxiety turns out sooner or later to be the main source of anxiety.


If you are willing to work at it, and with the right help, you are going to get better. However, for many who may not believe they can change or are unwilling to seek help, there is deepening distress. Your stress load accumulates over time.



As stress accumulates over time, there is more and more wear and tear on your body and emotions. Changes take place that weaken your immune system, exhaust your body’s coping resources, and even change your brain chemistry. These changes in turn make it harder for you to resist subsequent stressors. You may feel run down, unable to effectively meet new challenges. You may feel depressed, even hopeless, and your anxiety is increased.



As stress accumulates over time, you have essentially three choices: develop an addictive lifestyle, become a stress casualty, or find better ways to deal with life. You are most at risk if you are someone who meets pressure and stress with still greater effort, someone who cannot waste time relaxing, an “adrenaline junkie.”



You may know you are in trouble, but cannot ask for help. You may have headaches, backaches, G.I. tract distress, sleep disturbance, anxiety, and depression, yet see no alternative other than looking in control and pushing on. Be aware that you are living a largely self-imposed pressure cooker life. It is self-destructive. If you do not already have a full blown anxiety disorder, addiction, or other mental or physical illness, it may be on the way. Life circumstances may be difficult, but the real solutions are internal.


Now the good news. From the preceding material, you probably have a good idea how you developed an anxiety disorder or an anxious lifestyle. You can probably see how you keep your anxiety going. Congratulations! You have just taken your first step in treatment, understanding “Why me,” an awareness of providing a foundation for positive choices and changes.


Rather than believing your essence as a person is fatally flawed or that it is in your genes, you can now see how you were programmed by family, environment, and events. Using a computer analogy, the “program” is the problem, not you. It is time to write a new program, delete some files, update some, and creates some new files altogether. Helping you rewrite your program systematically, step-by-step, is our mission and the purpose of Mindful Choices. The end result-freedom from fear and worry, freedom to be truly you.




















Appendix 2




Bill Story: What’s Happening?


 It was late January, 1973. In Paris, the United States agreed to stop fighting in Vietnam. Liddy and McCord were found guilty in connection with Watergate. LBJ suddenly died of a heart attack. Ironically, his death came as the war that forced him out of office was coming to an end. Quite a start for a new year.


I remember reflecting on these events one cold and blustery winter day as I made my way across the University of Tennessee campus in Knoxville. I had been at UT for two years, dividing my time between being an Air Force captain serving as an Air Force R.O.T.C. instructor and a student pursuing a doctorate in counseling psychology.


As I approached the Volunteer Statue in the center of campus, something extraordinary happened, something I will never forget. It started as a cluster of strange sensations, and a sense that something was terribly wrong.


It came on without warning. One moment, I was simply walking from one building to another, lost in thought, trying to sort out and file away what seemed to be an increasingly complicated life. There was no shortage of worrisome thoughts, but most of that would have to wait. There was much I had to do. Deadlines had to be met. I had to “push on.” There would be more time for tying up loose ends later. For now, I had to move faster, get more done.


Suddenly, everything changed.


It was a strange sense of unreality. I felt disoriented. My heart was racing. My mouth felt like cotton. I couldn’t think. I was lightheaded and felt unsteady. There didn't seem to be enough air. I felt cold and clammy but I was sweating. Most of all, I felt paralyzed. I struggled for understanding. What’s happening to me? What should I do?


I sat down on the base of the Volunteer statue, trying to sort it all out. My brain seemed frozen and I felt strange all over. I wondered if I should ask for help. Would anyone notice my distress? The sidewalk was full of students and faculty, but no one seemed to notice. How could that be? How could I feel such a loss of control without anyone seeing the signs? How strange!


Within a few minutes, the worst was over, leaving me confused and worried, unable to comprehend what had happened. I knew only that something strange, seemingly inexplicable and frightening had taken place, something totally outside of my understanding or experience. Would it happen again? What if it did? What if…?


I wondered what I should do. Should I forget my original purpose and go back to my office? Should I go to the clinic? Should I go on to class and hope it -whatever “it” was- would not happen again? Suddenly, I had far more questions than answers and a new sense of urgency. I had to find out what had happened and keep it from happening again.


At last, I continued on to my 5:00 p.m. class, struggling to regain my composure. Once there, I sat through a lecture I scarcely heard, unable to let go of my uneasiness at what had happened and my dread of a reoccurrence. What if it happened again? By the end of class, I had my second episode. I still had no idea what was happening or that it had a name. Something was seriously wrong! Now, nothing else seemed to matter except finding an explanation and a solution.


During the next few days and weeks, the attacks continued. Increasingly distressed, I was ready for help. I was motivated. I wanted to find answers. I wanted it, whatever “it” was, to stop.


A psychologist friend I knew told me she didn't know what was happening to me. She told me she couldn't help and referred me to a physician. The physician told me it was probably “stress” and prescribed Mellaril, a drug I promptly flushed after it made me feel even more disconnected from my body. Fellow doctoral students and several instructors shook their heads and told me they had no idea what was wrong. A friend suggested a vacation. No one mentioned “anxiety attack” or “panic attack.” That would've helped immensely if only I had some idea what was happening. The attacks continued. I felt lost.


Finally, after several weeks of torment, a professor said, “Oh, you’re having anxiety attacks. I used to have those myself.” Incredible relief! Just knowing it had a name and happened to other people - and it was something some people USED to have. At last there was hope.


I didn’t know it at the time, but my future career as a psychotherapist was being powerfully shaped by my extreme distress in the first months of 1973. I began reading everything I could find on anxiety disorders in general and panic disorders in particular.


I had sometimes wondered what Socrates meant when he said: “The unexamined life is not worth living.” He came right to the point. He didn’t say “The unexamined life could be better,” or “The unexamined life isn’t very meaningful.” No, he came right to the point and stated flatly that life wasn’t even worth living if you weren’t taking the time to slow down, observe yourself, and reflect upon your own life. I had somehow been too busy for all that. Now I was experiencing the consequences for skipping some important steps in “Life 101.”


I began to see my panic disorder as the result of my learned beliefs and behaviors. My motto had always been, “When the going gets tough, the tough get going.” Now I began to question my perfectionism and lack of self-nurturing, as well as my tendency to not complain or express anger. I began to see how I had relentlessly driven myself, ignoring needs and feelings that I would not let get in the way. A major realization was that an anxiety problem was something I was doing to myself. I became determined to learn and change. When the tough keep on going, and going, and STILL going, unlike the Energizer bunny, they begin to wear out and break down.


And here is a really strange part of the story, but not something that is uncommon for anxious people. Believe it or not, until my panic attacks, I had never seen myself as having much anxiety, certainly not an anxiety problem.


These days I frequently find myself saying that anxious people often don’t know that they are anxious. That was certainly true in my case. I simply thought that I was leading a rather intense life, and that was just the way it was. In fact, I sometimes boasted that I did my best work amongst chaos and confusion. Now looking back, my hindsight is of course twenty- twenty vision. I had incredible stress in my life but I was in denial, even being proud of the fact that I was able to keep on going anyway. Stress management? If I knew the term at all, it was a totally abstract concept having no relevance to my life situation and life experience.


Recently, someone in one of our anxiety groups said: “I think my panic attacks are trying to tell me something. I just have to pay attention and figure out what that is.” Not bad! Panic attacks are only the tip of the iceberg. They tend to happen to those of us who have a high level of general anxiety, often because we have long ignored some of the basics of physical, emotional, and even spiritual self-care. They may happen to those of us who are too busy keeping our lives going to figure out real solutions to real problems. They happen most to those of us who avoid what we perceive as the sources of our stress, meaning anything that seems to result in anxiety. They happen often to those of us who believe we are somewhat immune, or tough enough that we don’t need to be  concerned with managing stress, but in actuality none of us are exempt. We are either making the kind of choices that lead to very satisfying, effective, and low stress lives, or we are making choices that erode away the quality of our lives, leading to greater and greater stress, anxiety, and depression (what Robin and I call dis-ease).


My panic attacks were trying to tell me something, and for once I was listening. I was learning that needs and feelings can’t be placed on hold while you’re busy doing other things. I learned that feelings, particularly anger, that you repress, will be “expressed” in other ways, such as higher levels of anxiety. I learned problems ignored or denied are still there, and still exerting an influence on your physiology and overall well-being. Most importantly, I was beginning to accept my number one mission on planet Earth was taking truly excellent care of me, something I hadn’t thought was particularly important.


As a student counselor at the University Counseling Center, I began seeking work with anxiety problems as often as possible. I quickly discovered there was no shortage. Anxious students were easy to find. With insight and ongoing and persistent practice of new ways of thinking and behaving, my own bout with anxiety gradually subsided. By the end of a year, anxiety attacks were a thing of the past. I had stopped fearing them. They have never returned.


When it was happening, it was awful! It is a level of discomfort almost impossible to comprehend if you haven’t been there, but for those readers who haven’t had an anxiety attack, I will try to explain. Imagine your car stalled at a busy intersection with an out-of-control cement truck, brakes squealing, skidding and careening toward you. Imagine your feelings. Your heart races, You break into a sweat. You fear you are about to die.


Now imagine having those same feelings except for one difference; there is no cement truck, no obvious threat, just the sense that something truly awful is happening. You feel faint; your chest hurts. There isn’t enough air. Your legs tremble and feel as if they will not support you. You think you are having a heart attack. It is the same distress, but no real danger. It is really quite easy to see why so many panic disorder sufferers think they are going crazy or that something truly terrible is about to happen.


Of course, not everyone will have panic attacks. As we said previously, panic attacks are only the tip of the iceberg, affecting about six million Americans. At least forty million adults in the United States, age 18 and older, have diagnosable anxiety disorders. At least another forty-sixty million are suffering from severe stress. Anxiety disorders affect one in eight children and anxiety disorders often co-occur with other disorders such as depression or eating disorders. Quite commonly, almost half of those with moderate to severe anxiety also suffer from depression, and vice versa.


So, in early 1973 I officially joined the legions of others who struggle with anxiety (my unofficial membership actually came decades earlier, years before I would take ownership of having a “disorder.”


Imagine my response if someone had told me in the first months on 1973 that my disorder would someday be an asset. I would have been less than polite. I did not want a therapeutic asset-I wanted the problem gone and I wanted it gone NOW.


So guess what? The prediction would have been on target. My own struggle has helped me immeasurably in helping others with anxiety disorders. Now I can say I honestly appreciate the lessons learned, the insights gained - but I will never forget how awful it seemed when it was happening. I suppose it’s best I don’t forget. I don’t want to ever make the mistake of discounting or minimizing the distress of my clients. Too many of them have received no other help than being told, “It’s all in your head,” or worse yet, “It’s a problem you’ll always have. You will just have to live with it. Your only hope is medication.” All bad and false advice!


The good news? While anxiety disorders are the most common psychological problems in the US, they are also the most treatable. Unfortunately, only one third of those suffering receive treatment.


My experiences in 1973 led to decades specializing in the treatment of stress and anxiety, helping others overcome lifestyle driven problems that take away from quality of life and often result in years, if not a lifetime, of misery. Our work draws heavily upon lessons learned and insights gained during that most difficult time when I learned how to simply slow down, pay attention and open myself to learning some of life’s most important lessons.



Revelation and a New Direction


So, what were these most important lessons?  What did I learn?


First, many if not most people already possess the resources to recover, and often without medication or becoming dependent upon mental health services.


Secondly, recovery happens when old beliefs give way to new conviction.  For example, I tell people recovering from panic disorder that they must learn to believe completely six things:

  It’s only anxiety.It can’t hurt you.You can handle it.It passes quickly enough if you let it.You can develop all the tools you need to manage your anxiety.You don’t have to worry about panicky feelings in advance – that’s what brings them on. 

Third, and perhaps most important, most stress, anxiety, and depression stem from a life out of balance.  You’ve been violating some basic rules.  The solution – find your balance.  It’s all about choices.


Finally, getting away from the more obvious symptoms of stress, anxiety, and depression, should mean that another journey is beginning, a journey toward living effectively and having a sense of well-being.  Reducing symptoms is only the first half of the process.  The second half is the fun part.


As it has evolved, Mindful choices is a systematic and comprehensive program for not only overcoming dis-ease, but also addressing root lifestyle issues and promoting transformation to well-being and happiness.


Like many other veteran therapists I've tended to redefine myself as I've grown both professionally and with the wisdom that comes with living life with a psychological mindset. Therapists are curious people. We want to understand, and we strive to continuously grow in understanding others-- and ourselves. My work has been such a journey. I have evolved.



I’ve been trained in the medical model, focusing on mental health issues and mental health diagnoses. Many hundreds of people have come to me because they felt broken or damaged, dysfunctional, anxiety ridden, stressed out, depressed, unhappy, or simply very dissatisfied with where they found themselves in their lives. They wanted relief. They wanted less suffering.


Each of them had a mental health diagnosis such as generalized anxiety disorder, panic disorder, major or moderate depression, adjustment disorder, or some other “disorder.” The expectation was that I would treat them until their symptoms went away, or until they no longer warranted a mental health diagnosis, and their insurance companies were no longer obligated to pay for their treatment.



Working to help others within the medical model, diagnosing and treating "disorders" has been  central to my professional life. It's been fulfilling, but I've always wanted to take it further. Being a "therapist," having a therapist mindset, has always left me wanting more.



Even the term "therapist" means someone whose job is to help people with physical, mental, or emotional problems, using a particular type of therapy. The focus for mental health therapists is on curing people ("patients") of their problems, reducing their anxiety and depression to a normal range, eliminating what we now call "dis-ease."



Is "normal" enough? To a large extent what we call "dis-ease," anxiety, depression, general unhappiness, is symptomatic of a life out of balance, a life where the normal state of "ease" has been disrupted. Is simply reducing the symptoms to the point of no longer meeting diagnostic criteria going far enough? What about enriching lives? What about joy and happiness? Normal is not synonymous with well-being and well-being means thriving, not simply achieving "normal."



Well-being of course means being relatively free of anxiety, depression and stress, but it also means finding meaning, balance and optimism. It means developing as a person and having a sense that life is deeply fulfilling and worthwhile.



This is our mission. Robin and I are therapists but also life coaches. Yes, we still treat disorders but we don't end our work at "normal." We believe in promoting growth and change without limits. We believe in helping people make choices. It’s all about choices!



The French have given us a wonderful term: "joie de vivre," meaning quite literally "joy of life,"


 a quality 20th century proponents of self-actualization such as Abraham Maslow or Carl Rogers saw as central to well-being, something Rogers referred to as "the quiet joy in being one's self...a spontaneous relaxed enjoyment, a primitive joie de vivre"



I'm multidimensional. I'm a counselor when I'm giving professional guidance, a therapist when I'm treating a "disorder," a "life coach" when promoting well-being. Usually my work involves all three roles, but my most enjoyable work is aimed at promoting well-being.



Our program, Mindful choices, addresses a continuum from dis-ease to well-being, from a medical model focus on reducing distress to a focus on well-being and balance. From the first session we work on developing mindful awareness, corrective self-talk, and self-calming and centering skills. Self-assessment of present and possible choices sharpens awareness and focus, and ongoing focused practice in implementing healthy choices leads in time to personal transformation. This book is a guidebook for overcoming dis-ease and finding well-being. We've kept it down-to-earth with an easily implemented process of many small choices.



Our Philosophy




 Originally schooled in the medical model, diagnosing and treating specific conditions or disorders, we’ve come to question whether those disorders actually exist in the way that we were taught to think of them – as distinct entities that have a life of their own. Going beyond a medical model, we now embrace a wellness model. Instead of an exclusive focus on eliminating “disorders,” we see our larger role as promoting well-being. We believe our clients have unlimited potential to grow toward lives of balance and wellness. Our role is largely teaching mindful awareness and centering, and mindful choice and practice



It’s been a fascinating journey. Now that our focus has evolved to a primary emphasis on well-being and happiness, and life coaching aimed at facilitating great Mindful choices, the journey has become even more interesting.




Appendix 3




Robin’s Story: Becoming My Own Best Friend




The first time I heard a therapist say “It’s important to become your own best friend,” I thought, “hmmm, that sounds nice…but I can’t imagine how you’d even begin to go about doing that!”



I was an anxious kid.  Always worried about what others would think of me.   Wanting to be the top student in the class.  Wanting to be popular.  Trying to be perfect, afraid to make mistakes.  Worried about the clothes I wore, worried about my too curly hair.  I was often sick with stomach aches and headaches, missing a lot of school.  My anxiety continued to grow through junior high and high school.  Always busy and always moving, I had part-time jobs after school and during the summer months from the time I was 14 years old.  I would obsess about mistakes I might make, playing and replaying in my mind the actions I had taken at work and what I should have done to improve.  I began to have difficulty sleeping, My emotions spoke to me through my body, but I wasn’t yet listening. I would get spasms in my neck and shoulder to the point I couldn’t move.  By my senior year in high school I had ulcers.



College was no better.  I was fearful of making any mistake.  While doing clinical rotations during my nursing program, I was deeply embarrassed about the way I would sweat profusely.  Nonetheless, I managed to function, largely ignoring the messages from my body and doing my best to avoid the incessant self-critical nagging in my mind.  I don’t think anyone around me had any idea of the private hell in which I was living.



After graduation, I became fearful of going many places by myself.  The anxiety felt overwhelming. It was an ordeal to fill my car with gas or go to the grocery store.  I could get myself to work, but at work I continually obsessed about my “poor performance.”  I felt like a fake!



I married and had children.  Being pregnant and then having babies to care for gave me a wonderful “excuse” to slow down.  There were many times during this period of my life I felt relaxed and comfortable.  However as my children became toddlers, I returned to part-time work and the anxiety was back with a vengeance -- constant, unrelenting, and tyrannical – and there was an eating disorder!



Now I felt I had to be superwoman---be an exceptional “do it all” mom, be a high achiever at work, entertain like Martha Stewart, be a leader in my church, sing in  the choir, train and show my horses, be an amazing and available wife, and look pulled together while doing it all.  There were times (especially through the holidays) I would go without sleep three nights in a row.  My mantra:  “You can sleep when you’re dead!”



Just recalling those times makes me feel exhausted (and a bit sad for myself, too).



After 10 years of marriage, my relationship dissolved.  Add single parenthood to this mix. . . And oh yes, this would be a very good time to return to school for a graduate degree (REALLY???)  Uh huh, I did! 



No wonder I soon found myself sitting on a sofa across from a psychotherapist recommended by a friend.  After a session or two I became very impatient.  I would sit with legs crossed, bouncing my foot up and down.  Sometimes I would drum my fingers.



“Just give me the book!” I remember saying to my therapist with irritation.  “I’m a good student.  I can read and follow the directions.  Now just give me the book so I can fix me!”  Oh my, he was so very patient with me. . .and yet, I could not be patient with myself.



While I continued in therapy, I also looked everywhere else I could think of to find answers. I read self-help books, listened to tapes, attended seminars.  I learned about “self-talk,” becoming aware of how harsh and abusive my inner dialogue was.   I was determined to change it.  Oh my, this was a REAL challenge.  I would carry note cards with me, put post-its on my fridge, write on my bathroom mirror with old lip color--ways of reminding myself to change my thinking and my “self-talk.”



During my therapy sessions, many “old wounds” were revealed.  I would often come home, sink into a rocking chair and let the tears flow--feeling very sad and “needy,” a child whose heart hurt. 



And little by little – I began to realize sitting with myself and letting my tears come was self-compassionate. 



I worked diligently at my therapy.  I found it to be the most difficult work I had ever done. . .harder than parenting, harder than obtaining a college or graduate degree. I had to look deeply into myself, and struggle to find and accept ME.  I had avoided “me” all my life--



Slowly, I was beginning to get a sense of being a friend to myself.  But I was not arriving at this place quickly.  Becoming my own best friend would take many more years and much more self-compassion and self-acceptance. Instead of struggling and striving, what was needed was more in line with accepting myself and letting go of old tapes, principally the belief that what I had always done was the only possibility of what could be done. I discovered a whole new world of choices and a new freedom.



Several years after beginning psychotherapy, I took the opportunity to learn biofeedback for use in my new profession as a Marriage and Family Therapist.  Through this training I learned to tune into various parts of my body, consciously relax my muscles, slow my breathing, warm my hands and feet.  As I did this, my mind focused and became quiet.  I felt complete relaxation, and I could achieve this at will.



I learned to be “present.”  “Be here now…” I would remind myself as I exhaled.



Getting “in touch with yourself” has the ring of a well-worn cliché, but it has real meaning for those of us who have long-lived on autopilot, disconnected from our needs and feelings. Finally learning to relax and let go I began to give myself very different messages.



“I am connected to all that is. . .”  This reminded me I belonged.  I had a place in this world.



“In the overall scheme of things, does this really matter?  Will it matter tomorrow?  Next week? Next month?  Five years from now?”  Will it matter 100 years from now? “ Now that gives one a different perspective on what is/is not important!



I would often sit with my palms up and my hands open, reminding myself to “let it go,” as I imagined my disturbing thoughts inside a big bubble drifting up, up and away from me.



I began to conscientiously tune into my body as I worked out.  I felt a deep sense of appreciation for the way it worked, allowing me to do things I love:  hike, ride my horses, hold my children, play the piano.  I could easily do physical labor:  shovel snow, clean a stall, scrub a floor on my hands and knees, stack firewood, etc.  My relationship with my body changed.  It was a joy to eat nourishing food, food I had prepared for my family and myself.  I started to ask,  “What am I hungry for, what sounds good to me?“ making choices based on what my body was telling me.



I learned to check in with myself several times a day, asking: “What are you feeling?  What are you needing?  What are you wanting?”  listening carefully to the responses and then doing my best to take care of those feelings, needs and wants.



I paced myself, no longer driven to be superwoman.  I could say “no” when I meant “no.”  I planned each day with time to work out, to prepare and eat healthy meals, to go to bed early enough, with time for my hobbies, time for my kids, time for friends.  And I let go of perfectionism.  



Ultimately, I discovered becoming my own best friend took TIME:  time to listen to my body and honor it, time to listen to my thoughts and feelings, refraining from judgment but seeking to understand, time to change any negative self-talk to empathetic and encouraging self-statements, time to take care of myself in every way. When I ACTED AS IF I MATTERED I began to feel and BELIEVE I mattered.



We believe most anxious and depressed people are on autopilot, carrying out a predetermined program, following a script written years before, mindlessly reacting their way through life unclear on what they really want, and what is really important. They are unaware of the choices for living a life that feels truly meaningful, authentic, and satisfying.



Changing the program requires awareness and action. Mindful Choices has grown out of our own experiences, our individual paths toward awarenessNow we find ourselves on a common pathway, and we’ve developed a program of mindful awareness, systematic self observation and self-assessment, and consistent and selective mindful action designed to help you become “your own best friend.”



I’ve lived more than one third of my life stressed and highly anxious, and I’ve learned valuable lessons. I’ve learned to be calm, peaceful, and aware. I’ve learned how to be good to myself. I’ve learned how to be my own best friend. It’s all about awareness, choices, and action.



I like my life. I can’t imagine going back.



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