The Covid-19 pandemic is “under control” in France, with the prevention and vaccination policies having brought their fruits – and tasty ones, too. So, in these post-pandemic days, If I may call them that, I candidly thought that I was finally going to return to working below the bar of 70 hours per week.
Sweet utopia, because medicine, in the broad sense, and patients redoubled their efforts so that I would not be bored!
In this context, I was allowed to see Karen, 24, for the third time in 10 days, and always for the same reason: severe neck pain causing sleep problems… After the classic advice on muscle relaxation and prescriptions for analgesics, she returned with X-rays results so that we could discuss them. Her pains did not give way; they even intensified. She had already had two osteopathic sessions without convincing results.
I could not explain this situation: soft mystery music was slowly creeping into my head, especially since the exam results had reached me the day before: nothing to report. So I brought a Karen with ringed and reddish eyes into my office:
– “Okay, Karen, these x-rays are perfect. How are you feeling?”
– “I’m still in so much pain. It just doesn’t work out.”
– “Okay, seeing your ringed eyes, I imagine the pain is preventing you from sleeping…”
– “The drugs make the pain bearable. But, hey, evenings before going to bed, I start wondering whether I’ll have a stroke during the night. Sometimes I have tingling in my arm, and I’ve read online that this can signal a stroke. Thinking of this feels like a wave of anxiety washing down on me.“
– “Oh, Karen, I see; the stress and anxiety are taking over and reinforcing your fears. So whatever you try to do, you can’t help but see the worst and the darkest.”
– “Yes, I am afraid of being paralyzed and dying from a stroke or having MS (Multiple Sclerosis),” she said between two sobs she could not control.
– “Don’t worry, Karen, I’m here for you. You’ll be fine…”
– Here is a classic and striking example of a:
” DISTORTION FROM REALITY “
You perceive things as more terrible than they actually are, and you believe the situation will get worse. It’s like looking at yourself in a distorting mirror! The total loss of rationality is constant, preventing criticism or, at least, less self-criticism. It’s like looking through blinders and seeing only part of the field of possibilities – the worst, obviously!
This black vision of what is presumably a shade of gray is the starting point for anxiety. But does it mean to be anxious? Many people say they are stressed. More and more, stress and anxiety merge in a semantic stretching, and through abuse of language, “I am stressed” turns into “I have anxiety” or vice versa. However, panic attacks (anxiety attacks) and generalized anxiety have unequivocal definitions in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Annex 1 & 2.
” KNOW YOUR ENEMY TO OVERCOME HIM BETTER…”
Anxiety disorders can have a debilitating impact on daily functioning and well-being. Many people experience this situation as a real handicap that directly influences their life quality, acting as a brake on their personal development. In addition, people with anxiety disorders are at an elevated risk of cardiovascular disease and premature mortality.3
The mechanics of anguish are frightfully efficient; they are similar to watchmaking precision., We will refer to the following image to fully understand its different facets:
A concrete example :
Negative / Anxious thought: I will fail this job interview.
Negative / Anxious emotion: I feel powerless.
Negative / Anxious behavior: I’m not preparing for the interview. What’s the point? I’m going to miss it!
This triangle explains the chain of events fueling anxiety: anxious feelings never exist alone. Thoughts, emotions, and behavior are interconnected: they create a three-headed beast.
The following five concepts are fundamental:
- Emotions (or feelings) are created by thoughts, cognitions, the way of seeing things, and the paradigm.
- When you feel anxious, the negative side takes over your thinking.
- Distorted thinking changes reality, thus causing negative or anxious emotions. These feelings contribute to discomfort and maintain anxiety. This is the leading cause of your discomfort. Identifying and reshaping anxious thinking helps combat this.
- When negative or anxious thoughts become systematic, we speak of automatic thoughts. That means you start to live with anxiety daily.
- Anxious emotions generate anxious behaviors, which, in turn, lead to distorted thoughts: The triangle turns into a spiral of anxiety and negativity.
” WHAT WEAPONS ARE BEST FOR TRIUMPH? “
- Identify negative distortions.
- Objectively analyze any negative or anxiety-generating thought to make it less credible.
- Commit to positive behaviors that generate positive thoughts: Behave as if you were in a good mood, and then you feel in a good mood!
- Consider sessions with a psychologist, particularly cognitive-behavioral therapy.
- Talk to your doctor, who will consider drug treatment if necessary.
We will take these points one by one.
1. Distortions of reality
The following infographic summarizes the most frequent distortions. There are others, but I am sure you will recognize yourself in at least one of these ten images. It is up to you to identify the distortions that concern you; it is the beginning of the therapy.
2. Objective criticism of distorted thoughts
After identifying these thoughts, it is necessary to undergo objective criticism. Reason is the ultimate weapon against the subjective irrationality that belittles and paralyzes you daily. Distorted thoughts are incredibly vicious in that they attack our self-esteem, which is fundamental and characterizes all of us. There are different techniques, but I will talk to you about ” mental feedback. ” The idea is to identify and write down anxiety-inducing thoughts in a notebook or on your smartphone to do three things:
- Count down from a hundred (it can be lower than a hundred, though. This number will stabilize over time, you’ll see).
- Criticize objectively by referring to the table of distortions above.
- Replace anxious thinking with objective thinking closer to reality.
3. Adopt positive behaviors
We must act; we must move to make things happen, get better, and overcome anxiety. Action is an extraordinary weapon. Procrastination is your inner enemy because it sneaks up on you as a personal choice.
Apparently, you choose to do nothing because you don’t want to! This is the true definition of “letting yourself go.” You must not do things because you want to, but because it is an absolute necessity to fight against anxiety.
Otherwise, this anxiety will win the battle by forcing you to curl up on yourself and your negative feelings.
You can use a Daily Activity Schedule to force yourself to move. This program features two columns: one for the activities you would like to do and one for those you did. During the evening, analyze your accomplishments and rate the difficulty (e.g., X out of 10 or 5). Notice how good you feel when you keep your commitments! Anxiety hates surprises, so planned action is a strong weapon.
4. Cognitive Therapy
These are techniques used by a psychologist to help you fight anxiety. We don’t want to shock you, but what you are doing by reading this article is already a form of cognitive therapy. While it is pretty simple, it corresponds to learning and practicing different techniques to improve your condition. Thinking that “going to see a psychologist is useless; they will not help me because there is no escape for me anyway” is a highly objectionable distortion of thought! Cognitive-behavioral therapy (CBT) is a technique aimed at effectively combating anxiety and is validated by various scientific studies.4
Treatments have to be discussed on a case-by-case basis with your doctor. The different existing formulas have their beneficial and undesirable effects. Adverse reactions should never be overlooked. I remind you that a panacea against worrying is a fantasy! No medicine will make you happy. These drugs aim to limit the paralysis of thought induced by anxiety, allowing you to tailor the best solutions for your situation.
Anxiety treatment means personalizing the care according to each patient. The concept of Medical Active Coaching is a much more relevant approach. This paradigm admits that similar causes may produce very different effects. These results depend on your experience, background, social condition, and current spirit. With this approach, people are doing more than following general recommendations. Instead, you will do what you are ready to agree to. You will move forward, in your strictly personal context, here and now! This personalized mental and physical fitness program starts from validated scientific theories, building on them and adding value.
“KAREN’S MEDICAL ACTIVE COACHING”
Be positive in the morning.
Karen now says a phrase called “mantra” every day after waking up. I suggested: “today will be a great day” to her; it’s the Maui Habit (BJ Fogg, Tiny Habits).
Identify anxious thoughts.
She should write down the anxious thoughts that cross her mind on her smartphone as often as she can. She replied: “Okay, my smartphone has 512 Giga of memory.” I laughed a lot.
Analyze anxious thoughts.
For example, I asked her, “what could cause neck pain, but is neither a stroke nor MS?” She replied with a pinched nerve or stress! Then I asked what the most prevalent cause was, having her choose between stroke and MS versus pinched nerves and stress. Karen answered logically, proving my point that objectivity was a weapon against anxiety.
Meditation and relaxation are highly effective weapons against anxiety attacks.
Karen is skeptical about meditation, so I proposed cardiac coherence, which I also practice daily. We agreed to start with 2 minutes every morning.
Get daily physical activity.
Karen does not play sports at all; the concept seems distant to her.
So we set out to start very, very small: She will have to do 25 skips every morning. The goal here is to create a habit, even a minimal one, that we will know how to exploit later.
Consult a psychologist.
Karen’s anxiety stems from her troubled past, and the sore point seems to be a lack of self-confidence. The therapy sessions will give her the weapons to see herself as she is, slowly removing the filter caused by years of distortions.
” AND NOW WHAT ABOUT KAREN? “
Well, our Karen still has neck pain from time to time, but she manages it with physiotherapy. She stopped the therapy sessions after about six months. Karen is much less stressed but came to see me once for a headache that she didn’t know could be related to her neck pain. Karen told me she and her boyfriend were buying a house and planning to have a baby. Although she had anxiety spurts once in a while, Karen said they were under control. Anyway, she and her psychologist agreed to resume sessions if she felt the need. I am very happy for this young woman who overcame her fears and moved forward. Even if she still has clinical anxiety (which will surely not change), she has found a way to articulate her future. Karen doesn’t let her fear of what could happen to take control; she is now motivated by the happiness of what is already happening… It is up to us to use this story as an example of how to decide for ourselves, creating our ideal psychological environment. It is up to us to create our own cocoon, conducive to any metamorphosis
- Anxiety in UE: Percent of adults aged 18 and over with regular feelings of worry, nervousness, or anxiety. https://ec.europa.eu/eurostat/databrowser/view/HSW_PB5 custom_1331213/default/bar?lang=en
- Anxiety in the USA: Percent of adults aged 18 and over with regular feelings of worry, nervousness, or anxiety. https://www.cdc.gov/nchs/fastats/mental-health.htm
- Kandola A, Stubbs B.Adv Exp Med Biol. 2020;1228:345-352. doi: 10.1007/978-981-15-1792-1_23
- Giacobbe P, Flint A.Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):893-919. doi: 10.1212/CON.0000000000000607.