“Control the controllables” is what an ex-professional rugby player friend told me when I confessed to feeling anxious.

I was reminded of this recently when listening to Patrick McKeown. He talked about a famous Irish rugby player who would get really anxious and lose sleep before a big match, despite many years experience. So what might he worry about? The weather, the state of the pitch, the referee, what the crowd is going to be like. All these are things that he can’t control. Spending time worrying about these is not helpful. Sound familiar?

If you are like me, you can easily spend hours worrying about what has happened, analysing whether you said or did the “right thing”, berating yourself for having said or done the “wrong” thing or having said something “stupid” or that could have been misinterpreted.

Or alternatively, not doing things because you worry about what might happen next, what people might think of you, or whether you will be any good at it. Or if you do do it, then planning for every outcome and possibility.

Time spent in our heads thinking about the past or the future can often be helpful. If we learn from our mistakes, for example, we can progress. This is what entrepreneurs do all the time. But if we dwell and ruminate on them, we can go round and round in circles. Similarly, planning and being organised, packing that umbrella or raincoat, and some warm clothes, makes sense (especially in our climate!). It saves time and often results in better outcomes (no-one cold and wet!). However, if we worry too much about what might happen, this can be very exhausting and unproductive.

So how can we manage worry and anxiety better?

Here are 8 things that have helped me.

1 Creating space

I returned to clinical practice recently. I enjoyed it but immediately started worrying about the patients I had seen. Had I missed anything? What if…..?

I went to yoga that evening. Through focussing on the movement and breath, I distanced myself from what was whirring around in my head. My worries started to feel smaller.

2 Control the controllables

Focusing on what you do have control over. Similar to our rugby player.

Is this thought process useful? Is this problem solvable? If  so , can I take a positive action to resolve it? Or is it something with no immediate solution but which might be addressed with a bit of brainstorming / collaboration with others?

If you encounter something truly unsolvable then this is more tricky. And this is when the other following tips help.

3 Minimise stress

This is key. We will have all seen patients with severe mental health problems who are stable for some time but then relapse when something stressful happens.

Similarly, my anxiety had always been manageable when my stress levels were low or stress was high but for a finite time, When the stress mounted and persisted, the anxiety spiralled out of control.

This comes down again to controlling the controllables. Minimising stress in our lives is something that we can often control, although we don’t always see it.

For example, are you able to cut right back on any external commitments that are work-related such as private work, extra roles? Can you reduce your clinic time or increase your consulting time? Are there other commitments in your personal life that aren’t essential that could be reigned in whilst you take action such as voluntary work (unless they are energising.)

I will be talking more about managing stress in a future blog

4 Focussing on the present

Rather than ruminating about the past and worrying about the future What is here now? Meditation and mindfulness are excellent ways of training our brains to do this.

I say training as this is not something that happens immediately or even quickly. Like training for anything whether it be a marathon, a triathlon or something mental like medical finals, it takes time to build up the muscle strength and neuronal connections, but once in place, it is easier to pick up and maintain.

5 Surround yourself by people that energise you and make you feel good.

Avoid people or situations which make you feel negative as they can often fuel anxiety.  Certainly, when I was recovering this was true. I would come away from seeing some people feeling worse about myself. When I was anxious, speaking to certain people would be feed the anxiety further and sometimes raise new dilemmas in my head to worry about!

6 Accepting negative feelings rather than fighting them.

Emotions are a part of everyday life.  Feeling stressed, anxious or low at times is normal, as are unhelpful thoughts. It is when these thoughts and feelings become so frequent and / or severe that they prevent us from coping with daily life that they become a problem.

Learning to accept them may sound strange. It is something that I still struggle with but it does help. Once you accept your feelings by observing them like an outsider would, or as in mindfulness, like clouds passing, you fight them less. You know that they will pass. This is reassuring and saves a lot of wasted energy and time.

7 Challenging the worrying thoughts

When we worry we often distort problems in our mind, known as “cognitive distortions”. Many of these will be familiar as they are common in doctors and include:

  • All or nothing” thinking – ‘if I can’t do this, I am a total failure.’
  • Over-generalisation – ‘because I failed one exam, I’ll now fail all my exams.’
  • Filtering – focussing on the negative, however small, and filtering out the positive
  • Mind-reading – you ‘know’ that someone else thinks in a certain (negative) way (about you)
  • Personalisation – very common in medics where we often assume responsibility for events outside our control.
  • Catastrophizing – where you imagine the worse case scenario. Because one area of your life is not going well, your whole life is falling apart.
  • Labelling – negatively on perceived shortcomings – ‘I’m stupid’, ‘I’m a total failure’.

Being aware that we do these can help in itself. The next step is to question them. What is the evidence that it is true? Is there a more positive way of looking at the situation? What might you say to a friend who has the same worry?

CBT can really help with this. There a variety of ways to access this such as Moodjuice, a free on-line CBT workbook, through your GP or privately.

8 Be kind to yourself

Something that we all too often forget. We are all human. We all make mistakes and will continue to do so. Changing ingrained thoughts and behaviours that we have lived with for so long won’t happen overnight, but we can take small steps to trying to tackle them.

This is what I have been doing over the past 12 months. Taking baby steps. Making small changes. It is constant work, but 15 months on, I can see the progress and am much happier for it.

Anxiety’s like a rocking chair. It gives you something to do, but it doesn’t get you very far.

Jodi Picoult

 

Resources

  1. Moodjuice Scotland – CBT workbook
  2. Helpguide – managing anxiety

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