Hi, I'm Dr. Tracey Marks a psychiatrist, and I make mental health education videos. Today I'm talking about
how to cope with worry during this time of uncertainty. And this is based on
a question from Helen. She says, "People with generalized anxiety "and depression are usually taught in CBT, "which is cognitive behavior therapy, "not to engage in catastrophizing. "However, given the current situation, "I don't think that
technique works anymore. "After all, isn't the world
experiencing a real catastrophe? "I don't think many
pessimists saw it coming "and yet it is here. "Are there any alternative
techniques people "with anxiety and depression can use "in order to give themselves some hope?" Thanks for the question, Helen. It is true that one of the
distorted thinking patterns that a person with anxiety can
get into is catastrophizing. And this is anticipating and focusing on the worst case scenario
for any given situation. But what about when
the worst case scenario seems like a real possibility? Here's something that you can do. First of all, realize
that there is some amount of worry that is helpful. Helpful worry is thinking ahead, anticipating problems
and trying to solve them. Unhelpful worry is
fretting about the things that you can't change or things that may or may not come to pass. To get a better look at this, you separate out real problem worries versus hypothetical worries. Real problem worries are about problems that are currently affecting you. And these are things like needing to find more toilet tissue, or needing to take care
of your infant child while you recover from the virus. Hypothetical worries are about things that are not true at the moment, but might happen in the future. And examples of this are
worrying that you'll get sick and there'll be no more ventilators or you'll catch the virus
in the grocery store and everyone in your home will die. Here's a tool that you can
use to help you recognize the two types of worry in yourself. And this is called the Worry Decision Tree that was introduced by doctors, Gillian Butler, and
Tony Hope in their book "Managing Your Mind: The
Mental Fitness Guide". Here are the prompts for this or the questions that
you can ask yourself. Start with, what am I worrying about? Is it a problem that I
can do something about? If the answer is yes, then you continue on one side of the tree. List your options of
possible interventions or actions that you can take. Then, of those options, is there anything that
you can do right now? If the answer is yes, then do it now. Then after you do it, let the worry go and focus on something else. How do you let the worry go? I'll speak to that after I
finish the branches of the tree. Let's go back to this point. What if there isn't
anything that you can do about your problem right now? Then you plan what you can
do and when you will do it. Then you again, let your worry go and focus on something
else that is important. If you determine that this is a problem that you can't do anything about, then you let go of the worry and focus on something else
that's important to you. So how do you let go of the worry? You set aside worry time,
you can start with 30 minutes and this will be dedicated
time to just let it rip and make it a formal process. Don't just stop doing something else and then sit and worry in your head because then it won't feel much different from your usual worry. Instead, go to a designated place like you're showing up for an appointment and make it an active process by writing down your hypothetical worries. Here are some other prompts to think about during your worry time. How concerning are these
words on a scale of one to 10 with 10 being the most worrisome? Are they any less worrisome
when you think about them now during your worry time than
when they first came to mind? Chances are when you defer the worry and contain it to a certain time, it won't seem as critical or distressing. Also, while you're having
your worry appointment think, are any of these
hypothetical worries things that can convert to real
problems that you can work on? I think it's helpful
to keep a worry journal that you only look at
during your worry time, then you can keep up with
the worries or the problems that persist versus the
ones that get resolved either by your efforts
or by circumstances. Now worrying thoughts
tend to be intrusive, they just pop into your mind even when you're not trying
to think about them. So it takes discipline to defer your worry until you're worry appointment. But having an appointment to indulge your worry can help with that. So when you have a thought
that pops into your mind, make note of it and tell yourself that you're gonna save it for later. Then practice mindfulness to pull you away from that thought. Remember, worry is about focusing on a future threat or a past pain, and being mindful pulls
you into the present. And you can do this several ways. One way is by taking a
couple of deep breaths while counting to four in your head, and slowly exhaling while
also counting to four. Then do a survey of your
environment using all five senses. What do you smell? What do you see? What do you hear? What do you taste? What do you feel? If you can't remember what
your senses are at the moment, just remember that four of them are on your face in your head. Your nose is in between your eyes and then you go around to your ears and then come back to your mouth. We tend to think of feeling
things with our skin. Another thing you can do
is focus on the sensation of breathing as a way to be mindful to bring yourself back
to the present moment and away from your worry thoughts. One other resource in your
toolbox is to practice gratitude. And this helps you connect
to the positive feelings in a personal and tangible way, and there are several ways to do this. But here are two suggestions. When you're in a state of distress, you can't spontaneously think of things that you're grateful for. So at a time when you're
calm, write down the things that give you pleasure and
that you're thankful for. And these can be experiences,
people or material objects, write them on a piece of
paper and keep them in a jar. Then when you're having trouble pulling yourself away from your worry, pull out a couple of your
notes and reflect on them. If they are experiences put yourself back into that experience. You can also write this in a journal or keep a list on your phone. You may also want to reflect on this list after you get out of
your worry appointment. That can be a way to come down from that if it made you more anxious. But what I've seen though, is people tend to have trouble filling the
time during their appointment and their minds start
wandering to other things. Then they feel like they don't need to do the appointments anymore, and they use mindfulness and gratitude to pull them out of their worry thoughts. Another way to use the gratitude practice is at the end of the day
to reflect on the things that you're thankful for that day. With this approach,
you're keeping it fresh and specific to your
experience from that day, rather than reminding yourself of the blessings that you already have. And it doesn't have to be
either or you can do both. So let's recap. To handle worry and anxiety go through the Worry
Decision Tree exercise to separate out real problem worries from hypothetical worries. And this exercise also
prompts you to think about immediate solutions
to the real problem worries. Then, if you have a lot
of hypothetical worries, set aside an appointment time each day to worry about these things. Any other time during the day
is off limits for worrying. If you find that you're
still having worries pop into your mind outside
of your appointment, use my mindfulness and gratitude
to push those thoughts away so you can save them for later. I hope this is helpful for you. Here's another video
talking about general ways to manage Coronavirus anxieties. Stay well. See you next time.
