I wanted to outline the methods, strategies and approaches that have helped me with anxiety (moderate to severe OCD). Although I hope you might find something useful here, you may not. Seek qualified and competent psychological advice. To make it very clear that this is only my experience, and not general advice, I’ve written a lot of the post in the first person. I apologise if that gets grating.
The critical concepts are:
A). Insight . You have insight when you regard your problem as anxiety and you recognise, on an intellectual if not an emotional level, that your anxieties are either very likely unreal, or at least greatly overplayed. When you lack insight you regard your problem as the content of your anxieties. Insight exists on a spectrum.
B). Rumination. To ruminate is to spend excessive amounts of time thinking through your anxieties.
C). Attention shifting. The antidote to rumination is attention shifting. As a strategy, attention shifting means a decisive, insistent and active refusal to engage with or entertain anxiety thoughts.
The aim is to raise the degree of insight while avoiding rumination. You might be wondering how this is possible- how can both happen at once? after all, to challenge a thought, doesn’t one have to think about it? The strategy that has worked for me is multi-headed. When I face a spike in anxiety, I employ the following steps:
1. Get my general factors right: All the usual advice, plus a few me-specific things. If I am not taking a med, start one. If I am taking a med have a conversation about whether I should raise the dose with my doctor. Consider supplements with some scientific basis, such as ashwanghanda. Exercise! An anxiety beating combo for me is walking while listening to podcasts. Cut stressors and utilise supports. Keep in mind there’s a delicate balance here- I don’t want to cut stressful activities in an avoidant way, or give into anxiety and become a hermit. I also need to remind myself to use the supports I have available.
2. Conceptualise myself as ill and recognise the limitations of my own reasoning: This is going to sound paradoxical or self-limiting to a lot of people, but I’ve found it useful. I get myself into a headspace where I am very aware that I have an anxiety disorder, and that having an anxiety disorder means that some of my thinking will be irrational and disorted even when it “feels” right. I develop and use a mantras that will help me remember the limitations of my own thinking. For example: “Anxiety is distorting my thinking so I can’t trust my own judgements about my fears”.
3. Read some articles by experts about my specific form of anxiety: It is sometimes also wise to read the stories of people who have similar anxieties to myself (there are plenty of forums where people post descriptions of what they are worried about). Reading experts and fellow sufferers writing about fears like mine is an extension of point 2. The aim is to begin to see my thoughts as the manifestation of a common illness by reading about similar manifestations in other people- similar content to their worries. The aim is to create a perspective shift in which I see myself as a sick person, rather than as a person endangered by the content of my worries.
N.B. This could very easily become a weird kind of compulsion- a sort of reassurance seeking- although that hasn’t been my experience thus far. This is important to monitor.
4. Meditate on the optimistic meta-induction (article here): Really burn it into my mind. This step also builds on point 2.
All these steps help reduce degree of belief in the content of fears and worries, without going down the rabbit hole of rumination.
5. Go see a psychologist ASAP: Even in a session where I don’t make much progress (and that is rare), seeing a psychologist is at least a tangible reminder that I am a person with an anxiety problem, and not a person with a “whatever I am worrying about” problem- so once again it comes back to insight.
6. Create a defined, delimited space in which I am permitted to ponder my anxieties: About 15 minutes a day is appropriate. I sometimes even want to limit the time to “When I see my psychologist”. In that space, called “worry time”, it is appropriate to ponder my anxieties. When thoughts occur outside that space, I push them aside, and mentally acknowledge that the right time to think about those worries is in worry time. It’s easier to dismiss things if there is a space where those things are permitted, so I am not simply saying “No, bad thought!” I am instead saying “In its proper time”.
7. In worry time, bookend every chain of reasoning with the thought that, whatever my assesment of the situation good or bad, the truth is probably better because anxiety is systematically biasing my thinking towards bad: Weave this liberally through my thoughts.
8. If I find myself worrying or ruminating outside worry time, squash those thoughts with prejudice by shifting my attention: Think about something else. This is easiest when I act quickly. Often there is a moment of vague anxiety just before I think my first anxious thought in a train of worries- I try to use that moment to squash my anxieties and force myself to think about something different. In our culture there is a bias against the idea of squashing thoughts. It’s seen as a form of cowardice. In truth, going over the same thoughts over and over again is a futile search for comfort and certainty- abandoning that takes courage. Novels and pop psychology teach us that if we can only find some perfect key, we might find some great revelation or answer to our worry. In truth, when we leave thoughts that are no longer constructive behind, we create the space for personal growth.
9. Aim to think everything through once and once only: In practice the way I do this is oriented around sessions with my psychologist. I prepare before the session (making notes to bring in to the session) and then really go through every argument and fact I can think of relevant to an issue with my psych in detail before to a conclusion. If I am later plagued by some aspect of that same topic again again, I consider whether it’s really novel, or just a rehash. If it’s really a novel perspective or fact, I resolve to mention it in my next session with my psychologist, or at least not think about it till worry time. If it’s just a rehash, I remind myself that I’ve already made a determination, under the closest to ideal and rational conditions I can, and that whatever my feelings, re-litigating it can only lead me further away from the truth (in expectation).