Overcoming Anxiety and Taking Back Control

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We all experience worry and anxiety but for some, it can impact overall functioning in a negative way. What’s the difference between anxiety and an anxiety disorder? Productive and unproductive worry? UH psychologist, Dr. Robert Chester, a specialist in anxiety disorders, offers advice about recognizing cognitive distortions or errors in thinking. Overcoming anxiety may be challenging but there are ways to take back control.

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Pete Kenworthy
Many of us feel anxiety at one time or another, but the past couple of years really seems to have turbocharged those feelings. You know, the pandemic amplified things for some people and also created new anxieties for others, for sure.

Macie Jepson
Pete, I know what you mean. I have a lot to be thankful for. So do you. We’ve got good health, good jobs, great family, but I worry. You worry. The rapidly changing world feels like the ground is constantly shifting, and there isn’t anything, at least in my own experience, that I can draw on to get through it. I wish I could stop worrying. I mean, really, it’s pointless. It doesn’t make a difference. Right?

Pete Kenworthy
Yeah. I mean, it really doesn’t, but from what I understand, all behavior has some sort of reward. Right? In other words, I act in a particular way because I’m rewarded for acting in that way. And it makes me wonder if there’s some reward in worrying. And if I can pinpoint what that reward is, maybe I can break the cycle. Hi, I’m Pete Kenworthy…

Macie Jepson
and I’m Macie Jepson. And this is Healthy@UH. Today, we are going to explore anxiety and how to break that cycle of worry. Joining us today is Dr. Robert Chester, a University Hospitals psychologist who specializes in, among other things, anxiety disorders: OCD, post-traumatic stress disorder. Dr. Chester, thank you for being with us today.

Dr. Robert Chester
Thanks for having me.

Macie Jepson
Let’s start with anxiety being a learned habit. Is that the case? Well, first of all, what is a habit?

Dr. Robert Chester
So, a habit is, I think of it as something that you repeat over and over again, and over time, it kind of happens without even thinking about it so much. You just kind of fall into a groove, basically. And that could definitely happen with anxiety as far as of avoiding the feelings of anxiety. You can really get caught in that. It’s hard to get out of it sometimes.

Macie Jepson
So, anxiety is a learned habit?

Dr. Robert Chester
It can be. Well, your response to anxiety can be a learned habit. Worrying about things can be a habit, too, which is part of anxiety. The main part is worry, really. So, you can get in this habit of worrying about things and feeling like you have to in order to prevent something bad from happening or be prepared for it. But in reality, it doesn’t prepare you much at all. And honestly, a lot of people with anxiety disorders end up actually handling crises pretty well when they happen. It’s not because they’re prepared for it, like all the worry prepared them. It’s because they can just handle it when it happens. There’s nothing to worry about when something’s actually happening, right? That’s a big part of it.

Pete Kenworthy
Yeah. That’s interesting. We talk about this trigger equals behavior equals reward. Right? But in this case, reward doesn’t seem to fit. Right? Because anxiety, worry, that that doesn’t feel good. So, I guess what I’m looking for is how is this a reward? Right? How is the worry, how is the anxiety a reward for the person and how does that cycle keep itself moving?

Dr. Robert Chester
So, the reward part can come in a few different ways. The one is, you know, the worry itself, again, feeling like you need to in order to prepare for something, so you do kind of feel that reward like I’m doing something, you know, that’s preparing me, instead of just trying to forget about it and then, which is hard to do, if you have an anxiety disorder, for sure. You have it at the forefront of your mind are thinking a lot about it, especially if it’s far out and it’s an unknown, you can really get caught up in that over time. So, I usually try to get people to do things that make them anxious, like tomorrow or next week or something, not three months from now, cause then they’re going to be spending that whole time worrying about it.

Macie Jepson
You mentioned the stressful times and how that’s the easy time for someone who’s anxious. It’s really the relax…when there’s nothing to worry about, that’s when the problem arises?

Dr. Robert Chester
If someone has a test coming up, for example. A lot of times…this isn’t true for everyone…a lot of times once the test is actually happening, they can’t focus on anything else, like they’re able to focus on the actual test and get it done, because they’re not worrying about if they’re going to do well on the test necessarily because they’re taking it right now. Some people will, I’m sure, but most of the time, the thing that we actually worry about is much easier to cope with than we ever thought. And the worry leading up to it is way worse than the actual event or the thing that they worried about, most of the time, because of the unknowns, really. So, a lot of unknowns that we can’t really prepare for. And we like to be prepared. So, it doesn’t really, you know…brings up a lot of anxiety for people, for sure.

Macie Jepson
So, it’s more about the unknowns. How much is it about not having control of a situation?

Dr. Robert Chester
Control is a very big part of it, too. There’s two types of worry. There’s productive worry, and there’s unproductive worry. So, you could think of productive worry as like, for example, me coming here, I needed to know when to leave, where to park, where to go in the building, you know, get lost a little bit, find my place, you know. A lot of that was productive because if I didn’t worry about when I’d have to leave and all that stuff, then it wouldn’t motivate me to figure out those answers. Right? So, it is a good thing a lot of times, but the important thing is to recognize if it is productive or not, because it wouldn’t be productive for me to, you know, worry about embarrassing myself or something or coming off awkward or whatever, because I can’t predict that, necessarily. And it actually, if I worry about it enough, it might actually happen, too. That’s the downside of it.

Pete Kenworthy
How does that apply to others? Productive versus unproductive worry. What kind of things are we talking about, primarily, I guess, for people who deal with this on what is unproductive for them?

Dr. Robert Chester
If we take that test example, it would be productive to study for it. Right? I mean, that’s going to reduce your anxiety in itself just because you’re more prepared for it, and legitimately prepared for it, too. But worrying about if you get below a certain percentage point or, you know, how it’s going to affect the rest of your life and your career and that kind of stuff is really not going to help you in the moment. It’s not going to do anything but make it worse and actually make it harder for you to absorb the information that you’re studying. So, it can really the way in that way. And that would be unproductive worry.

Pete Kenworthy
You mentioned something along these lines, but I read that 85% of the things that worriers worry about turn out to have a positive outcome. So, I’m going to say that again. Eighty-five percent of the things that worriers worry about have a positive outcome. Does it help if worriers know at statistic? If they know that, gosh, almost nine out of every 10 things that I worry about aren’t going to come true?

Dr. Robert Chester
Yeah. Not as much as you’d think. Because there’s still an unknown. You still can’t predict the outcome, necessarily. So, they get stuck on that, really. It can help, but I try to remind them as much as I can, like you handled way better than you thought you would. And they recognize that, too. And they start to kind of beat themselves up for even worrying about it. But it’s hard to remember that when anxiety starts coming up, because anytime we have really strong emotions, any emotion, really, we start to get pretty irrational, all of us. So, you could say that all day, but then you start getting anxious, and you’re like, oh, “I don’t know. Maybe I need to worry about this. I don’t know how it’s going to turn out,” that kind of thing.

Macie Jepson
You mentioned anxious. We’re talking a lot about worry. What’s the difference between worry and anxiety?

Dr. Robert Chester
So, I think of anxiety as a combination of like the physical symptoms of anxiety, so, like your heart racing, shaky, sweaty, that kind of thing. And worry is more the mental part of it, really. So, when we say worry, we really mean anxiety in a lot of ways, but anxiety’s kind of the outcome of worry.

Macie Jepson
So, Doctor, let’s talk a little bit more about triggers. For me, I love to travel, love to scuba dive. Flying’s not an issue. 9/11 came around, and I watched people trying to dig people out from underneath crumbled buildings. And I became obsessed with being trapped. It was a game changer for me in my life. I know that’s normal and you could probably help me out of that, but could you give me some other examples of what might trigger something like this claustrophobia increased anxiety?

Dr. Robert Chester
Yeah. So, I think it’s pretty much anything that you previously thought wouldn’t happen to you. Whether you see that, or it happens to a friend or family member is something that can trigger a lot of anxiety. So, you can worry about, well, this could happen to me, like it’s closer to home kind of thing. The pandemic might be a good example, really, like COVID. You might not be worried about getting COVID until a family member does, or you see like more people going into the hospital and that kind of thing. Then you start to get more worried about it, cause it’s closer to home. It’s not super-irrational because it’s just as likely to happen to you than anyone else, really, but that’s really kind of how our brain works in that regard.

Pete Kenworthy
How does one get to the point where it affects quality of life? You know, Macie and I were talking about this before this recording, and she referenced some of that there, that 9/11 kind of turned her into she’s got some claustrophobia issues. She talked about, off-microphone, she told me about a show she was watching where someone was trapped, and she couldn’t even watch the show anymore. I’m not saying she has an anxiety disorder, but many people do. And how does it get to that point? How does it get to the point of, okay, I’m worried a little bit about things I can’t control, and a lot of us get over that, but a lot of people don’t, right? And that’s when it becomes a disorder. How does it get to that point?

Dr. Robert Chester
It, I think it’s really important to distinguish the two: anxiety and anxiety disorders. I’ve seen a lot online lately, this idea of high functioning anxiety or depression. And I kind of have an issue with that, because all of our disorders, you have to have impaired functioning aside from personality disorders, really. So, all of them, you have to have impaired functioning. And we all experience anxiety from time to time. It doesn’t have to be a disorder. I think when it becomes that is usually avoidance is what makes that become a disorder, because you start avoiding more and more things. Like if you start avoiding, you know, anything where you could be trapped potentially. That could be a lot of different things. And the more you avoid that, the smaller your life gets, really, the less you can do. And so you get really stuck in it, the harder and harder it gets to dig out of that hole.

Macie Jepson
That’s when it becomes an issue when it begins to affect your quality of life?

Dr. Robert Chester
Yeah. And your functioning overall, whether that’s engaging with other people like social anxiety related or agoraphobia, like being unable to get out of the house, anything like that can really develop the more you avoid. So, I always try to get people to not avoid as much as possible.

Macie Jepson
And you know, we hear a lot about those extreme examples, but we need to remember that there are everyday people dealing with anxiety all the time. And we want to try to help them today. So, let’s talk about some solutions. How can we use this understanding of anxiety or worry to break that loop that Pete was talking about earlier?

Dr. Robert Chester
Aside from not avoiding, which I think is the number one most important thing. And for that, I think you want to pay attention to – am I saying that I don’t want to do this thing just because I’m anxious? – which can be hard to answer sometimes, because we can, you know, combine that with, oh, I just don’t like it now, which really, you know, you might not like it because you’re anxious. That could be a big reason, too. But if you’re just, you know, don’t want to do something because it makes you anxious, that’s a good sign to go ahead and do it anyway. It’s easier said than done, but you really want to push yourself to do that, because it’s going to get easier and you’re going to gain more confidence and resilience, too, for upcoming, you know, unknowns and things like that, so, I would start with that.

Dr. Robert Chester
Then beyond that, really paying attention to your thoughts and how they infect, you know, how you feel and what you do. So, if you have the thought of like I’m afraid of small spaces, you’re going to feel anxious when you see it in a movie or something like that, and your behavior would be to avoid anything in which you might be in a small place. All based on that thought of this could happen to me, essentially, which is true. It’s possible it could happen to you, but is it going to happen today? Tomorrow? We don’t know, that kind of thing. So, you want to really pay attention to, are you engaging in what we call cognitive distortions, which are errors in thinking, things like generalizing to a whole group of people or situations. Predicting the future is a big one for people with anxiety. They try to predict the future. They might do that by catastrophizing, thinking, you know, only the worst possible outcome or, you know, mind-reading a lot of times, too, like, oh, this person doesn’t like me, cause they looked at me funny or something like that. You want to make sure you have evidence to support those thoughts. Otherwise, they’re negatively affecting you for no reason. So, if you really don’t have much evidence to support the fact that, you know, someone doesn’t like you, then you’re making yourself miserable for no reason, really. Easier said than done to just stop that, but paying attention to it first is the most important thing.

Macie Jepson
So, what you’re describing is what we’ve heard a lot about, facing your fear, but that’s a lot easier said than done. Walk us through that.

Dr. Robert Chester
So, you could, you can start small. So, there’s something called exposure therapy that I do a lot of. And one part of it’s called systematic desensitization. And basically, what you do is you create a hierarchy or a list of things that you avoid because they make you anxious, different scenarios, stuff like that, and then you rank how much anxiety you anticipate having in those situations. Then you start with the easiest one, the one that you’re going to feel anxiety, because that’s the point. You want to feel that anxiety and feel that it goes down on its own over time, even if you don’t do anything, and you want to face your fear and that kind of thing. So, each time you actually do those exercises where you go out and do whatever it is – let me give an example of that, too. So, I do a lot of trauma work, and a big part of that is exposure therapy.

So, a lot of people who’ve experienced trauma have a fear of crowds. They avoid things like grocery stores when they’re busy. So, what I’ve done with people is start with, you know, depending on how anxious they get, just sitting in the parking lot at the grocery store. We might start there. So, sit in the parking lot every day for like 30 minutes or something. After a little while, not that long, really, maybe a week, if they’re able to keep up with it, they’re not going to feel anxious at all sitting in there. So, we might work up to, okay, let’s try to go in when it’s not busy. Maybe even bring someone with you if that makes you less anxious or able to tolerate it, really. If they’re able to do that, then kind of move up the ladder all the way until they’re, you know, able to go to grocery store whenever by themselves without much anxiety. I can’t say I’m going to get rid of all of it, but if we can decrease it to the point where they can function better, then that’s the point, really. And we can all do this, too. It’s not just for people with anxiety disorders. I would encourage people, really, to expose themselves to things that make them anxious, that are objectively safe, by the way.

Macie Jepson
For lack of a better word, I think you’ve described some physical anxieties: spaces, crowds. What about anxieties that are harder to explain, emotional anxieties that may not manifest themselves in everyday actions that you’re avoiding? Does that make sense?

Dr. Robert Chester
I would want to clarify first, too, that we want to make sure that we understand it’s not the situation that’s causing us anxiety, which seems counterintuitive, but it’s what we’re telling ourselves about the situation. So, that’s why like I’m able to go in a crowd and I’m fine, but someone else might have an issue, because I don’t tell myself the things that they tell themselves. That’s a big part of it, but something like, you know, just worrying generally about the future, that can be tough, because you feel like you should, and there’s a part of you that really should like productively think about the future, cause then you can make plans for it. But if you get to the point where you’re like predicting that, you know, you’re going to lose your job or you’re going to, your wife’s going to leave you or something like that, if you don’t have any evidence for that, then you’re just making yourself miserable for no reason. But you got to be able to pay attention to your thoughts in order to get to that point in the first place.

Pete Kenworthy
But paying attention to those thoughts, doesn’t make it go away.

Dr. Robert Chester
No.

Pete Kenworthy
Right?

Dr. Robert Chester
Right. Yeah. So, the first step is making sure not only paying attention, but seeing if they fit into those different categories of cognitive distortions like I talked about earlier. Once you figure that out, then it’s the challenging of the thoughts time, which you can do on your own. You don’t need me, but I can help guide people through that process on how to do it. And it could be nice, you know, hearing another person’s perspective, especially, you know, someone who doesn’t have, you know, an emotional investment in the person or their, I mean, I can have some of that as a therapist, but I’m not living with them every day. You know, there’s a big difference there. If you are, that can be really hard to cope with someone who has a lot of anxiety, because you know it’s irrational, they know it’s irrational, but they can’t stop themselves from doing it.

So, this is why people say, oh, just stop worrying. I mean, if that worked, I wouldn’t have a job. So, that doesn’t work. It just makes people worry more and get angry at you for it. So, there are times when it would be beneficial to see someone like me who can guide you that process and how to challenge these thoughts. But it starts with looking for evidence. And when I say evidence, I mean it more in the legal sense, really, like what is some evidence that would convince a jury that your thought’s accurate or correct? Not, you know, it just feels right. You need something more like, well, this has happened to me before or something like that. That doesn’t necessarily mean it’s going to happen again, but that can be some evidence that it could happen at least. And that evidence against, of course, you know. What are some of the reasons why this is unlikely to happen? I try to get people away from thinking about possibilities and thinking more about probabilities, which is a big deal, cause anything is possible. And if we worry about that, then we’re really going to be stuck. But if we can think about, well, what’s likely, or what’s probable to happen? Everything in life carries risks. So, we need to always be weighing that pretty much.

Pete Kenworthy
You talk about how it might be beneficial for some people to come talk to someone like you. How do we know when it’s that time? Right? That’s kind of the key here. Right? Lots of people worry. Lots of people, everybody has anxiety. Right? But not everybody needs to come talk to you. If we’re living with someone who we think maybe borderline disorder or maybe has a disorder or we’re that person ourselves, how do we know? How do we know when it hits that point to come talk to you or to talk to someone about medication or any of those kinds of measures?

Dr. Robert Chester
I think when it starts to affect your functioning in a negative way. So, if you’re avoiding a lot of things and that’s starting to impact, you know, your grades in school, cause you’re missing classes all the time, that would be a great indication to come see someone like me, cause you’re stuck now in that kind of thought process and need someone to help kind of guide you out of it. That would be the main thing is like if you’re avoiding a lot of stuff and it’s impacting your functioning, it’s a good sign. If it’s also like you’re feeling it all the time, it’s not a good feeling and it wears you out. It can affect your sleep, for sure, which makes you more tired and then more anxious cause you’re exhausted. It can really lead to depression a lot of times cause you’re not able to do things that you used to be able to do. Or at least you tell yourself that. And your quality of life just decreases as a result, too. So, that can be a good indication as well.

Macie Jepson
You talked about avoiding and maybe not getting to class, not getting out of bed. That sounds like depression to me, but it could be anxiety? And how important is it to understand the difference and what you’re dealing with? Or is it all lumped into one?

Dr. Robert Chester
It can be lumped in, really, cause avoidance can be part of any kind of disorder in a way. I don’t know about any, but a lot of them. For depression, yeah. It could be avoiding getting out of bed, cause you don’t want to face the day. Or if it’s anxiety related, it could be like, I’m just too anxious to get out of the bed. I’m kind of stuck here, because I don’t want to face my day. So, it could be similar kind of worries or concerns, but feels different. Like with depression, it might feel more of like I don’t have the energy to get out of bed, whereas anxiety, it’s like I have the energy, for sure, but I can’t bring myself to get out the door. Right?

Macie Jepson
That’s helpful. Thank you.

Pete Kenworthy
Okay. Dr. Chester, before we let you go, any final thoughts on anxiety and worry?

Dr. Robert Chester
So, you’re not crazy. We all worry about things. And a lot of times it doesn’t make sense. It doesn’t help to beat yourself up for that either. So, you want to be able to recognize…I tell patients all the time this…if I had that same thought, I would feel that same way. I would do that same thing. That’s just what it comes down to, really. If I believe that thought as much as you do, I would have the exact same outcome. There’s no reason to believe I wouldn’t. So, recognizing this happens all of us and it’s nothing to be ashamed of. And we have really good treatments for this, too. They’re not necessarily easy, especially exposure therapy, but they’re worthwhile, for sure. They’re very effective. We’ve had lots of research over the years and decades to show that, but you’ve just got to show up. That’s the first step.

Macie Jepson
Dr. Robert Chester, University Hospitals psychologist, thank you for being with us today, for breaking this down.

To schedule an appointment with Robert Chester, PsyD, call 216-844-2400.