The Worry Thirty

This exercise if for anxious people who find themselves worrying about things to the detriment of quality of life, concentration on their work, and/or getting to sleep at night.

Rather than thinking about everything you need to worry about throughout the day and into the night, choose a thirty-minute time period that is not directly before bedtime, and sit down to get your worrying out of the way for the next 24 hours. Now is your chance to worry thoroughly and completely about every anxiety, concern, and fear that you face. The first step is to make a list identifying each of your worries. Take a sheet of paper and write as follows:

1.
2.
3.
...etc. up to thirty worries.

Once your list is absolutely complete (make sure not to leave anything out), review each worry. Consider every possible consequence of what you're worried about--including the dire, extreme, and catastrophic. Worry hard. That is what you are doing right now. Then when your thirty minutes are up, fold the list and put it away somewhere safe--in your pocket or purse, or at your desk or nightstand. You still have the list, so there's no danger of forgetting anything. But now you're done with worrying for the day, and can go on to living the rest of your life.

The Essential Bibliography

Here are my favorite books for dealing with depression and anxiety:

The Feeling Good Handbook by David D. Burns, MD. It's jam-packed with cognitive behavioral techniques for dealing with depression, and can't be digested all at once, but is a good resource.
For people who have been through at least one course of therapy for depression, Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You, by Richard O'Connor, Ph.D.

For anxiety in general, and specific anxiety disorders, "The Anxiety and Phobia Workbook" by Edmund J. Bourne, Ph.D.

For emotional distress and lack of coping skills, a book I really like, even though it was written especially for people with Borderline Personality Disorder: "The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotional Regulation & Distress Tolerance": by Matthew McKay, Ph.D., Jeffrey C. Wood, Psy.D., and Jeffrey Brantley, MD. I particularly like this book because of how accessible it is. I have been practicing some of the skills it suggests since I began reading it and using it in therapy.

Overview of Anxiety

Anxiety disorders can be difficult to understand and treat because they seem to operate in a paradoxical manner--sometimes the more aware the person is of the anxiety, and fighting it, the more intractable it seems to grow. The reasons for this are clear, however, when anxiety is viewed in terms of reinforcement theory.

Anxiety involves mental and physiological autonomic nervous system arousal in reaction to a feared stimulus. The person soon learns that by avoiding the stimulus, he or she is released from the anxiety. This is negative reinforcement for avoidance. The person will continue to avoid the stimulus, and continue to be reinforced (by the relief from anxiety) for that avoidance.

Unfortunately, reaction to anxiety-provoking stimuli tends to generalize. Soon, other similar stimuli are avoided. Even thoughts, memories, or indirect reminders may be avoided. The person's life becomes constricted and restricted by everything that must be avoided in order to stay anxiety-free--and eventually that doesn't work either, and the person may feel anxious at even the remote possibility of encountering the stimuli.

Treatment in one way or another interrupts the cycle by removing the reinforcer. In other words, the person must not avoid the anxiety-provoking stimulus any longer. this does not have to be done all at once--in fact, systematic desensitization, probably the most widely used technique, involves incrementally introducing exposure to thoughts of the feared stimulus and waiting until there is no more anxiety before moving on to the next small step. Other techniques such as flooding or implosion, which involve prolonged exposure to the stimulus, should be done only with care and caution and in absolute safety, with plenty of time to "decompress" and process the experience. But all techniques boil down to facing the feared stimulus rather than avoiding it.

The physiological state of extreme anxiety cannot be maintained for long periods of time. As the person faces some form of the stimulus in a controlled setting and lives through the anxiety in safety and without harm, the autonomic nervous system essentially shrugs its shoulders and says, "oh, what's the point in getting so upset."

Relaxation skills are essential in dealing with an anxiety disorder. Some cautions are in order. Actual exposure to the anxiety-provoking stimulus should be done only in a safe and controlled setting. the person should not leave the anxious situation without using relaxation to bring the anxiety down to acceptable levels. If the person leaves while still feeling anxious, then the avoiding behavior has been reinforced again and the problem becomes worse. The person shouldn't give up if they seem to backslide, however; but move back to an earlier step.

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More on Religion and Depression

The group blog Segullah is continuing its series on depression, with Part IV: Family Ties and Part V: Parenting Children with Depression. I found the discussions sensitive, knowledgeable, and hopeful. The participants talk about other disorders as well, such as Bipolar Disorder and Obsessive Compulsive Disorder. The comments after the discussions are detailed and helpful.

When Relationships Go Wrong*

Dealing with Depression

I have recently noticed some very good roundtable discussions about depression on some of the Mormon blogs. The first two were moderated by Kathryn Lynard Soper, on blogs Segullah: Part I; Part II; and Part III, and By Common Consent: Overview; Part I; Part II; Part III; and Part IV. Here's a post and comments about Post Partum Depression on Feminist Mormon Housewives.

I'm glad to see people talking openly about cultural contributors to depression and sharing ways they deal with depression successfully.