Worry Record Keeping

Social Anxiety, part 3

I mentioned in the first post in this somewhat old series* that I would write about personal experiences with specific Cognitive Behaviour Therapy (CBT) techniques against social anxiety.

The first CBT technique I learned was Worry Record keeping, which I infer is a Cognitive Restructuring technique. It works as follows:

After each experience of social anxiety, fill in a Worry Record form to sort of report the incident to yourself. The purpose is to analyse and expose destructive irrational thinking patterns to take away their power and learn and reinforce new, more constructive cognitive approaches.

Recorded aspects typically include date, duration (when did worrying start and finish in relation to the event), degree of anxiety on a scale, symptoms (tick off from a list), and descriptions of:

  • Trigger event
  • Worried thoughts
  • Anxious behaviours

in relation to each incident of social anxiety.

 
How it worked for me.

In the Social Anxiety case stories, worries were verbalised along the lines of (for example) ‘He thinks I’m incompetent’. ‘I am sweating and loosing control; people can see how nervous I am and think I’m a looser’. ‘I look like a complete idiot’. So they all evolved around a strong need for social accept and a strong awareness of social competition with other people. Moreover they had clear, consistent triggers.

 
depressed turtle with social anxiety - cartoon


 
Social acceptance in the workplace was essential for me too, and especially in focus in the beginning, but the examples didn’t ‘click’ with me. I could identify some thoughts that did fit the formula and I wrote all of them in the forms, but they didn’t seem to me like the drivers of the problems I experienced in my workplace of that era, and the exercises didn’t have any emotional impact at all at the time.

 
Miscommunication, and shyness as social protection

Initially when I started in the job in question, I was very shy and overwhelmed, and several of my colleagues were incredible supportive. Particularly one of the managers was very friendly and emphatic, and he made me his unofficial part time assistant when my area was quiet so the top boss didn’t get a chance to sack me for redundancy reasons (Top Boss was not a great fan of me).

This very friendly manager, who I was very fond of, often tried to engage me with friendly chat about random topics. He would start a conversation suddenly, usually with a question or remark that sounded like nonsense, but which required an answer nevertheless. I would be baffled for a number of long seconds, stumble through the sudden change of context, and then come up with a confused dorky reply in panic. That was my standard reaction to most friendly chat-attempts in the office.

The office culture was matey and informal. I wasn’t usually part of the casual group banter and couldn’t quite grasp what it was all about. I didn’t advance professionally either. I was just sort of parked in my corner, doing easy stuff.

Also, I was terrified of the Top Boss. His perfume, the way his corporate outfit sat on him, his gait, his standing position, his face expressions, his voice… basically everything about him induced paralysing horror. There was something predatory and stealthy about him, and no instruction manual for staying stay safe in the shadow of his perfectionism, moodiness, sharp intelligence, mind games and socially manipulative manoeuvres.

 
All in all the workdays were buried under layers of fear, miscommunication and boredom although there were nice aspects too (occasionally).

Over time the anxiety faded, but social miscommunication and boredom remained. I felt misunderstood and under-utilised and increasingly became cranky about the lack of relevant challenges. Basically, people seemed to have concluded that I was a bit slow in the uptake or mentally fucked up somehow, and not really useful in a practical way. I was just ‘the stranger amongst us’ doing my own stuff inside my own little world.

I reasoned that I was deliberately kept out of the loop from any strategic things going on, as if I was a spy or something, and started to become very defensive of the narrow areas of responsibilities that I did have. I had a good degree of autonomy under my direct boss, and that worked. But whenever my direct boss went overseas, a micro-war started up between the replacement manager and me. The other manager wanted to micromanage and change the way things were done to his way, and I fiercely defended my territory against loss of control.

In a sense my social situation became more conflict ridden and complicated once I shed most of the shyness that initially kept me quiet and out of control, but sweet and flexible. I can see how shyness tends to trigger goodwill and helpfulness in people, and in some ways serves as a layer of protection which can cover up more complicated social incompatibilities.

 
Cat in box cartoon, says SHY = CUTE

 
I expect that if I’m blushing, if people can see that I’m nervous and stumble across my words, that they will be gentle; supportive. People tend to be kind to people (and animals) who seem vulnerable. That’s my observation, and that is how I too react to persons whom I perceive to be shy, vulnerable and out of their element. So I don’t understand why the case story characters were so convinced that symptoms of shyness would generally cause people to judge them.

 
Worry Recording when it works well

However, I later used and still occasionally use the principle of Worry Record keeping (and cognitive restructuring overall) successfully in some situations.

For example, I used to get myself worked up when I drove to meetings with a girl I planned to start small a business with. I was afraid to scare her off because I have a lot of respect for her, and see her as a very socially competent person, so I feared she would pick up on my difficulties and loose confidence in me. I knew she considered me to be assertive, and that was one of the reasons she teamed up with me – that was a trait she needed. So I was afraid to come across as awkward and helpless.

The meetings always went well (albeit were exhausting); we worked well together as a team, and she expressed enthusiasm about the project and the teamwork, so the perceived risk of being ditched was probably ‘just in my head’.

At some point when I drove to one of our meetings, I got fed up with myself and my destructive nervous tension, so I stopped my car in the roadside and did a simple ‘Worry Record’-like entry in my iPhone notebook:

  • How do I feel – which anxious feelings?
  • What are my negative assumptions about how I may be perceived by others (her)?
  • What can go wrong – What is the worst case scenario?
  • What would be the consequences?
  • How likely is it? (in %)

It helped! I arrived in a much more relaxed mode than usual and from next time I drove there, the anxiety was totally under control. A surprisingly quick and efficient ‘cure’ against a destructive irrational thinking loop. – I guess that’s a beautiful text-book example of CBT effectiveness.

 
… and when it doesn’t

Worry Records (and similar methods) can work well when there is a clearly destructive thinking pattern associated with a particular trigger; where the symptom emerges predictably before the trigger situation; and where the thinking pattern is clearly irrational. That criteria doesn’t apply to the majority of my anxiety issues.

For example, I don’t like crowdedness, and a trigger for me is to be stuck with a large unfamiliar group of people in a confined space over many hours (e.g. a large meeting, or air travel). Trigger situations don’t necessarily trigger anxiety, but they may. When they do, the fear isn’t entirely irrational. Panic attacks can cause me to pass out and in a work-related meeting, a workplace, on a plane or when driving a car, passing out can potentially be embarrassing and have severe repercussions.

The potential consequences of passing out is the real trigger. Passing-out incidents can look like epilepsy, last over 20 minutes (so some people have said), cause people to call an ambulance, and I’m pretty sure, could cost me my job (where driving is essential). Traffic safety is obviously a major concern in that regard.

‘How likely is it to happen?’ I have no clue. Passing out happens rarely, but does happen. Panic tends to strike like lightning coming out of a blue sky, rather than build up gradually**. Mild anxiety may linger for a while until suddenly it isn’t mild. I often can’t imagine feelings in advance that I’m likely to feel in the future, like anxiety the next day at a certain event. I often can’t emotionally remember feelings I’ve had in the past either. That makes it hard to prepare mentally for trigger situations and analyse them afterwards.

Out of control panic may suddenly loom when I drive on the motorway to attend a day training session, or after I sit down at the table in a room with 30+ people and know I have to stay there for at least 3 – 4 hours. I am not afraid to talk and participate – on the contrary, I like it: task focus overrides shyness with ease. I am afraid of panic sensations, but only because they could cause me to pass out. I might feel like I’m ‘freaking out’, then half an hour later I’m like a fish in the water, and then a few hours later, someone talks and talks, I’m bored, and suddenly panic sensations loom again.

What’s the ‘worried thoughts’? Restless sensations, frustration that a person keeps talking or talks too slow, an urgent need for physical movement, fear of panic. Not really good record-material.

A similar pattern applies to air travel; another of my triggers. Being strapped in my seat hour after hour, squeezed in between strangers with restricted mobility, can cause intense panic sensations and dizziness (and yes, I have passed out on a plane).

However, I don’t think of that when I plan the travel, buy my ticket or board the plane. I know that I’ll probably feel anxious in the plane but I can’t imagine how it feels like, so I’m unworried. I sort of don’t have empathy with myself! Not even when I strap on the seat belt and when the plane takes off am I worried. But every now and then after some hours and before some more hours, without any obvious trigger, panic strikes and creates what feels like urgent crises with physical impacts.

 
Plane flying - clipart

 

The only thing that seems to work in that situation is to move, walk around on the plane, stretch, touch different surfaces, touch cold windows, look out, drink water … physical activities and sensory stimulation.

Physical stimulation is my universal anti-anxiety and anti-stress strategy, the only one that seems to work once the ‘thinking’ stage is surpassed and the stress gets physically intense: I try to distract myself, release pressure physically and wait it out.

If I’m driving then I turn on air conditioning to literally cool down. Rhythmic and repetitive activities and familiar pleasant touch sensations are calming. Drive with a hand in the open window, feel the air flow on the skin; sense familiar hard plastic surfaces under the fingers, listen to music or familiar radio hosts, sing, hum, imagine things, plan ideas. I planned how I would rewrite this post last time I experienced a driving-anxiety incident (I wasn’t happy with the draft).

After a while, I notice that the anxiety is gone. It may come back later. Anxiety is an unpredictable energy force.

 

*This whole series was drafted more than a year ago, and has been ‘stuck in the pipe’ with all the other drafts since then!

**However, passing-out has a reasonable long lead time and only happens under unfortunate circumstances if I have to force myself to remain in a stressful situation for hours or days

 

Illustrations from OpenClipart.org with Thanks! (except the 2 cartoon figures, which are made by me)

Advertisements

11 thoughts on “Worry Record Keeping

  1. musingsofanaspie

    First, I’m excited to see that you’ve rescued this from your drafts folder and published it!

    I’ve read both that CBT is great for people with ASD and that it doesn’t work for people with ASD so I was excited to see that you have first hand experience to write about. It sounds like you’ve had mixed results.

    When I think about trigger events for me, it’s generally unstructured social events made up of mostly strangers that I’ll have to mix in with for an indeterminate time period. I also find situations where I don’t have clear interests in common with strangers hard to navigate. My fears revolve around not being able to smoothly join in conversation groups, not being able to keep up a conversation (the dreaded awkward silence), and generally finding myself stranded alone at a event where everyone else is mixing together. My experience is mixed–sometimes these things happen and sometimes they don’t. I might have an evening where I mix in just fine or an evening where I’m desperate to leave as soon as possible because socializing feels like more work than I have the energy for. So the CBT technique of telling myself that my fears won’t materialize doesn’t work very well because they do materialize about 50% of the time.

    OTOH, I sometimes have the “people will think I’m awkward, weird, etc.” type negative thoughts and I’ve learned to set those aside consciously by reassuring myself with some generic “everything will be fine” self talk. Even if people do think I’m socially awkward or weird or whatever, I doubt anything short of a brain transplant would do much to change that anyhow. So I guess I use CBT’s positive thinking aspect in some way.

    I also know what you mean about not necessarily being able to anticipate trigger events and feeling “in over your head” without much warning. I use a lot of physical techniques to quell my anxiety too. Pacing, touching things, bouncing in place. I can also use sleeping (or at least letting myself close out the world by drifting into that place between sleep and waking) in situations like being on an airplane. It’s probably not the healthiest strategy but I can purposely dissociate myself from reality if necessary–a bit like a voluntary shutdown I guess.

    I’m really enjoying this series!

    Like

    Reply
    1. Mados

      Thank you! I am glad you enjoy it.

      What you write about navigating unstructured social events does sound like classic social anxiety. – Not the conversation difficulties as such, but your worries that people may judge you if you can’t keep up a conversation and see you stranded alone at an event where everyone else is mixing together!

      And you are most likely right… They would probably judge you! Isolation in a crowd really is stigmatising (unless it is justifiable with a socially appropriate special case type of excuse, that can help… a little bit. Like ‘I am normally very popular, but here I’m a bit like a fish out of the water because I belong somewhere else;-) That’s how social anxiety is not necessarily irrational.

      So the CBT technique of telling myself that my fears won’t materialize doesn’t work very well because they do materialize about 50% of the time.

      Make that 95% of the time in the case of my youth… *sigh*.

      I suffer at unstructured social events too, the larger the worse… They tend to be unpleasant, even torturous experiences, but I associate that with pain, stress, sensory overload, hard work, and not so much fear of being judged by others… although that is in the mix too. Conversation skills don’t even become relevant in most cases, because I can’t hear people properly and can’t cope with the noise.

      Dinners, parties et.c. are not usually on, but I do go to Church. ‘Morning Tea’ after the sermon, in a room behind the Church room is therefore a weekly social event with maybe 10 – 20 people present and expectations about mingling with different people. The acoustic properties of the Tea room makes socialising in there impossible for me due to the infernal noise alone, so my conversation skills and non-existing interest in what people talk about is not even on the agenda.

      So I’m having my coffee by myself on the bench outside. If the weather is lovely then there is typically others out there who I sort of hang out with, and my husband often comes and hang out with me for a while, which tends to attract ‘the gang’. If the weather is poor and my husband isn’t around (he is out of the country almost half of the time), or some other random reasons, then I’m sitting all by myself outside while everybody else mingle inside.

      I think some people may find that weird, but they are used to it and people in Church don’t usually engage in viscous gossip (I hope not!). The pastor has occasionally made a few awkward chat-and-round-up attempts, like a herding dog feeling uneasy that one of the sheep sits outside;-) but that is the best I can do. IMO my behaviour is within the realm of socially appropriate behaviour. I’ll happily talk with whoever comes outside and chats me up:-) so I am not being anti-social, just small-scale, calmly social:-) People can come and talk with me if they like.

      I have become somewhat insensitive to the potential ‘alone in crowd’ stigma over the course of my life (a long term resignation to the 95% tendency..;-). I found it excruciatingly embarrassing when I was young, especially in school, to be the visibly alone one, like an outcast who didn’t hook up with any groups, someone who was visibly unwanted, socially unadoptable … Such situations are still socially painful of course, but it rarely happens now and when it does, it doesn’t usually cause much anxiety, embarrassment and self de-valuation, more frustration and irritation – They don’t appreciate me! They don’t know what they are missing out on! 😉

      I am usually OK with ‘awkward silence’, even if the person I’m with isn’t… (Cue: the person initiates a series of frantic conversation upstarts with short intervals)… I certainly prefer awkward silence over relentless talk!

      I think many people may actually enjoy intra-conversation silence, although some don’t know it yet if they have been brought up under a paradigm that interprets conversation silence as a communication break down, or passive aggression, or something else that needs fixing.

      Letting go of the notion that any conversation consists of a constant flow of words can actually turn awkward silence into pleasant, bonding silence. Good communication silence = hanging out together without words (a well known characteristic of long term friendship) – Observing something together (bonding through shared experience) – Taking a thinking break to come up with new ideas (refreshing the conversation topic pool) – Taking a mental break to recharge the social batteries (refuelling social energy/motivation)… et.c.

      Like

      Reply
      1. musingsofanaspie

        I’ve found that I can sometimes be socially acceptably isolated in a crowd by being helpful. For example asking the hostess if she needs help in the kitchen or offering to wash some dishes, etc when I’m feeling like I need a break from socializing. We’re about to go on a big overseas trip to stay with family for 10 days and I will be washing many many dishes. 🙂

        The sensory issues are a big problem for me too. I can manage conversation better when I’m feeling less taxed on the sensory side so my ability to socialize at an event tends to start out a little nervous but willing to engage and then progressively heads toward relaxed by getting exhausted. I think there’s like a 15 minute sweet spot where I get to enjoy willing to engage plus relaxed, before the scales tip.

        I really enjoy companionable silence. My husband and daughter are quite comfortable with this and will happily spend long periods of time in quiet if we’re on a long car drive or something. I gravitate toward friends who are enjoy things like taking our dogs for walks, so that we don’t have to talk the whole time.

        My preferred conversational pace has long breaks for thinking time and people I know well have adapted to that. With people I know less well, it can be awkward. For example, I met someone at school and she asked to have lunch with me and I could tell that my falling silent between conversational “spurts” made her anxious because she kept randomly starting new topics with questions so that I felt like I was being interviewed!

        Like

        Reply
        1. Mados

          Helping out as a way to divert from the crowd sounds like a good idea. I do that at too when I’m at home in my dad’s house, because I do it anyway (help with housekeeping), so it seems natural.

          With social dinners of acquaintances we know, the helpfulness trick doesn’t usually work because it is common that the women do that, so that puts me in the worst possible situation… basically in the middle of the ‘hen’s cage’! (= the kitchen) which is very noisy, social, intrusive/approaching and not at all relaxing. I prefer to stay outside instead (a good thing about Australia, is that outside is a natural place to be, also for socialising!), mostly hanging out with my husband or his friends, and I’m aware it might seem a bit rude. Or I just excuse myself to leave when I can. Or don’t come at all… The latter is my favourite choice in 98% of the cases! My husband tells everybody we know that I have problems with noise and therefore don’t come to dinners/parties et.c., and that way hopeful no one gets insulted.

          I can relate to what you say about a sweet spot – a brief window of opportunity where socialising works really well.

          And I really enjoy companionable silence too!

          I gravitate toward friends who are enjoy things like taking our dogs for walks, so that we don’t have to talk the whole time.

          I gravitate towards people who like animals (especially dogs) and who don’t need to talk all the time. I think that people who can relate with animals and like to interact with them tend to be good at companionable silence:-) After all, interaction with animals is mainly non-verbal, observation-based and about enjoying and respecting each other’s presence without necessarily directly interacting.

          My preferred conversational pace has long breaks for thinking time and people I know well have adapted to that. With people I know less well, it can be awkward. For example, I met someone at school and she asked to have lunch with me and I could tell that my falling silent between conversational “spurts” made her anxious because she kept randomly starting new topics with questions so that I felt like I was being interviewed!

          Yes, it does sounds like she felt the pauses were awkward conversation failures. If you felt relaxed about the pauses but she ‘panicked’ about them, it was actually her ‘social anxiety’ that created the awkwardness: her irrational assumptions about how a conversation should be and her feeling responsible for ensuring the conversation met the ‘standard’. Not that the conclusion helps with the situation…

          Like

          Reply
  2. enyaji

    First of all, I just really want to say that it’s really good to read a first hand account of how CBT techniques can help someone with anxiety – normally I tend to read about them in textbooks which doesn’t really give a good picture.

    If I’m not being too personal, I was wondering if you had Asperger’s as I see a lot of your posts mention the condition? If so, your accounts of CBT are particularly interesting to me as I’m actually an assistant psychologist (specialising in ASD) doing a MSc (Masters of Science) over in the UK in CBT approaches. For my thesis, I’ve decided to explore adults with Asperger’s and ASD (high-functioning) and their experiences of CBT in regard to anxiety. You’re posts specifically about this are a great insight for me as not many researchers have actually looked at the benefits of CBT for adults with Asperger’s or ASD, nor have they looked at (in depth) the techniques that are best suited to individuals with the condition. Also, you’re posts have given me a couple of ideas in how to help my clients using CBT techniques.

    Thank you so much for sharing your experiences with CBT and I’m looking forward to reading more posts from you!

    -Enyaji

    Like

    Reply
    1. Mados

      Thank you very much for your comment, I am very happy that my post is helpful. I like your research focus and find it personally relevant:-)

      I can recommend the post My Anxiety Is Not Disordered by Musings of an Aspie about the fundamental difference in premise between Normal and Aspie social anxiety. What she says is very much what I wanted to say about it:-) Musings of an Aspie (and its comment tracks) is one of the most informative/insightful self-report blogs about adult female asperger’s IMO, and a good starting point if you’re researching this type of sources.

      I can also recommend The Anxiety Gap – Thoughts (and feelings!) on public speaking by Catastrapie, insightful and relevant to your research focus as well, and it has a nice graph:-)

      (I can recommend more blogs of relevance to your research focus if you like)

      I also have a draft more about social anxiety sitting that concludes the series. The posts about social anxiety were very hard to write, because I find my version of social anxiety and the strategies that work rather weird compared to what I learned about it and have read about it on blogs that focus purely on social anxiety.

      And yes, I do have Asperger’s, apparently. It isn’t too personal to ask, and I am glad you asked. The reason my blog has many references to the condition is that I have used it as a base for exploring the topic (focusing on adult Asperger’s in females) over the last few years, since I discovered the strong relevance of the aspie mind structure and traits for many of my life difficulties & history… but I have not actually written much about it. I have some drafts but am wary of writing about the topic because it seems highly charged with identity-politics, it is like a collectively owned, tribe-like label besides being a psychiatric diagnosis, and that scares me off taking ownership of it.

      I’d been speculating whether I had Asperger’s as such, or maybe just many traits of it, or just ‘mildly, or maybe PDD-NOS or something ‘aspie-like but not quite asperger’s’. I’m still a bit confused and reluctant to identify as ‘aspie’ as such, but my psychologist is an experienced & competent ASD specialist and has said that I do have Asperger’s without any doubt, so I guess that is the case.

      Like

      Reply
  3. autisticook

    Reading your last section I got stuck on something that I think can be categorised as irrational anxiety in myself, as opposed to what I see as the rational forms of social anxiety that you and Musings describe so well.

    Getting up from my seat while on a plane. I can’t. Reading that you got up and walked around, my first instinct was “no no no, that’s not ok, it’s dangerous”. And also “other people will get annoyed if you try to get up”. It’s one of the reasons why I’ve always asked for aisle seats once I got old enough to travel on my own. It’s ok to get up then (very very quickly) because other people want to pass you on the way to or from their seats. But you don’t have to ask others to get up for you. That helps a lot. But then I already start feeling anxious at the idea that they might take too long. Leaving me standing instead of sitting down. Like I should.

    *headdesk*

    Do people have any idea how much some of us internalise these instructions? It literally takes a head purser to convince me that it’s ok to move to a different seat if not all the seats are taken, for example. And I know it’s irrational but I can’t shake it.

    Maybe CBT would be effective with that. It would be interesting to try.

    Like

    Reply
  4. Mados

    Yes, that is precisely what CBT is good for! Step by step break-down of irrational anxiety-enforcing thought patterns. I find it very effective to dissolve that type of problems.

    Your plane travel description is interesting. I too do feel a bit embarrassed to have to ask people to move out so I can get out when on a plane, so therefore I’ll stay out longer than I otherwise would so as to not have to bother people too often. However, once I’m in anxiety/panic mode, then I my attention to what others may be thinking about me diminishes dramatically. The “trigger-less” anxiety type is massively stronger and has much more severe consequences than the “social” type, so it overwrites it:-) and I’ll do whatever it takes to calm myself down in the best way I can. So I prefer the window seat so I can touch the cold window and look out and feel less like I’m strapped into a tiny tin can with an overload of people! It is not that I don’t care about people, it is just that in the situation I feel avoiding panic is a matter of survival, and people’s opinions isn’t.

    Why would it be dangerous to walk around on a plane? (except when it takes off or lands, which isn’t allowed anyway)

    And thank you:-)

    Like

    Reply
    1. autisticook

      No, thank you for writing such interesting stuff that makes me want to comment all over the place. 😀 I had looked at some of your posts before but I’m going through the archives now until I reach the beginning/end. AS ONE DOES.

      The not getting up is mostly just compliance I think. Someone in authority telling me off for not staying put. I used to travel by plane a lot when I was young, or at least more so than others my age. I have rationalised it because there is actually a small risk of hitting an air pocket causing the plane to drop a bit, which is ok when it just gives you that stomach in your throat feeling, but is less ok when it’s a drop of a few hundred metres and you end up plastered to the ceiling. That’s why they always ask you to keep your seatbelt fastened when seated. But this can’t the reason why I have such a kneejerk reaction to the idea.

      Like

      Reply
      1. Mados

        Thank you for all your time & effort reading and commenting!

        I have never been told to stay put (I don’t think). I don’t think I’m able to comply with it either, I really need to move or I’ll get very ill. But I can see what you’re saying about being plastered to the ceiling (I sort of like the image … as cartoon material… I already imagine how Eating Off Plastic would illustrate that:-)

        Maybe the seat belt makes you feel safe too, after all? (it does for me… I just need to move more) Restraint can be calming. Or it could be a fear of not complying with authorities while your life is in the hands of those same types of authorities. Just guessing:-)

        Like

        Reply

Say something!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s