I envy those people who are certain of themselves. They have no doubts. “This is what I want. This is what I’m doing. This is what I believe. Don’t really care if you agree with me or not.”

Me. I have major doubts about all kinds of stuff. From whom to marry? (Knew I was making a mistake when I said “I do.” But I did.) To what to buy? (I spend way too much time returning stuff.)

When I finally do make a decision, does that end the turmoil?”

Mr. Indecisive continues:

“I wish it did. I’m forever second-guessing my decisions. Did I do the right thing? Maybe I should have done this instead of that. The incessant chatter in my head can drive me crazy. Well, not really crazy.

I’m not a nut job. But I guess you could say I’m neurotic. I read somewhere that the best definition of neurosis is that it’s a need that can never be satisfied. Like people who have a neurotic need for money. They can be billionaires, yet they never have enough. (Maybe that’s what’s wrong with the greedy one percent who won’t pay their fair share of taxes).

Well, I think I should stop jabbering away, Doc, and let you get a word in edgewise. Maybe you can help me become more decisive.”

Whew, I said. Let’s both take a few deep breaths before I say anything. Let’s just be here — you and me. Let me assure you that nothing you have described is horrendous. Yes, it’s irritating. Yes, it’s troublesome. Yes, it robs you of positive energy. But it’s not something horrible. And it’s not something that you can’t modify.

Now that you’ve taken a breather and stopped beating yourself up, let me tell you a few things that might lighten your load.

1. There are so many choices in the marketplace that we can feel tormented over whether we made the “right” or the “best” decision. From our travel decisions to our toothpaste decisions, we have choices. Lucky us. Sometimes we make a great choice. Other times, we don’t. But it’s rare — extremely rare (unless you’re on a self-destructive bender) — that any decision you make will have major negative consequences.
2. Looking for the “perfect” decision is a prescription for driving yourself crazy. Instead, look for a “good enough” decision vs. the absolute best one. But shouldn’t you always want the best? No, no no! Why not? Because if you always have the best, you’ll never appreciate it. Because if you demand the best, you’ll always second-guess yourself as to whether what you have is, indeed, the best. Because if you’re only satisfied with the best, you’ll spend way too much time and energy seeking that elusive goal.
3. Seek to make peace with the different parts of your brain. Your emotional part wants everything to be easy and enjoyable. Why not? You only live once – go for it! Then, the executive part of your brain (the part that’s concerned with long-term planning) chimes in and gums up the works. Let’s say you bought an expensive item and feel great about it. But then, you feel guilty that you spent so much money. Did you really need it? Was it worth it? Your brain is in a tug-of-war. Which part wins? Whichever wins, you’re going to feel uncomfortable with your decision unless both parts of your brain work cooperatively. So, strive to make your decisions acceptable to all of you, not just a part of you.
4. But aren’t there ever times that one should spend a lot of time pondering a decision, weighing what’s really best? Absolutely. But pick your battles. If it’s truly a significant decision, spend time reflecting on your choices. Get information. Speak to experts. Do your research. Just don’t confuse mundane decisions with meaningful decisions.

Lawyers and judges use mindfulness to listen to and present evidence and reduce distractions. In other work settings, business leaders, workers and HR departments are using mindfulness training to reduce workplace stress, improve focus, communication, creativity and productivity.

And mindfulness is widely used in the treatment of mental disorders, such as depression and anxiety. It’s also used to assist people with medical conditions, such as diabetes, fibromyalgia, hypertension and insomnia and to improve the symptoms of stress.

If you’re new to mindfulness, you likely already have some understanding of what it is and its benefits. Now you’ve made a decision to try it.

Many people have heard the definition of mindfulness: paying attention in the present moment, on purpose, nonjudgmentally.

But if you don’t have access to a mindfulness training program through your work or through therapy, how do you start a mindfulness practice?

It’s hard to learn mindfulness on your own. It is possible, just as it’s possible to teach yourself to play the piano by reading books and practicing on your own. Mindfulness can be learned on your own through books, apps, YouTube videos and other resources.

However, like playing the piano or learning a sport, good instruction can significantly improve your learning.

And so, the first step to a mindfulness practice may be to research work programs, the possibility of accessing programs through your insurance or a mental health provider or mindfulness opportunities in your community.  Many yoga classes or studios, for example, incorporate mindfulness into the practice or have a class that is devoted to mindfulness or meditation techniques.

But like a new exercise regime, once you’ve made the decision to try it, you may want to just get started. 

If that’s the case, you can try the following exercise, which is an example of a mindfulness exercise.

• Choose a time when you have 10 minutes to yourself and find a quiet place to sit comfortably.  Whether you are at your desk at work or in your home, clear the space of obvious distractions.  Put away phones, email and other distractors.  If setting a timer would help you stay focused, rather than worried about how much time you have, then set a timer.
• Acknowledge any thoughts or judgments you have about starting your mindfulness practice.  You may be uncomfortable, skeptical or excited.  Our minds are constantly thinking, so you may want to notice whether you are caught up in thoughts as you get ready for your practice.  If this is the case, simply acknowledge thoughts and emotions that come into your awareness and then refocus on getting settled and comfortable.
• Once settled and comfortable, you can choose to close you’re eyes or keep your gaze focused in one spot in front of you.  Take a few deep breaths and then begin by bringing your attention to your breath, as you breath in.  Notice the tip of the nose as your breath enters your body.  Continue to breathe normally, following your inhalations as your breath flows down into your lungs.  Notice your lungs expand as your breath fills them and then notice them begin to contract during your exhalations.  There is no need to change your breathing.  Simply notice it as it flows in and out of your body.
• Follow your exhalations, with your awareness, as they flow out of your body.  Notice your breath flowing from the lungs, up through airways and out your nose again.
• Continuing following your breath in this manner for 10 minutes.  The first few times you practice, you may find that much of your time is spent lost in thought, rather than focused on your breath.
• The practice of mindfulness is about beginning to notice these internal distractions and mind wanderings and, once noticed, to bring your focus back.  You may lose focus and bring your attention back many, many times over the course of several minutes.  Don’t worry, this is part of the practice.

When you practice a piece on the piano, your fingers are more likely to find the right notes with repetition.  In mindfulness, with practice and repetition, you will likely find that you are better able to keep your focus and are less distracted by thoughts and emotions that come up during your practice.

A piano teacher may help you to make a song come to life, by focusing on dynamics or by following the beat.  In the same way, learning mindfulness with an experienced practitioner can help you to improve your practice.

One of the appealing aspects of mindfulness practice is that it can be integrated into daily life, but to do that, you need to have times when you formally practice, either with instruction or by intentionally setting time aside for it on your own.  Research studies tend to find positive outcomes with 20 minutes of daily practice.

Simply becoming more aware might sound easy, but we often don’t realize how distracted we are in our lives.  Retraining our minds takes time and effort, but it’s worth it.  And what’s better to focus your awareness on than the everyday aspects of your life?

Today’s panic disorder might’ve prevented our ancestors from venturing to potentially dangerous places, far away from their families and tribes.

Today’s social anxiety might’ve maintained social hierarchies and peace in primitive times.

Today’s obsessive-compulsive disorder (OCD) might’ve helped our ancestors keep tidy and safe nests.

In part one of his book, Kahn delves into the social instincts that underlie these five disorders: panic disorder, social anxiety, OCD, atypical depression and melancholic depression. In part two he delves into the advancement of civilization and the rise of reason (which explains why we’re not shackled to our social instincts, running amok; we’re able to override these cues).

Angst may be the result of a tug-of-war between our primal social instincts and our modern-day rational, civilized selves. According to Kahn:

Amazingly, those instinctive biological sensations that told our primeval ancestors how to comport themselves in society can today turn up as conscious emotional pain. So when you feel the pain of angst, you are actually feeling the unrecognized call of ancient social instincts. These days we don’t obey these painful instincts blindly. They become especially unpleasant when they conflict with our rational choices — that is, when we experience them as anxiety and depressive disorders. So, in our modern context, these social instincts can become so intense that they backfire, certainly not providing just the socially adaptive benefits that evolution had in mind.

In Angst Kahn draws from the work of Charles Darwin and Sigmund Freud along with scientific studies and theories from fields such as psychology and evolutionary biology.

Here’s a closer look at ancient instincts and two disorders: social anxiety and OCD.

Social Anxiety Disorder

People with social anxiety fear embarrassment, especially when they’re being observed. Their anxiety might heighten during speaking events, work evaluations and social situations. They might worry about everything from their appearance to their performance. They’re also self-critical.

For our ancestors, however, social anxiety might’ve been beneficial. It might’ve kept them from challenging “a ruthless hierarchy,” Kahn writes. “Our ancestors wouldn’t want to find themselves beaten down, or thrown out of the tribe – another way they’d be on their own and exposed to all sorts of dangers.”

Kahn speculates that our ancestors had a biologically based social hierarchy. Today, our society has a clear-cut structure. (Work is a good example of a hierarchy, with managers, bosses and higher-ups.) But our ancestors did not. Having a biologically determined hierarchy kept our ancestors in line and tempered competition.

“Social Anxiety today may reflect the biology of low social rank. Indeed, people with Social Anxiety may think or act as if they have a lower ranking in the hierarchy, not to mention having more submissive behavior and less closeness among their peers, friends and romantic partners.”

Obsessive-Compulsive Disorder

In ancient societies OCD-like traits would’ve been helpful for survival and keeping a sanitary, safe home. As Kahn writes:

The evolutionary advantage of OCD is that you don’t forget some very necessary concerns and tasks. Our ancestors wouldn’t want to find themselves living in filth (though since they didn’t know about germs, they weren’t actually germaphobes), unable to find or protect their homes, left without food or tools in an emergency, or stealing each other’s food or spouses. The instincts behind OCD help to prevent those problems.

Long ago, they also might’ve helped mothers protect their young and ensure their survival. According to Kahn, today, many women who have postpartum OCD struggle with “cleanliness and arranging behaviors, and [with] controlling harmful thoughts about the newborn.”

This is similar to what happens with other mammals. “They clean up the newborns and the afterbirth and they keep the nest tidy.” Their instincts also are to protect their kin from predators and invaders.

For some species, these predators might even include family and other adults in the same group. “Having aggressive thoughts already in mind makes for a quicker defense,” Kahn writes.

Whatever the origins, one thing is clear: These disorders disrupt the daily lives of many individuals. Social anxiety affects about seven percent of the population, and OCD affects about one to two percent.

Both disorders are debilitating. Kahn notes that, on average, people with OCD spend almost six hours a day preoccupied with their obsessive thoughts and almost five hours with compulsive behaviors. People with social anxiety disorder have lower levels of career success and may have fewer friendships.

Fortunately, both disorders — along with the other illnesses Kahn writes about — are highly treatable with psychotherapy and medication. (This website is a valuable resource for postpartum illnesses.) In other words, if you’re struggling with anxiety or depression, you can get better. The key is to get help.

I was astounded that this creature was capable of the empathy that I so craved in my closest friends and relatives. It was like she could read the pathetic and sad thoughts that disabled me and wanted me to know I was lovable in the midst of my suffering.

She continues to be a supportive presence in my life, especially on the days that I grow weary of trying on — and throwing out — every mindful exercise and cognitive behavioral strategy… the hours where staying positive seems impossible. She gets it. I know she does.

Every week I hear tales of four-legged creatures becoming angels in times of terrifying darkness. Indeed, a substantial body of research indicates that pets improve our mental health.

How? Here are a few ways.

1. Pets offer a soothing presence.

Studies indicate that merely watching fish lowers blood pressure and muscle tension in people about to undergo oral surgery. That’s why all the aquariums in dentists’ offices! Think of the behavior Darla in Disney Pixar’s “Finding Nemo” would have exhibited without the fish tank.

Other research shows that pet owners have significantly lower blood pressure and heart rate both before and while performing stressful mental tasks — like, say, performing a family intervention or supervising kids’ homework. Finally, persons recovering from heart attacks recover more quickly and survive longer when there is a pet at home. It seems as though their mere presence is beneficial.

2. Pets offer unconditional love and acceptance.

As far as we know, pets are without opinions, critiques, and verdicts. Even if you smell like their poop, they will snuggle up next to you. In a Johns Hopkins Depression & Anxiety Bulletin, Karen Swartz, M.D. mentions a recent study where nursing home residents in St. Louis felt less lonely with some quiet time with a dog alone than a visit with both a dog and other residents.

The study enrolled 37 nursing home residents who scored high on a loneliness scale and who were interested in receiving weekly half-hour visits from dogs. Half of the residents had quiet time alone with the pooches. The other half shared the dog with other nursing home residents. Both groups said they felt less lonely after the visit, but the decrease in loneliness was much more significant among the residents that had the dogs all to themselves. In other words, at times we prefer our four-legged friends to our mouthy pals because we can divulge our innermost thoughts and not be judged.

3. Pets alter our behavior.

Here’s a typical scenario. I come through the door in the evening and I’m annoyed. At what, I don’t know. A million little snafus that happened throughout the day. I am dangerously close to taking it out on someone. However, before I can do that, my Lab-Chow walks up to me and pats me, wanting some attention. So I kneel down and pet her. She licks my face, and I smile. Voila! She altered my behavior. I am only agitated a little now and chances are much better that someone will not become a casualty of my frustrations. We calm down when we are with our dogs, cats, lizards, and pigs. We slow our breath, our speech, our minds. We don’t hit as many people or use as many four-lettered words.

4. Pets distract.

Pets are like riveting movies and books. They take us out of our heads and into another reality – one that only involves food, water, affection, and maybe an animal butt – for as long as we can allow. I’ve found distraction to be the only effective therapy when you’ve hit a point where there is no getting your head back. It’s tough to ruminate about how awful you feel and will feel forever when your dog is breathing in your face.

5. Pets promote touch.

The healing power of touch is undisputed. Research indicates a 45-minute massage can decrease levels of the stress hormone cortisol and optimize your immune system by building white blood cells. Hugging floods our bodies with oxytocin, a hormone that reduces stress, and lowers blood pressure and heart rates. And, according to a University of Virginia study, holding hands can reduce the stress-related activity in the hypothalamus region of the brain, part of our emotional center. The touch can actually stop certain regions of the brain from responding to threat clues. It’s not surprising, then, that stroking a dog or cat can lower blood pressure and heart rate and boost levels of serotonin and dopamine.

6. Pets make us responsible.

With pets come great responsibility, and responsibility — according to depression research — promotes mental health. Positive psychologists assert that we build our self-esteem by taking ownership of a task, by applying our skills to a job. When we succeed — i.e., the pet is still alive the next day — we reinforce to ourselves that we are capable of caring for another creature as well as ourselves. That’s why chores are so important in teaching adolescents self-mastery and independence.

Taking care of a pet also brings structure to our day. Sleeping until noon is no longer a possibility unless you want to spend an hour cleaning up the next day. Staying out all night needs some preparation and forethought.

Redundancy — losing your job in a layoff — is difficult for most people. I’ve worked with many people who have been made redundant and struggled with the aftermath. On the whole, these individuals have been hard workers, intelligent, and loyal to their companies; when the hammer finally fell, they often went into an emotional tailspin.

After the initial shock, and even though many had been compensated well for losing their job, it’s interesting to note money became the least important factor.

What really mattered was suddenly losing direction and meaning in their lives. Without work, they became unsure and lost.

One executive I worked with received a very healthy financial package when he’d been made redundant. With money and time on his side, he could have used this opportunity to take his family away for a long-needed vacation, something he hadn’t done in many years. But instead, all he started to focus on was, “I should have done better at my job. I’ve failed.” This became his daily mantra and within a week he started to become very depressed.

His sense of self had been totally shattered by this turn of events. He’d worked with the same company for twenty years, he was the VP of a large multinational company, and his identity was wrapped up with what that meant: the power, the prestige, and the financial trappings that came with the title. In his eyes, he’d absolutely failed, therefore he was a total failure. Period.

There was no rational thinking going on here — he wasn’t able to step back and rationally examine the work situation, and what might have lead to him being let go. He couldn’t see that after his company had been taken over, the new management structure meant there were two people in his position. Too many chiefs and his position was superfluous. Nothing personal.

To add to his depressive emotional state and irrational thinking about being a failure, he began to create anxiety by asking his wife over and over, “I will be all right, I will get another job won’t I?” At the beginning she would reassure him, but as is the way with anxious thinking, his incessant need for reassurance meant she lost patience with him, causing a rift in their relationship, which he then used to reinforce his belief that he was a ‘failure.’ Down, down, down he went.

Long story short, he tried to hang himself — and fortunately failed. This is when I met him and started to help him on a long road back to being a confident, capable man.

Redundancy can be a shock to the system, and that’s completely natural. It threatens our sense of safety. But when our sense of safety is threatened, our emotions can take over. It’s important to keep calm because anxiety and depression are not good bedfellows. The last thing you need to do is have your cognitive abilities impaired because you’re thinking irrationally about yourself and the situation you’re in.

Don’t let your thoughts overwhelm you. If you catch yourself constantly thinking things like, “I can’t stand this, I must get another job” or “I’m going to lose everything, I’m such a failure,” then there’s a good chance you’re going to become anxious and depressed – and that’s not going to help.

If you are in this situation, I always think it’s a good idea to talk to somebody else, quickly. Often people feel shame for being made redundant and will hide away, but don’t ruminate on your plight, talk. Friends and family are helpful, but they may not be objective enough. Also, family members tend to have their own anxieties about you not working and this might influence your thinking and mood. One of the best early options is to talk to a coach or therapist. This can be an efficient way to help you organize your thoughts, while setting realistic goals and addressing how you’re going to achieve them.

Some people worry about the cost of this help, but it’s quicker and cheaper to spend a few hours with a coach forging a sense of direction than it is to ruminate on your plight and become depressed. If depression takes hold, you probably won’t be in a good place to think rationally, or function well enough to look for work, let alone be able to work. In the face of redundancy, it helps to be calm, be smart, and get support.

For many, the security of having a job is essential for their well-being. If you know anything about Maslow’s hierarchy of needs, safety and employment are in the second level, just above breathing — so it’s pretty important.

If you are facing the threat of redundancy then I imagine you’re going through many different emotions right now, but there are some things you can do to help you deal with these rumors more easily.

Take my friends, for instance. A few welcome the idea of redundancy and are actively seeking to be made redundant. Others are struggling with the idea, mainly because of their unhealthy thinking about redundancy and how it will ultimately affect them.

It’s important to learn to deal with unknown threats well, otherwise anxiety can become overwhelming. Once that happens, it’s very easy to cause ourselves even more emotional, cognitive, and behavioral problems.

So what can those facing redundancy do?

First, understand that this is a rumor and may not be true. Worrying about something that doesn’t exist or over which you have no control is a waste of time and effort.

Second, check that you are not causing yourself anxiety by creating unhealthy thoughts and putting yourself in a “loss-condition.” That’s when you focus so much on the potential loss that you magnify it and take it to a catastrophic conclusion. For example, a person in a loss-condition might start thinking, “What if I lose my job? I can’t lose my job, that would be awful. What if I don’t find another one and can’t afford to pay my rent? My children won’t be able to go to school and my wife will leave me. I’ll then be alone and homeless on the streets. Oh God, I can’t stand it. This must not happen!”

The problem with creating this loss scenario is that once you think it, your mind will create a visual story of that thought and react accordingly. Your brain will begin to believe that thought is true. The more you think that irrational belief, the quicker your brain will recall that devastating visual and it’ll react to the threat by creating even more anxiety symptoms. Before you know it, you won’t be able to think clearly and cope with the threat or the reality of redundancy.

Essentially, you’ve created a fictitious scenario that your brain believes to be true. You’ll be convinced that this will be your ultimate outcome. This thinking is very dangerous to your health.

Third, while you are focusing on the loss scenario, you are not focused on what you might be able to do to help yourself if the redundancy does become real and does affects you. While you’re becoming more anxious and spending more time thinking about how awful life will be, you could have gotten your resume updated, gotten an idea about the state of your finances, checked out insurance policies to see if you have unemployment payment protection, and so on. (There are many good sites that offer practical advice.)

It’s perfectly healthy to have concerns over being made redundant, because it’s not a small thing. It’s also healthy to be cautious and prepared for the possibility that you may be made redundant. But it’s too easy to let our healthy concerns turn into unhealthy anxiety.

With just a small change in thinking, while rationally assessing the situation, you will be putting yourself in a healthier position to react, and manage any potential loss situation in healthier, more productive ways.

“Between a shaky world economy, increasing unemployment, and related issues, many today are being forced to come to the edge of uncertainty. Just like the baby sparrows, they find themselves leaning into the mystery that change brings, because they have no choice: It’s fly or die.”

For persons struggling with depression and anxiety — and for those of us who are highly sensitive — uncertainty is especially difficult. Forget about learning to fly. The uncertainty itself feels like death and can cripple our efforts to do anything during a time of transition.

I have been living in uncertainty, like many people, ever since December of 2008 when the economy plummeted and the creative fields — like architecture and publishing — took a hard blow, making it extremely difficult to feed a family. In that time, I think I have worked a total of 10 jobs — becoming everything from a defense contractor to a depression “expert.” I even thought about teaching high school morality. Now that’s desperate.

I don’t think I’ll ever be comfortable with uncertainty, but having lived in that terrain for almost five years now, I’m qualified to offer a few tips of how not to lose it when things are constantly changing.

1. Pay attention to your intention

I’m not a new-age guru. I don’t believe that you can visualize a check for $20,000 and find one in your mailbox the next day. Nor can you get on Oprah by believing you’ll be her next guest. (I tried both of those.) But I do recognize the wisdom in tuning into your intention because therein exists powerful energy that you can tap.

Awhile back I did Deepak Choprah’s exercise of recording my intentions and seeing how many of them actualized. I was surprised at the synchronicity between intention and events. Psychologist Elisha Goldstein writes in his book, The Now Effect: “Our intention is at the root of why we do anything and plays a fundamental role in helping us cultivate a life of happiness or unhappiness. If we set an intention for well-being and place it at the center of our life, we are more likely to be guided toward it.”

2. Tune into the body.

Psychologist Tamar Chansky, Ph.D. reminds us to listen to the body when we get anxious. If you understand why certain symptoms occur in the body – racing heart, dizziness, sweating, stomachaches – and repeat to yourself, “This is a false alarm,” you are less afraid, less panicked by the situation. Knowing that these symptoms are part of the sympathetic nervous system (SNS) trying to protect you from danger – part of the primitive regions of the brain mobilizing the “flight-or-fight” response –the reaction becomes less about the situation and more about talking to your body about why it’s freaking out so that you can use the parasympathetic nervous system (PNS) to restore the body to normalcy, which, in my case, is still pretty panicky.

3. Imagine the worst.

I’m not sure you will find a psychologist to agree with me on this exercise, but it has always worked for me every time I do it. I simply envision what it would look like if my worst nightmare happened. What if my husband and I could not get any architecture gigs or writing assignments? What if we can’t pay for health care insurance and my heart malfunctions (I have a heart disorder)? What if we both come to a bone fide professional dead end? Then I move to my actions. I think about selling our house, moving into a small apartment, and working as a waitress somewhere or maybe as a barista at Starbucks. (If you work more than 20 hours, you get health care insurance.) I research health care insurance options for persons who make minimum wage. Under ObamaCare, my kids, at least, would be covered. I invariably come to the conclusion that we will be okay. All is okay. A huge adjustment. Yes. But we are getting to be pros at that. This exercise makes me fret less about the things that I think I must have and get back to the essentials—literally a warm meal on the table, even if it’s one a day.

I am comforted by the words of Charles Caleb Colton: “Times of general calamity and confusion have ever been productive of the greatest minds. The purest ore is produced from the hottest fire.”

4. Describe, don’t judge.

In his book Get Out of Your Mind and Into Your Life, Steven Hayes, Ph.D. dedicates a few chapters to learning the language of your thoughts and feelings. Especially helpful to me is learning how to distinguish descriptions from evaluations.

Descriptions are “verbalizations linked to the directly observable aspects or features of objects or events.” Example: “I am feeling anxiety, and my heart is beating fast.” Descriptions are the primary attributes of an object or event. They don’t depend on a unique history. In other words, as Hayes, explain, they remain aspects of the event or object regardless of our interaction with them. Evaluations, on the other hand are secondary attributes that revolve around our interactions with objects, events, thoughts, feelings, and bodily sensations. They are our reactions to events or their aspects. Example: “This anxiety is unbearable.”

If we are feeling anxious about the uncertainty of our job, for example, we can tease apart the language of our thoughts and try to transform an evaluation, “I will be destroyed if I am fired,” to a description, “I am feeling anxious and my job is unstable.” By naming the emotion and the situation, we don’t necessarily have to assign an opinion. Without the opinion, we can process the object, event, etc. without hyperventilation.

5. Learn from fear.

Eleanor Roosevelt wrote, “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face … You must do the thing you think you cannot do.” My body usually protests against that statement, but theoretically I concur with Eleanor. I sincerely believe the good stuff happens when we are afraid. If we go a lifetime without being scared, as Julia Sorel said, it means we aren’t taking enough chances.

Fear is rather benign in itself. It’s the emotions we attach to it that disable us. If we can confront our fear, or rather approach it as an important messenger, then we can benefit from its presence in our life. What is the fear saying to us? Why is it here? Did it bring roses or chocolate? According to Jones, this is an exercise of getting comfortable with being out of control, of learning to let go of the illusion of control — because we never really had it in the first place — and developing an inner knowing that everything will be okay.

Proper treatment doesn’t suppress emotions or dull a person’s ability to feel things deeply. It builds a protective layer — an emotional resilience — to safeguard a depressive from becoming overwhelmed and disabled by the difficulties of daily life.

However, the tools found in happiness research are those I practice in my recovery from depression and anxiety, even though, theoretically, I can be happy and depressed at the same time. I came up with my own recovery program that coincides with the steps toward happiness published in positive psychology studies.

1. Sleep

Sleep is crucial to sanity because sleep disturbances can contribute to, aggravate, and even cause mood disorders and a host of other illnesses. The link between sleep deprivation and psychosis was documented in a 2007 study at Harvard Medical School and the University of California at Berkeley. Using MRI scans, they found that sleep deprivation causes a person to become irrational because the brain can’t put an emotional event in proper prospective and is incapable of making an appropriate response. Chronic sleep deprivation, especially, is bad news. It often affects memory and concentration. And, according to one recent study, it can cause a decline in cognitive performance similar to the intoxicated brain.

2. Diet

My mouth and brain are in constant negotiation with each other because while one loves white bread, pasta, and chocolate, the other throws a hissy fit whenever they enter my blood stream. My diet has always been an important part of my recovery from depression, but two years ago — after working with the naturopath and reading Kathleen DesMaison’s “Potatoes Not Prozac” — I could more competently trace the path from my stomach to my limbic system. Moreover, I recognized with new clarity how directly everything that I put in my mouth affects my mood.

Here are the bad boys: nicotine, caffeine, alcohol, sugar, white flour, and processed food — you know, what you live on. Here are the good guys: protein; complex starches (whole grains, beans, potatoes); vegetables; vitamins (vitamin B-complex, vitamins C, D, and E, and a multivitamin); minerals (magnesium, calcium, and zinc); and omega-3 fatty acids. I’m religious about stocking up on omega-3 capsules because leading physicians at Harvard Medical School confirmed the positive effects of this natural, anti-inflammatory molecule on emotional health.

3. Exercise

Dr. James A. Blumenthal, a professor of medical psychology at Duke University, led a recent study in which he and his team discovered that, among the 202 depressed people randomly assigned to various treatments, three sessions of vigorous aerobic exercise were approximately as effective at treating depression as daily doses of Zoloft, when the treatment effects were measured after four months. A separate study showed that the depressives who improved with exercise were less likely to relapse after 10 months than those treated successfully with antidepressants, and the participants who continued to exercise beyond four months were half as likely to relapse months later compared to those who did not exercise.

Even as little as 20 minutes a week of physical activity can boost mental health. In a new Scottish study, reported in the British Journal of Sports Medicine, 20,000 people were asked about their state of mind and how much physical activity they do in a week. The results showed that the more physical activity a person engaged in — including housework, gardening, walking, and sports — the lower their risk of distress and anxiety.

Exercise relieves depression in several ways. First, cardiovascular workouts stimulate brain chemicals that foster growth of nerve cells. Second, exercise increases the activity of serotonin and/or norepinephrine. Third, a raised heart rate releases endorphins and a hormone known as ANP, which reduces pain, induces euphoria, and helps control the brain’s response to stress and anxiety. Other added benefits include improved sleep patterns, exposure to natural daylight (if you’re exercising outside), weight loss or maintenance, and psychological aids.

4. Relationships and Community

We are social creatures and are happiest when we are in relationship. One of the clearest findings in happiness research is that we need each other in order to thrive and be happy, that loving relationships are crucial to our well-being. Relationships create a space of safety where we can learn and explore. Belonging to a group or a community gives people a sense of identity. Studies indicate that social involvement can promote health, contribute toward faster recovery from trauma and illness, and lower the risk of stress-related health problems and mental illness.

Plenty of evidence indicates that support groups aid the recovery of persons struggling with depression and decrease rates of relapse. The New England Journal of Medicine published a study in December 2001 in which 158 women with metastatic breast cancer were assigned to a supportive-expressive therapy. These women showed greater improvement in psychological symptoms and reported less pain than the women with breast cancer who were assigned to the control group with no supportive therapy.

Another study in 2002, published in the American Journal of Psychiatry, followed a group of more than 100 persons with severe depression who joined online depression support groups. More than 95 percent of them said that their participation in the online support groups helped their symptoms. The online groups here on Psych Central are a great resource where you can find support from people going through similar struggles.

5. Purpose

The father of positive psychology, Martin Seligman, explains in his book, “Authentic Happiness,” that a critical element to happiness exists in using your signature strengths in the service of something you believe is larger than you. After collecting exhaustive questionnaires he found that the most satisfied people were those that had found a way to use their unique combination of strengths and talents to make a difference. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, believes that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression. And then there’s Gandhi, who wrote: “the best way to find yourself is to lose yourself in the service of others.”

6. Gratitude

Gratitude doesn’t come easily to me. When my girlfriend sees a half-full glass of fresh milk, I see a half-empty glass of cholesterol-rising, cardiac-arresting agents. And when the kids’ school is called off because some road somewhere in our county apparently accumulated a half of an inch of snow, she thanks God for an opportunity to build snowmen with she kids. I have a conversation with God, too, but it’s much different.

However, I train myself to say thank you more often than is natural for me because I know that gratitude is like broccoli — good for your health in more than one way. According to psychologists like Sonja Lyubomirsky at the University of California Riverside, keeping a gratitude journal — where you record once a week all the things you have to be grateful for — and other gratitude exercises can increase your energy, and relieve pain and fatigue.

Shameless plug! Join me at one of three private screenings of “Happy,” a film that explores what makes us happy, followed by a discussion on depression and happiness and a book signing. Click the following links for more information:

When we function in a healthy manner, we don’t just experience joy and happiness, prancing around without a care in the world. We actually still experience a range of emotions, some of which can be very difficult to live with.

It’s absolutely healthy to feel anxiety, depression, anger, jealousy, envy, guilt, hurt or shame. But what makes experiencing these emotions healthy is that we don’t linger in them for longer than is good for us. We don’t demand that they ‘go away.’ We accept the appropriateness of how we feel, and do something about our situation.

Let me give you an example of how a person’s thinking can perpetuate depression.

Imagine that your favorite dog was very sick and you took her to the vet, who tells you she’s in a lot of pain and it’s best to euthanize her. How do you think you might feel? Very sad (most likely), guilty (perhaps), happy (to some degree if you know you can stop her suffering). So, do those emotions seem healthy and appropriate to you? Of course they do, and to experience them is human.

Given the choice, you may not have wanted to face that situation in the first place, but we can’t always pick and choose what happens to us in life. We can only choose how we deal with those situations when they arise.

So how could a person drive themselves into depression after such an event? It’s easy. When a person feels sad about a loss or death, if they start taking far too much responsibility for what happened and judging themselves negatively, then depression will be only a short taxi ride away. The kind of thinking that perpetuates depression will be thoughts such as “I’m such a bad person for killing her,” “I should have done more to make her life happy,” “I should have taken her to the vet sooner and I would have saved her.”

None of those statements is wholly true, yet when you repeat them, you start to believe it and you feel depressed. You’ll even start acting depressed. Instead of going out for a walk, which you used to enjoy, you might stay at home watching TV, because ‘there’s no point in going out without your dog.’ You might even stop socializing with other dog walkers and so you’ll become more isolated, which perpetuates the problem.

So from a healthy sadness about the loss of a loved pet, with unhealthy thinking and behavior, your mood sinks into depression. And once there, it is a lot harder to get out of than when you’re healthily sad.

Anxiety, on the other hand, is depression’s opposite. Rather than dwelling on the past, people with anxiety tend to focus on the possible threat in the future, and employ defensive mechanisms against that perceived threat or problem. Let me give you another example.

Frank gives a presentation at work that doesn’t go down well with his boss. Frank gets shouted at and bawled out for not doing a good enough job. His boss also tells him that he must improve before the next presentation or else! How do you think you might feel? Disappointed (sure). Frustrated (maybe). Concerned (oh yeah).

So how does Frank perpetuate his anxiety? The first thing he does is to fly into the future and use ‘what if’ and ‘if…then’ type thinking. “If I deliver another bad presentation, then my boss will fire me.” “What if I can’t do it the way he wants?” “What if I’m terrible?”

These ‘what if’ thoughts are the precursors to the unhealthy demands that lead to anxiety: “I must know that the presentation will go well.” “I must not screw up the presentation or my boss will fire me.” “I must be perfect.”

The trouble with these irrational demands is that they lead to anxious behaviors: spending hours on the presentation; not sleeping; seeking others’ opinions; asking for reassurance; feeling nauseous beforehand; sweating; feeling ill at ease.

Clearly, Frank is not in a good state to be giving a presentation. He’ll most likely deliver a sub-par presentation. What do you think will happen next time he needs to give a presentation? He’ll feel worse.

To end these destructive cycles, we need to understand that emotions — even the difficult ones — are healthy. Emotions should be used as a guide to let us know that something is off-balance and might need changing. When we demand unreasonable things from ourselves, we’re destined to feel strong, unhealthy emotions.

It’s a thin line between healthy and unhealthy emotions, but by understanding how our thinking perpetuates our emotional disturbance, we can become a healthier version of ourselves.

In my 20 years living in the Boston area, I cheered on the runners on many occasions and now, even from far way, these events feel close to home.

Experiencing trauma can have a dramatic effect on our bodies and our minds.  And although it’s a different experience to witness a trauma on television, it still can affect us.

When you perceive a threat, the body activates the stress response. The stress response occurs in both your body and brain.

The body’s response to acute stress is a preparation for emergency.  Adrenaline and other hormones are released.  The body shuts down processes associated with long-term care.  When under immediate threat, digestion, reproduction, cell repair and other body tasks related to long-term functioning are unimportant.

Of immediate importance is survival.  Increased blood sugar can provide extra energy for muscles. Increases in cortisol counter pain and inflammation. Blood pressure increases. Blood is diverted from our extremities to our major muscles to provide us with extra strength. Increased endorphins can help us ignore physical pain.

You can see the effects of these changes to the body in many of the symptoms of stress, such as racing heart, dizziness, nausea, shortness of breath, shaking, feeling hot and flushed, and sweating.

But it is the impact of trauma on the mind that is often the most disturbing.  Traumatic events can leave us feeling unsafe.  They can disrupt our beliefs and assumptions about the world. Your sense of your ability to control your life may be shattered. You may question how much influence you have over your life and your life choices.

A trauma, such as the one the occurred at the Boston Marathon, can leave us distrustful of other people.  You may question your basic trust of other people in the world.  Trauma can affect your ability to be intimate with others and may impact your feelings of self-worth.  Those who survive the trauma often feel guilt and wonder why they lived when others were less fortunate.

As we grow, change and have varied experiences throughout life, our beliefs and assumptions typically evolve over time.  With trauma, those beliefs and assumptions that we use to make sense of the world around us change nearly instantaneously.

It’s common to experience a wide range of psychological symptoms, including intrusive thoughts, worry, difficulty sleeping, trouble focusing, bouts of crying, blame or self-judgment and lack of satisfaction.

The effects of trauma also can cause intense emotion, including extreme emotional fluctuations, unhappiness, anxiety, loneliness, anger, and irritability.

Multiple traumas or repeatedly being exposed to life-threatening events can have a further impact on your body and mind. Parts of the brain can become sensitized, causing you to be on high alert and to perceive threats all around, leaving you jumpy and anxious.

Other parts of the brain associated with memory can actually shrink, making it difficult to consolidate and form new memories.  Prolonged stress can effect the development of a number of health issues, including diabetes, obesity and hypertension. And repetitive stress affects our moods, brings on anxiety disorders, and affects our experience of chronic pain and our ability to control food intake.

But when horrible events occur, such as those that occurred at the 2013 Boston Marathon, we also see the generosity and caring that is a large part of human nature.

Countless individuals ran to help without a second thought.  First responders, medics, EMTs and even bystanders jumped into action to do what they could to save lives.  Runners crossed the finish line and kept on running straight to give blood.

As we deal with the impact of violence, we can also keep in our minds the heroes and the strength of the human spirit that brings us together when we are faced with senseless tragedy.

Image: Wikimedia Commons: Aaron “tango” Tang

At one time in my life, this used to bug me. I would look at the clock and think, “oh no, I must get back to sleep or I’ll be so tired in the morning.” And then I’d spend the next hour or two willing myself to go back to sleep: tossing and turning, demanding that I slip back into unconsciousness; huffing and puffing that I wasn’t sleeping. I’d even check the clock every 10 minutes to see if I’d slept.

But the reality was, and still is, the more that I demand something of myself, the less likely I am to achieve that goal — and that really is the principle of living an unhappy life.

Sure I want to go back to sleep. I would even really, really, really, prefer to be sleeping right now, but I’m not. So, instead of lying there, beating myself up for waking when I “absolutely shouldn’t have,” I get up. I grab a drink, get something to eat and power up my laptop.

I realized a while back that, for me, it’s easier to get up and do something I enjoy. Use the extra time I have to write something, read, watch some TV, or just get lost in the weird and wonderful things people upload on YouTube.

This extra quiet time can be a bonus, before the world machine cranks up, and I slip into my lane on the daily highway of life.

Sure, I might be a little tired later, but the reality is that a few hours less sleep every now and then is not going to affect my performance. It will only affect that if I’m constantly telling myself, “I won’t be able to cope with work/life/kids because I woke so early and I’ll get tired.”

If you’re the type of person who uses that snippet of destructive thinking, then you’ll start sabotaging yourself. Sometimes after not sleeping well, people even play the ‘poor me card.’ They tell work colleagues how little sleep they’ve had, and how they won’t be able to do so-and-so job, or how they might need to go home early because of exhaustion.

Thinking and behaving like this can be quite common, and its roots can usually be found in childhood messages such as “You’ve got school tomorrow. You need to get your sleep or you won’t be able to do well.”

Really? How many times did you hear this, yet still stayed up late reading about dinosaurs, and made it through school the next day?

Even scientists don’t know how much sleep people need.

Each person’s sleep patterns and needs are different. You might be somebody like me, who likes around eight hours a night, or you might need fewer, such as four. Trouble is, if you’re the type of person who needs four, but you think you should have eight, that is where your problems will start.

Sleep problems can start if, instead of embracing your pattern and learning to live with it, you start to create your own anxiety around not getting enough sleep. Soon enough, sleeping will start to be a problem because you’ll be worrying about it before you go to bed, and that worry will interfere with your sleep pattern.

Soon you’ll be going to sleep, only to wake yourself so you can check that clock to see if you’ve been sleeping. And as you can tell, that irrational behavior will confirm that you haven’t slept as much as you demand because you woke yourself up!

The next step from there is usually some type of insomnia, because you’ve worked yourself up into such anxiety about sleeping. After a while you will be tired and your cognitive functioning will be impaired. You’ll be worrying during the day whether you’ll even sleep at night; and nearer to sleep time you get, the more anxious you’ll become and the more your body won’t be able to relax, so the more impossible it is to sleep. Catch-22, created by you.

If you do wake early, then make the best of that time. If your sleep pattern is such that you sleep a few hours a night, but need a nap during the day, then do it. Stop telling yourself you “must sleep now or else.”

I’ve found my way with managing my occasional lack of sleep. What about you? Is there a pattern you could change? Are you demanding something of yourself that leads to sleep problems? If so, these need to be addressed. So go do it — go change.

Then, I walk into the lab next door for a blood test and the line I hear is: “Oh, your blood pressure was high, let me see if I can draw your blood now.”

Wait, what? Do they actually think that these comments will make me feel more relaxed?

I’ve also experienced more direct unpleasantries from doctors who project an icy, or even a rude demeanor. A poor bedside manner does affect a patient’s emotional disposition; it does heighten any anxiety, and it certainly ensures difficulty in forming a positive bond with a professional who’s in a field that’s supposed to alleviate illness.

“A bedside manner refers most often to the way a medical professional interacts and communicates with patients,” a 2012 post on Wisegeek stated. The post stresses that a doctor with a good bedside manner demonstrates empathy,¹ and emits an aura of ease for the patients, while also involving them in health decisions. On the flip side, poor bedside manners reflect rudeness, cold attitudes, inadequate listening skills, and a complete disregard for the patient’s fears.

Why are such mannerisms prominent in the medical field?

Lorianna De Giorgio’s 2012 article in the Toronto Star discusses why positive relationships between patients and doctors may be lacking in the profession.

Adam Waytz, assistant professor of management and organizations at Northwestern University, explained that a process of “dehumanization” lies behind an unfortunate patient-doctor rapport. Dehumanization may occur due to psychological demands placed on practitioners, and from ongoing advances in technology as well. Waytz determined that a bulk of medical decision-making gives way to a very mechanical method of thinking; problems are often solved and issues are fixed without recognizing the patient’s feelings.

While many individuals enter the medical field for humane reasons, “they get into the system, and the system is so stressful that sometimes the humanity is just beaten out of them,” notes Marjorie Stanzler, senior director of programs at the Schwartz Center for Compassionate Healthcare.

Waytz and Stanzler advocate that a proper bedside manner would result in improved psychological and physical outcomes for the patients in treatment.

A 2008 blog post entitled What Bad Bedside Manners Really Mean reviews the negative impact and consequences of these adverse behaviors:

“Doctors are supposed to be in the line of work of helping people. With this profession comes a lot of responsibility. The medical field is not supposed to be simply diagnosing a problem, handing out a few pills, and moving onto the next patient. It means much more. It means being a physician, and a physician means being a healer.”

I could not agree more. Patients may feel naturally anxious, waiting on an impending prognosis (especially if the condition has the potential to be serious). Do they really need aloofness on top of that?

“If the doctor seems disinterested in what you are telling him, there are greater chances of him missing something that you said,” the post stated. “If he seems put-out or preoccupied, the patient might be more likely to leave out pertinent information.” Furthermore, if the doctor is disrespectful, it may discourage patients from seeking medical assistance altogether.

Due to a distressing environment and technological developments, I can understand why medical practitioners may harbor some poor bedside manners, but that doesn’t make their etiquette right or beneficial.

I think it’s important for them to remember why they’ve entered the field in the first place; if it’s because they sincerely want to help people, it’s crucial to know how to relate to patients on an emotional level.

1. l personally think medical schools should have official courses on being more empathetic

So what is alternative treatment? You may already have some experience with the most popular, according to the Monitor on Psychology. Meditation, biofeedback, hypnosis and progressive muscle relaxation are all popular complementary or alternative psychological treatments. 

Although you may be familiar with the most popular, there are dozens of alternative and complementary treatments, which typically fall into four categories:  mind-body medicine, biologically-based practices, manipulative and body-based practices and energy medicine.

The Monitor article reports that, although these, and many other, alternative and complementary treatments have been around for thousands of years, the National Institute of Health (NIH) has been studying their usefulness, safety and role in improving health and health care for only a little more than a decade.

But many people embrace these treatments and are visiting alternative medicine practitioners more frequently than they visit their primary care doctors.  And these treatments are big business. A 2007 study found that $34 billion is spent each year on products and services for alternative and complementary medicines.

Continued research on the effectiveness of these treatments is ongoing and crucial.  However, current research suggests that many are effective for treating a wide range of problems, ailments and disorders.

There are too many to document in one post, but the following are the top 4 according to frequency of use, as reported in the Monitor.

1. Dietary Supplements.

Dietary supplements are used to promote general health, as well as to improve depression and anxiety and to decrease pain.  Common supplements reported in the Monitor include ginkgo biloba, St. John’s wort and vitamin supplements.  Although regulated by the FDA, they are held to very different quality standards than more conventional medicines.

• Caution: The FDA does not review the safety and effectiveness of any supplement before it is sold to consumers.  Supplements can vary widely from brand to brand and may interact with other medications. They should not be used without the knowledge of a physician.

2. Meditation.

Meditation is a process in which people learn to focus their attention in a particular way and on purpose.  It is used to treat a variety of symptoms, including high blood pressure, chronic pain, anxiety, depression, stress and insomnia.  It is also used to promote general health and well-being.

Meditation is integrated into many psychological treatments and practices with positive results; however, there are no formal qualifications necessary to practice it.  It is important that those who use this method receive appropriate training.

3. Chiropractic.

Chiropractic physicians use noninvasive treatments, such as spinal manipulations or chiropractic adjustments, with the aim of improving nerve and organ functioning by aligning spinal vertebrae.  These treatments are used to treat an array of ailments, from pain and headaches to stress and ADHD, among others.

Becoming a chiropractic physician requires several years of graduate work.  Most psychologists are unlikely to hold a chiropractic degree and, if they did, it would not be appropriate to serve as both a psychologist and chiropractor for the same client.

4. Aromatherapy.

Aromatherapy uses smells and aromas naturally extracted from plants to balance, harmonize and promote health of mind, body and spirit.  It is used clinically to relieve symptoms typically addressed in psychotherapy; holistically, to improve overall well-being; and aesthetically, in various oils and skin care products.

The Monitor cites recent research that indicates that aromatherapy can help treat pain, anxiety and agitation specific to dementia.  However, while certification is not required, it is recommended.  There are also risks related to toxicity, skin irritation and dosing regulations that require a competent professional to oversee, the article states.

Reference

Barnett, J.E., Shale, A.J.,(2013). Alternative Techniques.  Monitor on Psychology, 44(4).

Unfortunately that advice wouldn’t have been able to stop me from praying rosary after rosary when I was in fourth grade to avert going to hell, nor does it quiet the annoying noise and chatter inside my brain today in any given hour. But the fact that a great leader battled the worry war does provide me some consolation.

It doesn’t matter whether you are a chronic worrier without an official diagnosis or battling severe obsessive-compulsive disorder (OCD), a neurobehavioral disorder that involves repetitive unwanted thoughts and rituals. The steps to overcome faulty beliefs and develop healthy patterns of thinking are the same.

Worrying about facing the inferno as a 10-year-old and fretting about whether or not I’ll provide enough income to keep my kids in private school stems from the same brain abnormality that Jeffrey M. Schwartz, M.D. describes in his book, Brain Lock.

When we worry, the use of energy is consistently higher than normal in the orbital cortex, the underside of the front of the brain. It’s working overtime, heating up, which is exactly what is the PET scans show. Too many “what if’s” and your orbital cortex as shown in a PET scan will light up in beautiful neon colors, like the walls of my daughter’s bedroom. However, with repeated cognitive-behavioral exercises, you can cool it down and return your PET scan to the boring black and white.

In their book, The OCD Workbook, Bruce M. Hyman, Ph.D., and Cherry Pedrick, RN, explain the ABCDs of faulty beliefs. It’s a four-step cycle of insanity:

A = Activity Event and Intrusive Thought, Image or Urge. (What if I didn’t lock the door? What if I upset her? I know I upset her.)

B = Faulty Belief About the Intrusive Thought. (If I don’t say the rosary, I’m going to hell. If I made a mistake in my presentation, I will get fired.)

C = Emotional Consequences: Anxiety, Doubt, and Worry. (I am a horrible person for upsetting her. I keep making mistakes … I will never be able to keep a job. I hate myself.)

D = Neutralizing Ritual or Avoidance. (I need to say the rosary to insure I’m not going to hell. I should avoid my friend who I upset and my boss so that he can’t tell me I’m fired.)

Those might seem extreme for the casual worrier, but the small seed of anxiety doesn’t stay small for long in a person with an overactive orbital cortex.

Hyman and Pedrick also catalog some typical cognitive errors of worriers and persons with OCD:

• Overestimating risk, harm, and danger
• Overcontrol and perfectionism
• Catastrophizing
• Black-and-white or all-or-nothing thinking
• Persistent doubting
• Magical thinking
• Superstitious thinking
• Intolerance of uncertainty
• Over-responsibility
• Pessimistic bias
• What-if thinking
• Intolerance of anxiety
• Extraordinary cause and effect

One of the best approaches to manage a case of the worries and/or OCD is the four-step self-treatment method by Schwartz, explained in Brain Lock,

Step 1: Relabel.

In this step you squeeze a bit of distance between the thought and you. By relabeling the bugger as “MOT” (my obsessive thought) or something like that, you take back control and prevent yourself from being tricked by the message. Because I’ve always suffered from OCD, I remind myself that the illogical thought about which I’m fretting is my illness talking, that I’m not actually going insane.

Step 2: Reattribute.

Here is where you remember the PET scan that would look like your brain. By considering that colorful picture, you take the problem from your emotional center to your physiological being. This helps me immensely because I feel less attached to it and less a failure for being able to tame and keep it under control. Just like arthritis that is flaring up, I consider my poor, overworked orbital cortex, and I put some ice on it and remember to be gentle with myself.

Step 3: Refocus.

If it’s at all possible, turn your attention to some other activity that can distract you from the anxiety. Schwartz says: “By refusing to take the obsessions and compulsions at face value—by keeping in mind that they are not what they say they are, that they are false messages—you can learn to ignore or to work around them by refocusing your attention on another behavior and doing something useful and positive.”

Step 4: Revalue.

This involves calling out the unwanted thoughts and giving yourself a pep talk on why you want to do everything you can to free yourself from the prison of obsessive thinking. You are basically devaluing the worrying as soon as it tries to intrude.

“Partners may find themselves in roles they do not want, such as the compromiser, the protector, or the comforter,” says Kate Thieda, MS, LPCA, NCC, a therapist and author of the excellent book Loving Someone with Anxiety.

They might have to bear the brunt of extra responsibilities and avoid certain places or activities that trigger their partner’s anxiety, she said. This can be very stressful for partners and their relationship.

“Partners of loved ones with anxiety may find themselves angry, frustrated, sad, or disappointed that their dreams for what the relationship was going to be have been limited by anxiety.”

Thieda’s book helps partners better understand anxiety and implement strategies that truly support their spouses, without feeding into or enabling their fears.

Below, she shared five ways to do just that, along with what to do when your partner refuses treatment.

1. Educate yourself about anxiety.

It’s important to learn as much as you can about anxiety, such as the different types of anxiety disorders and their treatment. This will help you better understand what your partner is going through.

Keep in mind that your partner might not fit any of these categories. As Thieda writes in Loving Someone with Anxiety, “The truth is, it doesn’t matter whether your partner’s anxiety is ‘diagnosable.’ If it’s impairing your relationship or diminishing your partner’s quality of life or your own quality of life, it will be worthwhile to make changes.”

2. Avoid accommodating your partner’s anxiety.

“Partners often end up making accommodations for their partner’s anxiety, whether it is intentional [such as] playing the part of the superhero, or because it just makes life easier, as in, doing all the errands because their partner is anxious about driving,” said Thieda, who also created the popular blog “Partners in Wellness” on Psych Central.

However, making accommodations actually exacerbates your partner’s anxiety. For one, she said, it gives your partner zero incentive to overcome their anxiety. And, secondly, it sends the message that there really is something to fear, which only fuels their anxiety.

3. Set boundaries.

Your partner might continue asking for accommodations, such as having you drive everywhere or regularly stay home with them, Thieda said. “You have the right to have a life, too, and this may mean telling your partner on occasion, and in a loving way, that you are going to do what you want and need to do.”

In her book Thieda devotes an entire chapter to effectively communicating this to your partner. Essentially, she suggests being empathetic, using “I” statements and giving specific requests.

For instance, she gives the following examples: Instead of saying, “You worry too much about what other people think of you,” you might say, “I’m concerned that your fears about what others think of you are holding you back at work.”

Instead of saying, “Don’t call me at work so much,” you might say, “It would be helpful if you would try some of the techniques you’ve learned for calming yourself down before calling me at the office.”

Also, “always consider whether a compromise is possible, but also recognize that you have the right to do things independently,” she said.

4. Relax together.

There are many techniques you can try together to alleviate anxiety. According to Thieda, “The body scan is a great couples mindfulness technique because one person can guide the other through the process.”

This promotes mindfulness for both partners. The partner giving instructions needs to pay attention to timing and the specific directions, she said. And the partner receiving the instructions needs to pay attention to each body part and releasing its tension, she said. (Here’s a sample body scan.)

5. Focus on your own care.

According to Thieda in her book, “When you live with an anxious partner, there can be a lot of tension in your relationship and in your home. Having self-care routines and plans in place can help you neutralize the static.”

Consider what you’re already “doing to promote physical, spiritual, mental, emotional, professional, and relationship health,” Thieda said. Assessing where you are helps you better understand where you need to go. For instance, you might want to set goals about improving your health or seek support from others, she said. You might want to work with a therapist or attend support groups.

What to Do When Your Partner Refuses Treatment

Anxiety is highly treatable. But your partner might not want to seek professional help. Thieda suggested considering the reasons behind their refusal.

For instance, they might’ve tried treatment before but it didn’t work. One reason treatment “fails” is because it’s not the right treatment for the person’s anxiety. According to Thieda, “It is best to work with a professional who uses cognitive-behavioral therapy techniques and is specifically trained in working with people who struggle with anxiety.”

They might’ve tried medication or psychotherapy alone, but they’d do better with a combination of treatments, she said. It’s also possible that your partner tried to take on too much, and ended up feeling even more anxious. “Maybe they need to approach their treatment in a different way, breaking down the challenges into smaller, more manageable pieces.”

Ultimately, the decision to seek treatment rests with your partner, Thieda said. “No amount of begging, pleading, or threatening is going to be effective, and will likely make things worse.”

The best thing you can do is to be supportive, encouraging and loving when they do decide to seek help, she said.

Having a spouse who’s struggling with anxiety can naturally become stressful for partners. But while this can be challenging, by educating yourself, setting healthy boundaries and practicing self-care, you can truly help your spouse and your relationship.