Dubbed Confessions of a Worrywart: Husbands, Lovers, Mothers, and Others, and featuring such colorful chapter titles as “Shrinks are Like Boyfriends Who Can’t Dump You,” “Saving E-Mail, Saving Voicemail,” and “In Search of Grief,” Orlins’s story weaves through her life in rough chronological fashion. We learn of her kindergarten crush; her 20s as a single woman in Washington, D.C.; her 18-year marriage, which included stints of living in China and also produced three kids; her divorce; the loss of her parents; and, eventually, her life as an active and happily-independent divorcee with grown daughters.

Her writing is candid, vibrant, funny, and touching. Even so, I found myself reading more slowly than usual, simply because her stories were so evocative that they prompted near-constant daydreams, in which I’d remember similar personal incidents and ponder my reactions and feelings. I found myself alternately nodding along with recognition and recoiling in shock. As a woman in the same age range as Susan’s daughters (I feel I know Orlins so well by now that I can’t help but think of her as “Susan”), I can recognize that some things have stayed the same since the previous generation, but that, thankfully, others have changed drastically.

In the aforementioned “Shrinks” chapter, for instance, which spans 1967-1976, Orlins recalls snippets of her interactions with the various therapists she saw in her 20s. I cringed through her entire account of Dr. Miller. She begins, “When I walked into his office for my initial consultation, he hugged me — too long and too hard. As I unfolded the story of my life, he kept interrupting to tell me about his amorous triumphs” — and as I read I realized that my lip was curling back in distaste.

By the time she describes how Dr. Miller fell asleep in one session and later invited her to join a “nude group session,” which she declined (thank god!), as well as to try hypnosis, which she accepted (oh god, no, Susan!), I was completely keyed up, imagining being placed in those situations by a (male) therapist myself. I could not understand the sanguine manner by which she documented what seems to me outrageously unprofessional behavior. Perhaps we can chalk this up to “Wow, we’ve come a long way.”

But at many points in her story, I found myself chortling or nodding along in recognition. Early in the book, Orlins describes choosing her college major and minor based not on her passions, but on what she got her best grades in, and what would most likely lead to a job. She says, “…my father insisted I have something to fall back on. There was always this falling back, a requirement to stockpile safety nets, as if it were unthinkable to surge through life upright or tilting forward.” I loved her phrasing there, and empathized with her situation completely. Will that dynamic between parents and children ever change?

Likewise, on page 227 I groaned aloud at both the author and myself when I read this reference to a man she was seeing: “As with the no-soap, I quickly dismissed anything about his looks that detracted from my interest; I wanted to be gaga over him.” That hit a little close to home. I’d venture that many, many women identify with that tendency to want to want a partner more than one actually does want him, and to ignore the little twinges of misgiving.

No matter if I identified with her feelings or not, Orlins’s colorful prose made me smile. A few of my favorites: “My idea was that a psychiatrist ought to be able to mold my mind, the way a plastic surgeon could change a person’s nose” (p. 62); “ ‘When we’re engaged, you can pick me up.’ If you have never gone through a divorce, let me propose you prepare for this kind of gut-flip-flopping, bile-choking, brain-exploding remark to just fall out of your mouth without warning. Peter was decent enough not to break the date” (p. 169); and “Don’t mistake me for a sleek, zippy cyclist hunched over racing-style handlebars. I am none of that. I plod along high and upright, arms spread wide, more Mary Poppins than Lance Armstrong” (p. 249).

Orlins’s delightful writing style, combined with a touching look back at the major relationships and events she’s lived through, made this a captivating read. I was sorry to reach the last chapter, and I highly recommend her book to any “worrywart” looking to peek into the mind of a kindred spirit.

Confessions of a Worrywart: Husbands, Lovers, Mothers, and Others
Seneca Books, January, 2013
Paperback, 304 pages
$12.95

However, “people with an anxiety disorder are essentially phobic about the feeling state of anxiety.” And they’ll go to great lengths to avoid it.

Some people experience generalized anxiety disorder (GAD), excessive anxiety about real-life concerns, such as money, relationships, health and academics, he said.

Others struggle with society anxiety, and worry about being evaluated or embarrassing themselves, he said. People with obsessive-compulsive disorder (OCD) might become preoccupied with symmetry or potential contamination, he said.

“The bottom line is that people can experience anxiety, and anxiety disorders, related to just about anything.”

Some people may not struggle with a clinical disorder, but want to manage sporadic (yet intrusive) bouts of anxiety and stress.

Whether you have occasional anxiety or a diagnosable disorder, the good news is that you can take small, effective and straightforward steps every day to manage and minimize your anxiety.

Most of these steps contribute to a healthy and fulfilling life, overall. For instance, “making some basic lifestyle changes can do wonders for someone coping with elevated anxiety,” Corboy said. Below, you’ll find 15 small steps you can take today.

1. Take a deep breath.

“Deep diaphragmatic breathing triggers our relaxation response, switching from our fight-or-flight response of the sympathetic nervous system, to the relaxed, balanced response of our parasympathetic nervous system,” according to Marla Deibler, PsyD, a clinical psychologist, executive director of The Center for Emotional Health of Greater Philadelphia and Psych Central blogger.

She suggested the following exercise, which you can repeat several times: Inhale slowly to a count of four, starting at your belly and then moving into your chest. Gently hold your breath for four counts. Then slowly exhale to four counts.

2. Get active.

“One of the most important things one can do [to cope with anxiety] is to get regular cardiovascular exercise,” Corboy said. For instance, a brisk 30- to 60-minute walk “releases endorphins that lead to a reduction in anxiety.”

You can start today by taking a walk. Or create a list of physical activities that you enjoy, and put them on your schedule for the week. Other options include: running, rowing, rollerblading, hiking, biking, dancing, swimming, surfing, step aerobics, kickboxing and sports such as soccer, tennis and basketball.

3. Sleep well.

Not getting enough sleep can trigger anxiety. If you’re having trouble sleeping, tonight, engage in a relaxing activity before bedtime, such as taking a warm bath, listening to soothing music or taking several deep breaths. (You’ll find more tips here.)

And, if you’re like many people with anxiety whose brains start buzzing right before bed, jot down your worries earlier in the day for 10 to 15 minutes, or try a mental exercise like thinking of fruits with the same letter. (Find more suggestions here.)

4. Challenge an anxious thought.

“We all have moments wherein we unintentionally increase or maintain our own worry by thinking unhelpful thoughts. These thoughts are often unrealistic, inaccurate, or, to some extent, unreasonable,” Deibler said.

Thankfully, we can change these thoughts. The first step is to identify them. Consider how a specific thought affects your feelings and behaviors, Deibler said. Is it helpful or unhelpful?

Unhelpful thoughts usually come in the form of “what ifs,” “all-or-nothing thinking,” or “catastrophizing,” Deibler said. She gave these examples: “What if I make a fool of myself?” “What if I fail this exam?” or “What if this airplane crashes?”

These are the types of thoughts you want to challenge. Deibler suggested asking yourself:

“Is this worry realistic?” “Is this really likely to happen?” “If the worst possible outcome happens, what would be so bad about that?” “Could I handle that?” “What might I do?” “If something bad happens, what might that mean about me?” “Is this really true or does it just seem that way?” “What might I do to prepare for whatever may happen?”

Then, “reframe or correct that thought to make it more accurate, realistic and more adaptive.” Here’s one example: “I would feel embarrassed if I tripped on the stage, but that’s just a feeling; it wouldn’t last forever, and I would get through it.”

5. Say an encouraging statement.

Positive, accurate statements can help to put things into perspective. Deibler gave these examples: “Anxiety is just a feeling, like any other feeling.” and “This feels bad, but I can use some strategies to [cope with] it.”

6. Stay connected to others.

“Social support is vital to managing stress,” Deibler said. Today, call a loved one, schedule a Skype date or go to lunch with a close friend. “Talking with others can do a world of good.” Another option is to get together and engage in an activity that improves your anxiety, such as taking a walk, sitting on the beach or going to a yoga class.

7. Avoid caffeine.

Managing anxiety is as much about what you do as what you don’t do. And there are some substances that exacerbate anxiety. Caffeine is one of those substances. As Corboy said, “The last thing people with anxiety need is a substance that makes them feel more amped up, which is exactly what caffeine does.”

8. Avoid mind-altering substances.

“While drugs and alcohol might help to reduce anxiety in the short term, they often do just the opposite in the long term,” Corboy said. Even the short-term effect can be harmful.

Corboy and his team have treated countless clients whose first panic attack occurred while they were taking drugs such as marijuana, ecstasy or LSD. “Panic attacks are bad enough if you are straight and sober, so imagine how bad they are if you are high, and can’t get un-high until the drug wears off.”

9. Do something you enjoy.

Engaging in enjoyable activities helps to soothe your anxiety. For instance, today, you might take a walk, listen to music or read a book, Deibler said.

10. Take a break.

It’s also helpful to build breaks into your day. As Deibler said, this might be a “simple change of pace or scenery, enjoying a hobby, or switching ‘to-do’ tasks.” “Breaking from concerted effort can be refreshing.”

11. Problem-solve.

Deibler suggested considering how you can address the stressors that are causing your anxiety. Today, make a list of these stressors and next to each one, jot down one or two solutions.

12. Pick up a book.

There are many valuable resources on anxiety, which teach you effective coping skills. Corboy recommended Dying of Embarrassment for people with social anxiety; The BDD Workbook for body dysmorphic disorder; The Imp of the Mind and The OCD Workbook for obsessive-compulsive disorder. Deibler suggested Stop Obsessing for adults with OCD (and Up and Down the Worry Hill for kids with OCD).

For people with panic attacks, she suggested Don’t Panic: Taking Control of Anxiety Attacks. For a general overview of cognitive-behavioral therapy for anxiety, Corboy recommended The Anxiety and Phobia Workbook. He also recommended Get Out of Your Mind and Into Your Life and The Wisdom of No Escape.

(You can find more book recommendations at Corboy’s website.)

13. Engage in calming practices.

According to Corboy, “meditation, yoga, or other calming practices can help minimize anxiety in both the short and long term.” Sign up for a yoga class or watch a yoga video online. (Curvy Yoga is a wonderful resource for yoga for all shapes and sizes.) Meditate right now for just three minutes. (Here’s how.)

14. Contact a therapist.

“Sometimes anxiety can be difficult to manage without professional help,” Deibler said. Many organizations include databases of providers who specialize in anxiety (along with helpful information). She suggested these organizations: www.ocfoundation.org, www.adaa.org and www.abct.org.

15. Accept your anxiety.

“If you really want to effectively manage your anxiety, the key is to accept it,” Corboy said. This might sound counterintuitive. But anxiety, “in and of itself,” isn’t the real problem. Instead, it’s our attempts at controlling and eliminating it, he said. “Not accepting these unwanted inner experiences is the actual source of so much of our self-induced suffering.”

Accepting anxiety doesn’t mean “resign[ing] ourselves to a life of anxious misery. It simply means that we are better off recognizing and fully accepting the existence of anxiety and other uncomfortable emotional states that are inevitable, but transitory,” Corboy said.

So if you experience anxiety today, simply observe it, Deibler said. “Think of it like a wave of the ocean; allow it to come in, experience it, and ride it out.”

Anxiety can feel overwhelming. It can feel like chains around your feet, weighing you down. But by taking small steps – like the ones above – you can minimize your anxiety and cope effectively.

Treatment is warranted when mental illness strikes. It could be as simple as acknowledgement (vs. denial) and getting involved in exercise, support groups, hobbies, anything that noticeably lessens the burden and eases the mind. If the illness is debilitating, ongoing medication or short-term hospitalization might be needed. Study and application of effective behavioral strategies and therapy are middle-ground treatments that can bring needed understanding, relief and coping mechanisms for symptom flare-ups or deeper issues.

The people behind Mental Health First Aid (MHFA), a relatively new program in this country, hope to educate laypeople about mental health concerns. Their focus is relatively simple: training people how to spot acute mental health symptoms in friends, neighbors and colleagues and guide them to treatment. Mental health advocacy also is rolled up in this equation.

My work as vocational coordinator at a psychosocial rehab agency years ago involved finding meaningful work for folks with mental health diagnoses. But due to necessity I had to be an advocate, first, for mental illness. Whether minor depression or schizophrenia, if you are talking to employers, you quickly realize that mental illness needs to be destigmatized in order for any progress to be made.

MHFA’s goal of guiding people to treatment also involves identifying the difference between functional and temporarily nonfunctional states. If only this continuum of real distress could be better understood by a broad public, acute mental health care in this country could be vastly improved, advocacy could be championed, and people would begin to see that true health is more than just physical.

Mental Health First Aid had its beginnings in Australia in 2001. A professor, Tony Jorm, and nurse, Betty Kitchener, created it in affiliation with the University of Melbourne. Studies soon documented its effectiveness in saving lives and improving the mental health of the layperson giving the care and guidance. According to MHFA program material, “just as CPR training helps a layperson without medical training assist an individual following a heart attack, Mental Health First Aid training helps a layperson assist someone experiencing a mental health crisis.”

So successful was this Australian pilot program that other countries followed suit, including the U.S. in 2008, and communities are now offering the training course. Hospital, nursing home and school personnel initially took part. (One might think professionals in these arenas might not need the training, but mental illness often is out of the scope of those who deal with physical illness and trauma.) It’s envisioned that someday the training will be as common as that for cardiopulmonary rehabilitation (CPR).

Typically a 12-hour course over two days, it includes identification of risk factors and “warning signs of mental health problems.” An overview of treatment options is given, including individual information on depression, anxiety, psychosis, substance abuse, and even eating disorders and self-injury.

Integral to MHFA is a five-step action plan regarding skills needed for situation assessment, implementation of appropriate interventions, and connecting the person in distress to available resources on a spectrum of professional, peer, social and self-help. Part of the training reinforces nonjudgmental listening, as well as reassuringly imparting information about available resources in the gentlest, yet most effective manner.

An excellent video of a MHFA role-play can be found on the national website. Two individuals are seen acting out dialogue as if neighbors talking on a porch. The man raps on the door of a woman who he feels has not been doing well. He asks nonthreatening questions in a soothing, helpful manner, and asks her to come out on the porch to talk to him. His words seem comforting and he acknowledges that her feelings (which seem to be paranoiac) must be very scary. He suggests a call to the crisis team, to come and simply talk to her. He says, tellingly, “If I were this upset, wouldn’t you want to help me?” The role-play comes to a good conclusion and the actors reflect, for the camera audience, on what went well.

Mike Gruber is just one of many professionals teaching MHFA in Allegheny County, Penn. Quoting a Pittsburgh City Paper reporter in a recent article, Gruber feels that what is the experiential approach of MHFA makes it “more effective at reducing stigma than would a public-awareness campaign.”

The National Council for Community Behavioral Healthcare is asking for the public to sign, on their website, letters of support for MHFA legislation. (Staffer Meena Dayak is available to answer related questions.) H.R. 274 would authorize $20 million for the program in 2014. One of three templates to congressional leaders mentions that MHFA was endorsed as a best practice for state and local governments, and this is indeed the direction that the National Council would like to gain momentum in, according to the organization, striving for training across as many local communities as possible in the U.S.

To find MHFA near you, visit this website