Last issue, we said that to address chronic worrying, we address it at three levels: the physical stress reactions, risk assessment and worry exposure, and worry behavior prevention. Let us start with managing stress reactions.

Chronic worrying creates chronic muscular tension. It is very important that you learn relaxation techniques and practice them daily so that you can provide crucial breaks in the cycle of flight/fight reactions that worry causes. 

Take the time once a day to perform full Progressive Muscle Relaxation (PMR). It is a relaxation technique that involves tensing and relaxing all the various muscle groups in your body in a specific sequence. Follow these instructions to do it.  

1. Make tight fists while flexing your biceps and forearms in an Atlas pose, yes like you are joining the Mr. Universe. Tighten the muscles slowly for 7 seconds and then release slowly relaxing them for 20 seconds. 
2. Press your head back as far as you can. Roll it clockwise in a complete circle, then roll it once counterclockwise. As you do this, wrinkle up your face as though you were trying to make every part of it meet at your nose. Then relax them. Now tense your jaw and your throat muscles and hunch your shoulders up. Hold this position, then relax. 
3. Gently arch your back as you take a deep breath. Hold this position, then relax. Take another deep breath, and this time push your abdomen out as you inhale. Then relax. 
4. Point your toes up towards your face while tightening your calf and shin muscles. Hold the position, then relax. Now curl your toes while tightening your calf, thigh and buttock muscles. Hold this position then relax. 

There are some other relaxation techniques. The key is to practice them daily, do not skip or shorten them not until it becomes second nature to you. 

To address the cognitive features of worry, you need to do risk assessment and worry exposure. Perhaps you always worry because you have not learned the skill and art of risk assessment. No one can escape risks. The trick is to know which risks you can avoid, which you should prepare for, and which simply you don’t have to worry about. 

People who worry a lot consistently overestimate risk. And this happens because of some combination of experience and belief. Even if nothing bad happens, some people ignore historical evidence and continue to worry. Others experience a traumatic event and they give too much weight to it and believe that it might happen again. 

Deeply held, unexamined beliefs can make worry worse. You might predict outcomes based on these beliefs. You might think that things happen because you keep on thinking about them, or it can be the opposite, things do not happen because you keep on thinking about them and therefore prevent things from occurring. Either way, they are not healthy. 

What about worry exposure? Here are some steps. List your worries. All of them. And then rank your worries, from least to worst. And then apply relaxation technique. Then visualize a worry, vividly imagine them as you listed them from least to worst. Stick with it, do not think of any alternative scenario. Do this for 25 minutes. Rate your anxiety from 0-100. Then imagine alternative outcomes. Rerate your anxiety from 0-100 after imagining another scenario. And then repeat the visualization until your anxiety rating gets to about 25.  

Worry behavior prevention involves checking on behaviors that you habitually perform to keep bad things from happening. These rituals may be perpetuating worry. Here are some steps to do. Record your worry behavior. Let us say, you are afraid of social disapproval that is why you always come too early in appointments or parties. List some more behaviors surrounding this scenario.

And then pick the easiest behavior to stop and predict consequences of stopping it. Stop the easiest behavior and replace it with a new behavior. All this time, assess your level of anxiety from 0-100. Repeat the process until you get to the other behaviors that perpetuate your worry.

I understand that this might be a handful but knowing and applying these techniques have been found out to be very effective and productive. These are routine practices that are used by clinicians as part of Cognitive Behavioral Therapy to address worrying and other anxiety disorders. 

If you like to get some more detailed guidelines to assist you in these exercises, email me at kitbalane@boholchild.com.