‘Too much’ anxiety

If there’s an emotion that people most commonly have too much of, it’s anxiety. There are

various ways that too much anxiety can wreck people’s lives. For example, anxiety sits at the

heart of numerous mental health problems, including panic attacks, social anxiety, obsessive-

compulsive disorder (OCD), phobias (e.g. of dogs, spiders, heights, and so forth) and post-

traumatic stress disorder (PTSD). In fact, it’s estimated that during any single year, between

10 and 21 per cent of people will meet the criteria for an anxiety-related diagnosis (Bandelow

& Michaelis, 2015). But anxiety doesn’t have to be in the form of a diagnosed mental health

difficulty to cause problems. Anxiety can prevent us from asking someone that we like out on

a date, or picking up the phone and arranging to go for a meal with a friend, or applying for

that new job that we are interested in. Anxiety can get in the way of doing things we might

enjoy or benefit from (e.g. socialising, engaging in an activity, travelling, and learning), or

from taking full advantage of what we’re good at and might bring meaning in life (e.g. going

for a promotion or starting a new hobby).

Of course, as we outlined in Chapter 2 of the book, all our emotions evolved to serve

important functions, and we need to hold in mind why we experience anxiety and fear. From

an evolutionary point of view, fear and anxiety emerged in the context of an actual or perceived

threat. Initially, like other animals, it is likely that these threats were linked to predation (the

danger of being eaten), or about others taking things of value to us (e.g. territory, food, sexual

opportunities). However, with the emergence of our new brain competencies for planning,

rumination, worry and imagination (Chapter 3), it’s likely we started to experience anxiety

about an increasing number of things. In a sense, the same abilities that led to cures for

illnesses, tests to explore our genome, and machines to scan inside our heads, could also focus

on the fragility of our health and life. Our awareness and imagination gave rise to the reality of
getting ill and dying, and of this happening to our children and loved ones. They also led to the

ability to monitoring changes in our body, and form narrative about this. For example, pain in

our chest can become a heart attack (rather than indigestion), or the appearance of a brown or

reddish blemish on our skin after lots of sun exposure can become skin cancer (rather than a

benign rash). It is here that these same new brain abilities for self-monitoring, imagination and

so on can take these bodily experiences, and magnify them in such a way that we can become

vulnerable to anxiety. Let’s look at an example.

Shanice came to therapy one morning describing herself as ‘a mess’. Although she lived

a short bus ride away from my office, it had taken her three hours that morning preparing for

the journey. She described imagining that she would have a panic attack once she was outside

her flat, and that felt so scary that it prevented her from leaving. She went on to tell me how

her life was currently wracked by anxiety and panic; how she spent hours in the day worrying

about the next time she had to leave her home; how it sometimes took over an hour to open the

door just to head to the supermarket, and the struggle to sleep at night. She worked as a team

leader for a successful local business, and previously enjoyed an active social and creative life

outside of work until six months ago. On the way to work one day she was involved in a serious

car accident and was trapped inside her car for two hours fearing she might die, before being

cut free. Since then, Shanice described initially avoiding being in cars, then buses and finally,

the tube. She tried to walk to places at first but, over time, she found it increasingly difficult to

go out of the house altogether. She had been signed off from work for the past three months,

had stopped seeing her friends and stopped engaging in any activities that involved getting out

of the house since the crash. Understandably, Shanice was feeling very distressed, low in mood

and worried that she would never ‘get better’ again. We’ll use Shanice and her situation as a

way of exploring ways that we can turn towards anxiety and fears, and develop the courage

and wisdom to tolerate and even reduce these, if we can.

How do you know if you’re experiencing too much anxiety?

As with any emotion, this is a difficult question to answer in isolation, as it depends on many

factors. High levels of anxiety at one time (e.g. admission to hospital for a week of tests after

recent chest pain) may be quite different from anxious worry about whether chest pain may

turn up again, two years after being discharged from hospital following tests after chest pain,

but with no current symptoms. However, some of the following can be useful questions and

prompts in reflecting on this:

• I feel anxiety is too easily triggered in me

• I seem to get anxious in many different situations, and more than other people seem to

be

• I am frequently anxious

• When I get anxious, it tends to last for a long time

• When I become anxious, it tends to be at an intense level that prevents me from living

life in the way I’d like to

• When I get anxious, I don’t feel that I’m in control of my feelings or actions

• What I get anxious, this tends to have negative consequences on my life, or on other

people

• When I get anxious, it tends to take a long time to settle down again

• After settling from anxiety, I often feel that my feelings or reactions may have been

misplaced, or disproportionate to the situation

• Other people tell me I’m an anxious person

It’s worth taking some time to reflect on this, and make a few notes if that’s helpful. If there

were a number of items that were descriptive of how things are for you, it might be worthwhile

spending some time reading through the rest of this chapter.

When we looked at these questions with Shanice, she recognised that anxiety was

featuring too frequently and powerfully, and she didn’t feel she had much control over anxiety

across many of these domains. It was also having a distressing impact on her career and social

life.

‘Too much’ anxiety: what can help?

There are a number of steps that we can take to start working with anxiety. First up, it’s useful

to check back on the emotion regulation model (ERM) that we’ve been working on throughout

the book (see Section IV, Chapters 12 to 16). When looking through this, see if you can locate

at which of the five steps of the emotion regulation model you struggle when it comes to

anxiety.
 EMOTION REGULATION MODEL (ERM)
– ‘TOO MUCH’ ANXIETY
Less Helpful More Helpful
Little or no awareness or Awareness of situation and
Awareness of
ability to modify situation that triggers of anxiety, and some
Triggers
triggers anxiety ability to modify these

Unaware, cut off, dissociated Awareness of Awareness of anxiety (e.g.

or hyperaware of anxiety Anxiety body/physiology) and impulse

Unable to discriminate between Can discriminate between

anxiety & other emotions Labeling of anxiety & other emotions/blends
Unable to describe, put words to Anxiety Can put words to, describe and
or verbalise anxiety verbalise anxiety

Invalidate Can validate anxiety

Understand
Unable to mentalize Can mentalize
Can’t evaluate appropriateness Anxiety Can evaluate appropriateness
Unaware of what maintains Aware of what maintains

Avoid, block or suppress Tolerate & Accept

Unable to modify emotion Coping with Can modify - down/up regulate
Emotion about emotion & using Can use & express anxiety
Self-criticise, Ruminate, Worry Anxiety Mindfulness & Compassion

When Shanice did this, she recognised that she struggled most with stages 4 (understanding

emotions) and 5 (coping with and using emotions). She described frequently invalidating her

anxious feelings, and struggled to understand why she was feeling as she did (for example,

appreciating the impact the car accident had had on her life). She also described how

challenging it was to cope with anxiety, and realised that she was often engaged in a struggle

or fight with it – trying to suppress and block it, or alternatively, engaged in a lot of worries in

an attempt to circumnavigate the likelihood of experiencing feared outcomes.

Depending on which of the five steps of the emotion regulation model you struggle

with most when it comes to anxiety, it can be useful to spend some time on the chapter (or

chapters) in Section IV (Chapters 12 to 16) that correspond to building skills at that stage of

the model. So, as you work through the chapter(s), use the examples and practices in them, but

apply them to the difficulties you have with anxiety.

 Once you've taken your time to do this, there are some specific steps that you can

engage into work with high levels of anxiety. Some of this overlaps somewhat with stages of

the emotion regulation model, but these are more focused on helping you to work with

problematic anxiety.

Step 1: Motivation to face anxiety

It’s fair to say that anxiety can be a highly unpleasant, painful and, at times, overwhelming

emotion to experience. Given this, it can be useful to start with tapping into your motivation

for why it’s important for you to turn towards anxiety, and try and manage it in a different way.

Remember, this is not about getting rid of anxiety, but rather, the compassionate motivation to

approach and tolerate it, and find ways to bring wise change to it (or your responses to it) over

time.

Let’s explore this with an exercise:

Exercise: Approaching anxiety – focusing on compassionate motivation

Let’s start here by building your intention to treat your anxiety compassionately and non-

critically. Take a few moments to sit in an upright, confident position in the chair, allowing

your shoulders to open up a little, and bringing a friendly expression to your face. When you

feel ready, engage with your soothing rhythm breathing, helping your body to slow down a

little. When you feel ready, bring to mind the qualities of your compassionate self – wisdom,

strength and caring commitment. Spend a short time feeling your way into this version of

you. From this part of you, take some time to think through each of the following questions,

making notes on a separate piece of paper if that helps:

• If you weren’t struggling with such high levels of fear and anxiety, what would you

be able to do instead?
 • Given the wisdom of your compassionate self, why is it important to bring change to

anxiety? How would life be richer for doing so? How would you benefit from facing

things you feel anxious about?

• What problems do you envisage in facing the things that make you feel anxious?

• What might get in the way of being able to tolerate high levels of anxiety? What can

you do to support yourself with this?

• If you had your compassionate self by your side, how might that help you to tolerate

anxiety?

If it’s helpful, make a few notes on the responses to these questions. Try to hold on to your

intention here – the ‘why’ beneath your attempts to work with your anxiety – as this is likely

to be useful in both guiding the following steps below, and helping you if you experience

setbacks or difficulties on the way.

Step 2: Understanding what anxiety might be protecting me from

One way to explore the role anxiety is playing in your life is to look to see if it’s serving certain

functions. Take a moment to consider the following questions:

• What would your concern or fear be if you were to lose or let go of anxiety?

• If anxiety was to settle, or you didn’t experience it so intensely, what concerns arise for

you?

• Can you imagine any negative consequences if anxiety was less intense for you?

• Do you have any concerns about how other people (or things in the world) could hurt

you if you were less anxious?

• Do you have any concerns about other emotions showing up in its place, if anxiety was

less frequent or intense?

 When Shanice thought about this, her concern was that without anxiety, she would be

unaware of danger – that she would miss the car speeding towards her, or not notice the ‘dodgy’

person on the street who might mug her. It was with this realisation that she began to recognise

that anxiety was serving to try and protect her, and in that sense, it was unsurprising that she

was ambivalent about trying to change it. For other people, there can be a concern that if they

don’t hold on to anxiety, they’ll make mistakes or say something ‘stupid’ that would then bring

criticism or rejection from other people, or that if they were less anxious, another emotion (for

example, anger) would show up in its place, and cause problems.

Take some time to think about this. Sometimes it’s helpful to imagine yourself on a

usual day, but without anxiety being present, and then imagine what your threat system might

begin to focus upon. Not everyone will find something ‘underneath' anxiety, and if this is the

case, feel free to move on to Step 3. But for those of you reading who did recognise fear of

letting go of anxiety, it can be useful to use your compassionate mind to help with this:

Exercise: Fears of letting go of anxiety

Sit in an upright position, and engage in your soothing rhythm breathing and friendly facial

expression. Allow your breathing to slow down, and gently rest your attention on its flow.

When you feel ready, bridge into your compassionate self and its qualities of wisdom,

strength and commitment. Allow yourself to embody these qualities – notice your facial

expressions, body posture and compassionate intent. When you feel connected with your

compassionate self, consider the following questions:

• Given your concern or fear about what might emerge if you were no longer anxious,

how can you understand what anxiety gives you? What are the positive or protective

aspects of anxiety?
 • When did anxiety learn to protect you in this way?

• Given the protective role that it may play for you, can you validate or have empathy

for why trying to turn towards and bring change to anxiety might be understandably

difficult?

• How could you bring wisdom, strength and caring commitment to what might

emerge if anxiety were to reduce? What would the thing that sits behind anxiety need

so that you’d feel less on edge about this?

If it’s helpful, make a few notes about your responses to these questions. Following this, it may

be useful to return to the following sections of the main book to explore these ideas further:

• Chapter 15 – understanding emotions (‘what maintains difficult emotions’)

• Chapter 19 – compassionate letter writing (so writing a letter about the fear of what

might emerge if anxiety was no longer in your life)

Step 3: Identifying anxiety triggers and avoidance

The next step on our journey involves learning about the things that cause us to be anxious.

Like a doctor running tests to help with a diagnosis, it’s likely that if we can identify things

that trigger us into anxiety, we might then be able to do something about this. But it’s not just

the triggers to anxiety that are important here – it’s also useful to learn about the strategies we

engage in to avoid feeling anxious, as these also play an important role in maintaining these

feelings.

In terms of triggers to anxiety, grab a piece of paper or take out your smartphone, and

make a few notes of the types of situations that commonly trigger anxiety for you. This could

be speaking to people, going to a party, saying no to family or friends, giving a presentation or

using certain forms of transport. Here’s what Shanice noted:

 Common triggers to my anxiety:

1. Cars

2. Public transport

3. Roads

4. Going outside my home

Anxiety, like any of our emotions, can also be made worse by the way we think about

it. For example, anticipating and worrying that we might have a panic attack brings greater

attention to monitoring our body, noticing any small changes in breathing or physical state that

might be a sign that we are going to panic. This in turn, then makes it more likely that we do

have a panic attack. So how our ‘new brain’ gets in on the act can have an important role in

triggering difficult emotions like anxiety, and it’s quite easy for us to get caught up in loops

(see Chapter 3, and Chapter 20 on working with thinking for difficult emotions).

Once you’ve noted down a few triggers to your anxiety, it’s useful to then identify how

you manage these situations, and your feelings of anxiety. One of the tricky aspects of anxiety

is how we can get harassed by our own anxiety – a type of ‘anxious about our anxiety’

experience. Under these circumstances, it’s common for people to avoid things they feel

anxious about. Now on one level, it’s vital for anxiety to guide us to avoid certain dangers, and

in fact, this is crucial for our survival. The problem often arises when we start avoiding things

that we need to do, such as using public transport (e.g. bus, train, tube) to get to work, public

speaking (e.g. in your role at work) or socialising with friends. While it’s understandable to

want to stay away from things that cause anxious feelings, doing so can stop us from engaging

in life, and disconnect us from activities that are pleasurable and meaningful.

Avoidance comes in many shapes and forms. We can physically avoid something that

is anxiety provoking – such as not going to parties, not doing public speaking, or keeping

distance from dogs. We can also mentally avoid something we’re scared of, such as trying not
to think about something we’re fearful of, blocking out certain thoughts, images or memories,

or distracting ourselves (e.g. through work, the internet). We can also try to avoid anxiety by

‘numbing’ it – for example, by using alcohol or drugs, or trying to feel ‘happy’ instead. There’s

a famous psychology experiment in which you’re instructed not to think about a pink elephant.

So, you have to try really hard not to think about this elephant, and how pink it is. What we

find is that when people try not to think about something, a phenomenon called the bounce

back effect occurs – the more you try not to think about something, the more likely you end up

actually thinking about it. So, although it’s a challenging message, avoiding things that make

us anxious often makes anxiety worse, and part of the compassionate approach here is to help

you learn how to tolerate anxiety so that you no longer need to engage in ways of avoiding it.

Let’s take some time to think about how you might use avoidance to shield yourself

from anxiety.

Exercise: What do I tend to avoid?

To start with, spend some time thinking about the things or situations that trigger high levels

of anxiety in you (e.g. certain emotions, memories, people, places or situations).

Shanice’s answer: ‘I avoid situations where I have to use transport, or be close to cars

or roads.’

Are these things external to you (e.g. people or certain situations, such as public speaking or

meetings), or internal (e.g. certain emotions or feelings, memories or urges)?

Shanice’s answer: ‘They’re mostly outside of me linked to roads and transport, but I

guess I do avoid thinking about these things and try and not let myself feel anxious.’

How do you try and protect yourself from the things you fear? What are your safety or

avoidance strategies?
 Shanice’s answer: ‘I stay at home as often as I can. If I have to go out for something, I

take medication to block my feelings, or sometimes drink alcohol first.’

What are you afraid might happen if you don’t engage in your safety behaviours/avoidance?

Shanice’s answer: ‘I think I’ll have a panic attack and collapse on the floor. I’m scared

I might die or feel trapped and unable to escape.’

Step 4: Identifying a hierarchy of fears

Once we’ve identified how we avoid things that cause us anxiety, we can work on taking steps

towards change. Let’s think about how we're going to do this. To start with, remind yourself

about what you wrote earlier in the chapter about the things you avoid in life and would like to

bring change to. Now we're going to find ways to help ourselves relearn and adjust our fears

by breaking this down into smaller steps or stages. For example, given Shanice's fears and

pattern of avoidance, she created a list of gradual steps, from the easiest task (opening her front

door) to the most difficult and scary one (driving in a car).

Shanice’s feared situations

1. Opening my front door

2. Walking on the street

3. Seeing cars, buses or public transport

4. Travelling on a bus

5. Getting in a car

6. Driving in a car
She took her time to engage in and practise each step, allowing feelings of anxiety to be present

rather than blocking them out or avoiding the situation altogether. Over many weeks, she

gradually worked her way up to being able to use transport again. With each step, she used her

compassionate mind training skills to deal with anxiety as it emerged, allowing her to tolerate

the feeling. This, over time, helped her to see that after a while, her anxiety decreased and she

was less affected by the situation.

Similar to Shanice, spend some time identifying some of the steps you might need to

engage in to face something that causes you a lot of anxiety. If you can start with those things

that are easier, building up to the most difficult, or anxiety-provoking situation.

List of anxiety-provoking situations I want to face

Activity

Now that we have an outline of some of the specific anxiety-inducing situations you are

struggling with, it can be helpful to look at how we can engage in this using our compassionate

mind.
Step 5: Imaginal exposure

Our next step involves helping you to move towards and learn how to tolerate anxiety. A

common thread to most, if not all, psychological treatments to help with anxiety is exposure.

Exposure is a type of therapeutic intervention that involves helping people to get into contact

with avoided situations or experiences that cause them fear and anxiety, and doing this in a

way that allows the person relearn that what they fear is not as scary or overwhelming as they

currently feel it is. Essentially, what is learnt (e.g. in Shanice’s case, anxiety about cars) can be

unlearnt.

Before you start to face your fears in ‘real’ life, it can be helpful to work gradually

through your list of fears developed in the previous steps by using your imagination. This is

often referred to as imaginal exposure. As we discovered in Chapter 9, our imagination has a

powerful effect on our physiology. So, using images of the things that we find anxiety-

provoking can be a useful way to turn towards and tolerate anxiety, before facing them in ‘real’

life. Let’s see how we can practise this, starting off with the least anxiety-provoking situation

on your list.

Exercise: Using imagery to help me gradually face my fears

Sit in an upright position, and engage in your soothing rhythm breathing and friendly facial

expression. Allow your breathing to slow a little, and gently rest your attention in the flow

of breathing in, and breathing out. When you feel ready, bridge into your compassionate self

and its qualities of wisdom, strength and caring-commitment. Allow yourself to embody

these qualities – notice your facial expressions, body posture and compassionate intent.

As your compassionate self, imagine engaging in the least anxiety-provoking

situation on your list. Imagine yourself in the situation, engaging in the behaviour that you

find challenging and anxiety-inducing, from the part of you that is strong, wise and has a
 caring commitment to engage in things that are beneficial for you. Notice if your threat

system kicks in as you’re engaging in this imagery. If this happens, remember that your

compassionate self is strong, confident and wise, and can tolerate this feeling. Tap back into

the bodily sense of your compassionate self – your body posture, facial expression and voice

tone. Use your soothing breathing and body posture to ground yourself, or bring to mind a

helpful person who would be supportive and encouraging to you in this situation, before

returning to the scenario in your mind’s eye. Take your time being with this image, allowing

yourself to become acclimatised to it, and to your anxiety. Once you have finished taking

this imaginary journey as your compassionate self, return to your soothing breathing. If you

want, you can spend some time in the soothing rhythm of your breath, before you let the

image fade.

How did you get on with this exercise? How strong was your threat response throughout, and

did it change as time progressed? How did your compassionate self help you work through

this? If it helps, take a few minutes to make some notes on this.

When people practise this type of imaginal exposure, they often find that over time,

their anxiety begins to reduce. Given this, it’s important to spend time repeating the imaginal

exposure exercise for the same anxiety-provoking situation a number of times, until you find

that the level of anxiety you experience starts to drop. We want you to get used to being in the

presence of your threat system in a different way, learning that you can tolerate it, and not have

to engage in protective behaviours such as avoidance.

A common response – or concern – at this stage is ‘this isn’t real’. While this is of

course true, as we mentioned earlier in the book (Chapter 9), imagined scenarios can generate

similar emotional experiences as ‘real’ ones (if you remember, we used the example of sex –

whether you’re actually with someone you find sexually attractive, or just imagine someone
you find attractive, your body gets aroused in the same way). In this sense, imagery is a useful

vehicle through which we can begin the process of regulating anxiety.

Step 6: Real life exposure

While imagery is a powerful and helpful way of approaching things that are anxiety-provoking,

it isn’t a substitute for engaging in these things in real life. Exposing ourselves systematically

to things that we are frightened of is a common approach in behavioural therapies, and has

been found to be a very effective way of reducing anxiety (Ougrin, 2011). To start here, take

another look at the list that you developed in Step 4, and check if you need to break some of

the difficulties down further into smaller steps. With this in mind, take some time to consider

what you can do to approach the first step on your hierarchy. Each of us will have differences

here. If you fear heights, your first exposure exercise may be to go to the first floor of a building

and look out of the window, before moving to the second floor. If you have a phobia of public

speaking, the first step might be to speak in front of a friend or family member, before moving

on to a small group of friends, and so on.

There are some useful points to hold in mind when exposing yourself to things that

cause you anxiety. First up, it’s important to do the exposure without distracting yourself (e.g.

by watching something on your mobile phone or closing your eyes) from whatever is causing

the anxiety, as this is another type of avoidance and tells your brain that there is still something

to be feared . Second, it’s crucial to try and ‘stay with’ the feeling of anxiety long enough for

it to begin to reduce. Just getting into contact with it briefly, and then pulling back, is only

likely to add to the difficulties around the feared situation. Finally, it’s important to repeat the

process on numerous occasions, so that your body and mind can fully cement the process of

desensitising to the feared object or situation. The key thing here is to do things that are

‘challenging, but not overwhelming’ (Dryden, 1985), so pushing to the edge of your ability
and tolerance, but not over that line where you get overwhelmed and shut down by your threat

system.

Once you’ve got a clear idea about the first step of your exposure hierarchy, it’s now

time to put this into action. To help you with this, we’ll turn again to your compassionate self

– and its qualities of wisdom, commitment and strength.

Exercise: Engaging in compassionate action

Looking back to your list in Step 4 above, take the least threatening/anxiety provoking situation

on your list, and then plan for a time that you can engage in/face this difficulty.

Before facing this step, see if you can take a moment to step into your compassionate

self, the part of you that is wise, strong and committed. Consider what you might need or what

would help you to engage in what you’re frightened of. For example, sometimes it’s useful to

talk to a friend or ask them to come along with you on your first try out. When Shanice got to

the step of trying to get on a bus, she asked her friend Christina to come with her. They

discussed this beforehand and decided it would be most helpful for Christina to get on the bus

after Shanice, and sit in a different seat. This ‘hanging in the background’ proved to be very

helpful, and after the first time, Shanice went on to practise getting on buses on her own.

So, once you’ve thought about the step you’re going to take, it’s back to getting in touch

with that strong, supportive part of yourself – your compassionate self – and using this to help

you engage with the exposure task! Again, remember your wisdom here, taking this step by

step, ‘challenging but not overwhelming’, giving yourself the time to develop courage by doing

this in a step-by-step way. Remember, the aim here is not to expect to be anxiety free while

engaging in this difficulty – it’s likely that you will feel anxious while doing it. Rather, it’s

about learning that you can feel the anxiety without shutting down, avoiding, or trying to block

it out.
 It’s usually helpful to practise this first step (and subsequently, each of the other steps)

a number of times. For example, Shanice practised her first step (opening the front door and

standing looking out to the street) twice a day for a week. She noticed that as the week went

on, her anxiety dropped (she initially rated it 90 out of 100 in intensity), so that by the last

couple of days, she only felt mildly tense (and gave a rating of 20/100). Sometimes using a

rating scale to describe the intensity of anxiety can be helpful, and can help to track progress

through doing exposure work.

With each step that you take remember first to spend time bringing your compassionate

mind ‘online’ to encourage you to face and continue to work on each step. Take time to work

through your listed steps gradually, persevering with the support of your compassionate self.

Try to give yourself credit for what you are able to do, even if you feel this didn’t go perfectly.

If you do notice setbacks and difficulties, it’s useful to move to the next step.

Step 7: Dealing with setbacks

When working on exposure like this, it’s common that we’ll experience setbacks. When

Shanice first attempted to get on a bus, she froze up and quickly had to get off it before the

doors even closed. She noticed that her self-critical voice started to kick in – ‘you’re so weak!

How are you even going to get in a car again if you can’t step on a bus?!’ Like Shanice, if we

make attempts to engage in a behaviour or action that brings a lot of anxiety, but then feel

overwhelmed and unable to do this (or feel like we have failed in some way), it can be easy for

our threat minds to take this experience and double down on it. For example, we can paint

pictures in our mind of the hopelessness of the situation, how things won’t change, and that

we’ll always be ‘stuck’ feeling overwhelmed and scared. It’s understandable that facing

something for the first time might be hard, and that the inner critic will show up in these
situations. However, it’s at these times, when you are struggling not only with the behaviour

itself but with your critical mind too, that we really need compassion, and where your

compassionate mind can really come into its own. Here it can be useful to turn back to the

skills you developed in Sections III and IV of the book, stepping out of a threat-based,

invalidating mind state, and into a supportive, encouraging one in which we recognise that

setbacks are part of life, and are likely to be an inevitable part of doing exposure work. Here’s

an exercise to try if this is the case:

Exercise: Compassionately dealing with setbacks

Spend a few moments engaging in your upright, confident body posture, soothing breathing

and friendly facial expression. After a couple of minutes, begin to connect with the wisdom,

strength and caring commitment of your compassionate self (or your compassionate other, if

you prefer). Take enough time to feel your way into this. From this perspective, turn towards

the setback and consider the following:

• Try to be aware and notice the feeling you’re having that is linked to the setback/sense

that the exposure task didn’t progress in the way you wanted (e.g. disappointment,

shame, anger)

• Try and validate and bring empathy to this – how it’s understandable to feel distressed

following a setback, and that difficult emotions are common when we’ve been blocked

to or thwarted from achieving something. If it helps, return to Chapter 15 of the book

to remind yourself of how to validate and bring empathy to this.

• Consider what would help you going forward. What can you learn from this? What

would help you next time?

 • Try to recall your compassionate motivation – why was it important to try to change

things in the first place? Can you hold in mind that in doing many things (e.g. learning

a new language, musical instrument or technical skill) there will inevitably be setbacks,

but that this doesn't mean failure, but rather just a natural part of the process?

It can also be useful here to look into the nature of setbacks themselves. As Winston

Churchill suggested, ‘Success consists of going from failure to failure without loss of

enthusiasm’ and ‘Success is not final, failure is not fatal: it is the courage to continue that

counts.’ Although not easy – particularly as it often triggers our threat system and shuts down

our drive system – when we use our compassionate mind to look at them we may find that

there is something precious about setbacks. When we can tolerate setbacks with strength and

courage, and take a caring approach towards ourselves, wisdom can often emerge – an

understanding about why we weren’t successful in our endeavour, which can help to unearth

insights into what we can do differently next time.

Assertiveness training

One of the other common difficulties with high levels of anxiety can be our struggle to engage

in assertive communication and action. One way of looking at this is that if we struggle to be

assertive, it’s like we’re trying to move around with our eyes closed. So rather than drawing

upon all our senses, we are restricted in how we navigate the world. Similarly, if we struggle

with high levels of anxiety and are non-assertive, it’s likely that many things in life will become

more difficult. So, learning how to be assertive, how to get needs met and interact with the

world from a strong, grounded and confident position, can help reduce anxiety. We explored

developing skills in this area in Chapter 16c. So, if you feel developing your assertiveness

skills, take some time to re-read that section of the book.

Key reflections

• Anxiety and fear are central to our survival – they helped our ancestors to be vigilant

to danger and respond quickly by avoiding or fleeing from things that could be harmful

• Anxiety can become ‘tagged’ to various experiences in life, and become detached from

what is appropriate – it can leave us feeling that there is a ‘lion in the room’ with

situations that don’t involve lions!

• Compassion for high levels of anxiety involves learning how to understand why anxiety

is tricky, and bringing strength and commitment to helping our brains ‘relearn’ what

we need to fear in order to survive, and what we don’t

• Compassion for managing ‘too much’ anxiety involves turning towards things that

make us anxious, and learning to tolerate these feelings so that we can live life as we

want to