Five steps to happiness

    9 May 2015

    Like Christmas, Eurovision and tube strikes, it happens too often — a phone call that begins: ‘Hi Patrick. [Name] is having an anxiety meltdown. He/she is off work, not functioning, and I’m really worried. Would you speak to them?’

    And I do. People come to me because for ten years panic attacks stalked me, strangled me. My twenties were a write-off. After I was brutally attacked in my home by burglars, everything was danger, my brain vibrated. I gasped, hysterical. I needed drugs. I was addicted to sleeping pills. I needed help. Nothing worked.

    But then, after trying every treatment and medication imaginable, I recovered. The lunacy was over. I may never quite grace the cover of Sanity Fair, but the beast was tamed. My friends and family know this. So, now, I’m the expert with no qualifications except bitter experience, the go-to for those special moments when you can no longer leave the house without ringing for an ambulance. This, then, is your cut-out-and-keep guide to giving anxiety the middle finger. Tape it to the fridge.

    According to Anxiety UK, a tenth of us will be, at some point, disabled by an anxiety disorder. Many more stagger on unaided, quietly convinced that they are going mad and about to die. There are, in the broadest, commonest terms, two types of anxiety problem: generalised anxiety disorder, where the sufferer is regularly or constantly plagued by fear in various forms; and panic disorder, where dramatic, sometimes hysterical anxiety attacks beset the sufferer, typically causing hyperventilation, palpitations, shaking and sometimes even vomiting.

    The Nice treatment guidelines recommend antidepressants, sedatives and group or individual psychotherapy for these conditions. I have no real truck with this — what is available on the NHS is not enough. Recovery demands panoramic action. No single drug or treatment or life change will soothe your crazed soul. (And if anyone tells you to go to a support group for ‘anxiety management’, ignore them. You do not learn to be calm by sitting with a dozen people who live in constant terror.)

    Instead, draw a chart and divide it into five sections with five headings, enact everything under each five, and you will be sane again. Probably. But before we embark on this sanity pentagon, there is a crucial issue to grasp. Take yourself back to a recent anxious state: how does it feel? Like being invaded by a grotesque fear poison — an alien inhabiting you and making you horrifically on edge? Yes, of course it does. Anxiety’s greatest trick is to convince you it’s happening to you. It isn’t — you’re doing it. Yes, you. Sorry.

    The single most important step in conquering the madness is to understand your role in it. If this sounds like I’m blaming you, you’re even more determined to be a victim than I was. Being a victim of your anxiety will not help you. Believing it’s just happening to you, like flu, will ensure it continues. Instead, you must accept that your every response to the initial sensation of fear that you’re currently involved in is exacerbating it.

    But the great thing is, you can do something else. Starting to hyperventilate? Well, despite what you might think, you can deliberately slow your breathing down, sending potent messages to your brain that in fact there is no impending danger. Telling yourself, ‘I’m having a heart attack, I’m terrified, I’m dying’? Tell yourself something else: ‘This is just silly anxiety. I’m fine. I will do calm instead.’

    Every single response to fear can be countered. But you have to accept fully that you are doing (it really is an action), and you can do something else. The reason this takes a lot of practice is because our mind and body are wired to respond dramatically to fear, for self-preservation. Flight, fight or freeze reactions kept us from being eaten. Now they stop us going into Sainsbury’s or the tube, as ‘That’s where it happens.’ No, that’s where you’ve learnt to do it.

    The first section in our chart is (1)therapy. Again, I apologise if this is not what you want to hear, but you need it. You wouldn’t learn to fly a helicopter all by yourself, so how do you think you’re going to learn to be sane by yourself? There are two main approaches to consider. The first is the cognitive treatments, which examine your thought processes, how they create anxiety, and what you can do to intercept and change them. You will learn how you became a master of madness and, in turn, how to kick it in the gut. There is, of course, cognitive behavioural therapy (CBT), loved by Nice, the NHS and researchers alike, as it proves effective again and again, quickly, and thus cheaply. Find someone with specific training in CBT — your GP can refer you.

    The other approach is something called the Lightning Process. I am aware this sounds like some dreadful hippy shamanic ritual. But it is not. This three-day course saves people by teaching them how to think differently, more healthily. It deploys some aspects of CBT while combining it with all sorts of other techniques, including visualisations, neurolinguistic programming (NLP) and hypnotherapy. A kind of 3D CBT. It was this that made me realise — ten years into anxiety — that I had a choice, that I could do and be something else.

    The other approach is to go deeper, to look at your past and your subconscious, to understand how you got into this state. With psychodynamic psychotherapy or psychoanalysis, or just counselling, you can start to understand who taught you to be anxious. Because someone did.

    The second column is even more hippyish. I’m not going to apologise again; you will thank me in the end. So: try (2) yoga. Try pilates. They will at least have some effect. More useful, I suggest, is meditation, mindfulness and breathing techniques. Personally, I favour a method called Transformational Breathing as it’s quite tricky, thus forcing you to focus on your breath, taking the best from all three approaches. But you are not me. Explore them all. Go to a class. Watch demonstrations on YouTube. It doesn’t matter. Just try it and continue; practice is everything. Remember, you’re learning to be sane. No one became a concert pianist after one attempt at Für Elise.

    Next, exercise (3). Your brain and body, even without the madness, need it. You need it more than anyone. All that adrenaline and cortisol coursing through your system all the time? They needs to go somewhere, and that will allow more calming hormones to be released. Some favour short intensive bursts of cardio. Others prefer gentle resistance training. Whatever works, do it, and do it regularly.

    (4) Food and sleep come next. If you constantly down coffee and/or alcohol, you are asking for anxiety. Ease yourself off them. Similarly, eating a lot before you got to sleep will give you a fitful night, upping your chances of anxiety the next day. Regulating your blood sugar is vital — the link between low blood sugar and anxiety is strong and well documented. One causes the other, a looping nightmare triggered by twin evils. Small, regular meals containing complex carbohydrates that release glucose slowly will help. Stay off the sugar.

    Finally, assess your environment (5). This is overlooked far too often. You need to look at your life — your job, your relationship, your lack of relationship, your home, your friends and family, your finances — and examine what is exerting pressure, what might be feeding into the anxiety loop. Bear in mind something else that is important about the nature of anxiety: in some regards it is not an emotion at all, but merely the surface response to another one. Sometimes we engage in anxiety as a distraction, to avoid something more painful. Perhaps your father never loved you and still tells you that you are nothing. Maybe your career is dull and boredom is intolerable for your intelligence. Is your partner undermining you? Whatever it is, it’s welcoming in anxiety like a trusted friend. I became a journalist because it turned out writing was sufficiently engaging to keep anxiety away. It’s your life; drastic action may be needed to change it. By continuing as you are, you are sending yourself the message that you do not deserve happiness. If that is your core belief, you need therapy, fast.

    This is a huge project, a mosaic of many pieces. Parts will fail. But overall, by fighting on all fronts, you will win. And there is no peace like victory.