Allison was a forty-two-year-old physical therapist who was afraid of heights, enclosed spaces, authority figures, and confrontations with her father and ex-husband. She filled out her Alarm Bells lists like this:
When you’re talking about anxiety, relapse is not actually “preventable,” in the sense that it will never happen again. The occasional feeling of anxiety is an inevitable fact of life. You are bound to feel anxious again, probably sooner rather than later. But if you face your fears and carry on with your chosen path in life in spite of your anxiety, that’s not really a relapse in the terms of this chapter.
However, if you fall back into your old patterns of avoidance and allow anxiety to divert you from what you want to do in life, that is the kind of relapse we’re talking about in this chapter. And let’s be honest: that kind of relapse is also a fact of life, because no change is perfectly straightforward. In the real world, psychological change happens in a stop-and-start, back-and-forth fashion. You take two or three steps forward, then a step or two backward. It’s like driving a manual shift car up a hill in heavy traffic. Periodically, traffic stops your forward momentum and you have to brake, push in the clutch, downshift, and then try to get going again. Typically, you have to roll backward a little bit before you get the gas and clutch coordinated and start going forward again. The key is to not stall the engine, not stop too long, and not roll so far backward that you have a fender bender.
To switch metaphors, let’s compare emotional health to physical health. It would be nice if anxiety could be treated the way we treat some physical problems. If you could have your anxiety surgically removed like a bad appendix, that would be great. But it doesn’t work that way. Fixing emotional problems is more like renewing your tetanus shot every few years or developing the habit of applying sunscreen before you go out. You have to keep treating the problem. The emotional skills you’ve learned in this chapter have to be renewed or reapplied from time to time, so consider the skills you have learned in this book to be something you have on hand, to use as needed when you relapse into avoiding what you fear.
If you find yourself relapsing into prolonged anxiety and avoidance, remember that’s natural. It happens to everybody. It’s the signal that you need to apply the plan you made in this chapter, to apply your emotional sunscreen, step on the gas, let out the clutch, and resume your journey.
For perhaps the first time in your life you have accepted and endured your anxiety by exposing yourself to a feared situation that you formerly avoided. And you got through it okay. You didn’t die, didn’t melt down, didn’t explode or blow away in the wind. This success gives you a rush of very pleasant self-confidence and pride. It can be a high, even an altered state. Brain chemicals called endorphins flood your neurons like a runner who has just crossed the finish line at the head of the pack.
But eventually the endorphins of successful change are reabsorbed. Your brain chemistry literally changes and the thrill is gone, the honeymoon is over. Along comes a stressor, you feel anxious, and old patterns of avoidance reassert themselves. Anxiety starts to feed off itself and spiral upward. The whole process is not only scary, but it’s also depressing, because it feels like failure. Your new confidence and self-esteem evaporate.
Since relapse is inevitable, it makes sense to plan for it. The first step in crafting a plan is to make a list of alarm bells.
Alarm bells are all the things in your life that can signal the start of a relapse. An appointment in a high-rise building can be an alarm bell if you fear heights. A person such as a police officer or tax auditor can be an alarm bell if you get nervous around authority figures. Certain thoughts or memories can be alarm bells if you can’t stop thinking about them. An upcoming meeting on your schedule might be an alarm bell, or it might not be an alarm bell unless you try to postpone it or start obsessively overpreparing for it. Everybody’s alarm bells are different.
In the following exercise, make a detailed list of your personal alarm bells. (A downloadable version of this worksheet is available at http://www.newharbinger.com/34749.)
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Who (particular people) |
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What (things, situations) |
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Where (places) |
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When (events) |
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Thought suppression |
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Distraction through fantasies, mantras, prayer |
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Rigid thinking (obsessively repeating the same thoughts) |
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Prolonged worrying |
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Misappraisal of threat (overestimating danger) |
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Feeling too hot or cold |
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Being very tired, exhausted |
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Getting out of breath, sweaty |
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Sexual arousal |
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Excessive reassurance seeking |
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Distraction |
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Procrastination |
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Overpreparation |
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Rituals |
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Perfectionism |
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Overreliance on a support person |
Allison was a forty-two-year-old physical therapist who was afraid of heights, enclosed spaces, authority figures, and confrontations with her father and ex-husband. She filled out her Alarm Bells lists like this:
Allison’s Stressor Alarm Bells
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Who (particular people) Father, ex-husband |
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What (things, situations) Evaluations with my supervisor, talking to the lawyers or judge |
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Where (places) Hospital administration offices, high-rise hotels, steep hiking trail |
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When (events) Camping with daughter in claustrophobic tent, cliffside trail |
Allison’s Cognitive Alarm Bells
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Thought suppression |
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Distraction through fantasies, mantras, prayer |
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Rigid thinking (obsessively repeating the same thoughts) I’ll never be free of my ex-husband My father likes my ex more than me |
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Prolonged worrying When I catch myself staring at the wall, worrying, frozen in place Thinking supervisor wants to fire me, hospital administration thinks I’m a malcontent |
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Misappraisal of threat (overestimating danger) Thinking it’s inevitable that I’ll lose my job and be homeless someday |
Allison’s Sensation Avoidance Alarm Bells
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Feeling too hot or cold Camping trip this summer |
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Being very tired, exhausted |
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Getting out of breath, sweaty Hiking with my daughter |
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Sexual arousal |
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Excessive reassurance seeking Pestering my daughter about snakes, poison ivy, first aid kits |
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Distraction Playing games on my phone when I should be taking care of business |
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Procrastination Being late with papers that need to be signed |
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Overpreparation More than two drafts of an equipment request Spending more than an hour on case notes |
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Checking and double-checking |
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Rituals |
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Perfectionism See “Overpreparation” |
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Overreliance on a support person |
When one or more of your alarm bells goes off, it’s time to apply the skills you’ve practiced in this book. It is a three-step process:
Example: Allison’s Relapse Strategy
Alarm bells went off for Allison as her daughter Rachael’s school camping trip approached. Twice, Allison almost “accidentally” signed up for extra physical therapy hours at the hospital on the same weekend as the camping trip. She annoyed her daughter by repeatedly quizzing her about such things as the likelihood of rattlesnakes or polluted stream water.
“Mom,” Rachael said, “if you don’t want to go, I wish you’d just say it.”
“No, no, I want to go,” Allison lied. She realized that her alarm bells were ringing loud and clear and that she was on the verge of backing out of the trip, which would have deeply disappointed her daughter. She needed to “name it and claim it” before she relapsed completely and avoided the trip entirely.
Allison stopped her safety behavior of asking for reassurance, and blocked out the weekend clearly on her calendars at work and at home. When the dreaded weekend arrived, she loaded the car and set off with Rachael on time, biting her tongue to stop herself from worrying out loud. In the mountains she drank the water, slept in the dark and confining tent, and hiked up the scary trail to the waterfall. She felt anxious several times during the weekend, but the feelings soon passed. Overall, she had a good time, especially when Rachael said that camping together was “the best.”
A couple of months later, Allison had to receive an evaluation from her supervisor. She caught herself ruminating furiously about the upcoming meeting, when there was nothing she could do about it. She wanted to call in sick, maybe even quit, to avoid her supervisor, but she didn’t. She fell back on her defusion skills from chapter 8, telling herself, “There’s a ‘getting fired’ thought again” and “Thank you, mind, for that inadequacy thought.” Her anxiety relaxed a little and she got through the evaluation with her job intact. In fact, her supervisor remarked, “You haven’t seemed so nervous lately.”
Allison’s father and ex-husband were involved in a family business, so her divorce was a nightmare of recriminations, bad feelings, and complex negotiations. She was supposed to read and sign a thick stack of papers that sat on her nightstand for two weeks past the date by which she had promised to return them. She moved them to the dining room table to work on them, then distracted herself by binge-watching TV until the papers were covered with junk mail and she forgot where she had put them. One day she was playing a game on her phone when yet another text from her ex-husband reminded her that she was avoiding signing the papers. She realized that her procrastination and distraction behaviors were alarm bells. She turned off her phone right then, ransacked the house until she found the papers, and forced herself to sit in a straight chair at the dining room table until she had read and signed them all. It took a painful two hours, but she was relieved when she was finally done.
Summarize your relapse plan by using the following worksheet to make a contract with yourself. Even though you have already listed your alarm bells in the previous exercise, it’s a good idea to refine that list here to reinforce your plan. (A downloadable version of this contract is available at http://www.newharbinger.com/34749.)
When these alarm bells ring:
I will:
Signature Date
Contract
When these alarm bells ring:
Scary trip with daughter
Business meeting with ex-husband
Avoiding entering a high building
Being evaluated or judged by others
Overpreparing for stressful work meetings
Constant worry
I will:
Signature Allison Date April 23
You’ve come a long way in your journey through this book. Congratulations on your persistence and your dedication to living your life according to your true values, in spite of your fears. As you go forward and encounter challenges from day to day, remember that although some relapse is inevitable, you have a plan to get back on track, and the skills to accomplish it.