Anxiety Management II: The World is a [insert expletive] Place

Everyone really is on a diet. Random stuff causes cancer, or prevents cancer, or does both at the same time. Fat is evil. And “Coming up after the break, learn about this dangerous thing you do every morning that could kill you!”

The nightly news reduces us all to comparing water bottle lips* the next day. This would be so ridiculously funny if it wasn’t for the fact that it seriously places all of us on anxiety crack.

*a real TV news clip that drinking from water bottles causes thin lines around the mouth.

Surian Soosay:

Surian Soosay:

Two-Day, Two-Part Experiment

Here’s a way to identify when those around you are on anxiety-crack and how, by identifying it, you can avoid getting pulled into the anxiety cascade yourself.

Spend the two days with a notebook handy. Go about a usual day that involves interactions with family, friends, classmates, colleagues, what have you. Whenever you get spare moments throughout the day, jot down the topics of conversation and the people involved, as best as you can recall everything.

You can also include conversations you overhear as well if you found yourself paying attention to the dialogue.

On day one, you are going to focus on identifying only the conversations that match the criteria below:

Firstly, list the number of times that each person utters an “I should” statement. That doesn’t necessarily mean they have to say the words “I” and “should”, but rather that they are expressing their sense of having to follow through on something. They may use the words “must”, “ought to” or they may say “I plan to” but the nature of what is planned is an obligation of some sort.

Secondly, list the number of times that each person speaks of their weight, shape, fat, body parts, or is speaking of someone else’s weight, shape, fat or body parts. List whether the comment is negative, neutral or positive.

Thirdly, identify how many times a body statement (weight, shape, fat or body parts) is subsequently linked to an “I should” statement.

Fourthly, identify the number of conversations you may have had throughout your day (meaning not just exchanging a passing greeting) that had absolutely no examples of a body statement linked to an “I should” statement.

Fifthly, rate your anxiety level (1 being relaxed and calm, and 5 being so agitated you may have to run from the room and you want to crawl out of your own skin) for each one of these conversations in which you were involved (or overheard).

And finally, and most importantly, rate your perceived sense of the person’s anxiety level when he or she uttered both a body statement and the “I should” statement.

On day two, you are going to focus on taking notes on all the conversations that fit the following criteria:

List how many conversations involved a main topic that relayed the distress, crisis or misery of individuals not known at all to the people present. Essentially you are looking most often for people relaying shocking news stories. Examples might include: a violent crime or accident where neither the victim(s) nor perpetrators are personally known to you or to those who are part of the conversation; natural disasters and wars; and fraud, cruelty, scams and abuses of power. 

List how many times, in the course of these conversations whether anyone suggests any action that could be taken by those present to rectify the wrongs that have been highlighted in the news story that was relayed. That one is usually pretty easy to complete— it is almost always a “zero” times. An example might be: “I wonder if we could start an office donation to help those people who are now homeless because of that fire in the building across town?”

Then rate your anxiety level (1 being relaxed and calm and 5 being so agitated you may have to run from the room and wanting to crawl out of your own skin) for each one of these conversations in which you were involved. And also rate the overall mood of the group at the end of the conversation (where 1 is upbeat and relaxed, 3 is neutral, and 5 is down, stressed and somewhat pessimistic).

For most of us, the results of this two-day experiment will likely not be too surprising. Generally, you will notice that both body/should statements and news of distressing situations where there is no action that can be taken, are anxiety-provoking conversations not just for you, but for everyone around you as well.

It is not that we need happy and upbeat stories to alleviate anxiety— and in fact that those can heighten anxiety as much as distressing stories— but rather we have to identify locus of control in a conscious way.

B.W. Townsend:
B.W. Townsend:

Locus of Control

The photo immediately above is a great example of external locus of control. Although, interestingly, there are likely grounding wires on both towers and that means that humans have identified that they can sometimes mitigate things that are out of their control (lightning strikes) when they understand the physics (the strike will take the least resistant path to ground).

There are two primary loci of control in life: external and internal.

If your house is swept away by a mudslide, then that event was never going to be in your locus of control. For all external locus of control events in our lives, we can sometimes be a bit prepared (house insurance) but many times there is no way to do anything except deal with the aftermath.

The North American philosophies of life have generated a preponderance of assuming everything is actually an internal locus of control. Got cancer? It’s your fault because you should have exercised more, eaten better, slept more, been nicer to your kids. Your friend is injured in an accident? It’s your fault because you should have told her not to go to that party— you had a sense it would turn out badly. Fired from your job? It’s your fault because you had too many sick days, were rude to a colleague once, never went golfing with your boss. 

Of course living your life assuming everything is someone or something else’s fault is equally futile. Most life events are a mixture of things we might have done differently to generate different outcomes, and things that simply would have occurred no matter what we would have done or not done. In fact, as Robert Sapolsky highlights in his book Why Zebras Don’t Get Ulcers, being able to accept when things are either inside or outside your locus of control mitigates your stress response enormously. 

Certainly, some things are clearly run by an internal locus of control, and this is particularly the case if you are somewhere in a middle-class socioeconomic stratum in a developed nation in the world. Where you live, what food choices you make, where you go to school, where you work, the car you drive and the clothes you wear all tend to sit within your internal locus of control. Your thoughts and feelings are largely, although not exclusively, within your internal locus of control as well. Other people’s thoughts and feelings are not! 

Here is what I said on the topic in an archived forum thread:

This process is called identifying your locus of control. Many people of faith embody that process in the serenity prayer:

"God, grant me the serenity to accept the things I cannot change; the courage to change the things I can;and the wisdom to know the difference."

But it does not require faith to identify what is in your locus of control and what is outside your locus of control.

Unfortunately, we often assume that our body is in our locus of control— we should be able to say what weight it will be at; how long recovery will take (actually how short it will take!); how it reacts to stress; and what pains should or should not be there.

If we can move through accepting that our minds are living within an ecosphere that, while supportive of the mind, is not actually controlled by the mind, then we can begin to understand a bit more of the mystery of the locus of control for our bodies being largely outside our conscious control.”

But what happens, thanks to modern medicine, when we can in fact treat our bodies as completely under our mind’s control? You can get a nose job, have liposuction, mutilate your stomach so that it no longer physically accommodates the energy your body needs, you can diet and workout, you can change your hair color, and you can take all manner of drugs to nudge all manner of biological functions in whatever direction it is deemed they must go.

No one can really pass any overall ethical judgments on these decisions, but it is wise to recognize that messing with any ecosphere, including your own body, is almost never achieved without some risk and possibly unwanted outcomes in the end.


Anxiety-Crack Harm Reduction Program

Firstly, I have to share the details of the photo above— these are actual vintage craps dice that were part of a Tylenol marketing campaign to doctors when they launched Tylenol® with codeine in 1963. Seriously?! Prescribe Tylenol® with Codeine and you’ll come up a winner every time (4 on all faces of one die and 3 on all faces of the other die equals lucky 7 every time). The more things change the more they stay the same.

Back to the topic at hand: anxiety.

Now we’ll put the two-day, two-part exercise together with an understanding of loci of control and voilà! your anxiety-crack harm reduction program will be well underway.

Body/Should Statements From Others

First and foremost, you will want to alleviate the anxiety you experience when you hear others speak of their diets, their horrible thighs, their self-admonishments for not going to the gym, their refusal of a second piece of something tasty, because these things run straight to the heart of your already ED-anxiety-heightened state.

When the topics turn towards body/should issues, then you have three choices in social circumstances (family, friends, colleagues, classmates etc.):

1 Change the subject.

2 Wander away with some excuse of needing to go do something (if indeed an excuse is even needed).

3 Challenge it.

The situations I personally used to love to challenge in workplace settings was when someone invariably had brought goodies to work or there was the obligatory group lunch involving the hemming and hawing over dessert options: I was right in there short circuiting all the “I shouldn’t” with “Well, I am most certainly not turning this down!”

You have to be in a good space to feel the wash of anxiety from the other people back at you when you challenge the status quo in this way. And there will be the once up and down when they blatantly look at your body shape. And even worse there can be the retaliatory: “Oh, well you can afford to, but me I have to be careful!” or worse still there is the retaliatory “Really? You really think that’s wise given, well…” (as they look you up and down).

In any case, if and when you are ready to take on a challenge-it moment, then channel this quote from Mae West:

It's better to be looked over, than overlooked.

No matter what choice you take, the goal is to keep their anxiety firmly in their locus of control. A yawn can be pretty contagious with many animals, but if you don’t see it, you don’t ‘catch’ it. The same is true of all these body anxieties around you.

And, if you are consciously paying attention and someone yawns, you can actually suppress yawning in response. The trick is to be conscious of the fact that anxiety is easily transferred from one locus of control to the next. If someone is worried about his or her diet, or exercise regime, or shape, then by noting it is his or her worry you can suppress the transfer of that worry to your thoughts and feelings altogether.

Taking the Shock Out of Your Life

And while we’re at it, you’ll want to lower the multi-tasking, the “check-again” and the helplessness cycles from your life as well.

If you’ve never had a chance (and you have 21 minutes and 20 seconds to spare), check out Dan Gilbert’s TEDTalk on The surprising science of happiness.

As he mentions, our pre-frontal cortex is a phenomenal futures-simulator. We can anticipate many things and determine (and feel in real-time) our emotional response to those things without actually experiencing the events in real life.

There is also, although contentious within various scientific practices, the possibility that our distributed mirror neuron network actually simulates what we see in others, within ourselves. Vilayanur Ramachandran touches on some of his research in this area in this TEDTalk, The neurons that shaped civilization (7:44), and this one as well 3 clues to understanding your brain (23:38).

In fact our mirror neuron network is often interchangeably referred to as our empathy network. Do you feel an emotional surge watching an interview on television with the woman who was attacked the night before? Most likely yes you do. The question is whether you are aware of your emotional responses to it or not. And if you are aware, do you believe that the response is positive or negative?

Whenever I suggest to highly anxious individuals that they cease watching or reading the news altogether, they push back instantly with the concept that it is important to know what is going on.

And while I don’t know if the The 4-hour workweek by Tim Ferriss really holds the key to anyone’s success but Tim Ferriss’, I cannot help but really like the guy (another TEDTalk to assess him for yourself: Smash fear, learn anything). And while his recommendations are about efficiency, I would suggest they are equally (if not more) applicable for those needing to implement an anxiety harm-reduction program:

“The world doesn’t even hiccup, much less end, when you cut the information umbilical cord.” 15

Paying attention to current events in today’s world means you will experience horror, helplessness, fear, anxiety and stress on a global scale compressed into your brain’s mirror neuron system. I imagine that this must be the equivalent of the non-consensual Vulcan mind meld (referencing the TV and movie series: Star Trek):

Mind melds can also be very violating and potentially harmful under certain circumstances. In Star Trek VI: The Undiscovered Country, Spock forcefully used the technique on Valeris in order to discover information she had that could be used to prevent a war; Valeris began screaming just before Spock broke the connection.” 16

Cut the news feeds (both pop-culture and current affairs). It’s okay to recognize that your mirror neuron system is simply not optimized to take in the experiences of seven billion people strewn across our planet.

As I mentioned earlier, consider the option of speaking up when people talk of world events by offering up suggestions for action. A “do something or don’t dwell on it” attitude can be helpful for all concerned. If everyone is talking about some recent tragedy, then be the one to offer to organize a way to help the victims in some way. As with speaking up during body/should conversations, there is no need to take on the burden of action, there is merely the option if it feels right for you at that time and place.

MCAD Library:
MCAD Library:

Close It Down Now

Much as I loathe the term “neuroticism” it is unfortunately the de facto definition used within psychology to identify neurological states that are subjectively labeled as negative states: anxiety, anger, envy, guilt, vulnerability and depression. From a neurobiological point of view this irritates me, as it blithely assumes that such states have no biological value simply because they can be subjectively assessed as “negative”, based on narrow social norms identified primarily within western white cultures.

In any case, good multi-tasking performance and neuroticism appear to be inversely correlated, meaning more anxiety will predict poorer multi-tasking performance outcomes. 17 Fascinatingly, this correlation may be because ‘neuroticism’ actually generates an existing cognitive load such that less cognitive brainpower is available to try to manage multi-tasking efforts effectively. 18

Given that you have quite a cognitive load when dealing with an eating disorder (essentially an anxiety-based condition), it will help both your emotional landscape and your task-completion performance to keep your e-mails, facebook, twitter, tumblr, pinterest, reddit (and yes this site sadly too!) and all other social media feeds closed on your computer except at specific times during the day.

Treat your smartphone as the smart gadget it is, and don’t have it interrupting you constantly throughout your day. I am always amazed at how many treat any lull as an opportunity to check the Crackberry (yes, it's true that only government workers are still relegated to Crackberries while the rest of the world lives on iPhones, but you get the idea) rather than actually experience the lull as the break it was possibly meant to be.

You know how I always encourage everyone to focus on consciously breathing out and breathing slowly back in until the pace of their thoughts slows? Well, the “check again” smartphone cycles heighten the pace of your thoughts and that will keep you at a commensurately higher state of anxiety and arousal as well.

Just try to be mindful of all the things in your day that may be worsening your ability to stay calm enough to always maintain the upper cognitive hand with your eating disorder-generated thoughts and feelings.

1. Strober, Michael, Roberta Freeman, Carlyn Lampert, Jane Diamond, and Walter Kaye. "Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes." American Journal of Psychiatry 157, no. 3 (2000): 393-401.

2. Milos, Gabriella, Anja Spindler, Ulrich Schnyder, and Christopher G. Fairburn. "Instability of eating disorder diagnoses: prospective study." The British Journal of Psychiatry 187, no. 6 (2005): 573-578.

3  Halmi, Katherine A., Suzanne R. Sunday, Michael Strober, Alan Kaplan, D. Blake Woodside, Manfred Fichter, Janet Treasure, Wade H. Berrettini, and Walter H. Kaye. "Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior." American Journal of Psychiatry 157, no. 11 (2000): 1799-1805.

4. Tozzi, Federica, Laura M. Thornton, Kelly L. Klump, Manfred M. Fichter, Katherine A. Halmi, Allan S. Kaplan, Michael Strober et al. "Symptom fluctuation in eating disorders: correlates of diagnostic crossover." American Journal of Psychiatry 162, no. 4 (2005): 732-740.

5. Castellini, Giovanni, Carolina Lo Sauro, Edoardo Mannucci, Claudia Ravaldi, Carlo Maria Rotella, Carlo Faravelli, and Valdo Ricca. "Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study." Psychosomatic Medicine 73, no. 3 (2011): 270-279.

6. Eddy, Kamryn T., David J. Dorer, Debra L. Franko, Kavita Tahilani, Heather Thompson-Brenner, and David B. Herzog. "Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V." American Journal of Psychiatry (2008).

7. Eddy, Kamryn T., Pamela K. Keel, David J. Dorer, Sherrie S. Delinsky, Debra L. Franko, and David B. Herzog. "Longitudinal comparison of anorexia nervosa subtypes." International Journal of Eating Disorders 31, no. 2 (2002): 191-201.

8. Online Etymology Dictionary

9. Research and Design in Historical Patterns

10. Wardle, Jane. "Compulsive eating and dietary restraint." British Journal of Clinical Psychology 26, no. 1 (1987): 47-55.

11. Barr, Susan I., K. Christina Janelle, and Jerilynn C. Prior. "Energy intakes are higher during the luteal phase of ovulatory menstrual cycles." The American journal of clinical nutrition 61, no. 1 (1995): 39-43.

12. Gong, Elizabeth J., Dominique Garrel, and Doris Howes Calloway. "Menstrual cycle and voluntary food intake." The American journal of clinical nutrition 49, no. 2 (1989): 252-258.

13. Tarasuk, Valerie, and George H. Beaton. "Menstrual-cycle patterns in energy and macronutrient intake." The American journal of clinical nutrition 53, no. 2 (1991): 442-447.

14. Bryant, Maria, Kimberly P. Truesdale, and L. Dye. "Modest changes in dietary intake across the menstrual cycle: implications for food intake research." British journal of nutrition 96, no. 05 (2006): 888-894.

15. T Ferriss, The 4-hour Workweek, Crown Publishers, 2009, p.90


17. Poposki, Elizabeth M., Frederick L. Oswald, and Hubert T. Chen. Neuroticism negatively affects multitasking performance through state anxiety. No. NPRST-TN-09-3. Navy Personnel Research Studies and Technology Millington, TN, 2009.

18. Bredemeier, Keith, Howard Berenbaum, James R. Brockmole, Walter R. Boot, Daniel J. Simons, and Steven B. Most. "A load on my mind: Evidence that anhedonic depression is like multi-tasking." Acta psychologica 139, no. 1 (2012): 137-145.