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  • The Reflective Doc

Managing a Worried Mind (My Own)

"How could you have let your boys bicycle by themselves to the park? What if they don't watch out for cars? What if they get lost, or hurt? How could you ever forgive yourself?"

This is anxiety at its worst.

My brain does many good things: recognizes faces from years past, prepares kids for school without forgetting their snack or perpetually unused water bottle, even grasps the complicated neuronal pathways contributing to dementia or depression.

It also fires intrusive, anxious thoughts my way, especially when I’m under stress.

Many of my patients will say “I was an anxious kid.” They remember restless nights before exams, frequent worry about the safety of their parents or other loved ones, or difficult speaking up in class. A number of them also describe checking behaviors, such as repeatedly turning light switches on and off, or returning to the front door to make sure it’s closed. Occasionally this group will continue on to develop diagnosable obsessive compulsive disorder (OCD), but the majority will not.

In hindsight, they can often identify thoughts and behaviors that were anxiety-related, though at the time, as kids, they just thought they were “different” or even “weird.” They saw their friends enjoying slumber parties or trying new activities, and wanted to participate, but often ended the evening sitting defeated in the back seat of their parent’s car, or missing the fun while they waited on the sidelines.

I don’t recall having significant anxiety as a child, though a few situations suggest that maybe all was not calm in my little head. For example, my nightly prayers typically involved asking God to protect my family from harm, and I would feel guilty if I missed a night, fearful my lapse would lead to catastrophe.

I also have a distinct memory of sending my obliging brother downstairs to inform my parents the house was in danger of flooding. To their credit, they tried to respond supportively. After all, we lived on a hill in drought-prone North Dakota, so we probably were not at high risk of rising tides. I recognize now that my vigilance was unnecessary.

Sitting across from patients each day, reviewing the standard symptom checklist doesn’t always resonate. Over the years, I have found ways to better describe how our anxious minds can trick us. One analogy that often resonates is the movie soundtrack. Most people understand that watching scary movies with the sound turned off is far less impactful. What would “Jaws” have been without the ominous “duh dah, duh dah” as we gazed over the serene water? I point out that when they are in the middle of an anxiety flare, their anxious brain is creating a threatening soundtrack, blanketing all of their activities.

I often tell my patients that anxiety, in moderation, is adaptive. We have survived as a species because when we are faced with a true threat, we respond appropriately. For example, if we are being chased by a large, hungry tiger, our brains immediately detect danger and kick start our bodies to get out of there. A surge of adrenaline prepares us to run, fight, find a way to survive. The physical sensations created by this release: racing heart, faster breathing, sweating, hand tingling, are responses to the physical changes our bodies undergo to perform at the highest level. No need to hold anything back when you might be eaten.

However, anxiety can become decidedly less adaptive when it skips to the far end of the bell curve, now creating significant distraction and distress. Thought to live, roughly speaking, in a small structure in our brains called the amygdala, anxiety can be triggered by any number of things: the chronic stress of parenting during a pandemic, an unexpected physical sensation, a late night phone call, even disruption in our daily routine.

In an example of the last type of trigger, I find my perception of safety is disrupted when I veer off of my usual daily schedule. My kids are in school either way, but I feel at unmoored, worrying about their safety much more acutely. Their risk of harm when I am away from the office doing an unusual activity, even something pleasurable like a lunch date, seems significantly higher than when I’m adhering to the schedule. I have to remind myself repeatedly that the overall risk only appears greater because I have varied the day, but those thoughts often persist.

I speak with patients often about these kinds of “sticky thoughts.” The kind that pop into your head and refuse to leave, which we in psychiatry might also call “intrusive thoughts.” Once they implant in our conscious mind, it can be very difficult to remove them. Often people will attempt thought blocking, essentially working as hard as they can to “not think about that.” But this technique is really difficult. It reminds me of the psychological experiment that instructed individuals, “Don’t think about a white bear.” You just did, didn’t you?

Sticky thoughts are particularly intrusive and upsetting in obsessive-compulsive disorder, but aren’t found exclusively there. Even people without a diagnosable anxiety disorder experience them. For example, a phone ringing at an unusual time may evoke thoughts about the safety of loved ones. It isn’t always easy to clear that frightening image, especially when lying in bed at night without the day’s distractions.

Recently I was on a bike ride with my eldest son. The pandemic isolation and recurrent disappointments have been hard on him, and he has been struggling, like his mom, with anxious thoughts. On his urging, we took the bike path into the woods, and came across a small pond, studded with lily pads and skating insects. The point of our access was next to a small cement spillway, with water slowly streaming with gravity to the larger lake below.

As I watched him play in the water, I thought about our mutual anxiety, feeling both guilt for my likely genetic contribution, as well as fortunate to have tools I could teach him to manage his own worried thoughts. I picked up a large burnt orange leaf, and walked to the stop of the spillway, alongside the stream. Placing my leaf into the water, I watched it slowly float away, pointing out to my son that we can place our worried thoughts on our own imagined leaf, and send them down the river.

Excited by the thought, he began experimenting with all kinds of nearby objects. When things got stuck in the flotsam of the small river, we talked about how that could happen with our thoughts too. The delight and relief on his face was lovely, and as we walked back to our bicycles, he said, “Mom, thank you for talking to me. That was really philosophical.”

It was one of my favorite moments with him, as we both found ways to navigate life alongside our worried thoughts. We are so much more than our anxious minds, and so, indeed, are all of you.

Take care, friends.

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