Ask what could be done differently to get a better outcome

One form of opting out is procrastination: putting it off until later. While this is fine at times, if I do it too much, important issues do not get dealt with, problems do not get resolved, and my `to-do' list grows bigger and bigger (which generates extra anxiety). When we over-rely on thinking strategies, there are many costs. A particularly big one is that we spend a lot of time in our heads instead of engaging in our lives. Others depend on the strategy used. Blaming others leads to relationship conflicts. Fantasising about the future leads to discontent with the present. Beating ourselves up just makes us miserable. But I remember you telling me about a really hard period in your life, when you worked for a contractor one summer during high school. LENNY: Yeah, I didn't really know what I was doing at first. PAULINE: What happened? LENNY: I watched the other guys, saw what they were doing, and then I tried to do the same thing. PAULINE: Was it hard the whole summer? LENNY: No, eventually I caught on. I mean the work was physically hard, but I did a good job. PAULINE: Can you imagine yourself back at that time? Maybe your last day of work? Can you see yourself? As he tells Frank what has happened, Kim notices that his jaw, shoulders, and chest relax. With his stress reduced, he realizes that he really is capable and competent for his new tasks.

Carol narrowly avoided an accident on her way home. Now her hands shake as she dresses for her big date with Rob. Not wanting to spoil the romantic ambiance, she decides not to mention the near miss. But Carol is so tense that when Rob hugs her, she involuntarily flinches. She sees the hurt in his eyes and realizes that she really can't hide her upset. After calming herself with several deep breaths, she looks into Rob's eyes and tells him what happened. Relieved to know that he's not the problem, Rob smiles and hugs her reassuringly. Kevin has had an extremely stressful workday where anything that could go wrong did. I THINK, THEREFORE I WORRY: THE INNER WORKINGS OF A STRESSED MIND At 65, Urvashi Patel should be reaping the rewards of retirement. Her kids are grown up, married, and well settled in high-paying jobs. Her husband's smart investments, along with her own savings from over forty years of employment, are enough for the couple to live it up, senior citizen style. So what's the problem? Urvashi is a self-confessed worry wart. Always convinced the worst is going to happen, she is too busy to enjoy the moment. For their fortieth wedding anniversary, her husband surprised her with two tickets for a luxury cruise to the Caribbean Islands. Urvashi spent the entire time anxiously calling home and inquiring if the dog had been fed properly, if her grandson was getting to his karate lessons on time, and whether her daughter's evil boss had finally seen the error of his ways. Fear makes the mind imagine things. Positive thinking and challenging thoughts leads to frustration and disappointment when they don't have the desired effects. And if we over-rely on substance use, the costs to our physical health vary from addiction to lung cancer to obesity.

But arguably the biggest cost of all is that the more we avoid our own fear, the bigger it grows and the more influence it has over our actions. We get stuck in the fear trap: the greater our efforts to get rid of fear, the greater our fear becomes, and the more negatively it affects our lives. For example, Seb tried to avoid his fear of sexual failure by refusing to have sex with his wife. In the short term, this strategy helped him avoid his fear, but in the long term, his fear of failure just grew bigger - and he therefore became even more reluctant to have sex. By the time he sought help, he'd avoided making love to his wife for four years, and it had turned into a major source of conflict within their relationship. The fear trap Have you ever heard the saying, `Get back on the horse'? Personally, I've never fallen from a horse, but I've been told it is pretty scary. PAULINE: What are you doing? LENNY: Helping another guy putting in beams. PAULINE: Was it hot? LENNY: It sure was. PAULINE: Can you see it in your mind's eye? It's hot, you're doing this hard work. LENNY: Pretty good. PAULINE: Confident? PAULINE: Knowing you were doing something hard but doing it well? PAULINE: Can you see that you're still the same person? All he wants to do is go to bed, but before leaving for work that morning his wife told him that she had something important to discuss with him that evening. Recognizing that his body feels too tense and exhausted for him to be much of a listener, Kevin stops at the gym before heading home.

After a half-hour swim, his energy is restored and he meets his wife with a broad smile and a sincere look of interest. Nancy is so nervous about taking her qualifying exams at work that she can't think clearly. All the coffee she drank has made her nervous, jittery, and unable to focus. Because Nancy knows that physical exercise relaxes her mind and body, she puts on the tennis shoes she keeps in her desk drawer and goes for a run. Afterward she feels focused and ready for the exam. Frank is attending his first office party with his fiancee, Vivian. Overwhelmed because he can't remember the names of many of the people, Frank fails to introduce Vivian. She feels hurt and becomes upset, but doesn't want to lose her temper. When it got too much, Urvashi's body gave up and she was rushed to the hospital. The family was relieved that what seemed to be a heart attack was only a panic attack. But that didn't make it any less sinister. There's a fine line between being genuinely concerned and worrying unnecessary. And that line generally finds its way onto an ECG chart. Most chronic worriers worry to a point where they fear that if they don't fret about everything, something bad will truly happen. So, in Urvashi's mind, if she didn't waste her mental peace stressing about the littlest things, her family wouldn't be the happy, well-adjusted one it is today. Urvashi desperately needs to stop beating herself up with this crazy stress stick that she always carries around. But it's not easy. When you've spent a lifetime treating stress as a hobby, it's hard to let go. Immediately after a big fall, most people would have some fear of getting back on - especially if they were injured when they fell. But the sooner you get back on and start riding again, the sooner you will regain your confidence.

What happens if you don't remount the horse; The longer you put off riding, the greater your fear grows. If you want to get back into horse-riding, then you have to face your fear; Psychologists refer to this concept as `exposure' (and it has nothing to do with taking your clothes off in public). And it has more positive impact on behaviour than any other tool, technique, or strategy known to humankind. You've probably seen documentaries where people overcome their phobias. Let's say the subject is terrified of spiders: he panics whenever he sees one, and he won't go anywhere near them. He lives his life doing whatever he can to avoid spiders. Someone who can do hard things? You have depression, true, but you haven't given up. You do hard things every day. And some things, like cleaning up around the house, doing errands, volunteering at the homeless shelter--all of these things have gotten easier, haven't they? LENNY: Yeah, that's true. PAULINE: Do you think it could help this week if you try to remember more about that summer in high school, where you were faced with a challenge, a hard challenge, and you succeeded? And then remind yourself that you're still the same person and that some things have already become easier. LENNY: Yeah, I could do that. Rehearsing Adaptive Coping Techniques You use this technique to help clients practice using coping strategies in imagination. So she excuses herself and takes a little walk to calm down. During that time, she realizes Frank's dilemma.