By Brian Robinson.
What is a Mindset?
Definitions for what amounts to a mindset vary considerably, but in the broadest sense, we could say it is a set of core beliefs, perceptions, attitudes, opinions, principles and values etc that not only determine who we are, but shape the way we live our lives.
In a narrower sense, we could point to sub-mindsets which amount to a settled view on things like, education, politics, crime. And these mindsets can vary tremendously. One person might see education as cramming our heads with useless information: another may see it as the cornerstone of their existence. Education opens the door to everything. One thing we can say for sure, mindsets are vitally important because they guide, drive and shape our lives.
It is important then, for a mindset to have particular characteristics. It should aim for the truth; it should be positive where possible; it should be built on realistic appraisals and so on.
Most people probably wouldn’t have an inbuilt mindset when it comes to recovering from anxiety. This is something we have to construct for ourselves. It’s not something we are born with and simply are able to tap into.
This is where we come to a problem. Anxiety disorders, by their very nature, have the power to influence, change and distort our mindset. And in a very literal sense, they can change who we are and how we function. This is something that non-sufferers find difficult to understand. They often do not get why anxiety sufferers reason and behave the way they do. They do not always understand why anxiety sufferers can seem to be impervious to logic.
This then is the problem for the anxiety sufferer. They have to try and build a recovery mindset, that in many respects may be the opposite of what they believe to be true. In effect, they have to operate with two competing and conflicting mindsets, and they have to find a way for the recovery mindset to begin to dominate. In practice, this is not something that happens overnight. It is something that we work towards.
If you’ve read module 1, which focuses on understanding anxiety, you will be familiar with the view that potentially everyone can recover from anxiety. But we ought to ask, is there a foundation for that view? How do we know that will happen and that our anxiety will settle? To begin with, we now have a much better understanding of the role a person’s psychology, emotions and behaviours plays in these conditions. What we think, feel and do can be decisive regarding what causes and maintains the anxiety. It is these understandings that have given rise to most of the therapies that are available today. We may not be exactly sure how things have gone wrong: but we are at a stage where we pretty much know how to put things right and there is solid evidence for that
Most of the experts appear to be saying that if the sufferer receives the right therapy, the recovery rate sits at roughly 70%-80%. Now whilst this is quite a high and encouraging percentage, it does give rise to a problem for the anxiety sufferer. The anxious mind is not always as open to persuasion about recovery rates as the rational mind. What this means in practice, is that the anxious person may tend to think they must be one of the 20%-30% who can never recover. This is especially true of long term sufferers who have tried various therapies some of which may be away from the mainstream. Unfortunately, there are lots of so-called therapies which promise much but deliver little.
A better way to look at the objective evidence, is to focus on those who do not recover and ask what is it that can we say about them? Many doctors now refer their anxious patients to Cognitive Behavioural Therapists. And we are told that there is strong evidence to support the claims made by this therapy. But even with CBT, not everyone is able to engage with the therapy for one reason or another. The sufferer may not gel with the therapist. This may not be the fault of the therapist. And it may not be the fault of the sufferer. It is not always that two people feel comfortable with one another. And when that is the case, it should not be surprising when the therapy fails to have a positive effect.
Timing also seems to be important. Sufferers sometimes have to reach a point in their condition or in their lives when they feel they are ready to recover. There may be lots of other things going on and they often decide to wait for a lull in those before they feel ready to undertake a programme of recovery. Bad timing can put you into that 20-30% bracket.
Some sufferers have a handicap in the sense that they look to the therapist or the doctor to cure them. That’s how it works with physical conditions, so why can’t it work the same with mental health conditions? However, although medication often has a role to play, none of the experts are suggesting there is a pill which can cure anxiety. In reality, medication nudges you in the right direction; the therapist sets out a recovery pathway; and it is the sufferer who has to do the real work and make the necessary changes.
Now we have to turn our attention to the therapy and the therapists. Not all therapies are regarded as mainstream by the professionals. And some of the approaches are on the fringe of what might help. The person may think they’ve recovered. But the recovery may not as profound as we would like or it may not be sustained in the way we would hope. The person may relapse back into anxiety as time passes and the worries begin to take hold again. And, if we look at the objective evidence for the therapies on the fringes, we may find that the true recovery rates are poor and many of the claims made unjustified.
However, there are some therapies with a proven record and an evidence base for their claims. Cognitive Behavioural Therapy is one such therapy. Cognitive Therapy is founded on the central premise: that it is not things which make us feel bad: it is the way we think about things. In other words, it is the stuff going on in our heads that cause us to become anxious. Behavioural Therapy works on the premise that the way we behave has a direct connection with maintaining the anxious condition. So in the case of general anxiety, if we behave like someone who is in danger, our brain will continue to believe that we are in danger and will naturally want to keep us in escape mode. And likewise, if we have a phobia, and continue to avoid the dangerous situation, then again our brain will continue to think that danger really does lie in the situation being avoided. If we change our thoughts and behaviours then, these therapies suggest that our inner systems will come to understand the new reality and will automatically begin to settle.
You will have gathered from what has just been said, that CBT is actually a blend of two therapies i.e. Cognitive Therapy and Behavioural Therapy. But it doesn’t have to be restricted to these two approaches. There is no reason why CBT cannot amalgamate with other therapeutic approaches where appropriate. For example, there is now such a thing as Mindfulness based CBT. This is sometimes felt appropriate to help people with Obsessive Compulsive Disorder. And there is no reason why CBT cannot involve Relaxation Therapy or Emotional Therapy. Quite often, the reality is that the broader the approach, the better the results.
What is the true objective view then? Are we really stuck at no better than a 70%-80% chance of success? Or, could we argue that with the right approach, there is no such thing as treatment-resistant anxiety? Well, perhaps that is taking things a bit too far, but it is fair to say that every sufferer should feel justified in being optimistic about their chances of recovery, even if there is a voice inside telling them the opposite is true.
What we have discovered so far amounts to a good foundation for a recovery mindset. We understand the nature of the condition; and we understand that the objective evidence tells us that recovery is on the table for everyone. This should sit at the forefront of our thinking. It may not sit as a belief, that would be unrealistic, but it can sit as an objective view. If you find that impossible, don’t worry, there is a good substitute for belief.
If we find it hard to believe we can recover, then we have to trust that we can recover. We have to trust in the objective view of matters; we have to trust in the recovery process itself; and we have to trust in ourselves. Trust is different to belief. A belief has to aim at the truth and that can be difficult. But trust doesn’t require a foundation of truth. Trust is a gift we can give to ourselves. And trust can act as a facilitator. It allows and encourages us to do the things we have to do in order to get back to normal. But let’s not abandon belief altogether. Belief is something we can work towards; something that will grow and flourish as we begin to recover, and something that waxes as anxiety wanes.
Many sufferers will ask, “Can I recover without the help of a therapist? There will be no suggestion here that there is anything wrong with getting help from a therapist. But we have to ask should recovery hinge on finding the right therapist? In today’s reality, whether or not we see a therapist is more about questions of availability or finance. For most people, provided they have the right understanding and the right approach, there is no reason why they can’t recover through self-help. For others, there is no doubt that the help of doctors and therapists may play a decisive role. But recovery via self-help methods should not be seen as a second or third best option. Recovery by this route can be the most profound recovery of all and the one most likely to be sustained.
So, what other attributes make for a good recovery mindset? ACCEPTANCE is a key element in anxiety recovery. We have to accept the current state of affairs because it is impossible to simply switch off anxiety. Recovery is a gradual progressive process and we have to accept that. But acceptance does not mean we do nothing. The reverse is true. The alternative to acceptance is resistance and resistance only serves to increase tension.
KEEPING AN OPEN MIND. Don’t try and predict how things will go day to day or week by week. Anxiety is unpredictable by nature and we can only judge how we are progressing over a period of several weeks.
COMMITMENT. We have to commit to the recovery process and be prepared to stick with it. A half-hearted recover plan isn’t much of a plan.
WORK ETHIC. Be prepared to work hard at getting better. The harder you work the quicker you will recover. But recover shouldn’t feel like a millstone around your neck. There will be things you have to do, but they will all be healthy relaxing things.
DETERMINATION. When it comes to overcoming difficult conditions such as phobias and OCD we have to try and get into a determined frame of mind. The phobic or OCD mind can be resolute in getting what it wants and we have to be determined to overcome that. But it will give way if we send the right signals.
Finally, and to be realistic, no one person will have the perfect recovery mindset. But provided we know what recovery takes; and provided we make a good effort, the odds are we will recover.