Sunday, March 15, 2020

How to manage worries in a time of crisis (and other times too!)

A few weeks ago I was invited to give a talk about CBT (Cognitive Behavioural Therapy) to a group of  doctors.   A good opportunity to spread the word about  therapy and how it can be beneficial, I thought - but at the same time quite a challenging. task  The doctors I would be talking to, GPs,  are in the front line, they have less than 10 minutes to help people.   They would definitely  see straight through any bullshit or waffle.

Then came the Coronavirus crisis.  Surely I had to do something that connected with this, which would be on all their minds. But how?

I decided to ditch my theoretical CBT talk and make it more about how CBT could help my audience. Sure, I described some  techniques  they could share with their patients about depression, stress and worry. But I also  made sure to enquire f they could apply any of the tools to themselves, there and then.

Today I  want to share with you  the tool that had the biggest impact.  I hope it is helpful for you to,  in this time when everyone is, naturally enough, worrying about Coronavirus. 

Is it worth 5 minutes of your time right now to read about the Worry Tree and see if it can help you?

So here's how I presented it to the doctors

"Is worry a good thing or a bad thing, what do you think?"

"Bad, obviously", one of the younger female doctors replied.

"Not always",  argued another - "sometimes you need to worry to sort out a problem."

This was great, I thought, we are  starting to get the audience engaged ... "Right",  so when is worry useful and when is it less useful?" I asked.

"It's useful when it leads us to solve a problem", chimed in a third lady GP - "and when it leads us to do something or plan to do something?" - I added.

"But worry is sometimes not so useful" I pointed out.  " Last week I read that an asteroid, about which we can do nothing, has a .001% chance of crashing into the earth . Is it helpful to worry about that?"

"No", replied the first  GP, helpfully, "because we cant do anything about it".

"Exactly. So if we pull these ideas together, we get a really useful tool called the Worry Tree. 
This is a CBT tool that I often share with clients, an it usually proves to be very helpful."

I then showed them the Worry Tree, which looks like this ...


So, I asked, "Any worries on anyone's minds right now?"

"What if my elderly mother gets Coronavirus from me?" asked a lady who hadn't previously said anything.

"Ok, let's apply the Worry Tree.  First you have to notice when you get caught up in worrying. Then you ask one key question  namely."

"Is there anything helpful I can do? Is there?"

"I can give her up to date advice - like to wash hands regularly, perhaps limit going out"

"Yes, that will be a bit of role reversal with what your mum used to tell you ", I joked. "What else can you do?"

"Maybe I need to limit my contact with her. After all I am in the higher risk group of catching the virus as a GP, and she is in the higher risk group of being seriously affected if she catches it."

"Yes, you are right. Can you do that?"

"Yes"

"How?"

"By checking in on her by Skype and text rather then face to face. By asking my brother who lives quite close to do more of the physical checking"

"Great, how does that sound?

"Good"  she replied.

 I was really happy with this and so was this doctor who took a photo of the Worry Tree with her phone and texted it to a friend.

Then I noticed  a bunch of  sceptical looking male doctors at a table at the back.

"What are you thinking?", I asked one of them

"Well, the worry is still there isn't it.  You haven't really solved it all. Her mum still might get the virus"

"Actually, we have done something. We have made a plan to advise mum and limit contact.  So the Worry Tree has solved something.  But it can't solve problems we can't do anything about. We can't make certain that mum will be OK.  Once we have used the Worry Tree to do all we can, the advise is to then park the worry."

"But how do you do that?"

"Partly by reminding yourself that you have done all you can do at the moment."

"And if that doesn't work?"

"This is where in a CBT session we would discuss and experiment with various ways to help neglect the  worry. One idea that helps some people is worry time, which means cordoning off 15 or 20 minutes  a day to do all your worrying. You can jot down worries at other times, but you ban doing the actual worrying."

I am not sure if  my sceptical questioner was totally satisfied with this answer. The truth is that the worry tree helps a lot of people with a lot of their worries. However it is not a universal panacea, and the full treatment for Generalised Anxiety Disorder (GAD) - which is what you may have if worrying has become a big problem for you  - can take a lot more than a 10 minute explanation of the Worry Tree.

So most of the GPs were happy, and so was I. They now had some  tools that can help them and their patients. I can share the other ideas that they found helpful about stress and depression another time, if  you would like that.

Can using the worry tree help you in this time of crisis?

Here is my attempt to apply it to some other common worries people have about Covid-19
Worry: Will I get the virus myself?
Worry Tree Answer: Can I do something helpful? Yes. Follow government advise - wash hands thoroughly, limit social contacts, be especially careful with contact with elderly ....
Worry: But what if I do get it?
Worry Tree Answer : Having done all you can or planned to do all you can, you need to neglect the worry. Remind yourself that you have done all you can, and focus on something else.



Worry: Are the government doing enough?
Worry Tree Answer; Can I do something helpful about this? Not really. Let's focus my energy on things I can do something about instead?


Worry: What if I can't do what I planned to do in March, April, the summer ...
Worry Tree Answer : What can I do about any of this that is helpful? Maybe make contingency plans - go on holiday in the UK rather than abroad, perhaps? But most of this worrying will be about something you can't do anything about at the moment, so it;'s  best to park the worry until closer to the time.



With practice, you can internalise the Worry Tree so you get to do this helpful thinking automatically. Come to think of it, this is what I did with regards to my worry about presenting to the doctors.
I had beebn worried whether they would find it helpful,  and problem-solved this by making it as relevant as I could to them.  The worry tree worked for me! Do you want to give it a try yourself? If so, do it right now on something on your mind, then teach it to someone else.

The key take-home is this

 Having  a worry isn't a problem, it's when you worry about it rather than problem-solve or take action that it becomes one. 
The Worry Tree can help you stop worrying and start leading a more productive and effective life.



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