Like many other autistic people I struggle with anxiety. I have struggled with anxiety for as long as I can remember. For me anxiety is mostly about worrying and ruminating. I catastrophise and imagine the worst possible outcome. My biggest fear at the moment is home maintenance, and in particular plumbing. I get so worried thinking that a minor fault will flood my house. Then when the plumber arrives I catastrophise that they won’t be able to fix it and I will never be able to use my shower again! After they leave I worry it is still faulty. I could worry about plumbing as an Olympic sport! One of the worst things about my anxiety is that I spent years being too ashamed to tell anyone that I was anxious about something that I considered shameful. This meant that I got no help for what in fact became a very dangerous situation.
For me anxiety can turn into psychosis. Apparently the brain chemistry that happens when you are anxious can trigger off the neurotransmitters that cause psychosis. This is very common for people with psychotic illnesses – like me. So when I start to get anxious I then add to the worry that it means I may get really unwell and all that entails – hospital, taking extended leave from work, lots of suffering.
I don’t just want to talk about what anxiety feels like or leads to though. I want to share some of the strategies I find effective to help address my anxiety. My strategies are drawn from a few therapy models that I have used. I think that there is value in most of the main therapy models and that people can find a range of skills useful. I know some autistic people don’t like Cognitive Behaviour Therapy (CBT) but I have found some value in CBT approaches. Therapy models really are up to the individual and what works wonderfully for one person will be totally useless for another.
The first strategy I use is a simple one – deep breathing. Anxiety is a physical, bodily sensation. It is the fight / flight / freeze / fawn response to a perceived threat and is a hang on from when we were under threat from sabre toothed tigers and the like. What happens when you are anxious is your body getting ready to cope with a threat and it is a physical thing. As such the physical act of deep breathing can help address the physiological manifestation of anxiety. There are lots fo different deep breathing techniques but they all involve consciously slowing down the breath. I find this approach very effective. I also practice deep breathing when I am not highly anxious. I find it helps with sleep and to slow me down – I am a very high energy person and am usually rushing from one thing to another.
Mindfulness. Mindfulness is a meditation technique which helps with anxiety. Mindfulness is all about being present in the moment. Not worrying about the future or dwelling on the past but experiencing what is happening now and working through that. Dr Emma Goodall has a wonderful website which focusses on mindfulness for autistic people – https://mindfulbodyawareness.com/interoception/ You can also download mindfulness apps for your phone or tablet. I recommend Smiling Mind.
Distress tolerance. This is a skill from the Dialectical Behaviour Therapy model. It comes from the premise that avoiding things which make us anxious is actually unhelpful in a lot of cases. Distress tolerance is about ‘sitting with’ difficult emotions and working through them. Avoiding things which make us anxious can be a very destructive thing as we will just stop doing a range of things that are too hard. For me I have found myself avoiding using taps which ended up being pretty restrictive! One thing you can do is gradual exposure. You start small with something you find anxiety-provoking and gradually increase your exposure until you are less anxious when you do the thing causing you worry. This is quite a challenging technique but can be very effective. It is also great for giving you a sense of mastery when you have overcome a challenge.
Distraction. This is a skill used in many therapy models. The premise is pretty straightforward. It involves engaging in an activity to occupy your mind. When your mind is occupied it is not devoted to anxiety. I find distraction very effective but it can be hard to remember to do it when you are in the middle of fear and anxiety.
Seeking help. You do not have to go through this alone. There are counselling services like Lifeline, mental health clinics and psychologists who can help you manage your anxiety. Be aware that some clinics and psychologists could use a bit of education in the area of autism so ask around and try to find a clinician who ‘gets it’. Clinical services can do more harm than good for autistic folk sometimes! I would recommend talking to neurodivergent friends and peers to see if you can find a clinic or psychologist who is likely to be helpful.
Anxiety is a big issue for many of us, including me. The strategies I have listed don’t ‘fix’ anything but hopefully can make things a little easier to manage.