How a planner can help you to better manage anxiety
Keep track of your anxiety by monitoring your mood and sticking with healthy habits. Here we outline how the humble planner can help you to achieve your goals when it comes to anxiety.
How a planner can help you to manage anxiety
By Joyce Chong
Anxiety is part of life. It keeps you safe from danger - think of anxiety as your body’s alarm that is designed to protect you from threats in your environment. At times, your alarm may be overactive. This can be experienced in response to stressful events (job stress, global pandemic, relationship breakdown, cumulation of daily hassles), or reflect a longer-standing anxiety disorder (such as social anxiety disorder, panic disorder; learn more about when anxiety tips into an anxiety disorder here).
We’ve worked with many individuals over the years to build skills to manage anxiety better - skills such as tuning in to triggers and early warning signs for anxiety, learning relaxation and mindfulness skills, shifting thoughts that contribute to anxiety, and gradually facing triggers for anxiety that they have previously avoided.
As with most things, sustaining the skills to manage anxiety in the longer term takes regular practice, and can easily get lost amidst the busyness of everyday life. So how can you ensure those anxiety management skills stay with you for years to come?
Enter the humble planner…rather than just serving as a To Do list, a planner can help with setting anxiety-related goals, keeping anxiety management skills on your radar, and track your levels of anxiety (and related concepts) so you can better understand and manage anxiety. Below we’ll show you how to use a planner to better manage your anxiety - we’ve used our Productive Life Planner which has specific sections for projects (or goals) and managing your wellbeing, but feel free to use any planner that will suit your needs.
TIPS TO BETTER MANAGE ANXIETY USING A PLANNER
Below we outline some tips for using a planner to help you better manage anxiety. These are based on our work over the years with the many individuals we’ve helped to make sustainable changes when it comes to anxiety, where we’ve seen what helps and hinders longer-term shifts in anxiety. These tips are by no means exhaustive, but will give you a good starting point. Let’s see how using a planner can help Heni.
Heni is a new graduate who has been experiencing anxiety for the past year. She has just commenced her first ‘major’ role in a high pressure environment, and is taking on challenges that she has not yet encountered. Heni is acutely aware of the need to look after her anxiety so that she can perform in her role and avoid burnout. She also recognises that she is prone to worrying about negative appraisals, which then feeds into her confidence levels and her anxiety.
1.Set goals for managing anxiety
Think of what goals you’d like to achieve when it comes to better managing your anxiety. Is it that you have an upcoming social function when the idea of making small talk with strangers causes you significant anxiety? Is it that you live in a house that has spiders when you have a spider phobia? Or is it that you want to be able to better manage your panic symptoms?
Whatever your goal is, use your planner to break down the larger, overarching goal, into smaller components that are less anxiety-provoking and move you gradually towards your overarching goal.
Heni has been tasked with the project of giving a conference presentation in April on behalf of her workplace. This is a trigger for increased anxiety for Heni - not only is it the first presentation she is giving on behalf of an organisation with high standards, she also suffers from public speaking anxiety.
To help reduce her anxiety, Heni decides to break this larger and more overwhelming task into smaller and more manageable actions using SMART goal-setting:
First, she reaches out to her colleague Will and buys him lunch to seek advice on designing her presentation. She also sets time frames to ensure she stays on track with this project.
Second, she decides to sign up to do a public speaking anxiety course, and looks at linking in a friend so she can practice her speech before the day.
2. Keep healthy habits on your radar.
There are many healthy habits you can adopt that support your anxiety and wellbeing. For example:
Habits for physical health include getting sufficient sleep, exercise, and nutrition.
Habits for psychological wellbeing include practising relaxation, journalling, and many of the psychological skills learned in therapy (e.g. exposure, controlled breathing, cognitive restructuring, mindfulness).
It’s easy for these habits to fall off your radar, so by using a planner as reminders to engage with the habit, you’re increasing your chances of looking after your anxiety.
Heni believes that there are a few things that are particularly helpful when it comes to managing her anxiety. She finds exercise and sleep to be vital for her to stay calmer. She also knows that journalling and reflecting on events of the day on a regular basis make a difference to her anxiety. Keeping these healthy habits on her radar using a daily planner helps her to stay on track.
3. Track stuff.
We’re talking all sorts of stuff to do with anxiety, including:
Physical and psychological habits that help you manage your anxiety.
Emotions such as anxiety, stress, overwhelm, and any other related concepts (e.g. level of social confidence when it comes to social anxiety, severity of worry in generalised anxiety disorder).
We especially love being able to track anxiety over weeks, months, and even a year, as tracking helps identify what particular triggers and patterns there may be to your anxiety (see the next point!).
Heni finds that tracking a combination of her moods (anxiety, overwhelm) and confidence level, as well as her energy and motivation, help her to see her progress with managing anxiety. She can also take this information in to her sessions with her psychologist and they can dissect the information together and set new goals.
4. Reflect
Once you have tracked emotions and habits related to your anxiety, use this data to help you reflect and learn more about:
What triggers your anxiety (e.g. prolonged weeks of tight deadlines, certain emotional stressors, or even a lack of exercise)
Which habits make a meaningful difference to your anxiety (do more of these!) and which habits may have less of an impact.
What helps you stick to your helpful habits and what reduces your ability to stay on track (e.g. busyness at work, burnout, late nights).
After consistently tracking her anxiety, Heni takes the information in to her session with her psychologist. They reflect on the patterns together, and identify that comparing herself to others and facing social situations more generally are triggers for increased anxiety. Using this information, they incorporate a few additional exercises in this area to help Heni better cope with such situations.
All of the above tips are designed to help you understand your anxiety better, and to help you stay on top of managing your anxiety. Using something as simple as a planner can really make a difference to how you understand and look after your anxiety.
If you’d like more tailored support to help stay on track with your anxiety, why not contact us and book in with one of our psychologists?
Working in FIFO: The challenges for mental health (and tips to help)
A FIFO lifestyle presents unique challenges to your sleep, relationships, and mental health. We cover these challenges and suggest tips to help you cope.
Managing mental health while FIFO
A Fly-in-Fly-out lifestyle is not for the faint-hearted – long days (think 12-hour shifts) working away in remote mining locations for weeks at a time, separated from family and loved ones, feeling isolated, sleep disruption, coping with heat and dust, and a workplace culture where bullying and sexual harassment are commonly reported. With these challenging conditions, it’s not surprising that approximately 33% of FIFO workers report a higher level of psychological distress compared to the average population [1]. FIFO workers experience higher levels of depression and anxiety symptoms as well as higher levels of burnout compared to the standard population [1]. This article outlines some of the unique aspects of a FIFO lifestyle, its impact on wellbeing and mental health, and offers tips to striking a helpful work/life balance. Read on to learn more about:
Common challenges in FIFO Roles
Signs your mental health might need support
Strategies to help your FIFO wellbeing
common challenges in fifo
FIFO roles are those based in remote locations away from towns, and often facing extreme weather conditions. Workers travel to site for several days or weeks at a time, then return home for days or weeks of rest (depending on rosters. Whilst on site, accommodation is often temporary (‘dongas’). Other common features of FIFO roles include long shifts (often 12 hours each day with highly regimented routines), working in male dominated industries (mining, construction, oil and gas), and working in an environment in which stigma regarding mental health often exists.
In light of the nature of FIFO work, it’s no secret that a FIFO lifestyle can take a heavy toll [2][3][4][5]. Let’s dive deeper into these challenges, and consider both workplace-based challenges (which may be harder to shift) and individual-based challenges (which we can have more influence and control over).
workplace-based challenges
Workplace-based FIFO challenges related to the organisation, how it structures work roles, the work environment itself (job conditions, physical environment), and also the organisational culture:
Workplace Culture. Numerous surveys point to the challenging workplace culture in FIFO environments, with gender-based discrimination, bullying and sexual harassment reported to be higher in what is typically a high pressure, male-dominated environment [1][6][7][8]. Living at camp means it can be difficult to separate from work, feel psychologically safe, find like-minded people to connect with.
Work Structure. Shiftwork, long hours, and roster length have all been shown to impact wellbeing. Shiftwork and long hours can increase fatigue due to disruption to sleep and sustained physical or mental demand [. The highly regimented structure of long hours with strict meal and recreation times can also create a challenge in maintaining connections with supports at home, especially if on night shift. Even-time and short rosters , choice in roster, and permanent rooms, are all linked to better mental health outcomes. [1][2][7]
Reduced Autonomy. The highly regimented nature of FIFO work (with strict compliance to safety and operational matters, and a highly structured daily routine and rosters) can lead to a reduced sense of control and autonomy and, in turn, poorer mental health outcomes. [1][2][3] Factors such as difficulty travelling home in emergencies, difficulty obtaining time-off or sick leave, changes to changes to camp rooms, and limited choice in job tasks, all impact mental health and a sense of agency over one’s life. [1][2]
Environmental Factors. Site-based work often occurs in harsh environments - heat, flies, dust, camp conditions, food onsite and access to recreational facilities, can all impact on mental health and wellbeing. Not having your creature comforts can be challenging, as can living out of your suitcase not knowing if you’ll return to your same donger can contribute to feeling displaced and unsettled. Is it any wonder that the environment can impact your wellbeing? [2][3]
individual-based challenges
Whilst punishing work conditions that accompany FIFO work contribute to poorer mental health, there are also individual-based challenges at play. These include:
Managing multiple demands. While working FIFO, employees can feel as though they are leading two separate lives. Depending on your commitments, it can look like a feast/famine cycle (e.g. long hours with a highly regimented daily routine with set times on site vs. nothing structured when on R&R) or a continuously busy cycle with little respite (e.g. long hours on site then coming home to dive right into parenting duties and taking care of the household). Continuous adjustment is required when travelling to/from site, and time away can impact on relationships, friendships and parenting.[2][3] Learning how to juggle these demands is key to maintaining good mental health.
Maintaining social connections. FIFO workers report that time away often can result in feeling socially disconnected. [2][3][5] Time away often means missing important events and celebrations in the lives of loved ones – missing out on friends’ major celebrations or children’s birthday parties - and can certainly create a barrier to forming new relationships or participating in activities on R&R.
Beliefs about seeking help. In spite of the higher prevalence of mental health difficulties in FIFO workers, there is often reluctance to seek support due to significant stigma. [4][8] A machismo culture of ‘getting on with it’ and ‘toughing it out’ means that seeking support may be viewed as a sign of weakness, resulting in help being sought at the point of high distress. The reality is that by seeking help along the way – to fine tune negative thoughts, or learning how to manage a suitable sleep routine whilst FIFO – it can actually help prevent things from getting to breaking point.
Golden Handcuffs. One of the main benefits of FIFO is the financial security, allowing for more investment into building a life, supporting partners and children, and moving towards financial freedom. However, the seductive financial benefits can often lead to ‘lifestyle creep’ (nicer toys, more holidays) and higher levels of debt. In turn this can lead in FIFO workers feeling ‘trapped in their roles, resulting in increased stress and potentially taking on more overtime to catch-up. [2][3][5]
signs of poor mental health in fifo workers
Research into the mental health of FIFO workers has shown higher rates of depression, anxiety, burnout, as well as higher overall psychological distress, compared to the standard population. [1][2][3][4] Some early warning signs that your mental health may be impacted can include:
Changes to mood: Feeling consistently stressed, numb, flat, or having a ‘shorter fuse’ than usual, or even reduced enjoyment during R&R.
Changes to health: Difficulty sleeping, trouble winding down, fatigue
Changes to behaviour: Withdrawing from social gatherings, increased alcohol and substance use, increased gambling
Dreading work: Finding it hard to travel to site (i.e. becoming increasingly anxious or down on fly-out day).
Even though these may be signs that you experience it doesn’t mean that you have to put up with it because it’s part of the job. There are steps you can put in place to help improve your mental health.
tips to manage fifo life: relationships, health, wellbeing
One of the biggest challenges to FIFO life is maintaining positive social connections and looking after yourself. Others may seem to get on with their regular daily and weekly routines back home, but as a FIFO worker you’re transplanted into another world for a few weeks at a time, disconnected from your regular life back home. Below are some tips to help with managing your FIFO life:
1. Sort out your priorities. Having a realistic understanding of the potential impact of FIFO work, and its challenges can assist in managing mental health and wellbeing. [1][2] Developing a plan with practical and financial goals, things to look forward to, and what you would like to get out of a FIFO career, all help with increasing a sense of autonomy and control.
2. Prioritise Relationships. FIFO workers who are happy with their personal relationships have been shown to have significantly better mental health and well-being. [1][3][5][9] This may include planning social activities on your R&R, having alternative ways of communicating to maintain relationships with those back home, and prioritising time-off for key celebrations or events. This could also include exploring social activities onsite and connecting with your crew.
3. Create a Routine. It’s common for FIFO workers to feel ‘lost’ or unsure of what to do on R&R, and therefore managing the transition between site and home can feel challenging. Creating a routine for site and home can help support wellbeing, as well as allowing you to make the most of your R&R.
4. Know your warning signs. Tune in to some of the early signs that you may need some extra physical or mental health support. These could be physical signs such as feeling consistently tired, headaches, or difficulty sleeping, as well as emotional signs such as difficulty switching off, feeling flat, or being snappier and more irritable than usual.
5. Check in with your physical health. FIFO work is demanding on your body, with long shifts, disruption to sleep schedules, night shift, heat, dust and continued physical demands. [7] It’s important to pay attention to your physical health, monitor alcohol and substance use, and work with a GP or psychologist to create a manageable sleep routine.
6. Reassess as needed. Remember to regularly check in with yourself and reassess how you are going. Different life stages will often mean different goals (financial, career, relationship) and balancing different demands (i.e. relationships, sport, parenting). As you go through different stages of your life, remember to reassess and develop new routines and goals.
7. Work with a psychologist. You do not have to wait until you are exhausted or at the point of burnout before working with a psychologist. Ways a psychologist can help include:
Laying the groundwork in preparing to start a FIFO role.
Helping you to build helpful sleep strategies.
Finding ways to support your relationships.
Helping you to find a work/life balance.
Supporting you with problematic alcohol or substance use.
An additional benefit of having periodic check-ins with a psychologist (like me!) is that psychologists are also trained to identify emerging wellbeing issues such as depression, anxiety, burnout, problematic alcohol use, and can work with you to build strategies to improve mental health and coping.
REFERENCES
[1] Parker, S., Fruhen, L., Burton, C., McQuade, S., Loveny, J., Griffin, M., ... & Esmond, J. (2018). Impact of FIFO work arrangements on the mental health and wellbeing of FIFO workers. https://www.mhc.wa.gov.au/media/2548/impact-of-fifo-work-arrangement-on-the-mental-health-and-wellbeing-of-fifo-workers-summary-report.pdf
[2] Roets, A. (2021, October 19). How FIFO work impacts mental health and well-being. Engineering Institute of Technology.. www.eit.edu.au/how-fifo-work-impacts-mental-health-and-well-being/
[3] Gardner, B., Alfrey, K. L., Vandelanotte, C., & Rebar, A. L. (2018). Mental health and well-being concerns of fly-in fly-out workers and their partners in Australia: A qualitative study. BMJ open, 8, e019516.
[4] https://www.mmhg.com.au/blog/depression-and-anxiety-in-mining-and-fifo-work-australia
[5] Brook, E. R. (2020). Fly-in/fly-out working arrangements: Employee perceptions of work and personal impacts (Doctoral dissertation, Murdoch University) https://researchportal.murdoch.edu.au/esploro/outputs/doctoral/Fly-in--fly-out-working-arrangements/991005544778107891/filesAndLinks?index=0
[6] Pupazzoni, R. (2023, Aug12). ‘Not acceptable’: Women in mining speak out against sexual harassment and discrimination. ABC News, https://www.abc.net.au/news/2023-08-12/women-in-mining-speak-out-against-decades-of-sexual-harassment/102699944
[7] Joyce, S.J., Tomlin, S.M., Somerford, P.J., Weeramanthri, T.S. (2013). Health behaviours and outcomes associated with fly-in fly-out and shift workers in Western Australia. Internal Medicine Journal, 43(4), 440-444. https://doi.org/10.1111/j.1445-5994.2012.02885.x
[8] Van Halm, I. (2022, October 27). Why the Australian mining industry needs to address workplace culture. Mining technology. https://www.mining-technology.com/features/why-australian-mining-industry-address-workplace-culture/?cf-view
[9] Meredith, V., Rush, P., & Robinson, E. (2014). Fly-in fly-out workforce practices in Australia: The effects on children and family relationships. https://nla.gov.au/nla.obj-400935781/view
Thank you to the FIFO workers who contributed to this article.
Emetophobia - when a fear of vomiting holds you back in life
Emetophobia, or a fear of vomiting, can have a significant impact on everyday life. Here’s a guide to signs of a phobia of vomiting and to treatments that work.
Emetophobia: when a fear of vomiting holds you back in life
By Giulia Villa
Many things that can be unpleasant or scary can be an unfortunate part of life: Spiders, heights, needles, flying. In this article, we’ll be talking about another addition to this category. That’s right - vomit. Among specific phobias, emetophobia, or an extreme fear of vomiting, is one not often spoken about. Keep reading to learn more about:
Why emetophobia is so debilitating
About emetophobia: What is emetophobia, and what makes it unique
Spotting the signs of emetophobia
Emetophobia, eating disorders, and OCD
Treatment options for emetophobia
And if you’re unsure about the difference between a phobia and the experience of fear or anxiety – take a look at this page where we clarify the distinction between these concepts in more detail.
How debilitating can a fear of vomiting be?
To those who don’t experience it, a fear of vomiting may not seem that problematic – after all it could be a low frequency event as some people do not vomit for years. However, emetophobia is so much more than that. Unlike, say, a fear of heights and flying which can usually be avoided, a fear of vomiting means chronic hypervigilance and manoeuvring for a wide range of everyday situations in which vomiting may be possible. Some examples include:
Your study group wants to go to a local cafe for lunch whilst you’re all working hard on a group assignment. Unfortunately you can’t take your own food in! You don’t know your study group that well, so you feel the pressure to go along with the groupthink. Whilst you’re there, there are all sorts of smells that make you want to gag… cheeseburgers, fish sauce, parmesan… it’s a minefield.
Your out-of-town relatives are visiting for the first time ever and really want to take a boat to an island to see quokkas which they won’t find anywhere else in the world. The mere thought of being stuck on a boat and experiencing motion sickness strikes fear into your heart.
There’s a morning tea at work to celebrate finishing a big project that you’ve played an important part in. However, you avoid going as you don’t want to eat or drink, and don’t want to spend that time explaining yourself.
You’ve been invited to a close friend’s wedding reception at a winery. Unfortunately there’s food you would not usually eat that’s been prepared by someone else, and the other guests will be people drinking alcohol. To top it all off…the winery is a 40-minute drive away along winding roads and your friend has organised a bus to and from the reception so that everyone can “feel more comfortable”.
From the above examples, it’s clear that a fear of vomiting can really affect daily life. Given its wide-ranging impact, let’s take a closer look at what emetophobia is.
What is emetophobia?
Emetophobia is an anxiety disorder which falls under the classification of a specific phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) [1] defines a specific phobia as:
An intense fear or anxiety about a specific object or situation that lasts at least 6 months
The phobic object/situation always provokes immediate fear or anxiety
The phobic object/situation is actively avoided or endured with intense fear or anxiety
The fear or anxiety is disproportionate to the actual threat posed by the phobic object or anxiety
The fear, anxiety or avoidance causes significant impairment to daily functioning e.g. not being able to eat food cooked by others, not seeing friends and family, not going to work etc.
The fear, anxiety or avoidance isn’t better explained by another medical disorder
Emetophobia is thought to affect between 0.1% and 0.2% of the population [2], though this is thought to be a conservative estimate [2], and usually starts in childhood or early adolescence. This condition is more common in women than in men.
what makes emetophobia unique
At its core, emetophobia shares many similarities with other specific phobias - intense fear, anxious thoughts, and avoidance. However, there are certain characteristics that are unique to the fear of vomiting which are important to consider:
Control in emetophobia
A distinct belief held by many people with emetophobia is that, if necessary, they can exercise enough physical control over themselves and their environment to prevent vomiting. Most people with emetophobia have not thrown up in a considerable length of time, and they credit their strategies (or safety behaviours, which we will look at in more detail) for this. In the context of treatment, this belief can make it very difficult for individuals to let go of such safety behaviours and coping mechanisms as they believe these are vital.
Gastrointestinal anxiety symptoms in emetophobia
A common feature of anxiety is stomach and intestinal discomfort. This is because of the strong connection between the brain and the body’s gastrointestinal system. When stress or anxiety becomes significant enough to trigger a fight-or-flight response, our body suppresses digestive functions in order to redirect resources to other areas and can lead to a reduced appetite, nausea, stomach pain/cramps, acid reflux, butterflies, and irregular bowel movements. With emetophobia this gets tricky, as intestinal discomfort can be anxiety-provoking in itself, catapulting individuals into worrying about whether they’re about to be sick.
This creates a vicious cycle, where the intense fear and anxiety around vomiting leads to physical sensations, which intensify the anxiety felt by the emetophobic individual. Over time, someone with emetophobia may become hypervigilant of their bodily sensations, constantly directing their attention towards sensations that could suggest the possibility of vomiting. For a person with emetophobia, a tummy gurgle or a brief wave of nausea has the power to trigger a spiral of anxious thoughts. Avoidance of vomiting then reinforces this cycle.
Spotting the signs of emetophobia
How do you know if you have emetophobia rather than just a dislike of vomiting? In addition to the chronic intense and disproportionate fear and anxiety in relation to vomiting, consider the role of avoidance and how it interferes with your daily life. Below are some common signs of avoidance that we commonly see in emetophobia - monitoring your environment on an ongoing basis to avoid these threats can be extremely debilitating indeed.
What’s the difference between Emetophobia, Eating disorders, and Obsessive Compulsive Disorder?
The lack of current research and training around emetophobia mean that this condition is unfortunately often misdiagnosed. Most commonly, emetophobia may at times be misdiagnosed as Anorexia Nervosa (AN) or Obsessive Compulsive Disorder (OCD) due to similarities between the conditions. Below we outline common and distinct features of these conditions in comparison to emetophobia.
Emetophobia and Anorexia Nervosa (AN)
People with emetophobia may restrict the types and quantity of food that they eat, in order to reduce or eliminate the risk of being sick, which might result in significant weight loss. Restriction of food is also a key feature of AN, but in the case of AN the restriction serves the purpose of weight control rather than avoidance of vomiting. Another key difference in these diagnoses is that AN is characterised by an intense fear of gaining weight and a sense of self-worth that is heavily influenced by one’s weight or shape (DSM-5). These features are not present in emetophobia, where the fear itself is of the act of vomiting.
emetophobia and Obsessive Compulsive Disorder (OCD)
Individuals with emetophobia may also take measures like excessive hand-washing and wearing a face mask to reduce the risk of contracting an illness that may lead to vomiting. Obsessive, persistent, and distressing thoughts that revolve around fear of exposure to germs are a symptom that might also both present in emetophobia and OCD.
An important distinction between a diagnosis of OCD and emetophobia is the presence or absence of magical thinking and ritualistic safety behaviours. While both conditions can involve seemingly irrational thoughts and excessive behaviours, the context and motivation behind these actions can help differentiate between the two conditions.
Magical thinking is a feature of OCD which refers to the belief that a person’s thoughts or actions have a very real potential to influence events, even in the absence of a logical cause-and-effect connection between the two. For example, someone with contamination OCD might think "If I don't wash my hands exactly seven times after touching a doorknob, I'll get sick and start vomiting." In emetophobia whilst the act of hand washing is seen to reduce the likelihood of contamination, there is not stipulation around the number of times this is to be performed.
Ritualistic behaviours are also a feature of contamination OCD that can distinguish it from emetophobia. Rituals and other neutralizing behaviours are a hallmark of OCD. These compulsions, (e.g. repetitive hand washing, excessive cleaning, checking, counting, arranging objects in a specific way) are carried out in an attempt to prevent feared outcomes (i.e., vomiting) or reduce the anxiety caused by obsessive, irrational thoughts. Thus, someone may wash their hands exactly seven times, and in a prescribed order (and, if interrupted when performing this ritual, will feel compelled to restart the ritual again).
Individuals with emetophobia may also engage in similar excessive behaviours like frequent hand-washing or avoiding certain foods, however these actions do not have a ritualistic flavour to them but instead these behaviours (frequency, number) have a straightforward link to preventing vomiting. For example, someone with emetophobia who fears contracting a stomach virus may thoroughly wash their hands once. However, they are unlikely to believe in washing their hands a specific number of times or in a particular way in order to guarantee that they won't become ill.
Treatment options – what works for emetophobia
The recommended treatment for all specific phobias is Exposure Therapy as part of Cognitive Behaviour Therapy (CBT). Essentially, this involves facing vomit-related fears, and thus the thought of exposure therapy can be incredibly intimidating as it involves confronting the very subject of fears.
Facing something that we are scared of is daunting, which is why it’s important to work with a trained professional who can guide you at a pace that stretches you but does not create excessive fear. The goal of exposure therapy is to shift your fear of vomiting, help your body to adjust to the increase in anxiety in that situation, and then to help you recognise your ability to cope.
Treatment for emetophobia needs to be highly tailored to the individual, because different people experience the phobia in different ways and intensities. Working with a psychologist helps with considering where the individual is at, what typical triggers there are, and what avoidance strategies are in place. Consider:
Ty may have a fear of vomiting and overestimates the likelihood of himself vomiting. He works as a librarian in administration and is not often exposed to people vomiting, nor is he concerned by others vomiting. Ty’s main concern when it comes to vomiting is in his personal life – his friends are all hitting the age of weddings and he anticipates having to eat many foods that he considers ‘unsafe’.
Priya is a doctor who will be rostered to work in the gastroenterology department in a few months’ time. She cannot stand seeing others vomit and is very worried about catching illnesses from people who are unwell. Needless to say, her emetophobia makes work extremely challenging. Priya also wants to start a family in the near future, but experiences extreme fear due to the prospect of feeling nauseous due to morning sickness.
Thus, whilst both Ty and Priya have emetophobia, treatment will look different for them due to the differences in triggers, situations where they have to face vomiting, and the impact on their lives.
What does treatment of vomit phobia look like?
After a thorough and individualised assessment, a therapist will guide you through systematically increasing your tolerance to these three key areas:
The physical sensations associated with vomiting (e.g. nausea, stomach pain).
Vomit-related triggers like words, pictures, sounds, and videos
Environmental triggers, such as food, smells, and public places
Treatment for emetophobia also involves a cognitive component which aims to challenge and restructure unhelpful thoughts and beliefs that are contributing to the fear. Working one-on-one with an experienced clinician means that you will be receiving a tailored approach that will provide you with adaptive skills to take into your life outside of therapy.
Here at The Skill Collective we work with emetophobia – and the following psychologists in our team have a passion for exposure therapy, so why not book in and get started on shifting this debilitating fear?
REFERENCES
[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.
[2] Becker E, Rinck M, Türke V, Kause P, Goodwin R, Neumer S, Margraf J. (2007). Epidemiology of specific phobia subtypes: Findings from the Dresden Mental Health Study. European Psychiatry,22,69–74. doi: 10.1016/j.eurpsy.2006.09.006.
[3] Sykes, M., Boschen, M. J., and Conlon, E. G. (2016) Comorbidity in Emetophobia (Specific Phobia of Vomiting). Clinical Psychology & Psychotherapy., 23: 363–367. doi: 10.1002/cpp.1964.
7 tips for living with social anxiety
Living with social anxiety can be limiting and lonely. If you find that your fear gets in the way of you living your best life, read on to find out how to turn things around.
7 tips for living with social anxiety
By Joyce Chong
In the 2007 National Mental Health and Wellbeing survey that surveyed 16million Australians to gain a picture of the nation’s Mental Health we found that anxiety is the most common mental health disorder experienced by individuals. (see here for a brief summary)
Within anxiety, social anxiety is the second most common anxiety disorder experienced (behind posttraumatic stress disorder). Social anxiety is linked with poorer quality of life and workplace productivity [1] and also with the increased use of alcohol and cannabis.[2]
If you're one of the many who experience social anxiety or know of someone who does, read on for our 7 tips for living with social anxiety. We've also included a printable version at the bottom of the article.
1. Know the difference between shyness and social anxiety
It’s easy to fall into the trap of seeing social anxiety as just an extreme of shyness. Indeed, there is a higher rate of social anxiety amongst shy individuals compared to individuals who aren’t shy, however the majority of shy individuals do not have social anxiety.[3]
However, social anxiety differs from shyness in that there is a marked level of fear involved, there is avoidance of feared situations, there is a strong fear of negative evaluation, and the social anxiety has a negative impact on functioning in several areas of life (e.g. work performance or relationships).
For example, a student may feel shy in a tutorial room, but if that person is distressed at the prospect of having to speak in the tutorial, and the tutorials have a participation component that students must pass (that is, they risk failing the entire unit if they don’t contribute) then we are looking more at a picture of social anxiety.
Did you know that for some, the anxiety is present only in situations where performance is concerned? So, while they may do well in most aspects of socialising, there may be anxiety just when doing public speaking or talking to people in positions of authority (e.g. managers, lecturers).
2. Take action…now!
Social anxiety typically starts between late childhood and mid-adolescence, with sufferers waiting an average of 15-20 years before they seek treatment.[1]
Given the wide-ranging impact of these social fears, it is understandable that social anxiety is linked with poorer quality of life and wellbeing – how restrictive would it be if you were afraid to go for a job interview, ask someone for directions, ask a question of your teacher, or even looking people in the eye in a passing conversation in case they think negatively of you?
How long have you lived with social anxiety? How does it hold you back in your life? Take action now so that you don't have to continue to live this way.
3. Challenge your avoidance
Avoiding a scary situation may bring you immediate relief, but over time you may notice that more situations cause you anxiety, or that your anxiety gets more intense.
The reality is that striving to feel safe all of the time is unrealistic, and trying to achieve this means that the number of situations in which you feel comfortable starts to rapidly shrink.
Make changes by taking one small step at a time. For example, if you're afraid of making conversation with people, start off by making small talk about the weather with the check out operator at a new grocery store, then build up to making small talk with the receptionist at your doctor's surgery. It takes one small step to get the ball rolling.
4. Rethink your drink
Social anxiety is associated with an increased rate of alcohol dependence. [4] Alcohol is often used to cope with nerves before and during a social situation, but it's important to rethink your drink and take a good hard look at whether it's just another form of avoidance.
Why is using alcohol to cope with anxiety a bad thing when many of our social situations involve alcohol? Well, alcohol may make you feel less anxious in the short term, but in the longer term do you learn that you can cope without a drink? Sound familiar? Refer to Point 3 – yes, using alcohol sounds like a form of avoidance.
5. Check your thoughts
Are your thoughts and thinking styles making your anxiety worse? Tune in to your thoughts when you first notice anxiety building up in a social situation. Are you making an incorrect assumption? Are you jumping to conclusions, or catastrophising by focusing on the worst case scenario?
If you're giving a presentation, do you assume that one small mistake in your presentation means that you have made a fool of yourself? Will the worst case scenario of being laughed at by everyone really come true?
We’ve previously blogged about Checking your Thoughts in relation to social anxiety here in our post on social anxiety and Christmas functions so use that as a starting point. You can also find more information on thinking styles here.
6. Conduct an experiment
Sometimes we believe what we believe because we haven’t had evidence to the contrary. Let's say you keep your head down on the bus because you think that others on the bus will stare at you. By keeping your focus on your feet or phone, you won't see that they’re not staring at you. In other words, your belief is reinforced or, at the very least, not disputed.
Let’s mix things up a little. Let’s conduct an experiment by sitting at the back of the bus, and then watching what people actually do. Chances are, you’ll see that people are either looking at their phones, or looking out the window. The thing is, though, you won’t really know unless you do the experiment to test your belief.
7. Seek professional help
A lot can be done to help with social anxiety, so please take action before 15-20 years pass you by (see Point 2). Psychological treatments such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to be effective in the treatment of social anxiety.[5] You can also speak with your GP to discuss medication options.
Thanks for reading. We hope that the tips on managing social anxiety are helpful.
Want more? Learn about Social Set, our 8-session Social Anxiety Course. Work one-on-one with a psychologist to develop a tailored approach to bounce back from social anxiety.
REFERENCES
[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition, DSM-5). Washington: American Psychological Association.
[2] Buckner, J.D., Schmidt, N.B., Lang, A.R., Small, J.W., Schlauch, R.C., & Lewinsohn, P.M. (2008). Specificity of Social Anxiety Disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42, 230-239.
[3] Heiser, N.A., Turner, S.M., & Beidel, D.C. (2003). Shyness: relationship to social phobia and other psychiatric disorders. Behaviour Research and Therapy, 41, 209-221.
[4] Schneier, F.R, Foose, T.E., Hasin, D.S., Heimberg, R.G., Liu, S.M., Grant, B.F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40, 977-988.
[5] Craske, M.G., et al. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. Journal of Consulting and Clinical Psychology, 82, 1034-1048.
Perimenopause: What it is and how to cope with the physical and emotional impact
Perimenopause - or the period of transition into menopause - can be a time of great upheaval when it comes to the physical, mental, and social aspects of life.
Perimenopause: What it is and how to cope with the physical and emotional FALLOUT
By Joanne Collyer and Joyce Chong
Menopause is a significant time in a woman’s life, marking the end of ovulation and signalling the end of natural fertility. In the lead up to this time, hormones fluctuate, leading to a range of symptoms - physical (hot flushes, night sweats, weight gain), emotional (mood swings, irritability), and cognitive (brain fog, slower processing speed)[1]. As a result, relationships, work interactions, and performance can all suffer, leading to poorer quality of life, lower self-esteem, and depression. Discussions about menopause have largely been ignored in the media, and women often find themselves wading through a combination of uncomfortable symptoms, wondering what is happening to their mind and body. To demystify this, we take a closer look at the transition phase into menopause – perimenopause – and the changes that happen at this stage in life. This article covers:
What is Menopause (+ Perimenopause)
Perimenopause – the time(ing) of your life
Psychological distress and identity shifts in perimenopause
What predicts adjustment and coping during perimenopause
Tips to help navigate perimenopause
WHAT IS MENOPAUSE (+ PERIMENOPAUSE)
Menopause occurs following your final menstrual period and signals a time when your body is no longer ovulating, often occurring between the ages of ages of 45 to 55[2]. Menopause can also occur earlier due to medical reasons (medical condition such as primary ovarian insufficiency, cancer treatment, or surgery).
Perimenopause refers to the period of transition into menopause – it’s the last stage of your reproductive years during which ovaries slow down egg production, and hormones (oestrogen and progesterone) fluctuate. Perimenopause usually occurs in the few years prior to menopause, and generally occurs in your forties. Fluctuating levels of estrogen during perimenopause can result in a range of symptoms, including[3]:
Physical: Hot flushes, night sweats, dry skin, reduced libido, body aches, insomnia, and lower energy are all very common in perimenopause. irregular menstrual cycles and heavy bleeding. Additionally, declining levels of oestrogen leave you more vulnerable to osteoporosis[4] and heart disease[5]. Body shape may also change as oestrogen levels decline.
Cognitive: Brain fog, reduced psychomotor speed, memory difficulties are common symptoms[6]. This can lead to difficulties in word finding and information processing, which can impact performance and communication.
Emotional: Mood changes are very apparent in perimenopause, with anxiety, sadness, depression, and anger observed. These can lead to negative interactions with others, which in turn can exacerbate stress and anxiety[7][8].
Psychological: Perimenopause is also a time of significant psychological adjustment not only to the physical changes but also adjustment to life roles and a shift in identity. We’ll cover these in greater detail later in this article.
perimenopause – the time(ing) of your life
Compounding the challenges of perimenopause is its timing – usually in midlife, and often coinciding with increased responsibilities including:
Caring responsibilities – parenting children whilst also caring for parents (the sandwich generation), and also fur babies.
Work responsibilities - Those at this stage in life often find themselves in a senior role at work and in charge of a team. This can also lead to heightened responsibility for the wellbeing of your team.
Mental load - juggling the coordination of various healthcare appointments, multiple work tasks, multiple social calendars, balancing finances, and maintaining positive relationships.
Between increased responsibilities during midlife, and the physical and psychological effects of perimenopause (reduced sleep, concentration problems, mood swings), something has to give. Unfortunately, that may be a poorer quality of life, increased stress, impacted relationships, and increased vulnerability to burnout. The impact of these challenges is very real - research has highlighted, for example, that in workplaces the severity of the physical symptoms of perimenopause affect job performance, and the severity of the psychological symptoms affect job retention.[9]
PSYCHOLOGICAL DISTRESS AND IDENTITY SHIFTS in perimenopause
The psychological changes experienced during this time often centre on identity and ageing, but can also include feeling a loss of control overall and a perceived shift in personality. Take for example:
Someone who has not started or completed their family: Perimenopause can cause distress as it represents loss of hope, particularly if they have entered into early menopause.
Someone for whom youth and fertility are tied to their identity: Perimenopause and the inevitability of ageing may be hard to face, particularly in a society that values youth, and it can lead to feelings of invisibility and affect self-esteem and body image. It may also prompt reflection on where they are at in life (and whether there are dreams they haven’t yet fulfilled).
Someone used to being in control and capable of multitasking can find the perimenopausal symptoms of increased forgetfulness and lower energy can lead them to feel disorganised and incapable.
Someone who takes pride in being a calming influence may find experiencing irritability, mood swings, and even rage to be challenging to their sense of self and to their relationships.
Given the potential for identity to be impacted, it’s no wonder that grief, loss, anxiety, depression can emerge during perimenopause. Perimenopause can also exacerbate pre-existing anxiety and depression.
what predicts adjustment and coping in perimenopause
Several psychological factors have been linked to positive coping in perimenopause. These include:[10]
Optimism is linked with positive adjustment to perimenopausal symptoms.
Higher levels of emotional stability and emotion regulation are linked to lower levels of stress and depression symptoms during perimenopause.
Self-compassion predicts emotional balance as it promotes a non-judgemental approach to the self.
Higher self-esteem appears to be linked to better adaptation to stress, lower depression symptoms, and fewer menopausal complaints.
The presence of the above factors is related to lower psychological distress and higher life satisfaction, and more positive mental health in perimenopause.
Tips to COPE with perimenopause
With all of the changes that you face physically and psychologically during perimenopause, here are our top tips to help navigate this significant time.
1) Link in with your GP
With the multiple changes in your life (physical, emotional, behavioural, cognitive), it helps to connect with a GP well-informd about menopause to coordinate your team. This may include linking in with dietitians, exercise physiologists, and psychologists. Your GP can also provide guidance if you are considering menopause hormone therapy.
2) Look after your physical health
When it comes to looking after yourself during this time, take steps to improve your physical health to ease perimenopause symptoms and reduce future health risks associated with menopause.
a. Adopting a healthy diet to reduce hormonal fluctuations and maintain a healthy weight. A balanced meal consisting of whole foods, vegetables, and lean protein, with minimal sugary and processed foods, as well as foods high in saturated fats is recommended. Staying hydrated and limiting alcohol consumption is also beneficial, as is taking a bird’s eye view of your nutrition as you plan to reduce the risk of osteoporosis and cardiovascular disease.
b. Improving your sleep to help you to think clearly and regulate your emotions. Practising good sleep hygiene, reducing stress, and creating a relaxing bedtime routine all help.
c. Exercising to support stress, adjustment, and healthy ageing. Regular physical exercise supports healthy ageing and adjustment during perimenopause. Walking, swimming, weight training, and yoga are great choices and readily accessible. Exercise helps your physical health by preventing age-related conditions such as osteoporosis and cardiovascular disease, and boosts your energy levels. Exercise also benefits psychological health, helping with stress management, emotion regulation, and motivation levels.
3) Managing stress
Helpful coping skills can go a long way to reduce the impact of perimenopausal symptoms as increased stress can exacerbate sleep issues, brain fog, and hot flushes. Concurrently, reduce reliance on unhelpful coping skills such as relying on alcohol use and falling back on emotional eating. Replace them with more helpful coping skills including:
a. Problem-focused coping skills to help reduce stress where you can. This may draw upon time management, assertive communication, and goal-setting.
b. Emotion-focused coping skills can including building helpful self-talk through cognitive reappraisal, practising self-compassion, talking through emotions, mindfulness, meditation, and social support.
4) WORK WITH a psychologist with knowledge of issues associated with perimenopause
Link in with a psychologist well-versed in working with menopause and the challenges in this stage of life. A supportive psychologist can help you to clarify your concerns and help you find a way forward by:
a. Understanding the changes you’re experiencing, and to assist you with adjustment and acceptance of the transition into a new phase of your life.
b. Coping with juggling multiple responsibilities. Your psychologist can help you identify stressors and formulate a plan of attack, drawing on a range of problem-solving skills including time management, assertive communication, and shifting unhelpful mindsets. They can also help you with increasing self-compassion.
c. Coping with grief and loss of identity due to ending one phase of life and starting the next, and adjusting to this great change in your life. As part of this, work with your psychologist on improving self-esteem, redefining meaning in life if you are feeling lost, and building optimism for the future ahead of you.
d. Improving emotion regulation and mental health through helpful self-talk, reducing irritability, improving communication to support healthy relationships, as well as helping you with mindfulness and grounding techniques.
e. Improving communication and relationships with partners, children, and more generally with friends and colleagues. Partner relationships and parenting relationships come into sharp focus at this time, and a psychologist can support you to build better communication and relating skills.
f. Supporting healthy habits. Adopting healthy lifestyle habits - from exercising, to sleeping well, to reducing alcohol - is often easier said than done. Lifestyle procrastination is very real, and your psychologist can help you maintain your goals for exercise, sleep nutrition, and other forms of self-care.
Further reading:
Perimenopause | Jean Hailes: For general information on perimenopause and other women’s heath conditions, this is a great resource.
Menopause and mental health - Australasian Menopause Society: For further information on perimenopause and mental health.
Management of the Perimenopause - PMC (nih.gov): L. Delamater, MD & N. Santoro, MD, Clin Obstet Gynecol. 2018 Sep; 61(3): 419–432.: For information on underlying hormonal changes and medical insight regarding the different stages of peri-menopause.
REFERENCES
[1] Simpson, E. E. A., Doherty, J., & Timlin, D. (2023). Menopause as a window of opportunity: the benefits of designing more effective theory-driven behaviour change interventions to promote healthier lifestyle choices at midlife. Proceedings of the Nutrition Society, 1–10. doi:10.1017/S0029665123004810
[2] https://www.jeanhailes.org.au/health-a-z/menopause
[3] https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
[4] https://www.menopause.org.au/hp/information-sheets/osteoporosis
[5] https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease#:~:text=If%20your%20oestrogen%20levels%20fall,risk%20of%20coronary%20heart%20disease.
[6] Than, S., Moran, C., Beare, R., Vincent, A., Lane, E., Collyer, T.A., Callisaya, & Srikanth, V. (2023). Cognitive trajectories during the menopausal transition. Frontiers in Dementia, 2. DOI=10.3389/frdem.2023.1098693
[7] de Kruif, M., Spijker, A.T., & Molendijk, M.L. (2016). Depression during the perimenopause: A meta-analysis, Journal of Affective Disorders, 206, 174-180. https://doi.org/10.1016/j.jad.2016.07.040.
[8] Alblooshi S, Taylor M, Gill N. (2003). Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australasian Psychiatry, 31,165-173. doi:10.1177/10398562231165439
[9] Steffan, B., & Potočnik, K. (2023). Thinking outside Pandora’s box: Revealing differential effects of coping with physical and psychological menopause symptoms at work. Human Relations, 76(8), 1191–1225. https://doi.org/10.1177/00187267221089469
[10] Süss H, Willi J, Grub J, Ehlert U. (2021). Psychosocial factors promoting resilience during the menopausal transition. Arch Womens Mental Health. 24,:231-241. doi: 10.1007/s00737-020-01055-7.
Public speaking anxiety at work: Tips to manage a common challenge
Public speaking anxiety holding you back at work? Step up to the next level with these tips to help you manage your anxiety.
STEPPING UP AT WORK: TIPS FOR OVERCOMING PUBLIC SPEAKING ANXIETY TO HELP YOUR CAREER
By Giulia Villa
What holds you back at work? Over your working life, there will inevitably be barriers and missed opportunities. At times, these barriers will be external – the work environment may not be suitable, or the workload unrealistic. At times, however, these barriers are internal – your mindset, skills, and habits get in the way of stepping up to the next level at work. Some examples of these include difficulties with being assertive at work and setting boundaries, managing procrastination, managing a team, or managing burnout. Another common internal barrier we often see – that touches so many areas of working life – is that of public speaking. In fact, public speaking is seen as an important skill in the workplace. However, a fear of public speaking – or glossophobia – is widespread, with estimates ranging from upwards of 20% to a whopping 75% of populations. How far-reaching is the impact of public speaking anxiety at work? Let’s look at some examples:
Ella, a high-achieving teacher, has been asked by the Department of Education to train a cohort of early-career teachers. In spite of her passion for educating the next generation of teachers, Ella is considering turning down the role because it involves public speaking – training large groups of teachers, giving regular progress updates to senior staff, and speaking at Department of Education conferences. At present, Ella copes with public speaking anxiety by preparing for hours to reduce the likelihood of making mistakes and ease her anxiety. She knows given the sheer number of sessions she will be delivering, it will not be possible to overprepare for each session whilst maintaining her usual teaching duties without experiencing burnout. Ella could turn down the position and keep her workload and anxiety more manageable, however she knows she will feel trapped remaining at her current level, without opportunity to progress.
Oliver was recently promoted to management level due to his excellent technical skills as an engineer. However, while he excelled at research, problem solving, and producing written deliverables, the director of his team has recently expressed concern at Oliver’s performance in his new role. Notably, Oliver has cancelled several meetings, preferring instead to communicate via email to avoid being put on the spot and to have time to plan what to say. Rather than delegate project work to the team and Oliver being the ‘face’ of the project, Oliver carries out the technical work himself and assigns more junior staff to present project updates and lead team calls. After a conversation with his director, understands he will struggle to progress in this workplace without tackling his avoidance of public speaking.
The situations faced by Ella and Oliver are just a few examples of how typically high-performing individuals may be held back by their fear or avoidance of public speaking in their workplace. Let’s break down public speaking anxiety a little further. In the DSM-5-TR (2022) public speaking anxiety is a specific subset of social anxiety. Key features of this type of anxiety include:
A fear of acting in a way or showing anxiety symptoms (e.g., blushing, trembling hands, excessive sweating) that will be embarrassing or lead others to negatively judge the speaker or the content of the presentation.
An avoidance of public speaking situations, or enduring these situations with fear and anxiety. Avoidance might crop up as frequent sick days, low involvement in work meetings, joining calls at the latest possible moment, or agreeing with everyone to avoid conflict.
The fear provoked by public speaking situations and the possibility of being judged negatively by others is intense and significantly impacts one’s functioning in their work and/or social life.
HOW PUBLIC SPEAKING anxiety HOLDS YOU BACK AT WORK
As we’ve seen in Ella and Oliver’s examples, there are many situations at work in which public speaking may have a negative impact and hold you back from succeeding in your career. Let’s take a closer look at some of these scenarios.
NETWORKING: A MINEFIELD FOR SOCIAL ANXIETY
Networking is often a highly dreaded activity for those with public speaking anxiety – in effect it’s being ‘on show’, making small talk in a work context, often in small groups. However, networking has become an essential component of success in our hyper-connected society – did you know over half of jobs are never publicly advertised? In 2016, LinkedIn reported that 70% of professionals starting a new role already had an existing connection at their company. The takeaway? You’ve got to meet groups of people and make connections so as to be at the forefront of people’s minds when upcoming jobs arise. Unfortunately, nerves about being on show in public can make the ever-important act of networking a nightmare and may lead you to connect online, to avoid unfamiliar people, or even to undersell yourself during in-person networking events. In any case, anxiety stops you from making the most of an important networking opportunity.
WORK MEETINGS
Speaking up in front of others – whether it’s the weekly check in around the meeting table, or your turn to give an update on a project – can feel extremely daunting to someone who dislikes public speaking. You may focus on all eyes being on you, and have spent the night before thinking about how exactly to present what you need to but minimise your time ‘on display’.
Post-pandemic flexible work arrangements may mean that many meetings now take place over video calls. For some, these online meetings may be even more anxiety-inducing than face-to-face meetings. You may feel more aware of being watched and of being negatively judged by others, and thus experience more pressure to perform well. Social anxiety can also lead to a greater focus on scrutinising one’s own onscreen image, thus amplifying self-consciousness. Additionally, brief moments of silence that feel natural in person may become accentuated and feel awkward in a video call.
DELIVERING PRESENTATIONS AND SALES PITCHES
If the idea of delivering a presentation to a client or even your own colleagues is enough to make your heartrate quicken, you may have developed ways to deal with this seemingly inevitable anxiety. For example, you may spend hours overpreparing like Ella. Or you may be so focused on getting the presentation over and done with, you don’t have much energy to put into designing the presentation itself. Then, of course, there is question time – a period where you don’t know what questions will be thrown at you.
A good presentation in a work setting boils down to how you design your presentation and the speaking techniques that you employ to deliver your message. Unfortunately, it can be incredibly challenging for someone with anxiety to simultaneously manage uncomfortable physical symptoms, quiet down unhelpful self-talk, remember the content, and remember how to deliver it, and have the presence of mind to adapt the presentation to the audience.
Public speaking anxiety might also affect your presentation by impacting:
Speech rate
Tone of voice
Posture and body language
Use of filler words
Use of visual materials
Engagement with the audience
Public speaking anxiety may hold you back from being able to recognise what style is most appropriate for your audience and situation, and also on helping you to handle unknown questions (as part of question time). This is where we can help – keep reading to find out how our team of counsellors and psychologists can help you manage anxiety and become a more confident public speaker in your workplace. We’ve helped students manage anxiety for their university presentations, helped doctors to present confidently in their clinical exams, helped teachers to present to peers and parents, and helped professionals develop networking and sales pitch skills. We enjoy helping people grow their skill set and their confidence.
tips for managing PUBLIC SPEAKING ANXIETY
Try the following tips for managing social anxiety at work:
TIP 1: LEARN TRIGGERS AND HABITS THAT MAINTAIN PUBLIC SPEAKING ANXIETY
What exactly is it about public speaking that causes you anxiety? Perhaps it’s the idea of drawing attention to yourself, or perhaps you’re worried about visibly freezing or sweating. Having a clear grasp on what causes and maintains your anxiety goes long way in developing a targeted action plan to reduce your fears.
TIP 2: DISMANTLE UNHELPFUL SELF-TALK THAT FUELS YOUR FEAR OF PUBLIC SPEAKING
Negative self-talk is a common thread underpinning public speaking anxiety. The ‘stories’ you tell yourself can increase your anxiety. For example, Ella might notice a senior staff member check their phone during one of her presentations. Self-talk along the lines of “I’m not doing enough to hold their attention, they can tell I’m inexperienced and underprepared” is likely to make Ella more nervous, possibly increasing her likelihood of making mistakes.
On the flipside, self-talk can also be a helpful tool to reduce anxiety and help you to feel more comfortable during your presentation. A more helpful thought for Ella in the above situation could therefore be, “They may be checking their phone as they could be expecting a call”. In this case, Ella would feel less nervous and better able to continue with her presentation as planned.
TIP 3: FINE-TUNE YOUR PRESENTATION STYLE
We all have a different idea of what it means to be a good public speaker. Presenter ‘personas’ can vary widely across people, furthermore different types of speeches require different styles and components – presenting a sales pitch marketing muesli requires a different approach to delivering a lecture on research developments in biotech. By clarifying your goal – for example, who is your target audience (Formal? Informal?), what are you trying to achieve (Sell a product? Disseminate information?) – you have a clearer idea of how to shape your message and design an effective presentation. By having confidence in your materials and your messaging, you will also feel more comfortable in delivering!
TIP 4: GET EXPERIMENTING
Running ‘experiments’ on yourself is a great way to challenge pesky thoughts and fears that are standing in the way of your career success. Thoughts aren’t exactly the most reliable source of information when it comes to public speaking – fears that ‘everyone will laugh at me’ or ‘if I stumble over my words I’ll get fired’ can disproportionately dial up your anxiety to the point of interfering with your presentation.
In order to move past your fears try setting up small behavioural experiments to test how true these predictions are. The next time you are asked to speak in front of others, perhaps intentionally slip in a small mistake. Carefully notice the reaction of your audience – does it fit with your predictions? This testing can help you to determine whether the evidence fits with what you’ve been telling yourself.
If you’re interested in a tailored approach to dismantling your public speaking anxiety at work, check out our Speaking Volumes course. Over six weeks (allowing for time to practice your new skills in between sessions), you will work individually with one of our clinicians through an evidence-based, practical approach, to reduce public speaking anxiety and provide you with the skills and tools you need to succeed in the workplace.
Speaking Volumes, our 6-week course to help with public speaking anxiety covering how to improve your presentations skills as well as anxiety management skills (cognitive restructuring, exposure therapy). This course is based on CBT and social skills training.
REFERENCES
Aderka, I.M., Hofmann, S.G., Nickerson, A., Hermesh, H., Gilboa-Schechtman, E., & Marom, S. (2012). Functional impairment in social anxiety disorder. Jounral of Anxiety Disorders, 26, 393-400. Doi: 10.1016/j.janxdis.2012.01.003
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). American Psychiatric Association Publishing.
Blöte, A. W., Kint, M. J. W., Miers, A. C., & Westenberg, P. M. (2009). The relation between public speaking anxiety and social anxiety: A review. Journal of Anxiety Disorders, 23(3), 305–313. https://doi.org/10.1016/j.janxdis.2008.11.007
Ebrahimi, O. V., Pallesen, S., Kenter, R. M. F., & Nordgreen, T. (2019). Psychological Interventions for the Fear of Public Speaking: A Meta-Analysis. Frontiers in psychology, 10, 488. https://doi.org/10.3389/fpsyg.2019.00488
Martin-Lynch, P., Correia, H., & Cunningham, C. (2016). Public speaking anxiety: The S.A.D. implications for students, transition, achievement, success and retention. In: Students Transitions Achievement Retention & Success (STARS) Conference 2016, 29 June - 2 July 2016, Perth, Western Australia. https://researchrepository.murdoch.edu.au/id/eprint/39766/1/SAD.pdf
Vriends, N., Meral, Y., Bargas-Avila, J.A., Stadler, C., & Bogels, S.M. (2017). How do I look? Self-focused attention during a video chat of women with social anxiety (disorder). Behaviour Research and Therapy, 92, 77-86. https://doi.org/10.1016/j.brat.2017.02.008.
Social anxiety at work: How social anxiety affects your performance
What is it like showing up at work when you live with social anxiety? In this article we dive into tips to help you better manage social anxiety in the workplace.
How social anxiety AFFECTS work
By Giulia Villa and Joyce Chong
Living with social anxiety can be challenging, particularly in the workplace. Even if your job seemingly does not involve much social interaction (for example, working with computers, in data entry, as an author, or as an artist) when you dig a bit deeper it’s surprising how many social interactions are involved in performing your role. These situations include speaking to colleagues and managers, speaking up in meetings, giving a presentation, even being ‘put on the spot’ and asked for your opinion. Other roles may involve a greater social component including networking, client contact, and pitching projects. Indeed, social anxiety can be quite debilitating in the workplace. Let’s take a look at a few examples:
Will is an engineer who wishes to become a manager and lead interesting projects within the organisation. However, a major obstacle is Will’s social anxiety and his worries that others think that he is incompetent. His social anxiety stops him from sharing ideas in a meeting, giving project updates, and networking at industry events to build industry connections. Will’s fears lead to excessive preparation in relation to reading up and fact-checking, on rehearsing what he is going to say, and on anticipating how others may react. Needless to say, this increased workload - and mental load - has brought Will close to burnout a number of times, and he sees that if he were less concerned about what others think that he could be more productive and less overwhelmed.
Ali believes that social anxiety has led to a ‘failure to launch’ in their career as an accountant. Having lived with social anxiety for decades, they’ve found many ways to minimise their social anxiety through avoidance. Ali avoids the lunchroom to reduce the likelihood of making small talk, agrees with others’ opinions just to avoid conflict, and is unable to set boundaries regarding their workload. Ali does not apply for jobs that require interviews, instead working for family friends who sought them out because that way they know they’re good enough to be wanted in the workplace. In fact, Ali rationalises their way out of applying for promotions because this would involve an interview as well as potential rejection. Even if Ali were to be successful, it would then mean meeting new people (and facing the possibility of additional rejection). an element of public speaking, they avoid the lunchroom in case small talk arises, and agrees with others’ opinions at work just to avoid conflict. Ali is also unable to set boundaries at work and as a result feels taken advantage of, as well as feeling overwhelmed.
Ali and Will are not alone. Let’s dive deeper into situations at work that can be challenging for those experiencing social anxiety (see below):
What is social anxiety?
According to the DSM-5-TR (2022), some core features of social anxiety include:
* Significant anxiety regarding social situations wherein one may be scrutinised by others, with a fear of acting or behaving in a way that will lead to being negatively evaluated.
* The fear or distress is persistent, out of proportion to the situation, and interferes with functioning (e.g. occupational, social).
* These social situations are avoided, or endured with intense anxiety. Avoidance of social situations may be quite common in the form of sick days, ‘alternate appointments’ occurring at the same time as feared situations (e.g. work meetings), or even in subtler ways such as choosing to transact via emails rather than face to face, or attending a meeting but ‘hiding behind’ a more outgoing colleague.
* Social anxiety may also be specific to performance situations (e.g. musicians, athletes, public speaking).
stressful workplace situations for social anxiety
Various workplace situations that present difficulties for those with social anxiety. Indeed, it is unsurprising that social anxiety is linked to increased absenteeism (for example, calling in sick on training- or team-building days) and declining promotions or opportunities because they involve a greater degree of social interaction. Such situations include:
Small talk and networking: A minefield for social anxiety
In situations of small talk and networking, whilst there may be common ground (e.g. the workplace) or a common goal (networking and promoting your organisation), the initial exchange of social pleasantries may include talking about a wide range of topics - the weather, holidays, current affairs, entertainment, travel… the possibilities are endless. Navigating the transition from making small-talk to focusing on work-related discussions can also be a source of stress.
work meetings
Work meetings are also often a source of anxiety. In addition to making small talk with colleagues prior to the start of the meeting, once the meeting commences you may be called upon to provide an update on your projects or asked your thoughts on a work issue. Cue all eyes on you and being the focus of attention, and being ‘put on the spot’. These situations can seem highly intimidating, and often those with social anxiety may miss meetings altogether, or opt to dial in remotely (with their camera off so they can sit silently in the background).
Public speaking, giving presentations, and being observed
In our work with individuals with social anxiety, public speaking is easily one of the most dreaded scenarios. In fact, public speaking is a very common fear - and not just for those experiencing social anxiety. Avoidance of giving talks and presentations is very common in individuals experiencing social anxiety. To learn more about public speaking anxiety in the workplace, read our article and find out how you can helps your fears.
Another workplace concern is that of being observed, particularly by supervisors and managers but also more junior colleagues (or even students on placement), where you are required to demonstrate competency in a skill. This can impact a wide range of professions including those in healthcare, hospitality, education, and performance.
Talking to managers and authority figures
Talking to managers and authority figures can be extremely daunting for those experiencing social anxiety. Each interaction with someone who is in a position to assess your work is seen as potential for scrutiny, and common unhelpful thinking styles that dial up anxiety in these interactions include mind-reading (assuming that your manager thinks poorly of you) and catastrophising (worrying that saying something incorrect will lead to criticism and punishment down the track). Performance reviews are likely to further exacerbate anxiety.
Job interviews
Job interviews may be avoided by those with social anxiety for several reasons. This is a scenario where the goal is to convince someone (and often, a panel of interviewers) that you are ‘good enough’ for the position. Sources of stress in job interviews typically include being asked unexpected questions, crafting a response that answers their question, monitoring non-verbal responses (for example, tone of voice, use of fillers, what to do with your hands), and speaking about your strengths and experiences.
tips for managing social anxiety at work
Try the following tips for managing social anxiety at work:
Tip 1: Flip the script on your socially-anxious thoughts
A fear of social situations can trigger a host of unhelpful thoughts and assumptions:
“I can’t give the presentation, it’ll be disastrous.”
“They think I’m incompetent.”
“I’ll make a fool of myself.”
“They’ll see my anxiety leaking out and I’ll look weak.”
These thoughts are often exaggerated or even untrue, and it’s when you flip the script on these thoughts that you reduce your anxiety. Helpful questions to ask yourself include whether your thoughts are realistic and proportionate), and whether you are able to cope with a negative situation should it arise.
Tip 2: Avoid your avoidance of social situations
Whilst avoidance leads you to feel better in the moment, in the longer term it reinforces your fear of the situation. Instead, face your fears gradually through setting small exposure tasks. Start with making a conversation about someone’s weekend, or by briefly drawing attention to yourself by clearing your throat.
Tip 3: Build a set of social skills for work
Often social anxiety can be exacerbated when you don’t have a set of skills to cope with social situations. Skills such as making small talk, networking, attending job interviews, being assertive and setting boundaries, and public speaking, are some examples of skills to develop so that you can build up your confidence to navigate your workplace.
Hopefully the above tips will help you to better manage social anxiety in the workplace. If you’d like a more tailored approach you can book in with one of our team by contacting us (click on button below). Alternatively, you can look into our Social Set or Speaking Volumes courses:
Social Set, our 8-week course to help you better manage social anxiety. Social Set focuses on building four sets of skills for social anxiety - skills to improve your mindset, skills to help your body’s anxious response, social skills across a range of situations, and skills to help you set the scene for success in real life through exposure therapy. It is based on CBT and Social Skills Training.
Speaking Volumes, our 6-week course to help with public speaking anxiety covering how to improve your presentations skills as well as anxiety management skills (cognitive restructuring, exposure therapy). This course is based on CBT and social skills training.
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American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). American Psychiatric Association Publishing.
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Hofmann, S.G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 38, 193-209.
Hofmann, S. G., & Otto, M. W. (2017). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques. Routledge.
Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157, 669-682.
Moitra, E., Beard, C., Weisberg, R.B., & Keller, M.B. (2011). Occupational impairment and social anxiety disorder in a sample of primary care patients. Journal of Affective Disorders, 130, doi:10.1016/j.jad.2010.09.024
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Zhang, I.Y., Powell, D.M., & Bonaccio, S. (2022). The role of fear of negative evaluation in interview anxiety and social-evaluative workplace anxiety. International Journal of Selection and Assessment, 30, 302-310. doi.org/10.1111/ijsa.12365
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