Getting Ready to Return to Work: Managing Worry about Return to Work

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1 Getting Ready to Return to Work: Managing Worry about Return to Work Back in Motion Rehab Inc. January 2014

2 Managing Worry about Returning to Work Most people experience worry and anxiety about going back to work. It is a totally normal reaction. We know that returning to work is a stressful and scary process for almost everyone who has been off work for some time. In this module, you will learn more about what worry is and how to recognize it, the triggers for worry, and what you can do about the worry about returning to work. Hopefully, by better managing your worry, you can lessen some of the anxiety and stress about going back to work. What is Worry? Worry involves thoughts ( self-talk ) about negative or feared events that might happen in the future. Worry usually begins as a "what if" question and ends with a prediction of something bad happening. For people who have been off work, it is common to have these kinds of thoughts about being able to perform their job and cope with work demands and stressors. Sometimes worry can also be a mental picture, such as an image of you crying at your desk or getting yelled at by your boss. Typical worries about returning to work include: What if I can t cope with going back to work? What if I can t perform my job? What if I mess up at work? What if my symptoms get worse again? What if boss or co-workers treat me negatively or differently because I ve been off work? What if I get fired? An initial What if question or an image can often trigger a worry episode consisting of a chain of worries (e.g., What if I start making mistakes at work again? And then, if that happens, what will my boss think of me? And, if that happens, what if I get fired? And if that happens, what if I can t find another job? Then, what if my spouse leaves me? And what if I end up homeless? What are your main worries about returning to work? Back in Motion Rehab Inc. Page 2

3 What Triggers Worrying? Worrying can be triggered by various things. Some triggers related to returning to work may be obvious and linked to external things, such as talking about returning to work with your clinician or the insurance company, or having to attend a family/social function where people might ask you about returning to work. Other situations, places, and people related to return to work, such as seeing certain images (e.g., in the newspaper or on the TV) or hearing people talk about it (e.g., on the radio or in a conversation about work) can also trigger worry. Some triggers may be less obvious. Sometimes worry (in the form of thoughts or images) seems to just pop into our heads out of the blue. Memories can also trigger worry (e.g., a memory of breaking down at work in front of a co-worker). What are your main worry triggers about returning to work? Back in Motion Rehab Inc. Page 3

4 Effects of Worry You may find that you are becoming anxious right now even thinking about your worries about returning to work. As our thoughts and feelings are inter-connected, when we worry, we naturally feel more anxious and nervous. It can also be a vicious cycle the more we worry about something, the more anxious we feel. And the more anxious we feel, the more we tend to worry. The following illustrates the worry and anxiety cycle. Returning to Work Worrying Anxiety The worry cycle has an impact on our bodies. When we worry and feel anxious, we often experience the physical sensations of anxiety, which are natural automatic reactions (like an internal alarm system) that prepare us to respond to danger or threats. This is also called the fight-or-flight response. This alarm response involves numerous physical changes, such as rapid heartbeat, rapid or shallow breathing, sweating, and muscle tension. We are designed to have these physical reactions on a temporary basis (as needed to respond to dangers/threats) but they can take a toll over time if the worrying and anxiety persists. We know that excessive and chronic worrying can contribute to physical symptoms such as fatigue, sleep and concentration problems, and make other conditions worse (e.g., chronic pain, headaches, digestion problems). What kinds of physical reactions do you experience when you worry about returning to work? Back in Motion Rehab Inc. Page 4

5 The anxiety-worry cycle also influences our behaviours. A common way of coping with worry (and the anxiety) about returning to work is to avoid thinking or talking about it. We may try to distract ourselves from the worry with other activities or mentally push the worry away. It is also common to try to avoid the triggers of the worry (e.g., places, activities, and people that bring to mind returning to work, such as talking to co-workers or going by one s workplace). Although avoidance can provide a sense of temporary relief (like a short-term fix) from the worry and anxiety, this strategy tends to perpetuate the cycle over time, and can lead to delaying or avoiding returning to work, making it even harder to go back as time passes. The following illustrates how avoidance can feed into the worry and anxiety. Returning to Work (Stressor) Worrying Avoidance Anxiety What kinds of things do you do to avoid worrying about return to work? Although avoiding the stressful situation can provide temporary short-term relief, it does not usually solve problems in the long term, and sometimes these problems actually get worse. And the worry also tends to always comes back! When we keep avoiding problems, it keeps us from learning that we can successfully cope and solve life s challenges. Back in Motion Rehab Inc. Page 5

6 So - when we put it all together, worry, anxiety, our behaviours, and body s physical reactions are all connected and each can affect the other. Returning to Work (Stressor) Worrying What if I can t cope? Anxiety Physical Responses Heart racing, shallow breathing muscle tension, etc. Behavioural Response Avoid thinking and talking about return to work; Avoid other reminders of work (e.g., talking to co-workers, going by workplace) The trick is to break the vicious cycle by targeting what we can change and influence our thoughts, actions, feelings, and bodily reactions. One of the best ways to break this cycle is to target our worry. By reducing worry, we can lessen the anxiety and also influence other actions and even our bodies physical reactions. In life, we cannot eliminate anxiety or stressful situations (such as going back to work). However, we can lessen the anxiety and make it easier to get through life s challenges and difficulties by changing how we think (e.g., reducing worry) and what we do in our actions (e.g., coping behaviours, gradually facing feared situations). The reality is that you may still be anxious about returning to work (remember that is normal!) but hopefully the worry and anxiety will be less intense and will help to ease the transition back into the workplace. Back in Motion Rehab Inc. Page 6

7 Steps to Managing Worry Step 1: Figure out what you are worried about. The first step is to figure out what you are worried about. This can be more difficult than it sounds and it takes practice to become an expert at recognizing your worry. You may have become so used to worrying that is has become automatic and you don t always notice you are doing it. One approach that can be helpful in learning more about your worry is to keep a worry record (or worry diary). To do this, describe the situation (or trigger) in which you started to feel anxious. Then ask yourself what you were thinking when you started to feel anxious (remember worry can come in the form of thoughts and images). Next, write down how you felt your emotions and you can use your own words (e.g., nervous, panicky, impatient, or dread, not just anxiety ). It can also be useful to write down how your body reacted and what you did in response (your behaviour). Tips: Think of yourself as a detective - trying to string together clues to what triggers and makes your anxiety worse. Carry paper and a pen with you so you can write things down just after they happen. If you can t do it at the time, try to recall and write down the thoughts as soon as possible after the event. For the next week or so, write down any anxious thoughts you experience as you go about your day. Try to get into the habit of noticing them. Here is an example of a worry record: Situation What was I thinking about? How did this make me feel? How did my body react? What did I do in response? Waiting for my kids to get home Start worrying about returning to work My memory is so bad these days, how will I function at work? I ll make so many mistakes. You just can t make mistakes at work. I ll probably get fired. Anxious Heart racing, fidgety. Turned the TV on to stop thinking about work. See one of my coworkers at the grocery store She is going to tell everyone at work that I look fine and should be back at work. No one is going to understand what I ve been through. Nervous Panicky Shallow breathing, heart racing, shakiness. Left store as quick as I could Back in Motion Rehab Inc. Page 7

8 Worry Record Situation What was I thinking about? How did this make me feel? How did my body react? What did I do in response? Back in Motion Rehab Inc. Page 8

9 Step 2. Challenging the worries that make you anxious. The next step after identifying worry is to learn to analyze whether these kinds of thoughts are realistic or helpful, and to develop alternative ways of thinking, which offer a more accurate and balanced perspective. Remember that worrisome thoughts are often biased (leaning towards predicting bad things will happen in the future) and are based on guesses and exaggerations, rather than on facts. Furthermore, because these thoughts can be very disturbing, you may try to push them out of your mind without thinking things through carefully or rationally and you may not be able to see the big picture. Learning to challenge worry also takes a lot of practice, and here are five questions you can ask yourself. 1. Are There Any Good Reasons To Be So Worried? When trying to answer this question, ask yourself: What are the facts of the situation? Do the facts support what I think? Would somebody else think my thoughts were based on facts? 2. Are There Any Good Reasons Not To Be So Worried? Now ask yourself if there are any possible reasons why you should not be having this thought. Ask yourself: Am I jumping to conclusions? Am I predicting the future? Am I guessing what other people think? Am I overestimating the probability of this happening? Perhaps you can think of past examples that contradict your current worry. Sometimes people find it helpful to ask themselves: Will this problem matter one month/one year from now? It can also be helpful to ask yourself, What is the worst that could happen? This may show that: Your worst fear is so exaggerated that it is extremely unlikely or even impossible. What you fear may be much less likely to happen than you previously predicted. If what you fear does happen, you may be better able to cope with it than you originally thought. Once you have identified your worst fear, ask yourself: How likely is it that this would actually happen? This may be enough to help you put the thought into perspective. It can be even more helpful to ask yourself: How would I cope if this did happen? Don t underestimate yourself. You probably have past experiences and personal skills that would help you cope in difficult situations. Back in Motion Rehab Inc. Page 9

10 3. Is There Another Way to Look at This? There is almost always another, more realistic and more helpful way of looking at a worrying situation. It can be difficult to think of different ways of thinking when you are anxious, so it may be helpful to take another person s perspective. For example, you could ask yourself what another person would think in your situation, or consider what you would say to a friend who found themselves in a similar situation. 5. What Can I Do About the Problem? Ask yourself what you can do in the immediate future to deal with the situation, and try to make a specific plan. Here is an example of a thought challenging worksheet. Thought Challenging Worksheet Anxious Thoughts or Worry: I am going to make mistakes if I go back to work. My supervisor will be critical and disappointed in my work. What if she thinks my work is terrible and I lose my job? Are there good reasons for me having this thought? I m having trouble paying attention and concentrating, and I have trouble remembering even simple things. I think it is realistic that I will make mistakes at work. And my supervisor is critical. Are there any reasons why I shouldn t be so worried about this? I can do some things to help my attention and memory, like making lists, getting my smartphone to give me reminders, and using my calendar to keep track of my schedule. My supervisor is critical but it isn t just me she criticizes. My coworkers will be more supportive and will probably help me as I get adjusted. I need to remember that my supervisor is critical but she is critical of everyone, not just me. Realistically, I think it is unlikely that I will lose my job over this. I know that one of my coworkers did a gradual return to work after some time off and even though she said she found coming back to work to be hard, she didn t get fired. If I did get fired, I would look for a new job. I have lots of experience, so it shouldn t be too difficult to find one. Is there another way I can look at this? Maybe my supervisor will be more supportive than I expect. Even if she has some criticisms, it won t mean that everything I do is a failure. What can I do about the problem? I can start planning and preparing now. I can use strategies right now to help my concentration and memory and get ready to use these at work. I can plan how I will cope if my supervisor is critical. It will be important to think about her criticism rationally and blow it out of proportion. It may also be a good idea to talk to my colleague Debbie if I feel stressed so that I can get her perspective. Back in Motion Rehab Inc. Page 10

11 Thought Challenging Worksheet Worry or Anxious thought: Are there good reasons for me having this thought? Are there any reasons why I shouldn t be so worried about this? Is there another way of looking at this? Back in Motion Rehab Inc. Page 11 What can I do about the problem?

12 Worrying about Worrying Sometimes, though, worrying can be made worse by our beliefs about worrying. Some people have very strong beliefs about the negative effects of worrying in other words, they worry about worrying. This may be you if: You worry that your worrying is out of control You worry that your worrying is harmful (that it will hurt your physical health or make you go crazy or have a nervous breakdown) Let s start with the belief that your worrying is out of control, or that you just can t stop. These kinds of beliefs can make you feel like you have no control and there is little you can do to stop worrying. But let s consider this in a bit more detail. Think about what it s usually like when you are really worried and anxious, and then ask yourself: Do I eventually stop worrying? Can I think of times when something happened that interrupted or stopped the worrying (e.g., the phone rang)? What happened? Can I think of times when I did something that interrupted or stopped the worrying (e.g., turned on the television, or talked to someone about something else)? What did I do? Have I ever succeeded in stopping myself from worrying by distracting myself? Jot down your responses to these questions in the box below. It is important to think clearly and rationally about worrying. If you don t worry all the time, or you are sometimes able to interrupt your worry, take note of it! This shows you have more control than you thought over your worrying. Look at what you wrote down in the box above. What does this show about your control over worry? Write down your thoughts in the box below. Back in Motion Rehab Inc. Page 12

13 The problem with trying to control your thoughts Have you ever noticed that as soon as you try not to think about something, you think about it even more? So telling yourself to just stop thinking about it! actually makes it pretty certain that you will worry even more. The sad fact is that rather than helping your worrying, this makes it more likely that you will start worrying, or keep on worrying. And what s more, this will probably convince you (wrongly) that your worrying is indeed out of control. What you need is a strategy that is less likely to make the problem worse, such as controlled worry periods. Use controlled worry periods for one week and see what happens to the amount of time you spend worrying during the day. As soon as you notice you are worrying, postpone it by telling yourself that you will allow time to worry about it later in the day Choose a time in the day when you will give yourself 15 minutes to worry (preferably not in the hour or two before bedtime) When this time arrives, allow yourself to worry for 15 minutes and no more (set a timer if you need reminding!) Only spend the time worrying if you still feel it is necessary to worry. If the problem doesn t seem important any more, don t spend time worrying about it. Postponing your worries is different from trying to suppress or ignore them. When you postpone a worry, you are not telling your mind to stop worrying. Instead, you are asking your mind to move the worry aside for a little while so you can focus on other things. Later, you will allow your mind to come back to the worry. Back in Motion Rehab Inc. Page 13

14 Now let s move on to worrying that worry is harmful. This kind of worry can make anxiety even worse. Remember your job is to try to think as realistically as possible. It s not normal to worry there must be something wrong with me Is it normal to worry? YES! Most people say that they worry, and at some point in their lives, they find worrying distressing. In fact, it would be virtually impossible to find an adult who said he/she NEVER worried. Find this hard to believe? If so, it might be a good idea to find out for yourself whether the people around you spend time worrying. Ask four people two that you think may spend some time worrying, and two that you don t think worry at all (or very much) whether they worry. Have they ever worried too much about something? When was the last time they found themselves worrying about something? Record the answers below. What does this tell you about worrying being normal? Worrying is going to make me go crazy Remember that almost everyone worries sometimes and that most people say that worrying has, at some point, been distressing for them. Does this mean that most people have mental health problems? Of course not! Worrying is normal and not a sign of mental illness or breakdown. Think about all the times in your own life when you have been very worried. Did you have a mental breakdown? Worrying is going to harm my health The physical symptoms of anxiety can be quite uncomfortable and you may worry that anxiety is doing damage to your body. It is important to understand that the physical symptoms of anxiety are a natural part of our bodies defense system preparing us for physical exertion in Back in Motion Rehab Inc. Page 14

15 the face of danger. The physical symptoms of anxiety are there to help us, not harm us unfortunately, they feel really uncomfortable. Thinking about worrying in a more helpful way Read over the worrying about worrying section above. Review everything you have written down. Think about any proof for or against the belief that worrying is harmful. Then write down a more fair and helpful way of thinking about the effects of worrying. You may need to repeat these exercises whenever you find yourself worrying about worrying. Remember that changing the way you think about things takes practice. What if I believe worrying is helpful? It is not uncommon for people to believe that there are actually positive effects to worrying. This can make it a lot harder to give up worrying! Some examples of positive beliefs about worrying include: worrying helps me solve problems worrying helps me cope if I worry, I will prevent bad things from happening if I worry, I will be prepared Do you think there are any advantages to worrying? Back in Motion Rehab Inc. Page 15

16 Are there any reasons why I shouldn t give up worrying completely? These beliefs can convince you that you SHOULD be worrying and this can lead to worrying even more. Let s see if you can develop a fairer and more realistic way of thinking about the usefulness (or uselessness!) of worrying. Start by weighing up the advantages and disadvantages of worrying. Here is an example: Advantages of worrying Worrying helps me cope If I worry it will help me prepare in case the problem really happens Disadvantages of worrying Worrying makes me anxious and miserable I spend too much time worrying it is a waste Most of the things I worry about don t happen Worrying probably isn t helping me prepare I would probably solve the problem in the same way whether I worried or not Most of the time I don t think about how I m going to solve the problem when I worry I just worry Back in Motion Rehab Inc. Page 16

17 Now try filling in a chart like this for yourself. Advantages of worrying Disadvantages of worrying Just thinking about it and listing the pros and cons like this can help you realize just how many disadvantages there are to worrying. Examine the evidence Put your positive belief about worrying to the test! Ask yourself the following questions: Do I have any evidence for my belief? If so, could there be an alternate explanation? Back in Motion Rehab Inc. Page 17

18 Do I have any evidence against my belief? Can I think of any times in my life when I did not worry and events turned okay? Does worrying really prevent bad things from happening, or make good things more likely? Or will good and bad things happen regardless of whether or not I worry? Does worrying really help me cope or does it interfere with my coping? Would I be able to handle a bad situation if I had not worried beforehand? When I am worrying, am I really problem solving? Or am I just going over the same thoughts again and again, without finding a solution? What are the real effects of worrying how it is affecting my life? How often does my worrying really reflect reality? How often do I overestimate the likelihood of something going wrong? Back in Motion Rehab Inc. Page 18

19 How often is worrying really worth it? Think of a time when you were really worried about an approaching event. Write down the worrying thoughts that you had in as much detail as possible. Next, try to recall what actually happened. Write that down too. Situation: The worries that I had: What actually happened: How accurate were my worries? Was worrying a useful coping strategy? Back in Motion Rehab Inc. Page 19

20 Read over your answers to these questions. In the box below, write down a new, more helpful and realistic belief about worrying. It takes practice to effectively manage worrying. If it were easy to stop worrying, you probably would have done it a long time ago! Keep at it. Practice the strategies every day, and keep a record of your efforts. And if you notice that you manage to reduce your worrying even a little bit! congratulate yourself. You are one step closer to your goal. Back in Motion Rehab Inc. Page 20

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