Taking the Anxiety Monster by the hand – An expert interview

At various stages of our lives, we all experience fears of one kind or another. There’s nothing unusual in that. In fact, fear and anxiety can be essential for survival, because they help to recognize potential threats and take appropriate steps to protect ourselves. Yet most people don’t really know much about anxiety. If we’re honest, lots of us even try to avoid or deny it. But with the coronavirus pandemic in full swing right now, fear and anxiety have become very relevant topics, especially as the crisis triggers or intensifies many of our deepest and most personal fears. So why not join us as we explore the best ways Caspar Health patients can master their fears and anxieties?

To help us address the topic of anxiety, we have brought our very own expert onto the Caspar Health team. Henrik Grobe is a psychologist and psychological psychotherapist with a background in behavior therapy and has been with Caspar Health for six months now. In addition to the work he does with patients, he is also responsible for developing psychoeducational content for the Caspar platform. We spoke with Henrik at length about the topic of anxiety and he explained to us why it is important to consider anxiety-related issues in rehab, what impact the coronavirus pandemic is having on mental health, and how we can all better manage anxiety.

Henrik, great to have you as part of the Caspar Health team. What brought you to Caspar as a psychotherapist?

We are increasingly moving away from the traditional image and work most people associate with psychotherapists. I have always wanted to move beyond pure psychotherapeutic patient work.

Henrik Grobe und Isabelle Scheer beim Interview

Particularly as a result of the crisis in 2020, the healthcare system, and indeed psychotherapy, has become more and more digital. As our field continues to evolve, we will see more of our work outsourced from classic psychotherapy. When I think of specific lectures on psychoeducational content in rehab, I find myself wondering why these lectures have to take place face to face. In order to allow as many patients as possible to access the best psychoeducational content, we also offer seminars in the Caspar Library, including some very interesting sessions on managing stress and anxiety.

But why should patients with orthopedic complaints be interested in content on psychoeducation? 

Well, most medical conditions are complex and have an impact on patients’ everyday lives. For example, a sore knee can trigger a lot of worries: “Will my knee heal again? What if it gets worse? What if I can't go back to my job – what would happen to my family?” In turn, such worries can lead to an intense array of emotions, including anxiety. This is often also associated with a feeling of losing control and being at the mercy of outside forces.

Anxiety was one of the first topics you dealt with at Caspar. Why?

For a number of reasons. Firstly, physical complaints often have an impact on our psychological well-being, and vice versa. Secondly, anxiety disorders are among the most common mental illnesses in Germany. 

In particular, however, I was also inspired by the current situation. The coronavirus pandemic has unleashed a wave of fear and anxiety. It is a completely new situation and we first have to find a way of adapting to it or we will very quickly feel that we are losing control of our lives. I often find myself using the barrel example to explain the vulnerability-stress model..

Just picture a barrel of water. The barrel represents a person and their individual vulnerabilities. Each person can cope with different levels of stress due to their genetics, past experiences, and so on. If the barrel is already very full, it can quickly overflow when more water is added. The water symbolizes acute stress factors, such as conflicts and trauma. If a person is permanently confronted with stress, then more and more water pours into the barrel until it overflows. At that point, we reach the limit of our mental resilience, which could even result in a mental illness.

The coronavirus pandemic adds to the strains we are already under, causing a continuous influx of water into each barrel. As a result, there is a higher risk that the barrel will overflow. You can see this from the sharp increase in inquiries to psychotherapists. And it’s a trend that looks set to continue. In response, Caspar has decided to provide psychoeducational content to complement our medical and psychological content. This will allow us to educate our patients and fill gaps where people are not getting the care they need. More generally, there is also a massive lack of understanding when it comes to emotions. In my opinion, we all need to understand our emotions better.

What is fear? What functions does it have and when does anxiety become a problem?

First of all, anxiety consists of three components: Thoughts, physical reactions, and behaviors. These three components can be thought of as the interlocking sides of a triangle. The relationship between them is clear if we imagine being stuck in an elevator. For example, we experience physical symptoms such as racing heart, sweating, and rapid breathing. We think, “What will I do if help doesn’t come?” and we use behaviors to try and escape, such as shaking the door.

Fear can be an important and natural emotion. It is okay to be afraid. Feelings are part of life and have a wide range of functions that are essential for survival. Fear helps us recognize dangers, assess them and take protective action. For example, when we perceive a threat, our body is put on alert and we initiate an automated and non-specific stress response. This enables our bodies to mobilize quickly and prepare to take appropriate action. At the same time, our brains focus on the threat and analyze it accurately and slowly. As soon as it becomes clear that the situation is dangerous and beyond our abilities to cope with, a feeling of fear is triggered and we flee, for example. From an evolutionary perspective, this is a helpful response. After all, if one of our ancestors had gone after a saber-toothed tiger, we might not be here today.

Many people perceive anxiety as annoying and ominous. That’s why I like to work with the image of an Anxiety Monster. The Anxiety Monster is persistent and follows us everywhere we go. Our first reaction is to try to get rid of the AnxietyMonster and push it away, but that just makes it angry. Our goal should be to take the monster by the hand and travel through life with it as a close companion. After all, the monster really only wants to help us and, if you look closely, it may even look quite cute. Accepting and embracing our emotional responses is therefore an important first step.

Das Angstmonster

If we don’t manage to take the monster by the hand, anxiety can become a real problem. Especially if our anxiety becomes too intense, lasts too long, or becomes too frequent; we feel as if we have lost control and our anxieties amplify themselves, creating an anxiety feedback loop. When anxiety takes such an overbearing hold on your life, you should definitely seek help and support. There are numerous places you can turn to, including doctors and psychotherapists. Overall, it is important not to wait too long before seeking help. The longer your symptoms and fears persist, the more chronic they become and the more difficult it will be to treat them.

What can patients do to deal with their feelings of anxiety? Do you have any practical tips? 

Mindfulness is very helpful. This is a Buddhist technique that teaches you to focus on the moment. The goal is to perceive things consciously and without judgment or trying to influence them. Let’s imagine, for example, a river on which boats are sailing. We sit on the shore while all of our thoughts are on these boats, passing us by. We simply perceive them. We don’t try to engage with them or evaluate them. This technique helps us to establish a distance between ourselves and our thoughts and then, with time and practice, to our emotions. For beginners, I recommend mindfulness apps and the mindfulness exercises from Caspar, which give you guided meditation content and techniques that will help you integrate more mindfulness into your daily life.

A simple, yet effective method to reduce the symptoms of anxiety is the lip-block breathing technique. Intense anxiety leads to rapid and shallow breathing, which in turn can lead to shortness of breath. This method focuses on a gradual lengthening of exhalation and thereby regulates anxiety symptoms.

In addition to conscious breathing, I also encourage patients to try “thought stopping” techniques. Especially when we are anxious, we find ourselves overcome by oppressive thoughts and worries. We can say “Stop” inwardly or aloud to interrupt these thoughts. With the help of this short interruption, it is possible to shift our focus to more pleasant thoughts and emotions. It is very important to take a break from thinking because our brains are constantly trying to solve problems and spend a lot of the time working at full speed. Normally, that is a good thing, but sometimes we need to put things on hold. This has also been true throughout the coronavirus pandemic. We are constantly confronted by the pandemic and our bodies and minds respond with stress and anxiety. It is important to regularly interrupt and actively break the chain of worrying thoughts.

A constant preoccupation with unpleasant topics leads to anxiety, withdrawal, and a slumped posture. Our posture and behaviors are among the factors that we can change most easily to reduce anxiety. Another tip, therefore, is exercise and movement. When we stand up, sit up straight, go outside and move, we counter the action impulse of anxiety and change the physical sensation. Exercise can also reduce stress and anxiety and create a mental distraction. Optimally, you should exercise outside in the fresh air during the day. This is because darkness increases our sense of anxiety and the vitamin D we produce in sunlight has numerous health benefits.

If you want to incorporate these exercises into your everyday life, it is important to know that changes always require effort and time. You have to understand your limits, take things one step at a time, and maybe even use small aids to help you. For example, you can set yourself a “movement or mindfulness alarm clock” that regularly reminds you to exercise. As you are starting out, however, it is also perfectly fine to invest as little as five minutes a day in mindfulness, for example.

What will happen with Caspar's theme of psychoeducation and anxiety? Can you give us a little insight?

In order to share our insights into dealing with anxiety with as many patients as possible, we are currently working on a series of seminars on this topic. In five entertaining workshops, we want to share the most valuable aspects of our work on anxiety and anxiety disorders and present tips that will help patients deal with anxiety. Our content is aimed at people with an interest in the topic and will provide initial support and advice to anyone who is experiencing anxiety and anxiety disorders. We also want to offer more mindfulness exercises and a seminar on restful sleep in the near future. Overall, the feedback from our patients on our psychoeducational content is very positive indeed. They let us know that the exercises and content are helping them to become active and improve their emotional well-being. That’s great to hear.

In the future, I want to do even more to encourage patients to embrace Caspar. The app should give patients a tool that they can use to help themselves achieve their personal health goals and minimize their health complaints. 

Thank you for the interesting interview Henrik!