Making Sense of Worry When Life Feels Uncertain

Many people seem to be managing day to day, while privately dealing with a mind that rarely switches off. Worry can go round in circles – replaying conversations, looking for reassurance, imagining what might go wrong or trying to feel certain about an uncertain future.

In this episode of The Choice Space, Dr Lee David is joined by GP and author Dr Martin Brunet to explore why worry happens, what keeps it going and what can help when it starts to take over.

They discuss the role of uncertainty in anxiety, and why the mind often responds to uncertainty by producing more thinking rather than more clarity. From health anxiety to fears about loved ones, they explore how checking, reassurance seeking and repeated mental reviewing can bring short-term relief while keeping the cycle alive.

Martin shares practical ways to respond differently, including shifting from “what if?” to “even if”, using planned worry time, and learning how to calm the body through breathing and inner tone of voice. The conversation also explores his memorable character Wilbur – an anxious companion who is trying to protect us, but often uses unhelpful methods.

Together, they reflect on a more compassionate relationship with anxiety – not handing it control, but not fighting it endlessly either. They also explore the value of taking laughably small steps towards the life that matters to you, even when fear is present.

This is a warm, practical conversation about understanding worry, building flexibility and creating more choice in the moments that matter.

00:00 Why worry feels so powerful
01:05 Understanding anxiety differently
03:32 Fear, avoidance and self-judgement
06:09 Anxiety as one part of us
06:56 Meeting Wilbur
11:40 Patience instead of criticism
13:44 Health anxiety and symptom checking
18:07 What if versus even if
25:07 Choice Pause – moments of uncertainty
31:39 Using worry time well
35:04 Breathing and calming the nervous system
41:14 Laughably small steps forward

About the guest

 Martin Brunet is a GP, speaker and author with an interest in communication and mental health. He works three days a week as a GP and spends the rest of his time writing, teaching and posting about mental health on social media, where he has been surprised to find that his @doc_martin_gp accounts have built a large following. His first book, The GP Consultation Reimagined, a Tale of Two Houses, was published in 2020 and outlines the Two Houses model for the consultation. Your Worry Makes Sense, his new book on anxiety and burnout, was published in 2025 for a general readership. 

You can connect with Martin on Instagram and TikTok

About the host

Dr Lee David is a GP, CBT therapist and author specialising in mental health and wellbeing. Lee has written many books on CBT, mindfulness and teen wellbeing, and speaks regularly at conferences and in the media. Away from work she enjoys running, hiking, singing in a choir and spending time outdoors with her family. You can find Lee through her website and on Instagram, TikTok (@dr.lee.david), Facebook and LinkedIn.  You can find more about her books, wellbeing courses and therapy here:  https://linktr.ee/dr.lee.david 

Transcript

SPEAKER_01 0:01

I think so much of anxiety is down to uncertainty. It's down to that big question, what if? What if this symptom is a stroke or multiple sclerosis or cancer or you know something that scares us? Anxiety is all about looking forward and trying to guess what's around the corner. But you can't always guess what's around the corner. And what we tend to do is focus on the content of what we're worrying about and try and eliminate that what if by achieving certainty. So we might seek reassurance, we might keep texting the person and say, Are you home yet? And yet that only fuels it really. Whereas if we can recognize that we're engaged in a thinking pattern that is unhelpful, of worrying and worrying and worrying what if, what if, what if, and change that thinking pattern. It's recognising when trying to eliminate the uncertainty is unhelpful when we need to change our pattern thinking.

Dr Lee David 1:05

Welcome to the Choice Space Podcast. I'm Dr. Lee David, GP, CBT therapist and author. Many people notice their mind constantly scanning for problems, replaying conversations, or imagining what might go wrong. Worry can feel relentless, even when life outwardly seems manageable. Yet worry rarely appears without a reason, and understanding why it develops and what keeps it going can start to change how worry feels so that it becomes less overwhelming and easier to manage. I'm delighted to be joined today by Dr. Martin Brunett, GP and author of the fabulous book Your Worry Makes Sense. Martin, welcome. Could you start by telling us a little about yourself and what led you to write your book?

SPEAKER_01 1:55

Thank you, Lee, and thank you for inviting me on the podcast. It's really lovely to be with you. So I'm a GP. I've been a GP in my practice for 25 years and I still work there three days a week. And I've always been interested in two things, education and mental health. And I've come to realize that one reason why I have enjoyed helping people with their mental health is it's mostly about education. There's so much to learn about your own mental health. If if you've got pneumonia, because you don't need to learn about pneumonia to get better, you just need to know that you've got to take the antibiotics, follow a few principles of pacing and recovery, and you'll get better. But if if you don't learn about your mental health and learn about how to handle worry or anxiety or depression, the pills were not going to do it for you. And most of the time I'm not going to prescribe anything anyway. So it's mostly about education, which I really enjoy. I realized that I was having the same conversations with a lot of my patients. And there were two, particularly, that stood out. One was patients saying, I know it's ridiculous, but when they were talking about their anxiety, because it made them feel foolish somehow, when for me I knew there was nothing foolish about it. And the other was people saying, I'm not the sort of person for this to happen to, and that was in the context of burnout, when they just didn't understand what was going on with them. And having those conversations with patients on a one-to-one level in my surgery just made me think, gosh, there's so many people with the same questions and tackling the same issue. And it made me want to write about it. So my book is primarily about trying to make sense of worry, what's called your worry makes sense. And also there's a big section on burnout because that can be very bewildering for people.

Dr Lee David 3:33

I think my own experience as a GP and also as a therapist is that if people can make sense of their experiences, if they can step out of, I feel foolish for this being my experience, this is happening, and I don't know how to make sense of it. So I'm going to judge myself somehow negatively, I'm going to become critical of myself. But actually, if we can step back for that, it can be hard and we can we can really acknowledge how hard it actually is. But equally, that recognition is so powerful and a sort of gentle acceptance of okay, this is where I'm at, but this is why. Do you find that that helps people then to find some ways to go forwards?

SPEAKER_01 4:11

Yeah, I think once you make sense of it, it works on two levels. One is it stops that blame or that feeling foolish. There's there's not a great place to start from. So it stops you making mistakes or judgments about it. And then it can also help you think, okay, now I understand what's going on, I can go forward. So, you know, as an example, someone might find they get really anxious and have panic attacks going to the supermarket and may well feel that that's ridiculous because they know in their head that nothing dangerous happens generally when you go shopping in a supermarket. It doesn't make sense to them, but they avoid the supermarket because they're too scared to go there. And yet, if you know that every time you go to a supermarket you have a panic attack, which is one of the most unpleasant experiences we can have in our life, well now all of a sudden the supermarket is a very dangerous place to go. So once you've understood that actually it's the fear of the panic attack that's the problem, not the fear of the shopping, then you can stop feeling quite so foolish. And then maybe you can then actually understand that it's in avoiding going to the supermarket that that has become more powerful. And that while avoidance makes sense, it's not a great strategy. Because one one of the things with mental health is very often our innate instincts are to do things that keep us safe right now, today, in this moment, but have no foresight and are not long-term strategies, and it's all about survival today. So avoiding the supermarket is the best way of avoiding panic attacks in the short term. But you can't ever go to the supermarket. So then but you've got to do that groundwork before you're gonna think, okay, I need to stop avoiding supermarkets. How do I do that? Because the answer is not just to plunge yourself into a supermarket and having another panic attack. You've got to build up to that. Um but but your brain and your physiology is unlikely to get you there on its own because its instinct will just be keep you safe today. And that's that's the challenge.

Dr Lee David 6:10

It really sounds like that our threat system kicks in, and and I sometimes think of it as a as an anxiety part. We have a part of us who who has anxiety, it's not all of us, and that part says, but I don't want to go to the supermarket, it's terrifying, and it's really dangerous. And that part is utterly convinced that it is dangerous and and that whatever the fear is, and it might be of a panic attack, it might be fear of leaving the house. And so that part is valid, it's got a point, but we have other parts. A part that says, But I actually really want to go to the supermarket, I'd like to get some food, I'd like to be able to live my life, I'd like to be able to get out and see people and not feel shut away and not feel controlled by anxiety. So it's kind of maybe hearing from everybody, but then making a choice that enables us to live the best life that we possibly can.

SPEAKER_01 6:59

Yeah, and I think that separation um and creating some separation between yourself and your anxiety is really key or can be so helpful when it comes to overcoming it and making progress. So in the book, I have a a chapter about your anxiety monster and suggest you call him Wilbur and take him with you. And sometimes anxiety monsters or worry monsters are something that's been used for children, you're meant to give your worries to your worry monster, and that can be useful. But this isn't a child thing, this is an adult thing I'm thinking of, um, or all everyone thing. Where if you're going to go and do something that you know is going to make you a bit scary, like going into town or going to the supermarket or just you know, walking out the door. You've got a few strategies you might be thinking, well, hopefully I won't worry. Hopefully the panic won't come. And you go to the supermarket and you're fine until you start panicking, and then everything goes wrong and you run home again. So just hoping it won't happen doesn't really work. Or your other way of not panicking is to never go. But the third way is to take that anxiety with you and say, So if you imagine that part of you that's anxious um and trying to warn you that the supermarket could be dangerous, like a silly, slightly funny monster. So in in the book, I talk about Wilbur, he's he's got orange fur and purple spots and googly eyes and goofy teeth. He's on our side, he wants to protect us, keep us safe, but he's not very good at it and he needs training. But you don't try and say, Wilbur, you're not coming today, because he'll turn up. So you say, Come on, Wilbur, where are you gonna go? You know, you're coming in my pocket and my bag, let's go, we're gonna go to the supermarket. I know you're gonna be with me. Um and part of the point of making him quite amusing is it's very hard to feel two emotions at once. So if your emotion is fear or anxiety, but you bring in humor, it tends to push the fear and anxiety out. If you can imagine the if Wilbur is scary and terrifying to you, that's not going to help so much as if Wilbur is slightly amusing. And when you think of him, you kind of have to smile. And then, you know, you might check in on Wilbur and you might even thank Wilbur and say, Thanks for trying to keep me safe. You're a bit silly, aren't you? And and you don't always get it right. And actually I'm in charge, but you can come and we'll we'll see how we get on. And that can make such a difference to just hoping it doesn't happen or being too terrified to go somewhere.

Dr Lee David 9:21

I really love the idea of Wilbur, and I I can see how you could build in some compassion, you could give Wilbur a big hug. He sounds like he's pretty scared and he needs someone to be kind to him because the tendency is to be like, bad Wilbur, stop making such a fuss, go away. And poor old Wilbur, he's just trying to help, but he's not doing a great job of it. He's not really helping in the long term. So we can give him a hug and say, Come on, Wilbur, in the pocket, like you say, or in my backpack, or you know, where are you gonna go? But you're not gonna choose, I'm not gonna let you dominate or bully me. We're going to to do this together. And I know it's scary, but okay, come on, come on, let's go. And it feels like that is such a different approach to trying to silence Wilbur or cut him off. Because as you say, he will always just pop back up again, won't he?

SPEAKER_01 10:14

Yeah, absolutely. And another way, you know, if you don't like the idea of a monster, another way is to imagine Wilbur like an excitable puppy and maybe give him a puppy name. And he's a puppy that's that's meant to bark when there's burglars, but he barks every time a sparrow flies past the room or the when you go out with him, he's barking at everything. And and he just needs to be trained. So it seems bizarre that you might think your anxiety, but it's such a different way of dealing with it that actually that can help you make huge progress. Because when you've had a lot of anxiety, you're not innately going to think your anxiety, you're going to be crossed with it or fearful of it. The trouble with getting crossed with our anxiety is that's an aroused state, the same as anxiety. So our brain it feels the emotion of being aroused and stressed, and it can't always tell whether that's because it's crossed with the anxiety or anxious. Um, so you need to bring that a different emotion, as I was saying. Helps just change those neural connections in your brain. It takes practice. I mean, that that's the other thing. If your brain has been used to responding to anxiety in one way for a long time, and you try something like, okay, I'm gonna go out, I'm gonna imagine Will with anxiety wants to come in with me, and you know, it's not gonna work brilliantly the first time. It's gonna take practice, it's gonna seem a little odd to start with. The trouble if you've had anxiety for a long time that's been affecting you, you've got pretty practised and good at being anxious. So you've got a bit of unlearning to do as well as learning new ways.

Dr Lee David 11:40

I really like the puppy idea as well, because I'm just starting to imagine if anyone's ever had a puppy trying to train a puppy, is it takes time and it does require patience, it requires kindness, not just negative, not just punitive telling off, but actually encouraging in positive ways. And and I think that thing you were talking about thanking Wilbur or or the anxious puppy is is a bit like saying if we can build kind of more civil, polite, friendly relationships between everybody internally, we're gonna do better as a team. And so actually it's bringing the anxiety into the team rather than trying to separate it. We've got so much self-criticism, and as you see, that just triggers our threat system again because then the anxiety is about not just because I'm fearful of the supermarket, but now I'm failing in life because I'm not going to the supermarket. So that's just another layer of stuff to worry about, isn't it?

SPEAKER_01 12:34

Yeah, very much so. And a life with zero anxiety or zero fear is powerless. You know, you wouldn't spot any danger, you'd climb too high in the tree and fall out of it, or you drive too fast in the motorway because you you don't care. Anxiety is a necessary part of life. We might think, oh, I wish I was never anxious, but actually we need a degree of anxiety in the same way as we need to be able to feel pain to know when there's danger to our physical body. But just as excessive chronic pain can become debilitating, so anxiety being turned on into threat mode all the time then just restricts and debilitates us. So it's a matter of learning to help anxiety have its rightful place in our life without dominating and without controlling us or us getting angry at it.

Dr Lee David 13:20

Yeah, because I guess if if our anxiety is on all the time, it's a bit like having a smoke alarm that's constantly going off. In the end, you don't really know when there actually could be something that we need to act on. And so it's not so useful if if it's overused as a discerning response. Um and I'm wondering what what kinds of anxiety do you tend to see in the people that come to see you as a GP? And I know in my practice, certainly as a GP, people would come in, maybe there'd be anxiety about health, or there might be just generalized anxiety about lots of life worries. What kind of patterns do you tend to see?

SPEAKER_01 13:55

All of those. I think health anxiety is a really interesting one. There's there's a chapter in the book about health anxiety, and it's probably the chapter that I've had the most response from people about to say, you know, this is what I needed. Because I just don't think there's enough said about health anxiety. Um it's really interesting that on a GP's note system, there isn't a code for health anxiety. I can't write health anxiety as a diagnosis. And there aren't guidelines, nice there's no nice guideline on health anxiety. And I I think given how many people are affected by it, that's astonishing. And I I think that that image of the broken smoke alarm is a really useful one because we need to be able to filter out symptoms that our body's giving us all the time. So, you know, right now um I've got a little itch on my back, I've got a little bit of tinnitus, because I always have a little bit of tinnitus, and I've got a slightly odd feeling just about here on my head. But my brain just filters them all out. I know they're okay. But if I were to start having a heart attack, I'd need to recognise it and know, no, this needs my attention. And it's like your symptom filter has broken when you've got health anxiety, that every symptom could be serious. And then you've got the confounder that being anxious creates symptoms. So, well, now my heart's racing, or I'm feeling dizzy, or I'm getting tingling in my fingers, or because of the physiological effects of being anxious. And so that snowballs the whole thing. So someone with health anxiety will often have a belief that, oh, but it's always better to check, it's always better safe than sorry. And yet the checking and the reassurance and the warning to have tests for every symptom actually puts them more in danger because it just reinforces the fact that they don't know how to interpret an important symptom from a not important one. But it's it's tremendously challenging. I'll often find patients with health anxiety will usually come to the GP because of the physical symptoms they're anxious about. And so it's quite hard to focus and find the time to deal with the health anxiety because there's so much time given to the physical symptoms. And occasionally, you know, I'll say to someone, okay, well, we've we've checked out those physical symptoms, but I'd really like to see you again to talk about your health anxiety and what do we do about the anxiety. So they might make an appointment about health anxiety, but there's a reasonable chance that the day before the appointment, a symptom will come and that one will totally sort of sabotage the appointment because they're so focused on that. Which is really understandable, but it's very challenging because it means the underlying health anxiety doesn't get properly dealt with.

Dr Lee David 16:26

And there are no guidelines and actually very little information about health anxiety for clinicians. And yet, in terms of the quality of life impact that I see, it just has this enormous effect. I have worked with people who spend many hours a day checking their symptoms, checking their bodies in case there's a new symptom. And of course, every time you prod, you might find something a bit different, or you might even create uh soreness because you're checking so often, or you you maybe look online. And then when you do look online, you find out something terrifying, you find a new possibility that the symptom might mean. So it kind of snowballs into this really increasing level of anxiety where Wilbur, if you like, is getting bigger and bigger and bigger. He's just getting, you know, superpowered, isn't he? He's just growing in in his energy, and it feels so difficult. I would sometimes think about it like a seesaw, where on the one hand, we don't want to ignore our health. We don't want to avoid, and that can sometimes happen when people get very health anxious, they just avoid it completely.

SPEAKER_01 17:28

Yeah, don't ever come to the doctor. Yeah, yeah. Yeah.

Dr Lee David 17:31

And of course, you know, as GPs, we don't see those people, but actually they're very attracted at home and still it's not healthy for that individual. And and then we might miss something important. So that isn't how we want to. We the other end is that we spend all our time thinking, checking, planning, worrying. And and I don't think that makes us safer, and it has this huge impact on our quality of life. So it feels like we're aiming for somewhere in the middle where we do some health checks and we're we're aware of our health, we take reasonable precautions. If we have a symptom, we do get it checked out that we don't ignore it, but we don't repeatedly go over and over and over the same symptom. And maybe, do you think that's something about being able to cope with uncertainty? Because there's always a bit of uncertainty, isn't there, about health? We can never be 100% sure.

SPEAKER_01 18:21

Yeah, I think I think so much of anxiety is down to uncertainty. It's down to that big question, what if? What if this symptom is a stroke or multiple sclerosis or cancer or something that scares us? But similarly, you've got what if they haven't got home safely because they haven't sent me a text yet to say that they've got home. Uncertainty is a huge thing with health anxiety, but but it's a huge thing with with almost all anxiety. I always feel like anxiety is all about looking forward and trying to guess what's around the corner, but you can't always guess what's around the corner. Um and what we then tend to do is focus on the content of what we're worrying about and try and eliminate that what if by achieving certainty. So we might seek reassurance when it comes to health anxiety, we might keep texting the person, say, Are you home yet? Are you home yet? And yet that only fuels it really. Whereas if we can recognise that we're engaged in a thinking pattern that is unhelpful of worrying and worrying and worrying, what if, what if, what if, and change that thinking pattern. So one great way of doing that is to change what if into even if. So someone with health anxiety might notice that a mole has changed on a Saturday and they're thinking, actually, I think I should get this checked, which is not an unreasonable thing. But the GP is closed. So they're gonna make an appointment with the doctor on the Monday. Now, thinking what if, what if, what if over the whole weekend is really unhelpful. And yet they might not be able to stop themselves, or they might even take themselves off to AE because they can't deal with the uncertainty over the weekend. Whereas trying to say, well, okay, even if it's serious, I'll deal with it when I know it's there. I've I've made this plan to see the doctor on Monday, and in the meantime, I'm going to I'm gonna recognise that that thinking pattern is unhelpful. It's not not where I want to be. So, you know, maybe Wilbur's involved in that thinking pattern. I'm gonna just say, Well, thank you for warning me, but I have made an appointment on Monday, and now I'm gonna calm my nervous system and distract and go and do something else. I mean, there are lots of ways of of doing that. It's recognizing when trying to eliminate the uncertainty is unhelpful and we need to change our pattern thinking.

Dr Lee David 20:37

I think naming uncertainty, saying this is a moment of uncertainty, I've I've got a new symptom and I'm not sure. And there can be an urge to have certainty. And I think our brains sometimes tell us, Wilbur says, if you think about this enough, you can make a safe. It's like a problem-solving approach. And that would work in certain circumstances. If we're in a an escape room, then it absolutely would help us with it. But when it's something that's in the future, so you know, is this going to mean that this is something serious or is something bad going to happen tomorrow or next week? There isn't really a way that thinking today can actually get rid of that risk entirely. So we end up in a loop where we go round and round and round thinking over and over the same things, but without really getting to a conclusion where we can say, Oh, I'm out of the escape room, done, move on to the next thing. And I think that just gets a bit stuck on a on a loop. Is that something you've come across?

SPEAKER_01 21:30

Yeah, stuck on a loop or an ever downward spiral. So I've seen this mall on a Saturday, I'm gonna get it checked on Monday. But what if? What if it's a melanoma? And then then the brain goes to the next what if? Well, what if it's a melanoma that can't be treated? And what if I then lose my job because I can't carry on working because I'm having so much treatment? Or what if we then can't pay the mortgage? We're gonna have to move, the kids are gonna have to move school. What how will they cope with the new school? And all of a sudden a mole. That's probably completely harmless, and you're planning a new life for your entire family. It's very easy to see how that catastrophic thinking happens. But what you then end up is trying to problem solve about your child's new school, which is so far removed from the original thought. It's exhausting. You're just using all this nervous energy thinking about all those what-ifs. And that that's the problem. Even if you deal with one what-if, so many more can crowd in, particularly if you're prone to that sort of pattern of worrying.

Dr Lee David 22:28

Yeah, because our brains are so creative, they can generate cinematic ideas about the most catastrophic, terrible scenarios. And often they're entirely unrealistic and they're not really based in what's probable, but they feel very scary. And so again, Wilbur starts to feel more powerful, more real. And so we have this kind of emotional reasoning thing, I think, where the more emotional we feel, where the intensity of the anxiety means that it feels true, even when actually, as you say, we're planning something which is nowhere near to being actually what's likely. And we can be very kind about that. It's one of those things that our brain does, it's just trying to help, but it feels like it doesn't really help. And I really like your even-if approach because what I'm hearing there is it's something about starting to plan to cope, how I'm going to cope. So maybe managing worry isn't just about eliminating risk, it's also about coping and navigating complexity.

SPEAKER_01 23:28

And even if it's not about problem solving, even if it's kind of saying, well, even if it's that, then the time to deal with it will be when I know that's what it is. And there's, you know, checking is there anything I need to do beforehand? No. So it's even if, and only really taking you one step rather than saying, well, I've got to do even if for everything, but you know, I'll deal with it then. And it's recognising that so many of the what ifs never turn into an even if you know they disappear because actually this mole was harmless. I think we often have a belief that if we that the way to keep ourselves safe is to check all of those possibilities and make sure we're prepared and fully prepared. But you then end up preparing emotionally for all sorts of possibilities that never happen, which means you're too exhausted to actually deal with the one bad thing that does happen. Because bad things do happen. Telling yourself, well, I'm sure it's completely harmless. Um, you don't know that, because otherwise, why are you going to see the doctor? So you can't convince yourself it's completely harmless. So just telling yourself that the uncertainty doesn't exist, it doesn't work. It's not true. There is uncertainty. Uh I really like what you said just now about our thoughts and our brain can make our body anxious. But also when our body's anxious, our brain thinks, well, there must be something to be anxious about. So, you know, with the mole, you start worrying about it and your nervous system gets aroused and feels anxious. And then as a result of that, your brain then just thinks, I'm feeling anxious. This mole must be something to worry about. Because otherwise, why am I so anxious about it? There must be something genuine to be really worried about. I mean, all in an unconscious way.

Dr Lee David 25:07

This is the choice pause, a short tool you'll hear in every episode drawn from my books and therapy practice. Each time it offers a different way to pause, notice what's happening, and choose your next step. Today is a pause for moments of uncertainty. Take a slow breath in and a longer breath out. Let your shoulders soften. Release any tension in your face or jaw. Allow your hands to rest. Worry often appears when something in life feels uncertain. Perhaps you're waiting for an email or a message that hasn't yet arrived. Maybe your mind keeps replaying an important decision, or you're lying awake at night thinking about what tomorrow might bring. In moments like this, the mind often starts scrolling through different possibilities, trying to make the future feel more predictable, and when that happens, it's easy to get pulled into a spiral of worry. For a moment, just gently widen your attention. Notice your feet on the floor, the support beneath you, the steady rhythm of your breathing. You might ground yourself with a long, slow sigh. Exhale. And then quietly remind yourself, right now I'm safe in this moment. I don't have to solve the future right now. And then look for one small supportive choice. It might mean letting one unanswered question rest for now. Turning your attention to the next small task ahead of you. Stepping outside for a few moments of fresh air. Allowing your mind a short break from thinking by moving your body. And as you continue with your day, remember that when uncertainty appears, you can pause, take a breath, be kind to yourself, and choose your next step. I'm hearing something about creating a bit of a pause and acceptance of yes, there is a risk here, there's a change to my mole, and I think it needs to be kept out. So thank you for raising that. That's back to the thank you heart, because we don't want to miss that if it is important, and it feels very important to be able to notice if there's a change. But what we don't want to then do is go into a whole list of issues that haven't yet arisen. So it's maybe staying more present, which is well, at this point we don't know what it is, so there's some uncertainty. So we'll make some space for that. And actually, when we have more information, then we'll respond to that. So it's being more concrete and it's dealing with the things as they come up, rather than, as you say, trying to pre-plan and predict every eventuality and try and fix it in advance, which is an endless loop of anxiety and overthinking.

SPEAKER_01 28:16

Very much so. Thinking about the health anxiety, you might see a mole and think, okay, I'm worried about it, so I'm going to make an appointment with the doctor. And that's how you're going to deal with it. But then the temptation might be over the weekend to keep seeking reassurance, keep looking at it, keep checking it. And then you might go on to Google. A lot of patients will come and say to me, Oh, I've been on Google, I know I shouldn't. And which is quite funny. They often feel guilty about Googling. And actually, for most patients, it's fine to Google if you want to. Um, but if you've got health anxiety and you start Googling your symptoms, you need to be very wary because going onto the internet is is such a snare. I liken it a little bit to someone who's got a gambling issue going on a slot machine, in that the first few times they start on the slot machine, it might be fine and they might then win. But they will always stay there until they've lost. And it's similar, if you start Googling your symptoms, the first two or three hits might be reassuring and you feel a little bit calmer, but the temptation to just do another search is hard to resist. And all you need is one website that tells you it could be serious, and it's like you've lost all your winnings. So I think you've got to be hugely careful about that, but also recognize over the weekend that you have a plan for reassurance, which is to go and see a doctor and get that mold checked. And therefore, all the checking over the weekend is a pattern of anxious thinking that's unhelpful, and you need to then teach Wilbur that actually you can wait till Monday. One of the tactics I quite like about this is the well-known one called worry time, which is where you say, Well, I I can't tell myself never to worry about it because that doesn't work. I'm too used to worrying, but I'm going to defer my worry. If you worry a lot, you set a time every day that you actually set aside to worry. You even set an alarm and say, right now I've got 15 minutes where I'm allowed to worry, I'm I'm meant to worry. Or your other way of doing it is just to defer your worry until a more sensible time. So one example I give in the book, we've we've got two uh cats, and when they got to about a year old, one of them started wandering and would disappear for a little bit. And the first time she did this, she didn't turn up for tea time, she wasn't there around at bedtime. But at I woke up at two in the morning, there was still no sign of her. And so I was worrying. But I knew at two in the morning we'd already checked the garage in the shed. I wasn't going to go and knock on my neighbour's door and say, Could you check your shed or your garage? And I knew that cats can do this. So lying there at night worrying was not helpful. So I visualized taking my worry, actually leading it by the hand to 6.30 in the morning when the alarm went off, and said, Look, at 6.30, if she's still not around, you can worry again then. I didn't hadn't decided what I was going to do at that point, other than permission to worry at 6.30. You can go and check and look around the house and see if she's turned up. And at 4 in the morning, she woke me up by sitting on my head. So I never had to do that worry at 6.30 because the problem had gone away. So you know, if you've got a mole on Saturday, you might visualize yourself taking your worry until after your GP appointment. Or maybe even the morning of the GP appointment. But you would just say, worrying about this, trying to eliminate that uncertainty on the Sassan Sunday is of no value. I'm not going to tell myself, don't worry, because I'm allowed to worry, but I'm going to say it's reasonable that you worry, but the right time to worry about this is going to be Monday morning, not to spoil the weekend.

Dr Lee David 31:39

I really like worry time. And it's kind of like allowing permission. If we keep with Wilbur, giving him permission to have a voice sometimes, because then he's less loud all the rest of the time, because actually he's been heard. And so actually he then doesn't feel the need to keep tapping you on the shoulder and reminding you. But we need to put boundaries around the amount of time. And as you described really eloquently, how it can really pull us in that we keep going with it. So I think for people who are very prone to worry, it can be helpful to set some time to worry each day, anything between 15 minutes, as you say, maybe 30, but then have a really concrete end time, maybe an alarm that goes off, and then we go and do something else. I I really like moving our body afterwards because I think we process worry not just through thinking, but we can process it by moving physically. And that also helps your plasticity. It helps regulate some of that threat system distress. And then our worry brain gets turned down a little bit. So we're not wrestling as much as just allowing it's like an exhale, and then there's more perspective. But we need to make sure that there are these boundaries. We can sort of ask, is there anything that we could say or that mean you'd never have to worry again? And if the person says, Oh, yes, but actually the reality is an hour later, a day later, a week later, the anxiety comes back because something else happens that triggers it, right? So it's never lasting.

SPEAKER_01 33:02

Yeah, absolutely, because we're focusing on trying to eliminate the content of what we're worrying about rather than the pattern of thinking that that needs to change. If you do worry a lot and you say, Well, actually, when my alarm goes off at this time, not only am I allowed to worry, but I'm meant to set aside some time to worry, that you then find yourself being told to worry when you're not actually feeling that stress. Actually, it then can start to associate different states of your body with those things that you worry about. And you might actually, rather than believe I'm always worried, you might think, actually, sometimes I find it quite hard to worry because I'm not in that state. And you can then recognise that actually worry is not an innate, an innate part of you. Um and always makes you think, oh, I'm bored of having to worry now.

Dr Lee David 33:45

I want to go out and do something.

SPEAKER_01 33:47

Exactly, exactly. I'm fed up with this worry time. Um and and that would be a good thing. Um, so I I think it's a very interesting discipline.

Dr Lee David 33:56

And I think it is about creating that sense of it's okay, that worry, we don't have to be scared of worry, and and it's not something that's out of our control. And I think it's exactly what you're saying, that when you're scheduling it, it becomes a choice. And so instead of it just coming up and saying, You've got no control over this worry, and if we resist that, whereas when we're choosing to do it, there's something much more sort of spacious, and and actually this is an act that I'm choosing to do, and actually that's helpful to me. And so, by definition, as you say, I think that feels so much better.

SPEAKER_01 34:29

Yeah. And I suspect people don't need to do it for very long, actually, to s to break a cycle and then recognise that if worry's getting out of control, they can they can set worry time again. Which maybe most of the time you're not that worried, but you've got a an appointment this week that's stressing you, okay. Well, for the three days beforehand, these are my worry times, and the rest of the time I'm you know I'm going to distract and you know use my body and make my brain think about other things.

Dr Lee David 34:56

Can you share with us, do you have any other tips that you really like to use when you're supporting people where anxiety is a big issue for them?

SPEAKER_01 35:05

Breathing is really important. So there's a whole chapter in my book about breathing. For me, it's about learning to control your breathing, as opposed to necessarily breathing exercises. Because most of the time we don't want to be even thinking about our breathing. We want to just be doing ordinary breathing, totally unaware of it. But when we're anxious, quite often our breathing gets out of control. And that's when learning to control your breathing can really help. Because when our body is in an around state, breathing is the thing we can control. So our hands are shaking, our hands are sweaty, our heart rate is racing. Well, I can't just tell my hands to stop shaking. I can't dial down my pulse, my heart rate, and just say, oh, just turn that down 10 beats a minute. I can't do it. But I have complete ability to manage my breathing. So it's the bit of physiology we can control. And if we start there, then the rest of our body can follow. Particularly breathing through our nose rather than our mouth, recognizing that that we need to not breathe with these muscles between our ribs and at the top of our chest. And I talk in the book about the difference between those muscles and the diaphragm. Because the the diaphragm is this remarkable muscle that can contract 12 times a minute forever, and it never gets tired and it never complains, it never gives us any pain, it just gets on with its job, in the same way as the heart does. Whereas I talk about these muscles as being like our booster rockets. These are, you know, if you're really exercising, then you would involve the muscles in your chest and your shoulders to really get you that extra 20% lung capacity. But like any booster rocket, they complain, they burn and they they don't like being used all the time. So that's why when you over breathe, you start getting chest pains and feeling tight in your chest and all of that. So recognizing that that you don't want your booster rockets on all the time, you need to drop your shoulders, breathe with your abdomen. And then I talk about box breathing where we breathe in very slowly, hold our breath, breathe out very slowly, hold our breath again, and it's like you're going around a box as you breathe in and out and hold your breath. And the the holds are so important. It's not about breathing deeply, it's about slowing it down. And when you slow that down, then you can calm your whole physiology. I love the concept of co-regulation, which is where when you've got two people, they might regulate their emotions. So if you're stressed, I might co-regulate with you and become stressed and aroused. On the other hand, if you're very stressed and anxious and I can stay calm and keep my tone of voice very calm and talk steadily and slowly and compassionately, you might be able to co-regulate with me and calm down. So then the question is, well, what voice do we use when we speak to ourselves? Which is why I've called it auto-co-regulation, because it's like, can you in your inner voice and in your inner tone and your inner pace regulate your emotions by deliberately choosing a slowing down, a slowing tone. So just dropping your voice, dropping how fast you're speaking, dropping how quickly you're breathing, can regulate your own nervous system. And talking com kindly and compassionately to yourself rather than angrily and shrill. So trying to learn what's your inner tone and your inner voice, and can you use that to auto-co-regulate?

Dr Lee David 38:16

I really like the idea of that because I think many of the people I speak to slip into a really critical tone of voice. We are so hard on ourselves and we call ourselves names, and the tone, the tone itself is just really sort of sharp. I think this idea about just choosing to use a tone and to use language and use that slower voice, maybe using some kind phrases that we might practice them before so that when we're stressed we've we've got them on hand. I think that's really powerful, actually.

SPEAKER_01 38:50

No, I think it's really important. And recognizing that we have an inner voice, or inner voices, you know, that you talked about parts, and we might have an inner critic. The internal family systems talks a lot about this as a type of therapy, doesn't it, about having an inner critic and an inner manager, and recognizing there might be multiple voices. Um, not because we have got some multiple personality disorder, but just because we're all composed of parts and recognising that sometimes maybe the critic's voice can be very harsh. And again, rather than just shout at the critic and say, stop being so mean to me, say, look, I know you're trying to help and you're trying to somehow keep me safe and protect me from criticism from others, but I just like you to calm down a little bit. Um and as a GP, it's not unusual to have somebody who's panicking in the waiting room and you bring them into your room. And and I kind of know that to start with, they can't process any of my words. They're so panicked that I could probably be talking in another language. So it's not my words that matter, but my tone really matters to start with. And so just talking very simply and in a calm tone of voice, and then they calm down enough to start hearing my words, and then they can maybe follow my instructions about their breathing. So recognising that even before we think about what words we're going to tell ourselves, the inner tone is so important. And then we'll start hearing the words as well.

Dr Lee David 40:12

We talked earlier about having Wilbur in one pocket, and I'm I'm wondering if we also need to put the critic in another pocket, because we can't critic the critic. We're not really wanted to shout at anybody, because it's really just us, isn't it? So we're kind of shouting at ourselves. Everyone's welcome, everyone's trying to help, but actually it's probably that we don't want either Wilbur or the critic to be making our actual choices about how we live, and so we need to give them a bit of a hug and pop them in the pocket, slow things down, and then use that tone to help decide what to do next. So it's been such an interesting conversation. So I think I'm gonna have to invite you to come back when your new book comes out and maybe we can talk more about that.

SPEAKER_01 40:54

Hopefully July 2027, so in a year's time.

Dr Lee David 40:58

Okay, something to look forward to. We always do finish with a little practical step. So just for somebody who does tend to get a bit caught up in worry, can you think of one or two small steps that they might try this week that could make a difference?

SPEAKER_01 41:14

I really love the idea of your comfort zone, your expansion zone, and your no-go zone. So if anxiety has made everything small for you because you've avoided doing lots of things, then your comfort zone may have got very small. Again, I talk about this in the book. But you'll have a no-go zone, things you never want to do. Bungee jumping is in my no-go zone. It would make me too anxious, but I can live a very happy life, never bungee jumping. But there might be something in your expansion zone, something that you would like to be able to do but anxiety stopping you doing. And I would say have a think about the very smallest, even laughably small step that you could take that would dip a toe into that. So if it's a big thing like going outside the house and just leaving the house makes you anxious and you haven't done that for a while, then that small, laughably small thing might be opening the front door, taking one step out, being there for 30 seconds and going back in. But if you haven't done that for a while, that's actually really important. Um it might be that your laughably small step is much bigger than just leaving the house or very personal to you. But make it small and make it something that you can do that you maybe you haven't done for a while, and then give yourself a big pat on the back and then practice it and then build up to more steps.

Dr Lee David 42:32

I'm loving the idea of a laughably small step. And I think that we think they don't mean much, but actually cumulatively, they're moving us in the direction of having more choice, of being less controlled by anxiety, they're giving us more flexibility. So they're incredibly powerful to do, even when they they may not fix the anxiety or a problem in one step, but actually they're moving us in that direction so that we're no longer as stuck and controlled by it. So I feel like it's hugely important. And I'd just build on that as well to say think about your values, think about what you really care about, and then make that laughably small step that you've mentioned in the direction of something that matters to you. So do it because you care about it, rather than letting anxiety stop us do the things that matter to us most in life, then it's to rebuild because these things matter, because actually I want a life where I can go out and see my kids or my grandkids. I want to be able to go to the supermarket, I want to be able to live a full life, and I don't want anxiety getting in the way of that. So, what what do I want to do instead of my worry and actually picking stuff that we love and that would actually make us feel kind of happier and fulfilled.

SPEAKER_01 43:43

Yeah, absolutely. If you don't want to be able to do it, it doesn't matter to you, then stick it in your no go zone and it's fine. There are lots of things that many of us will never do because they would make us too anxious and we live a very fulfilled life. But it's those things that are yeah, that are with our values that matter to. To us and either because we used to enjoy doing them and we've not been able to do them, or maybe you know, we'd be quite happy to never do this, but now we've got children and we don't want them to grow up thinking that you can't go to the supermarket or chat to someone at the school gate or go to a social event with a family and we we think we've got to change for that reason.

Dr Lee David 44:19

Thanks for listening to the Choice Space Podcast. I hope this conversation has offered a little room for you to pause and find your own way forward. We've linked all the ways you can connect with Martin in the show notes and a link to his book. If this episode has been helpful, please download and share with someone else who might value the conversation as well. And please do leave a rating or review on whatever platform you're listening on. It really does help people to find the show. This episode was edited by L. Dixon.