Pregnancy is a time of enormous transition involving psychological, physiological and social changes. With so much change in such a short period of time, it is common to experience anxiety. Ellen Brooks is another fabulous Psychology student I was lucky to have on practice with me this year. She has put together this article looking at what worry is, and how we can manage it in pregnancy
Anxiety and worry is commonly encountered by new mothers and mothers-to-be, with concerns relating to a range of issues including:
- Child’s health and wellbeing
- Parental competency to care for the child
- Impact of parenthood on relationships and marital satisfaction
Many mums start worrying about one thing, then begin to question everything about their pregnancy, their baby, and even their own ability to parent. This anxiety can become extremely distressing and for some, it may develop into generalised anxiety disorder (GAD), with worries significantly interfering with daily life, effecting the ability to wind down and be “present”. It might surprise you to learn that one in five pregnant women struggle with GAD or other anxiety-related disorders.
Regardless of the degree to which worry is experienced, there are many strategies that can help. So, what can you do?
Understand your worries
The word ‘worry’ gets thrown around a lot, however we don’t often sit back and think about what it actually means. Put simply, worry is the thinking ingredient of anxiety. It is a series of ideas about unknown future scenarios that are feared to be negative. Worry often consists of the ‘what ifs’. The most straightforward definition of worry is: negative or damaging thoughts about the future.
Monitor your worries
Once you know how to spot them, you can begin to observe your own individual worries. Acknowledge how you feel (e.g. on edge, uneasy, worked up) rather than what thoughts made you feel this way. A helpful strategy is journaling your worries; detailing both the scenario and what has worried you (see resources and apps). You can examine your journal entries and determine if they are unreasonable worries. That is:
- Are they negative or damaging thoughts?
- AND; are they regarding the future?
Journaling will help find the origin of your worry and gain some ‘distance’ from your thoughts.
Is your worry productive?
Worries that help you resolve issues are called productive worries and are characterised by;
- Being about the present or close future;
- Being specific or expected to happen;
- AND; has straightforward steps that can be taken to alleviate the problem.
A common productive worry in pregnancy is one which focuses on potential harm to your baby. These kinds of worries can be dealt with by implementing practical strategies. For example, if you are worried that you might be eating foods which are unsafe in pregnancy, you could visit a doctor to discuss foods to avoid. This would be productive as it would help to identify problematic foods, and allow you to worry less.
However, a lot of worries are far more unproductive. Unproductive worry is characterised by;
- Regarding the distant future;
- Has a small likelihood of happening; AND
- the outcome being out of control.
These worries are often significantly anxiety-inducing as the issues cannot be resolved and are out of your control.
Question your unproductive worries
Think of a recent worry and ask yourself:
- Am I sure this is going to end up occurring?
- What proof do I have for this prediction?
- What are the other feasible end results?
- What can I do to help myself cope if the worst case does come true?
- What advice would I give to a family member if they had the same concern?
By answering these questions, you can step back from your thoughts a little. Give yourself the chance to realise that your future fears are just that – fears – they are not certain. Remember that there are multiple ways to deal with the things that concern you.
Worry behaviours are actions we take to decrease a threat. Unfortunately, they don’t actually alter outcomes, and only temporarily decrease the anxiety surrounding the situation. They may offer momentary relief to anxiety, but they stop us from acknowledging our damaging thoughts and finding more effective ways to manage them.
If you find yourself answering yes to the following questions, you may be engaging in worry behaviours:
- Are you frequently seeking reassurance from loved ones?
- Do you find yourself participating in rituals excessively (e.g. tracking your baby’s kicks)?
- Do you find yourself employing specific routines to stop fears from occurring or avoiding situations that remind you of your concerns?
- Do you find yourself googling symptoms regularly for reassurance?
It is important to decrease worry behaviours or substitute them with other behaviours such as, mindfulness or self-care exercises like;
- light exercise
- prenatal massages
- catching up with friends or family
Cutting back on worry behaviours may initially make you feel more, but in the long run, it will result in less anxiety.
Relax and breathe
Pregnancy comes with many physical symptoms, some inducing anxiety. Rapid breathing (the outcome of shallow breaths in the chest) can result in a surge of physiological anxiety symptoms. One solution is to prompt slow and rhythmic breaths. Give it a try:
- Get comfortable and direct your concentration to your breath
- Put a hand on abdomen and the other on your chest
- Attempt to direct your breath to your abdomen from your chest. While your stomach inflates and deflates with every breath keep your chest still
- Begin to count your inhales and when exhaling, imagine words such as ‘calm’ or ‘relax’
- Do this for a few minutes.
Check out the suggested apps and resources for guided relaxation options which will help develop this skill.
Risk cannot be eliminated completely
Maybe you have attempted these suggestions and they have made you feel better. However, you may still find yourself seeking reassurance about your fears. Unfortunately, life is unpredictable and we have to deal with uncertainty throughout our day. For example, we drive our cars, despite the risk of accidents. We all know that there is risk involved, but we find ways to manage this in order to go about our day. Absolute assurances are often unavailable and we have to find ways to tolerate this unpredictability.
Worry is common. The aim is not to remove it but rather acknowledge and accept it. Here are some more strategies to try:
- When you experience unproductive worry, practice thinking these thoughts to acknowledge the worry and how you can cope:
- I cannot forecast what is going to happen.
- I’ll manage situations as they occur.
- Risks are a common occurrence in life.
- When you start feeling anxious, use mindfulness exercises (see resources) to ground yourself in the present moment:
- Stop for a moment and bring your attention to your feet touching the floor.
- Observe the room you are in and note five objects you can observe.
- Listen to your surrounding and note five noises you can hear.
- Lastly, note a couple objects you can feel.
By knowing what worry is, and identifying which worries are unproductive, you can stress less and enjoy your pregnancy more!
The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions (2009). by Kevin L Gyoerkoe and Pamela Wiegartz. Contains helpful activities and exercises to handle worry and anxiety.
Worry Less, Live More: The Mindful Way through Anxiety Workbook (2016) by the Susan M Orsillo and Lizabeth Roemer. Includes exercises to establish self-compassion and knowledge through mindfulness.
Mind the Bump. A free app designed especially for pregnancy by Beyond Blue
Headspace. A great app for mindfulness exercises. It is a paid option, however there is a free trial period of 10 days.
Oak. An awesome free app for breathing exercises.
Breathwrk app. Another great app with breathing exercises based upon your specific goals. Some free features and a low-cost version.
CBT Thought Diary. A free tool for journaling, especially worries and anxieties. The premium option offers more tools.
Moodnotes. Another great anxiety journaling app built on CBT techniques and positive psychology. 7-day free trial period then a subscription fee.