Asperger Syndrome and Anxiety

The forum on anxiety on Aspergermanagement.com is one of the most visited on my website.

The reason being, I think, is not just because people with Asperger syndrome (AS) are often subject to anxiety as a result of the condition, but because many other issues stem from it as a result. At work, these factors can come into play very powerfully.

It was for this reason I was looking forward to reading Asperger syndrome and Anxiety: A Guide to Successful Stress Management as there are few other books on the subject currently available. The other reason was because it was written by Nick Dubin, a writer whose work I have always enjoyed and respected.

Dubin starts with the accepted assertion that those with AS have to fit into a world that sometimes feels alien to them. The process of integration can not only be frustrating and exhausting, but it can also provoke uncontrolled anxiety.

However, as he importantly points out, everyone faces uncertainty and, though he refuses to accept this as an excuse, stress can be contained and used to motivate and inspire.

According to the author, coping with anxiety and stress for an individual with Asperger involves encompassing three factors:

1. Understanding how having Asperger has contributed to higher anxiety levels; having Asperger syndrome must be brought into the equation;
2. You must understand the manner in which you personally respond to stress and anxiety, i.e. your modus operanti in confronting stress and;
3. You must take advantage of specific strategies which are proven in helping a person with AS. Central to this is keeping an open mind in your approach.

The book starts by looking at how anxiety operates and some ways of controlling it. Stress according to Dubin is a complicated phenomenon with several, different components: physiological – how the body responds and cognitive – how stress is mentally processed. The latter affects reaction to the former.

According to Hallowell, “psychological stress results when a person feels vulnerable when confronted by a source of power”. This according to Dubin has profound implications for someone with Asperger as it often results in a feeling of loss of control in certain situations. This is something that I feel is highly pertinent in a work context.

The author believes that if a person lacks confidence with their social skills, they will put others on a pedestal in social situations, e.g. “the boss”. If you belittle yourself or habitually put people above you, you unwittingly give power away to them and increase your own feelings of vulnerability. Overcoming this necessitates reframing ones thinking by accepting you do have intrinsic value as a human being.

According to Dubin “unhealthy compensation” is the unconscious act of trying to reduce powerlessness in inappropriate ways. This usually backfires! By becoming aggressive or “noisy”, or trying to get others to think you are “good” beyond an actual level of capability to compensate for inferior feelings only camouflages the feeling of inferiority. When you accept yourself for who you are, you don’t have to overcompensate. As the author says, being different is not being inferior.

Psychological stress can also occur when the demands imposed upon a person from the outside world outweigh the ability to cope with them. Stress results when you are overwhelmed. I can relate to this very strongly from an employment perspective. Many of the instances of stress I have experienced at work have been as result of assuming too much responsibility too soon.

According to the author, people with AS has less “coping skills” because they are less able to control their emotions or manage their lives in terms of multitasking and organisation. By not taking on too much too soon, we can “scaffold” our development and face just the right amount of stress at any one time to be able to deal with new tasks effectively. Too little stress can be de-motivating; too much leads to disengagement.

However, by building oneself up gradually, we learn to appreciate when we can cope with a situation and when we cannot! This prevents anxiety developing and enables personal progression.

Our nervous system shifts to “fight or flight” mode when we perceive danger. An unexpected stimulus can startle a person with Asperger. However, as Dubin, rightly in my opinion points out, there is often no battle. When a boss summons us, we don’t need to automatically assume it is for negative reasons.

The book states that the nervous system plays an important role with Asperger: it can lead to problems in “shifting gear” and transitioning between activities or different emotional states, especially where there is personal importance attached. When this occurs emotional brakes need to be applied after the situation via relaxation methods. Often, however, with a person with AS, these are not applied!

I personally can strongly empathise also with the next point. When stressed the animalistic part of the psyche takes control and hijacks any rational response that is more appropriate to the situation. Sometimes anxiety can come from no-where and a panic attack takes place leading to a loss in ability to control and remain calm. I can think of numerous occasions when this has happened to me at work. Probably the most important lesion I have learned in relation to anxiety is to not in any way react!

The chapter closes by talking about traumatic stress whereby exposure to an extreme, past unpleasant event can cause high anxiety. An example is cited of seeing someone who is a past protagonist. This happened to the person I identified as “Bill” in my book Managing with Asperger Syndrome who did enormous, long-term damage to my confidence and self-esteem. This is the reason why I try to retain composure no matter what the provocation or anxiety I may feel. In a work context, I have found, it is imperative to maintain personal gravitas.

Anxiety and Asperger Syndrome then looks at the root causes of anxiety. This involves going back to the start. As a child with AS you may have been told your eccentricities were bad, your special interests weird, your non-conformist behaviours problematic etc. You almost certainly were conscious of feeling “different”.

You may view yourself today as likewise and of others as more powerful. I have certainly felt this in a work context. As the author says self-image often coalesces around the opinions of others which become internalised. Shifting this perception into something that is more realistic and accurate can mean old patterns, (see decision-making) being eradicated and personal growth achieved.

Learning stress management is harder for someone with AS. However, accepting this is the starting point for enabling transformation to begin from within. If you allow others’ unfair treatment of you (because of your AS), as an excuse for continuing to be anxious, you will always let others get the better of you. You must learn to manage your anxiety: accepting the world is unfair is a good starting point.

A person with Asperger experiences may encounter higher amounts of stress for a variety of reasons: lower frustration tolerance of situations and events; hypersensitivities from sensory overload; perfectionism which leads to a very narrow definition of success, (unless you are 100% successful at something, you consider the attempt a failure).

If you are constantly reprimanded at work, you will become hyper-vigilant about your job performance. If you continually experience social rejection, you are going to try extra hard to win people over. Total perfection, as Dubin correctly says, is never possible!

Unpredictability is another issue. What will happen at the meeting today? Being anxious about everything expends a lot of energy. Transitioning between activities is hard and if a situation is threatening it will take a lot of energy to confront it. This can make the next, similar situation much more daunting.

The book then looks at monotropism or the focusing on small details and not the wider picture. Having AS means that synthesizing detail into a coherent understanding overall is hard. For example, socially people with AS may focus on just one part of a social encounter meaning that extra effort is required in social situations. This issue applies to me with meetings.

However, Dubin then makes the important point: that much anxiety and stress occurs in the mind and not in the real world and how changing thoughts to mirror reality frees up energy previously expended on worrying. I can think of countless occasions when I have assumed things at work when, in reality, the outcome was far less problematic. Hard though it is, I have tried to simply “careless”; let things pass and not fester.

The book then looks at two other anxiety related issues. Firstly, processing and decoding auditory information. I can often find this difficult when in meetings or where a third-party needs a fast response to a question as my cognition is slower. This means I can feel internally pressurised.

Secondly, experiencing numerous emotions simultaneously results in a feeling of consciously not knowing what you are feeling. Recognizing your emotions as Dubin says is important. When I do feel anxious or hyped-up I stop, if necessary withdraw from the situation and force myself to regain composure.

The effect of attention deficit disorder and Asperger is then looked and the difficulty of filtering out external stimuli. According to Dubin, everything catches the attention and the mind wanders meaning you are unable to focus on something for any period of time. For someone with AS however, only certain things grab the attention making concentrating on things which are of no interest hard.

I can certainly resonate with this. I can think of numerous meetings where, particularly, after I have said my piece, I have drifted back into my own world. It can be hugely detrimental. What it usually means is that I miss important information and convey the impression to other colleagues that I am not interested. This can cause anxiety later. Focusing beforehand on the need to remained focused throughout the duration of a meeting or presentation is something that I have worked hard to implement.

Related to attention deficiencies is obsessive-compulsive disorder and intrusive thoughts. These are thoughts that occur without conscious permission. According to Professor Tony Attwood these centre on a preoccupation of making a mistake. Again, I can resonate with this as it can make me cautious in decision-making at work.

For solutions, the author understandably turns to cognitive behavioural therapy. By looking at situations in an entirely different way anxiety can be reduced. Dubin believes that most people have never learned the skill of how to control their anxiety, and to master emotions in order to control anxiety.

Monotropism or “black and white” thinking can also have a similar effect. Thoughts and feelings may be based on perceptions that simply aren’t accurate because of long-held, false assumptions.

I found the last point interesting. In a work context, I have often assumed that I have been responsible for something when, with hindsight, I have not. A person who was overlooked for my a position I subsequently secured, and with whom I then experienced difficulties, later told me that it was the fact he didn’t get the role – not me personally – which caused discord on his part. Now, I never automatically assume that I am the cause of a problem!

As the text then says, unnecessary self-blame can lead to magnification of certain issues. If you go into a meeting with your boss and feel vulnerable about your performance of late and he criticises you, it becomes self-perpetuating even though it is based on illogical assumptions. According to Dubin, people with AS practice such cognitive distortions which results in narrow thinking.

Cognitive distortions also exist in other spheres: “all or nothing thinking”, “over-generalization” – taking one situation and wrongly concluding it applies to others automatically; “disqualifying the positive”: ignore the positive aspects of a situation and only focus on the negatives. “should/must trap”: having unrealistic expectations of oneself and others, i.e. “the person should be nice to me!” and; “personalization”: blaming yourself for a seemingly random event.

As the author rightly I think suggests, we retreat and stop taking risks because of the inability to deal with associated anxiety effectively. Instead of facing anxiety head-on, you retreat from future perceived risks. This, of course, can be very damaging in a work environment and can really hinder personal development and progression.

The key point, which I think is so invaluable here, is that emotions and thoughts are intertwined. You need to be in control of your thoughts. If you are unaware of your emotional thought patterns during times of high emotion, they will exert excessive and detrimental control. The answer is to consciously reject them.

Cognitive behavioural therapy aims to get a person to slow down by becoming self-aware of ones emotions and conscious thought patterns to enable any stressor to pass and processed non-emotively. If you react prematurely and automatically then your anxiety will inevitably increase. Cognitive distortions then become second nature – unless you stop them occurring.

The book then looks at appraisal theory. This asserts that emotions do not occur without something from the external world triggering them, and how it is your appraisal of something that is important in determining how damaging they become. If we believe a person has ill intentions, we will perceive a threat exists. This, I believe, is hugely important.

Primary appraisal is the first chance to assess a situation (and associated self-esteem). Sub-consciously there are related motivations that results in primary appraisal happening very fast! If something is relevant to your well-being, you take immediate action and so generate an emotion. This happens to me when I come under pressure at work.

Cognitive distortions also take place during the secondary phase as a consequence of perceived anxiety. It’s what you tell yourself about a situation; if it is automatically accepted as a core belief and a threat then other, rational adult alternative possibilities are not envisaged which result in inflexible thought processes and negative emotions. It is during secondary appraisal however, that Dubins asserts one has the chance to slow down and block negative, established cognitive distortions.

By challenging cognitive distortions you empower yourself and stop them developing. To change beliefs, however, you need to understand how they were initially formed.

Dubin identifies five different sources of maladaptive schemas for people with Asperger syndrome and this part of the book – for me – is one of the most insightful and useful:

i) Disconnection and rejection: the world is not trusted because of others not understanding our specific needs. This sometimes leads to mistrust and difficulty forming relationships. The fear of emotional distance from others then creates social isolation. Anxiety can also result in not being able to match the achievements of others. Trying to achieve positions and status beyond our means or being distant from colleagues are pertinent work examples;

ii) Impaired autonomy and performance: people with AS feel unable to function independently or survive without outside support. The danger here is that one can become too dependent on caretakers to assist – I personally have in the past, perhaps, relied too much on other people at work and not been sufficiently proactive or self-sufficient;

iii) Impaired limits: low frustration tolerance which leads to perfectionism or failure and nothing in-between – at times I certainly have not “gone for it” and tried to get things too right!;

iv) Other directedness: without other people’s approval we view ourselves as worthless. There is a fear that people will reject us if we don’t do what they want us to do. Without direct instruction you cannot pick up on required task or social cues – my ex-boss at the BBC once told me that I liked – and needed – “clear instruction”;

v) Over-vigilance: becoming out of control and believing that something could go wrong at any moment. Emotions are not expressed in case they are viewed negatively. There have been times when I have not communicated my personal needs.

In other worlds, when we view the world inaccurately it creates unnecessary anxiety. All of the above points have certainly related to me at some stage in my career!

To address these issues Dubin advocates practising “mindfulness”: quietly “observing” your thought patterns to control your mind and actions. Each though or schema has its own emotional flavour and so can make us anxious when they are activated.

The book then lists the outcomes relating to some maladaptive schemas: being overly mistrustful or suspicious of others, being over sensitive to criticism because of emotional deprivation, fear of rejection because of social isolation or subjugation because you fear disapproval. Becoming aware of these triggers enables self control to be attained. Hard as though it is to practice initially, I do agree with the author when he says that “it becomes surprisingly easy when you have done so”!

One way of becoming mindful is to focus on the “now” which, for a person with Asperger, can be really challenging. However, when fully engaged in the present moment, performance can be better because it involves not worrying about past events or future consequences. In the present moment we can deal with whatever confronts our attention. Though hard, I have found practising this as a manager incredibly beneficial.

The key to becoming mindful is to be fully aware of when you mind drifts away from the present moment and focusing solely on the task in hand.

The book then looks at anxiety and employment and two types of Asperger related anxiety experienced in a work context. First, “existential employment worries”.

According to Dubin, work represents a compromise of our individuality. In the corporate world, 9 to 5 jobs involve uniforms, codes of conduct and scripts. The fear of a person with AS of losing our identity is legitimate and real. Conformity reaps rewards while individuality invariably does not. I can concur with all this.

Existential anxiety also stems from the amount of mental resource that work often demands. Most people are expected to put in a 40 hr week which often leaves limited and insufficient down-time to re-charge personal batteries.

For someone with Asperger syndrome this can certainly be tiring. We may also be forced to try and play inauthentic roles which consume our real identity which takes up energy – as can changing personas from setting to another. The thought of having to play out an abnormal role can be extremely anxiety inducing.

According to Dubin, the 9 to 5 business office is perhaps the most difficult environment for someone with AS. The competitive nature and anxiety about answering in a certain way to the boss can be a source of real friction.

For this reason the author advocates unconventional jobs for someone with AS: scientists, professors, writers, entertainers, artists and engineers. To work within this area however, you have to deal with some of the practical employment worries associated with the workplace.

Most career ladders however mean starting at the bottom. To move up requires satisfying certain requirements: accepting having to “pay your dues”; putting the time in to gain the necessary experience and knowledge that leads to the next position. For a person with AS, this is likely to take a heavier toll than normal. The reward can however be possible entry to more appropriate positions.

To do what you really want to do however, may involve temporarily taking a job you really don’t want to do and framing your approach to it to overcome any negatives. If you view a boring job as a stepping stone to get what you want, you will be able to gain some perspective and view the position as acceptable in the short-term.

Much anxiety also stems from the expectations of others of our social behaviour. The author believes that this is a person with AS’s core deficit. We need to take a positive stance on this or: “I will do it”. Making a concerted effort to socialise at work, I have come to very strongly believe, is an absolute pre-requisite.

As Dubin I believe rightly points out, choosing a career haphazardly, or via intuition alone, can lead to a tremendous amount of anxiety once you start working if you make the wrong decision. However, as he also rightly asserts, if you are unhappy there is no rule to say that you must remain locked in that career, though dislike of change for someone with AS may discourage this.

To combat any anxiety associated with work-related issues, it is important to be confident regarding your strengths in any employment situation. Taking time to think of accomplishments can help overcome this; what were the qualities that enabled you to perform so well previously? What environmental factors were in place to ensure you performed the work to the highest possible level? Understanding these will help identify the right environment. The job may not be perfect but the aim is to get a better opportunity. All this to me makes eminent sense. The important point is to have an end goal based on your own, special qualities and an environment that brings them out.

The book then looks at “meltdowns”. According to the author this is a hugely pertinent issue in relation to Asperger’s and it is essential not to have them publicly. Meltdowns for Dubin usually occurred when something happened that didn’t match his pre-ordained script for a given situation. At work, I have found, this invariably happens.

Attachments are formed by people with AS to pre-ordained scripts and outcomes. If you can remove these you remove the basis for a meltdown. Accepting that things won’t go to plan is a helpful attribute to develop. A small cognitive shift in perception and perspective can make the difference in remaining calm.

By embracing uncertainty, rather than fearing it, we can understand how our concept of order can fuel meltdowns. By understanding how past events have unfolded we can understand how and why they occurred and how we can prevent them re-occurring again. Not reacting to criticism and remaining calm at work is something I have worked extremely hard to implement.

The book then turns to anxiety and “shame”. Schemas and core beliefs can make a person with AS feel shameful about them-self and potentially anxious. Shame – or a feeling of being different or inadequate – is usually a precursor to anxiety, not the other way round. When you feel less worthy about yourself numerous other defensive mechanisms begin to activate to afford protection.

I have worked hard personally to negate this. As mentioned, there have been occasions in my career when I have mistakenly assumed self-blame unnecessarily. I always question myself honestly if a problem arises, but I never automatically assume blame unnecessarily. Indeed, I have learned the hard way that doing so is dangerous.

According to Dubin, the “false self” – or who you really are – involves disavowing parts of yourself. Doing so, however, is a fallacy; if it remains part of your thinking you will generate further anxiety from it. To disavow oneself from Asperger’s is to try and appear neurotypical and be something that you cannot.

You have to confront consciously how you first came to believe in any perception of unworthiness. Your personality is not a failure; it is just that society is not always fair or tolerant of those who are different. If you adopt the negative reactions you receive from other people, then they will relate to the differences you perceive and over which you lack control. However, as Dubin says correctly: we don’t have to do this!

Dealing with this issue is not easy – especially when under the added pressure of a work context – yet by confronting it you can address a destructive part of the AS psyche. According to Baer (2002), millions of people have disturbing or negative thoughts. If you accept them as being part of being human, you take away the power these feelings have over you to cause discomfort and accept them as normal.

The book outlines two suggestions to help overcome this: forgive yourself and; sublimation. You can’t channel destructive thoughts positively if you repress them. Accept yourself for who you are to relieve your anxiety.

To further reduce anxiety the book advocates slowing down the mind to slow down your physiology. To do this you need to become aware when you are feeling anxious. Turn off the thoughts in your mind and focus on more peaceful thoughts or experiences. By fully engaging in the present moment and becoming full detached from the past and the future anxiety can be alleviated. At work, for me, focusing and concentrating only on the task in hand and refusing to let my mind wander.

Accepting that we will make mistakes, not fearing them and seeing them as an opportunity to grow is, the author believes, way forward. The book rightly asserts, in my view, that a person with AS should strive for success in life, something I passionately believe is possible career wise. By ensuring that the beliefs you have about yourself are not dependent on others or the outside world you can be who you are to achieve what you are capable of. Doing so will increasingly raise your self-esteem.

As Dubin helpfully goes on to say, having Asperger’s means we are required to conquer more anxiety in our lifetimes than perhaps we initially anticipated. But by overcoming these greater challenges we can achieve greater self-growth and success in our careers.

By allowing ourselves the ability to make mistakes we can relax more and become less anxious. We have the freedom to make choices in our lives. Reducing anxiety is the key to achieving it, so don’t let fear stop you!

I greatly enjoyed Asperger syndrome and Anxiety: A Guide to Successful Stress Management. To my mind, it is an important book. It fills a void that exists for people seeking to cope with anxiety in the workplace and provides many practical, effective tips to overcome it.

I know from personal experience at work that overcoming anxiety is far from easy. However, by adopting many of the strategies and techniques that Dubin outlines in Asperger syndrome and Anxiety: A Guide to Successful Stress Management, this objective can be realised. For this reason I hope that many people will read it.

Asperger Syndrome and Anxiety: A Guide to Successful Stress Management, Nick Dubin, (2009), Jessica Kingsley Publishers. ISBN: 978-1-84310-895-5

 

Managing with Asperger Syndrome