‘When we practise acceptance, it eases the internal struggle’

What I liked most about your book is that it starts off necessarily simple – e.g. around what you call the 'basics', and the 'first aid kit' – and then you're gradually revealing quite an in-depth approach, saying things like 'don't be tempted to skip this stage', and 'this is the most extensive chapter, I've seen the power of this aspect'. Talk to me about the importance of the 'stage' approach.

The approach in Ten Times Calmer enables the reader to experience progressive learning. By starting with simple, foundational concepts or the 'basics', readers can build a strong foundation before delving into the more complex ideas, making it easier to grasp and apply the concepts more effectively. Many of the concepts are interrelated… by following the staged approach, readers are more likely to see the bigger picture and understand how the different concepts fit together.

The book is structured and informed by my work with people struggling with anxiety problems, and breaking the material down into manageable chunks through stages is a way to avoid the overwhelm they often report. The sections provide a clear map of where we will be going, so readers know what to expect and when. Achieving results at each stage can boost motivation, confidence, and create a sense of accomplishment, helping readers stay committed to their journey of overcoming their anxiety.

Having said that, people have unique experiences of anxiety, so readers can be empowered to tailor the staged approach to their specific circumstances. They can prioritise the stages that align most closely with their difficulties once they've established the foundation with the basics they need and worked through an understanding of their anxiety. Furthermore, they should have acquired the skills needed to approach their anxiety differently, with a particular emphasis on acceptance and flexibility, which are foundational elements.

Beyond that, readers can give priority to the stages that closely match their difficulties. For example, one reader may struggle more with anxious thoughts, while another may be grappling with over-focusing on bodily sensations. Flexibility is key… readers can experiment with the different skills and resources offered to find what works best for them.

I know 'Ten Times Calmer' is based around it being a ten-stage programme, but do you also have an expectation of how much less anxious you're trying to get clients to be? Often, is 'twice as calm' a pretty decent outcome?

Quantifying the degree of anxiety reduction could be challenging, as there isn't a precise or universally applicable measurement readers can use. As readers progress through the ten chapters, they will acquire valuable skills, ultimately equipping them with ten different methods to achieve a sense of calm. The primary aim is to empower people to effectively manage their anxiety symptoms, enabling them to lead more fulfilling lives. This includes enhancing their capacity to cope with anxiety, reducing the frequency and intensity of their symptoms, and ultimately improving their overall well-being.

When I get books like this, on a specific mental health issue, I'm often interested in the extent to which the ideas and solutions actually underlie a real range of issues. For example, when you write 'Think of your anxiety as a story, where you are both the actor and the audience'. Is that something you bear in mind as you're writing, i.e. trying to communicate broader, transferrable skills for change?

Yes, I do aim to convey broader, transferrable skills for change. For instance, when I suggest considering anxiety as a story where you play both the actor and the audience, my goal is not only to provide a coping mechanism for anxiety but also to highlight the broader skills of mindfulness and self-awareness. These skills can be applied to a range of emotional difficulties, and they extend to personal growth and self-improvement as well. By integrating these broader, transferrable skills into the narrative of Ten Times Calmer, my intention is to empower readers not only to tackle the anxiety issue at hand but also to develop a toolkit of skills and strategies they can adapt and apply to different areas of their life if they wish to.

Another example is the skill of mindfully observing anxious thoughts. While Ten Times Calmer primarily focuses on addressing anxiety-related issues, readers can also apply this transferable skill to other types of non-anxiety-related thoughts that trouble them.

If you had to pick out a main 'anxiety myth', what might it be?

The belief that all anxiety is solely caused by trauma is a common misconception and an oversimplification of the complex nature of both anxiety and trauma. While trauma can indeed be a significant factor in the development of some anxiety disorders, it is not the exclusive cause. Anxiety can stem from various sources and it's crucial to recognise that not everyone who experiences trauma will develop an anxiety disorder, and conversely, not everyone with an anxiety disorder has experienced trauma.

To gain a more nuanced understanding, we have to acknowledge that anxiety disorders can also originate from factors other than trauma. These factors include temperament, personality traits, environmental stressors, life transitions, habits that develop in response to anxiety-inducing situations and persist, patterns of thinking and behaviour influenced by how much attention is given to stressors, reactions to doubt and uncertainty, and learned behaviours. Additionally, some people may develop anxiety without any identifiable cause, and that's okay too.

Of the tools you advocate, what would you say tends to make the biggest impact on clients?

It's difficult to single out one tool: all of them have their role and effectiveness. If I had to choose, I'd highlight 'acceptance', which involves acknowledging and allowing uncomfortable thoughts, feelings, and physical sensations to exist without attempting to control or eliminate them. This is because the struggle to control or eliminate these feelings tends to exacerbate them. When we practise acceptance, it eases the internal struggle, freeing up mental resources to address our anxiety problems more flexibly, allowing us to respond to anxiety in more adaptive ways. Acceptance also demonstrates that when we embrace these inner experiences, their distressing impact gradually fades.

What needs to change in how applied psychologists tackle anxiety? Is it about the right balance of self-help and professional help, for varying levels of anxiety?

There is a pressing need for changes in how we approach the treatment of anxiety. We need to address the diverse needs of people with varying levels of anxiety severity, requiring a comprehensive yet flexible approach. Traditionally, many services have employed a one-size-fits-all approach to anxiety treatment pathways, which is not suitable for everyone. Some people need less support, while others need more intensive intervention, including home visits for those unable to leave their homes – something I've done countless times, knowing it's the only way to initiate the process of help for that person. For instance, someone who has been housebound for three years, it's unrealistic to expect them to turn up to a clinic. I visit clients like this at home, often after the third session, they are able to leave the house again. We must think creatively, even if it means doing things differently. Even when people say, 'we don't usually do that' sometimes we have to deviate from the 'usual' to provide real benefits to people who are suffering. I do recognise that funding limitations often present frustrating obstacles for many of us in being able to work flexibly and creatively to provide our clients with the best help.

Shifting from a reactive approach to anxiety towards a more preventative one is also a change I'd like to see. Prevention efforts are crucial for many aspects of health, and educating people on anxiety prevention should be a part of this too. Public awareness campaigns can play a pivotal role in this, yet we don't often see them for mental health, we only regularly see them for physical health, even though mental health services are overwhelmed with demand.

Has being on TikTok changed your approach to your professional practise, or to your writing?

Not really, I am a clinical psychologist, and that's who I am on TikTok or Instagram, and who I am professionally. My presence on social media has allowed me to reach a broader audience and share mental health insights in a more accessible format, but it hasn't changed my approach to my professional practice. I continue to draw from my clinical knowledge and experience to provide accurate and helpful information on social media. In terms of writing Ten Times Calmer, it has been informed by my clinical experience. While social media has provided a platform to discuss mental health topics and engage with a diverse community, the content and principles in my book have been shaped by years of working with people dealing with anxiety and related issues. The book is a culmination of evidence-based approaches and the related practical strategies that have been effective in my clinical practice.

I can see that you're aiming for direct and relatable. Do you think that many psychologists have their own anxieties around communicating in that way?

Yes, I believe many psychologists do experience their own anxieties when it comes to communicating in a direct and relatable manner. I've encountered numerous colleagues who share these concerns. Putting yourself out there on social media can be intimidating for anyone. There's a fear of public scrutiny, potential backlash, or misinterpretation of the messages you're trying to convey. I think this anxiety often arises from the awareness that social media can be a challenging platform to navigate, especially when discussing complex topics like mental health. Additionally, not everyone on social media is kind, and building resilience to navigate these challenges is important.

In my view, being direct and relatable is not only acceptable but can also be highly effective in communicating with a broader audience. Really, it's about finding a communication style that aligns with who you are, your personality, and your values, and how you feel comfortable. When you are authentic and true to yourself, without attempting to mimic something else, communication flows more effortlessly. Personally, I've always been direct, a trait influenced by my family, we're a straightforward bunch. So this is how I engage on my social media platforms and in my writing, it enables me to connect with people looking for clear, relatable insights into anxiety, and mental health.

Was there any part of writing and publishing the book, or recording the audio version, which made you particularly anxious yourself? If so, how did you tackle that?

Writing the book was a very enjoyable and exciting experience with occasional anxiety-inducing points. There were moments when I felt a bit anxious about the prospect of my words being out there for everyone to see, particularly the worry of unintentionally saying something incorrect or misleading. To add to the mix, during the writing process, my husband, children, and I all contracted Covid-19 for the second time! This induced anxiety, not only because of health concerns but also because it disrupted the writing timeline.

My anxiety doesn't usually linger, and I don't say that to show off. Despite enduring challenging experiences, one key strategy that has really helped me is to consistently focus on what truly matters and keep taking action. If I am anxious I acknowledge it, accept it, and then do what I can to move forward. This approach has allowed me to navigate anxiety effectively. As someone who has authored a book on anxiety, I practise what I preach.

• Ten Times Calmer: Beat Anxiety and Change Your Life by Dr Kirren Schnack is out now (Bluebird, £16.99 hardback). For your chance to win a copy, see @psychmag on X.