Anxiety: What it is and how to treat it.

“Nothing to worry about, I’m sure that won’t happen”

“But It could…”

“It’s always turned out fine before”

“But it might not this time…”

 

Sound familiar?  It may not always be that clear but anxiety is often this voice in your head that just won’t listen to logic.  The unlikely possibility, the worst-case scenario, the 1% probability of something terrible happening: that’s what it wants you to think about.  In fact, it doesn’t just want you to think about those things, anxiety wants you to believe the 1% probability is 99% likely. 

 What is Anxiety?

Anxiety is often thought of as an emotion, but it’s really more than that, especially when it gets to be problematic.  Similar to depression it is a process.  It is a full body experience.  Certainly there are emotions (worry, fear) but there are thoughts that go along with them (like the ones I opened with) as well as physical sensations.  Your heart races, maybe you feel flush or sweaty, nausea is not uncommon.  When anxiety is at it’s worst and reaches the level of panic it can be debilitating and feel paralyzing.  Your mind gets a little too suspicious.  Suspicious of what might happen, what could happen, suspicious of other people. 

I imagine you are familiar with the idea of fight or flight.  It is an activation of the sympathetic nervous system that prepares us to either fight a perceived threat or flee from it.  Anxiety sees too many things as threats, it sees threats too easily.  As a result, the fight or flight response is triggered too often and too easily.  Social anxiety is a nice example.  Through the lens of anxiety crowds are a threat, parties are a threat, even small talk with a stranger can be viewed as a threat.  Your mind and body tell you to “flee”.  You duck out of the crowd as quickly as possible (regardless of whether or not you accomplished whatever it was you were there to do in the first place), you decline the party invitation, you keep your eyes down and avoid small talk at all costs.  The “fight” side of the coin doesn’t pop up in the form of physical conflict; instead it’s irritability and defensiveness.  Anxiety inserts an irritable edge into a conversation or disagreement.  Your partner asks a question that edges that anxiety a bit higher, you provide a snappy response, and things go downhill from there.  With each “threat” your heartbeat quickens, that “pit of your stomach” feeling gets a little more intense, your mind races a bit quicker, you’ve got to do something to get out of this…

 

Anxiety is tricky.  The truth is that is that it is a normal, universal, and sometimes actually helpful.  If you have a test or big presentation coming up there is likely some anxiety that comes with that date looming on the horizon.  It makes sense to listen to that anxiety.  Doing so means you study, you review notes, you rehearse your speech, spellcheck PowerPoint slides.  You prepare adequately.  Often times you’ll find that preparation lessens anxiety.  It’s a win win; you are well prepared and anxiety is well managed.  It makes sense, if something is making me anxious, I do something about it.  That works, until it doesn’t.

     

When there is a clear source of anxiety it can be easy to prep for, and equally easy to turn the volume on that anxiety down.  Things get dicey when the source of anxiety isn’t so clear, or is something that doesn’t have an end date like a test or presentation.  Social anxiety doesn’t have an expiration date.  We are social creatures, so a future likely doesn’t exist where one can accommodate their anxiety so much that we avoid all human contact and peacefully live out the rest of our days.  It’s natural and human to want to appease our anxiety.  The tricky part is this gets us into a game of short term gain but long term loss.  The party invite shows up in your email and your anxiety spikes.  As long as that e-vite sits unanswered that anxiety hovers in the background.  You want to go, but your mind is already thinking of all the embarrassing things that could happen and what could go wrong.  Thinking about going just makes the anxiety worse.  You decline the invite and poof, anxiety is gone.  However, there is something else in its wake now.  New anxiety about how to answer questions about why you declined, or maybe guilt if you already included a little white lie about why you can’t make it.  Maybe there is regret for not going, or the same mind that talked you out of it is now chastising you for not going anyway.  The anxiety gets worse with the next invitation that shows up.  Decline too many and the invites stop coming entirely.  The more you appease the anxiety the smaller your life gets.

 It isn’t all bad, is it?

It may be weird to think about this way, but anxiety really wants to help us.  In a funny way it wants to protect us; it just goes about it all wrong, or does too good of a job.  If I am being candid, I have always leaned towards anxiety myself.  One particularly anxious point was after the birth of my first son.  There was all of the expected anxiety with being a first time parent, but it wasn’t just that.  The worst of it could be summed up in one thought: what if I die in a car accident?  Doing what I do for a living I am familiar with the devastating impact of losing a parent, something I had seen first hand in my work.  The thought of my infant son suffering through that life trajectory seemed unbearable.  My mind was now insistent on pondering: what if you die in a car accident.  I live in the suburbs, so driving to get pretty much anywhere is a necessity.  Running errands, going to my office, any personal appointment, any social engagement that isn’t my neighbor’s house, all require getting behind the wheel.  My anxiety didn’t just spike at the idea of getting into the car.  My office at the time overlooked a fairly busy Speer Boulevard.  I’d find myself quietly sitting in my office, notice the sound of traffic just outside, and suddenly my mind jumps to “you have to drive home in that, what if you crash and die?”.  That’s how anxiety works, it creeps and sprawls.  There is a simple but not so workable solution here: I could just avoid driving anywhere.  Again, I live in the burbs.  Not gonna happen.  Just imagine the course that might take for a second.  The rationalizing: do I really need to grab lunch with that friend?  Nah.  Anxiety goes down.  That doctor’s appointment I’ve been putting off?  I’ll schedule it tomorrow.  Anxiety goes down.  The can keeps getting kicked down the road to keep that anxiety at bay.  The further the can gets kicked though, the heavier the weight of that anxiety grows under neglected relationships and obligations.  Life gets smaller and the more power that anxiety holds.  Take this example to the extreme, what happens if I were to avoid driving altogether and essentially be confined my neighborhood?  Not much of a life at all, and I’m sure my mind would just find something else to worry about. 

 

Fortunately, I’d done enough work on my own anxiety in the past to have the skills to work through this new manifestation.  Despite all of that it was still uncomfortable.  We are evolutionarily wired to be anxious, it’s really a matter of self preservation.  Technically speaking driving is the most dangerous thing most us will do in a given day.  My odds of survival increase if I avoid it all together.  Seat belts, airbags and a slew of other modern inventions mitigate a lot of the risk and it really isn’t possible to avoid driving, but the more primitive parts of the brain responsible for fight or flight haven’t gotten that message.

 So what can we do about it?

As I said earlier anxiety is a process, and therapy is a process to work through it and drastically reduce the impact it has on your life.  As I described in an earlier post on behavior, even complex ones, are really just a series of antecedents, behaviors, and consequences. Anxiety is no different.  My mind ruminates on a worry so I fixate on a problem to solve.  I feel flush and my heart rate increases, so I start looking for an exit strategy.  This one also falls into the “easier said that done” file, but treating anxiety is really just learning new ways to respond and relate to the antecedents of anxiety.  There is an analogy I like to use with my clients, learning to do something different with anxiety is kind of like wading into a cool pool or lake on a hot summer day.  I’m sure most of you have had that experience.  First you dip a toe in and want to pull it out as quick as possible.  You could just jump right into the deep end, but that would be the equivalent of a panic attack here, sending you right back to the poolside seeking the refuge of a warm, dry towel.  You are committed though and you get both feet in up to the ankles.  Not too bad yet, so we’ll take a few more steps, up to our knees, then our waist.  It’s getting pretty intense now.  The steps are getting slower, the water feels colder.  Your whole body tenses a bit, making sure any bit of dry skin stays dry.  Eventually you make it to your chest, all the way to your shoulders.  The last bit left is submerging your head, and that always seems to take the most effort, doesn’t it?  Make it deep enough, and give it enough time, and your body acclimates to the temperature difference.  At the end of the day we are evolutionarily wired to find homeostasis as well.  Stay in that cool water long enough and your body will adjust.  Stay in that anxiety evoking situation long enough and your body will adjust there as well.

 

While anxiety wants to help and protect it really makes life smaller.  We give up more and more to keep anxiety at bay.  Decline enough social invitations and eventually they stop coming.  Play it too safe at work and career paths narrow.  Stay where our anxiety has convinced us it is safe for too long and things keep moving on without you.  The art and nuance of therapy is reworking our response to anxiety to start making our lives bigger again.  It’s NOT learning how to tolerate it, or simply “jumping into the deep end” and hoping for the best.  It’s more like learning how to play a musical instrument.  Learning what skills and responses are workable and helpful to you is a little like learning how your own unique fingers fit on and navigate an instrument.  We look at some of the theory for why you do what you do, identify with a reasonable degree of confidence what directions will make life better, and get to work on how that fits your life and values.  Also like playing an instrument we figure out how to apply what we talk about each session to your day to day life and give you things to practice in real life where they can actually make a difference.

 

At best anxiety is uncomfortable, at it’s worst it can be paralyzing and debilitating.   It is also very treatable.  If you’re ready to get past anxiety and back to really living life reach out and let’s get to work.