When it comes to overcoming debilitating anxiety in young adults, what matters most is not just an improvement according to a diagnostic manual (known as “syndromal improvement”) but also functional improvement. In essence: Has the young adult’s life improved in ways that he or she now has more hope, feels happier, and has a sense of real, meaningful connection to the world around him or her?
Most of the evidence-based treatment models for anxiety utilize a more cognitive behaviorally based approach. This approach is often very effective in reducing symptoms and creating syndromal improvement. Individuals can manage to leave the house to go grocery shopping, take public transportation, go to work or school, or meet up with a loved one. They may become more skilled at no longer procrastinating and avoiding, and they may feel less emotionally dysregulated.
While these accomplishments will, no doubt, improve one’s sense of well-being, the ultimate questions that look at the overall quality of life remain: Are you happy? What are you doing with your life?
These questions are understandably more complex. Young adults are at an important stage of development, and it is critical that when anxiety becomes disabling, either on its own or in conjunction with another mental health diagnosis or learning disability, that individualized treatment plans that take into account their personality, learning style, and emotional disposition are created and implemented by a qualified clinical team. It can’t be “just therapy” if we want to see long-lasting results, and we need to cognizant of the fact that what works for one person may not work the same for the next.
There is a growing awareness of this, nationally and internationally, that has actually gotten the attention of our President. In his recent State of the Union message, President Obama noted that one of his goals is to revolutionize medicine by moving beyond a one-size-fits-all treatment. The National Academy of Sciences also recognizes that there is a need for a new taxonomy of disease, and this is applicable to medical as well as psychiatric disorders, including debilitating anxiety.
So, while cognitive behavior therapies can result in notable syndromal improvement, the bottom line is, if you want to stop anxiety, you must resolve your attachments to “thinking mind.” This takes more than traditional therapy, and it is why our model at Optimum Performance Institute (OPI) and our Roanne Program for young adults with Borderline Personality Disorder includes treating the whole person. What does this really mean?
Engaging in activities that elicit joy and allow one to find, express, and share a passion is part of the final common pathway of healing for young adults who suffer from mental health issues, including anxiety. We explore this in our programs through a variety of groups and clubs, such as surfing, improvisational acting, equine therapy, and our in-the-works filming workshop, to name a few. It has been our consistent observation and experience that if a young adult has been able to experience a moment of true freedom from thinking mind through experiential opportunities in a safe, supportive environment, they will understand freedom from anxiety in a way that words cannot express, and this can have a lasting, positive impact.
The basic premise in all mindfulness practices is that suffering comes from attachments, and the nature of mind is such that it is programmed to think in a sequential, linear way, and that is essential to get us through the day, but the answer to “Are you happy during these days?” is a far more complex query for the mind to process. And, then, especially for young adults transitioning to the next stage of development with living independently, working, or going to school, change is inevitable.
What is unique about the age group that we see at OPI is that the notion of what we call “existential anxiety” is felt/present. The anxiety of “What am I going to do with myself? I want to find something that I can feel… that I can tap into… that I can express… to give me some joy in this life.” I don’t believe these questions can be satisfactorily resolved by any pharmacologic brain stimulation, in whatever form, or solely with evidence-based CBT.
The resolution or, more clearly, the forward movement on the journey is achieved by many interdependent experiences encompassing elements of all of the therapeutic modalities and then opportunities to validate the potential of having a moment of joy and sharing it with others. In this process, one discovers a non-achieving mind to overcome existential anxiety and essentially move beyond a very rigid attachment to the thinking mind.
That does not mean that you are in a state of consciousness that when a tiger comes in a room, you won’t see it—the question is the number of times we react as if the tiger were in the room, but there is actually no true danger, no real threat present.
With fear, whether it is of change or anything else, this sometimes manifests in young adults as difficulty with launching, because avoiding is a natural response to anxiety. One of the greatest impediments to the launching process is an avoidance of engagement—the effect of avoidance is again related to not only a sense of depression and failure but, perhaps most importantly, to undermining our own sense of confidence and esteem. Anxiety is pervasive and fundamentally has a lot to do with our ability to tolerate change.
We all would like things to be the way we want them to be. We feel safe with predictability. But in reality, the human condition is described by chaos theory—as living on the edge of chaos—meaning there are elements of unpredictability that can impair us.
Some call this unpredictability of life “bliss.” Some call it “inspiration.” And sometimes, especially with severe anxiety, some people call it suffering.
Ultimately, failure-to-launch syndrome due to anxiety can be successfully overcome. At a stage in the development of the young adult years, there are great possibilities for growth. These individuals are not as habituated certainly as someone my age, so there are wonderful opportunities for growth and healing. There are many interventions that, when combined by a skillful clinical team, can help young adults overcome anxiety issues and emerge as self-confident, capable adults who are ready to succeed in this world and, most importantly, find true happiness.