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Anxiety is the most common problem people seek to address in psychotherapy. Anxiety problems are linked to both genetic and environmental factors, and they manifest in various forms. Some people suffer with chronic, free-floating worry; others fear certain specific objects or situations, or dread being evaluated negatively in social situations. For some, anxiety relates mainly to the recollections of past trauma, while others may suffer from debilitating panic attacks, marked by symptoms such as racing heart, breathing difficulties, sweating, trembling, and dizziness. Untreated or poorly managed, excess anxiety can hinder severely one’s quality of life. Fortunately, anxiety problems can often be treated well with a combination of medication and psychotherapy.
As a psychologist, I have been treating anxious clients for roughly 25 years. People who deal with anxiety are a diverse group and do not share a single personality profile. They come from all walks of life, ethnicities, and backgrounds, each with his or her own history, temperament, challenges, and sensibilities.
Yet there are commonalities. Over the years I’ve noticed that certain issues keep showing up in treatment, particularly some erroneous assumptions, attitudes, and habits related to anxiety, that stand in the way of improvement and success. Below are quick outlines of some of these most common misconceptions regarding anxiety (I have written about some of these before, here):
The linearity assumption: “If I do nothing, my anxiety will continue to increase indefinitely.”
Many people who deal with anxiety and panic will recognize the situation: you are somewhere doing something. Suddenly, your body is a frenzy of symptoms. You’re breathing hard, dizzy, and lightheaded; your heart is beating a mile a minute; you feel like you’re going crazy. Feeling your anxiety rising, you tell yourself that if you don’t do something, the symptoms will continue to escalate in a linear function, fast and upward with every passing minute, getting worse and worse ad infinitum. This prediction is intuitive, but erroneous.
In fact the relationship between panic symptoms and time is not linear but curvilinear, shaped like an inverted U. If you stay with your symptoms past the point of marked discomfort, they will continue to escalate for a while, but not forever. After a while they will level off, and then decline. This is largely due to the physiological process of habituation by which prolonged exposure to the same stimulus leads to reduction in nervous system excitation, and hence reduced anxiety.
People who deal with anxiety and panic are often uneducated about this fact. One reason for this is that they have never experienced it in real time because they tend to escape the situation before entering the habituation zone. Thus, an important part of anxiety treatment involves exposure practice, by which a person is guided to remain with their symptoms past the point of discomfort, to give their nervous system the time to habituate and to provide them with firsthand evidence refuting the linearity assumption.
Delaying to avoid, rather than avoiding delay.
If you are feeling scared while in line to jump off the high diving board at the pool, your anxiety may compel you to retreat to the back of the line, thus delaying that dreaded dive. Alas, what you’re also doing is extending your waiting time, and with that your anticipatory anxiety period. Anticipatory anxiety is usually much worse than the actual anticipated event, because it is unbounded by the parameters of a specific action in the world. Since nothing is actually happening, your anxious mind is free to roam wherever it wants—which usually means toward catastrophic scenarios. Now in life, real catastrophes are rare and unlikely. But within the anxious mind, they are frequent and imminent. Going to the back of the line will thus make you more, not less, anxious and therefore more likely to fail at achieving your goal. If you’re anxious about something (assuming it is not actually dangerous), your best bet is to move toward it, not away from it.
Shifting attention from the anxiety-provoking task to the anxiety symptoms.
The psychologist David Barlow and others have shown that people who deal with performance anxiety in bed have several common characteristics. For one, their anxious thoughts (“am I a good lover?”) cause them to turn their attention to the thoughts and away from the lovemaking, with predictably negative consequences for said lovemaking. That’s a common mistake outside the bedroom as well. When we’re anxious, our fight-or-flight system gets activated, which involves several annoying, distracting, and alarming (yet not dangerous) bodily symptoms. The discomfort of these symptoms may tempt us to focus on trying to eliminate them, which in the short term usually means avoidance or escape. Skilled anxiety management, however, involves taking your anxious arousal as a call to focus more intently on the task at hand, rather than focusing on the symptoms. The correct response to a fire alarm sounding off is not to turn off the fire alarm or cover your ears, but to go fight the fire.
Conflating fear and danger: “I’m scared, therefore I must be in danger.”
Our anxiety system has evolved in a time where danger and fear were closely aligned. But today, you probably live in an environment where ancient fear cues no longer denote real danger. It’s important not to confuse the two, but doing so required some cognitive effort. When you feel anxious, ask yourself: ‘am I in danger?’ If not, then the anxiety symptoms are noise, not signal, and are best regarded as such.
Related to this is the distinction between how you feel and how you are. These are not necessarily one and the same. For example, drunk people often feel they can drive fine. And people in the midst of a manic episode feel they can accomplish anything, etc. Likewise with anxiety, people in the midst of a panic attack may feel out of control, but they are not in fact out of control. Those who experience panic attack while driving, for example, will always find a way to bring their car to a stop safely and call for help—all of which are signs of ample control. Your feelings are mind events, not world events. Don’t believe everything you feel.
Hating on yourself because you are anxious: “I’m weak and stupid for being anxious about this.”
Many people beat up on themselves for getting over-anxious in certain situations. They may berate themselves, call themselves weak, stupid etc., believing that such self denigration will somehow motivate them to improve and overcome. This is a mistake. Self-rejection is not a path to self- improvement. The correct approach is to use self-compassion and curiosity when learning to deal with anxiety. It’s much more effective to tell yourself: “To feel anxiety is part of being human. Let me accept this feeling, inquire about it, get to know it, and treat myself with kindness as I take on the challenge of learning to manage it well.”
Hating on anxiety because it afflicts you.
The symptoms of anxiety are annoying and scary. It’s no wonder that once we have experienced severe anxiety, we are disinclined to want to repeat the experience. Hence avoidance. Alas, while avoidance is effective in providing short-term relief, it is counterproductive in the long term. By way of an example: Let’s assume that you hate mold. Now let’s assume you find mold in your basement. Your intuitive, initial impulse may be to avoid going in the basement for fear of encountering the noxious mold. This is effective in the short term, yet problematic in the long term, because under these conditions the mold will spread, soon invading other rooms in the house. If you want to get rid of your mold problem, you have to actively confront it; you have to make contact with the mold, in the basement. It’s unpleasant in the short term, but profitable in the long term. And life is long term.
It’s important to remember in this context that the anxiety system is designed to protect us. Hating on anxiety just because it’s annoying is a bit like hating on a baby who cries a lot. Crying, for a baby, is a proximity-seeking behavior necessary for creating attachment relations with a caregiver. By crying, the child alerts you to some unmet need to which you may then tend. A child who’s unable to cry when they’re hungry, scared, or in pain is less likely to survive. Like crying, our anxiety response is a system designed for protection, not harm. You don’t want to get rid of it. You want to learn how to understand, manage, and deal with it properly.
The ‘gain without pain’ expectation: “A good life is free of discomfort.”
Human beings like comfort. And American human beings like comfort perhaps more than anyone. Most of us are deep in the business of avoiding discomfort. And that’s OK. Except that discomfort is an unavoidable feature of life. In fact, achieving any meaningful goal or end in this life entails enduring discomfort (think: marriage; raising children; running a business; finishing college; getting old). Therefore, while we spend much time and energy figuring out ways to reduce or avoid discomfort, it is also useful to spend some effort learning how to tolerate discomfort, so that we are able to handle it when the situation calls for it.
Thus, anxiety episodes and experiences are de facto opportunities to practice discomfort-management and to develop skills in that area. For someone who can’t swim, the swimming pool is scary. Yet the best solution is not to avoid the pool, but to learn to swim.
