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Essential Secrets of Psychotherapy: Why We Worry (and what we can do about it)

How can we worry a little less?

First and foremost, we fear the future. The unknown. We worry about what will happen to us, our family, our partner, our business, our money, our home, our possessions, our country, the world, etc. We live in a universe which is inherently unpredictable, dangerous and deadly. Indeed, anxiety (and the worry it generates which generates more anxiety) can be understood as an acute or subliminal awareness of life's insecurity. And the ever-present possibility and absolute inevitability of death. So much of what we worry about has to do with losing what we have: health, happiness, love, wealth, power, status, wisdom, freedom, independence, support, vitality and, ultimately, life itself. Either through making some mistaken choice or via the vagaries of fate. Existential anxiety is a recognition, either conscious or unconscious, that life is finite, existence tenuous, and that all or what little we have can be taken from us at any time. This is why existential psychotherapy places such emphasis on the experience of anxiety, seeing it as an inescapable and even necessary aspect of the human condition. And it is why we worry so much about making important decisions: We don't want to deal with the consequences of making a mistake. So we procrastinate, avoiding the existential anxiety of choosing without knowing for certain whether we are right or wrong.

In his classic work The Meaning of Anxiety (1950, 1977 ) existential psychoanalyst Rollo May differentiated between normal and pathological anxiety, suggesting that neurotic or even psychotic anxiety typically stems from the chronic avoidance of normal or existential anxiety. In other words, when we refuse to accept and tolerate anxiety as an inescapable part of existence (and the "dizziness" of our freedom, as Kierkegaard pointed out), we paradoxically set ourselves up for the appearance of pathological anxiety and pathological worrying. Some worrying and concern for the future may be unavoidable, and, in certain situations, necessary and potentially helpful. We need the capacity for anxiety to anticipate danger, detect and deal with fundamental threats to our basic survival, to motivate and energize us, to warn us when we have been inauthentic or betrayed our basic values, to grow more fully conscious and become more creative. But when we try to avoid or repress this healthy anxiety by denying reality and our true feelings, it turns toxic, taking the neurotic form of persistent worrying, chronic tension and fatigue, disturbed sleep, headaches, hypervigilance, irritability, restlessness, impaired concentration, digestive and other physical problems, panic attacks, paranoia and myriad other debilitating psychiatric symptoms. Our non-stop worrying has made us sick. And then we worry about having these symptoms, causing even greater anxiety.

Worrying can also pertain to wanting to be perceived by the world as we wish. And desiring to see ourselves as we want to be seen. When we are heavily invested in projecting and maintaining a certain image or persona to others, we must be ever-watchful and guarded about that particular persona being penetrated and seen through. We worry about being exposed. Being known. Found out, as, for example, in the so-called "imposter syndrome." Being judged. Criticized. And we worry about knowing ourselves. About being confronted with who and what we truly are. We humans innately harbor a primal fear of the unconscious, the unknown, and of what C.G. Jung termed the shadow. For the persona, as Jung pointed out, is specifically designed to hide our shadow, to keep us from fully knowing ourselves as well as for fooling others. For many, the facade or persona of a competent, confident adult disguises a worried, anxious little girl or boy trying to get by in a scary grown up world. Any circumstance that potentiates such embarrassing exposure, revealing the real person behind the mask, is deeply threatening and, therefore, extremely worrisome. Anticipatory anxiety kicks in: What if I can't hide my feelings? My insecurity? My love? My sadness? My rage? My neediness? My vulnerability? My true self? What many try so hard to hide and worry so much about others seeing is the fact that they feel anxious in the first place. We worry about what people will think of us if they know we have anxieties or insecurities. So we work hard and worry about how to conceal our shameful anxiety, which only makes it stronger and doubly difficult to disguise. Ad nauseum

So what is the solution to this perennial dilemma? How can we stop our excessive worrying? Cognitive-behavioral therapy attempts to help patients see that their worrying is irrational and counterproductive. That it serves no purpose, heightens anxiety, and does nothing to prevent that which we worry about from taking place. "Catastrophizing," for example, is a very common kind of worrying in which we imagine the worst case scenario possible even for relatively minor events. Yet, in reality, such cataclysmic outcomes fortunately rarely occur. So why continue to do it to ourselves? True enough. Reasonable. Logical. But neurotic worrying and anxiety are, by definition, not rational. And as with other irrational symptoms like delusions in psychotic patients, they are not very amenable to rational disputation. Nor--despite the fact that psychiatric drugs like Lexapro or Klonopin can help reduce anxiety and thereby lessen excessive worrying--are they all that amenable to pharmacological intervention over long periods of time, since this treatment can become yet another potentially habituating type of avoidance. Existential psychiatrist Viktor Frankl employed a technique he called paradoxical intention: rather than worrying about controlling and concealing your anxiety, willing instead to be as anxious as possible in certain nerve-wracking contexts can paradoxically decrease your situational anxiety and worry. This is sometimes a helpful trick. But we need to dig deeper. We must also address what underlies and drives the obsessional worrying, the underlying anxiety itself. And discern the significance of that anxiety rather than trying merely to medicate it out of existence.

Existential philosopher Soren Kierkegaard felt that anxiety can be our best teacher. So the crucial question is whether we are willing to stop worrying long enough to listen to what our anxiety has to tell us. To sink more fully into our anxiety rather than run from it. To be more present to it. Is it a warning of some kind? An alarm or wake up call? An overactive thyroid or perhaps a sign of some other latent physiological illness? A byproduct of some psychoactive stimulant, like caffeine, nicotine, cocaine or amphetamine? Or a "signal," as Freud suggested, that we are resisting becoming more conscious of something unconscious and conflictual? Or could it be a psychological call to arms? An urgent inner necessity for action? Might it herald the pressing need to change our life, our persona, our relationships, our world-view? To live in closer alignment with our true temperament? Establish better balance in our personality or life-style? To seek some new sense of spiritual purpose and meaning? Find a more fulfilling work, social or love life? Or could anxiety sometimes be a clarion call and a spur to greater creative expression? (I discuss the close connections between anger, anxiety and creativity in my book Anger, Madness, and the Daimonic.)

Existential psychotherapy suggests that we must learn to accept and tolerate our anxiety, and that some anxiety is the inescapable price of being free, conscious, mortal and responsible for ourselves. But is this necessarily so? Philosopher and theologian Alan Watts, in his brilliant book Psychotherapy East and West (1961), doesn't buy it. What, Watts wonders, if we were to just stop caring so much about what we have to lose? In Buddhism, for instance, suffering (which certainly includes worrying and anxiety) is seen as the consequence of having too much desire, grasping or attachment. Attachment to material things. Desire to have certain feelings or experiences, and not others. Grasping for what we don't or cannot have. Expectations about how life, relationships, and people should be, and what the fruits of our efforts will bring. What if it were to turn out that we actually have nothing to lose? Because, in reality, we have nothing but our existence itself. All else is accoutrements or accessories. And what if even our existence is nothing more than a dream? A very convincing hallucination? (See my previous posts about reality and the movie Inception.) Or, in Hindu and Buddhist terminology, mere maya or illusion. What then is there to worry about? How can one lose what one doesn't really have? Or what one doesn't truly need? This would not be to say that we no longer care about others or the world. Only that we choose to be less attached to and more accepting of the world and what happens in it. Living in the world but not being of it. Ultimately, less anxiously attached to our own continued existence. And, therefore, less fearful of our own demise. We would be virtually liberated from worry. But such liberation is much easier said than done. For one thing, the survival instinct is primitive and supremely powerful. Traditional Western religions take a similar tack and serve a similar purpose: Spiritual faith in an all-powerful God and belief in life-after-death for some makes life more meaningful, mitigates anxiety, and diminishes excessive worrying. Unswerving faith and trust in a benevolent and omniscient God and relinquishing control eliminates any need to worry about what will happen. It's all in God's hands. The philosophical concept of predestination--that all is predetermined and planned for us in life, that free will is just an illusion, and that therefore it makes no difference what our decisions and choices are since the outcome is set--is yet another method of precluding the need to worry.

Still, there is no denying that death anxiety--or really, it's avoidance--is the surreptitious source of so many of our daily worries. When our worries are carefully examined and carried out to their logical conclusions, death is often what we find lurking there. Fear of death. Fear of Hell. Fear of reincarnation. Fear of nothingness or oblivion. Fear of suffering. As Woody Allen once put it, "I'm not afraid of death. I just don't want to be there when it happens." But what happens when we no longer dread death, but rather accept it as merely the necessary counterpart to life, as darkness is the counterpart to light? When we embrace suffering as the necessary counterpart to joy, pleasure and happiness? Opposite poles of the same existence. And when we see that there really is no such thing as security in life. Except for that sense of security that comes from within. A spiritual rather than physical security. We arrive at what Watts called in another superb book the "wisdom of insecurity." We realize that our constant worrying was always a way of denying these existential facts. Of escaping the present. Of avoiding our existential anxiety. Of trying to convince ourselves that we have more control over life than we actually do.

Relinquishing our illusions of control, accepting our relative powerlessness over life and death, and accepting ourselves as we are--including our anxiety--can be extremely liberating. It can allow us to stop worrying so much, and get on with living. The mysterious future will unfold soon enough. Make necessary plans and decisions. But don't dwell on them or their desired outcomes. Focus instead on what's happening right now, this very moment, however anxiety-provoking, painful, difficult or infuriating, rather than anxiously anticipating what may or may not happen next. And when you catch yourself worrying way too much about something, remind yourself that sooner or later you, just like all who have come before us, will be dead. We are destined to die someday. Given that sobering realization, how many matters are really worth worrying about? Try that existential perspective on for size. You might find it refreshing.



Dr. Diamond is co-founder and director of the Existential Psychotherapy Center of Southern California, a clinical training program for mental health professionals and graduate students located in Los Angeles.