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Anxiety Addiction and Crisis-Dependent Function

How we hold ourselves back by needing anxiety to function.

At a cardiac arrest, the first procedure is to take your own pulse.

- Samuel Shem, MD, House of God

What is "anxiety-dependent functioning"?

For many years now, I've been thinking about the idea of "anxiety-dependent functioning" and using the concept in clinical and organizational settings. People get it right away. People also like the term "crisis dependent functioning", for contexts in which the stakes are experienced as higher, and seems there is with impending disaster.

It's a simple yet powerful notion: people develop the need to get highly activated in order to perform basic functions, and that sustained activation while adaptive at first leads to impairment. Sustained stress has been clearly shown to impair cognition and lead to changes in brain structure and function (Shalev, Gilboa & Rasmusson, 2011). Crisis mode is short-term solution which unconsciously becomes deployed as a routine, long-term solution. Anxiety dependence becomes a self-sustaining dysfunctional system, similar to an addiction. Somehow diminishing returns and bad outcomes aren't enough to get us to change our ways, at least not until something really terrible happens. It leads to burnout, and is a common maladaptive pattern of self-motivation, one which depends on denial rather than self-awareness.

Furthermore, the anxiety which becomes necessary to function moment-to-moment reduces the ability to fully appreciate what is happening, leading to multiple a cascade of problems as hasty efforts to put out fires spreads sparks which create new ones, and so on.

As a result, perception of the situation and involved people (including oneself) is distorted, decisions are rushed and based on incomplete and inaccurate information, actions, therefore, do not have the desired impact.

Learning from experience is also impaired in anxiety-dependent functioning. This is because self-appraisal and corrective action are also adversely affected by anxiety, worsening the problem and re-enforcing misconceptions about oneself, others, and how to approach similar situations next time. Learning doesn't happen right. Executive function - reflection, planning, assessment, action - is off track.

In crisis-dependence, the situation is intensified. Every problem is treated is if there were a looming disaster to be averted, every single time. The ability to reflect and process situations as they are happening is deeply affected. If we haven't drilled extensively, then our auto-pilot reactions can lead us astray, into danger. Self-care suffers as a consequence, compounding problems even more as depleted personal resources lead to even more difficulty slowing down and thinking clearly.

Anxiety is intergenerationally-transmitted

Recent research (Eley et al., 2015) shows that anxiety is significantly a consequence of social learning (rather than only genetic), based on modeling of family behaviors, emotional functioning, problem-solving style, and communication. Anxiety-dependent function may be passed from one generation to the next, from parent to child. For example, a child may grow up in a home where the parents wait until the last minute to do important things such as paying bills, addressing school issues or health problems, etc, causing an avoidable crisis. They then respond in a frenzy to avert disaster, saving the day but re-enforcing the pattern - and letting other things fall by the wayside because they are too tired and too preoccupied to address them - leading to the next crisis.

The upshot

Everyone has their own way to arrive at anxiety dependent functioning. The final common pathway, however, is consistent and repetitive - and painfully familiar to many of us. We may come from a family background characterized by chronic anxiety and constant crises, handled by authority figures (most notably parents and other caregivers) depending on manufactured crisis to get thing things moving.

If nothing happens to intervene, these basic developmental, familial patterns are re-enforced in adolescence, and adulthood, and become consolidated over time. The longer a person utilizes anxiety-dependent approaches to complex situations, the more they become dependent on this mode of functioning.

Fortunately, there are plenty of better options if we can recognize the problem, clear some space to catch our breath, and work toward unlearning maladaptive patterns and replacing them with sustainable approaches.

Twitter: @GrantHBrennerMD




Eley TC, McAdams TA, Rijsdijk FV, Lichenstein P, Narusyte J, Reiss D, Spotts E, Ganiban JM, Neiderhiser JM. 2015. The intergenerational transmission of anxiety: a children-of-twins-study. The American Journal of Psychiatry, Vol 127, Issue 7, July 01, pp. 630-637.

Shalev A, Gilboa A, Rasmusson AM. 2011. Neurobiology of PTSD in Post-Traumatic Stress Disorder, in Post-Traumatic Stress Disorder (eds. Stein DJ, Friedman MJ, and Blanco C). John Wiley & Sones, Ltd, Chichester, UK.

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