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"I'm Too Anxious to Get Better"

Part 1: Anxious people are terrible at helping themselves.

SkyPics Studio/Shutterstock
Source: SkyPics Studio/Shutterstock

Living with anxiety is like driving a car without shock absorbers: Everything is a big deal, always hurried, easily overwhelmed, and rarely happy. Some people don't understand that life doesn’t have to be that way. Here are some useful tips I've gathered over years of working as a psychiatrist:

"I feel terrible, but also really good sometimes. Wine helps!"

Anxious people are terrible at helping themselves. An interesting part of my work is seeing people with anxiety who don't think they have anxiety. The thought of "needing help" makes anxious people more anxious. They are often determined to not show weakness (even to themselves) and to just to push forward with business as usual.

Even when patients realize they do have anxiety, they are still anxious and inconsistent about getting help, whether it's getting into therapy, taking medication, or even supplements. Anxious people have an impatience and critical scrutiny that makes it hard to stay any course long enough to see the benefits. Unfortunately, in psychiatry, besides alcohol and Xanax, most interventions take some time, maybe weeks — but they do work.

I especially feel for anxious people because they are set up to suffer quietly inside while on the surface they look fine to everyone else and often perform at a very high level. Their success just comes at an extremely high cost and alcohol sometimes ends up being the opiate of the anxious. They have nothing left when they come home at the end of the day. Anxious people also have some random really good days, when they feel on top of the world. Times like these make them think everything is fine, and that there is no need to seek or continue treatment. It helps to chart the good days and bad days to see where the balance lies, and how interventions like therapy or medication move the needle over time.

"But you gotta be prepared!": The Ant and the Grasshopper

Relax: Some anxiety is useful. We're not trying to throw all worry away. Some preparation and forethought help. In the Aesop fable of the ant and the grasshopper, the ant prepared for the winter, while the grasshopper played. Then, winter came. The grasshopper, unprepared, starved. The ant who prepared all summer did just fine. Who enjoyed their life more, though, is questionable.

Some worry, or "thoughtfulness," makes you more conscientious, thorough, or even obsessive, and can be a source of drive and motivation. But there is an optimization curve on which too little anxiety is as problematic as too much. Anxious people tend to think in extremes — all or nothing, good or bad — while the reality is that most things in the natural world, and certainly in the realm of psychology, are along a spectrum.

One way to look at anxiety is as what I've called the "care spectrum." Indeed, some people — for example, sociopaths — care too little. They have legal problems, or lie, cheat, or hurt other people, and it’s no big deal to them: They sleep just fine at night. Anxious people often care too much. Every little thing is a big deal, and the forest is lost in the trees.

For a brief overview of other helpful tips, and Dr. Dimitriu's practice approach to psychiatry see:

In part 2 of this post, we'll look at the spectrum of anxiety and interventions: click here for part 2 of this article :…