Why am I anxious?

Typically, people respond to anxiety by trying to avoid or mitigate the perceived threat. This can give rise to all sorts of
“avoidance behaviours”, such as avoiding social interactions (like that party where you don’t know anyone!) or activities (like doing that homework or sitting down to file your taxes). Moderate anxiety can lead to procrastination—putting off things that you know you should do. When anxiety gets too strong, it feels paralyzing. It feels too scary to do anything, except to retreat into the perceived safety of the home, the bed, food, alcohol, the internet etc. Anxiety and addiction are closely intertwined.

If avoidance is not possible, and people feel forced to engage with the world (to go to work, engage socially, etc.) they may engage in “controlling” behaviours to attempt to mitigate the threat. The idea goes something like this: “I have to do scary thing “X”, but if I do things in a certain way (work hard enough, go through enough scenarios in my head, be super vigilant, etc.) than I just might get by”. The problem with this strategy is that the world is very big, and we are very small. Trying
to control what happens in our lives is a little like a fish trying to control which way the stream is flowing:

• a) usually destined to fail and
• b) causes us to be very hard on ourselves (and others) for our apparent failures: “why was I so dumb/incompetent?” “if only I had done “X” instead”; “next time I have to get it just right”, “why can’t my husband/wife/child just be what I want them to be like — they’re going to ruin everything!”.

Writing this section has made me reflect on the many ways in which anxiety has shaped my life, and how, thankfully to a smaller degree, it still shapes it today. How about you? How does anxiety manifest in your life? How would your life be different without it?

If anxiety is about exaggerating the scariness or seriousness of potential threats, then psychotherapy aims to reduce this threat perception or to bring it more in line with reality. There are literally hundreds of types of psychotherapies in the world today, and they all attempt to do this a little differently (sometimes very differently). Here are the broad strokes of the most common approaches:

• Cognitive Approaches: These therapies focus on identifying and changing negative thought patterns that contribute to anxiety. Have you ever noticed yourself, or someone that you know, focus only on the negative aspects of a situation and to discount the positive? Do you know someone who see things in as either-or, or black-and-white? Perhaps you know someone whose mind jumps to conclusions too easily (and often to the worst-case scenario!) Or someone who minimizes their successes and magnifies their failures? Cognitive approaches teach us to spot such irrational cognitive patterns and to replace them with more balanced ones. Anxiety, on this view, arises because of defective thinking/beliefs. Fix the thinking and you’ll fix the anxiety.
• Mindfulness Approaches: Mindfulness-based therapies emphasize paying attention to the present moment. Why the present moment? Do a little experiment for me: find an anxiety or worry that you might have. Try to see if it’s source is
  in the past, present or future. Now, to the extent that you can, try to bring your mind back from the future and into the present moment by bringing very careful attention and curiosity to your current experience—perhaps becoming really curious about the feeling in your fingertips as you gently rub them together, or bringing curiosity and attention to your breath or to an object in your room (it may help to pretend that you have never done the action or seen the object before). Give this your full attention for a minute or two. Were you able to focus your attention? If so, what happened to the worry while you were doing it? By learning to focus on the present moment we discover that thoughts and feelings (including our worries) are only mental events—they come and go— and we have the power to disengage from them. As a bonus, we also find that the world of our present experience is much richer and meaningful than we had imagined….

• Psychodynamic Approaches: Have you ever experienced some part of you wanting something (like the sixth chocolate in a row!) but another part telling you that you shouldn’t, or making you feel guilty about it afterwards? Of course! We all have. But wait. This experience is so commonplace that we don’t even notice how weird it is. It is as if there are different
  entities within you, each with their own perspectives, desires and even temperaments. Psychodynamic approaches are about taking this idea seriously (to varying degrees). Psychodynamically speaking, there are many semi-independent forces within us. Most of the time, we’re dissociated/unconscious of them. Yet it is these forces, or the interplay between them, that create our mental states, including feelings of anxiety, depression, etc. From a psychodynamic perspective then, resolving an anxiety entails identifying and understanding the (often unconscious) part of you that is anxious and finding a way to reassure it. Thinking psychodynamically can give us some powerful insights. For example, we often assume that anxiety is about some threat “out there” in the world. But what if the threat is internal? Have you ever had an experience of being hard on yourself? It is as if there was a harsh, judgemental inner critic within you cracking the whip and punishing you for not meeting its unreasonably high expectations. In such cases, the resulting anxiety may arise more from a fear of being berated or belittled by your inner critic than form anything out there in the ‘real world’. Resolving such an anxiety will require helping that inner critic soften and relax. 

• Behavioral Approaches: These approaches see behaviour as primary: therapy is about identifying and changing maladaptive behaviours through the principles of learning theory — primarily classical conditioning, operant conditioning, and social learning. In the case of anxiety, a common technique a behaviourally-minded counsellor might use is to very gradually expose a person to an anxiety-provoking stimulus (this is “exposure therapy”). For example, someone who might be afraid of going to the store might be asked to first look at a picture of a grocery store. In such a situation the person’s heart rate might initially spike but would soon settle down as disinterest and boredom set in. The person might then
  be shown a picture of the inside of the store, asked to imagine going into one, or be asked to get a shopping bag ready, and so on. Step by step, the person would become more and more comfortable with the anxiety-provoking task as their nervous system became less reactive to it.
• Somatic Approaches: These therapies work directly with the body to help regulate the nervous system. Since anxiety is as much a bodily experience as a mental one, somatic techniques like breathwork, grounding exercises, movement (such as yoga or dance), and somatic experiencing can help discharge stored tension and promote a sense of physical safety. These approaches emphasize that sometimes healing happens through the body, not just in the mind.

Each of these approaches offers a unique pathway to alleviating anxiety and I plan to discuss each of them (and others) in much more detail in future blogs.

Ultimately, reducing anxiety is a journey that requires patience, courage, self-compassion, and sometimes the support of trained professionals. From personal experience, it is a journey well worth taking.

What have you tried that has helped you? What have you tried that hasn’t? And which of the above approaches are you most curious or skeptical about?

Thank you for reading!