The Anxiety Dilemma: An Intro 1

The Anxiety Dilemma: An Intro

Imagine your life as a path that leads in a meaningful direction.  This path represents your values.  Your deep priorities.  The things you hope to do and see and touch and taste while you have the opportunity.   Say someone asks you a very tough question: “How do you truly want to live your life on Planet Earth?”  The path represents your honest answer after years of research and reflection.   It would be great, in a perfect world, if our paths were clear: unhindered routes completely free of obstacles or impediments.  But our world is not perfect, so our paths will not be clear.   Sometimes they will be very large...

Anxiety Problems are Avoidance Problems 2

Anxiety Problems are...

Anxiety is part of life.  It is the cost of admission of the human condition.  It is the price of the ticket to go on this ride. Life is hard and wonderful and bumpy and beautiful, and anxiety is just a part of it.   The fact that anxiety is part of life, however, is not the source of...

About CBT 3

About CBT

There are many forms of psychotherapy and many of them are good.  When it comes to anxiety, though, the evidence is now clear: cognitive-behavioral therapy is the most effective treatment.   In 1993, the American Psychological Association appointed a special team to determine which...

What’s In It For Me? 4

What’s In It F...

Let’s make sure we are on the same page before continuing onward.  While anxiety is a part of life, it is definitely not the only part.   There is also a joyfulness to existence.  A jubilation in getting to do this.  A grateful exuberance that accompanies the act of living.  Sure,...

What is “Anxiety?” 5

What is “Anxie...

Many definitions of anxiety have been offered throughout history.  For our present purpose, it can be defined as a sense of apprehension or dread about something that might happen in the future.   Imagine walking a dark and dangerous jungle path where tigers may lurk in the underbrush....

Anxiety Versus Fear 6

Anxiety Versus Fear

The terms “anxiety” and “fear” are often used interchangeably.  While closely related, however, the two experiences have different biologies and distinct functions, and are not the same: Anxiety arises when we believe something in the future might threaten us Fear arises when we...

Why Does Anxiety Exist in the First Place? 7

Why Does Anxiety Exi...

All of us experience it.  Half of us struggle with it.  A quarter of us suffer from one of its disorders.  So why does the feeling called “anxiety” exist in the world in the first place?   To answer this question, we must review one of science’s most important ideas: the theory...

Anxiety and Evolutionary Mismatch 8

Anxiety and Evolutionary Mismatch

According to “evolutionary mismatch theory,” there is a tension between our ancient biology and the modern world.  This tension plays a role in many issues, from drug use to excessive eating.   Human characteristics arose from evolution.  But the bulk of our evolution took place between 1.8 million and 150,000 years ago.  This means our traits evolved to help us survive in the Paleolithic era, when hunting, gathering, and escaping from predators were central tasks.  And because evolution tends to work quite slowly, many of these characteristics remain alive and well today.   Yet the present-day world is vastly different...

Anxiety Is Not Dangerous 9

Anxiety Is Not Dange...

Many of us are anxious about being anxious.  If anxiety gets too strong, we assume, something terrible might happen.  Maybe it will kill us.  Or make us lose control.  Or induce a nervous breakdown.   But there is good news here.  There is no such thing, from a scientific...

Avoidance, Avoidance, Avoidance 10

Avoidance, Avoidance...

Avoidance, avoidance, avoidance.  Most roads in our dilemma lead back to this behavior.  But before avoidance becomes a problem, it starts as an inclination: a strong, ingrained tendency to avoid anxiety.   This avoidant tendency is not a real surprise.  Experiencing anxiety is clearly...

A Dilemma is Born: The Short-Circuiting of Avoidance 11

A Dilemma is Born: T...

By now, a logical question has likely made an appearance.  If avoiding anxiety is protective, what is so bad about it?  Why is avoidance disruptive if it helps us deal with threats (i.e., avoid anxiety = avoid the tiger)?   Because this ancient function has been short-circuited in the...

Review: The Basics of the Anxiety Dilemma 12

Review: The Basics o...

Anxiety is a sense of apprehension or dread about things that might happen in the future.  It is the feeling nature provided to help us defend against threats.  Because threats are part of life, anxiety is part of life.   Like all animals, humans have a powerful tendency to avoid...

Anxiety and Our Two Mistakes 13

Anxiety and Our Two ...

Imagine arriving at work one morning and a coworker shares a rumor: layoffs may be coming.  Even though this information was received from a single source, we decide that it is valid.  Layoffs could indeed occur in the next few weeks.  Yet we don’t just assume they could occur.  We jump...

The Three-Component Model 14

The Three-Component ...

The science of anxiety can be complex.  Luckily, there is a model we use in CBT to help us keep our bearings.   Most anxiety problems consist of three components: Feelings:  Research suggests that feelings are anxiety’s core — the part that presidents share with penguins.  There...

Anxiety Versus Depression 15

Anxiety Versus Depression

Anxiety and depression are closely related, and many people struggle with both.  Yet research shows that the two experiences are not the same.   When we are anxious, we feel as if negative events may occur at some point in the future.  Our sense of control is shaky but not entirely absent, which makes us highly inclined to engage in avoidance (i.e., doing something instead of just sitting there).   In contrast, depressed people feel as if negative events have already occurred, and there is nothing they can do about it.  The defining behavior of this helpless state is not avoidance.  Depression is a syndrome of...

Anxiety and Attentional Bias 16

Anxiety and Attentio...

A caveman walks an ancient path in the fading light of evening.  His head swivels from side to side, scanning for signs of danger.  His eyes quickly dart from right to left.   Suddenly, something rustles in the ferns beside the pathway.  What was that?  A tiger?  A rival clan member?...

The Anxiety Tap Dance 17

The Anxiety Tap Danc...

Imagine reading an advertisement on a late-December day: “Participants Wanted — Paid Experiment.”  Finding ourselves tight on cash after holiday shopping, we decide to go sign up.  We are greeted by a researcher when we arrive at the facility, who attaches an electrical device to our...

Passive Versus Active Avoidance 18

Passive Versus Activ...

Most anxiety problems, we have seen, are really avoidance problems — and the thing we are trying to avoid is anxiety itself.  Observing our dilemma from a high level, we do this in two different ways. By not engaging in behaviors that increase anxiety (passive avoidance), and engaging in...

Avoidance and Negative Reinforcement 19

Avoidance and Negative Reinforcement

To get a sense for reinforcement, picture a mouse in a box. On the inside of the box, there is a lever. If the mouse presses the lever, it is rewarded with a food pellet. After a while, it will press and press without hesitation to obtain its reward: press lever –> get food –> feel good (e.g., Yeah!) –> press lever again in future   This is an example of positive reinforcement, where behaviors that increase positive feelings tend to be repeated. But positive reinforcement does not play a substantial role in our relationship to anxiety. The main concern here is negative reinforcement.   Imagine the...

The Anxiety NONO 20

The Anxiety NONO

In our last post, we explored the first avoidance-fueling factor: negative reinforcement.  I call the second factor the Anxiety NONO, which stands for the “non-occurrence of negative outcomes.”   The Anxiety NONO has its roots in a happy situation.  Because we overestimate the...

The Costs of Avoidance 21

The Costs of Avoidan...

Quitting smoking is tough and people don’t do it for fun.  They quit because smoking has costs.   In the same way, it takes hard work to resolve the problems caused by chronic avoidance.  It is very possible and important.  But it can be hard.   So before we work on resolving...

Cost #1: Avoidance Keeps Us Anxious 22

Cost #1: Avoidance K...

It is one of life’s great ironies.  We go to tremendous lengths to avoid anxiety.  Yet the things we do to avoid anxiety actually keep us anxious.   Say we measure our average anxiety on a scale from 1 to 10.  Over time, why does anxiety remain at 7 or 8 instead of dropping to 3 or...

Cost #2: Avoidance Creates and Maintains Our Symptoms 23

Cost #2: Avoidance C...

Avoidance creates and maintains the symptoms of anxiety disorders.  People with OCD, for example, often check and recheck to ensure a task is complete.  Studies show this checking is an active form of avoidance, with each check followed by brief anxiety reduction (“phew!”).   This...

Cost #3: Avoidance Disrupts Effective Behavior 24

Cost #3: Avoidance D...

No one likes feeling anxious.  And no one enjoys worrying for hours on end.  Yet the biggest cost of avoidance is not the way it keeps us anxious or maintains our symptoms.   The biggest cost of avoidance is how it impacts effectiveness.   Many people believe that anxiety affects...

Resolving the Anxiety Dilemma: An Overview 25

Resolving the Anxiety Dilemma: An Overview

Most anxiety problems, we’ve explored, are really avoidance problems.  The dilemma isn’t that we’re anxious.  It’s that we excessively avoid anxiety . . . and this avoidance keeps us anxious and disrupts our lives.   Fortunately, cognitive-behavioral therapy (CBT) provides a way to overcome this issue.  It might take a month.  It might take a year.  But within a finite period of time, we can make a change that stops anxiety from causing major life disruption.  From a broad perspective, this change is represented by the letters GTNA:   Anxiety strengthens and gains power when we routinely go away from it....

Courage (C) 26

Courage (C)

“Courage.”  The word is familiar, but often misused.  Images of gallant knights come to mind, laughing fearlessly as they gallop into battle.   Yet soldiers and first responders know that courage is not the absence of fear.  It is the act doing what needs to be done when we are in...

Attentional Control (A) 27

Attentional Control ...

Recall that an anxious mind is biased toward scanning the world for threats.  Our brain searches for tigers more than fences, flowers, and coffee cups.  Once a threat is identified, two things tend to happen: perseveration and elaboration.   Perseveration involves thinking about...

Letting Go (L) 28

Letting Go (L)

Imagine playing catch near a swampy body of water.  When the ball inevitably lands in muck, someone has to retrieve it.   There are two ways to handle this task.  We can plod through the swamp in a steadfast manner, grab the ball, and plod back.  Alternatively, we can gingerly walk in...

Management (M) 29

Management (M)

Managing something and mastering something are two different things.  In the three steps above, we have not been trying to manage anxiety, or directly influence its length, strength, and frequency.  Instead, we have been mastering how we live in the face of it.   At the same time, no...

Resolving the Anxiety Dilemma: Conclusion 30

Resolving the Anxiety Dilemma: Conclusion

We are walking along our path in life.  The ground ahead is firm and dry.  The sky above is cloudless.  Things are going smoothly as we put one foot in front of the other.   But we see it when we round the corner: a swamp of anxiety in the middle of our pathway.   Our strong inclination is to avoid the swamp.  But there is no veering away from it without veering off our course; no avoiding the swamp without avoiding the path itself.  To stay on our path in life, we must change our relationship to anxiety.  This change is captured by the letters GTNA:     When anxiety stands between us and things we value deeply, we...