According to the National Institute of Mental Health, nearly 1 in 5 people in the US experience anxiety severe enough to be diagnosable by psychiatry in any given year. I guess it makes sense, then, that Xanax is our top prescribed psychiatric drug. Given the explanations we often hear about why so many of us are struggling, it can be hard to believe there’s actually zero evidence that anxiety is a biological illness caused by chemical imbalances. But in the fervor to find medications to help us relieve our anxiety, what’s often left behind is what we do know about the psychology of anxiety. And that’s too bad, because this knowledge holds important keys for those of us who are sick and tired of living lives driven by fear.
If you could take a guess at the one thing capable of driving our anxiety in deeper, of giving it steam and longevity, what would it be? Irrational worry? Physical panic? Not seeing a professional? No, the one thing research shows is capable of digging permanent trenches for anxiety is trying to escape it. In a society that has trained us to be always seeking happiness, we’ve come to believe that managing our anxiety away is our only hope for a good life. And in this foundational belief, we’ve given this simple, natural emotion power. The power apparently required to become quite disorderly.
If you’re anything like me, the idea that you should somehow just be cool with your anxiety is likely rubbing you the wrong way right about now. It can sound a little too much like “Toughen up and deal with it.” Like anxiety isn’t actually a problem or that we’re just making it all up. And we’re right to be sensitive to this because we often do hear these insensitive, incorrect ideas. But the idea that avoiding anxiety exacerbates it doesn’t have to be dismissive of our pain. Of all the things we know and don’t know, we know that the attempt to avoid the pain of anxiety and fear is the common thread connecting everyone who struggles with anxiety. And we know that it’s the one thing that paves the way for this anxiety to become stronger and more debilitating.
More Than a Hunch: The Evidence
While it’s true that a lot of things can sound intuitive but turn out to be completely false, the idea that avoiding anxiety makes it worse isn’t just the invention of some stuffy psychologist setting out to torture us. It’s an idea found in the research on what anxiety is and how it works. The first place we find it is in studies on different types of anxiety. Really, all anxiety is essentially the same when you strip it down to its core, but we often divide it up based on what people are anxious about and how they deal with it. Those dealing with what’s often called “post-traumatic” anxiety are haunted by remembering a painful experience from their past. Things in their environment that resemble the experience in some way become reminders. These reminders are so difficult to face that that they go out of their way to avoid them so as to avoid the pain of the original experience.
No one is blaming anyone for wanting to distance themselves from terrible things that have happened to them. But when this happens, the brain learns to fear the reminders and more and more things that are less obviously like the original experience become feared. Through all of this, the person gets the clear message that the old experience is an ever-present threat, and the brain tries its best to avoid anything that will trigger thoughts and feelings related to it. This cycle of avoiding thoughts of the past experience and of anything that might somehow resemble it entrenches the anxiety and makes the brain believe that the anxiety associated with it is unbearable. And so the anxiety gets worse.
We can see the same concept a little differently in what’s known as “obsessive-compulsive” anxiety. The common theme here is when people learn to cope with anxiety by using thoughts or actions to neutralize it. When they feel terrifying anxiety that threatens what they care about most, they think or do something to make themselves feel better. The reason this becomes such a seductive cycle is that it works, at least at first. But because the thoughts and actions are being used to avoid anxiety, they also make the brain believe that the threat is real and this makes the anxiety seem more threatening over time. The strategies used to reduce the anxiety become compulsive because they only work for a little while and end up being needed more frequently to continue to work. In the end, they make the anxiety stronger and more long-lasting.
Avoiding triggers and using compulsive behaviors are both intuitive ways of avoiding anxiety that people come up with on their own. But it’s not just the strategies we invent that can act as avoidance and potentially make anxiety worse in the long-run. A 2015 study found anti-anxiety medications worsened outcomes in those with post-traumatic anxiety. This is thought to be because the medications work to dull the anxiety, numbing the person from the pain of experiencing it constantly. In the short-term, this is obviously a positive. But as with the other strategies of making anxiety more bearable in the short-term, it has the potential to give us bigger problems in the long-run because we can become unable to deal with emotions related to our anxiety. And in turn, the anxiety becomes stronger.
Making the Theoretical Practical
If this is true, you may be wondering why we don’t hear more about it and why doctors keep encouraging patients to take anti-anxiety medications without informing them of the risks. I would venture a guess that it’s simply because many prescribers don’t understand the psychology behind anxiety disorders and the drugs they’re prescribing for them. Plus, the idea that exposure to anxiety is helpful is understandably a hard sell to someone who’s struggling. I can personally attest to the fact that someone who approached me in the middle of my worst anxiety with wisdom like “Just accept it, man” would have had a high likelihood of getting punched. And that’s why I think that this concept isn’t so much a crisis-situation solution, but more of a long-term strategy for after you’ve had time to get some clarity around your anxiety and some support around you.
Once we realize what a primary role avoidance plays in driving anxiety deeper and deeper into our lives, it becomes obvious that it’s far too important to ignore if we no longer want our lives to be at the mercy of our anxiety. But what does it mean practically and where do we start?
- Get your supports in place.
It’s hard to make progress alone because we can get stuck in our own heads and come to believe that nothing can change. We’re social animals and that means we need support from other people. Whether it’s your family, your romantic partner or a friend, find someone in your life who is compassionate about your struggle and who will listen to understand. They don’t necessarily have to experience hardcore anxiety themselves as long as they’re committed to understanding the best they can. You may need to call on them for a good cry, a hug, or a night out.
A good therapist can also help you sort through your anxiety, and can take some of the pressure off of family who might feel discouraged that they can’t fix the problem. Spoiler alert: therapists can’t fix it, either, nor should they try. But they can support you on the road to becoming the amazing powerhouse that you deserve to be.
- Develop the practice of sitting with anxiety.
Think about how you tend to respond to anxiety now. If you’re anything like me, this could include things like hyperventilating, overanalyzing, crying, or getting the fuck out. It could also include using substances or self-harm to cope with the pain. All of these responses are based on the fairly natural idea that terror is a bad thing. The problem, as we’ve realized, is that this kind of response teaches our brain that something is actually terribly wrong. It teaches us that we should be anxious, and so more anxious we become.
Consider that anxiety is a functional emotion. It exists to alert us to when we should worry about something, and it can be very helpful. When it exists in excess, however, we come to fear the emotion itself. Experiment with noticing your anxiety when it rises, as non-judgmentally as you can. It might help to think of it as a fuzzy little poofball who’s always flipping his shit, but he’s so goddamn adorable you’ve just got to give him a hug and tell him you’ll be around. (Metaphor from this book). Don’t worry if it’s not perfect right off the bat. It’s a practice. Perfection not required.
- Get clear on the difference between anxiety and your emotional needs.
Working on sitting with our anxiety instead of running from it is a sensitive pursuit. We’re anxious about the things near and dear to us, and anxiety can make us defensive in the worst ways. So when we involve other people in the journey, it can get messy if we feel like they want us to accept our anxiety at our own expense. When we learn the difference between what our anxious self wants and what we actually want, we can identify the things we need emotionally and communicate them to our support people so we can feel cared for when we’re also feeling vulnerable.
This might take practice if you’re not used to noticing what you need as you go about your day, or if you have a hard time being assertive about what you need. Sometimes what you need will be something you can give yourself (Netflix or a walk at the park) and sometimes it’s something someone else can give to you (encouragement, cuddles, listening). We live in a culture that thinks it’s normal to let people guess what we need and then get angry when they get it wrong, but all this does is lead to unsatisfying relationships. Be clear about what you need so you can get it.
The idea that learning to sit with our anxiety instead of trying to escape it can help us to overcome it in the long-term is great news, but it’s not news anyone needs to implement perfectly right away. Take your time, digest the ideas, and think about how it relates to your own anxiety. How do you see yourself avoiding the unpleasantness of fear and anxiety, and what can you do to begin to challenge that instinct? It’s not easy. Even the idea is challenging. That’s why I encourage you to toss it around, grapple with it, see if you can tease out the truth of it in your own life. You might find the particular brand of therapy that deals with this, acceptance and commitment therapy, helpful. But know that you don’t have to work with a therapist to work with these ideas; studies find powerful results in those who use acceptance on their own as well. If you’re interested in learning more, you can find a couple of my favorite resources here and here.