What is anxiety?

“Anxiety” and “stress” are terms that get thrown around a lot these days. Different people experience anxiety differently. For some, anxiety is a chronic condition that can best be characterized as an anxiety disorder, such as Panic Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Social Anxiety Disorder, Specific Phobias, or Post-Traumatic Stress Disorder. These disorders are often accompanied by some form of Depression.

For others, anxiety arises during difficult life transitions, such as leaving for college, becoming a parent, coping with infertility, changing jobs/careers, or adjusting to life as an “empty-nester.”

Still others describe experiencing daily stress and pressure as a result of their overscheduled, hectic lives.

While there are many different types of anxiety, at varying degrees of severity, there are several features that virtually all forms of anxiety have in common and that serve to maintain anxiety.

They include:

• Avoidance: It makes sense for us to avoid what we are worried about. But there are two significant problems with avoidance:
  • Avoidance can significantly limit where we can go and what we can do
    For example: a woman who is worried that a terrorist attack will occur in New York City limits her trips into New York as much as possible. She confines herself to a local area and misses out on activities that she enjoys (e.g. attending Broadway shows)
  • Avoidance can prevent us from successfully facing the source of our anxiety
    For example: a man who is afraid of flying refuses to take plane trips, and therefore never learns whether he can successfully survive a plane flight. His fear of flying is maintained because he never puts his fear to the test.
  • Avoidance may appear to be an effective short-term anxiety management strategy, but in the long-term, it maintains anxiety.

• Anxious Thinking: Anxiety is often maintained by the way people think about certain things, situations, or people. In his book The Worry Cure, Dr. Robert Leahy outlines 17 typical “cognitive distortions” to which anxious people often fall prey. Among them are:
  • Catastrophizing: Believing that the worst possible outcome will definitely occur
  • Fortunetelling: Believing that you can predict what is going to happen in the future
  • All-or-Nothing Thinking: Believing that all situations can be viewed in black and white; for example, I am either 100% successful, or a complete failure

• Intolerance of Uncertainty: Thanks to the work of Freeston, Ladouceur, and their colleagues, clinicians have recently focused on the role of intolerance of uncertainty in maintaining anxiety. Anxious individuals tend to have a very difficult time tolerating uncertainty, and strive to create certainty, often in situations where no certainty is possible (i.e. will it rain during my vacation?). It is common for anxious individuals to frequently seek reassurance from others in order to reduce uncertainty. If uncertainty cannot be reduced, frustration and increased anxiety result.

• Need for Control: Anxious individuals tend to want to control as many aspects of their lives as possible. The trouble is that there are many things in life we cannot control, no matter how hard we try. When anxious people fail in their attempts to control a situation, they are often left feeling frustrated and even more anxious.

• Safety Behaviors and Rituals:
  • Safety behaviors are any behaviors people adopt to help them cope with anxiety
    For example, always carrying around a bottle of anti-anxiety medication or always taking someone along when traveling
  • Rituals, typically found in OCD, are physical or mental actions that people feel compelled to perform in order to reduce their obsessive thoughts
    For example, counting, checking, repeating, arranging
  • Rituals and safety behaviors provide us with a false sense of security; that is, they tell us that the only reason we were able face the thing we fear is because we engaged in our safety behavior or ritual. This keeps us thinking that whatever we are fearing is indeed scary and should be feared. And it keeps us performing the rituals and safety behaviors, no matter how burdensome they become.

Below are some common profiles of people with anxiety. Do any of these people sound like you?

The Self Helper

I have been anxious for as long as I can remember. One of the things I have been anxious about is my own ability (or lack thereof) to find a method that will “cure” my anxiety. So I spend my days trolling the internet, reading about the latest fads in anxiety treatment. I try all kinds of exercise classes. Yoga. Meditation. Hypnosis. I watch “Dr. Oz.” Go on “WebMD.” Still, I’ve been unable to find that “miracle cure.” And I have been driving myself crazy in the process.

The Medicator

I keep telling myself that there must be a medicine that will definitively cure my anxiety. As a result, I have tried everything. Antidepressants. Anti-anxiety medications. Antipsychotics. Vitamins. Herbs. Different combinations of things. Unfortunately I haven’t yet found the drug I’ve been searching for. This has left me frustrated and hopeless.

The Avoider

I have a history of panic attacks, which are terrifying because they feel just like heart attacks. I am now in constant fear that I will have a panic attack and lose control or go crazy. As a result of this fear, I severely limit where I go and what I do. Crowded places, like malls, train stations, and airplanes are the worst for me; if I had a panic attack in these places, I wouldn’t be able to escape. And the people around me would think I was crazy. So I avoid these places completely. I used to love traveling and socializing, but now I don’t do any of this. My world has become a really narrow place.

The Ritualizer

There are certain triggers that fill me with obsessive fear and dread. I wish these triggers made sense, but they don’t. For example, I am fearful of anything that comes in odd numbers (for example, if a salesperson gives me 3 bills in change; if I receive 3 letters in the mail; if I have to take 3 steps up to a building). I am convinced that having a “bad” thought (such as, “I wish this person would drop dead”) will automatically make that thought come true. And I am extremely fearful of germs and illness. The only thing that brings me relief is engaging in structured rituals. For example, I have phrases that I must repeat over and over in my head to counteract my experience with an odd number or to a “bad thought.” And exposure to germs means that I have to spend inordinate amounts of time handwashing and showering. These rituals take so much of my time, they interfere with my work and social life.

The Comparer

My anxiety comes from comparing myself to others and always feeling that I come up short. I am convinced that my co-workers are doing a better job than I am. That my friends are better parents and have better marriages. That my neighbors seem to be better able than I am to manage the myriad stresses of life in the NY Metro Area. I stare at people’s Facebook pictures and posts for hours, jealous of how happy and “together” they and their family members look in these pictures and posts. I doubt that I will ever be able to be that happy and “together.”

Put simply, anxiety can keep you from fully engaging with your life.

• Anxiety may cause you to avoid a wide variety of places, situations, or experiences.
• Anxiety may cause you to avoid connecting with other people, which can have ramifications for your social, work, or romantic life.
• Anxiety may keep you from enjoying things you once enjoyed.
• Anxiety and your attempts to cope with it may take up time that you would rather devote to other pursuits.
• Anxiety may frustrate your family and friends, who may be at a loss as to how to help you.
• Anxiety may affect your sleep, appetite, and ability to function in daily life.

Stop and take a moment to think: How has anxiety stopped me from living the life I want to live?