Anxiety is everywhere. It’s an epidemic. An estimated 40 million adults (18 and older) or 18% of the population endorse symptoms of anxiety (not to mention 1 out of 8 children). Treatment of anxiety is a 1/3 of the $148 billion dollars spent annually on mental illnesses in America. In other words, we spend $42 billion a year on treatment of anxiety disorders in America. Women are 60% more likely to develop an anxiety disorder than our male counterparts. The average age of onset is 11 across genders. Add to these statistics that nearly half of the 40 million adults with anxiety also suffer from depressive symptoms, which is the leading cause of disability in the US for ages 15-43. These numbers are terrifying to me as a clinician, a woman and a mother.
But is there anything we can do to slow these statistics from what seems to be an endless climb north? Or, is anxiety simply something you catch or that you get from your genetics? Are the intergenerational symptom patterns that emerge within families simply a case of genetic destiny and bad luck or can we influence the severity and the way we cope with our feelings such that we can influence the trajectory of these statistics?
This blog is designed to strip anxiety down to the studs and reveal the intricate scaffolding system that provides structure and fortitude to the anxious process. This is not an exhaustive list of the prodromal symptoms of anxiety by any means, but we will explore several of the key components that contribute to the vast majority of all anxiety patterns. Namely, we will examine the role of avoidance, rumination, and speculation in the eventual onset of a full-blown anxiety disorder.
At the center of anxiety is a neurobiological dis-regulation, affecting most notably the central nervous system. This dis-regulation is most readily obvious in the form of panic attacks. But the subtler aspects of anxiety, the patterns in thinking that are often the unrecognized participants in an ongoing anxious process are the inflection points we want to understand in therapy in order to rework your unconscious patterns and mitigate the more severe symptoms.
Anxiety moves in circular motion, although you are constantly spinning you are never truly gaining traction and moving forward. Perpetual loops of speculation, avoidance, rumination, and worry will hold you hostage to growth and internal contentment. But here’s the good news, anxiety is amenable to intervention and change. The only requirement is that you have to want it badly enough to work for it. You have to be willing to expose yourself to things and circumstances and (most importantly) feelings you have been avoiding, often for decades. And, you have to be willing to do the work to re-route neural patterns that have become dominant over the years, but no longer helpful in promoting a sense of internal equilibrium.
Let’s break down a few of the styles or patterns at the epicenter of the larger anxious process namely rumination, speculation, and avoidance.
Rumination is a prolonged state of cyclical worry and negative internal dialogue about your self, others, situations, or all three combined. Rumination is when you start to brood on an event or interaction. Usually this brooding takes on the flavor of having done something wrong or having been wronged (usually the former). Rumination is the “thing” you cannot seem to turn your minds eye away from. As you observe this style of thinking, notice that ruminations almost never take on a positive flavor. Ruminators will often also exhibit interpersonal styles that are marked by a propensity to be the victim and/or have other co-dependent dynamics that entangled them in a web of disempowerment.
The speculator is constantly looking into the future to source out the possible signs of danger ahead. These people forecast about the future most often with a flavor of doom, suspicion or dread. The speculator views the untapped horizon with apprehension, suspicion, and sometimes paranoia. At a clinical level, when I see non-psychotic features of paranoia I pretty much know I have a speculator on my hands. The speculator is most vulnerable to catastrophic thinking patterns, which are universally at the epicenter of more acute anxiety disorders. I urge you to view this style of thinking as a component of anxiety. If you read this and find that you too exhibit these traits, I’d encourage you to begin to observe when you shift in to the speculator role and explore why you are using this style of thinking at this moment in time.
From a therapeutic standpoint there are reasons you have snuggled in to this style of thinking vs. another style. By allowing yourself to observe that you are doing it, without necessarily going down the rabbit hole, you have a fighting chance to tap into real freedom of choice and free will. Previously, when you were unconsciously engaging this thinking style you weren’t actually making empowered decisions. You were living out neurobiological attachment patterns that had unknowingly hijacked your ability to make choices about the trajectory of your own mind and brain.
Avoidance is a complicated and highly effective defense mechanism, which cannot be fully explored in the scope of this blog. So please, if you identify with an avoidant style of intra-and-inter-personal dynamics, seek more information.
That being said, avoidance operates paradoxically. On the one hand, it is highly effective in reducing or discharging the feeling(s) the person is trying to distance him/her self from. The act of avoiding the uncomfortable feeling or situation results in immediate reduction in the discomfort. That’s why I refer to it as effective. But don’t mistake effective for healthy.
On the other hand, avoidance is a crippling style of coping. Left unchecked it usually results in significant emotional and interpersonal limitations. Here’s the fine print on the avoidance contract.
First, you have to continue to narrow your aperture of focus to accommodate the ongoing avoidant pattern. In other words, in order to maintain distance from the feelings you are trying to avoid, you have to engage in more and more avoidant behaviors. This how compartmentalization comes into play in the anxious process and how, in the most extreme expression of avoidance you see people struggling with overt phobias. Like the aperture on a camera lens the scope narrows proportionally on the left and right as it closes in on a more myopic view, avoidance follows the same philosophy when it comes to managing your feelings. As you effectively protect yourself from any of the unpleasant feelings you wish to escape, you simultaneously and proportionally narrow your ability to feel and absorb intensely pleasant feelings. That’s just the price of employing this defense mechanism. Over time, you will feel less discomfort, I suppose, but you will also feel less love, less bliss, less deeply connected to people in your life. The aperture closes proportionally until you are left with a narrow and often myopic emotional scope. You will be comfortably numb.
Thus brings us to your second fine print item: The more you narrow your emotional aperture to accommodate the avoidance, the more you participate in atrophying your ability to tolerate your feelings in general. The ability to tolerate feelings is a muscle. It’s an achievement that starts with an intricate and delicate dance between infant and caregivers and continues throughout our lives as we adapt and re-adapt to our changing environments. The more you exercise this muscle, the stronger and easier it gets. The more you avoid your feelings, the more the muscle atrophies and the harder it is to tolerate any sense of emotional discomfort or un-ease. Eventually you will be walking an emotional tight rope that is pulled taught with your internal friction.
Anxiety has physical, emotional and cognitive expressions that can be mutually exclusive or present as a symphony of symptoms. The overwhelming part about anxiety is that it impacts so many different and intersecting parts of our human experience. But that is also its greatest asset and part of the reason why it is often the most amendable to change in a therapeutic setting. Anxiety can be approached and massaged at various levels. In other words, we make good habits the same way we make bad one-we just keep doing a behavior.
So what can you do? How can you shift these long held patterns?
1.) Work with a skilled clinician to gain more insight and observance of how your mind works. Initially, all you have to do is observe your process. Start to become aware of how your mind and brain works and what kind of thought patterns emerges before, during, and after you feel acute levels of anxiety. Try to view these anxiety episodes as neurobiological. They are hard wired at this point. But do not confuse this with assuming its “genetic.” It’s not that simple or linear. There are fixed cognitive and emotional patterns that you can observe, understand, and eventually influence. As the patterns move from being unconscious to conscious, you will be better able to insert influence and choice over these central nervous system patterns that had previously held you emotionally hostage. The power to observe your mind from this neutral stand point allows us the possibility that we might eventually be able to slow the perpetual loop enough to reroute the course of motion.
2.) Try to view therapy as the emotional equivalent of working out. It’s your opportunity to train your mind and brain. Remember, if we want to get better (healthier) train to your weaknesses. Don’t train to your strengths. You are already proficient at the things that come easily to you. I encourage my patients to observe the parts of their experiences that are difficult for them to tolerate. I provide the space for people to increase the bandwidth you have to tolerate your feelings. I am purposely using the word tolerate because that is the threshold I want you to (re)-calibrate your interior world to. The goal is not to feel happy all the time. The goal isn’t to avoid your unpleasant feelings. The goal is to learn how to stay present in them. Just simply tolerate the feelings. They will pass. They have a beginning, middle, and an end. Like a wave, they will crest and then receded and crest again. Train to your weaknesses. Therapy is a form of emotional training. Build the muscles that need strengthening and allow the ones that are too robust to soften. This how we achieve a sense of balance and emotional equilibrium. It’s also how we extract peak performance from ourselves. So remember, train to your weaknesses.
And to all the parents out there raising small children. Now is the time you can influence these intergenerational patterns and change the trajectory of your shared history by helping your child to be better equipped to metabolize, tolerate, and react to his/her own feelings. Don’t help your children avoid difficult feelings. Don’t try to narrow or alter their reality so they do not have to feel difficult, sad, or intense feelings. Allow them to navigate these situations and build the muscles to be better prepared to handle the complex world of adulthood. Yes, we all want to protect our kids. But we are not doing them any service by passing on these patterns of avoidance. When you inadvertently pass on these style of coping you are, ultimately, creating limitations in their interior world. It’s not intentional. But it does happen. Help your child learn to increase their tolerance for discomfort by modeling your own capacity to manage your feelings without excessive avoidance, denial, etc. Encourage and applaud them when they feel intense emotions and remind them that feelings have a beginning, middle, and an end. This too shall pass.
3.) Commit to doing mindfulness for twenty minutes a day for one month. I suggest breaking it up to two ten minute segments. I’ve written else where about my preferred style of mindfulness. Click here to read more.
I want to re-emphasize I am not suggesting you try to clear your mind. Or think positively. Or even regulate your breath. You are simply being still in your body, mind, and brain. Observe. Breathe. Voila.