Anxiety

October 23, 2023

Anxiety has been called an “illness of uncertainty.” We all experience anxiety to greater or lesser degrees, in part, due to the certainty of uncertainty. In this article I will briefly describe very natural and unhelpful ways of working with anxiety and follow with what has been shown to be useful. There is a very good literature review of the available treatments through Pubmed. You can find that reference at the bottom of this article for anyone wanting additional information.

Unhelpful Tendencies

Self Judgment
One habit that is examined in studies is self judgement and how that impacts levels of anxiety. People with higher levels of anxiety view their own emotion as excessive, nonsensical, intolerable and/or not appropriate. Self judgment does increase anxiety and it can also increase other difficult emotions such as shame. This human tendency makes it difficult to look at life situations closely because self judgment is painful. If life situations are not looked at closely they tend to repeat themselves.

Suppression
Suppression is defined as ignoring and avoiding the expression of an emotion. Suppression relates to both positive and negative emotion and people who struggle with anxiety tend to push both down. It is appropriate to avoid acting out of fear (anxiety) but avoiding or suppressing emotion amplifies the experience by way of fueling the physiologic response. Studies indicate that masking emotion actually increases the experiential and physiological response. This is well documented. Carl Jung (1875-1961) coined the term, “What you resist persists.” Suppression is the most investigated response-focused method to manage anxiety perhaps because it is commonly used but is ineffective.

Distraction
Another unsuccessful method of managing anxiety is by way of distraction. This is relatively self explanatory. Shifting attention to avoid an anxious response is easy and very accessible to us almost all the time. This can be done through films, books, work, friends, surfing the web, substance use, shopping—the list goes on. Studies show that distraction is much like suppression. It is ineffective. Anything that we do to avoid ourselves is doomed to fail.

Regulatory Strategies
Another category that has been studied includes “regulatory strategies.” This phrase is also used in the corporate world. The corporate world defines “regulatory strategies” as a process of defining a direction; making a decision as to how to fund the direction; using some form of control to guide the process; and using research and analysis in pursuit of the goal. This also describes how some people manage themselves. There is a decision to try to take control of their emotional world, how to fund it, and using research and analysis to do so. Regulatory strategies are often utilized, in my experience, by bright and anxious people who demand much of themselves. These are people who have relied on their cognitive functioning to navigate their world. It may have served them well, and produced great success in other parts of their life. However, managing your inner life as you might manage a company, has been shown to not work.

Worry
Worry is considered a regulatory strategy. Generalized Anxiety Disorder has been examined in relationship to vagal tone. Vagal tone is used to assess stress on an organism and is also used to assess the organism’s vulnerability to stress. Vagal tone can be measured by direct, but invasive, methods. Vagal tone can also be measured indirectly by looking at heart rate and heart rate variability. There are a number of devices on the market that track both of these effectively, however, we are in the early stages of understanding heart rate variability. Vagal tone has been shown to decrease as worry increases. This means that heart rate goes up and heart rate variability goes down when the organism is stressed. Worry depletes physiologic health.

Helpful Habits to Cultivate

How do we approach anxiety in a useful way? What is available as a treatment? I will list, and describe very briefly, what we know from current studies.

Cognitive-behavioral
Cognitive-behavioral treatment has been shown to be useful for those people suffering from anxiety. Cognitive restructuring is a technique, one of many, that is utilized in cognitive-behavioral treatment. When there is a “cognitive distortion” that cognitive distortion is challenged with a number of probing questions. A cognitive distortion is a belief about the self or about a situation that, when examined, is seen to be false. Cognitive reappraisal is another kind of technique utilized in cognitive-behavioral treatment. The intent here is to look closely and notice if there are other possible ways of viewing an experience and, perhaps, seeing events more honestly with less fear attached.

Antecedent-focused emotion regulation
Antecedent-focused emotion regulation uses “reappraisal” before an event occurs. This can be used thoughtfully and effectively on mildly emotionally provoking events, such as a first date or a job interview. This method does not avoid or prevent emotion, its aim is to explore a situation before it happens and “reappraise” of how well it may play out instead of focusing on negative outcomes.

Acceptance based therapies
There are a number of acceptance based therapies as acceptance is one of those foundational pieces of good therapy. Two well known kinds of acceptance based therapies include Dialectical Behavior Therapy and Acceptance and Commitment Therapy. Both of these therapies have a structure to them and they give valuable information for navigating anxiety.

Allowing intense emotion
Something that most of us are not taught is how necessary it is to learn to allow for, not only emotion, but to allow for intense emotion. If emotion has been suppressed or otherwise avoided over a long period of time, approaching intense emotion will need to be done with some sensitivity. If emotion has been avoided, (and there are many many reasons why this happens) for a lengthy period of time, there may be an enormous intensity that will need to be approached carefully. I can’t emphasize this enough. There are not many rules when it comes to being a part of humanity but, as a rule, you do want to be careful with yourself. If your inner world is incredibly intense, find someone to be with the emotion with you. Approaching, especially fear/anxiety, is daunting. Approaching it goes against what the feeling is communicating to you. The feeling itself demands action to flee or freeze. These can be appropriate when in a dangerous situation but it won’t be helpful to continue once you are safe. Once safe, that part of you needs your attention to be able to shift effectively.

How to effectively engage with others
The basics of how to effectively engage with others is about listening, how to respond to praise or negative feedback, and when or what to disclose. Sometimes we need to look at how we engage with others. This includes looking at what capabilities we may or may not have when it comes to listening to others. This may seem like something that is easily checked off your list of capacities, but take a moment and think about the last time you stopped everything in your world and gave someone your center-of-the-universe attention. Listening is a lost art. Listening is the foundation of engaging with others. Learning how to respond to praise, learning how to respond to negative feedback, and learning when to disclose may be valuable skills—if it can be done in a way that is authentic to the person. Any time we get away from authenticity and move toward a rote form of communication, everyone feels the disconnect. Again, it could be useful but do use your own best judgement.

Mindfulness
Mindfulness is primarily attributed to a practice arising from Eastern religious traditions. It is a concept that many people in therapy based professions gravitate toward because the quality of our attention dictates the quality of our experience. This single practice can improve any experience. Of course this is not new information. It is part of any tradition that encourages deeper forms of contemplation and presence. The beauty of the concept of mindfulness is that it took on a slightly different sense that reignited peoples interest in it. The Buddhist tradition does have clearer pointers about mindfulness when compared to the Christian tradition but it is there in most any religious tradition. Mindfulness points us toward deep interest in the self and self experience.

I used the term “center-of-the-universe-attention” above and this description is a decent description of mindfulness. Here in the West it seems that mindfulness often gets relegated as a brain practice, which it is, but that is not all that it is. I actually prefer “center-of-the-universe-attention” because it gives you a feeling of listening with all your sensing instruments that you have available. Listening and experiencing yourself with your ears, your mind, but also your heart, gut, and skin. Mindfulness includes sensing into what you are, that indescribable part of you. The best parts of mindfulness may get missed when we utilize only our minds to become more engaged in the moment.

Defining what is most important to you
Defining what is most important to you will help guide you through life because it is something that you can fall back on. For example: if you find interacting with others to be taxing and confusing, and you know that what is most important to you is being honest, no matter how the conversation felt, you can always fall back on knowing that you were honest, and that is the most important part for you. It does help to know what is most important to you because you can use it as a North Star.

Defining what is most important to you can change. It is worth checking in with yourself and reassessing. What is most important to you could be anything. A sport, art, community engagement, family. It could be truth, freedom, compassion, healing. Whatever it is, when taken seriously, it will guide you in decision making and lessening anxiety. Defining what is most important to you really needs to come from you and only you.

Commitment to yourself
A commitment to yourself can seem so abstract so let’s look at the definition of commitment. There are two basic definitions and they are as follows: the state or quality of being dedicated to a cause, activity, etc. Synonyms include dedication, devotion, allegiance, bond, attentiveness, loyalty, faithfulness, fidelity, adherence. The other definition is as follows: an engagement or obligation that restricts freedom of action. Synonyms include obligation, responsibility, task, burden, liability, duty, tie, charge, pressure, undertaking, engagement, arrangement. This may give you a sense of where to start, what way makes sense to you, in how to move toward a solid and committed relationship to yourself. It is worth pondering because this is the foundation that everything else builds on. What stands out to me in the definitions are the synonyms. They can be used to create your own definition of what it may mean to be committed to yourself. Perhaps being “responsibly attentive” toward yourself makes sense—or forming a “bonding tie” with yourself—or how about a “pressure to be faithful” to yourself— or “devotion to your burden” within yourself.

Observation of thoughts
We all get swept up in thought as if all our thoughts were true and they are most certainly not. Observation of thought is designed to notice that your thoughts are passing and that you don’t need to believe or engaged with all thought. While this is true and something to focus on it seems equally important to, not only observe thought, but to take note of your relationship to thought. Are you aware of what your thoughts tell you and how do you relate to them?

Breath work
Breath work is well known to help calm the body and the mind. It can be a very simple but effective way to tune into yourself and settle. As a provider I notice that not many people take advantage of breath work. My sense is that it is simple which tends to not be agreeable to the mind. The mind likes to work on something, preferably something with some complexity. But breath work is simple, and therefore, very often rejected by the mind as an option. The nice thing about breath work is that it is always available, it is simple, it is easy to practice. If you can push past the part of the mind that wants complexity, breath work can be very helpful. There are many resources on the web to refer to, if this is of interest.

——————————

Studies point to something really important but rarely is stated clearly and it deserves to be stated clearly. Anxiety often stems from a difficult or unexamined relationship with yourself. Not having some curiosity of feelings and thoughts, not knowing what is most important to you, and not giving yourself time and attention, these all perpetuate a difficult relationship with yourself. Research bears this out clearly. The root of the situation, what is implied but not emphasized, is that anxiety bubbles up from a psyche that is unkind to itself or avoids itself. Imagine a friend who comes to you with a concern. Now imagine pushing your friend away during their struggle. Most understand that this would not build a healthy relationship. We miss that this is what we may be doing to ourselves and become rather confused as to why that relationship with ourself is not working out so well. We choose to not notice how problematic our relationship has become with ourself. When we neglect to listen closely to our own thoughts and feelings, we find that we do not know ourselves enough to know what is unfolding. An entire world view may be adopted without a real close look at what may be personally important. Sometimes anxiety can stem from holding tight to a world view that does not align with what is most important to the person. Either the world view was never true for them or the person may have outgrown it over time. Figuring this out takes some curiosity and focused attention.

If you find your own thoughts and feelings to be immature, it does not mean that what they are telling you is inconsequential. It is tempting to move away from thoughts that are clearly problematic but that is where the misstep can occur. Imagine someone you love and that someone is saying something immature or perhaps just plain wrong. Is it wise to move away from that person you love in that moment? Perhaps moving away in that moment is not a bad move but eventually you would want to come back and address what was said so misperceptions do not continue to grow. It is not different when you work with your own mind. And we can do this consistently and kindly, just like you would wisely work with that person you love.

We all know that superficial relationships can be witty and entertaining but, we also know that these relationships may not give you what you need when life gets hard. How you approach yourself is no different. You can offer yourself pleasure, you can have a decent but superficial relationship with yourself. Make no mistake that neither of these ways of interacting will offer sustained deep satisfaction. That deeper satisfaction leads to less anxiety driven action and stems from an authentic commitment to yourself and to your well being. This is where a therapist may be of use or perhaps or engaging with a mature friend because cultivating a strong connection with yourself is not something you can strategize. Learning to care about yourself will come from a different place inside of you. It will come from a place that is willing to listen to your worries, all your worries, patient listening, and a willingness to not understand the whole picture until you do. It will come from a place that is willing to learn about the depth of what it is to be human.

 

The literature review that I mention at the beginning of the article is from:
Journal of Anxiety Disorders. 2008: 22(2): 211-221.
Author: Ananda B. Amstadter, PhD.
Title: Emotion Regulation and Anxiety Disorders.