Anxiety Disorders Need Your Undivided Attention

All psychoeducation about anxiety begins with how anxiety is actually adaptive and protective.  Anxiety is what alerts us to danger and helps us survive.  The classic example is how our ancestors needed anxiety to detect and respond to predators and other dangers.  Without anxiety, we would not be here today.  However, anxiety can become maladaptive and cause dysfunction.  This is when anxiety becomes a disorder that may need treatment, psychological or with medication. 

Psychiatrists spend a lot of time with anxiety.  It is one of the most common mental health complaints.  And though it is tempting to simply prescribe a medication and move on, from my experience, anxiety can mean many different things.  A fundamental part of proper treatment and recovery from anxiety is knowing what our bodies and minds are trying to tell us in the form of anxiety.   With anxiety, we are compelled to act first and reason later.  When anxiety is healthy, this is most appropriate.  Counterintuitively, in anxiety disorders, the task at hand is to NOT react, but to sit with the anxiety to see what action is warranted.  It is to re-train and recalibrate the body's alarm system.  In social anxiety for example, though the instinct is the withdraw from social interactions, psychological treatment involves asking the person to enter into a social environment, with physical grounding techniques under their belt, and to examine whether or not their anxiety is appropriate.  It is to try to create a space for curiosity and detachment in an otherwise emotionally activating scenario.  If this sounds difficult, that is because it is. 

The most common errors I see patients making is that they believe to get over anxiety is to either follow what it tells them, so avoid situations that cause anxiety; or anxiety is something to ignore and just white-knuckle their way through as they try to carry on with their lives.  I have said this before, and it bears repeating: Avoidance perpetuates anxiety.  So any treatment for anxiety involves approaching situations that were previously avoided.    The next step is to understand that treating anxiety requires protected time that is devoted solely to the anxiety itself, and is not to be done in competition with other tasks. 

What I mean is that often when I ask someone about how they are managing their anxiety, they tell me about going to the grocery store, avoiding eye contact, putting in earphones so that they can just get the errand over with.  They tell me that no matter how many times they do this, their anxiety is still very high.  This is because the objective was never to manage the anxiety, but to buy groceries.  If you are serious about treating your anxiety, the priority needs to be tending to your anxiety and NOT buying that head of lettuce. 

So I tell patients, "just go into the space you are dreading, but with no other purpose then to pay attention to yourself, your body and your thoughts."  Before this exercise (which is called an exposure), mindfulness skills like a body scan or deep breathing are taught so that the patient has the tools to observe their mind and body as calmly as possible.  As soon as any anxiety shows up, I ask them to stop, right there and wait.  I ask them to breathe and observe.  What are they anxious about in that moment?  What is coming up for them?  Are there any memories or thoughts?  physical sensations?  Where are they and what are they doing?  In a waiting room?  In a crowd?  It is important to teach patients to slowly scan the space around them as another way to ground themselves and train their bodies for safety.  For the first few exposures we pick places that are predictable and safe, places that allow for this kind of reflection and self-monitoring without other distractions, like a library, or going out for a short walk in a familiar area.  The exposures will depend on each individual's anxiety and must be tailored to that specific person. 

If it helps, I also use the analogy of your anxiety being a puppy, whimpering and whining while you go about your day.  Do you try to ignore the puppy?  Or even yell at and discipline the puppy?  Drag it through the tasks you want accomplished, while being worn down by the crying and yelping?  Or do you deliberately and with care create the moments to check in?  Where you tend to the puppy, give it a hug and the opportunity to figure out why it is worked up and what might be done about it?