Isaac Hahn M.A Psychologist (Candidate Register)
What is anxiety
Anxiety involves thoughts and worries focused on possible negative events, a negative emotional state, and physical sensations. A person might be thinking about the possibility that they might not be able to pay their bills next week, which may lead to feeling anxious and stressed, as well as feeling tightness in their chest, rapid heart rate, and sweating. This example shows thoughts (something bad might happen), feelings (anxious and stressed) and physical experiences (chest tightness, heart beating fast, sweating).
Difference between fear and anxiety
Anxiety involves concerns about the future. Fear takes place in the present, and involves a negative reaction to something that is happening in the moment, or that is about to happen. When we say things like “I’m afraid I might lose my job next month”, that would actually be an example of anxiety. If a tiger were attacking you, though, you would probably feel active fear in that moment.
Anxiety has physical, emotional, cognitive, and behavioural components
Negative emotions, unhelpful behaviours (such as avoidance), negative thoughts and expectations, and physical feelings are all involved in anxiety. Thoughts represent one component of anxiety; when anxious, specific thoughts usually come up (e.g., “If I go to that party, someone will make fun of the way I look”). Physical sensations and experiences are another element of anxiety. When anxious, it’s normal to experience sweating, increased heart rate, and other feelings of tension or discomfort. These feelings can be seen as unpleasant, and might lead a person to worry that someone is wrong in their body. Anxiety also involves an unpleasant emotional state – we feel anxious, and we feel stressed. Finally, anxiety motivates us to take or avoid taking certain actions (e.g., staying at home because we are anxious about attending a gathering with friends).
Some anxiety can be a good thing. Anxiety or worries about the future can encourage us to take helpful actions or to plan ahead. Without anxiety, we would probably never study for tests, or never wear seatbelts. Failing to study will likely lead to problems in school, and failing to use a seatbelt will lead to far greater injuries in a traffic collision. If we didn’t have some realistic, healthy concerns, we would not be motivated to engage in helpful actions that will help us to succeed and help us to be safe. Anxiety can motivate us to sit down with a textbook and do the studying we need to, or to use a seatbelt whenever we get into a vehicle.
Anxiety can become too much of a good thing. We can develop anxieties that are out of proportion to what we are worried about, and we can have inaccurate negative assumptions. Being anxious can prevent us from accomplishing important goals, and can cut us off from many positive experiences. If we expect to fail, we may not even try. If we always expect bad things will happen, we might never leave our homes, or never reach out to another person. Then, we might never experience many good things, either. Unpleasant and difficult experiences can and sometimes will happen, but they are not the only possibilities.
How anxiety can develop
Anxiety can develop out of our own experiences, or from learning about the experiences of others. Let’s use a made-up example: Alice goes to the grocery store. She doesn’t have cash, but knows there is enough money in her bank account to pay for her groceries. Alice tries to pay with her card, but it gets declined. There must be a glitch. She tries her card again, and it doesn’t work. People in line behind her start to shuffle and look at each other. Someone behind Alice mutters “I can’t believe this”. Alice starts to feel embarrassed, and she is worrying about what she will do if she can’t get groceries tonight. Ultimately, she apologizes and leaves her order behind, leaving the store with her face flushed and her breath feeling short. There was no way Alice could have realistically predicted that specific electronic glitch happening, and that she would not be able to get her groceries that day. Now, whenever she thinks about going back to any grocery store, she remembers how it went last time – how other people seemed annoyed, how uncomfortable she felt. Alice thinks the same problem might happen again, and that she would not be able to handle it. So, she stays away from the store. Alice asks her roommate to pick up her groceries on her own trips, so that Alice can simply pay her back later. Alice is engaging in avoidance behaviour. She thinks that a bad outcome is either too likely, or too severe, for her to risk it.
Alice assumes that problems with payment will likely happen again if she goes to the store. However, she has been to the store many times, without problems. If Alice has paid with no problems 49 times, and encountered a glitch 1 time, then we can say that she has run into problems 2% of the time. Can we say it is reasonable for Alice to believe that she will run into problems next time? Evidence from her own experiences shows that things work out okay most of the time.
Checking the facts
When we have a worry, we sometimes wonder if the worry is realistic. If you are worried that you will mess up your words if you try to talk to someone at a party, how can you know if that worry is realistic? Looking at concrete evidence helps us to determine if worries are realistic. How many times have you spoken to people at parties in your life? How many times have you messed up your words? Furthermore, if the worry is accurate, how bad would it be if it came true? If you have had trouble when speaking to someone at a party before, what was the outcome? Did the other person insult you because of it? Did they walk away and avoid talking to you completely? Is it normal for people to sometimes be tongue-tied, and would some people maybe be understanding about it? Would the person continue to intentionally remind you of an embarrassing moment for years to come? Sometimes, by looking at evidence and checking the facts, we can determine that a worry is unlikely to come true. We might also overestimate how bad it would be if a worry came true. In general, others do not remember our mistakes nearly as well as we do.
Our personal experiences shape our anxiety. When we are anxious about things, we frequently avoid them. Returning to the example of Alice in the grocery store, she now believes that something will go wrong if she goes to the store. She does not want to deal with more problems, and does not want to feel embarrassed. Alice avoids returning to the store, based on her personal experience of an unexpected problem, and her feelings of embarrassment in that moment. If she thinks about how she needs things at the store and will have to get groceries
soon, her anxiety and stress will probably increase as time goes on. If she decides to ask a friend to go instead, and the friend agrees, Alice will feel some relief. Alice is not going to the store, and she can’t be embarrassed if she stays home. Alice feels calmer and more relaxed, now that the anticipated “crisis” has been averted. This is essentially why we avoid things: avoidance decreases our distress in the short term.
Decreasing stress feels good, and encourages us to continue avoidance. In the long term, avoidance keeps anxiety going, and often makes anxiety worse. Avoidance strengthens the belief that things will go wrong, and prevents us from putting that belief to the test. If we keep avoiding, we cannot gather any new evidence to find out if worries are true. If Alice goes to the grocery store another 10 or 20 times, she will be able to see how accurate her worry is. You might expect that her belief would start to change with new information, and you would probably be right. It’s hard to keep believing bad things will happen every time if you can prove that they don’t.
What about when worries come true?
Avoidance can prevent us from gathering new information about our worries. Sometimes, our worries are true – something bad does happen. Avoidance prevents us from gaining practise and increased comfort in dealing with difficult experiences. Some people are too anxious to drive, because they are worried about getting a flat tire. They avoid driving, because calling roadside assistance or changing a tire on their own seems intimidating or difficult. If a person has had 1 flat tire, they could reasonably be anxious about the possibility that it might happen again. Part of this anxiety comes from not having sufficient skills to deal with the problem – a person might think they would make a mistake when changing a tire, and they might be absolutely right. However, if that person then practises taking tires off and putting them back on many times, or gets 20 flat tires on the road and has to fix them, their anxiety will most likely decrease. They are less worried, not because the worry is unrealistic or not true, but because they learned ways of dealing with the situation, and they learned, through experience (new evidence) that they can get through a difficult situation and be okay in the end. The worry may still be there, but it is not out of proportion, and they no longer let their worry prevent them from driving. Worrying about a flat tire won’t make it less likely to happen. Avoidance prevents us from learning how to deal with situations, and from knowing that we can deal with situations.
Keeping an eye on your anxiety
Noticing and tracking your thoughts is an excellent first step to responding to worries. Memory is imperfect, and we often cannot remember details of our thoughts and feelings. Writing down your worries as they happen, in real time, can help you to see what you worry about and when you worry about it. You can also keep track of when your worries come true, and when they do not. It is best to write these things down as they happen, rather than waiting until later and trusting to memory. We often remember information that confirms our beliefs more than we remember information that disproves our beliefs, unless we keep track on paper.
Putting our experiences on paper helps to take the problems of memory out of the equation. Inaccurate memories are not usually intentional; we do not necessarily have biases that we are aware of for only paying attention to certain types of information. The mind, however, loves to take shortcuts and try to be more efficient. Sometimes, mental shortcuts or habits of
thinking can help us to reach conclusions more quickly. Other times, mental shortcuts or thinking styles cause us to make mistakes, and to see the world less accurately. Automatically, we pay attention to certain information, without even thinking. We can jump to conclusions without enough information, and end up being mistaken. Unhelpful thinking styles can contribute to other problems, not just anxiety. Thinking styles, and how to notice them, will be the topic of a future post.
Responding to anxiety
When it comes to anxiety and specific worries, a key takeaway is not to trust your thoughts and assumptions automatically. Anxiety often tells us two lies:
1) Bad things will always happen 2) You can’t deal with bad things if they do happen
Look at all the evidence for and against your worries. Test your predictions. If worries do not always come true, you may be able to start believing your worries less. If worries do come true, you can work on skills to deal with problems when they happen. Thinking about how something bad might happen won’t usually help. Gaining experience in dealing with difficult issues when they happen can often help – you can turn your focus to actions, and away from worries.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic, 2nd ed. New York, NY: Guilford Press
Barlow, D. H. (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual, 5th ed. (D. H. Barlow, Ed.). New York, NY: The Guilford Press
Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55, 1247-1263. doi: 10.1037/0003-066X.55.11.1247
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond, 2nd ed. New York, NY: Guilford Press
Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014b). ‘But it might be a heart attack’: Intolerance of uncertainty and panic disorder symptoms. Journal of Anxiety Disorders, 28, 463-470. doi:10.1016/j.janxdis.2014.04.006
Carleton, R. N., Sharpe, D., & Asmundson, G. J. G. (2007b). Anxiety sensitivity and intolerance of uncertainty: Requisites of the fundamental fears? Behaviour Research and Therapy, 45, 2307- 2316. doi:10.1016/j.brat.2007.04.006
Esteve, M. R., & Camacho, L. (2008). Anxiety sensitivity, body vigilance and fear of pain. Behaviour Research and Therapy, 46, 715-727. doi:10.1016/j.brat.2008.02.012
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry?. Personality and Individual Differences, 17, 791-802. doi:10.1016/0191-8869(94)90048- 5 Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8. doi:10.1016/0005-7967(86)90143-9
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., & … Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176-188. doi:10.1037/1040-3518.104.22.168