Acting on Anxiety – Knowing When to Confront It or Avoid It
Image: Tableau by Free-Photos (CC0)
Synopsis: Anxiety can block us from doing the activities we love and can make our lives miserable, unproductive and inefficient. Making a proactive plan about how and when you will deal with your anxiety will immediately reduce your anxiety. The best and most durable solution for anxiety is confronting it at the right moment and at a rate that you can tolerate.
BY LEN LANTZ, MD / 4.18.20; No. 20 / 10 min read
Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post might also contain affiliate links. Please click this LINK for the full disclaimer.
“I don’t know why I feel anxious”
I hear this often from patients I work with, however, when we take the time to review possible causes of their anxiety, 99% of the time we find the answer. Only rarely is anxiety due to a medical condition or something entirely unexplained. Nearly everyone can figure out why they feel anxious. Common causes of anxiety:
You had a negative thought
A negative event occurred in your life
You are dreading something in your future
You are feeling stuck in a situation
You (or someone you love) are medically ill
You have trauma from your past that you are ignoring
You have inadequate sleep
You have a bad relationship that you have not dealt with
You have an addiction
You have depression
You got a bill in the mail that you forgot about
You read too much news
You eat too much unhealthy food or are not eating enough healthy food
You do not exercise
Medical conditions that trigger anxiety
It makes sense to get regular medical check-ups and to periodically have your blood tested for conditions that could harm you now or in the future. Here are some medical conditions that can trigger anxiety:
Medication side effects
Thyroid abnormalities
High blood pressure
Cortisol abnormalities
Atrial fibrillation
Paroxysmal supraventricular tachycardia
Mitral valve prolapse
Pheochromocytoma
Some of these conditions are easier to screen for than others. Starting with screening for common medical conditions makes the most sense and, as it turns out, is also the most cost-effective.
To deal with anxiety, you need to be proactive
Dealing with anxiety only requires you to make a decision. When you have anxiety and know why you have it, you can develop a plan around it. Imagine that it is 11 pm and you are worried about something. If you have to do something at that moment, then that is great, because you can immediately deal with the problem. If you cannot deal with the problem immediately, then that is also great. Why?
Nighttime worrying usually consists of fretting instead of effective problem-solving, so if your worry does not require direct, immediate action, you can actively set a time in the morning to worry about the problem and now you can go directly to sleep. It is far easier to deal with the problems of life when the sun is up. The night is often the time of feeling helpless, while problems seem more manageable in the morning.
A story about confronting anxiety
“Sarah” felt very anxious about making phone calls. She hated making phone calls. Just the idea of dialing someone’s number or, worse, having to leave a voicemail message, made her cringe. It was creating real problems for her. She found herself bumping every call she received to voicemail and avoiding calling people back. She would wait until she thought the other person was unlikely to call her back and then call and leave a message like, “Hey, call me back?” Because of her avoidance of phone calls, she was having problems at work and in her personal life.
To deal with this problem, she committed herself to return every call she received within 24 hours. Because one of the things that terrified her the most was leaving a voicemail, she wrote down her plan of action on a recipe card that said:
Say, “Hi this is Sarah Smith. My telephone number is 555-555-5555.”
Deal with the issue
Ask a question.
Answer a question.
Share information.
Finish by saying, “Again, this is Sarah Smith. My telephone number is 555-555-5555. I look forward to hearing back from you. Bye.”
She was relieved when she didn’t have to leave a voicemail message, but she found that it got easier the more she did it. She also started entering people’s phone numbers into her phone’s contacts list, so she would know if she really had to pick up a phone call or not. Making the phone calls was hard at first, but the more she did it, the more her confidence grew. It was exhilarating when she started noticing that she could make the phone calls without using the recipe card. She could just pick up the phone and call someone.
What it means to act on anxiety
Acting on your anxiety means actively making decisions about your anxiety. Proactive decision-making around your anxiety will lower your anxiety and stress level. Ignoring your anxiety until it passes, trying to forget about it and then freaking out the next time it recurs is not an effective method of dealing with your anxiety. Examples of proactively dealing with your anxiety include:
Spending time figuring out the cause of your anxiety
Scheduling a time to deal with the cause of your anxiety
Deciding if it is a healthy time to confront your anxiety
Determining if there are serious consequences when confronting your anxiety
Deciding that you will deal with your anxiety when you reach a certain point
Committing not to hide from, ignore or deny that you have anxiety
Why would you confront your anxiety?
Picture your anxiety as a monster, the Anxiety Beast, that wants to harm you or kill you. Do you want to feed the Anxiety Beast, making it more powerful and bigger, or do you want to starve it to make it weaker and smaller? When dealing with anxiety, most of us have the human instinct to flee from and avoid it. The problem is that when you flee from anxiety, you actually feed the Anxiety Beast. Running from your anxiety gives you temporary relief, but increases your long-term anxiety. You have fed the Anxiety Beast, so it will grow, have more power over you and make you more anxious the next time you have to deal with it.
When you confront anxiety, your anxiety will temporarily go up and then come down. The more you confront the same thing, the more you will find that the temporary increase in anxiety is less and less (this process is called habituation) as shown in Figure 1 (Rachman and Levitt, 1988) below.
Image: Figure 1 by Rachman and Levitt (1988)
Also, the more you confront your anxiety, the more you lower your overall baseline anxiety. Check out Figure 2 (Rachman and Levitt, 1988) below, which shows that 2/3 of people see their baseline anxiety go down as they confront it.
Image: Figure 2 by Rachman and Levitt (1988)
There is a little problem for about 1/3 of people, which is the return of fear. While most people find that as they confront something that makes them anxious, their baseline anxiety between the exposures goes down, a minority of people find that their anxiety instead can go up. Don’t blame yourself if you fall into this category. Some people are simply wired to be more anxious. The roughly 1/3 of people who deal with this problem are more prone to having anxiety disorders.
There are many theories about why someone’s anxiety could go up between exposures, but the best explanation is that people who experience this struggle have deficits in areas of Inhibitory Learning and Inhibitory Regulation. Having deficits in Inhibitory Learning (learning which of your anxiety triggers are not true threats; not generalizing your fears to something that should represent safety) and Inhibitory Regulation (actively and honestly stating your emotions while confronting your anxiety) leads people to fall into the trap of trying to solve their anxiety through avoidance. If you are among the 1/3 of people whose baseline anxiety goes up when you gut it out and show courage by confronting your anxiety, then you might need a therapist skilled in exposure-based cognitive behavioral therapy to help you improve areas of Inhibitory Learning and Inhibitory Regulation. There is an excellent 2015 article, “Optimizing Exposure Therapy for Anxiety Disorders: An Inhibitory Learning and Inhibitory Regulation Approach”, by Dr. Michelle Craske, which explains this in more detail.
What if I want to avoid my anxiety?
I was not attempting to tease you with the title of this article. In general, avoiding anxiety regularly leads to utter misery, so why would I suggest that you should avoid it? It is because secretly it is what we all want. Be honest. It is natural for us to want to run and hide from the things that cause us fear and dread. We are all human and it’s okay to feel this way. It’s the rare person in the world who wants to jump on a white stallion, whip out a sword and ride to (what feels like) certain death. That’s a weird image, but it’s kind of what it feels like to some people when they are encouraged to confront their anxiety.
So, why can’t you just avoid your anxiety? Because it does not work. Because there is a chance that you will be living a small life of utter misery in your mother’s basement until you need a walker of your own. So, when do you get to avoid your anxiety?
For everything, there is a season
You can (temporarily) avoid your anxiety when you have developed an action plan that you actually follow. You are allowed to temporarily avoid/delay dealing with your anxiety when you can honestly say:
I am not avoiding this anxiety, but I have proactively decided to deal with it at a later date ______ [specify date and time] because one of the following conditions exists:
Dealing with this issue right now would result in
Homelessness
Incarceration
Losing my job
Losing my marriage
Losing my child
The event or situation that is making me anxious has not yet occurred
Previous attempts to confront this issue have resulted in my feeling overwhelmed with worsened function, so I am currently improving my coping skills by:
Working with a skilled therapist
Doing mindfulness exercises
Starting a medication to help reduce my panic attacks
Doing yoga
Exercising daily
Taking steps to deal with the things that make you anxious is a process that takes time and practice. It is easy to become discouraged if you feel that you are not making progress and then say to yourself, “I never should have tried in the first place!” Do not be discouraged. Practicing mindfulness can help you deal with your negative thoughts or feeling overwhelmed and can help you combat your Inner Critic (See Len’s article, “Mindfulness – How to Chill Out and Stop Beating Yourself Up”).
What are the benefits of confronting anxiety if it increases my anxiety even briefly?
Think for a second about how much your anxiety interferes with your functioning, and now think about what you could do if you proved to yourself that you can master your anxiety:
Have more time in the day due to better use of time
Have healthier relationships
Work more efficiently
Improve your confidence
Have a better mood
Feel better physically
Sleep better
Act on a goal or a dream
Free yourself from guilt, shame and low self-esteem
Have fewer panic attacks
How do you confront anxiety?
There are therapeutic approaches in psychiatry called exposure and response prevention (or exposure and ritual prevention) that act to decrease the power of the cause of your anxiety. These approaches normally work but require effort and determination. Here is how you can ensure that acting on your anxiety will work:
Be a detective – Spend a significant amount of time determining the causes of your anxiety. Anxiety usually has several layers, like an onion, so peel away layer after layer until there is nothing left. It is easier to act on anxiety when you know exactly what you are dealing with.
Be a scientist – Study each effort that you make to confront your anxiety. What is your biggest fear or the worst-case scenario that could happen if you actually did the thing you are avoiding? Did it happen? What did happen exactly?
Develop a better memory – Keep a log of every time you confronted your anxiety. Make sure to write down the date and time. At some point, go back to your log. How many times did the worst-case scenario actually happen? 1 in 20 times? 0 in 20 times? Look at the data.
Reward yourself for your effort – There is at least temporary discomfort when you confront something you previously were avoiding. It’s reasonable to give yourself a small reward for a job well done. Frankly, it’s hard not to get discouraged or give up. Rewarding yourself is about taking care of yourself.
Map out your plan of action in case you have a panic attack – Panic attacks feel awful. It can feel like you are dying or going crazy. If you think that there is a chance that you will have a panic attack in confronting your anxiety, then plan ahead:
Is there a place you can go sit down until the panic attack passes?
Have you practiced deep breathing (mindful breathing) ahead of time, so that you can deep breathe your way through the panic attack?
Is there someone who will be a support (there with you or on the phone) to help to stay in the situation and coach you to continue doing deep breathing?
Is there an effective way to distract yourself from the panic attack?
Get help from a professional – Working with a knowledgeable therapist can make all the difference in the world. They can help you stay motivated and true to your personal values. Therapists can help you brainstorm and problem-solve and they can provide you feedback when you are trying to determine if you need medication for additional support.
Strategies for confronting anxiety
Stopping yourself from repetitive checking behavior such as, “Did I lock my car door?”
Going to stores
Ordering in a restaurant
Giving a talk/presentation to a group of people
Building on small successes
Opening all your mail, including your bills
Going to school
Making a phone call and leaving a voicemail if you need to
Singing or playing an instrument in public
Returning an item at a store
Imagine no longer being stopped by your anxiety
Let your mantra be: “I will make an active decision about my anxiety.” Think about what you can do about your anxiety. You could simply set aside time to think about what is making you anxious. Write it all down and get it out of your head for a moment and that will immediately lower your stress level. Consider that there is a time to confront your anxiety and a time to hold your position and plan strategically to deal with it later. While avoiding anxiety feeds the Anxiety Beast, confronting the things that make you anxious helps you to feel more in control over time and knocks down the feeling of being overwhelmed. Acting on your anxiety means that you are making proactive decisions about when and how you will confront it, which will enhance your confidence and improve your mood.
For further reading, check out:
Len’s article “Mindfulness – How to Chill Out and Stop Beating Yourself Up”
Len’s article “Cognitive Behavioral Therapy (CBT) – the Most Effective Therapy?”
Len’s article “Finding Quality Psychotherapy – Moving Beyond Talk Therapy”
Mindfulness for Beginners: Reclaiming the Present Moment and Your Life by Dr. Kabat-Zinn
Mind Over Mood: Change How You Feel by Changing the Way You Think (2nd Edition) by Greenberger and Padesky (See Len’s Book Review)
Getting Things Done: The Art of Stress-Free Productivity by Allen
Please follow us on Google News
It’s easy to follow us on Google News! Click this LINK to our FAQ page to learn how.
