Anxiety a Leading Reason for Therapy
Anxiety and related conditions are the leading source of unease and suffering that brings people to therapy. The severity and duration of anxiety can fall on a continuum from mild and quite manageable with or without psychotherapy to extreme to the point of a near total inability to function.
Tendency to Anticipate Danger
Our brains are wired for and have evolved to perceive immediate and serious potential threats. There are evolutionary reasons for the human tendency to anticipate danger and to fear for our survival. Three different parts of our brain create a triune of reactions that have remained part of the human psyche long past the time when humans had clearer threats, such as being harmed by a wild animal. The brain causes us to have rational, emotional and instinctive reactions to danger. As a result, not only threats to our lives can elicit powerful anxiety and fear reaction.
Existential Threats Which Provoke Distress
Humans of the 21st century typically, of course, live lives far removed from those of our distant ancestors but we share nearly the same brain and eons of evolution with survival being the predominant requirement. In our modern world, direct threats to our physical well-being may be diminished, but we still regularly experience setbacks such as perceived sleights, failures, troubled relationship, family conflict, loss of a job, perceived diminished social standing, or lack of meaning and connection in life, as an existential threat which can elicit enormous levels of distress and suffering. As a result, not only threats to our lives can elicit powerful anxiety but also our lives can feel as though we are facing existential threat on a regular basis and this of course is a deeply painful experience. This is in many ways the essence of most anxiety disorders
The Natural Tendency to Escape from Anxiety
As humans who wish not to suffer, it is normal and understandable that we seek to escape these anxiety producing feelings as quickly as possible. The trouble is that we often try to escape in ways which are of limited use, or even which make things worse. Some of the ways in which we seek to escape the painful feelings of anxiety include suppression or denial of painful feelings, diversion and inability to focus, obsession with other activities, such as work or exercise, television or video games, or problem use of drugs, alcohol, gambling or sex.
It is important to understand that the tendency to want to escape from anxiety doesn’t indicate a moral failing or a personal weakness. It is perfectly human to seek to escape by any means necessary from that which we perceive may destroy us. What is needed are new tools and methods to live with our distress, to be able to pursue and experience our lives as meaningful and to be able to find and experience periods of joy and contentment, in spite of the distress of anxiety. As a byproduct of this, we will often find that the anxiety severity and duration can abate and make space for other experiences and feelings which we may find much more satisfying and hopeful. d It is through such processes as psychotherapy and mindfulness based meditation in which the foundation of real change and progress can be begun.
Relationship between Fear and Anxiety
Anxiety disorders include those that share features of excessive fear and anxiety. Fear is the emotional response to real or perceived imminent threat. Anxiety is the anticipation of future threat.
The states of fear and anxiety overlap, but there are differences. Fear often initiates the fight-or- flight response due to thoughts of immediate danger and escape. Anxiety is more of a vigilance in preparation for future danger, initiating cautious or avoidant behaviors that cause muscle tension.
Types of Anxiety
Here are some of the most common forms of anxiety:
Agoraphobia: Fear of being in large or unknown public places, often associated with panic attacks. This phobia may cause a person to fear leaving home. This may be connected to a troubling or traumatic experience, and often in therapy, the reason for this fear may surface and allow the person to develop strategies that allow a more ordinary coming-and-going.
Free Floating or Generalized Anxiety: A chronic sense of doom or excessive worry that affects a person almost daily, lasts for six months or more, is difficult to control and does not seem to be attached to a specific issue or concern. Some symptoms include fatigue, restlessness, irritability and sleep problems.
Obsessive Compulsive Disorder: Recurring, unwanted thoughts or obsessions along with repetitive behaviors or compulsions. These behaviors might include hand washing or repetitive checking on things, for instance, whether the stove is turned off.
Panic Disorder: Unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath or dizziness.
Post Traumatic Stress Disorder: Anxiety that develops after exposure to a terrifying event, such as military combat, a personal assault or a natural disaster.
Social anxiety: Excessive self-consciousness or fear in one or more social situations, such as public speaking, or in more generalized cases, anxiety from being around other people in many types of situations.
Options for Treating Anxiety
The two main treatments for anxiety disorders are psychotherapy and medication, and sometimes a combination of the two.
Psychotherapy, also called talk therapy or psychological counseling, with a qualified professional is an important first step to get an accurate diagnosis and plan a course of treatment.
Cognitive behavioral therapy, or CBT, has been shown to be a highly effective form of psychotherapy for anxiety disorders. CBT focuses on learning specific skills to use in situations that may cause anxiety.
The proper treatment can lessen the severity and duration of anxiety and make space for other experiences and feelings that are more satisfying and hopeful. Often with anxiety, even a little progress can be very meaningful, as it can provide a path to a different and better way to experience our lives.
Research and experience has shown that processes such as psychotherapy and mindfulness-based meditation can be the stepping stones to change and an increased sense of optimism and hopefulness.
New Insights on the Nature of Anxiety
We are only beginning to more deeply understand that what distinguishes our species is our ability to contemplate the future. Martin Seligman, a leading expert on “positive psychology,” said in a New York Times article that, “Looking into the future, consciously and unconsciously, is a central function of our large brain, as psychologists and neuroscientists have discovered, rather belatedly, because for the past century most researchers have assumed that we’re prisoners of the past and the present.”
Seligman said this future orientation creates optimism in some people, while “… those suffering from depression and anxiety have a bleak view of the future, and that in fact seems to be the chief cause of their problems, not their past traumas nor their view of the present.” The human tendency to anticipate, combined with an over-estimating future risks, can cause anxiety.
It is one of the paramount goals of our practice to work assiduously and collaboratively with our clients to help them uncover their inherent strengths and resilience and to enhance and build on them to create meaningful and lasting positive change in their lives. As this work progresses, anxiety can evolve from a defining quality in one’s life to a more transient and diminished thought construct and feeling leaving space for other more positive, engaging and optimistic thoughts and feelings to take a more central role in one’s life.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5, American Psychiatric Association, Oct. 1, 2016
Price, John S., “Evolutionary Aspects of Anxiety Disorders,” National Institutes of Health, September 2003.
National Institutes of Health, “Major Types of Anxiety Disorders,”
News in Health, “Understanding Anxiety Disorders: When Panic, Fear and Worries Overwhelm,” National Institutes of Health, March 2016
Seligman, Martin and Tierney, John, “We Aren’t Built to Live in the Moment,” New York Times, May 19,2017.
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