The best treatments for anxiety focus on increasing insight into the anxiety that people are experiencing. Through establishing an understanding of the connection between thoughts, feelings, and behaviors, people can begin the process of interrupting the cycle of anxiety. In cognitive behavior therapy (CBT) which is the gold standard treatment for anxiety disorders, individuals learn how to break the cycle of anxiety at each level. They learn how their thoughts can become more accurate instead of catastrophic or worry focused. They also learn what behaviors promote anxiety, such as avoidance. Lastly, they learn about the way their feelings and the physiological experience of them like a racing heart or sweating can lead to more anxiety because many people become anxious about their anxiety or believe they are in physical danger. This phenomenon is called interoceptive sensitivity. In treatment for panic disorder, for example, people learn that the physiological experience of anxiety and anxiety itself is not dangerous and this breaks the snowball effect of panic symptoms during a panic attack. Lastly, with regard to behavior, people learn how avoidance through thought suppression, procrastination, or substance use to escape feelings all lead to increased levels of anxiety.
However, many people do not know what therapy for anxiety actually entails or they are put off by how intimidating it sounds. Here are the four most common misconceptions about anxiety treatment.
The Four Most Common Myths About Anxiety Treatment
1. I’ll never have anxiety again. You need anxiety, just as you need all your emotions. All emotions serve the functions of motivating individuals to take action, communicating to yourself something important about a situation, and communicating to others. When you experience anxiety, for example, it communicates to you that there is something dangerous in your environment, it motivates you to take action, and it will communicate to others that they should also take action. Anxiety is a completely adaptive evolutionary response that made survival possible for our ancestors. Anxiety enabled our ancestors to hunt without getting eaten by predators. Even today, living without any anxiety would be detrimental.
If while crossing the street you saw an oncoming car headed right for you, instead of experiencing anxiety to motivate you to get out of the way, you would undoubtedly get hit. Similarly, a complete absence of anxiety would leave people directionless and unmotivated to prepare for exams or work. It would also lead to many individuals making poor decisions and putting themselves in risky situations or would lead people to engage in dangerous or violent behaviors because they lack the normal amount of anxiety that motivates them to follow social mores and rules.
Research has shown that there is an optimal level of anxiety that one should experience in order to prepare for an exam, for example. Too much anxiety can lead to paralysis and catastrophic thinking and even the generalization of anxiety to all facets of one’s life, prompting people to avoid situations they believe are dangerous when in actuality they are completely safe. This is when anxiety crosses the line from adaptive, functional, and “normal” to pathological and a psychiatric disorder. In fact, interference in one’s life is the main criterion for the diagnosis of an anxiety disorder.
2. I’m going to have to talk about my childhood or my mother the whole time. Cognitive behavioral therapy will focus on the here and now and helping you learn how your current thoughts, feelings, and behaviors are perpetuating your anxiety. In therapy, you will actually learn how to change your thoughts to more adaptive ones and stop behaving in ways that perpetuate your anxiety. Eventually, you will likely address long-standing beliefs or where your current beliefs are coming from, but you don’t need to focus on the distant past to address anxiety in therapy.
3. I will need to take medication. Some SSRIs have research support for improving anxiety, but benzodiazepines like Ativan and Xanax which people typically associate with treating anxiety can actually perpetuate anxiety and make it worse. Taking benzodiazepines can lead to rebound anxiety and also can perpetuate anxiety by the associates people make to them. For example, if someone becomes reliant on having their medication with them at all times “in case,” then they will end up making their anxiety worse even if they are exposing themselves to anxiety provoking situations because they never learn they can handle the situations on their own. They attribute their success or survival to the medication.
4. Therapy will help me learn to stop having “bad” thoughts. Cognitive therapy does address thoughts that are unhelpful and which perpetuate anxiety but a good therapist will never tell you to “just stop having the thoughts.” Minimizing your anxiety and invalidating yourself is harmful. Often people decide that if they talk themselves through anxiety and somehow convince themselves that whatever they’re fearing is not a realistic fear, they will get over it. What you are doing, in essence, if you are minimizing or invalidating your own feelings is failing to acknowledge them. That itself will perpetuate your anxiety. It is also harmful to chronically invalidate yourself. Instead, in cognitive therapy you will learn how to be skeptical of your thoughts that are contributing to your anxiety and making it worse while still validating your concerns/beliefs. You will learn how to evaluate the evidence for and against your thoughts and replace your thought with a more accurate and helpful thought. It will take some time, but your thought patterns will change and your anxiety will decrease.
Let's say you are not currently in therapy and you are trying to manage your anxiety based on what you have read about treatment for anxiety disorders. Research and self-help can be great, but sometimes the application is not as simple as it seems.
1. It is human nature to avoid what we fear and so often the very things that help us feel better in the moment end up perpetuating and exacerbating your anxiety. If you either do not know how to manage your anxiety or if you think you are doing the right things but your anxiety is negatively impacting you and not decreasing, it may be time to seek therapy. Cognitive-behavioral therapy can be especially helpful for the treatment of anxiety.
2. Engaging in what cognitive behavioral therapists call “safety behaviors” will perpetuate the problem. Let’s say you learn through trial and error or through some research or advice that if you do deep breathing, your anxiety will decrease. Another safety behavior would be fearing enclosed spaces like elevators but being able to manage them as long as you have your cell phone with you.
3. Avoidance through the use of substances. Plenty of people try to manage their anxiety through substance use like having a few drinks to manage an otherwise overwhelming social situation or using other substances like marijuana to calm down before a big event. Substance use to manage your anxiety, even if it isn’t excessive or problematic in and of itself, will only lead to more anxiety in the future because you never confront the situation and learn that you can get through it on your own.
4. White knuckling to get through a situation. Let’s say you have a fear of flying or public speaking and you understand that exposure is helpful in treating your anxiety so you just push through it. That should help, in theory, right? Actually, just forcing yourself to do something you are afraid of while not attending to your feelings or taking deliberate steps to ensure you aren’t doing any subtle things to avoid your anxiety.
5. Minimizing your anxiety and invalidating yourself. Often people decide that if they talk themselves through anxiety and somehow convince themselves that whatever they’re fearing is not a realistic fear, they will get over it. What you are doing, in essence, if you are minimizing or invalidating your own feelings is failing to acknowledge them. That itself will perpetuate your anxiety. It is also harmful to chronically invalidate yourself and demean your own feelings.
In our society, and in the field of psychology, we have largely been taught that it is essential for people to experience their emotions fully and that this is the only way to move forward. Especially within the context of loss and grief, it is important to honor your feelings and who or what you have lost. Research and clinical experience indicates that emotions come and go as waves and it is only by trying to stifle them, avoid them, or push them away that people inadvertently end up perpetuating them. Psychologists work with clients to approach rather than avoid their emotions, sit with their emotions, and develop strategies (such as coping skills or emotion regulation skills) to navigate strong emotions.
A common misconception about grief in particular is that proper grieving should look a certain way and that all people who are doing it properly are 100% in the process, going through Dr. Elisabeth Kubler-Ross’s well known stages of grief ranging from denial to acceptance with a defined path in between that includes anger and bargaining. Prominent trauma experts in the field have also developed treatments for trauma and grief that emphasize exposure to negative emotions and processing the traumatic event or loss fully. The truth is that there is no correct way to grieve or process a loss and that in many instances, it is actually beneficial for people to utilize distraction in order to get through incredibly difficult situations. Psychologist, Dr. George Bonnano, of Columbia University Teacher’s College is a bereavement expert and has done research that backs the concept that not all people process grief or trauma the same way and that the differentiating factor that leads to healthier outcomes is resilience which he describes as the ability to maintain healthy psychological functioning by using emotion regulation and coping skills. Bonnano talks about a range of coping or emotion regulation strategies, including distraction, that are effective and healthy (Bonnano, 2013)
When people are confronted with extraordinarily intense emotions or challenging situations, it is not so easy to just sit with them. Healthy emotional functioning involves utilizing a range of strategies to manage emotions. Distraction is one of many forms of emotion regulation that is adaptive to use. It is helpful when faced with extremely intense emotions, in instances when someone just needs to get through a situation and tolerate distress and there is nothing proactive that can be done at that moment, and in situations when people are just learning how to cope and before they are fluent in a range of strategies.
If someone is experiencing grief or loss (which may be accompanied by trauma), distraction can have the positive effects of keeping people grounded in the present rather than getting lost in grief, developing confidence in their ability to manage the intense feelings, and enabling them to titrate their emotional response so they are able to also experience and honor their feelings. In fact, a psychiatric disorder called Complicated Grief can develop if people are unable to use coping skills with an orientation toward managing the loss and instead maintain a single-minded focus on the loss and nonacceptance of the loss. Complicated Grief can lead to dangerous habits like creating shrines to the person they lost and an unwillingness to live in the present and move forward. In most extreme circumstances, Complicated Grief can lead to feelings of wanting to reunite with their loved one and can result in suicide.
The bottom line is that it is healthiest to respond to difficult situations like loss with cognitive and emotional flexibility and a willingness to use coping skills to manage intense emotions so that people do not either completely block their emotional response or get consumed by it. Seeing a licensed therapist after a loss can be extremely helpful, as therapy can aid in the development of a range of coping skills.