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.