Why am I STILL afraid? Some thoughts on what recovery from chronic anxiety looks like

I provide psychotherapy for many with chronic and debilitating anxiety. Anxiety is the most common malady in the world and comes in all sizes and shapes: panic, phobias, OCD, GAD, social anxiety, PTSD and more. For some it is very context driven (e.g., fear of flying) and for others it is constant and wide-ranging (e.g., OCD, PTSD).

Frequently, when a person comes to therapy, their first and enduring question is, “Can you make this go away? I just need it to stop.” They have struggled for a long time and have tried many things. Some have tried medications, others tried to limit exposure and avoid situations that would trigger the anxiety, and almost everyone has tried to talk (aka berate) themselves out of their feelings. “If I really trusted God this would not be happening!”

This desire to extinguish anxiety is completely understandable. Anxiety is horrible, consuming, and exhausting! We want it to go away and never come back. But–and this may seem absolutely disappointing to many—having the goal of zero anxiety is actually detrimental to a positive outcome and recovery.

Let’s explore what therapy is/does and why changing your relationship to anxiety is a better goal than trying to extinguish it.

What does therapy for anxiety look like?

Therapy for anxiety (at least what I practice) tends to have these common features¹:

• Compassion, understanding and curiosity about the physiology of anxiety
• Experimentation on what short-circuits anxiety and identifying what intensifies the sensations
• Practice relaxation/mindfulness/distraction with increasing exposure to feared stimuli
• Exploring experiences/beliefs/values that may contribute to ongoing anxiety (e.g., a part is burdened with shame, perfectionism, assumptions of failure, etc.)

Notice the flow and trajectory. Compassion…Understand…Experiment…Practice…Examine (held beliefs). The flow isn’t really linear but it is hard to examine underlying beliefs or childhood experiences when you are in the middle of a panic attack.

Sessions early on look like understanding what is happening in our bodies when we are anxious. As we progress, we explore successes and challenges. We notice things that helped a little, or things that may have intensified anxiety. For example, having a friend try to convince you that your worries are unfounded may feel good at first but then leave you feeling more shame and more helpless. Or, maybe listening to a great podcast on the way to work reduces anxiety by a good 30 percent. This is, in essence, somatic psychotherapy.

The goal: PIVOT

When I am afraid, I put my trust in you. Ps 56:3

Notice the verse above says, “when.” Not if. When. We will be afraid, maybe often. And when that happens, we will do something. But what? How? In practical terms, we pivot.

What is pivoting and why do we do it? Pivoting is moving our mind/body/attention away from the cascade of fears. Instead of trying to dialogue with anxiety, we pivot away. Why do we pivot? We do so because anxiety is a TERRIBLE and completely unfair and unreasonable discussion partner. And since anxiety intrudes without your permission, you are not obligated to talk with it nor accept it as if anxiety is you.

Here is how it might work for me once I have recognized that what is happening is that my mind and body are locking onto an intrusive fear. I name the fear, then I pivot my mind by looking intently at the Ansel Adams photograph of El Capitan next to me. I describe the shadows and features I see. Or, I pivot my body by getting up and feeling the sensation of walking. I may pivot to my senses by smelling my coffee and taking a deep breath in and out. I do this pivot again and again in order to de-couple from the thoughts. And I actively use my body to lower felt tension. At first, this many seem about as successful as jumping off a cliff while flapping your arms. And yet, over time, your pivot will decrease your anxiety.

Notice what I do not do. I do not,

• debate the fears
• beat myself up for having fears
• assume success is the cessation of anxiety

Why does it take so much work to fight anxiety?

We have been habituated into fear. Changing the automatic response takes work. It wasn’t our choice to be afraid but now we have to find a way to pivot out of something we never wanted. It isn’t our fault but now it is something we must respond to, just like someone with a migraine didn’t choose it but now will have to discover what helps curtail one. As we practice our pivots we will find they become slightly easier and more effective, just as when you practice a sport or an art, you will notice you are becoming more skilled.

What if my goal is not extinguishing anxiety?

In short, it is building a new relationship with anxiety where you accept that it exists but does determine how you will live. You acknowledge it but do not engage it. In doing so, you accept the challenge of building a competing neurocircuit alongside the fear pathway and activating that experience on repeat. The best competing circuits have deep meaning and connections with others. Here are some examples:

1. Instead of trying to avoid making mistakes, look for mystery and experimentation
2. Instead of trying to avoid panic, lean into doing something with your body that you have not doe (advanced yoga or stretching, increased weight lifting, knitting)

I want to leave you with one thought. If you learned something new about how anxiety is expressed in your body and if you learned how to gain even a little mastery over your body’s anxiety response then you have already begun to change your relationship to fear! You are beginning to be in charge rather than feeling controlled by fear. Your success is not always winning against fear but knowing that when you are afraid, you will put your trust in God and in the body he has given you.

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¹These are common factors to all anxiety therapies though they may differ when focused on a particular kind of anxiety. In addition, I always recommend a medical evaluation to rule out other potential causes of anxiety as well as consideration of medications that may help support recovery.