Category Archives: Anxiety

June 17, 2024 · 5:52 am

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.

_____

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.

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October 13, 2017 · 10:37 am

What if we view anxiety as what it means to be human?


Do you often feel guilty that you struggle with anxiety? Do you beat yourself up afterwards? When you hear, “Be anxious for nothing but in everything and with thanksgiving present your requests to God” (Phil 4:6-7) do you feel more burdened knowing that you are often anxious and filled with worry?

Indeed the Scriptures speak very frequently about our anxieties and worries. Might it be that it is a human experience (this side of the Fall) that will not be removed? If you worried less about your worries; if you felt less shame and guilt for them, how might that change how you respond to your worries?

Discuss!

I leave you with this thought as you ponder your way of responding to your worry. Psalm 56:3 says, When I am afraid I put my trust in you. It doesn’t say that such trust erases fear. You can be afraid and be full of anxiety and trust God in the middle of that experience. One does not necessarily invalidate the other.

 

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October 18, 2016 · 11:15 am

Does trusting God remove anxiety?


Over the years of doing therapy with Christians I have noticed how many feel guilty for their anxieties. “If only I could trust God more…I say I believe he is good but clearly I don’t trust him because I can’t stop being anxious.” Still others express distress that their faith in God does not change their feelings of hurt over past relational wounds and fears it will never get better.

It seems we believe this maxim: If I really trust in God, I will be at peace. I will not struggle with the brokenness around me or with the unknown future.

Is this true? Is it possible to trust God fully and experience chronic negative emotion?

Let me suggest a better maxim and then illustrate it with a couple of Psalms.

Because I trust God completely, I bring him my angst again and again.

At the recent #CCEF16 conference on emotions, David Powlison referred to Psalm 62:8a, Trust in him at all times, O people; He noted that this assertion is strong. But what does it look like in action? David pointed us to the next line (8b) Pour out your hearts to him, for God is our refuge. Trusting God looks a lot like venting, crying out in our confusion, sharing our fears and despairs.

Take a closer look at this Psalm. The writer is under assault by others. He likens himself to being a tottering fence, something easily knocked over. He is asking his enemies, “how long are you going to harm me?” He knows their intent. But their evil is the worst sort, one that pretends to be good but is really evil. They take delight in lies. With their mouths they bless, but in their hearts they curse. It is likely the psalmist could say, “with friends like this, who needs enemies?”

So, how does he talk to himself? Look at the cyclical pattern: reminder-pain-reminder-warning-reminder

  1. He starts with some truth. My only rest (or silence/peace) is in you God. You alone are my fortress. I will never [ultimately] be shaken.
  2. He laments. But you enemies are trying your best to destroy me, a weak, tottering fence.
  3. He reminds himself. Remember, look for rest and peace in God alone, it is only there you can find it, even when the ground is shaking
  4. He warns self and others. Don’t trust in your position, don’t trust in ill-gotten gain. And if God blesses you, don’t trust in the blessing
  5. He cycles back to truth. Remember this one thing: God you are strong AND loving. You will remain righteous in your dealings with us.

While the Psalm ends, I suspect the writer could easily have kept the pattern going, as in starting again with the first verse or adding more to the pattern.

This pattern of truth, honest admission of pain, reminder of truth is a far better picture of the reality of life hidden in Christ than the false stoic (or Zen) image of being unperturbed by the chaos in and around us. God does not remove us from the storm. Instead, we express our trust (as much to remind ourselves as in bold assertion), we lament, we groan, we pour out our troubles and we circle back to the one truth we can hang our hope on.

You can see this pattern also in Psalm 42 and 43 with slight variations: Remember when I used to be out in front leading the worship but now my tears are my only food. Why am I like this? I hope in God. But I am downcast. Day and night God is loving…but it seems you have forgotten me in my oppression? Vindicate me. You are my stronghold so why is this not getting better? Free me so I can worship you…yet I am still in despair even as I hope in you.

If you feel guilty much of the time when thinking about your level of trusting God, consider this alternative narrative: it is the greatest act of trust to keep bringing God your troubles, even when things or your response to them do not get easier.

So, does trust in God remove our anxieties? Not as much as we might think. But, if you could no longer feel guilty about your angst, might you in fact feel more peace as you trust God through the storm?

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October 5, 2016 · 10:41 am

3 negative consequences of having too many options


I prefer having choices to make over not having the option to choose how I spend my time. And yet, just like any medication you might take, the freedom to choose brings with it some potentially dangerous side effects. I’d like you to think about 3 and then consider a couple of modifications about how you make choices.

Consider the differences between choosing a mate today versus 50 years ago. According to Daniel Jones (listen at the 17 minute mark), in previous generations people chose mates from close proximity–from their block, building, or neighborhood. Now, we have endless choices if we are willing to use the Internet.  Consider the differences in choosing professions. In the past, your father was a farmer, you became a farmer. Now, not only can you pursue any career, you have to choose from endless post-secondary educational schools on your way to that career.

How can having choices/options lead to negative consequences?

  • Dissatisfied. You are always wondering if there is something better out there. Again, consider Daniel Jones as he discusses online dating sites,

“…it turns you into a flaky person who is always looking for something better, that can become a kind of mania…if you have a moment of boredom, you think there are 12 more possibilities in your inbox…”

Later in the same interview, Jones tells us that the issue of today is “not labeling relationships. Based on his college student interviews, many young people today are loathe to identify someone as their partner or lover. They tend to resist labeling someone as a boy or girlfriend. The failure to accept normal labels not only lead to potential of chronic dissatisfaction but also confusion–if you don’t know when a relationship begins, ends or what it is founded upon. It would seem that commitment to a relationship would suffer if it never is named as such.

Dissatisfaction leads to comparing self against others and both lead to depression.

  • Anxious. Coupled with the tendency towards feeling dissatisfied with life, more choices lead many to anxiety. What if I made the wrong decision? What if the next person I meet would make a better spouse? What if I’m missing out on something important? Continual choice and/or rumination over choices increases the sense of importance for the choices we have.

Anxiety leads to chronic stress and chronic stress begins to break down our immune system.

  • Fatigued (cognitive and emotional). We find ways to simplify life. A colleague of mine has a system to know what to wear each day so as to avoid the “What am I going to wear today” question. We (try to) put our keys in the same place to avoid the stress of looking for them every time we leave the house. When we live with too many open choices and options, we burn more glucose and our brains become less efficient. We numb our feelings or we become edgy.

Fatigue leads to poor decision-making (impulsive, reactive, unthinking). This is why we blow diets more at 10 pm than we do at 9 am. This is why those with addictions are more likely to use later in the day than early in the morning. When we are emotionally and cognitively fatigued, we are prone to feel greater anxiety and dissatisfaction. The “gift” of choice continues to give.

Can We Do Anything About This?

Now, rest assured that I am not advocating for life to return to a place of no choice (arranged marriage, one career path, etc.). Choice has enabled me to learn about myself and given me many wonderful experiences that as a boy growing up in Vermont I never imagined. But are there ways we can minimize the common negative consequences of too many choices?

  1. Examine your view of God’s will. I meet many people who fear making a choice God does not want them to make. They fear they will somehow end up on plan B of life as punishment from God. While there are many very black and white decisions (should I cheat on my taxes? Is it okay to kill my annoying neighbor?) most decisions are not that clear. What if most of your decisions are neither right nor wrong? Whether you go to university A or B, marry person A or B is less of concern for God than we might think. Typically God seems more interested in our motives than some of our daily choices. Consider seeing God’s will as guardrails on a road rather than a pinpoint decision.
  2. Limit your decision-making time. It can be a habit of some to mull over future decisions long before the decision needs to be made. Do you find yourself worrying about the challenges of next week? While it might seem wise to think through your decisions in a thorough way, anxious rumination is not helpful. Limit when you think about big ticket future decisions. For example, if you are considering a career change, set a specific time during the week to search out available options. Then, when you find your mind mulling over options outside that set time, you can say to yourself, “I’m going to think about that during the scheduled time, not now!” When you do make a decision, use the same technique to limit when you review/evaluate that decision, thereby limiting time for “what ifs.”
  3. Challenge post decision “if only” regrets. I made a major career decision 17 years ago. I chose to become a seminary professor over an Ivy League appointment. For the first few months at Biblical Seminary I found myself wondering if I had made the right choice. I imagine this was the result of financial struggles (the other job paid double) and the overwhelming stress of creating grad courses from scratch (the other job was something I had ample experience to do). So, I could easily see that I chose the harder job for less pay. That became the truth I believed for a bit. But, the real truth is that I chose a job that had immense freedom and opportunity for growth. I would not have been able to travel the world as I do now. Of course, I couldn’t know all that then. So, work to challenge your assumptions about the future. Yes, like me, you will grieve when doors close. But remember, God is at work in providing a future for you, even in tough locations and times.

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April 17, 2013 · 9:14 am

The “End of Worry” in a dangerous world?


In light of the recent bombing in Boston, I thought I would use today’s post as a timely book note. Will van der Hart (Anglican vicar) and Rob Waller (Psychiatrist) have written a small but helpful book entitled, The End of Worry: Why We Worry and How to Stop (2011, Howard Books). What makes this book interesting is the fact that Will freely discusses his own struggle with worry, made more evident after the 2005 bombings in his city of London. While the bombings were the final straw to panic attacks, Will also explores some of the early roots of worry in his life.

If you struggle with worry, there are several reasons why this little book might be a comfort to you.

  1. The authors write as if they know worry and fear.
  2. It is not, as they say, “triumphalistic.” Meaning, they do not believe the right beliefs/prayers/faith will automatically solve the problem
  3. Worry is portrayed not only as a spiritual problem but also explored through lenses of psychology, biology, and habit formation.
  4. It is written to the worrier, not about the worrier
  5. Each chapter gives you opportunity to engage in a few key exercises
  6. They differentiate between solvable worry and floating worry (and the tyranny of the “what ifs…”)
  7. Their solutions are practical but do not pretend to be simplistic. In fact, they devote some space to the notion that you should “stop trying not to worry.” Sound radical?
  8. A number of their solutions are helpful for those who ruminate (OCD, scrupulosity)

The book sits firmly in the cognitive behavioral model of intervention. Therefore, much of it encourages readers to explore belief systems about self and world and to begin challenging faulty thinking and to work to replace with more appropriate cognitions, meditations, and self-talk. CBT is not the only therapeutic model but offers anxious people something to do.

If you would like to work through a book that describes the process of worry and perfectionism and then gives you some ideas to examine and change your own struggle, this might be the book for you.

*I received a free copy of this book without any obligation to write this post.

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October 1, 2012 · 3:38 pm

OCD or pathological grooming?


On the way to work this morning, I listened to a story on NPR’s Morning Edition about “pathological grooming.” Never heard of this disorder? It’s called biting your fingernails…or other similar things (hair pulling, face picking, nose wiping, etc.). Apparently, the forthcoming DSM 5 will lump it into an OCD diagnosis.

Here’s a couple of interesting tidbits from the 8 minute show.

  • Those with OCD tend to have more of a conscious awareness of unwanted repetitious impulses while pathological groomers may be more thoughtless in their nail-biting
  • Some mice with a specific genetic variant are excessive groomers, to the point of going bald, but not everyone with the gene displays the grooming habits. Thus, genes are surely part of the problem but not all
  • Given the spectrum of OCD symptoms and mental health disorders, maybe nail-biting isn’t that important to eliminate.

So, what do you think? Do you think chronic nail-biting fit better within an anxiety disorder, an addictive disorder, a tic disorder or just merely a silly habit unrelated to any mental health category?

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September 20, 2012 · 5:07 am

The Five Minute Antidote for Anxiety


I’m an anxious person by trait. It is a common trait, especially in graduate school (in combination with narcissism. I say this also in self-disclosure; both features support successful completion of doctoral studies). Anxious people tend to spend considerable time ruminating through “What if…” questions along with should, coulda, woulda thinking. We worry about our past failures coming to light and whether we’ll be up to the challenge the future presents.

Sound pretty negative way to live? It is. The only way we differ from depressed people is that we still have some thought that our worry might save us from disaster. As you can imagine, such worry robs us of joy. It keeps us from enjoying the present or seeing God’s gracious hand on our lives. And we compound our problems by then shaming ourselves for failing to follow God’s command, “Do not be afraid.”

The Five Minute Antidote

Part of the problem with anxiety is that we are trying to control/manage every possible outcome in order to avoid future disaster(s). Fearful people know that the answer to their anxiety will not include,

  • Just not caring anymore. We’ve tried that…it doesn’t work.
  • Making sure we get it RIGHT. Tried that too. Didn’t work.

So, what might work? Try this on for size,

What is God’s plan for me for the next five minutes?

Most of us have no clue what God is planning for us next year or even next week. But, I suspect most of us can discern what we need to do right now…for the next five minutes,

  • I need to make dinner
  • I need to read this assignment for school
  • I need to attend to my child’s homework
  • I can call a friend who is grieving

We usually know the one thing we can do for the next five minutes. Do that with as much focus as you can. Here’s what you are likely to discover: your anxiety decreases, or at least does not increase. When we stop the ruminations or internal conversations, our anxieties decrease and our ability to be present increases. So, when you find yourself in an anxious stew, try to ask yourself, What is one thing I can do for the next five minutes or What does God want me to do for the next five minutes? Consider this your method of living out Psalm 131, where you are are stilled and quieted like a weaned child, content with what He has for you for the next five minutes.

Oh, did you think this will solve all your anxiety problems? No, of course not. But where God does give you something to focus your attention, call that a success. Part of the Christian life is repetition–repeated worship, repeated repentance, repeated obedience, repeated trust. So, do pray for God to remove your “thorn” but look for five minute relief. Notice when it works and then ask God for another five minute focus on the thing he has for you RIGHT NOW.

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May 21, 2012 · 5:31 am

Why we react and then think


Human brain parts during a fear amygdala hijac...

Human brain parts during a fear amygdala hijack from optical stimulus. (Photo credit: Wikipedia)

Ever wonder why? Check out this quote by Richard McNally¹ about the role of the amygdala,

LeDoux discovered two pathways for activating the amygdala, a subcortical structure integral to the experiences and expression of conditioned fear. One pathway rapidly transmits sensory input about fear stimuli to the amygdala via a subcortical route, whereas the second pathway passes through the cortex, taking twice as long to reach the amygdala. Subcortical activation of the amygdala makes it possible for a fight-or-flight reaction to begin even before information about fear-evoking stimulus has reached conscious awareness via the cortical route.” (p. 178, emphases mine)

If this is true, then in anxiety and intense emotion-producing events our brains begin the reaction phase prior to any thought processes. If true, then we might consider

  1. The goal of trauma treatment or anger management is NOT to avoid having reactions but to more quickly reach cognitions and alternative emotions that help moderate a negative reaction
  2. the empirical evidence for the clinical process whereby a client adopts a neutral reaction as opposed to a negative reaction is quite lacking. There are a number of models that process to “cool down” the amygdala, but these treatments often lack serious empirical support.

So, the next time you instantly react in a way that bothers you, don’t be so hard on yourself. Instead stop yourself, take a deep breath, work to analyze the situation and to lean into a post hoc truth. We have our hands full enough with what we know we need to do, we don’t need to worry so much about our first reaction.

¹McNally, R.J. (2003). Remembering Trauma. Cambridge, MA: Harvard University Press.

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December 19, 2011 · 1:45 pm

Stopping seasonal high anxieties: Some strategies and a better goal


For most people, anxiety is a looped internal conversation. It just keeps starting over even when we don’t want to listen to it anymore.

The Christmas season we’re in can make anyone quite anxious. (Don’t think so, watch this fun video to remind you why.) Those of us naturally anxious and ruminative find the added responsibilities, family stresses, and disappointments just adding fuel to the fire. You try to take a moment to rest but all you can do is think about what is yet to be done or what you tried to do but failed. You pray but before you finish you are back to your worries. You distract yourself but the looped fears keep running in the background.

What helps you decrease your anxieties and repetitive worries? Can you really suppress them? Or should you have another goal in mind than just trying to shut them down? Are there any practical strategies that work?

Practical Strategies?

Daniel Wegner gave a short award address on this topic at the 2011 APA convention (now found in v. 66:8 of the American Psychologist, pp 671-680). In the address he tells us what we already know. It is hard to suppress thoughts in a direct manner (e.g., I won’t think about how much work I have to do). So, Wegner focuses on indirect strategies. Here is a sample of strategies with empirical support:

  • focused distraction
    • pre-planned alternative topic to think about when the rumination starts. Benefit? Avoids mind wandering which will more quickly return to the anxiety. Example: Every time I think about the conflict at work I will focus on a comforting favorite verse or an upcoming happy occasion.
  • Stress and load avoidance
    • Overall reduction of stress helps reduce unwanted/anxious thoughts. Focused distraction helps only to a point. Overwork which may provide some distraction will increase anxious thoughts over time.
  • Thought postponement
    • Choosing to postpone anxiety to a set time can work to reduce the amount of rumination experienced.  Example: I’ll spend time worrying about my visiting in-laws at 4:30 pm.
  • Acceptance
    • Instead of fighting and arguing with fears some find it helpful to observe fears without taking action. There is some evidence that those who accept the occurrence of unwanted thoughts have less distress than those who fight the thoughts.

Wegner goes on to mention other strategies (i.e., planned exposure, mindfulness, focused breathing, self-affirmation, hypnosis, and journaling) for reducing unwanted thoughts.

 A Different Goal?

What if the goal isn’t to remove or end unwanted thoughts and anxieties but to cope with them and not to be dragged along by them? Does this sound like failure to trust God? Failure to be at peace? if the goal is to trust God in the midst of uncertainty and anxiety, what would that look like? How would you know that you were doing well? To do this we would need to give up on the goal of having an absence of anxiety and to reimagine peace as something one can have in the midst of angst. After all, we are not seeking to be absent from this world but to live in the world that is full of chaos and uncertainty.

Here are two goals you might consider:

  • Being okay with things not done to perfection and with the disappointment of others who have come to expect perfection from you
  • Experiencing anxious thoughts as normal and yet savoring moments of rest when they present themselves
  • Using one strategy for anxiety reduction each day

So, how do you measure your seasonal high anxieties and what goal do you seek to reach during this Christmas season?

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June 21, 2011 · 12:08 pm

Is being a victim a weakness?


Just read a CNN piece on whether or not we should call Huma Abedin a victim or not (Rep. Anthony Weiner’s wife). The author says we ought not to, that only she gets to decide if she is a victim. The author quotes from Laura Munson’s book (This is not the Story You Think it is) and suggests that when one decides to be happy (and to be responsible to find happiness), one stops being a victim.

Seems to me that we ought to differ between being a victim and having a victim mentality.

Huma is a victim of her husband’s behavior. When someone is harmed by the behaviors of others, that person is a victim. Now, a victim commonly has various emotional experiences associated with being helpless to stop harmful behaviors. But, being a victim is not the same thing as being helpless in all things. One may indeed be helpless to stop a car accident or infidelity. But, one is not helpless to decide what they want to do about it.

How do you respond to the word “victim?” Do you hear it as helpless? Completely unable to make choices? Devoid of happiness?

At the end of the article, the author lists several helpful responses to being subjected to harmful behaviors by others (nonviolent that is). Her recommendations are below and besides a few tweaks, I don’t disagree. However, I think she gives the impression that feeling hurt, anger, and confusion are somehow signs of weakness. They are not.

1. Wait to make big decisions

2. Focus on the present moment

3. Create something now

4. Give up on the dream (your personal myth)

5. Look for your truth

6. Choose your own feelings

7. Do not play the victim

 

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