Updated: Feb 16, 2020
*Disclaimer: All of the information I am sharing is knowledge I have gained through my work and professional training. If you are experiencing anxiety, you may benefit from this information, but it is best to seek out a mental health professional who can work with you personally to treat your anxiety!
Most people experience anxiety at some point in their life, some more than others. Some people experience anxiety on occasion and some people have chronic anxiety and deal with it every day. Anxiety is probably the most common issue I see in my work with clients. In exploring this topic, it is crucial to first define anxiety. Once we understand what anxiety is, we can then learn the three most common causes of anxiety, and possible solutions.
SO WHAT IS ANXIETY?
Anxiety can be defined as an emotional reaction to fear. Think about biology and evolution. When we detect danger, we are wired to have a FIGHT OR FLIGHT response. Imagine you are at the zoo and they announce over the loudspeakers that a lion escaped from his den and is on the loose- Fight or flight! The brain releases adrenaline into the blood stream. The heart speeds up. The mind races. Our palms get sweaty. The chest feels tight. There may be a sense of panic. Anxiety is an appropriate response when there is real danger present. However, most of the time there is not actually a real danger present. A person who has chronic anxiety has a habitual way of perceiving danger where there is none, or mistaking the unknown or uncertainty for real danger. The body doesn’t know the difference between a real danger and a perceived danger. So whether the danger is real or not, the body reacts with a fight or flight response.
Now before we continue, here are some helpful things to know about anxiety and treatment:
The most common response to anxiety is avoidance. However, this only worsens the anxiety. The more we push it down, the more it bubbles up. We cannot ‘think’ our way out of anxiety.
Our brains are wired in a way that they can only focus on one thing at a time. When we are focusing on an anxiety provoking thought, we will be anxious. When we are thinking about something that is calming, we will be calm.
Our thoughts, feelings and actions are connected. We can intervene to change thought (CBT) and behavior (behavioral therapy), but our feelings are usually the last to change. So be patient! And find a therapist that is competent in working with anxiety.
Cause 1: Catastrophic Thinking
Now that we have defined anxiety, let’s delve into the three most prevalent causes, and their solutions. The first cause of anxiety is catastrophic thinking, or automatically going to the “worst case scenario” in our mind. In a given situation, we create a story about what may or may not happen in the future, and act as if our worst fears are actually going to occur. We then become anxious about the story we are telling ourselves, rather than the actual facts. This form of thinking usually starts with “what if…” For example, a young woman has been suffering from severe headaches for the past few weeks and sets up a doctor appointment. As the appointment approaches, she gets increasingly anxious… “What if they do tests and discover I have a brain tumor? What if I have cancer!” She goes on to picture the appointment, the brain scan, receiving the news… and her anxiety worsens. However, all she really KNOWS is that she has been having headaches. She is creating a story in her mind about the worst-case scenario (catastrophic thinking), and the result is anxiety. She has been increasingly stressed at work, her husband has been traveling a lot for his job, and her toddler is having the terrible 2s. There are many reasons why she could be having headaches, yet her mind goes to the worst possible outcome, which has no supporting evidence at the moment. Another example is a couple- one doesn’t text back right away and the other assumes their partner is cheating. Or we have a bad day at work and assume we will be fired. Again, we take the current circumstances and create a story with a catastrophic outcome, and act as if that story were true. The anxiety is in reaction to the story we create in our minds, rather than the facts and current reality in the here and now.
Solution 1: What Do I Know NOW?
So what is the solution to catastrophic thoughts? It can be so automatic that we don’t even necessarily realize that we are doing it! We have to engage in some mindfulness. We have to differentiate between the facts and the story we are creating. What is true right now? What do I know right now? We must disengage from the story, and realize that it is just our imagination running wild. It is not real.
I know, I know… you may say, “But it COULD happen…” But anything COULD happen. We have to be with what is real right now. So the next time you find yourself freaking out over something that may or may not even occur, bring yourself to the present moment. Disengage from the story you created and focus on the facts you know to be true right now.
There are also some other solutions to worst-case scenario thinking. If you are able to write down the catastrophic thoughts, you can then rate on a scale from 0-100 how likely you believe that the imagined outcome will occur. Has anything like that ever happened in the past? If the worst-case scenario did actually come to pass, what would it be like? How would you cope? What resources do you have to draw on- friends and family, skills and abilities? Sometimes leaning into the anxiety a bit, and thinking about it realistically makes the imagined worst-case scenario feel less scary and more manageable. You can also imagine what you would say to a friend worrying about such a thing, or what a friend would say to you, and turn that inward and say it to yourself.
Cause 2: Control
Another cause for anxiety is issues around control. People who have chronic anxiety may OVER-FOCUS on what is NOT in their control, and UNDER-FOCUS on what IS in their control.
Things that are NOT in our control:
Someone else’s thoughts, feelings and actions
Events of nature such as illness and natural disasters
Our flight being delayed or cancelled
Individuals who struggle with this issue have an underlying feeling of not being okay or safe. Often times individuals who struggle with anxiety related to control are highly functioning and capable people who just don’t trust themselves. You may have heard the term “control freak,” but the idea is that “if I can control it,” or “If I know what will happen,” then “I will be okay.” A person with anxiety due to control may try to plan for every possible outcome so that they feel safe and prepared, or try to prevent a possible worst-case scenario (see previous information on catastrophic thinking) from occurring. They may spend hours and hours researching and planning. This person is putting TONS of pressure on themselves, and taking on the burden of responsibility for things that are out of their control
Solution 2: Refocus, Trust, Internalize
In order to treat issues around this type of anxiety, a person must differentiate between that which is IN their control and that which is OUT of their control. Try to accept and disengage from that which is NOT in your control and attend to what IS in your control. And remember, accepting is not the same thing as liking. You don’t have to like if something is out of your control, but you have to accept it. If is in NOT in your control, there is no point in spinning your wheels about it. If it IS in your control, you can actually do something and have some agency.
Like I said previously, often times individuals who struggle with anxiety related to control are highly functioning and capable people who just don’t trust themselves. So it is imperative to cultivate a trust in oneself. We externalize reasons why we will be okay: “If I plan for the worst, I will be okay,” or “If I work double I will be prepared.” Instead, we must internalize reasons why we will be okay: “I am resourceful, so I will be okay,” or “I have a good support system I can call upon if something goes wrong and I need help.” The things that we plan for are almost never the things that go wrong. Other things may go wrong, but we have to develop a trust in ourselves that we will handle whatever the situation is in the moment as things come up. “I will figure it out when the times comes and I will be okay. I have the resources (both internal and external) to handle it.”
Sometimes, individuals who have experienced trauma especially struggle with issues of control. Because their world has felt chaotic, and frankly was very out of their control in the past, they overcompensate and attempt to control their environment. It is good to recognize where the need for control comes from, but to also understand that it is still not helpful. Obviously issues involving trauma are more complicated and deserve special attention and acknowledgment that is out of the scope of this discussion.
To summarize, when we focus on what is in our control and develop a sense of trust in ourselves to handle difficulties when they arise, then we will feel less of a need to plan and prepare for every possible scenario to control our environment. As a result our anxiety will lessen.
Cause 3: Distorted Beliefs
The final cause of anxiety is distorted beliefs. I believe that distorted beliefs are also at the root of many cases of depression. A distorted belief is something that an individual believes to be true and accurate, but is actually NOT true and NOT accurate. Imagine looking into a fun house mirror and believing that what you see in the reflection is what you actually look like. Usually there are one or two distorted beliefs that get triggered in a variety of situations, and are usually unconscious. Typically, distorted beliefs that cause anxiety are about how we view ourselves and the world around us: “I’m unlovable,” or “I am not good enough.” We engage in cognitive distortions to maintain our distorted beliefs about ourselves. The more an individual is attached to the distorted belief, the more creative and sophisticated their cognitive distortions are.
Our beliefs effect our actions, and in turn our feelings. If I believe I am unlovable, I will be much less likely to pursue new relationships. In turn, I will feel more isolated, and have lower self esteem. However, if I believe that I AM lovable and capable of maintaining meaningful relationships, I will be more likely to reach out to others, be less isolated, and feel better about myself as a result.
Here are a couple examples of cognitive distortions (taken from the following link: https://psychcentral.com/lib/15-common-cognitive-distortions/) :
Overgeneralizing: “That date went horribly. I will never find someone.”
All or nothing thinking: “I am always late.” “I never do anything right!”
Labeling: “I made a mistake, therefore I am a failure.”
Magical thinking:“Everything will get better when I get a raise.” “All my problems will be solved when I lose 20 lbs.”
Over personalizing: You take things personal, assuming what others say or do is in reaction to you. “My husband is complaining that the house is a mess. This must be because I didn’t get a chance to clean today.”
Shoulds: “I never should have….” “If only I….”
Negativity Bias: You notice all the negatives, but fail to notice the positives. “Everything is so horrible. I am in between jobs. My car payment is late. I need to loose weight.”
Double standard: You hold yourself to a higher standard than everyone else. “I think if my friend gets a B that is a perfectly acceptable grade, but I expect myself to get As.”
Blaming/Denying: You blame others for your problems or you blame yourself when it wasn’t your fault.
Emotional Reasoning: You act as if your feelings are reality. “I feel guilty for saying ‘no’ so it must have been the wrong thing to do.”
Here is an example how a cognitive distortion serves to maintain a distorted belief:
Distorted Belief: I am unlovable.
Cognitive Distortion: I haven’t been on a date in a month, since the last guy I went out with ghosted me. Surely nobody wants to be with me.
In this example, the disordered belief is “I am unlovable.” This is a negative belief about oneself.
The cognitive distortion is overgeneralizing by thinking that just because you haven’t been on a date in a month, nobody will ever want to be with you. The cognitive distortion is acting in such a way that it supports and reinforces your belief about yourself that you are unlovable.
Solution 3: Replace With A NEW Belief
There is no quick solution to correct distorted beliefs and negative thought patterns. This takes WORK! That is why it is so important to find a competent therapist to help you through it. And this is really where CBT comes in. The idea is that our thoughts, emotions and behavior are all connected. If we can change the way we think/believe, we can change our behavior, and how we feel about ourselves in turn. CBT works to identify and examine distorted beliefs and the cognitive distortions that maintain these beliefs. The CBT therapist then helps the client to replace the distorted beliefs with a more reasonable, positive, and ACCURATE thought pattern to operate from. It helps the client to step away from the fun house mirror, and step in front of a more realistic reflection.
It is also important to notice all the places that these negative beliefs are triggered and operating under the surface in order to plug in the corrected belief whenever the negative belief comes up. The client must open up to the possibility that what they believe is not true, and that something else is true. You are not necessarily looking for the opposite of the distorted belief or thought; rather something that is accurate and something that will better serve you. For example, rather than thinking/believing: “I am not likable,” you can say, “I may not be for everyone, but generally wherever I go people like me and I get along with others.” On multiple-choice tests, we are told to first eliminate any possible answers that begin with the words “all” or “nothing.” So too, most extreme thoughts we have in real life are not accurate.
Insight also plays a role in this work (this would be more of a psychodynamic model than CBT). This involves understanding where these distorted beliefs come from. Why do I believe so little in myself? When did I start feeling this way? What caused it? This enables one to realize that maybe this way of thinking was once adaptive in helping to cope, but is no longer serving a useful purpose.
Here is a link to more information on CBT, and on Aaron Beck and David Burns, who are leading psychologists in the field. I highly recommend David Burn’s book, “Feeling Good.” The link also includes some awesome CBT exercises.
Now that we have discussed the main causes of anxiety and how to treat them, lets talk about how to manage symptoms of anxiety day to day as they arise. Most of what we discussed previously is work that is done overtime to change the way we think and operate. But how do I handle my feelings of anxiety NOW!? …. Relaxation techniques, breathing techniques, and meditation! By managing symptoms as they occur, you turn down the intensity of the emotion so that you can do the deeper work of treating the root causes. Some breathing techniques include diaphragmatic breathing, inhale for 4-hold for 7-exhale for 8. Apps such as head space, insight timer, and calm are great for providing some practice in mindfulness meditation. In general, just bringing yourself to the present. Like I mentioned earlier, if our mind is occupied with a calming thought it will be calm. If it is occupied with an anxious thought, it will be anxious. So focusing on your breath, on the feeling of the floor beneath your feet, on the smells in the air, on the details of the painting on the wall… will bring you to the present moment and distract you from the anxious feelings.
The article above includes information from my personal knowledge and experience, and from a professional training by Noelle McWard of Chicago Counseling Solutions. You can find a handy outline of the three main causes of anxiety and their antidotes at