Generalized Anxiety (Part 1)

It is important to remember that, no matter how uncomfortable it may be sometimes, anxiety is a vital part of everyday life, implanted as it were by evolution to get our attention in the face of potential threats of all kinds. We wouldn't want to be without it, and at manageable levels, it is a huge asset with everyday tasks, preparing and sharpening our focus and attention.

It has also been my experience that people with anxiety are often sensitive, thoughtful, creative and empathetic of others. It is useful in this context to remember Jung's definition of an introvert (he invented the term): not someone who is necessarily socially anxious, but someone who particularly appreciates the inner life, of art, reading, ideas, nature. It is not better or worse then being an extrovert, just different.

Anxiety only becomes a problem when it regularly exceeds its function, when we are up all night tossing and turning, and find ourselves tense, unable to relax and our thinking appears out of control, and the worry possibly even dangerous to us. This is not true, anxiety in general is a natural function for which we are designed, but it can certainly seem that way.

There are many reasons why we might get to this point, including the complexity and stress of modern life, but in this blog post I will focus on two of four personality traits, below, that can cause and maintain this uncomfortable edge in life, regardless sometimes of how relatively well things seem to be going for us in the external world, In this discussion, my sources are the mental health bible, the DSM V, and the invaluable chapter in Dr. Bourne's book (linked elsewhere on the site), which I recommend to everyone who wants to learn more about anxiety, and how best to deal with it.

1. Perfectionism

2. Desire for control

3. Being out of touch with one's experience of stress

4. Need for approval from others

   
   

Perfectionism

We could arguably call perfectionism a Grandfather (or Grandmother) of generalized anxiety, (defined in the DSM as "excessive, persistent, and hard-to-control worry about everyday things"). Perfectionism is tricky because of course we all want to do well, and have high standards, and we live in a competitive, individualistic culture that can sometimes seem to value only achievement and the external signs of success, such as wealth, looks, and so on. In this sense, everyday life is a more or less ongoing opportunity to be triggered by work and relationships, as we compare ourselves with others, and particularly with our own idea of how we should be performing.

We are not saying that it is a bad thing to do well, or make money, only that if we are endlessly looking to get our sense of personal worth and validation from outside ourselves, we are setting ourselves up for uncertainty and anxiety, the behavior of others being more or less outside of our control. And it is a simple step to begin to look outside ourselves in drugs, alcohol and compulsions to fill up what we feel is missing inside.

We can see this played out close to home too, when our teen-aged children and young adults are comparing themselves to others on social media, people who, naturally, are posting their most appealing pictures day in and day out. Seeing where we belong in the group is a natural human characteristic, but if we are getting our whole sense of personal identity from outside ourselves, it is difficult not to be a bit worried about what's going to happen next! We can also see how this trait can easily shade into social anxiety, the fear of negative evaluation.

We can recognize perfectionism with the hallmark words "I should" "have to" "must." Moreover these exhortations to oneself usually carry a more or less punitive flavor, they are not couched as a helpful suggestion, they carry a sense of menace , that if you don't do better you're a pretty unworthy person, and at worst, might be punished in some way. It is the source of the sense of dread many of us are familiar with.

This voice is hard to single out and dispute because usually we believe it, we sincerely think we are falling seriously short, and need to do what we're told, or else...This latter phrasing gives us a clue to where this voice came from, our parents. Freud conceptualized this part of ourselves as the superego, the core of our conscience, and described it as the way in which children are socialized into the norms of their society, though the medium of their parents.

In this sense it is an absolutely normal and desirable part of human development, its just that some of us for various reasons develop a stronger inner critic than others, which becomes the problem in itself, and as we can't escape it, we may turn to self-medication of one sort or other.

The key to addressing the inner critic, the gatekeeper of perfectionism, is to recognize it. Instead of automatically going with it - and feeling increasingly powerless and hopeless as we realize we can't live up to an endless list of demands and defects - we can see that the inner critic is a part of our history; not the truth, or indisputable voice of authority, God even (for those with a religious upbringing) but more like an internalized parent. It would have been necessary and unavoidable to listen to our parents as they guided us (more or less skillfully) as we grew up, but we can now start to ask ourselves, do I still need to believe and follow this voice?

Becoming aware of and recognizing the inner critic is absolutely key. The moment we do so, there can be a shift, even if only briefly. We are looking at the thoughts, the flow of words, rather then from them, entangled in them. It is the difference between saying to yourself "I'm a loser" and saying "I'm having the thought that I'm a loser." Try it now. This is not about avoiding or denying the thoughts, only responding to them differently, the one area where we do have a choice, once the inner critic has been triggered.

The approach to these negative thoughts that I am suggesting is called defusion. With practice we can learn to notice the thoughts as they arise, and then, instead of getting hooked by them, we allow them to come and go, realizing we don't have to do anything about them, they're just thoughts that arise and disappear endlessly throughout the day, not some solid truths. Yes, some thoughts are useful and need to be listened to in furtherance of our values and goals in life, but a significant amount of our thoughts do not fall into this category, they are automatic patterns from way back, and we can even notice when they arise that they feel old, that this is not a new thought.

Actually there's not much we can do about them as they happily flow along like the ticker tape in Times Square, but the good news is that we don't need to try to control them, which is a good segue into the personality trait of control.

Desire for Control

By this, we mean the excessive desire for control of our inner life as well as external circumstances. And it is useful to remember that what appears to be the desire for control over a certain outcome in the world, or over a person, can in fact be an attempt at inner control i.e. not to feel something, or to feel better.

By way of example, consider the phenomena of agoraphobia, the fear of open spaces (literally the marketplace). In recent years, this phobia has increasingly been understood as the fear of having a panic attack in places from where it would be difficult to escape, such as bridges, tunnels, high places. The fear can become so severe that a person may refuse to leave their house and become housebound.

These are somewhat extreme, though not uncommon, examples of attempts to control one's life. In this case, the external control, not leaving the house, is in furtherance of inner control, not having a panic attack. The point is that the desire for control can limit one's life, sometimes quite dramatically.

If you're wondering how to identify a less dramatic but more ubiquitous sense of control, a good way is to consider what happens when your routine is disrupted, or your taxi is delayed on the way to the airport, the sense of being thwarted. We all rely on our routines to provide a sense of predictability and safety in an uncertain world, and this motive may not be readily apparent until things don't go as planned.

What might we feel then? A sense of unsettledness, our calm has been interrupted, or depending on the situation, stronger fear or anxiety as uncertainty grows. This helps show us one of the functions of the routine, to emotionally regulate us and keep these feelings at bay. This is not necessarily a bad thing, I for one enjoy my routine, but an excess of desire for control can backfire on us.

A common example for most of us is what has come to be called codependency, being overly concerned and feeling responsible for the state of mind of a loved one. Sometimes there is a very good reason, such as an active addiction, and legitimate worry about their well being. The problem is that we can see how feeling personally responsible for another, especially an adult, is likely to be a source of uncertainty and anxiety. With addiction in particular, the cliche that the person needs to want to do something about their condition is in fact absolutely correct. This is not to say that we shouldn't try to help, organizing an intervention, for example, but the attempt to control the other is doomed to fail if they do not wish to take action, which then becomes a great source of anxiety and frustration if we continue to believe its up to us to fix the person.

How do we deal with this if we recognize it? As mentioned above, one of the techniques is defusion, another is acceptance, and broadly speaking we defuse from thoughts,and accept feelings. The basic defusion technique is mindfulness, simply observing what is arising without judgement, as it is often the judgement that makes things appear worse than they actually might be. Watch your thoughts, notice what you are saying to yourself, and notice further that when you are observing, rather than being caught up in them, it can feel less overwhelming, you are less identified with the thoughts. This is a gradual process, and meditation can help with this.

Acceptance is pretty much what it sounds like: if a feeling emerges we don't like, we'll likely know very quickly, specially if we're being mindful. It is not just allowing the experience, but as with thoughts, we are doing our best not to judge, "I hate this feeling," "why does this keep happening," "it isn't fair," and so on. Acceptance of emotion and feelings does not mean approval, it simply means that as with thoughts we're allowing what is arising to arise as it is, and come and go on its own without interfering. Again, this is a practice, and it is best to start with smaller and more manageable feelings, and work our way up to more difficult feelings like traumatic memories, which are best faced with someone we trust and who can support us.

Above all, I have found that the desire for control is closely correlated with a lack of trust in life. We just don't think things will work out if we don't step in and do it ourselves. The trick, as the serenity prayer tells us, is the wisdom to know the difference between what we can and cannot change. In any event, I believe that the deepest solution to anxiety and uncertainty, in the existential sense, is a spiritual one. We can talk about increasing our faith or trust, and I think the key is to move away from an egocentric way of being, vulnerable and separate, fending for oneself, to more of a connection with something deeper.

There are many ways to move in this direction, but in general, some form of spiritual path is recommended: "a Higher Power as you understand it" can be a more lasting resolution of these human vulnerabilities and losses, that will sooner or later affect us all.

I have written elsewhere on this site about the benefits of meditation, and that is one way; and there are naturally many others, from attending church to following the 12 step framework, or a mixture. The important element is being drawn to something, which one can then try out, and practice for a while, to see how it works.