Of all the difficulties that I plan on writing about in this blog, this may be the most common. Thinking is what humans do. It’s who we are. But sometimes, it gets the better of us. The official name for this is Generalized Anxiety Disorder.
On a very fundamental level, we think because figuring things out improves our lives and our chances of survival. So natural selection has taken this to its pinnacle: hom*o sapiens, “humans, the thinkers.” Sometimes though, I think we should be called hom*o anxietudo…
As you can probably tell by now, I like to think about psychological problems in terms of why nature would build a system like this in the first place. Here, I think what happened was we have an anxiety system built for “situational anxiety,” (see my previous post). What nature did not anticipate, however, was imagination or what psychotherapists call “fantasy.”
All animals except for humans live in the here and now, and their minds are almost exclusively focused on what is really in front of them. If they come upon a situation that is reminiscent of another situation that caused a problem, they will experience anxiety and avoid that situation.
Unique in the world is the human ability to imagine things that are not happening. These imaginations can come along with entire scenarios, essentially an entire movie in our heads. This is very useful, if we are making an accurate prediction of something that is at least somewhat likely to happen. We can therefore do better than other animals at protecting ourselves from situations, because we can take steps to avoid things that are not yet happening.
Some people though seem to have been born with higher levels of anxiety. Some have had lives filled with trouble which has left them programmed to expect trouble, even if they are no longer in the troubled environment in which they grew up. Sometimes, there is indeed a real situation, but in an attempt to think it through, we start to fantasize about things that could happen, but aren’t at all likely to happen. We may become focused on catastrophes and worst-case scenarios.
The next step is what really causes trouble. We react with full emotion to our fantasies; with the same level of feelings as if the situation was real. Think about how we react to movies. We know they are not real, yet we find ourselves biting our nails, sitting on the edges of our seats, crying, or cheering.
As problems solvers, we try to think of solutions for these imaginary scenarios. Thinking about it though, often only creates more anxiety, not solutions. This then drives more anxious fantasies which make us more anxious, setting in motion a vicious cycle that can go on for days, or longer; maybe a lifetime.
Sadly, ironically, most of the things that we worry about never come to pass. And the things that do happen, are often not the ones we worried about in the first place. “No battle plan survives engagement with the enemy.” Or, in a quote often misattributed to Mark Twain, “I have lived a terrible life… most of which has never happened.”
So what can be done? There is a kind of psychotherapy known as cognitive behavioral therapy or CBT. It specifically asks people to pay attention to what they are thinking and what they are saying to themselves. It then helps them examine these thoughts, look for any evidence that they are accurate or inaccurate, and learn to recognize the kinds of characteristic “cognitive errors” that they make. They are then helped to come up with alternative narratives to say to themselves that are not merely “happy talk”, but legitimately better ways to think about it.
Mindfulness is another important approach. This is an idea that is expressed in sayings like “don’t forget to smell the roses” and also in Eastern philosophy, yoga, and meditation. The basic idea is to refocus your thoughts away from worrying about the future or regretting the past and to focus on the here and now. Think only about what you are doing right now. If you are not doing anything, focus on your surroundings. Yoga breathing is a related technique. Here you take deep breaths that start in your belly and work their way up to the tip of your shoulders. While you are doing this, you try to think only of the breath. You cannot order your mind to be blank, but you can focus on something simple and repetitive like breathing. Meditation is essentially doing this for longer periods of time, but often just ten slow, deep breaths will do a lot to calm anxiety.
In addition, medications originally designed for depression, the SSRIs (Prozac, Paxil, Zoloft, Lexapro, Effexor, Cymbalta, and others), are also capable of lowering the underlying level of anxiety which takes a lot of steam out of this phenomenon. These medications are preventative, but they must be taken every day in order to be effective. As with any medication, they can have side effects which are fortunately mild and infrequent, but include things like drowsiness, headaches, stomach upset and sexual dysfunction.
The medications that seem to be most often prescribed, are also in my opinion, the most problematic. The benzodiazepines (Ativan, Xanax, Klonopin, Valium) are all addictive. If you give an addictive drug to a person with a chronic condition, it does not take a rocket scientist to predict that this will end in tolerance to the medication’s effects, and addiction. Furthermore, unless you want to be constantly under the influence of these drugs, which share many characteristics with alcohol, you’ll only take them after you’ve already become anxious. That is why we generally prefer the SSRIs, because they are preventative.
Clearly there is a role for “as needed,” nonaddictive alternatives to these medications, and there are some, including hydroxyzine, Neurontin, BuSpar, and extremely low doses of “antipsychotics.” The effectiveness of these is variable, but if they work, you have a sustainable, nonaddictive solution.
While we may never completely free ourselves from worry, we can certainly do a lot to control it.
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