How are anxiety disorders maintained?
- There is a distinct anxiety trigger. This could be anything (e.g. bathroom doorknob, social gathering, being called on in class or at a meeting, spider, shortness of breath, dizziness, news report on TV, etc.).
- Because there is a “phobic connection” in the brain, (remember we’re talking about how established anxiety disorders are maintained, not how they are originated) when something pushes their anxiety buttons, danger thoughts are elicited. To one’s nervous system it is very simple: This trigger = danger! The themes of these thoughts will typically center around danger to oneself or someone else, going crazy, getting ill, catastrophic public humiliation, being stuck with never ending panic, and so on.
- Most people who have such thoughts will feel very anxious if they believe or respect them, even a bit. The anxiety can range from mildly annoying to terrifying panic. Other feelings, such as sadness, helplessness, embarrassment, dread, anger, or revulsion may get triggered as well.
- The person stuck in an anxiety disorder tends to do whatever they have to in order to avoid the aversive feelings of anxiety or the potential catastrophic outcomes their thoughts promise. This consists of either fleeing or avoiding the anxiety trigger as much as possible or engaging in safety behaviors designed to prevent the catastrophic outcome in the face of the anxiety trigger. There are limitless safety behaviors that people engage in. Examples include: going certain places with a “safe” person, carrying anxiety medications, seeking repeated reassurance, washing hands repeatedly, carrying a bottle of water everywhere, staying close to one or two people instead of mingling, etc.
- The result—they survive and feel that the “catastrophe” was narrowly evaded due to their actions above. The fearful flyer feels like kissing the ground after the flight, the germaphobic person feels they fought the good fight and kept themselves and their family healthy and safe through their actions. The person who did not speak at a meeting breathes a sigh of relief that their unbearable humiliation was put off for one more day. But guess what? The danger thoughts and beliefs remain alive and well and are certain to bring on more anxiety during the next trigger. It still feels dangerous! What do you suppose would have happened had they NOT engaged in avoidance and safety behaviors? They still would have survived. The catastrophe would not have occurred! Only instead of attributing their survival to their avoidances and safety behaviors, they would have had the opportunity to learn that the phobic trigger was not truly dangerous. Once the thoughts change from “this is very dangerous” to “I may not like this, but it’ll turn out just fine” then the anxious feelings will decrease.
The way out of the anxiety disorder is to learn through repeated exposure to triggers (without engaging in avoidances and safety behaviors) that the situation may be uncomfortable but is not dangerous. There are many wonderful resources available to help with this process. See www.216.194.169.74/~anxiet14 for a list of helpful links.
Eric Goodman, Ph.D.