Why am I not making progress? Anxiety Disorder Trouble-Shooting Guide
Let’s assume that at this point you have done the following:
- Correctly identified which anxiety disorder (or OCD) you are currently living with
- You have learned about anxiety disorders or OCD and know what makes yours worse and what can make it better
- You’ve correctly identified your avoidances and safety behaviors
- You have been practicing skills pertaining to coping and thriving with anxiety feelings and thoughts
- You have faced your fears repeatedly, without engaging in safety behaviors
…AND you are still not making progress towards freedom from anxiety’s control.
Interfering problem that needs attention first (addiction, mental health, physical health)
It’s not easy to face fears under the best of circumstances. When you are dealing with addictions or another serious mental or physical health problem or an unrelated crisis, facing your fears may need to be put on hold while you deal with the challenges at hand. Once the interfering situation has been resolved then you can jump back into facing your fears less burdened.
It might be that you need to engage in strategic problem-solving in order to come up with a solution to a specific problem (For example, I’d like to date, but I am broke).
Unrealistic treatment goals
If your goal involves:
- Complete freedom from anxiety
- No stress in life
- Unrealistic career ambitions (Director of FBI??)
- Unlimited riches
…it might be that your goals are unrealistic.
Not sure what your goals should be so you don’t know which direction to move in
When in doubt, look to your core values system—what is it that is truly important to you?
Needing specific skill to achieve goal
Perhaps you need to learn and practice either particular social skill or vocational skills in order to move forward with your anxiety goals.
It could be that you are doing exposure therapy, but somehow fighting the anxiety that it brings up. Remember, one of the goals might be to build up your anxiety-tolerance muscles so opening up to the emotion rather than running away from it is key.
Continued safety behaviors
If you are still engaging in safety behaviors, even quiet ones in your head, you may stay stuck. For example, you “expose” yourself to the anxiety of a party, but you stick close to one or two comfort-people. Or perhaps you have OCD and face your fear by touching yucky things, but find excuses to wash your hands even more often.
Not high-enough “dosage” of treatment
Typically ERP works best when you hit it and hit it hard. This means devoting significant time and energy to facing your fears frequently and consistently. If you are only putting in a little bit of time here and there, you may not make the kind of progress you would like.
Sometimes it takes working with a specialist in outpatient anxiety treatment. Other times, however, one might have such a severe anxiety disorder or case of OCD that they may need intensive treatment at an Intensive Outpatient Program (IOP) or even a residential specialty treatment center.
Perfectionism (or all-or-nothing thinking)
You might fall for the following trap: “Either I give ERP everything I’ve got or I’ll just sit this one out.” Perfectionism leads to procrastination.
Sometimes, people will turn good ERP into a compulsion, “I better do my ERP and do it right or I won’t be able to handle my anxiety!!!” Remember the important goals of building your anxiety and uncertainty tolerance muscles.
You are trying to make changes because someone else is pushing you to do so
Many of us don’t do so well when someone is pressuring us. Go back to the section on “motivation” and see if you can increase your internal sense of motivation—do it for you and your life!
If you are still stuck, my recommendation is to work with an anxiety disorder and/or OCD specialist near you. Check out the Anxiety and Depression Association of America (www.ADAA.org) and the International Obsessive-Compulsive Disorder Foundation (https://iocdf.org/) for lists of clinicians.