When people experience long term problems with anxiety it is common to feel hopeless. By the time someone considers therapy, they have usually been struggling with anxiety for months, often years. During that time they have certainly tried many, many ways to find relief, control their feelings, or solve their problems. And most likely nothing has really worked.
So feeling hopeless in the face of such a situation is to be expected. It’s not unusual to feel like something is deeply wrong with you, that there is something that can’t be fixed, or that there is no way out of your situation. Despite this, I feel considerable hope when treating anxiety, and that is because of the way anxiety works.
To understand how anxiety works, we need to understand what purpose anxiety serves. Anxiety is a normal part of being alive. We can’t completely get rid of anxiety, and in fact we would not want to. That is because anxiety is our brain’s way of telling us when we should avoid something. If we never felt anxiety we would probably make a mess of our lives and die young by doing something stupid or risky!
However, our brains aren’t perfect. Sometimes we feel anxiety about things that aren’t actually dangerous, or we feel anxiety that is out of proportion to the actual risk. When we experience an anxiety problem, it’s because we continue to obey that signal to avoid, and that pattern of avoidance is the actual problem.
This is because when we avoid something because we feel anxious, we do get some short term relief. At the same time, that avoidance keeps us anxious about what we avoid. Here’s an example. Most small children go through a time when they are afraid of the dark. They avoid the dark by sleeping with a nightlight, calling for their parents (who come and turn on the light), hiding their head under the covers so they don’t “see” the dark, and so on. In this way they gain some short term relief from the fear of the dark. It gets them through the night, but they still are scared of the dark overall.
At some point they begin to leave these avoidance behaviors behind. They stop using the nightlight, they stop calling their parents (or their parents make them stop), they begin to peek outside the covers. They have to be willing to feel at least a little scared in order to change. Maybe they are willing because they are curious, or they want to feel more grown up, or they’re just tired of being scared! So they stop avoiding, and maybe in the short term they feel more scared, but in the long term they learn that the dark is nothing to be afraid of.
This demonstrates an important principle about how anxiety works. Avoidance of anxiety gives short term relief, but it keeps anxiety the same, or makes it worse. The inverse is also true. Not avoiding anxiety produces more anxiety in the short term, but it results in less anxiety over time. This is where the hope comes from! If we reverse the process, we can dismantle the whole system that is keeping anxiety around, even anxiety that has been around for years.
This is the principle behind exposure therapy. Exposure therapy is the method of systematically reducing how much you avoid things that make you anxious, and instead confronting them on purpose. Over time, this lets you learn that the things that were making you anxious are not as dangerous or as risky as your brain was making them, and you feel less anxiety as a result.
We often do this naturally all the time. Children learn to stop being afraid of the dark. We overcome a fear of falling when we learn to ride a bike. We confront a fear of drowning when we learn to swim. We approach a fear of failure when we pursue education, or take on a new job, or an important project. So this is nothing new, but anxiety problems persist because we get stuck in patterns of avoidance that keep anxiety around.
Now, there is an important caveat. Not all sources of anxiety can be addressed in this way, and not all sources of anxiety should be addressed in this way. Exposure therapy is a way to help with anxiety that is excessive, or out of proportion to the actual situation. Certainly, situations exist in life where anxiety is normal and appropriate. For example, if someone is in an abusive relationship, an exploitative job, subject to persecution or violence, or even carrying on habits that are a threat to one’s health, trying to get rid of anxiety would be the wrong approach. However, many, many people suffer with anxiety that is not due to sources like this, and that is getting in the way of the lives they want to live. And that is where therapy can help.
This is why I feel hopeful as an anxiety therapist. There are scientifically studied approaches that have been proven to help people confront their anxiety in a safe, systematic, and effective manner, and I have personally witnessed the power that these approaches have to change people’s lives and liberate them from anxiety.