Did you know that more Americans suffer from anxiety disorders than any other mental health problem? Nearly 18% of American adults have a diagnosed anxiety disorder.* Some are even calling anxiety “the other pandemic“. Anyone who has suffered from an anxiety disorder knows how excruciating it can be. What, then, is the cause of all of this chaos and suffering?
Anxiety disorder symptoms run the gamut from racing hearts and sweaty palms to obsessive thoughts and compulsive rituals. I have never found it particularly useful, however, to understand a mental health problem by listing its symptoms. Such an approach has given rise to superficial insights and a lack of empathy, as seen in “manual-based therapy”, social media memes, and pop psychology clichés. I have even seen an anxiety disorder test online! Really…how can we hope to diagnose anxiety disorder online?
What we need
What we need instead is a deep insight and experiential appreciation of what is going on with anxiety. In the Deconstructing Anxiety model,** we take a unique approach to understanding the true source of an anxiety disorder. It starts with the idea that there is a single “core fear“ at the root of anxiety, and, indeed, at the root of any problem at all. We have said this many times in these blog posts, but let’s look at the idea from the perspective of how psychologists can help with anxiety disorders.
The core fear is akin to what Karen Horney (one of Freud‘s disciples) called “basic anxiety“. She hypothesized that there is a basic anxiety underneath all “neuroses” or dysfunctional psychological patterns. So, too, our core fears concept is to be found at the root of suffering. Find the core fear and you’ve got a powerful tool for identifying the true culprit behind your problem. Understanding our own core fear also gives us a very specific target for the real issue that needs to be addressed in therapy.
In more common psychological terms, we may understand that the diagnosis of “generalized anxiety disorder“ corresponds to the core fear and Horney’s basic anxiety. What is generalized anxiety disorder? It is defined in the DSM*** as excessive anxiety about a number of events or activities, associated with three or more of the following: restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). (This is an abbreviated excerpt of the most salient points of the definition).
To get a living, experiential “feel” for what this means, we may take a certain amount of artistic license and say that GAD (generalized anxiety disorder) is a non-specific, “free-floating“ anxiety that doesn’t attach to any particular situation or object. All of the other anxiety disorders, including social anxiety disorder, specific phobia, OCD, PTSD, etc., are defined by the particular situation or object the anxiety latches onto. Social anxiety disorder is anxiety in social situations. Specific phobia is anxiety about a particular object such as a spider. OCD is anxiety that manifests as obsessions and compulsions in response to specific triggers such as medical problems or tidiness. PTSD is an anxiety response only deployed in the presence of that which reminds the person of the original trauma. In this sense, we may understand generalized anxiety disorder as a substratum of anxiety that is more undefined and, again, less specific.
In a very real way, we all suffer from generalized anxiety disorder (not that it rises to the level of a clinical diagnosis for most of us). Therefore, the way in which psychologists help with anxiety disorders can give us a map for how all of us may deal more successfully with the challenges of the human condition, and offer help in any difficult situation we may find ourselves in. Again, understanding the true cause of anxiety (aka core fear, basic anxiety, GAD) can
show us a way “out”.
An astonishing discovery!
To explore this opportunity, let’s look at a fascinating study. In 2020, researchers LaFreniere and Newman (“Exposing worry’s deceit: Percentage of untrue worries in generalized anxiety disorder treatment”, Behavior Therapy) studied a group of people with GAD. They asked them to make a list of everything they were worried about. Understanding “worry” as a synonym for “anxiety”, they came back a month later to see how many of the things they were worried about actually came true. An astonishing 91.6% of the items on their lists never happened! And an earlier study upon which this one was based suggested that when an event they were worried about did come to pass, their experience of it was much less difficult and unpleasant than they anticipated. That is to say, it was not the significant source of anxiety they were imagining.
Not only is this a profound discovery with extraordinary implications, but the researchers found that simply letting clients know of this statistic helped the subjects detach from that which they were worried about. In fact, what I believe is going on here is that the clients are imagining (however briefly) the situation they were worried about, and then imagining it not coming true. This is a form of what psychologists call exposure therapy.
Exposure therapy is the great secret, I believe, to healing that which ails us. It means that we expose ourselves to that which we are afraid of, either in vivo (in real life) or in imagination. By virtue of moving through it and coming out the other side in one piece, we are no longer afraid of it. It has done its worst and we find we are still standing. As Neitzsche said “That which does not kill you makes you stronger”. This has given rise to the common notion that it is important to “face your fears”.
The great secret to healing anxiety
Exposure therapy, then, is the great secret to healing anxiety. A situation or object simply cannot scare us any longer when we have lived through “the full catastrophe”, as Kazantzakis said, and discovered that it is no more than a mouse that roared. No amount of positive thinking, affirmation or thought substitution will make a significant and lasting change in our fear, but exposing ourselves to what it is really like and finding out it is not so bad after all, is the chicken soup that cures all ills.
It is not as simple, however, as just plunging into our fears wherever they may lie! We must be wise in this. First, it would be foolish to face fears that one is not ready to face. This can backfire if the person stops mid-way, too scared to finish with the exposure. Now they have simply heightened their fear and convinced themselves it really is too awful to face. Nor is it helpful to face any fear. I have often seen people who have bravely performed exposure after exposure and have not shown any progress in relieving their anxiety. Each time, we found, they were facing the wrong fear–that is to say, a fear that wasn’t truly triggering the problem they were suffering from.
To have effective exposure, one must find the all-important combination of “the right insight and the right action”, as we discuss in the Deconstructing Anxiety program. This means finding the core fear (the right insight) and using it to inform the right action (what we call “doing the opposite” of the chief defense). This combination is the most effective approach I know to creating a successful exposure, all done safely and with a surprising degree of comfort in imagination. Only by moving through the core fear completely can we finally discover that our fear has no power over us. This is the way to freedom from anxiety, and this is the way to embracing the fulfillment that is waiting for us in this freedom****
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*This statistic predates Covid, which clearly has spiked the incidence of anxiety in America and around the globe. **Pressman, T. (2019). Deconstructing anxiety: The journey from fear to fulfillment. Maryland: Rowman and Littlefield.
***The DSM is the Diagnostic and Statistical Manual which mental health professionals use to understand the different diagnostic categories used in psychology.
****To learn more about the three ways of “doing the opposite” and finding freedom from fear, see www.deconstructinganxiety.com,