Anxiety is “generous”. With a menu including GAD, social phobia, OCD, relationship anxiety, specific phobia, panic disorder, PTSD, etc., anxiety offers so many varieties to choose from! Of course, I’m being sarcastic here, but the crucial point we must always keep in mind is this: while at first blush it may seem overwhelming to understand the different types of anxiety and how to treat them all, in truth (according to our Deconstructing Anxiety model*), there is only one problem to understand, a single source fueling all of these different forms–what we call the “core fear”.
The power of finding the core fear
And what is the core fear? It is the fundamental thought or belief system that drives our experience any time we are less than perfectly fulfilled – – which, of course, is most of the time. In the Deconstructing Anxiety model, we describe two basic drives in the human experience: the drive for fulfillment and the drive for fear.** As we attempt to get control over that which we are afraid of, we interpret the problem through the lens of this fundamental thought system we are calling the core fear. So, getting our hands on the core fear represents a unique opportunity to secure the threat, reach for the fulfillment, and effect transformation in our lives.
We have said in previous blogs that there are five “universal“ core fears:
- fear of abandonment (or loss of love),
- fear of losing one’s identity,
- fear of losing meaning,
- fear of losing purpose, and
- fear of death.
Once we know our core of fear (see my previous blogs on the “Digging for Gold” exercise), we may readily address the question “what is the best therapy for
anxiety?”. For the best therapy is, quite simply, the one which addresses the core fear. Any therapeutic modality, whether it uses the term “core of fear” or not, will be successful to the degree it addresses the true root of a problem. And only by addressing the true root of a problem can there be hope for real and lasting transformation.
Again, the particular type of therapy does not matter, nor does it matter what language it uses. So long as it helps one to find, face and move through that which is at the ultimate source of the problem, it will be successful.
There is another advantage of understanding the core fear principle: according to the Deconstructing Anxiety program, once we find our core fear, we will discover it is the root of literally any problem we can have. This is because we adopted its belief system when very young, and determined this was how we could best make sense of the world. Landing on this core fear interpretation provided such profound relief that we made a vow to use it as our way of understanding literally every problem that would follow. And so our core fear has been the driving force of our life ever since, any time we are less than completely fulfilled.
When considering how to help someone with anxiety, finding the core fear should be our first and highest priority. Any therapy that successfully resolves the problem has necessarily moved through the core fear (in vivo or in imagination). This is the only way we can fully trust that the situation can’t truly harm us; where the core fear had us anticipating ruinous consequences of some sort, moving through the actual experience shows us this is not so. This, of course, is the principle of what is called “exposure therapy”, but can be found in any therapy (even if not obvious) that succeeds in resolving the presenting problem.
The promise of complete healing
And any therapy that can claim a true resolution of the problem can only make that claim if the problem has been resolved completely and permanently. In other words, if the root is not completely dug up and removed or otherwise transformed, if the deepest level of the problem isn’t worked through, that root will grow new weeds…problems. This is what Freud called “symptom substitution”. The client may experience partial relief, or what first appears to be a complete relief, but is later proven to be only temporary.
So the best way to deal with anxiety is any way that meets these criteria. Unfortunately, in my experience, this is not as common an occurrence as we would hope. All too often, defenses assert themselves to keep the patient from achieving a full exposure to the threatening circumstance. They may resist moving through it completely, or even looking at it–admitting it into consciousness–to recognize what must be moved through.
Anxiety is scary
This is no surprise for the simple fact that anxiety is scary to look at, let alone move through. Some types of therapy fall short of fully facing the fear. For example, cognitive behavioral therapy for anxiety, while highly touted, doesn’t often get to the “root of the root” in my view. It can create a certain degree of symptom relief, but with the root left intact, new problems will issue fourth.
Other therapies emphasize action without getting the necessary insight into this root of the root, the core fear. How can a fear be fully faced if it is not clearly seen or understood? Again, I believe these shortcomings are the result of our inherent fear of facing fear. But there is no way around it …the best therapy for anxiety is the one which recognizes the fear must be faced and faced fully. Only by facing the core fear entirely, leaving no piece of the root intact, can we become convinced that the fear was not the ruinous proposition we had imagined.
Two factors to make facing fear easier
Again, the big obstacle in this pursuit is the simple fact that fear and anxiety are scary! We devote huge resources (in our psyches and external lives, individually and as a humanity) to staving off fear. We are a society in denial…of growing older, of not being “special”, of admitting our fears. In almost every effort, we try NOT to acknowledge, let alone face, fear. Fortunately, there are two factors in therapy that can help make the process of meeting our fear more tolerable.
First, we need what the Buddha called “right understanding”. With the right understanding that anxiety is a distortion and cannot actually fulfill on its threat, we develop a beginning, if tenuous, willingness to test the idea out. Such an understanding is easily achieved in therapy–one need only ask “how many times
has what you were afraid of actually come to pass and proven to be as awful as you were expecting?”. An honest appraisal readily shows the answer is at least “not often”. But we can go further than that. A 2020 study*** showed that a whopping 91.6% of the things people with Generalized Anxiety Disorder worried about never came true! A prior study made the point even more clear; it showed that if an anticipated problem did come to pass, it was experienced in a significantly more normalized way than expected, something much more manageable and less frightening.
The second factor that helps us become willing to face fear, and particularly the core fear, is that we have therapeutic exercises and techniques that make it quite doable, and without significant discomfort. Of course, there are classical exposure therapies, including flooding, which can be highly uncomfortable to say the least! These can be effective but require a more-than-average degree of motivation. Furthermore, too much discomfort can cause a patient to become overwhelmed and regress.
Thankfully, there are other techniques which give an intellectual and emotional “distance” from the problem while moving through the fear, and take much or even most of the sting out of the fear. The techniques in the Deconstructing Anxiety program, for instance, are notable in this regard. People engaging these techniques invariably say that there was no significant anxiety involved in performing the exercises. Rather, most report a comfortable detachment and intellectual satisfaction, as they observe the mechanics of their fear trying to form into a concrete perception, to then realize they are free to reverse that process and choose a more helpful perception. Some of the descriptions of this include “The fear just floated away”, “It dissolved like salt in the ocean”, and “I can see that the fear was just made up of dust and I could blow it away”. Other techniques can be relatively anxiety-free as well, so long as they foster the understanding that looking at the fear will expose its unreality.
Of course, there are many types of anxiety therapy and many anxiety therapy techniques. When looking for the “best” anxiety therapy, or the best therapy for depression and anxiety, or the best therapy for any problem at all, the most important criterion is whether the approach used will address the magic combination we talk about in the Deconstructing Anxiety model: one must find the right insight, the core fear at the ultimate source of a problem, and then use
that insight to inform the correct action–facing the core fear in a way which will demonstrate its unreality. It is important to then ask whether the therapeutic approach will cause undue discomfort–knowing that there are techniques which do not–and understanding that too much discomfort can reduce motivation or even cause someone to retreat behind their defenses and regress in the therapy.
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*Pressman, T. (2019). Deconstructing anxiety: The journey from fear to fulfiillment. Maryland: Rowman and Littlefield.
**To state this more precisely, the “drive for fear” is the drive to find any possible threats to our fulfillment, that we may then attempt to get control over those threats and secure that fulfillment.
***LaFreniere, L. & Newman, M. (2020). Exposing worry’s deceit: Percentage of untrue worries in generalized anxiety disorder treatment. Behavior Therapy, 51 (3), 413-423.