Dealing With Anxiety: Exploring the Patterns that Fuel the Anxious Process

Dealing With Anxiety: Exploring the Patterns that Fuel the Anxious Process

Anxiety is everywhere.  It’s an epidemic. An estimated 40 million adults (18 and older) or 18% of the population endorse symptoms of anxiety (not to mention 1 out of 8 children). Treatment of anxiety is a 1/3 of the $148 billion dollars spent annually on mental illnesses in America. In other words, we spend $42 billion a year on treatment of anxiety disorders in America.

Women are 60% more likely to develop an anxiety disorder than our male counterparts. The average age of onset is 11 across genders. Add to these statistics that nearly half of the 40 million adults with anxiety also suffer from depressive symptoms, which is the leading cause of disability in the US for ages 15-43. These numbers are terrifying to me as a clinician, a woman and a mother.

But is there anything we can do to slow these statistics from what seems to be an endless climb north? Or, is anxiety simply something you catch or that you get from your genetics? Are the intergenerational symptom patterns that emerge within families simply a case of genetic destiny and bad luck or can we influence the severity and the way we cope with our feelings such that we can influence the trajectory of these statistics?

This article is designed to strip anxiety down to the studs and reveal the intricate scaffolding system that provides structure and fortitude to the anxious process. This is not an exhaustive list of the prodromal symptoms of anxiety by any means, but we will explore several of the key components that contribute to the vast majority of all anxiety patterns.  Namely, we will examine the role of avoidance, rumination, and speculation in the eventual onset of a full-blown anxiety disorder.

At the center of anxiety is a neurobiological dis-regulation, affecting most notably the central nervous system.  This dis-regulation is most readily obvious in the form of panic attacks.  But the more subtle aspects of anxiety, the patterns in thinking that are often the unrecognized participants in an ongoing anxious process are the inflection points we want to understand in therapy in order to rework your unconscious patterns and mitigate the more severe symptoms.

Dealing with Anxiety: How it holds on and how to loosen the grip.

Anxiety moves in circular motion, although you are constantly spinning you are never truly gaining traction and moving forward. Perpetual loops of speculation, avoidance, rumination, and worry will hold you hostage to growth and internal contentment. But here’s the good news, anxiety is amenable to intervention and change.  The only requirement is that you have to want it badly enough to work for it.  You have to be willing to expose yourself to things and circumstances and (most importantly) feelings you have been avoiding, often for decades. And, you have to be willing to do the work to re-route neural patterns that have become dominant over the years, but no longer helpful in promoting a sense of internal equilibrium.   

Let’s break down a few of the styles or patterns at the epicenter of the larger anxious process namely rumination, speculation, and avoidance.

The Ruminator.

Rumination is a prolonged state of cyclical worry and negative internal dialogue about your self, others, situations, or all three combined.  Rumination is when you start to brood on an event or interaction. Usually this brooding takes on the flavor of having done something wrong or having been wronged (usually the former). Rumination is the “thing” you cannot seem to turn your mind’s eye away from.  As you observe this style of thinking, notice that ruminations almost never take on a positive flavor. Ruminators will often also exhibit interpersonal styles that are marked by a propensity to be the victim and/or have other co-dependent dynamics that entangled them in a web of disempowerment.  

The Speculator.

The speculator is constantly looking into the future to source out the possible signs of danger ahead. These people forecast about the future most often with a flavor of doom, suspicion or dread. The speculator views the untapped horizon with apprehension, suspicion, and sometimes paranoia.  At a clinical level, when I see non-psychotic features of paranoia I pretty much know I have a speculator on my hands.  The speculator is most vulnerable to catastrophic thinking patterns, which are universally at the epicenter of more acute anxiety disorders. I urge you to view this style of thinking as a component of anxiety.  If you read this and find that you too exhibit these traits, I’d encourage you to begin to observe when you shift into the speculator role and explore why you are using this style of thinking at this moment in time. 

From a therapeutic standpoint there are reasons you have snuggled into this style of thinking vs. another style.  By allowing yourself to observe that you are doing it, without necessarily going down the rabbit hole, you have a fighting chance to tap into real freedom of choice and free will.  Previously, when you were unconsciously engaging this thinking style you weren’t actually making empowered decisions.  You were living out neurobiological attachment patterns that had unknowingly hijacked your ability to make choices about the trajectory of your own mind and brain.

Avoidance.

Avoidance is a complicated and highly effective defense mechanism, which cannot be fully explored in the scope of this blog.  So please, if you identify with an avoidant style of intra-and-inter-personal dynamics, seek more information. 

That being said, avoidance operates paradoxically.  On the one hand, it is highly effective in reducing or discharging the feeling(s) the person is trying to distance him/her self from.  The act of avoiding the uncomfortable feeling or situation results in an immediate reduction in the discomfort. That’s why I refer to it as effective.  But don’t mistake effective for healthy. 

On the other hand, avoidance is a crippling style of coping.  Left unchecked it usually results in significant emotional and interpersonal limitations. Here’s the fine print on the avoidance contract.

First, you have to continue to narrow your aperture of focus to accommodate the ongoing avoidant pattern.  In other words, in order to maintain distance from the feelings you are trying to avoid, you have to engage in more and more avoidant behaviors.  This how compartmentalization comes into play in the anxious process and how, in the most extreme expression of avoidance you see people struggling with overt phobias. Like the aperture on a camera lens the scope narrows proportionally on the left and right as it closes in on a more myopic view, avoidance follows the same philosophy when it comes to managing your feelings.  As you effectively protect yourself from any of the unpleasant feelings you wish to escape, you simultaneously and proportionally narrow your ability to feel and absorb intensely pleasant feelings. That’s just the price of employing this defense mechanism.  Over time, you will feel less discomfort, I suppose, but you will also feel less love, less bliss, less deeply connected to people in your life.  The aperture closes proportionally until you are left with a narrow and often myopic emotional scope. You will be comfortably numb.    

This brings us to your second fine print item: The more you narrow your emotional aperture to accommodate the avoidance, the more you participate in atrophying your ability to tolerate your feelings in general. The ability to tolerate feelings is a muscle. It’s an achievement that starts with an intricate and delicate dance between infant and caregivers and continues throughout our lives as we adapt and re-adapt to our changing environments.  The more you exercise this muscle, the stronger and easier it gets.  The more you avoid your feelings, the more the muscle atrophies and the harder it is to tolerate any sense of emotional discomfort or un-ease. Eventually you will be walking an emotional tight rope that is pulled taught with your internal friction.

So what can you do? How can you shift these long held patterns?

Anxiety has physical, emotional and cognitive expressions that can be mutually exclusive or present as a symphony of symptoms.  The overwhelming part about anxiety is that it impacts so many different and intersecting parts of our human experience.  But that is also its greatest asset and part of the reason why it is often the most amenable to change in a therapeutic setting.  Anxiety can be approached and massaged at various levels. In other words, we make good habits the same way we make bad one-we just keep doing a behavior.

Be curious, and grow your awareness.

Start to become aware of how your mind and brain works and what kind of thought patterns emerge before, during, and after you feel acute levels of anxiety. Try to view these anxiety episodes as neurobiological.  They are hardwired at this point.  But do not confuse this with assuming it’s “genetic.”  It’s not that simple or linear.  There are fixed cognitive and emotional patterns that you can observe, understand, and eventually influence.  As the patterns move from being unconscious to conscious, you will be better able to insert influence and choice over these central nervous system patterns that had previously held you emotionally hostage.  The power to observe your mind from this neutral stand point allows us the possibility that we might eventually be able to slow the perpetual loop enough to reroute the course of motion.

Understand that the goal is not to feel happy all the time.

The goal isn’t to avoid your unpleasant feelings. The goal is to learn how to stay present in them. Just simply tolerate the feelings. They will pass. They have a beginning, middle, and an end. Like a wave, they will crest and then receded and crest again. Train to your weaknesses. Build the muscles that need strengthening and allow the ones that are too robust to soften. This how we achieve a sense of balance and emotional equilibrium.  It’s also how we extract peak performance from ourselves. So remember, train to your weaknesses.

Mindfulness

Commit to doing mindfulness for twenty minutes a day for one month. Try breaking it up into two ten-minute segments. I’ve written else where about my preferred style of mindfulness. Click here to read more. 

Seek outside support.

Work with a skilled clinician to gain more insight and observance of how your mind works. Initially, all you have to do is observe your process. Try to view therapy as the emotional equivalent of working out.  It’s your opportunity to train your mind and brain. Remember, if we want to get better (healthier) train to your weaknesses.  Don’t train to your strengths. You are already proficient at the things that come easily to you. I encourage my patients to observe the parts of their experiences that are difficult for them to tolerate. I provide the space for people to increase the bandwidth you have to tolerate your feelings. I am purposely using the word tolerate because that is the threshold I want you to (re)-calibrate your interior world to. 

And to all the parents out there raising small children. 

Now is the time you can influence these intergenerational patterns and change the trajectory of your shared history by helping your child to be better equipped to metabolize, tolerate, and react to his/her own feelings. 

Don’t help your children avoid difficult feelings.  Don’t try to narrow or alter their reality so they do not have to feel difficult, sad, or intense feelings. Allow them to navigate these situations and build the muscles to be better prepared to handle the complex world of adulthood. Yes, we all want to protect our kids.  But we are not doing them any service by passing on these patterns of avoidance. 

When you inadvertently pass on these style of coping you are, ultimately, creating limitations in their interior world. It’s not intentional.  But it does happen.  Help your child learn to increase their tolerance for discomfort by modeling your own capacity to manage your feelings without excessive avoidance, denial, etc.  Encourage and applaud them when they feel intense emotions and remind them that feelings have a beginning, middle, and an end.  This too shall pass.   

In conclusion.

I want to re-emphasize I am not suggesting you try to clear your mind.  Or think positively. Or even regulate your breath.  You are simply being still in your body, mind, and brain.  Observe. Breath.  Voila.

[irp posts=”2090″ name=”What Butterflies Can Teach Us About the Mind/Body Connection: A Shrink’s Guide to Listening to Your Gut (by Dr Sarah Sarkis)”]

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About the Author: Dr Sarah Sarkis

Sarah is a licensed psychologist living in Honolulu, Hawaii. Originally hailing from Boston Mass, she has a private practice where she works with adults in long-term insight oriented therapy. She works from an existential psychology vantage point where she encourages her patients to “stay present even in the storm.”  She believes herself to be an explorer of the psyche and she will encourage you to be curious about the journey rather than the destination.  She emphasizes collaboration, partnership, and personal empowerment.

She approaches psychological wellness from a holistic and integrative perspective. Her therapeutic style is based on an integrative approach to wellness, where she blends her strong psychodynamic and insight oriented training with more traditionally behavioral and/or mind/body techniques to help clients foster insight, change and growth. She has studied extensively the use of mindfulness, functional medicine, hormones, and how food, medicine and mood are interconnected.  Her influences include Dr.’s Hyman, Benson, Kabat-Zinn and Gordon, as well as Tara Brach, Brene’ Brown, Irvin Yalom and Bruce Springsteen to name only a few.

Please visit her website at Dr SarahSarkis.com and check out her blog, The Padded Room

 

4 Comments

Holly

Hi Sarah,
Ruminator is what I most commonly see myself as. I definitely go down the negative path based off of small interactions.do you have any tools to help after recognizing myself in the moment as doing this, and how to calm the negative thoughts and reinforce positive ones?

Reply
Em

Howdy! Great article.

Can you speak more about The Speculator style of anxiety? This is me to a T! And worrying about non-existent future problems can sometimes become a self-fulfilling prophecy.

Aside from awareness when you begin to spiral into this anxiety, is there a better way to redirect your thoughts? Is it through self-reassurance? Or practicing telling yourself you’re making a mountain out of a molehill?

Warm regards from Toronto!

Reply
Sarah Sarkis

Hi there:
Thanks for the comment. In terms of interventions to interrupt the spectator role I’d first really focus on observing when you are doing it and what you are feeling, both emotionally and physically. Just draw that awareness. this will allow you to begin to put together an understanding of what and why and when you employ this style of thinking. Then you can map out thought blocking techniques, and other tools to interrupt the neuro-linguistics loop.
First, we must wrestle with stillness and observation in order to allow the patterns to emerge.

It would also be helpful if you aren’t already to work with a skilled clinician to help you implement specific tools once you have gained insight around the pattern.

You can check out my blog, The Padded Room, for more articles that might prove helpful.

Thanks again for connecting.
dr. sarkis

Reply
sam

I think you’re a wonderful therapist Karen. You’ve been so helpful in my recovery from anxiety. I’m about 98% cured. I did have a relapse recently remembering a situation I felt I had no control of (one which felt shameful, embarrasing and feeling injustice) but I came out of it by learning more about myself and journalling. It forced me to stop ruminating and get into clear thoughts. I couldn’t trust anyone with my thoughts. I didn’t trust my medicare based psychologist. He just didn’t get me and my female issues plus I felt I would be judged or laughed at.

But anxiety forced me to look deeply at myself if I wanted to escape that horrible feeling and the answer isn’t just sitting with a feeling till it passes (but which has it’s merits too). Its much greater than that which you touch on in many other of your posts.

I have learned I had avoided most emotions at all costs caused by selfish and neglectful parents. I had to stuff my emotions and be the mother from a very young age. From my mother I learned to hate and distrust people and from that came my aggression and lack of empathy and lack of emotional (social) intelligence. I had no idea how to engage with other women and would get rejected often (subtly of course). That lead to my big-I-feel-I’m-about-to-die anxiety as well as experiencing trauma cause by friends who were boys when I was just a teen. I had nobody to share the shame that I put upon myself for what THEY DID TO ME. That experience only compounded my avoidance even further.

Despite being an athiest, something I learned is that our situation is there to teach us something. Call it energy or mother nature or God if you believe in him trying to shine a light on what you have been hiding or running away from.

What I found that worked the most was learning about emotions by signing up to newsletters like yours and most of all the feeling of having no control is what’s spurring the feeling of being unsafe. Find your belief that this is unfolding exactly as it should despite what you’re making of it. Just keep that belief and you’ll come out of the panic, the fear, the anxiety and the depression. There is something out there watching over you. You are where you should be. You will look back at this horrible time and you will say “aha I get it, thank you so much whatever you are”.

And most importantly be super kind to yourself – google self love.

Those 7 years were the toughest most scariest time of my life. The harder the feeling, the closer you are getting to the source of your pain. Let it come out with the sitting with your feeling or journaling it if meditation is too hard right now and you’ll find you’re happy again (in time) Something you think is never going to happen again, will return. You just forgot how good life can feel. It will return. I promise!

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Sometimes needs will come into being like falling stars - gently fading in and fading out. Sometimes they will happen like meteors - crashing through the air with force and fury. But they won’t always look like needs. Often they will look like big, unreachable, unfathomable behaviour. 

If needs and feelings are too big for words, they will speak through behaviour. Behaviour is the language of needs and feelings, and it is always a call for us to come closer. Big feelings happen as a way to recruit support to help carry an emotional load that feels too big for our kids and teens. We can help with this load by being a strong, calm, loving presence, and making space for that feeling or need to be ‘heard’. 

When big behaviour or big feelings are happening, whenever you can be curious about the need behind it. There will always be a valid one. Meet them where they without needing them to be different. Breathe, validate, and be with, and you don’t need to do more than that. 

Part of building resilience is recognising that some days and some things are rubbish, and that sometimes those days and things last for longer than they should, but we get through. First we feel floored, then we feel stuck, then we shift because the only choices we have we have are to stay down or move, even when moving hurts. Then, eventually we adjust - either ourselves, the problem, or to a new ‘is’. 

But the learning comes from experience. They can’t learn to manage big feelings unless they have big feelings. They can’t learn to read the needs behind their feelings if they don’t have the space to let those big feelings come back to small enough so the needs behind them can step forward. 

When their world has spikes, and when we give them a soft space to ‘be’, we ventilate their world. We help them find room for their out breath, and for influence, and for their wisdom to grow from their experiences and ours. In the end we have no choice. They will always be stronger and bigger and wiser and braver when they are with you, than when they are without. It’s just how it is.♥️
When kids or teens have big feelings, what they need more than anything is our strong, safe, loving presence. In those moments, it’s less about what we do in response to those big feelings, and more about who we are. Think of this like providing a shelter and gentle guidance for their distressed nervous system to help it find its way home, back to calm. 

Big feelings are the way the brain calls for support. It’s as though it’s saying, ‘This emotional load is too big for me to carry on my own. Can you help me carry it?’ 

Every time we meet them where they are, with a calm loving presence, we help those big feelings back to small enough. We help them carry the emotional load and build the emotional (neural) muscle for them to eventually be able to do it on their own. We strengthen the neural pathways between big feelings and calm, over and over, until that pathway is so clear and so strong, they can walk it on their own. 

Big beautiful neural pathways will let them do big, beautiful things - courage, resilience, independence, self regulation. Those pathways are only built through experience, so before children and teens can do any of this on their own, they’ll have to walk the pathway plenty of times with a strong, calm loving adult. Self-regulation only comes from many experiences of co-regulation. 

When they are calm and connected to us, then we can have the conversations that are growthful for them - ‘Can you help me understand what happened?’ ‘What can help you so this differently next time?’ ‘How can you put things right? Do you need my help to do that?’ We grow them by ‘doing with’ them♥️
Big feelings, and the big behaviour that comes from big feelings, are a sign of a distressed nervous system. Think of this like a burning building. The behaviour is the smoke. The fire is a distressed nervous system. It’s so tempting to respond directly to the behaviour (the smoke), but by doing this, we ignore the fire. Their behaviour and feelings in that moment are a call for support - for us to help that distressed brain and body find the way home. 

The most powerful language for any nervous system is another nervous system. They will catch our distress (as we will catch theirs) but they will also catch our calm. It can be tempting to move them to independence on this too quickly, but it just doesn’t work this way. Children can only learn to self-regulate with lots (and lots and lots) of experience co-regulating. 

This isn’t something that can be taught. It’s something that has to be experienced over and over. It’s like so many things - driving a car, playing the piano - we can talk all we want about ‘how’ but it’s not until we ‘do’ over and over that we get better at it. 

Self-regulation works the same way. It’s not until children have repeated experiences with an adult bringing them back to calm, that they develop the neural pathways to come back to calm on their own. 

An important part of this is making sure we are guiding that nervous system with tender, gentle hands and a steady heart. This is where our own self-regulation becomes important. Our nervous systems speak to each other every moment of every day. When our children or teens are distressed, we will start to feel that distress. It becomes a loop. We feel what they feel, they feel what we feel. Our own capacity to self-regulate is the circuit breaker. 

This can be so tough, but it can happen in microbreaks. A few strong steady breaths can calm our own nervous system, which we can then use to calm theirs. Breathe, and be with. It’s that simple, but so tough to do some days. When they come back to calm, then have those transformational chats - What happened? What can make it easier next time?

Who you are in the moment will always be more important than what you do.
How we are with them, when they are their everyday selves and when they aren’t so adorable, will build their view of three things: the world, its people, and themselves. This will then inform how they respond to the world and how they build their very important space in it. 

Will it be a loving, warm, open-hearted space with lots of doors for them to throw open to the people and experiences that are right for them? Or will it be a space with solid, too high walls that close out too many of the people and experiences that would nourish them.

They will learn from what we do with them and to them, for better or worse. We don’t teach them that the world is safe for them to reach into - we show them. We don’t teach them to be kind, respectful, and compassionate. We show them. We don’t teach them that they matter, and that other people matter, and that their voices and their opinions matter. We show them. We don’t teach them that they are little joy mongers who light up the world. We show them. 

But we have to be radically kind with ourselves too. None of this is about perfection. Parenting is hard, and days will be hard, and on too many of those days we’ll be hard too. That’s okay. We’ll say things we shouldn’t say and do things we shouldn’t do. We’re human too. Let’s not put pressure on our kiddos to be perfect by pretending that we are. As long as we repair the ruptures as soon as we can, and bathe them in love and the warmth of us as much as we can, they will be okay.

This also isn’t about not having boundaries. We need to be the guardians of their world and show them where the edges are. But in the guarding of those boundaries we can be strong and loving, strong and gentle. We can love them, and redirect their behaviour.

It’s when we own our stuff(ups) and when we let them see us fall and rise with strength, integrity, and compassion, and when we hold them gently through the mess of it all, that they learn about humility, and vulnerability, and the importance of holding bruised hearts with tender hands. It’s not about perfection, it’s about consistency, and honesty, and the way we respond to them the most.♥️

#parenting #mindfulparenting
Anxiety and courage always exist together. It can be no other way. Anxiety is a call to courage. It means you're about to do something brave, so when there is one the other will be there too. Their courage might feel so small and be whisper quiet, but it will always be there and always ready to show up when they need it to.
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But courage doesn’t always feel like courage, and it won't always show itself as a readiness. Instead, it might show as a rising - from fear, from uncertainty, from anger. None of these mean an absence of courage. They are the making of space, and the opportunity for courage to rise.
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When the noise from anxiety is loud and obtuse, we’ll have to gently add our voices to usher their courage into the light. We can do this speaking of it and to it, and by shifting the focus from their anxiety to their brave. The one we focus on is ultimately what will become powerful. It will be the one we energise. Anxiety will already have their focus, so we’ll need to make sure their courage has ours.
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But we have to speak to their fear as well, in a way that makes space for it to be held and soothed, with strength. Their fear has an important job to do - to recruit the support of someone who can help them feel safe. Only when their fear has been heard will it rest and make way for their brave.
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What does this look like? Tell them their stories of brave, but acknowledge the fear that made it tough. Stories help them process their emotional experiences in a safe way. It brings word to the feelings and helps those big feelings make sense and find containment. ‘You were really worried about that exam weren’t you. You couldn’t get to sleep the night before. It was tough going to school but you got up, you got dressed, you ... and you did it. Then you ...’
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In the moment, speak to their brave by first acknowledging their need to flee (or fight), then tell them what you know to be true - ‘This feels scary for you doesn’t it. I know you want to run. It makes so much sense that you would want to do that. I also know you can do hard things. My darling, I know it with everything in me.’
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#positiveparenting #parenting #childanxiety #anxietyinchildren #mindfulpare

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