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)”]

[irp posts=”2283″ name=”Circling the Storm Drain – The Origins of a Narcissist (by Dr Sarah Sarkis)”]


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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Behaviour is never from ‘bad’. It’s from ‘big’. Big hungry, big tired, big disconnection, big missing, big ‘too much right now’. The reason our responses might not work can often be because we’ve misread the story, or we’ve missed an important piece of it. Their story might be about now, today, yesterday, or any of the yesterdays before now. 

Our job isn’t to fix them. They aren’t broken. Our job is to understand them. Only then can we steer our response in the right direction. Otherwise we’re throwing darts at the wrong target - behaviour, instead of the need behind the behaviour. 

Watch, listen, breathe and be with. Feel what they feel. This will help them feel you with them. We all feel safer and calmer when we feel our people beside us - not judging or hurrying or questioning. What don’t you know, that they need you to know?♥️
We all have first up needs. The difference between adults and children is that we can delay the meeting of these needs for a bit longer than children - but we still need them met. 

The first most important question the brain needs answered is, ‘Is my body safe?’ - Am I free from threat, hunger, exhaustion, pain? This is usually an easier one to take care of or to recognise when it might need some attention. 

The next most important question is, ‘Is my heart safe?’ - Am I loved, noticed, valued, claimed, wanted, welcome? This can be an easy one to overlook, especially in the chaos of the morning. Of course we love them and want them - and sometimes we’ll get distracted, annoyed, frustrated, irritated. None of this changes how much we love and want them - not even for a second. We can feel two things at once - madly in love with them and annoyed/ distracted/ frustrated. Sometimes though, this can leave their ‘Is my heart safe?’ needs a little hungry. They have less capacity than us to delay the meeting of these needs. When these needs are hungry, we’ll be more likely to see big feelings or big behaviour. 

The more you can fill their love tanks at the start of the day, the more they’ll be able to handle the bumps. This doesn’t have to be big. It just has to be enough. It might look like having a cuddle, reading a story, having a chat, sitting with them while they have breakfast or while they pat the dog, touching their back when they walk past, telling them you love them.

All brains need to feel loved and wanted, and as though they aren’t a nuisance, but sometimes they’ll need to feel it more. The more their felt sense of relational safety is met, the more they’ll be able to then focus on ‘thinking brain’ things, such as planning, making good decisions, co-operating, behaving. 

(And if this today was a bumpy one, that’s okay. Those days are going to happen. If most of the time their love tanks are full, they’ll handle when it drops a little. Just top it up when you can. And don’t forget to top yours up too. Be kind to yourself. You deserve it as much as they do.)♥️
Things will always go wrong - a bad decision, a good decision with a bad outcome, a dilemma, wanting something that comes with risk. 

Often, the ‘right thing’ lives somewhere in the very blurry bounds of the grey. Sometimes it will be about what’s right for them. Sometimes what’s right for others. Sometimes it will be about taking a risk, and sometimes the ‘right’ thing just feels wrong right now, or wrong for them. Even as adults, we will often get things wrong. This isn’t because we’re bad, or because we don’t know the right thing from the wrong thing, but because few things are black and white. 

The problem with punishment and harsh consequences is that we remove ourselves as an option for them to turn to next time things end messy, or as a guide before the mess happens. 

Feeling safe in our important relationships is a primary need for all of us humans. That means making sure our relationships are free from judgement, humiliation, shame, separation. If our response to their ‘wrong things’ is to bring all of these things to the table we share with them with them, of course they’ll do anything to avoid it. This isn’t about lying or secrecy. It’s about maintaining relational ‘safety’, or closeness.

Kids want to do the right thing. They want us to love and accept them. But they’re going to get things wrong sometimes. When they do, our response will teach them either that we are safe for them to come to no matter what, or that we aren’t. 

So what do we do when things go wrong? Embrace them, reject the behaviour:

‘I love that you’ve been honest with me. That means everything to me. I know you didn’t expect things to end up like this, but here we are. Let’s talk about what’s happened and what can be different next time.’

Or, ‘Something must have made this (wrong thing) feel like the right thing to do, otherwise you wouldn’t have done it. We all do that sometimes. What do you think it was that was for you?’

Or, ‘I know you know lying isn’t okay. What made you feel like you couldn’t tell me the truth? How can we build the trust again. Let’s talk about how to do that.’

You will always be their greatest guide, but you can only be that if they let you.♥️
Whenever there is a call to courage, there will be anxiety - every time. That’s what makes it brave. This is why challenging things, brave things, important things will often drive anxiety. 

At these times - when they are safe, but doing something hard - the feelings that come with anxiety will be enough to drive avoidance. When it is avoidance of a threat, that’s important. That’s anxiety doing it’s job. But when the avoidance is in response to things that are important, brave, meaningful, that avoidance only serves to confirm the deficiency story. This is when we want to support them to take tiny steps towards that brave thing. It doesn’t have to happen all at once.l and it doesn’t matter how long it takes. Brave is about being able to handle the discomfort of anxiety enough to do the important, challenging thing. It’s built in tiny steps, one after the other. 

We don’t have to get rid of their anxiety and neither do they. They can feel anxious, and do brave. At these times (safe, but scary) they need us to take a posture of validation and confidence. ‘I believe you, and I believe in you.’ ‘I know this feels big, and I know you can handle it.’ 

What we’re saying is we know they can handle the discomfort of anxiety. They don’t have to handle it well, and they don’t have to handle it for too long. Handling it is handling it, and that’s the substance of ‘brave’. 

Being brave isn’t about doing the brave thing, but about being able to handle the discomfort of the anxiety that comes with that. And if they’ve done that today, at all, or for a moment longer than yesterday, then they’ve been brave today. It doesn’t matter how messy it was or how small it was. Let them see their brave through your eyes.‘That was big for you wasn’t it. And you did it. You felt anxious, and you stayed with it. That’s what being brave is all about.’♥️
A relationally unsafe (emotionally unsafe) environment can cause as much breakage as as a physically unsafe one. 

The brain’s priority will always be safety, so if a person or environment doesn’t feel emotionally safe, we might see big behaviour, avoidance, or reduced learning. In this case, it isn’t the child that’s broken. It’s the environment.

But here’s the thing, just because a child doesn’t feel safe, doesn’t mean the person or environment isn’t safe. What it means is that there aren’t enough signals of safety - yet, and there’s a little more work to do to build this. ‘Safety’ isn’t about what is actually safe or not, it’s about what the brain perceives. Children might have the safest, warmest, most loving adult in front of them, but that doesn’t mean they’ll feel safe. This is when we have to look at how we might extend bigger cues of warmth, welcome, inclusiveness, and what we can do (or what roles or responsibilities can we give them) to help them feel valued and needed. This might take time, and that’s okay. Children aren’t meant to feel safe with every adult in front of them, so sometimes what they need most is our patience and understanding as we continue to build this. 

This is the way it works for all of us, everywhere. None of us will be able to give our best or do our best if we don’t feel welcome, liked, valued, and free from hostility, humiliation or judgement. 

This is especially important for our schools. A brain that doesn’t feel safe can’t learn. For schools to be places of learning, they first have to be places of relationship. Before we focus too sharply on learning support and behaviour management, we first have to focus on felt sense of safety support. The most powerful way to do this is through relationship. Teachers who do this are magic-makers. They show a phenomenal capacity to expand a child’s capacity to learn, calm big behaviour, and open up a child’s world. But relationships take time, and felt safety takes time. The time it takes for this to happen is all part of the process. It’s not a waste of time, it’s the most important use of it.♥️

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