As a psychologist in private practice, I am sometimes astounded at the persistence of the illnesses of some of my patients. It seems that their illnesses consume them. Sometimes I suspect that they have come to love their conditions and identify with their sick role. Consciously they hate their condition, but secretly they love it, deriving some benefit. Anxiety, in particular, seems to be one of those stubborn, treatment-resistant conditions.
For example, Rachel, a woman who battled anxiety for decades, told me, “I can’t even imagine not worrying. I don’t know who I would be if I were not an anxious person. It would be scarier for me not to have something to worry about.”
Anxiety, sometimes called stress, is the most common and chronic mental health condition in our fast-paced society. It is so rampant that some people think being stressed out is normal. Research indicates that more than one-quarter of adults and nearly one-third of children will experience a clinical level of anxiety during their lifetime. For many, I believe, their anxiety, fear and worry become so persistent that it acts like a drug: exciting, numbing and possessing them.
When I suspect that a patient is addicted to his anxiety, I invite him to consider the following questions:
Do you feel powerless to stop your anxious reacting?
Does your life feel unmanageable because of it?
Does your craving for control interfere with your life?
Do you feel hopeless for a cure?
If the patient answers “yes” to these questions, it indicates that he is hooked on his anxiety. The anxiety acts like a stimulant drug that interferes with the person living a full life.
Even if all the conventional therapies the person has tried have not cured his anxiety, there is still hope. I use an approach that has helped countless individuals with a variety of addictions: the 12 Steps of Alcoholics Anonymous (AA). The Steps provide a framework for good therapy. I adapt the Steps in the following ways, which can be summarized in four moves.
When patients come to me, the first question I ask involves their goal in therapy. Invariably they respond, “I want to get rid of my anxiety.” They tell me about everything they have done to eliminate it, and how nothing has worked.
I then suggest a different approach. “Instead of trying to get rid of it, why don’t we try to accept it, work with it, and learn from it?” I tell them they are powerless over the flow of their thoughts and feelings, their past, and many circumstances in their lives. But I affirm, “You have power over your attitude and behavior regarding your anxiety.”
I explain, “Your thoughts and feelings are like clouds that arise and disappear. They come from you, but are not you. You are the blue sky. Your anxious thoughts and feelings are not as solid as you think.” That perspective often causes them to pause and think, “That really makes sense.”
This first move suggests a clinical question: “What can you learn from your anxiety? What is the message of the pain?”
Having faith in a Higher Power
The anxious mind dwells in a dark cave. It focuses on the negative, on what can go wrong, on “what if” thinking. I remind my patients that they have another mind: a wise, rational mind that views life from the mountaintop. I tell them that they have a power within themselves that probably goes unnoticed because they do not pay close enough attention. It is the power of consciousness.
I invite my patients to become astute observers of themselves. I tell them, “Imagine that your thoughts and feelings flow like a river. You can try to stop the flow. But the waters still get through. You can jump into the stream and be carried along by the thoughts and feelings, drowning yourself. Or you can step back and become an observer.”
As observers we can sense our freedom from the control of our thoughts and feelings. We do not have to react and follow blindly our impulses to action. We can stop, think and consider before acting. That is the power of consciousness, whose source is mysterious and unlimited. This power goes by many names: the Life Force, Spirit, Creative Intelligence, or Gracious Mystery. Whatever it is called, most of us recognize we are connected to something larger than ourselves.
In becoming observers and experiencing the power of consciousness, patients realize that their anxious reacting cannot control them, unless they let it. The awakening of consciousness releases the spirit of their true self. That is the gift of Steps 2 and 3 in AA.
This move suggests another clinical question: “Do you want to trust your anxious mind or your wise, rational mind?”
Seeing anxiety as a symptom
My patients think that being anxious is their real problem because it is so painful. Actually, their anxious reaction is a symptom of a deeper underlying problem. Anxiety arises from a fear of losing what we consider important, even necessary, for our happiness. We may fear losing love, control, status, health, possessions, and so forth. What we fear losing reveals what we cling to for happiness.
At the core of anxiety is a negative self-centeredness that craves security. The anxious mind creates the illusion of security by hanging on to fixed pessimistic ideas. It is not the anxiety that is the problem, but excessive attachments. We value some things too highly and become terrified of losing them.