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“Always do what you are afraid to do” – Emerson. 

A Spo-fan recently asked me what sort of patient is ‘the hardest’ type for me to deal with. The usual guess is someone who has schizophrenia or a borderline personality. It is the patient with anxiety who challenges me the most.

At the base of all anxiety is discomfort. When we worry or experience anxiety*  it makes us uncomfortable. We are wired to be on the lookout and ever vigilant for threats to our well-being. Alas, the lizard-parts of our brains do not discriminate between a scorpion and a deadline.  Anxiety only becomes a ‘disorder’ when it is too frequent and intense – and problematic.  Anxiety makes a good servant but a lousy boss. Treatment is geared towards reversing the role.

Over the years of treating anxiety I’ve seen a shift in thems with anxiety -and it is not good. The real treatment for anxiety is a gradual exposure and rethinking of the anxious person towards the realization the anxiety is over-rated and unfounded. One learns to lower the level of discomfort and/or live easier with your worries. “Yes, I am still uncomfortable, but it isn’t as intense, and I can deal with it”.  That is a good outcome.

What a lot of anxious people want nowadays is the unrealistic goal of NO anxiety. Any little amount is seen as overwhelming and unacceptable. In summary, people are finding it harder to manage discomfort.  It is human nature to want to avoid things that cause anxiety and discomfort.  But by going into it rather than away paradoxically deals with anxiety. In the cave you most fear to enter lies the treasure you seek.

Urs Truly tries to lead by example. Often when The Timorous Tim within me says ‘No, go, turn around” I pause and proceed. Here is a simple example. Yesterday at the gym The Personal Trainer wants me to do ‘lunges’ something I do not like (as it causes intense physical discomfort) and they make me anxious, so I often quit long before the assigned length.  I took the approach a) Yes I will feel short-winded and b) I will probably fall over but both are not the end of the world nor as bad as I imagine them to do be. So I did them. I did not fall and I yes I was quite exhausted. I felt exhilarated. I had faced my fears and done well enough. I still don’t like doing lunges, but I am going to continue doing them.

I try (not very successfully I might add) to get patients to practice doing  what makes them anxious, whether it is making eye contact or going back to visit the place where they felt anxiety.  What they want of course, is Valium to simply lower their anxiety.

This week I have made a little list of things I’ve avoided doing or confronting out of avoidance of anxious discomfort. Like The Mighty Hercules I will address them one by one and be victorious, realizing these labors weren’t that laborious – or scary – as they claimed to be.

 

*”Worry” is technically the anxiety we imagine while ‘anxiety’ is the physiological elements of the condition. I worry about my mother; in my anxiety I have palpitations and shortness of breath and pacing. This is straw splitting; most of the time the words are interchangeable.

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