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“Nothing in life is to be feared but understood”- Marie Curie.

Once in a while I get an email from a Spo-fan (or somebody like one) wanting to hear about anxiety, more specifically, what to do about it. I spend a lot of my working day addressing this issue. You would think the patients who are most challenging to work with would be the folks with mania or psychosis or depression. It is not so. It is the anxious ones that are the most challenging to work with as they are often literally and figuratively in a panic, seeing things as urgent if not catastrophic. It is a challenge not succumb to their anxieties.

So here are some tips for thems dealing with anxiety.
Pay attention, people pay me big bucks for this sort of stuff.

The emotion of anxiety is part of our physiology; it is there for a reason. We are the descendants of those who got tense and vigilant when they encountered something or someone dangerous or unfamiliar. The folks who shrugged off that funny-sounding noise from behind ended up as prey, not as parents. Our inner brains remain wired to react to new things/others with anxious trepidation. Alas, Babylon! These inner-brain parts don’t discriminate. An angry tiger pushes the same buttons as does an angry boss. Thus, it is normal to have anxiety; it pops up before our frontal cortexes kick in with a more relational reaction “hey, this isn’t a tiger! Cool it down there!” In summary: anxiety is not the enemy. Anxiety is a team member, one you really don’t want to live without. Anxiety is just not a good team leader. Anxiety makes a good servant but a lousy boss. I tell my patients to quit looking at anxiety as maleficent alien life form or an omnipotent enemy.

You may not be able to stop becoming anxious when something happens, but you can do something about how you react to it. Anxiety can feel intense, overwhelming, and ponderous, but it is nevertheless a treatable condition. What I mean by this is getting anxiety (acute and chronic types) down to a dull roar. Thems who are anxious often want anxiety not to be happening at all. They see it as a black/white on/off emotion: either not there or at a 10+ level. For those with chronic anxiety, approach it like any other chronic condition. One learns to live with it and not let it dominate your life. C.G. Jung said when you try to eradicate something it just comes back to dominate you worse than ever.

Emerson said “always do what your are afraid to do” – good advice for thems who are anxious. It is understandable that when faced with something that evokes anxiety we want to do a 180 and avoid it. If we persevere and practice what we fear, we realize ‘it wasn’t that bad’. This builds familiarity and confidence – and anxiety ameliorates. This needs to be done in steps called ‘desensitization’. I am presently working with a patient who has developed an anxiety to drive. She is practicing merely driving around the block in her familiar neighborhood, knowing if she becomes anxious she is only a few minutes from home. As she grows OK with this she will go out longer and farther, and eventually to highway driving (during a quiet time of the day).

I’ve trained myself whenever I get anxious about doing something, I pause to remember literally everything I like doing now started this way. Give it a try, knowing I will bungle/be anxious but survive and perhaps keep going.

Most folks tell me their anxiety is about the ‘what-ifs’ of life and the consequences of these scenarios.** At the heart of it all is fear of the unknown.

When patients tell me they are ‘frozen with anxiety’ I give them my spiel to pick a direction and start. “But how do I know if it’s the right thing and what happens if it fails?” You don’t really. How do you know anything about the future, no matter how you try to control for it by avoiding anxiety-evoking actions? If you want to improve your life you have to embrace uncertainty and allow anxiety to be. It’s not comfortable. You have to get comfortable with being uncomfortable. In this paradox the tyrant anxiety diminishes and becomes no longer the master. This is the true notion of head shrinking.

*These words are often interchangeable. To straw split, worry is the mental matter and anxiety is mental with physical components. I may worry did I leave the stove on; if I am having palpitations, tremors, dyspnea along with the worry, this is anxiety.

**Counseling/therapy often works with these ‘worse-case’ scenarios. How likely they are to happen, and how bad would it be really if it did happen. Often that anxious matter (like going to a party of strangers) may be not comfortable but hardly the ‘everyone will look at me/laugh at me/judge me” and I will be wiped out” that is feared.

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