What is Anxiety
John walked into my office and sat down with a heavy sigh. His face was tense and serious. He looked at me almost pleadingly and said, "Doc, you gotta help me 'get rid of 'my anxiety'. It's killing me!"
Sadly, John's story is far from unique: Over the years, I've heard this refrain (usually spoken in exactly the same way) from numerous clients; desperate souls burdened with the effects of near-crippling anxiety. Unfortunately, by the time they come in for help they've generally waited too long: Sometimes its panic attacks; on other occasions it might be social phobia, or some form of performance-related anxiety (e.g., public speaking) they're suffering from. Whatever the case, when they finally make the decision to get help they're truly at their wits-end (no exaggeration).
The good news is that unlike other serious medical problems or conditions, anxiety is not a disease. Surprised to hear this? If so, you're not alone. Many people think of anxiety as a disease; or if not a disease, some intractable medical/organic problem that is difficult to treat.
Interestingly, not all of medical science would agree with me regarding anxiety. However, let me set the record straight, emphatically: THE DISSENTERS ARE WRONG! Here's why:
DISEASES AND PATHOGENS:
In the vernacular of modern medicine, for something to be called a disease, more often than not, it must – by definition – be associated with a pathogen. There are, of course, a fair number of exceptions to this rule (e.g., Lou Gehrig's disease). But for the most part, if there's no pathogen, then there's similarly no disease.
What is a pathogen? It is a microscopic organism with a mission: To invade the cells of its host (e.g., humans) and cause symptoms to occur. Some examples of diseases are: Strep throat, Scarlet Fever, Diphtheria, Malaria, Whooping cough, Bronchitis and countless others.
Now, let's examine one of these diseases a bit more closely. Consider the case of "Strep Throat," commonly referred to as "Strep": Anyone who's had this awful malady knows the main symptom most commonly associated with it: A painful sore throat! But have you ever thought about what causes the sore throat? The answer, of course, is a pathogen; in this case, the specific pathogen called Streptococcus.
Pathogens vary in shape, size and number. However, there is one feature they all share in common: They cause disease. Therefore, anytime you contract a disease – whether viral, bacterial or fungal – you can be certain that a pathogen has invaded your body. Remember, it's the symptoms that generally define the disease. But, it's the pathogen(s) that cause it. We might even say for conveniencesake, that in a very real sense, the symptoms are the disease. There is a caveat: Strictly speaking, since no two people experience the same disease in exactly the same way, we can't literally say that the disease and the symptoms are one and the same. What we can say, however, is this: For all practical purposes a disease is merely a constellation of symptoms.
Think of this way: Tom and Betty both have sore throats. But Betty also feels much achier than Tom. So, even though they both have Strep, their symptoms can still vary to some degree; meaning, their experience of having Strep Throat can be somewhat different.
In much the same way, anxiety can reasonably be thought of as a constellation of symptoms. Though the specific symptoms (e.g., accelerated heart rate, constant worrying) may vary from person to person, the simple fact is that every person who reports feeling anxious, also reports the presence of symptoms. Without exception!
Having said this, let's take a closer look at what I consider are the basic components of the anxiety experience.
THE ANXIETY EXPERIENCE:
Imagine for a moment that you have a crystal ball. Want to know what you'll be doing in five years? Just ask the question and in a few moments, your crystal ball will reveal the answer!
Now if you did have one of these magical spheres, life would certainly be a lot easier. But the question is why? What is it about being able to foretell the future that is so alluring, so appealing to all of us?
The answer is surprisingly simple: To know the future is to live without UNCERTAINTY.
Please take a moment and think about this right now. "To know the future is to live without uncertainty……………"
You see, uncertainty is at the heart of what we call anxiety. In fact, it is a virtual truism that in the absence of uncertainty, there can be no anxiety at all. That's right. NO ANXIETY.
Our sense of certainty about almost anything is generally not absolute. Instead, it can be measured by degrees. The continuum below represents varying levels of certainty in regard to the occurrence of an event, which we'll call EVENT X. Each pole denotes absolute certainty, as shown below:
CONTINUUM OF CERTAINTY
-10___________________________0_______________________________+10
-10: Absolute certainty event X will not occur
+10: Absolute certainty event X will occur
*EVENT "X" REPRESENTS A POSITIVE TEST RESULT
Let's suppose you are due for a medical check-up. Based on the graph above, -10 would denote your sense of absolute certainty that the test results will not be favorable (i.e., you have health issues). Conversely, +10 would denote the opposite: Namely, your sense of absolute certainty that the results will be favorable (i.e., you have no health issues).
Now, here's the important question: What point on the scale best represents the maximum degree of anxiety you'd be likely to feel prior to obtaining the test results?
HINT: Recall the relationship between anxiety and uncertainty. Then, take a moment to think about this before reading the answer given on the next page...................
ANS: The maximum degree of anxiety you'd be likely to feel is at point "0" – the exact middle of the scale.
EXPLANATION OF ANSWER: Guided by their intuition, most people identify -10 as the point of maximum anxiety. This may seem correct, but it is not. Why? Because – as stated earlier – a sense of certainty, no matter the issue, brings relief from anxiety – not the other way around. Remember, -10 denotes your sense of absolute certainty that the test results will be unfavorable; meaning that you have health issues. It does not denote your disappointment or degree of distress about having medical problems.
Finally, another way to understand the role of uncertainty in regard to anxiety is to think in terms of extremes. Each pole on the continuum above represents an extreme. That is, whether event "X" will happen or will not happen. This decidedly unpleasant – "will it or won't it" happen feeling is something most of us experience at times when we're feeling anxious.
There are countless examples of these "will it or won't it" happen questions that make up our everyday lives:
- You're a high school senior and are wondering, "Will I or won't I get accepted into college?"
- Or, you're up for a promotion at work and the thought, "Will I or won't I get the promotion," keeps playing in your mind like a ping pong ball?
- Or finally, you want to have children but have had difficulty getting pregnant. Over and over you ask yourself, "Will I or will I not be able to conceive?"
Uncertainty, then, is the first component of the anxiety experience. Now let's consider the second:
Suppose you are asked, under two scenarios, to flip a coin. CASE A: You flip the coin just for the fun of it to see if it lands on a head or tail. CASE B: You flip the coin but must predict whether it will come up heads or tails. If you predict incorrectly, you'll lose your house!
First let's consider case A: In this instance it doesn't matter to you whether the coin comes up heads or tails. Why? Because the event has no personal significance to you. Now what about case B? If your house really was at risk, suddenly the outcome of the toss would matter a great deal. Meaning, the outcome would have great PERSONAL SIGNIFICANCE. And this is the point: Events which for us, have little or no personal significance, do not contain the potential for arousing feelings of anxiety.
Now, please take a moment to consider thoughtfully the following statement: "Events that are personally significant contain the potential for arousing feelings of anxiety…………………………………….….."
Not surprisingly, the second component then of the anxiety experience has to do with personal significance.
Taken as a whole, what the foregoing means is this: Anxiety is not some disease that invades the cells of our bodies. Neither is it a mysterious force that cannot be explained logically. Instead, it is – so far as we know – a uniquely human experience that is occasioned by two specific "situational conditions." These conditions are:
- AN EVENT OF PERSONAL SIGNIFICANCE
- UNCERTAINTY ABOUT THE OUTCOME OF THE EVENT
So far we have determined that two specific conditions occasion the experience of anxiety. What remains is to identify the context in which they occur. By this is meant, are we talking about the past, the present or the future? The answer of course is the future.
Events that have already happened do not arouse anxiety (though they may cause us to feel sad, disappointed or regretful). Nor does thinking about the present – the true present (e.g., watching birds soar in the air while at the beach).
It is only thoughts about the future (i.e., "what if," type thoughts), that arouse the potential for anxiety. Meaning, if we keep our attention focused constantly in the present (not an easy task) we will never feel any anxiety. How nice that would be!
To sum up then, we can now say that, anxiety is occasioned by the occurrence of two conditions which are invariably present in our experience each time we feel anxious. These conditions when viewed in the context of the future, explain fairly well, the mechanism by which anxious feelings are generated. We might even designate a formula to illustrate this relationship:
ANXIETY = a context of the future + an event or matter of personal significance + a feeling of uncertaintyregarding the outcome of the event.
Now let's look at the question, "what is anxiety," from a different perspective. Is it the same as fear, for example? The answer is, not quite, though the words are often used interchangeably. For the most part, fear can be thought of as predominantly a physical experience. This becomes evident when we consider the various metaphors used to describe fear (e.g., being in "the grip of fear", or "paralyzed with fear.") Such metaphors also underscore the fact that, unlike anxiety, fear usually implies some threat to our survival or our physical and/or mental wellbeing. We have only to imagine a Saber Tooth Tiger charging straight toward us to know this is true!
As we wind up this section on anxiety, you may be wondering, can we identify a common thread that elucidates our fundamental understanding of this construct? I firmly believe we can. And this is it: Whenever we feel unduly anxious, we also seem to feel a sense of trepidation that things are not going to turn out all right. This appears to be the core, irreducible psychological aspect of the anxiety experience.
There are countless examples in everyday life illustrating this notion: "Will my baby be born healthy?" "Will I get accepted to graduate school?" "Is my heart in good condition?" "Will I have enough money for retirement?" "What if I embarrass myself at the social event I have to attend this weekend?"
Each question represents an unknown. But most importantly, it is an important unknown that could have permanent adverse effects upon our lives (i.e., things may not turn out all right). The more this becomes true, the greater is the potential for experiencing the symptoms of anxiety. |
