“Learning to know anxiety is an adventure which every man has to affront…He therefore who has learned rightly to be in anxiety has learned the most important thing.”
Soren Kierkegaard, The Concept of Anxiety
As life is uncertain and filled with risk, we all experience anxiety from time to time. When facing important decisions, confronting worries, reflecting on the fragility of life or the inevitability of death, anxiety is a normal response. For some, anxiety is fleeting and does not disrupt the ability to function. But for others, anxiety is debilitating and chronic. It interferes with normal day-to-day functioning and acts as a barrier to a fulfilling and meaningful life. Those in the latter group suffer from an anxiety disorder.
In this two-part series we explore the nature of this psychological disorder. In this first video, we clarify what distinguishes ordinary anxiety from an anxiety disorder, and we examine what causes these disorders to develop and persist. In the second video, we turn to practical insights for recovery and introduce a relatively new, and paradoxical, therapeutic approach that has proven to be highly effective.
Every year more than 19 percent of American adults are diagnosed with an anxiety disorder, and one in three suffer from one at some point in life. There are several types of anxiety disorders, each with its own characteristics and symptoms. The most common is generalized anxiety disorder, or GAD, which is defined by persistent, excessive, and exaggerated worrying.
“Individuals with GAD report feeling anxious or apprehensive most of the time…problematic worry is a key feature of this disorder. GAD should be conceptualized as essentially a disorder of worry.”
Aaron Beck and David Clark, Cognitive Therapy of Anxiety Disorders
Social anxiety disorder, or SAD, is the second most common anxiety disorder. At its core is an intense fear of embarrassment, rejection, or humiliation in social situations. Individuals with SAD do not simply feel anxious when in public; they experience anticipatory anxiety and are weighed down with dread in the days or weeks leading up to a social event. Sufferers of SAD also experience post-event or evaluative anxiety. They replay conversations in their minds, scrutinize and criticize their social performance, and interpret others’ reactions in ways that confirm their fear of negative judgment.
“…people with social anxiety feel like all eyes are focused on them.” write Seif and Winston. “They often describe their distress as a form of unbearable over-self-consciousness. Anxiety can often reach the intensity of episodes of panic attacks, but doesn’t necessarily escalate to that point. People with severe social anxiety may describe themselves as “paranoid,”…”
Martin Seif and Sally Winston, What Every Therapist Needs to Know About Anxiety Disorders
While individuals with GAD or SAD may experience panic attacks due to excessive worrying or social anxiety, panic disorder is a distinct anxiety disorder. It typically begins with an unexpected panic attack that arises due to excessive stress or substance abuse. Afterward, the person develops a highly sensitive fear of having another panic attack, and this fear often triggers the very panic attacks that they worry about.
“Panic attacks are psychologically painful experiences, and patients often describe the feeling as the beginning of an endless nightmare. While in the process of panicking, patients fear going crazy, having a heart attack, having a stroke, going blind, losing control, doing something embarrassing or humiliating, or dying…First panic attacks are often so traumatic that they are ingrained in the patient’s memory with exquisite detail.”
Martin Seif and Sally Winston, What Every Therapist Needs to Know About Anxiety Disorders
A final type of anxiety disorder is obsessive compulsive disorder, or OCD, which consists of two components: obsessions and compulsions. Obsessions are intrusive, repetitive thoughts that feel disturbing or threatening, while compulsions are the behaviors performed to reduce the anxiety those thoughts provoke. A common manifestation of OCD involves obsessive thoughts of being contaminated or catching a disease. This leads to compulsive washing or cleaning in an effort to neutralize the perceived threat. Another common form of OCD is compulsive checking. For example, a person has the obsessive thought that the stove was left on and then feels the need to check, repeatedly, to ensure it is off.
“OCD is a complicated and sometimes profoundly disabling disorder. It consists of two components: Obsessions increase anxious distress. The other component is compulsions, which are actions or thoughts whose function is to lower anxiety.”
Martin Seif and Sally Winston, What Every Therapist Needs to Know About Anxiety Disorders
Although anxiety disorders manifest themselves in different ways, they share a common foundation. All of them are driven by a fear of fear itself.
“People with an anxiety disorder do not merely feel fear, they fear fear. They are frightened by their feelings of fear. They are anxious about being anxious. Being frightened of the fearful feelings is an essential component of having an anxiety disorder.”
Martin Seif and Sally Winston, What Every Therapist Needs to Know About Anxiety Disorders
To understand the fear of fear that underlies anxiety disorders, we must briefly summarize two distinct pathways which our mind uses to detect and respond to potential threats.
