Anxiety is a state of mind that obviously has a survival-protecting function and therefore, in-and-of itself, is not a disorder. Persistent (or episodic and recurring) and exaggerated (relative to a realistic assessment of the magnitude of the potential threat) states of anxiety are considered pathological — disordered. Anxiety disorders are the most common of all psychiatric disorders, estimated to afflict about 18% of adults in the Western hemisphere. The range of consequences of anxiety disorders stretches between mild and trivial to severe and completely disabling.
The sensation of anxiety is functionally a pain: A signal designed to redirect attention from where it is to where it is needed. As is the case with all forms of pain, anxiety can be acute or chronic. Chronic pain disorders, including chronic anxiety, increase the risk of chronic irritability, anger and depression (more accurately, despair; more on the distinction elsewhere).
Anxiety, like every pain, is distinct but inseparable from the experience of suffering, which can elicit misery. The suffering associated with the pain of anxiety is usually referred to as ‘stress’ (a detailed discussion of pain, suffering, and misery can be found here: https://wp.me/P7aKBB-3w ).
Also like all other forms of pain, anxiety can have an external trigger, in the surrounding environment, i.e., anxiety can have an extrinsic cause, or it can be intrinsic, i.e., generated internally — resulting from a problem in the nervous system itself, in which case it can be considered a ‘phantom-pain’.
Anxiety is unlike all other forms of pain in that at a low level it is part of the ‘normal operations’, contributing to sustaining wakefulness and alertness. The link between anxiety and wakefulness is illustrated by the fact that higher levels of anxiety are associated with increasing difficulty of initiating and/or sustaining sleep. Conversely, substances that directly reduce anxiety are sedating. For example, alcohol and anti-anxiety medications, such as Valium, Xanax and others; at a high enough dose these anti-anxiety substances will induce sleep — narcotize.
As the intensity of the anxiety-signal increases its benefits decrease: The initial wakefulness and alertness associated with low levels of anxiety give way to hyper-arousal, hypervigilance and, as mentioned above, insomnia. Elevated anxiety causes difficulty concentrating, a sensation of tension (both mental and physical), and ultimately results in an impairment of functioning. At a high enough level anxiety can become overwhelming (for example, in a panic attack), at which point deliberate mental operations may come to a temporary halt.
Medical research continues to produce valuable insights into the biochemical, cellular and anatomical underpinnings of anxiety. This has given rise to numerous pharmacologic and non-pharmacologic (e.g., brain stimulation and surgical) treatment options with considerable (albeit far from complete) efficacy. Fascinating as it is, this aspect of anxiety management is irrelevant to our present discussion.
What is centrally relevant to our discussion of the pursuit of happiness is that anxiety is inversely related to inner-peace: The more anxiety a mind experiences, the less inner-peace it has, and vice-versa. Moreover, anxiety is often experienced as a mental trap — it is difficult to “shake-off”, to move away from. This is to say that anxiety often registers as reducing freedom[glossary]. Loss of freedom is, firstly, a punishment, and secondly a challenge to inner-peace. Inner-peace is a prerequisite for the effective pursuit of happiness (along with passion and compassion, as discussed here: https://wp.me/P7aKBB-3C ). Therefore, anything that undermines inner-peace presents a hurdle in the pursuit of happiness, and anything that contributes to inner-peace supports it.
What follows are two conceptual/psychological models of anxiety that I present as the complementary, theoretical foundations for the two practice methods of anxiety-management discussed in the Practice section (https://whatilearnedsofar.com/practice/anxiety-management/ ).
The first model: Anxiety as a response to the perception of a potential threat.
The [glossary]state of mind associated with anxiety is similar, but not identical to a fearful state of mind. Their emotional component, i.e., the uncomfortable feeling associated with anxiety and fear is essentially the same. But their narratives are different: Fear is a response to the perception of an actual — i.e., objectively measurable, present and immediate threat. For example, the appearance of a predator in the immediate proximity, or the detection of a tumor in a brain MRI. Anxiety in comparison, is a response to the perception of a potential threat. For example, a noise coming from behind the bushes that might be caused by a hiding predator, or a headache that could be a symptom of a brain tumor that is yet to be diagnosed.
Anxiety is a much more sophisticated mental function than fear. A system assigned to the management of potential threats has to have an ability to recognize ominous meanings that exist in innocuous cues — i.e. an ability to recognize a neutral-appearing signal as harboring a threat before the threat actually materializes; this can be referred to as the system’s sensitivity. Additionally, a potential-threat management system has to have an ability to perform a statistical analysis — to estimate the probability that a perceived threat will actually materialize and either trigger a reaction or refrain from it; accordingly, this can be referred to as the system’s reactivity. In an ideal state a potential-threat management system is calibrated such that its sensitivity permits accurate discrimination of innocuous signals from innocuous-appearing but genuinely ominous signals. And, the system’s reactivity calibration permits accurate discrimination of low-likelihood threats, that can therefore be ignored, from high-likelihood or imminent threats that necessitate a response.
The added value of anxiety as a threat-management system (in comparison to fear) is unquestionable: Responding to the potential of a threat (rather than to the presence of a threat) is synonymous with an early response. The earlier the response to a threat is, the higher the likelihood of faring well in the encounter with it. However, the value of the early response depends on the system’s sensitivity and reactivity. The ideal system state is neither under-sensitive — i.e., the system does not overlook genuine threat-signals, nor over-sensitive — i.e., it can correctly dismiss irrelevant signals. Similarly, the ideal system state is neither over-reactive — i.e., the system does not trigger responses to threats that are unlikely to materialize nor, under-reactive — i.e., it is not too slow to trigger reactions when faced with a high likelihood of a threat materializing.
Under normal conditions, signals of low harm-potential and/or low probability threats are associated with a low level of anxiety. As mentioned above, a low level of anxiety has a positive value — it assists sustaining normal wakefulness. As the perceived potential for harm and/or likelihood that the threat will materialize increase, the corresponding level of anxiety rises. This results in a gradual shift of (mental and physical) resource-allocation to the task of threat-management, gradually leaving less resources for other, “routine operations”. Above a certain threshold level of anxiety, so much of the available resources become committed to threat-management that the “routine-operations” mode is replaced with a state of intensified, heightened physical and psychological responsiveness referred to as “survival mode”.
Anxiety disorders can be considered as inherent miscalibrations of a system’s base-line sensitivity and reactivity settings. An overly-sensitive system misinterprets benign signals as ominous. An over-reactive system overestimates the likelihood of a threat materializing. This will manifest with exaggerated responses to trivial and/or unlikely threats and, ultimately, with triggering “survival-mode” unnecessarily.
‘Survival-mode’ increases the chances of survival in an encounter with existential threats, but not surprisingly, at a cost. Sustained, lengthy “survival-mode” states have an accumulative cost, negatively impacting both physical and mental well-being. This is consistent with the observed association between anxiety disorders (which amount to prolonged or frequently recurring ‘survival-mode’ states) and an increased risk of physical (e.g., immune system disorders, cardiovascular disease) and mental problems (most commonly, depression).
It makes sense that the evolutionary design is to err on the side of overestimating threats, even with the added cost of “survival mode” in mind. Erroneously overestimating a threat results in an unnecessary, possibly costly expenditure of resources. This is affordable in comparison to the consequences of erroneously underestimating a survival threat — i.e., death, an unacceptable outcome from an evolutionary perspective. This understandable design-bias in favor of overestimating threats explains the almost universal prevalence of occasional problems with high anxiety and, at least in part, the high prevalence of anxiety disorders.
The practice of anxiety management (corresponding to the model presently examined) is geared to create an alternative to the automatic threat-management design. The practice aims to replace the reflexive sequence of mental events that begins with the perception of a threat (and ends with a behavioral response) with a systematic, rational examination. The process is geared to yield an objective, reliable assessment of the nature and magnitude of threats, the spectrum of possible outcomes, and one’s own degree of vulnerability. The mind’s resistance to substituting a fast, reflexive sequence with a slower, analysis-based approach is to be expected: ‘Downgrading’ a threat to a non-survival level tends to register as an attempt to invalidate an automatic, self-protecting mechanism. It should not be surprising that doing so would not be easy. But, it can be done. And, when accomplished, it is the beginning of reclaiming the mental territory hijacked by anxiety, and consequently, a regaining of mental freedom and inner-peace. The value of freedom and inner-peace in the pursuit of happiness can not be overestimated and hence, the effort is well worth making. And as is the rule — it does become easier with repetition, with practice.
The Second model: Anxiety as a result of the wish to control.
Firstly, note that there is no conflict between these two models. They examine anxiety from different points, yielding two different views that are complementary rather than contradictory. Each model has a practical utility; the one that works best in a given situation is the one to apply.
According to this model, anxiety produced by the collision of two mental forces: The wish to control something and the knowledge that controlling it is not an option.
To illustrate this, imagine a crash-testing operation in which cars’ safety is tested by driving them into a brick wall. Think of the control-wish as a car tested, and think of the wall it rams into as the knowledge that control is not an option. Anxiety then would be the noise produced in the collision. Anxiety management amounts to anything designed to reduce that noise level.
The analogy applies in a number of ways: The noise produced by such a collision has some of the features of anxiety: I imagine that living next door to such a crash-test facility one would find the noise generated by the repeated crashes bothersome, making it difficult to concentrate, relax, socialize (have guests over), and sleep. It’s easy to imagine getting jumpy and irritable if such a noise was persistent. If moving away or making the noise-producing activity stop were not available options, one would be very interested in methods that might reduce the noise level.
There are a couple of basic solutions one might consider: One is to use earplugs. Earplugs are likely to help, but have a downside — earplugs dampen all sounds indiscriminately, onerous as well as desirable. Additionally, they must constantly be within reach; the thought of not being able to get hold of the earplugs can paradoxically become a source of anxiety.
In this analogy, earplugs correspond to the use of anxiety reducing substances, such as alcohol and various types of anti-anxiety medications. Alcohol, which is an effective anxiolytic, is analogous to earplugs that (with repeated use) cause severe, potentially progressive and irreversible ear damage; and furthermore, it can become very difficult to stop using these earplugs, making it an unattractive option. Anti-anxiety medications are effective, but, as is the case for all medications, potentially cause side-effects. Common side-effects of anti-anxiety medications include sedation and a non-specific “dulling” that can interfere with experiencing life normally, analogous to the earplugs making it difficult to hear sounds one wants to hear. Furthermore, medications have the potential of causing dependency, the consequence of which can range from a mere annoyance to a serious problem.
The bottom line here is that medications can address the problem effectively, but with a cost — there really is no free lunch. (Note that both the positive and the negative effects of medications vary greatly. Some people are very sensitive to medications’ effects and others may hardly notice them. Therefore, choosing whether or not to use a medication in the treatment of anxiety is a personal choice that should be made on the basis of a pros-and-cons analysis specific to the person and the situation.)
Another way to reduce the noise level is to reduce the speed with which the cars hit the wall by backing off the gas pedal and reducing the energy produced by the engine (given the physics governing the noise’s production, a small reduction in the speed of collision would lead to a significant reduction in the noise produced by it). In our analogy this means reducing the energy behind the wish to control which is a key component of the psychological approach to anxiety containment: Replacing the wish to control something with a willingness to influence it amounts to reducing the anxiety around it. Developing the ability to substitute the wish to control with a willingness to influence takes some practice, but it is well worth the effort and it very likely to make a significant difference in impact of anxiety in one’s life.
A correct understanding of the concept of ‘Control’ should help to develop the ability to let go of it. ‘Control’, in the present context, refers to a relationship between a consciousness and some process. To have ‘control’ the consciousness must firstly have full and complete awareness of each and every variable that can potentially impact the process that is to be controlled, and secondly access to each and every one of these variables, such that it can be manipulated with infinite precision according to the wishes of the consciousness.
Obviously, in reality, neither such a complete awareness nor that level of manipulation are possible, ever. Therefore, in reality, control is not possible, ever, to anybody. The appearance of ‘control’ (one’s own or observed in another) is inevitably an approximation.
And, an approximation is not good enough. ‘Control’ is a binary concept: There is no such thing as “being in partial control”, any more than there is such a thing as “having more than complete control”. Conceptually, a process is either ‘under control’ or it is not. “Near control” — the approximation of control, is no control.
The unattainable prerequisites for ‘control’ dictate the concession that control is an abstraction: It can be imagined and it can be approximated, but it cannot be achieved. As such, ‘Control’ is in the same category as ‘Certainty’, ‘Guarantee’ ‘Happiness’ ‘Heaven’ and ‘Nirvana’ — imaginable, approachable (and worthy of the necessary effort), but forever unobtainable.
Coming to terms with the fact that, in reality, the human condition simply does not include the option of control may be somewhat bitter; but it does have a sweet side — accepting that control is unobtainable offers liberation from the fear of losing control: You can’t lose something that you never had!
Nonetheless, letting go of the illusion of control doesn’t come easy. Albeit subconsciously, our minds put up a fight to reject, or avoid accepting, this non-negotiable part of the contract with reality. This avoidance is a core feature of all anxiety conditions. Consequently, the opposite of avoidance — exposure, is at the core of the psychological approach to the treatments of anxiety disorders. The exposure can have many forms, depending on the specific treatment modality; often the exposure focuses on the perceived, or apparent, cause of the anxiety e.g., heights, spiders, etc.. With or without realizing it, therapeutic exposure is ultimately an exposure to the fact that control is not an option. Letting go of the attachment to the illusion of control, that is, acceptance of the fact that control is simply not an option, is a necessary, core element of transcending, or even just containing, anxiety.
While control is non-negotiably out of reach, what is achievable in reality is a varying degree of influence. Control can then be redefined as a relationship between a consciousness and a process, in which the consciousness has 100% influence over the unfolding of the process. Influence, in contrast with control, is not a binary phenomenon — it is a continuum.
Influence is not only possible, it is unavoidable — one cannot help but influence any process in which one participates. Thus, the human condition unfolds on a continuum of influence in which neither 0% (i.e., no influence) nor 100% (i.e., control) are possible.
(On a side-note: The fact that one’s influence cannot be reduced to zero provides the rational explanation for a role for morality ethics in the human condition: If indeed influence all that we come in contact with, then we exert much more influence than we can possibly be aware of. This, in turn, means that the risk of unknowingly exerting negative, or wrong, influence is always present. This risk can be reduced by conducting ourselves according to pre-examined guidelines, i.e. — moral and ethical principles. This increases the likelihood of exerting positive influence even when it is exerted unknowingly. Influence that expresses moral and ethical guidelines is more likely to be a positive influence than random or oblivious influence.)
Indeed, you personally, and humanity collectively, have arrived at this present moment without anyone possessing control — just influence. In other words, influence is evidently sufficient for each of us (and for all of us) to, at least, get this far. The distance covered to get “this far”, individually and as a species, may fall short of the imaginable, but it is nonetheless respect worthy.
Granted, ‘influence’ is not as glorious or as seductive as ‘control’. Control spawns the illusions of ‘certainty’ and ‘guarantee’ about the future, and ultimately supports the fantasies of arriving at ‘happiness’, ‘heaven’ or ‘nirvana’. But, influence is what we have. Embracing this offers the functional advantage that awareness of reality inherently has over an oblivious attachment to an illusion.
The illusion of ‘control’ is as prevalent as anxiety is, that is — it is universal. But, the attachment to the illusion is negotiable. With practice, it is possible to progressively improve the recognition of control for what it is — just an illusion. A recognition that supports a process that culminates with the letting go of it.
Psychiatry has defined a number of specific anxiety disorders which include generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder. Post-traumatic stress disorder has been considered an anxiety disorder until recently (when it was reclassified, unnecessarily, in my unconsulted opinion, under ‘trauma and stressor-related disorders’). Being that these are all anxiety disorders, their common denominator is the wish to control the uncontrollable. They differ in the focus of that control wish:
Generalized anxiety disorder patients suffer from persistent, excessive worry about real-life matters. Their pathologically intense control-wish is focused on facets of real life, such as their financial status, career, health, and family members’ well being. Because patients are aware of the fact that the control they wish for is not within reach, it is not a psychotic disorder. The persistent mental “collision” between the energized control-wish and the immovable realization that control is unobtainable, results in an ongoing loud and disruptive “ mental noise”, experienced as generalized anxiety. Consequently, patients with generalized anxiety disorder experience insomnia, irritability, difficulty concentrating and feeling physically and mentally keyed-up.
Panic disorder patients suffer from episodic bursts of high anxiety that are typically associated with an intense focus on their heart (panic disorder is the most common reason for emergency room visits for chest pain of non-cardiac cause) lungs, and at times, other internal organs. The wish to control the functions of these organs is often experienced as fear of dying. Alternatively, the control-wish in panic disorder can be focused on one’s own behavior, often expressed as a “fear of going crazy”, or on the ability to get away from a physical environment, often expressed as a “fear of getting trapped”. The “mental’ noise” produced by these high energy collisions can be so disruptive that, during the panic attacks, patients are unable to function at all.
Patients suffering from social anxiety disorder focus their control-wish on the way they are perceived in the minds of others. Impending or actual social situations trigger anxiety that results from the mental “collision” between the wish to control others’ perception (of the patient) and the recognition of its futility. An altogether avoidance of socializing is an understandable, albeit dysfunctional, strategy to circumvent the discomfort. Avoidance of social situations, which can be extreme and disabling, is a core symptom of the disorder. Another very common strategy that is often employed to dampen the anxiety “noise” is to use the “ear-plugging” offered by alcohol. This is at least a partial explanation for the extremely high prevalence of alcohol-use-disorders seen in patients with social anxiety disorder — about 20%, in comparison to about 6% in the general population.
Obsessive-compulsive disorder (OCD) can be understood as a manifestation of a wish to control one’s own mind: Obviously, to control anything (illusionary as that is) one must have control over one’s own brain — one’s own thoughts and mental processes. If your brain is “out of control” (which it is, like everything else) then nothing can be under control (and, nothing is). Obsessions are thoughts, images, or impulses that register in the patients’ mind as repeating reminders of the fact that their brain can produce material that is not only arbitrary, but can be (and typically is) in stark conflict with their own preferences and values. Compulsions are, by definition, a response to the obsessions. Compulsions are futile attempts to distract one’s attention from the uncomfortable admission of the uncontrollability of their own brain, and therefore, of life. Compulsions are meant to remove one’s attention from the “noise” produced by the “collision” between the wish to control one’s own brain and the admission that even that rudimentary level of control is unobtainable.
Post-traumatic stress disorder (PTSD) can be understood as a control wish focused on past events. Patients with PTSD have a wish (which may be conscious or subconscious) to go back in time and exercise control over events that have taken place in the past, and thus prevent their traumatizing experience. In focusing on the past, on controlling traumatizing events that had already happened, PTSD is different from the other anxiety disorders. As such, replacing the wish to control with a willingness to influence is an irrelevant approach — the past can neither be controlled nor influenced. The willingness to influence is effective when shifted to the relationship the patient has with their past: The past can be forgiven. Indeed, cultivating forgiveness is the key to recovery from PTSD.
So much on specific anxiety disorders. Let’s return to the general view of anxiety:
The human brain[/glossary is a statistical instrument: As part of routine ongoing functioning, the brain automatically rounds high-probabilities to 100% (inviting the seductive illusion of control) and low-probabilities to zero (permitting the distasteful illusion of complete helplessness). Rounding-off a high or a low probability to a certainty (of 100% or 0%, respectively) is acceptable in the name of functionality, i.e., it is justifiable in the name of “practical purposes” — it can help in the flow of making decisions and plans. For example, while agreeing to meet a friend for dinner at 7 pm, one briefly suspends the fact that the only certainty is uncertainty in order to get something on the books, rather than respond that the likelihood of actualizing the plan is only 80% with a 20% chance of a mishap preventing their coming to fruition.
Practicality does not justify ignorance. Ignoring the step of rounding a high probability up (or a low probability down) to a certainty amounts to manufacturing an illusion and then buying into it as if it was a discovered part of reality. The manufactured illusion of certainty goes hand in hand with the illusions of a guaranteed outcome which, in turn, support the seductive (and sometimes dangerous. e.g., when it serves as the foundations for fanaticism) illusion of control. In reality, uncertainty is certain and the only thing that is above doubt is the room for doubt (hence the only sensible fanaticism is the fanatical rejection of fanaticism).
A mind attached to the illusion of control is at risk of developing a conviction that the future is guaranteed to be worse than the present. Overlooking the abstract nature of ‘control’ and the unavoidable nature of our influence can threaten the pursuit of happiness. A practice designed to clarify and anchor these concepts as they pertain to anxiety is presented here: https://whatilearnedsofar.com/practice/anxiety-management/ and is worth serious consideration.