Anxiety is highly unpleasant. It causes physical discomfort—shortness of breath, muscle tightness, dizziness, queasiness—and mental anguish. In all my years of clinical practice, seeing thousands of people with anxiety, I have never encountered anyone who has not desperately wanted to get rid of it.
Earlier in my career, I was a dedicated advocate of techniques aimed to reduce, if not entirely eliminate, anxiety. I taught progressive muscle relaxation for tension- and pain-reduction, deep breathing to manage panic attacks, and thought-challenging to address catastrophic thinking. But in recent years, these approaches are no longer regular staples of my clinical repertoire. Like many of my cognitive-behavioral colleagues, I have changed the focus of treatment from reducing anxiety to learning to accept and manage emotions, even negative ones like anxiety, while embracing uncertainty with the aim of living a richer life.
Practicing acceptance requires a major shift in attitude. For most people with anxiety, avoidance is the most common coping strategy. But avoiding anxiety-provoking situations and triggers comes with a steep cost: a flat, joyless existence.
Think about anxiety as a wave in the ocean. If you try to outrun it, you may end up crashing into the shore with skinned knees and a mouthful of sand. But if you dive into the middle of the wave, it will wash over you and lose its momentum as it reaches the beach.
Why is it worth it for you to dive into the wave? If you can answer this question − hint: consider what values are important to you − you will finally be able to stop avoiding discomfort and start living a more fulfilling life, anxiety and all.
With summer travel in full swing, you may be tempted to look for “hacks” to make your packing and departure easier. Many are perfectly innocuous and even helpful. Rolling your clothes to maximize suitcase space or stuffing your shoes with your socks and underwear? Good ideas!
But if you have OCD and get stuck checking appliances, light switches, and door locks prior to leaving on a trip (or even for just the day), I would strongly advise you not to listen to the Lifehacker tip to take photos of your stove, thermostat, and appliances prior to travelling to ease your anxiety about having left something turned on.
It may be tempting to sidestep the checking process by snapping pictures to reassure yourself that you won’t have started a fire or caused a burglary. For a short time, your anxiety may lessen. But if you have OCD, the relief you feel will undoubtedly be short-lived.
Compulsions such as checking do serve to relieve anxiety in the short run. But they tend to escalate and demand more and more time because the doubt returns. The intolerance of uncertainty is a core feature of the thinking patterns fueling compulsive checking and other OCD behaviors.
Rather than checking over and over (or taking pictures) to feel certain, you need to train your mind to accept the lingering feeling of doubt by practicing—preferably before you go away for an extended period of time—setting a limit on the number of times you allow yourself to check and leaving even if you feel the urge to go back for another once over. The key is deciding ahead of time, rather than letting anxiety guide your actions. If you typically check appliances or the door ten times, say, start by cutting back by ten percent. When that becomes easier, reduce the number of checks again, and so on, until you are down to one or two.
When leaving for vacation, you can allow yourself an extra check (but only if you decide on the number in advance). Taking a picture might seem tempting, but it won’t lessen your discomfort if you have OCD. I’ve had patients tell me they’ve tried the picture hack only to question whether they might have turned the stove back on or plugged the iron in again after taking the photo.
So come up with a plan in advance, practice over and over before your trip, and save the photos for the sights you want to capture on your travels.
With vaccine distribution increasing and states relaxing restrictions on indoor gatherings, many of us are contemplating the prospect of resuming activities long abandoned over the last year. Some people can hardly wait to board a plane for a Hawaiian vacation or gather at a favorite restaurant with friends; others are feeling, as one patient of mine put it, “not ready for things to go back to ‘normal.’”
And what does “normal” even mean in the current context?
We know from studies conducted after the quarantines imposed during the SARS epidemic that the mental health ramifications of even short (more than 10 days) periods of enforced isolation are not trivial. Reactions included post-traumatic stress disorder, avoidance behaviors, and anger, lasting in some people for several years. Research conducted in the aftermath of the COVID pandemic is already uncovering similar—and even more pervasive, given the duration—patterns.
The absence of in-person social interactions over the last year may make it especially hard to go back to seeing people face-to-face (or, mask-to-mask, as it likely will be for quite some time) for those prone to social anxiety. Avoidance is a prevalent coping mechanism, albeit not a healthy one. It might relieve anxiety in the short run but over time, avoiding triggers backfires because it prevents practice.
Returning to the office or seeing friends in the flesh might feel awkward because social skills have grown rusty. And heightened body awareness might add to the uneasiness. Wearing “hard pants” after a year of working from the couch in sweats can feel strange and uncomfortable, especially for those (22% by one estimate) who have put on some weight during the pandemic.
People with OCD may fear seeing even fellow vaccine recipients unmasked and cling to washing and decontamination rituals adopted early in the pandemic, even if they are no longer deemed necessary. The over-estimation of danger is a thinking style common to all anxiety disorders. And as one recent study showed, news reported by media outlets in the US skewed overwhelmingly negative—87% of COVID coverage in national US media, compared with 64% in scientific journals, emphasized bad news—adding to the atmosphere of threat for those hypersensitive to it.
Even in the absence of preexisting mental-health issues, nearly all of us will experience some degree of post-traumatic stress, complicating our return to a BC (Before COVID) life. The trauma of actual illness and of losses—of lives and livelihood for many—have left deep emotional scars. Navigating the reentry into the world will take time, patience, and understanding, of others and ourselves. We all are grappling with a confusing mixture of emotions: excitement, fear, and even nostalgia for the early days of quarantine, when decisions were more black-and-white and unambiguous, and a sense of being “in it together” prevailed. Current times present a much higher level of uncertainty, making life far more complicated.
Acknowledging difficult feelings and allowing them to surface rather than trying to push them away are important strategies for coping with any challenge to emotional equilibrium. The road to the new “normal” will be rocky. But cultivating an attitude of acceptance will make the path less treacherous.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.