If you struggle to cope with anxiety, I guarantee you have developed patterns of avoidance to minimize feelings of distress. The current prevalence of trigger warnings accompanying TV shows, live performances, and social media posts may make avoidance appear to be an appropriate strategy. But protecting yourself from potential triggering content or situations will only heighten your anxiety, make it harder to tolerate in the long run, and seriously affect your enjoyment of life.
I am not suggesting a head-first plunge from the high board into the deep end of the anxiety pool as a means of overcoming trauma or unpleasant feelings. You can start at the shallow end, dip a toe in, and then ease in slowly, if the gradual approach suits you better. Ultimately, though, you have to get wet.
Minimizing avoidance is the rationale behind Exposure and Response-Prevention treatment, the primary evidence-based behavioral treatment for OCD and other anxiety-driven syndromes. There is even a protocol called Prolonged Exposure used to treat PTSD symptoms stemming from serious traumatic events such as combat. Any type of exposure treatment involves seeking out triggers and learning to tolerate the discomfort they provoke (or, in the case of Prolonged Exposure for PTSD, reliving the trauma over and over by visualizing it repeatedly).
For debilitating anxiety or trauma, you should undertake exposure exercises only with the support and guidance of a qualified professional. But if you see yourself opting out of situations that simply make you uncomfortable, such as social events, driving, or even shopping at a different grocery store, you can find opportunities to push yourself toward the discomfort every day.
Whenever I catch myself finding excuses not to engage in an activity that makes me nervous, I try to practice what I preach and do it anyway.
In the fall I organized a group of neighbors to play Pickleball. We were all beginners, equally clumsy and clueless, and it was fun. But then an injury sidelined me. I didn’t play again for four months, until a few weeks ago, when I was invited to join a group of regular players. Most of them play daily. They are at a level far above mine, and they are very competitive.
Despite considerable trepidation, I forced myself to go. I was embarrassed by my lack of skill and felt myself transported back to middle school, when I was the last to be picked for the team in whatever sport we were playing. I am not exaggerating when I say I felt close to tears.
I really wanted to make an excuse never to return. Which is exactly why I forced myself to go back the next week, and then again a few days later.
I am still the weakest link but my skills have improved. More important, I am proud I didn’t let my feelings of awkwardness and discomfort get the better of me. I may or may not keep playing with the group, but if I choose to stop or look for other, less intense Pickleball partners, I can be confident I am not letting anxiety drive my decision.
So get out there. Force yourself to do whatever your anxious brain is telling you to avoid. Don’t let it boss you around. You will be glad you pushed back and stopped letting anxiety control you.
The new Coronavirus outbreak has infiltrated our public consciousness, and it is exhausting. When the media are constantly bombarding us with updates about fatality counts and quarantines, even the most unflappable are finding it hard to stay calm. Everyone seems to be running to the nearest supermarket to stockpile disinfectant wipes, bottled water, and canned goods. So how are people with health anxiety and OCD—who are already prone to excessive worry about uncertainty, contamination, and illness— supposed to cope?
In treating anxiety, I use the evidence-based approach called Exposure/Response Prevention to help people tackle their fears and limit the compulsive behaviors, such as excessive washing, designed to make them feel less anxious about risk. But some of the practices my colleagues and I would typically recommend for someone with contamination worries, such as limiting hand-washing and avoiding the use of hand-sanitizer, fly in the face of current public health recommendations. Even so, if you keep in mind the rationale for exposure-based approaches to anxiety, which is to learn to tolerate discomfort and uncertainty, you can still come up with a personal plan allowing you to follow reasonable disease- prevention guidelines without letting your anxiety skyrocket and control your behavior.
This is a challenging time for all of us. But we don’t need to make it worse than it already is by fueling our anxiety. If we practice responding to the uncertainty with reason and thoughtfulness rather than reacting out of panic, everyone will benefit.
Update: When I wrote this post only ten days ago, the coronavirus situation was very different from how it is now. The current national emergency mandates strict social-distancing practices, which make my advice to carry on normal activities no longer medically sound. or feasible.
I will be writing another post in the coming days with tips for staying sane while stuck in the house.
People have strong opinions about New Year’s resolutions, as I’ve been learning over the past week. In the one camp are the Resolution Deniers, who say that resolutions are stupid, pointless, and scientifically proven to fail. In the other are the diehard Resolution Proponents, who embrace the idea of wiping the slate clean and use the start of another year as a motivation to change their undisciplined ways.
Most Resolution Proponents choose two or three popular areas for improvement: diet, exercise, organization and time management. My own vaguely considered goals for the year—all of which I’ve already failed to meet—include:
But my modest attempts at self-betterment pale alongside those of a couple I met at a New Year’s Eve party last week. Together they had made 310 resolutions for 2019. How is it even possible to find so many personal habits in need of improvement?
They started off the year—and it wasn’t even midnight yet—quarrelling about how to fulfill one of the items on their list (which they had written down lest they forget any). The host, a potter, invited her guests to choose an item from her studio to take home with them so she could start making progress on one of her own resolutions for the year: to declutter. But despite the generous offer, the super-resolution couple couldn’t decide if they should take her up on it because it conflicted with their own decluttering goal. They finally reached an agreement: they would accept a vase but wouldn’t allow themselves to bring it into their house until they first got rid of something else.
I wholeheartedly endorse efforts to change. Modifying behavior is, after all, my stock in trade. But in the therapy I do, I also stress the importance of acceptance. Accepting yourself at any given point in time—new year or not—means acknowledging the reality of what is and using that as the starting point.
So if you haven’t exercised in the last six months, say, deciding to go to the gym for an hour a day would be a recipe for failure. When reality collides with unrealistic expectations, people who don’t allow for acceptance often just give up instead of modifying their goals to make them more realistic.
So go ahead and make those resolutions. Just try to work on them imperfectly. You know you’ll mess up. But you can start again, January 1st or not. If you practice acceptance, you’ll be giving yourself a better chance at achieving those three—or 310—resolutions you made for 2019.
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.