The Anxiety Spiral

therapy anxiety spiralThere’s a reason people use a spiraling image to signify anxiety. The image is instantly recognizable, and even a little anxiety-provoking! Anxiety often operates as a kind of spiral of repetitive thoughts, turning on themselves. You start with a bit of anxiety about something, and your anxiety spreads and grows, and then you become extremely anxious about being so anxious. If you experience social anxiety, you may begin with an anxious thought that people are focused on you which leads you to become extremely focused on yourself, which produces still greater anxiety.

The experience of anxiety falls along a spectrum, or continuum. You may have a bit of difficulty concentrating; perhaps you’re restless; you may be worried and have repetitive thoughts; and/or you may feel an unpleasant self-consciousness. On the extreme end, you may have panic attacks, a feeling of impending doom, you may fear that you’re losing control or dying or ‘going crazy’; you may be dizzy and lightheaded, faint, sweaty, you may have difficulty breathing, you may have chest pain or heart palpitations. You may even experience depersonalization – the feeling that you have changed, and the world has become far away. It may seem like you are looking through the wrong end of a telescope.

Too much anxiety (and interestingly, too little anxiety) has a negative effect on performance, and researchers have discovered an inverted-U curve of anxiety. Without some anxiety, you can be sluggish and unmotivated, but with too much anxiety you have difficulty focusing and feel disorganized.  Performance goes down on both ends of the curve. The optimal level is in between, when you are energized enough to function yet not so agitated you can’t concentrate or get things done.

Anxiety is not just an emotion; it has obvious physiological components – sweatiness, dizziness, flushing, and difficulty breathing, for example. Anxiety is sometimes treated with beta blockers, which can reduce some of these symptoms by blocking the chemicals that cause them. Speakers, actors, and musicians who experience performance anxiety often experience some relief from beta blockers because they can reduce the extreme symptoms to a manageable level.

There are cognitive components of anxiety, too; if you’ve experienced anxiety, you probably understand the tyranny of repetitive thoughts, the kind of groove your mind falls into, where no matter how hard you try to think of other things that are less anxiety-provoking, or no matter how hard you try to stop focusing on the anxiety, you just can’t. You’re stuck, going around and around and around. Anxiety fear anxiety fear anxiety dread, stuck.

People attach anxiety to all kinds of things. Perhaps you experience anxiety when your mother is coming to your home. Perhaps you experience anxiety when it’s time to pay the bills and you may not have enough money. Perhaps work is anxiety-provoking.  Perhaps you feel anxious about driving in a car or getting in a plane. These are relatively concrete “causes,” issues that may be addressed by avoiding what triggers your anxiety. This is not to say that it’s a simple story: fix problem, eliminate anxiety; rather, the point is that anxiety often has an immediate referent.

Anxiety can also be existential; Kierkegaard talked about ontological anxiety related to questions about life itself. “Where am I going with my life?” “Is death the end of everything?” “Does my life have any meaning?” These are existential questions, and they may quite readily provoke deep anxiety. The issues may need to be addressed differently than those with a concrete ’cause,’ the consequences feel enormous and vast, and the questions are possibly unanswerable.

Anxious thoughts  and obsessions might also provide an illusory attempt at control. You may have been very worried about something in your life, and even though you know that worrying can’t help, hanging on to that worry gives you the feeling of doing something. Anxiety might also serve as a distraction from something underneath the issue you’re focusing on. Anxiety about going on a date may be a mask over your deep fear of being lonely for your whole life or your fear of extreme helplessness. Anxiety may be distracting you from a seemingly unbearable hurt, or fear, or anger. As unpleasant as the anxiety is, it’s more bearable than facing those deeper concerns which are rooted inside. Of course, you may not be consciously aware of those painful depths.

Real therapeutic work may involve working through the feelings which are under the experience of anxiety rather than working through the thoughts alone. Cognitive behavior therapy (CBT) may walk you through a process of identifying extreme thoughts, etc., but it doesn’t address the deeper issues which cannot be resolved with such concrete steps. For deeper resolution and integration to occur, one needs to confront, experience, and work through the issues underneath the anxiety. It’s important to note that anxiety and depression frequently occur together and they must be addressed together to resolve them both. Anxiety therapy and depression therapy are not separate endeavors.

Article Name
The Anxiety Spiral
Anxiety is a common reason people seek therapy, and the resolution of anxiety may require working through issues underneath the anxiety rather than simply identifying the thoughts. Depression and anxiety often occur together and should be treated together.

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma. I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years' experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information:
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