First Steps on the Road to Recovery from Excessive Anxiety

By David A. Clark, PhD, author of The Negative Thoughts Workbook, The Anxious Thoughts Workbook, The Anxious Thoughts Workbook for Teens, and Overcoming Obsessive Thoughts

Why am I feeling so anxious? How many times have you asked this question? Possibly you’re having a reasonably good day, then suddenly you feel hot, tense, and shaky. Your stomach is in knots, and you’re overcome with a powerful sense of apprehension. You just know something bad is about to happen, and now your day has been ruined by runaway anxiety.

Start at the Beginning

We all know what it feels like to be anxious. When this feeling of being on edge, agitated, or nervous persists, causing great personal distress and inability to function, anxiety is a problem that cannot be ignored. But anxiety is a complicated emotional state that can differ from one situation to the next, change over time, and differ from one person to the next. You can think of anxiety like a rope. Just as a rope consists of many strands of fiber twisted together, anxiety consists of several basic psychological processes. Which of these processes are present and how they interrelate determines how you experience anxiety. The first step in recovery from anxiety is knowing the unique combination of processes that characterize your anxious feelings. Once you’ve identified these processes, you’ll know which cognitive behavioral therapy (CBT) strategies will be most effective in calming your anxious mind. 

The Building Blocks of Anxiety

There are thirteen basic processes involved in anxiety. Anticipatory anxiety, fear of fear, and post-event processing are four of these processes. (This Is What Anxiety Looks Like has a complete list, explanation, and illustrations.) Each deal with a different aspect of anxiety. Anticipatory anxiety is the nervousness you feel even thinking about an upcoming dreaded event; fear of fear is feeling anxious about being anxious; and post-event processing is worrying that you embarrassed yourself in front of others. Not all of these processes will be relevant for your anxiety experience, and the most relevant processes may change over time or from one situation to the next. That’s why it’s important to gain a better understanding of your anxiety before doing any treatment. There are three things you’ll need to know:

• Triggers: What makes your anxiety worse? Are there certain situations, thoughts, or sensations that cause me to feel more anxious? Most people can list ten to twenty situations that provoke their anxiety. Some of these triggers will cause more intense anxiety than others. 
• Processes: What do you notice about your anxiety experiences? What symptoms are most distressing? Consider each of the thirteen processes, and decide which are most important in your experience of anxiety.
• Goals: How is anxiety interfering in your life? What are the specific tasks, responsibilities, or activities you’d like to do that anxiety is preventing?

Social Anxiety: A Case in Point

You can’t make progress on your anxiety without a plan. This simple, three-step outline gives you all the information you need to develop your own treatment plan for anxiety. Here’s how it can work.  Let’s say you have social anxiety. You avoid social situations as much as possible because you feel intense anxiety around people. We start by listing the triggers. In this case, various situations trigger your anxiety such as giving a speech, talking in a group, feeling like you’re blushing, initiating a conversation, being assertive, dealing with confrontation, and the like. You could put these situations in a hierarchy from the most to least anxious. You might decide to start working on the less anxious situations.

Next, you identify the processes most critical to your social anxiety. You might need to keep a diary of your anxiety experiences to gain insight into these processes. In our example, you might find anticipatory anxiety, anxious helplessness, avoidance, and post-event processing most important. You can then select the CBT strategy most effective in changing each process.

In the final step, you consider how social anxiety is preventing you from reaching several important goals. You might list sitting alone in a restaurant, inviting a friend over for dinner, speaking up at work-related meetings, or joining a gym as goals you’d like to achieve. You can use these goals to determine your progress in overcoming anxiety. The sign of success, for example, is not going to the gym with no anxiety, but rather that you are going to the gym despite feeling anxious—and, over time, the anxiety lessens.

Know Your Anxiety

Often, anxiety can feel so mysterious; it seems to come and go for no apparent reason. When anxiety is intense and unrelenting, the first step is to demystify the experience by identifying the triggers, processes, and goals that will show you how best to overcome anxiety. It is possible to strip away the mystique of anxiety, and discover why you feel so anxious.

David A. Clark, PhD, is a clinical psychologist, and professor emeritus at the University of New Brunswick in Canada. He is author of several books on depression and anxiety, including Overcoming Obsessive Thoughts, The Anxiety and Worry Workbook, The Anxious Thoughts Workbook, and The Negative Thoughts Workbook. He has coauthored several books with the pioneer of cognitive behavioral therapy (CBT), Aaron T. Beck, including Cognitive Therapy of Anxiety Disorders.