Imagine your life as a path that leads in a meaningful direction.  This path represents your values.  Your deep priorities.  The things you hope to do and see and touch and taste while you have the opportunity.

Say someone asks you a very tough question: “How do you truly want to live your life on Planet Earth?”  The path represents your honest answer after years of research and reflection.

It would be great, in a perfect world, if our paths were clear: unhindered routes completely free of obstacles or impediments.  But our world is not perfect, so our paths will not be clear.

Sometimes they will be very large and other times quite small.  Sometimes they will be close together, other times far apart.  As long as we walk our course, though, there is one thing we can count on: Anxiety swamps will appear on the path before us.

Yet this alone is not the dilemma.  Certainly, the fact that swamps of anxiety stand on our path isn’t cause for celebration.  But it is not the dilemma, either.

The dilemma is born from our response to the swamps, rather than the swamps themselves.  The swamps rise up and we flinch back.  The swamps emerge and we diverge.  We have a strong tendency to avoid anxiety — an ingrained inclination.  And because anxiety swamps show up on one’s path in life, this avoidant tendency causes great disruption.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Anxiety is part of life.  It is the cost of admission of the human condition.  It is the price of the ticket to go on this ride. Life is hard and wonderful and bumpy and beautiful, and anxiety is just a part of it.

The fact that anxiety is part of life, however, is not the source of our problems.  Anxiety itself is a feeling.  It is an unpleasant feeling.  An aversive feeling.  A feeling no one should have to experience in a severe and endless way.  But it is still just a feeling: an unpleasant, harmless feeling felt by every creature on Earth.

Anxiety problems, on the other hand, are more serious than a feeling.  They take our time, they take our freedom, and they take our opportunities.  And anxiety problems don’t arise directly from the feeling called “anxiety.”  They arise from how we relate to it.

Take the issue of anxiety disorders, such as generalized anxiety disorder, social phobia, and obsessive-compulsive disorder.  These and other diagnoses affect a quarter of all Americans.  They are the main reason anxious people end up in psychotherapy.

Yet anxiety disorders are not caused by anxiety alone. Instead, they emerge as syndromes of avoidance.  In other words:

When we worry too much . . .

or wash our hands too much . . .

or don’t make eye contact when we should . . .

or steer clear of safe-but-scary places . . .

or make to-do lists we don’t need . . .

or check and recheck and recheck the locks . . .

or excessively seek reassurance . . .

We are trying to avoid anxiety itself.

First and foremost, then, most anxiety problems are not really anxiety problems.  Most anxiety problems are really avoidance problems.  Avoidance is what keeps us anxious and disrupts our lives. Avoidance transforms a harmless feeling into a dilemma.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

There are many forms of psychotherapy and many of them are good.  When it comes to anxiety, though, the evidence is now clear: cognitive-behavioral therapy is the most effective treatment.

In 1993, the American Psychological Association appointed a special team to determine which therapeutic approaches work for particular problems.  Its findings in the anxiety category were very simple: All effective treatments were forms of CBT.  For this reason, experts around the world — from the National Institute of Mental Health to the Mayo Clinic — strongly recommend CBT for the treatment of anxiety.

As with most good things, there is something of a catch: for CBT to really work, we must really work.  Cognitive-behavioral therapy usually has a “face your fears” component, where we push ourselves into the world and confront the things that scare us.  This, as you might imagine, is easier said than done.  But research shows it is very doable, and the rewards are worth it.

To learn more about CBT, please visit The Association of Behavioral and Cognitive Therapies or The Mayo Clinic.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Let’s make sure we are on the same page before continuing onward.  While anxiety is a part of life, it is definitely not the only part.

There is also a joyfulness to existence.  A jubilation in getting to do this.  A grateful exuberance that accompanies the act of living.  Sure, we’re faced with a dilemma.  But we also have been given a gift.  And the approach ahead helps us receive it, whether we are anxious or not.

It helps us live a freer life within a wider world.  It helps us experience the things we deeply want to experience.  It helps us do what matters and works, even when we’re anxious.  This is what the work ahead is really all about — learning to fully embrace one’s life regardless of anxiety.

There is another benefit of the approach that follows, though: predictable and measurable anxiety reduction.  It is true that being anxiety-free is not a practical goal.  We live in a bumpy-but-beautiful world, and anxiety is part of the package.  At the same time, having low anxiety levels is very realistic.

A wonderful thing happens when we change how we relate to anxiety.  It drops!  It drains!  It wanes!  It dwindles!  It attenuates, moderates, reduces, and abbreviates!  Time after time, studies find that going away from anxiety strengthens anxiety, while going through it lowers it.  Total peace is very hard to find in a world with built-in challenges.  But when it comes to most anxiety problems, reasonable peace can be found by facing anxiety with courage.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Many definitions of anxiety have been offered throughout history.  For our present purpose, it can be defined as a sense of apprehension or dread about something that might happen in the future.

Imagine walking a dark and dangerous jungle path where tigers may lurk in the underbrush.  Would we feel warm and fuzzy at this moment?  Not likely.  We would probably experience anxiety: a sense of being threatened.

“Don’t just sit there, do something!” anxiety demands.  “Something you value may be threatened. Identify the possible threat and defend against it!”  This is the unpleasant, activated essence of anxiousness.  If we could visually capture what it feels like, it might look like this:

Anxiety, Edvard Munch (1894)

A tense apprehension.  A keyed-up feeling of dread.  A sense of, “Don’t just sit there, do something!”  We will later see that other factors, like thoughts and attention, also play roles in anxiety.  But boiled down to its essence, anxiety is an unpleasant feeling.  It is the looming sense that something could threaten the things we care about deeply.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

The terms “anxiety” and “fear” are often used interchangeably.  While closely related, however, the two experiences have different biologies and distinct functions, and are not the same:

• Anxiety arises when we believe something in the future might threaten us
• Fear arises when we believe something in the present is threatening us

• Anxiety is the feeling that accompanies the thought, “There might be a tiger!”
• Fear is the feeling that accompanies the thought, “There’s a tiger right there!”

• Anxiety involves keyed-up apprehension or dread
• Fear involves panic attacks: sudden rushes of intense discomfort

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

All of us experience it.  Half of us struggle with it.  A quarter of us suffer from one of its disorders.  So why does the feeling called “anxiety” exist in the world in the first place?

To answer this question, we must review one of science’s most important ideas: the theory of evolution.  “Nothing in biology makes sense,” renowned biologist Dobzhansky observed, “except in the light of evolution.”  The same comment could be made in reference to anxiety.  Little about it makes any sense unless we grasp how it came to be here.

As an evolution refresher, picture two monkeys: one with a tail and one without one.  Both monkeys do quite well during times of peace and prosperity.  But when there are too many predators or too little food, the former has an advantage.

Thanks to his bonus appendage, the tailed monkey can hang from trees to collect bananas and stay out of trouble.  Meanwhile, his tailless relative is stuck on the ground, picking up scraps and dodging tigers.  This means the tailed monkey would be more likely to survive and, if his romantic efforts were successful, produce baby monkeys.  The result?  More monkeys with tails and fewer without them.

Anxiety emerged through a similar process.  It evolved because it helped us survive.  It is here because it helped us be here.  It exists because it helped our species exist in the world in the first place.

Now, many of us have wished we would never feel anxious again.  But what would happen if this wish were granted?  Might we be a little less cautious crossing the street?  A little less vigilant about our health?  A little more inclined to blast down the highway without a seatbelt, singing, “I can’t drive 55”?

And how might these behaviors impact our life expectancy?

Anxiety is “adaptive,” to make a long story short, because it helps us defend against threats.  Because it promoted survival in the course of our natural history, it was selected and maintained by evolution.  The cavemen below illustrate the point.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

According to “evolutionary mismatch theory,” there is a tension between our ancient biology and the modern world.  This tension plays a role in many issues, from drug use to excessive eating.

Human characteristics arose from evolution.  But the bulk of our evolution took place between 1.8 million and 150,000 years ago.  This means our traits evolved to help us survive in the Paleolithic era, when hunting, gathering, and escaping from predators were central tasks.  And because evolution tends to work quite slowly, many of these characteristics remain alive and well today.

Yet the present-day world is vastly different from the world that shaped our species.  Hunting and gathering became working and shopping, footpaths are now highways, and tigers morphed into the prospect of war.  Needless to say, the side effects of these changes can be quite significant.

Imagine how a caveman would feel while walking through our hustling, bustling world.  Cars whizzing by, strangers all around, information bombarding him from every direction: The potential of encountering threats would seem virtually endless.

Perhaps this is partially why 50% of Americans struggle with anxiety.  And a quarter develop anxiety disorders.  And $50 billion is spent each year on anxiety treatment.  Being equipped with our ancient biology is like taking a machine for one purpose and applying it to another: like using a snowmobile to commute to work in July.  This mismatch will not stop us from getting where we are going, but it makes for a bumpy ride!

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Many of us are anxious about being anxious.  If anxiety gets too strong, we assume, something terrible might happen.  Maybe it will kill us.  Or make us lose control.  Or induce a nervous breakdown.

But there is good news here.  There is no such thing, from a scientific perspective, as a nervous breakdown!  The most extreme anxiety possible is still just anxiety, not a stage or step toward something scarier.  And no anxious moment — no matter how strong — will make an otherwise-healthy person die, lose control, or go crazy.

As a thought experiment, take the worst anxiety you have ever experienced.  Now double it.  Now double it again.  Now multiply by 525.  So what are you dealing with now?  You are still just really anxious.  No craziness, no heart attack, no profound loss of control.  Anxiety is just anxiety, and it is just not dangerous.

For evidence, look no further than cognitive-behavioral therapy.  The most effective techniques in CBT are about facing anxiety head-on: about feeling it fully.  And we don’t see patients dropping like flies in the midst of treatment!

Anxiety is definitely unpleasant but won’t make anything terrible happen.  Evidence suggests that anxiety is a universal feeling, and evolution would not have made us all feel anxious if it was harmful.  When dealing with anxiety, then, have faith in nature’s wisdom.  Anxiety is not dangerous because we are built to bear it.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Avoidance, avoidance, avoidance.  Most roads in our dilemma lead back to this behavior.  But before avoidance becomes a problem, it starts as an inclination: a strong, ingrained tendency to avoid anxiety.

This avoidant tendency is not a real surprise.  Experiencing anxiety is clearly unpleasant.  And humans are not the biggest fans of unpleasantness.

We are also innately skilled at steering clear of discomfort by distancing ourselves from its source.  Instructions are not required when our hands touch hot objects.  The avoidance of pain is intuitive.

Yet few feelings inspire avoidance as strongly as anxiety — this keyed-up sense of dread, this uneasy apprehension.  We are naturally inclined to recoil from it as a matter of reflex.

Our avoidant tendency, like anxiety itself, arose from evolution.  Back when cavemen roamed the Earth, anxiety was triggered by actual dangers that could and should be avoided.  Running into tigers.  Running out of food.  Ending up isolated and alone.  These were the threats that haunted our ancestors, and it indeed made sense to avoid them.

And how did our predecessors handle the process of avoiding threats?  By avoiding anxiety!  When a creature avoids anxiety, it also avoids the threat that triggers it.  By avoiding the anxiety evoked by the tiger, our ancestors avoided the tiger.

This sequence of “experience anxiety –> avoid anxiety –> live to fight another day” is older than any living species, and served us humans very well in our natural history.  Avoiding anxiety made good sense when it was triggered by avoidable threats.

In fact, avoiding anxiety is still very wise — when it is evoked by threats that can and should be avoided.  We would probably feel anxious, for example, if we found ourselves in an abusive relationship.  Or walking in the middle lane of a busy highway.  Avoiding anxiety in these scenarios helps us escape from real hazards.

So let’s be clear.  There are certainly times when it makes sense to engage in avoidance.  There are definitely times where we should avoid anxiety to escape from the escapable threats that evoke it.

But there are other times — many, many other times — when avoiding anxiety is not the solution to our problems.  It is the problem itself.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

By now, a logical question has likely made an appearance.  If avoiding anxiety is protective, what is so bad about it?  Why is avoidance disruptive if it helps us deal with threats (i.e., avoid anxiety = avoid the tiger)?

Because this ancient function has been short-circuited in the modern world.

Avoidance indeed played a critical role in our natural history.  We feel anxious, from an evolutionary perspective, when we sense that we are threatened.  And we avoid anxiety, from an evolutionary perspective, to escape from threats that evoke it.

For present-day human beings, however, the relationship between anxiety and threats has partially come untethered.  We still experience anxiety, of course.  But when we feel anxious now, there is often nothing we could or should be doing to defend the things we value.

Most of the time, there are no predators to drive back by building fences.  No starvation to ward off by hunting for food.  No rivals to repel by sharpening spears.  Yet we still feel anxious.  We continue to experience anxiety in the absence of actionable threats: threats we could feasibly act upon through our own initiative.  We are anxious in the absence of tigers.

Here is the kicker.  Anxiety is not just disconnected from threats in contemporary life.  It also tends to be connected to areas of personal value.

To clarify, there are occasional times when anxiety seems to appear at random.  A strong cup of coffee plus a poor night’s sleep plus a vulnerable moment in the rhythms of our nervous system . . . kaboom!  Anxiety makes its entrance.

More often than not, though, anxiety does not operate in this haphazard manner.  Anxiety is the feeling that arises when something we value seems threatened.  As a result, it is especially likely to emerge in areas of importance, going hand in hand with things that we do not want to lose.

Imagine carrying two bags through a dangerous area: one filled with gold and the other filled with dog poop.  If a robber tried to take your belongings, which would you dread losing?

On closer inspection, the connection between anxiety and value makes solid sense.  After all, this was evolution’s “plan” from the very beginning.  Evolution gave rise to anxiety to help us defend important things, such as our lives themselves, our bonds with others, and our prized possessions.  Consequently, it is naturally apt to appear in areas that matter to us most.

Anxiety will surface in our jobs because this is how it works.  Anxiety will show up in our relationships because this is what evolution selected it to do.  Anxiety does not arise at random, so avoidance does not disrupt our lives at random.

It causes systematic disruption in areas of great importance.

And so a dilemma is born.  At some point in the distant past, anxiety avoidance was adaptive (i.e., avoid anxiety = avoid the tiger).  But now anxiety

• appears when there are no threats to deal with, and
• tends to accompany areas of personal value.

Our avoidant relationship to anxiety thus no longer serves its intended function on a reliable basis.  It once was routinely productive, but now it is counterproductive.  It once got us out of a jam, but now it gets us into a jam.  It once came with benefits, but now it comes with costs.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Anxiety is a sense of apprehension or dread about things that might happen in the future.  It is the feeling nature provided to help us defend against threats.  Because threats are part of life, anxiety is part of life.

Like all animals, humans have a powerful tendency to avoid anxiety.  This tendency helped us survive in our prehistoric environment and is occasionally still useful.  But problems arise when an ancient reflex is applied to modern living.

In today’s world, we experience anxiety in important areas, even where actionable threats do not exist.  We continue to feel anxious when there is little we could or should be doing to defend the things we value.

Nonetheless, we respond to anxiety exactly as we did 150,000 years ago: through avoidance.  This avoidant tendency now has serious costs . . . unless we do something about it.

And do something we certainly will.  But we need a deeper understanding of our dilemma before we work on resolving it.  In upcoming entries, let’s take a look at the science.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Imagine arriving at work one morning and a coworker shares a rumor: layoffs may be coming.  Even though this information was received from a single source, we decide that it is valid.  Layoffs could indeed occur in the next few weeks.  Yet we don’t just assume they could occur.  We jump to the conclusion they will occur.

Of course, many people work at our company, so it is unclear who will actually lose their jobs.  But we remember receiving a look from our boss and suddenly have a hunch.  Layoffs are bound to happen, and we are very likely to be among those laid off.

But at least we can find another job, right?  Not so fast, our anxious brain reminds us.  This is a catastrophe in the making.  Layoffs will happen, we’ll lose our job, and not find other work.  Who knows what happens next.  Losing our house?  Losing our family?  Losing the very things that we value most?

The example above illustrates two thinking mistakes related to anxiety.  Anxious people pay special attention to threatening information, and a pair of anxiety-fueling errors arise from this attentional bias:

• overestimating the likelihood of bad things happenings, and
• underestimating our ability to cope with them.

The drama plays out like this:

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

The science of anxiety can be complex.  Luckily, there is a model we use in CBT to help us keep our bearings.

Most anxiety problems consist of three components:

The three components work together in a coordinated dance.  Anxious feelings lead to anxious thoughts.  Anxious thoughts lead to anxious feelings.  And avoidant behavior acts as the glue, holding the problem together.

*Panic attacks involve other physical sensations, such as shortness of breath, accelerated heart rate, sweating, shaking, and chest pain.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Anxiety and depression are closely related, and many people struggle with both.  Yet research shows that the two experiences are not the same.

When we are anxious, we feel as if negative events may occur at some point in the future.  Our sense of control is shaky but not entirely absent, which makes us highly inclined to engage in avoidance (i.e., doing something instead of just sitting there).

In contrast, depressed people feel as if negative events have already occurred, and there is nothing they can do about it.  The defining behavior of this helpless state is not avoidance.  Depression is a syndrome of withdrawal.

Depressive withdrawal creates great problems for modern human beings.  Yet as biologist Randolph Ness observed, the tendency to “do nothing where there is nothing useful to do” makes evolutionary sense:

Imagine a monkey that lives in a cave.  Every December, its territory becomes overrun with tigers.  And now it is November 1, so the monkey is currently anxious about the arrival of its feline neighbors.

“Soon there could be tigers everywhere, and I might not be able to collect enough bananas to last through the winter,” the anxious monkey thinks to itself.  “But maybe — just maybe — I can if I frantically scurry around!”

When December 1 arrives, however, the threats of the future are no longer potential.  They are here and happening now.  “Tigers are everywhere and there’s nothing I can do,” the depressed monkey concludes as it creeps back into its cave.  “I am helpless and hopeless.  Better lie low, keep out of trouble, and wait for brighter days.”

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

A caveman walks an ancient path in the fading light of evening.  His head swivels from side to side, scanning for signs of danger.  His eyes quickly dart from right to left.

Suddenly, something rustles in the ferns beside the pathway.  What was that?  A tiger?  A rival clan member?  The caveman’s head stops moving as he stares at the rustling ferns intensely.  His world just became a very small place.

This is how attention works in the context of anxiety.  Research shows that anxious people often have an “attentional bias” for threatening information, which makes us predisposed to finding signs of possible danger.

Say everything in the world is divided into four categories: fences (i.e., protective things), flowers (i.e., positive things), coffee cups (i.e., mundane things), and tigers (i.e., threatening things).  Anxious people are not overly attentive to fences, coffee cups, or flowers.  But we do tend to focus intensely on signs of tigers.  When a plane is taking off, for example, we notice scary-but-harmless noises more than the sound of healthy engines.  Our attention is biased toward focusing on threats.

This attentional bias, as you might expect, can really fuel anxiety — especially when it gets turned inward.  Anxious people often monitor their internal worlds the same way they engage in external threat scanning.  This makes us hyperattuned to the mechanics of our bodies, particularly those related to danger and performance problems.  Illuminated by a narrowed attentional spotlight, a heartbeat sounds like a thunderous drum and a tiny voice quiver seems deafening.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Imagine reading an advertisement on a late-December day: “Participants Wanted — Paid Experiment.”  Finding ourselves tight on cash after holiday shopping, we decide to go sign up.  We are greeted by a researcher when we arrive at the facility, who attaches an electrical device to our arms.  At random times throughout the day, the researcher tells us that the device will deliver a painful-but-harmless shock.

Then she reveals the important part: There is a secret behavior that instantly turns the shock off.  The researcher will not say what it is, however. It  might be standing on our heads, spinning in circles, or squawking like a chicken.  The shock-deactivating behavior could be any action.  The point of the experiment is to see how fast we find it.

A couple hours later, we receive our first shock: buzzzzzzzzzz!  Not a pleasant experience.

We first attempt to turn off the shock by clapping our hands, but the shock keeps shocking us.  Then we try snapping our fingers, which also does not work.  Buzzzzzzzzzzzz!  Finally, in a spirit of desperation, we stop everything and do a halfhearted tap dance on the sidewalk.  And it makes the shock turn off!  Phew!

But it is not long before the shock reactivates.  Buzzzzzzzzzzzz!  This time, though, we know what to do: tippetty, tip, tap . . . tippety tip tap.  We go right back to tap dancing, more energetically this time. And the shock turns off again.  Double phew!

By the third shock encounter, we are skilled at turning it off.  We really commit to tap dancing at this point, doing our best to look like Fred Astaire.

This cycle continues the rest of the afternoon.  Buzzzzzzz! –> tap dance –> shock turns off –> phew! . . . Buzzzzzzz! –> tap dance –> shock turns off –> phew!  Before we know it, we tap dance the day away in the name of avoiding a feeling.

This is the hidden motive behind most forms of avoidance.  First and foremost, avoidance is not about getting away from things it the world.  It is about getting away from anxiety itself.  Avoidance takes on many forms, but all serve this common function.  We engage in avoidance to minimize the length, strength, and frequency of our encounters with anxiety.  We engage in avoidance, whether we know it or not, to reduce our experience of anxiousness.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Most anxiety problems, we have seen, are really avoidance problems — and the thing we are trying to avoid is anxiety itself.  Observing our dilemma from a high level, we do this in two different ways. By

• not engaging in behaviors that increase anxiety (passive avoidance), and
• engaging in behaviors that decrease anxiety (active avoidance).

Passive avoidance means avoiding by non-doing, or escaping anxiety by not doing things that bring us into its company.  I think of this as the classic form of avoidance, because it is what we usually have in mind when we use the word “avoidance.”

Picture anxiety as one positively charged magnet and yourself as another.  At times, anxiety repels us from situations where it appears.  If work makes us anxious, we avoid going to work.  If a conversation is anxiety-provoking, we avoid the conversation.  This is passive avoidance.

Active avoidance is another way of avoiding anxiety.  Unlike passive avoidance, active avoidance isn’t about not doing things.  It is about actively doing things in an attempt to escape from anxious feelings.

Obsessive-compulsive disorder (OCD) provides a good example.  Some people with OCD wash their hands 100 times per day, at two minutes per wash.  That is over three hours of handwashing, which exceeds the standards of hygiene!

Why, then, would we wash our hands until they are raw and chapped?  Because this behavior is an active form of avoidance, reducing our anxiety briefly but dramatically.

On the surface, there are many forms of avoidance.  Some forms are passive, where we avoid anxiety by not doing things.  Other forms are active, where we avoid anxiety by doing things.  As we’ll see in upcoming entries, however, all forms of avoidance are driven by two common factors: (a) negative reinforcement and (b) the non-occurrence of negative outcomes (NONO).

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

]]> http://realanxietysolutions.com/blog/passive-versus-active-avoidance/feed/ 0 http://realanxietysolutions.com/blog/avoidance-and-negative-reinforcement/ http://realanxietysolutions.com/blog/avoidance-and-negative-reinforcement/#comments Wed, 06 Feb 2013 21:00:07 +0000 http://realanxietysolutions.com/blog/?p=488

To get a sense for reinforcement, picture a mouse in a box. On the inside of the box, there is a lever. If the mouse presses the lever, it is rewarded with a food pellet. After a while, it will press and press without hesitation to obtain its reward:

• press lever –> get food –> feel good (e.g., Yeah!) –> press lever again in future

 

This is an example of positive reinforcement, where behaviors that increase positive feelings tend to be repeated. But positive reinforcement does not play a substantial role in our relationship to anxiety. The main concern here is negative reinforcement.

 

Imagine the same mouse in the same box with the same lever. No food is involved this time, however. Now, there is an electrical grid on the floor of the box, which delivers a mild, continuous shock to the mouse’s poor little paws: buzzzzzzzz!

 

Luckily, there is a way to turn it off. When the lever is pressed, the shock instantly deactivates. A reasonably bright mouse will quickly learn to press that helpful lever:

• press lever –> get rid of shock –> feel better (phew!) –> press lever again in future

 

This is the powerful phenomenon of negative reinforcement, where behaviors that decrease negative feelings tend to be repeated.  Think of an anxiety-provoking event in your life. For some, this might be a speech or a toast at a wedding. For others, it could be an overseas flight or an overdue breakup. As the event grew closer, our anxiety might steadily increase: perhaps reaching a 9 on a scale from 1 to 10.

 

But what if, on the morning of the event, we decide to bail? For most of us, this would be a major “Phew!” moment. Our anxiety might rapidly plummet from 9 to 3, which would be a great relief. As a result, we would be very likely to repeat the avoidant behavior. This is an example of negative reinforcement: feel anxious –> avoid –> anxiety goes down –> avoid more in the future.

 

People are not mice, of course. Yet the entire animal kingdom learns by reinforcement:

 

 

 

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

]]> http://realanxietysolutions.com/blog/avoidance-and-negative-reinforcement/feed/ 2 http://realanxietysolutions.com/blog/the-anxiety-nono/ http://realanxietysolutions.com/blog/the-anxiety-nono/#respond Tue, 19 Feb 2013 23:33:04 +0000 http://realanxietysolutions.com/blog/?p=502

In our last post, we explored the first avoidance-fueling factor: negative reinforcement.  I call the second factor the Anxiety NONO, which stands for the “non-occurrence of negative outcomes.”   The Anxiety NONO has its roots in a happy situation.  Because we overestimate the likelihood of bad things happening, our worst-case scenarios usually do not come […]]]>

In our last post, we explored the first avoidance-fueling factor: negative reinforcement.  I call the second factor the Anxiety NONO, which stands for the “non-occurrence of negative outcomes.”

 

The Anxiety NONO has its roots in a happy situation.  Because we overestimate the likelihood of bad things happening, our worst-case scenarios usually do not come true.  Our loved one walks through the door completely safe and sound.  That cold is just a cold and our health remains intact.  The scary things we think will happen usually don’t actually happen.

 

This is excellent news.  But what happens when we engage in certain behaviors to reduce the chances of bad things happening?  And what happens when we connect these behaviors — in the back of our mind — with the fact that nothing happened?  The math looks like this:

 

 I thought something bad might happen.

+      So I did X, Y, or Z.

+      Nothing bad happened.        _

=      Maybe nothing bad happened because I did X, Y, Z . . . better keep doing X, Y, or Z!

 

Consider the example of compulsive checking.  Some people verify that locks are locked over and over at night: check-check, check-check, check-check.  The vast majority of the time, they wake up the following day and everything is fine.  As a result, a superstitious assumption builds in the back of their minds:

 

 I thought an intruder might enter my home.

+      So I checked the locks over and over again.

+      No intruder entered my home.        _

=      Maybe no intruder entered my home because I checked the locks over and over again . . . better keep on checking!

 

 

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

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Quitting smoking is tough and people don’t do it for fun.  They quit because smoking has costs.

In the same way, it takes hard work to resolve the problems caused by chronic avoidance.  It is very possible and important.  But it can be hard.

So before we work on resolving our dilemma, it helps to understand exactly why the work is needed.  Grasping the stakes of any game affects the way we play it.  And knowing the costs of excessive avoidance helps us refuse to pay them:

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

It is one of life’s great ironies.  We go to tremendous lengths to avoid anxiety.  Yet the things we do to avoid anxiety actually keep us anxious.

Say we measure our average anxiety on a scale from 1 to 10.  Over time, why does anxiety remain at 7 or 8 instead of dropping to 3 or 4?  Because excessive avoidance

• prevents corrective learning and
• obstructs habituation.

1.  Avoidance Prevents Corrective Learning

Imagine two anxious children who think of school as a scary place.  Monsters may lurk in the corners of hallways, bullies may be waiting to pounce, parents may never be seen again . . . Getting on the bus would not be easy for either of these kids.

But suppose one child goes to school despite her anxiety.  By doing so, she discovers that her scary predictions are false.  Day after day, she arrives safely home without monster encounters.  Day after day, she rarely deals with bullies (and when she does, she deals with them fine).  Over time, a calming discovery arises from the child’s consistent courage:  She is still here and can do this, whether she is anxious or not!

The other anxious child refuses to go to school.  As a result, he does not experience the same anxiety-reducing learning.  Monsters may indeed be waiting, for all he knows, because he is unable to test his worst-case scenarios.  In his mind, the only reason he is safe is because he avoided school.

How can we learn there are no threats in areas we will not go?  And how can we learn we can do something well when we never do it?  By preventing such corrective learning, avoidance preserves anxiety over months, years, and decades.

2.  Avoidance Obstructs “Habituation”

Avoidance also maintains anxiety by obstructing habituation.  Thanks to habituation, unpleasant feelings usually lessen when we are repeatedly exposed to their source.  Imagine a prankster sneaks up and yells “boo!” while we are reading this paragraph.  Would we jump? If our nerves are working, we would.  But what about if he yells “boo!” again a minute later?  And then again?  And then again?  Eventually, we would stop jumping.  Our brain is too efficient to crank out needless responses.

Unfortunately, chronic avoidance can disrupt this positive effect.  Imagine standing near a smelly garbage can. As unpleasant as this may be, the smell would gradually fade.  But what if we escape the odor by holding our noses?  Each time we release our nostrils, we will have a distasteful olfactory experience.  Hold nose –> release –> smell is still there!  Hold nose –> release –> the nasty smell is still there!

Avoidance obstructs habituation in a similar manner.  We can’t get used to something if we prevent ourselves from experiencing it.  Likewise, when we don’t let habituation work by engaging in avoidance, we lose an opportunity for anxiety reduction.

This paradox underpins our dilemma.  We engage in avoidance to escape from anxiety.  Yet by disrupting firsthand learning and habituation, avoidance is the very thing that keeps us anxious.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Avoidance creates and maintains the symptoms of anxiety disorders.  People with OCD, for example, often check and recheck to ensure a task is complete.  Studies show this checking is an active form of avoidance, with each check followed by brief anxiety reduction (“phew!”).

This is the case for most anxiety symptoms.  When we worry excessively, seek reassurance, or perform repetitive rituals, a single motive is at play in the back of our mind.  Symptoms we think of as anxiety are actually ways we avoid anxiety.

Consider the example of worry.  Worry is the act of thinking about the future in a repetitive, “what if” manner.  What if lose my house?  What if I lose my job?  You know the drill.  Worry is incredibly common.  And for those who worry way too much, it is a way of avoiding anxiety.

This surprising fact is well-supported by research findings.  There is a device called a skin conductance sensor, for example, that measures physiological symptoms of anxiety.  When anxious people worry while attached to this device, something remarkable happens. Their anxiety decreases!

The process unfolds as follows:

• Experiencing anxiety makes us feel threatened.  This is especially unpleasant when anxiety is free-floating (i.e., not triggered by obvious threats) because there is nothing we can meaningfully do about it.
•  Our brain responds to anxiety’s demand — “Don’t just sit there, do something” — by identifying something to worry about. This may or may not be the thing that made us anxious in the first place. It’s that lingering financial issue. It’s that recent social mishap. It’s the troubling state of world affairs . . .
• We then think about the worry topic (or identified threat) in a repetitive way, creating the illusion that we are preparing for threats.

Experiencing anxiety, then, is like encountering a problem: the problem of feeling threatened.  And worrying creates the false impression that we are doing something to solve it.  The result?  Small-but-significant anxiety reduction and negative reinforcement.

Like excessive handwashing, worry also promotes itself through the Anxiety NONO.  Imagine worrying about a loved one while she is out of town .“I hope she is OK.  What if something terrible happened?  How come she hasn’t called?”  Our anxious brain twists and churns and spirals.

Several days later, after worrying and worrying, our loved one arrives home safely. Unfortunately, our brain connects excessive worry with her safe arrival:

         I thought something bad might happen to my loved one.

+      So I worried about her.

+      Nothing bad happened to my loved one.

=      Maybe nothing bad happened because I worried . . . better keep on worrying!

This is how most anxiety symptoms work.  Behaviors like reassurance seeking, repetitive handwashing, and checking temporarily reduce anxiety, just as pressing a lever turns off a shock.  This reduction — and feeling of “phew” that accompanies it — reinforces future avoidance.

Such behaviors also trick us into believing that our safety results from avoidance.  Things are only OK because I sought reassurance.  My relationship is only OK because I called over and over again.  I’m only OK because I planned, prepared, and protected.

Together, the combined forces of negative reinforcement and the Anxiety NONO cause avoidance to snowball.  Checking produces more checking.  Preventative behaviors result in more preventative behaviors . . .

And worry leads to more worry.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

No one likes feeling anxious.  And no one enjoys worrying for hours on end.  Yet the biggest cost of avoidance is not the way it keeps us anxious or maintains our symptoms.

The biggest cost of avoidance is how it impacts effectiveness.

Many people believe that anxiety affects performance.  And excessive anxiety can, to a limited extent, disrupt performance in certain types of activities.

For example, it is hard to perform well as a flute player when anxiety makes our hands shake.  Psychologists call this the Yerkes Dodson Law, which holds that performance is maximized when we experience moderate levels of anxiety.  Too much or too little anxiety can interfere with particular tasks.

Much more often than not, however, it is the way we react to anxiety — not anxiety itself — that disrupts performance.  Say a squirrel has a natural tendency to collect nuts from five locations.  With this unrestricted routine, getting things done comes easy.

But what if the squirrel becomes anxious in three of these locations, and then starts avoiding them?  In one fell swoop, over half its options are no longer options.

Think of this as a process of tool removal.  Imagine we have four tools for handling our business: a wrench, saw, screwdriver, and hammer.  Now suppose we feel anxious while using three of these tools and engage in avoidance.  We lose 75% of our tools on account of avoiding a feeling!

This is just no good.  It is tough enough to be effective when we have all our options.  But when avoidance restricts our routine and steals the tools from our belt?  It becomes quite hard to get things done in challenging situations.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Most anxiety problems, we’ve explored, are really avoidance problems.  The dilemma isn’t that we’re anxious.  It’s that we excessively avoid anxiety . . . and this avoidance keeps us anxious and disrupts our lives.

Fortunately, cognitive-behavioral therapy (CBT) provides a way to overcome this issue.  It might take a month.  It might take a year.  But within a finite period of time, we can make a change that stops anxiety from causing major life disruption.  From a broad perspective, this change is represented by the letters GTNA:

Anxiety strengthens and gains power when we routinely go away from it.  Anxiety fades and loses its power when we go through it instead of away from it.  This change, on one level, is unified and global: a singular adjustment that we make in relationship to anxiety.

On another level, our GTNA change can be broken into parts.  Think of it as a CALM adjustment:

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

“Courage.”  The word is familiar, but often misused.  Images of gallant knights come to mind, laughing fearlessly as they gallop into battle.

Yet soldiers and first responders know that courage is not the absence of fear.  It is the act doing what needs to be done when we are in fear’s presence.  Experts of various kinds endorse this perspective:

“Courage is being afraid but going on anyhow.”

– Dan Rather

“Courage is not the absence of fear. It is the ability to act in the presence of fear.”

– Bruce Lee

“I learned that courage was not the absence of fear, but the triumph over it.”

– Nelson Mandela

Taking care of business in spite of it.  “Playing ball” in the face of it.  Staying on one’s personal course whether it arises or not.  To prevent anxiety from limiting our lives, we need not remove it from our lives.  Rather, we can purposely practice courage in a common scenario: When we are at Point A, our priorities are at Point B, and anxiety is in the middle.

Unto itself, anxiety only has a single power: the power to make us feel uncomfortable on a short-term basis.  Yet avoidance grants anxiety a wide array of bonus powers.  The power to disrupt important life events.  The power to determine what we say with our mouths and what we do with our feet.  The power to make us feel uncomfortable on a long-term basis

Courage strips anxiety of these avoidance-acquired powers, transforming it back into a feeling that will fade over time.  This returns us to the subject of control.

Much of resolving anxiety problems — and much of effective living, in general — comes down to the management of control.  More specifically, it requires assuming control in some areas and relinquishing control in others.

Pretend that we get an allotment of control in our lives, and say it looks like a sack of quarters.  These quarters represent all the things we can do and everything we can make happen.

Now imagine putting quarters in one of two buckets.  The first is a “controlling anxiety” bucket.  We allocate quarters to this bucket by trying to control how long anxiety lasts, how strong it feels, or how often it arises (which usually backfires).

The second receptacle is a “controlling how you live in the face of anxiety” bucket.  We add quarters to this bucket by behaving in effective ways within anxiety’s company; by living as we would if anxiety were absent.

On one level, courage is an exercise of control reallocation.  With practice and guidance as needed, we decrease our attempts to control anxiety . . . and increasingly control how we live in
anxiety’s presence.

We invest in the wrong project by struggling to control anxiety: a project that is not necessary and does not work.

Yet there is an alternative project in which we can and should invest.  We can control our hands and legs when we are feeling anxious instead of trying to control anxiety itself.  By reallocating control in such a manner, we greatly reduce the control anxiety has over us.

In cognitive-behavioral therapy (CBT), though, courage is not a vague idea or esoteric concept.  It is something we practice systematically through step-by-step “exposure.”

Exposure involves steering toward anxiety in a purposeful manner, or intentionally going to find the feeling we usually try to avoid.  Prior to completing exposures, some patients are so fearful of germs they won’t play with their children.  Or so concerned about traveling they won’t go a block from their homes.  A few months later, they are playing games of patty cake and booking trips to Europe. Exposure, research shows, rapidly yields results.  It is an exercise in courage, and its benefits can be breathtaking.

Unfortunately, a blog cannot give justice to the exposure process.  Consult with a licensed professional to learn more about this highly effective approach.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Recall that an anxious mind is biased toward scanning the world for threats.  Our brain searches for tigers more than fences, flowers, and coffee cups.  Once a threat is identified, two things tend to happen: perseveration and elaboration.

Perseveration involves thinking about something over and over again.  For example, we may spend hours asking ourselves, “What if I lose my job . . . What if I lose my job . . . What if I lose my job?”  Perseveration is repetitive and unproductive.  It seems like we are working on solving a problem, but we are really just spinning our wheels.

Patients describe elaboration as “going down the rabbit hole.”  It involves engaging with thoughts that cross through our minds, as if we are dancing or wrestling with them.

There is always a distinction between having a thought and actively thinking.  The thought, “What if I lose my job?” may simply pop into our heads.  Once it is there, however, we start elaborating.

“What if I lose my job?  Oh, I won’t lose my job — I got a good performance evaluation recently.  But how will I pay my mortgage if I do? And what will others think of me? Wait, I’m not going to lose my job.  But there were layoffs recently.  What if I lose my job?”

When Thought A enters our minds, we are merely having a thought.  When we go from Thought A to B to C to D to B to C to D to A, now we are actively thinking.  This is what it means to engage in elaboration.

Here is a recap of how anxiety affects attention and what happens next:

With practice, a technique called “attentional control” cuts off this perseverative, elaborative process and allows anxiety to fade over time.  The task is noticing when our attention wanders to anxious thoughts.  To do so, it helps to use the statement, “There I go again.”  Then, we gently but firmly shift our spotlight back to relevant present events.  This includes work activities, conversations, television shows, sporting events, birdsong, lovemaking, music playing, and anything else that is happening now.

A top view of this process looks like the following:

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Imagine playing catch near a swampy body of water.  When the ball inevitably lands in muck, someone has to retrieve it.

There are two ways to handle this task.  We can plod through the swamp in a steadfast manner, grab the ball, and plod back.  Alternatively, we can gingerly walk in a hesitant fashion, flinching each time muck touches our ankles.

Experience suggests that the former, unflinching approach is the preferable strategy.  Why?  Because a healthy portion of swamp-related discomfort is not caused by the swamp itself.

It is brought on by attempts to resist it.

The same goes, research shows, for many forms of discomfort.   Make a pie chart of the suffering caused by anxiety.  A slice of the pie is not caused by anxiety itself, but by our efforts to avoid it.  Make a pie chart of the suffering caused by pain.  One of those slices is not caused by pain itself, but by our attempts to fight it.  Struggling against feelings and thoughts often makes them worse.  This is why it makes sense to practice “letting go.”

To let go of something is to accept it; to refrain from making attempts to change it, at least for the time being.  The form of acceptance most applicable here is an evidence-based technique called “experiential acceptance.”

We have a rich array of inner experiences as human beings.  Experiential acceptance means letting these experiences unfold without trying to weaken them, strengthen them, shorten them, lengthen them, or otherwise change them in any way.  It is the act of allowing thoughts and feelings to simply be as they are.

To practice experiential acceptance, we let anxiety “do its thing” unfettered by attempts to control it. Imagine anxiety as a wave that wants to act like wave.  Waves tend to emerge, rise, and fade in a smooth, fluid manner.  This is how anxiety is inclined to behave as it moves through our body.  It wants to appear, swell to a peak, and gradually dissipate.

But when we attempt to control anxiety, we interfere with its natural course.  This gives it a jagged, jerky, lurchy feeling that makes it more unpleasant — like a wave that crashes unpredictably instead of rising and falling fluidly.

Now picture having two windows built into your body: one on your chest and one on your back.  The first lets anxiety in when it is ready to come in.  The second lets anxiety out when it is ready to go out.  This is what it is like to accept anxiety.  When an anxious wave is rolling toward you, lift up your windows and let the wave flow through.

Intuitively, it seems as though resisting anxiety would make it better and acceptance make it worse. Studies strongly show, however, the opposite is the case. Anxiety fades and becomes less disruptive when we work on letting go.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

Managing something and mastering something are two different things.  In the three steps above, we have not been trying to manage anxiety, or directly influence its length, strength, and frequency.  Instead, we have been mastering how we live in the face of it.

At the same time, no solution to any problem is black and white.  Sure, a healthy diet is the key to weight loss .  .  . but what about regular exercise? The main way to lower anxiety is to stop it from managing us: to prevent it from controlling how we live and determining what we experience.  But there are some effective ways to directly manage it.

Aside from medication, effective anxiety management strategies fall into three categories.

Let’s briefly look at each anxiety management category.

Cognitive reappraisal.  Reappraisal is a tool for managing anxiety by changing how we think.  It helps us feel less anxious by adjusting anxiety-provoking thinking.

Recall why this technique is helpful in the first place:

Notice how attentional bias creates two anxiety-fueling thinking errors by constricting our awareness.  Also observe how reappraisal corrects these mistakes by broadening our awareness.  We are not trying to eradicate anxious thoughts through cognitive reappraisal.  We are striving to see the rest of it.    

Relaxation training.  Picture stress as water in a bucket.  The higher the water level, the more stressed we are.  And the more stressed we are, the more likely it is that we’ll be anxious.

Relaxation training is a way of managing anxiety by lowering the level of stress in our bucket.  Hypothetically speaking, being stressed at an 8 might give us an 80% chance of feeling anxious.  Dropping our stress levels to a 4 lowers our chances to 40%.  Research particularly supports the use of two relaxation strategies: progressive muscle relaxation (PMR) and diaphragmatic breathing.

Healthy living.  We are probably all aware of the mind–body connection.  The way we live affects how we feel.  Our physical health impacts our psychological health.

This presents another opportunity for anxiety management: Leading a reasonably healthy lifestyle decreases our tendency to feel anxious.  Research shows that three lifestyle areas are especially important: sleep hygiene, exercise, and caution regarding the use of alcohol.

Cognitive reappraisal, relaxation training, and healthy living — these strategies form the M in our CALM adjustment.  True, courage is half the answer to most anxiety problems.  But it is easier to face anxiety with courage when we know some ways to manage it.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com

We are walking along our path in life.  The ground ahead is firm and dry.  The sky above is cloudless.  Things are going smoothly as we put one foot in front of the other.

But we see it when we round the corner: a swamp of anxiety in the middle of our pathway.

Our strong inclination is to avoid the swamp.  But there is no veering away from it without veering off our course; no avoiding the swamp without avoiding the path itself.  To stay on our path in life, we must change our relationship to anxiety.  This change is captured by the letters GTNA:

When anxiety stands between us and things we value deeply, we are best served going through it instead of going away from it.  This single, sweeping change can be broken into parts.  And if we put these parts into a pie, they form our CALM adjustment:

Courage is the first, hardest, and most important component of the change required.  Courage is not the absence of anxiety.  It is the willingness to do what needs to be done when we are in its presence.  This means decreasing both the things we do to avoid anxiety (active avoidance), and things we don’t do to avoid anxiety (passive avoidance).  With the help of exposure, we learn to remain on our path regardless of anxiety.

We should also keep our eyes on the path, or practice a skill called attentional control.  Our spotlight strays, we bring it back . . . our spotlight strays, we bring it back.  By gaining control over our attention, anxiety loses control over us.

And when our feet touch the swamp, we work on letting go (i.e., practice experiential acceptance).  Frantically fighting anxiety does not make it better.  What we resist persists, so let anxiety run its course without struggling to control it.

Where practical and non-disruptive, though, it makes good sense to drain the swamp, or engage in anxiety management.  Cognitive reappraisal, relaxation training, and healthy living decrease vulnerability to anxiety when used judiciously.

Courage, Attentional Control, Letting Go, and Management — walk through the swamp, keep your eyes on the path, don’t fight the swamp, and take steps to drain it.  In combination, these four components not only help us feel less anxious.   They also help us stay on our path . . .

Whether we are anxious or not.

Dylan M. Kollman, PhD

www.realanxietysolutions.com

dkollman@realanxietysolutions.com