Freud was of the opinion that in fear a person is responding to a specific and immediate threat to physical safety while in anxiety a person is responding to a threat that is objectless, directionless, and located somewhere far off in the future—ruination, for example, or humiliation, or decay. Daniel Smith, Monkey Mind: A Memoir of Anxiety
I spoke at Harvard Law about the challenges of living with depression and the epidemic of poor mental health in the legal profession. It was a memorable event.
Days before I am scheduled to talk, my sleep goes cuckoo. I become incredibly anxious about my speech. What if I fall flat on my face? I graduated from some third-tier law school, after all. I don’t belong lecturing at Harvard. My churning nighttime ruminations now seep into my days as the event gets closer.
I arrive early at Boston’s Logan Airport from Buffalo. It’s a cold, cloudy winter’s day. Butterflies are circling in my stomach. I go to a nearby Starbucks once I get into the city. I try to relax. Scribbling an outline to guide my presentation, I sip hot coffee. I’ve given lots of talks in the past about my mental health journey. No reason for jitters, I tell myself. But there is some part of me that always feels vulnerable. I feel a mix of excitement – – and fear. I want to give a great talk. But I also want to run away.
My watch shows it’s time. I run across the now slushy street. Once inside the law school, my heart starts pounding. I step into a nearby bathroom and sit in an empty stall.
The butterflies in my belly have given way to screeching eagles of terror. Sweating profusely, my heart rate accelerating, I can’t calm down. I’m afraid I’m having a heart attack. I am too young to die, I think. This goes on for five minutes. I look at my watch again. Two minutes until my talk. My shirt is soaked with sweat as if someone has thrown small water balloons at me. I cover up the patches of perspiration with my suit jacket.
Having no other choice, I straighten my tie in the mirror and walk into the classroom. Laptops open, some students seem interested while others scan their screens. They look like NASA mission control flight analysts, I think, as the blue light of the computers illuminates their young faces.
What am I doing here? They are all so accomplished and smart. What could they possibly learn from me? I am too wired to concentrate. My outline becomes worthless. I now feel sweat running down the inside of my pant leg. Maybe it will show and they’ll think I am peeing my pants, I worry.
I decided to wing it. After a quick introduction, the lights dim for my Powerpoint presentation. I breathe deeply and begin to calm down. My presentation goes just fine. I am relieved when it’s over. Feeling like I’ve been holding my breath for the last 60 minutes, I exhale deeply. Leaving the building, I pull the cold air into my lungs. It’s soothing like menthol. I feel the weight of anxiety slide off me after a few minutes. Jumping into the back of a cab, I head back to the airport for my flight back to Buffalo. I think about the talk I just gave about depression. But, I should have also told them about my dealings with its close cousin – anxiety.
WHAT IS CLINICAL ANXIETY?
We are all anxious – – sometimes. Perhaps, even more so now with the coronavirus spreading across the country. But what I’m writing about is “clinical anxiety,” an illness that afflicts 40 million people in this country in any given year. Like more than 60% of people living with depression, I also have clinical anxiety. Like depression, there are a number of symptoms mental health experts look for to diagnose anxiety.
While anxiety symptoms vary from person to person, in general, the body reacts in a particular way to anxiety. When you feel anxious, your body goes on high alert, looking for possible danger and activating your fight-or-flight responses. Psychologist Dave Carbonell writes:
“The problem is this. People instinctively follow their gut instinct in dealing with anxiety. They feel afraid, and treat that fear as a threat, an enemy. They try to fight it off or run away from it because those are our usual responses to enemies – we fight them or run away from them.
Those fight or flight responses don’t work with chronic anxiety disorders, because anxiety isn’t an enemy. A chronic anxiety disorder is a counter-intuitive problem. If you try to solve a counter-intuitive problem with an intuitive solution, that will make the problem worse rather than better. If you find “the harder I try, the worse it gets,” it’s probably because you’re using methods that actually do make it worse. You may be putting out the proverbial fires with gasoline!”
Common symptoms of anxiety include:
- nervousness, restlessness, or being tense
- feelings of danger, panic, or dread
- rapid heart rate
- rapid breathing, or hyperventilation
- increased or heavy sweating
- trembling or muscle twitching
- weakness and lethargy
- difficulty focusing or thinking clearly about anything other than the thing you’re worried about
- digestive or gastrointestinal problems, such as gas, constipation, or diarrhea
- a strong desire to avoid the things that trigger your anxiety
- obsessions about certain ideas, a sign of obsessive-compulsive disorder (OCD)
- performing certain behaviors over and over again
- anxiety surrounding a particular life event or experience that has occurred in the past, especially indicative of post-traumatic stress disorder (PTSD)
ANXIETY AND DEPRESSION
While there are differences between anxiety and depression, their symptoms tend to overlap. If you compare the two lists of symptoms, you can see that there is some overlap. Sleep problems, trouble concentrating, and fatigue are all symptoms of both anxiety and depression. Irritability may also manifest in forms of anxiety or depression (in place of low mood).
There are, however, some distinguishing features. People with depression move slowly, and their reactions can seem flattened or dulled. People with anxiety tend to be more keyed up, as they struggle to manage their racing thoughts. Another distinguishing feature is the presence of fear about the future in people with anxiety. Depressed people who do not have anxiety are less likely to be fraught with worry about future events, as they are often resigned to believing that things will continue to be bad. In other words, they may predict the future based on how they feel in the moment.
My sage therapist once said, “Anxiety turns something possible, into something probable. Using my speech at Harvard as an example, it was possible I would bomb in front of those law students, but improbable because I had given so many presentations before without anything bad happening. In fact, the talks were often widely praised. We can use positive self-talk to remind ourselves of the facts. Write them out, if that is helpful.
Stop and Swap
Psychologist Margaret Wehrenberg, Psy.D. thinks the problem with anxiety lies with searching for explanations:
“When people are anxious, particularly suffering from generalized anxiety, they feel the anxiety and then wonder why it is there. The natural assumption is that something MUST be wrong. And then their thinking brains go on a search for an explanation. Remember: if you can figure it out, anxiety goes away. However, because the anxiety is NOT caused by a real, objective problem, the what-if thinking spins without a solution. I am reminded of the symbol for “computer loading” that spins and when the computer can’t find a solution, it just keeps on spinning. The thought process of anxiety is like that. Without a solution, it keeps on searching.”
One of the 10 Ways she suggests you manage anxiety is the “Stop and Swap” approach. She writes:
“Oftentimes, and surprisingly, worry is a mistaken effort to get rid of an anxious feeling. When you don’t know what is going on or what to do about it you start in on “What if…” thinking. When you are a worrier and you feel nervous, your “What if…” thinking raises your anxiety. If you do not need your worry, then do a “Stop and Swap” maneuver. Figure out what pleasant or productive thought you want to dwell on (instead of your worry) and then when the worry pops up tell yourself, “Stop!” and swap in the pleasant thought you chose for yourself. But do this every time the worry pops up or you won’t achieve the mental calm you need.”
I have found mindfulness meditation enormously helpful and effective. At its most basic, it involves dropping out of our heads and anchoring ourselves in our bodies. We cannot not breathe, so breathing is an excellent anchor. The real benefits of mindfulness come when we practice it regularly. Consistency pays off. So, instead of setting overly ambitious goals of meditating 30 minutes one day, try 10 minutes a day for one week. Consistency is the key. Once you have the habit of meditating down, add more minutes.
By Daniel T. Lukasik, Esq.
The 10 Best-Ever Anxiety Management Techniques: Understanding How Your Brain Makes You Anxious and What You Can Do to Change It by Margaret Wehrenberg, Psy.D.
My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind by Scott Stossel
The Anxiety Toolkit: Strategies for Fine-Tuning Your Mind and Moving Past Your Stuck Points by Alice Boyes, Ph.D.
The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life by Susan M. Orsillo, Ph.D.
Outsmart Your Anxious Brain: 10 Simple Ways to Beat the Worry Trick by David Carbonell, Ph.D.
The Anxiety and Depression Association of America website