The most common reason people reach out to my practice is because they are experiencing anxiety. This isn’t surprising, given that nearly 1 in 3 people will meet symptom criteria for an anxiety disorder in their lifetime.[1] However, you don’t need to have an anxiety disorder for anxiety to affect your life and to want to change it. Therapy is an extremely effective tool in addressing the root causes of anxiety – whether there is a disorder present, or not – helping you to have a more fulfilling life.
Anxiety has a number of different faces – social anxiety (or social phobia), performance anxiety, panic, anxiety attacks, PTSD – and can manifest in a variety of different ways: it can feel sudden and unexpected or it can have a slow build up and linger, it can be overwhelming or it can always sit in the background making you always feel "on edge," it can be attached to a specific activity or it can be an ambient part of your life. Because of this and its high rate of prevalence, there is sometimes a confusion, even among mental health professionals, about whether or not anxiety is truly a disorder.
Is Anxiety Really a Disorder?
It is true that anxiety has an adaptive function, but anyone who has had a panic attack or turned beet red and start sweating uncontrollably at the mere thought of speaking to a crowd knows that experience is anything but adaptive. This is because anxiety works a bit like a smoke-detector.[2] That is, although it is annoying when your smoke detector goes off when you’re cooking, it is actually designed to do that. This is because the false-positive (that is, a smoke detector going off when their is not a fire) is merely irritating but the false-negative (a smoke detector not going off when their is a fire) is deadly. Similarly, your anxiety response was evolved to detect the slightest threats because the false-negative could have meant disaster to your ancestors.
But… what about when your smoke detector goes off all the time? Or never goes off even when there is tons of smoke? Or goes off randomly throughout the day? Or is miscalibrated so that it only goes off when water is running? Or when it goes off generates such a loud noise that you can’t even think straight enough to leave the building?
In these cases, your smoke detector is not working properly. Analogously, anxiety responses can be dysfunctional: if you are anxious all the time, or never, or randomly, or when something that should not cause you anxiety (e.g., someone loving you) causes you to be anxious, or if your anxiety response is so severe that you cannot do anything but curl up into a ball, your anxiety may not be adaptive - you may have an anxiety disorder.
Therapy for Anxiety
However, you don’t need to have an anxiety disorder to benefit from therapy for anxiety. In fact, most people seeking therapy for anxiety likely do not have a disorder and are helped by therapy!
Just as grief, relationship difficulties, and lack of motivation are not disorders but nevertheless painful conditions that therapy can help with, even adaptive anxiety can be unwelcome and therapy can help manage it. This is because, as Robert Spitzer (the designer of the modern DSM system) succinctly explained: "Diagnosis and need for treatment are not the same."[3]
We can have a greater control over our anxiety than we tend to think. Instead of simply succumbing to your anxiety, therapy can help you develop skills to lessen the severity of your symptoms and work through them.
[1] Harvard Medical School. (2017, August 21). National comorbidity survey. Retrieved from: https://www.hcp.med.harvard.edu/ncs/index.php [2] R. M. (2018), The smoke detector principle: Signal detection and optimal defense regulation, Evolution, Medicine, and Public Health, 2019(1).
[3] Spitzer, R. L. (1998). Diagnosis and need for treatment are not the same. Archives of General Psychiatry, 55.
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