Avoidance isn’t sustainable, and if it becomes the norm, one may never learn how to effectively manage the anxiety. Moreover, over time, that can contribute to experiencing depression.
Everyone experiences some level of anxiety during the course of their lives, from the butterflies in anticipation of a job interview to the uneasy feeling when thrust into an unfamiliar social situation to waiting for the results of a laboratory test. And that’s not necessarily a bad thing. “Anxiety as an emotion isn’t by definition pathological. In fact, in most cases it’s healthy,” says Trevor Schraufnagel, PhD, a clinical psychologist and associate director of the UCLA Anxiety Disorders Program at the Semel Institute for Neuroscience and Human Behavior.
But for some, Dr. Schraufnagel adds, anxiety stops being productive and instead drives dysfunctional behavior. “If your anxiety about how you look leads you to get a haircut before you’re in a wedding, that makes sense and is effective; but if you’re so anxious you get your hair cut every third day, and you’re irritable and not sleeping or eating well, that anxiety may be causing impairment and unnecessary distress,” he says.
David Kronemyer, PhD, a psychologist in the UCLA Anxiety Disorders Program, says anxiety disorders can be viewed as irrational fears about what might happen in the future. “They typically involve an oversensitivity to what we call false positives,” he explains. “Think about the early human hunters hearing a rustling in the bushes. If one of them checks it out and tells the other that it’s a saber-toothed tiger, that individual is going to experience a fight-or-flight response based on the potential for adverse consequences that is grounded in reality. But people who have anxiety disorders tend to perceive a threat well beyond what’s actually there. The solution is to revise what counts as a threat.”
Whether it’s a generalized anxiety disorder or a more specific anxiety-related condition or phobia — a profound experience of anxiety in response to a specific object or situation — the gold standard for treatment involves cognitive-behavioral therapy (CBT). CBT identifies and addresses patterns of thoughts and behaviors that inadvertently perpetuate the problem. “Often, an individual is trying to navigate life in the moment; however, persons with an anxiety disorder have learned to rely excessively on partially or completely avoiding the problem or perceived threat. This often isn’t serving that person’s long-term interests,” Dr. Schraufnagel explains. “Avoidance isn’t sustainable, and if it becomes the norm, one may never learn how to effectively manage the anxiety. Moreover, over time, that can contribute to experiencing depression.”
To change the pattern of avoidance in anxiety, CBT employs a set of techniques called exposure and response prevention — usually gradual exposure to whatever is causing the spike in anxiety without engaging in the avoidance behaviors that would normally provide short-term comfort. “It really comes down to confronting and acclimating oneself to the fear,” Dr. Kronemyer says. “Through exposure and response prevention, we gradually move up the hierarchy — starting with small or more approachable exposures to whatever causes the anxiety, and increasing the difficulty of them over time. As it turns out, the object or situation we fear becomes smaller as we get closer to it, deconstruct it and realize our anxiety is out of proportion with reality.”
Research suggests that medication can serve as a useful complement to CBT, particularly for people with severe anxiety, by helping to reduce anxiety levels to a point at which an individual may more easily engage in and fully experience the benefits of the cognitivebehavioral treatment. “Eventually, the goal in many cases is to help a person manage their anxiety medication-free, but anti-anxiety drugs are often useful, particularly at the front end of the therapy,” Dr. Schraufnagel says.
“What’s most important for people to recognize is that anxiety and its related disorders are among the most treatable mental health conditions,” he adds. “Evidence-based treatment for these problems is a public health must.”