If you have been working on anxiety reduction strategies for a while and not experiencing progress, you might too focused on stress management, and not enough on the behavioral changes that are necessary to address anxiety at its root.
Let me explain…
“Anxiety” is often used as a blanket term to describe any feeling of unwanted stress or unease.
Although there are similarities between stress and anxiety, anxiety is not the same as stress.
Stress is typically caused by an identifiable external trigger. It causes both mental and physical symptoms, such as irritability, fatigue, digestive troubles, and insomnia. Stress comes and goes.
Anxiety, on the other hand, is defined by chronic, excessive worries (otherwise known as obsessions) – even in the absence of an objective external stressor.
Stress management techniques address…stress! Things like breathing techniques, exercise, and other types of coping skills are an extremely important part of our lives. These methods help keep cortisol levels down; help us manage challenging situations; improve our reactivity; and are conducive to overall physical and mental health. We all need coping skills!
However…stress management does not address one of the most important parts of clinical levels of anxiety: compulsions.
Anxiety involves a complex process that involves cognition, biology, past experiences, and behavior. A big component of what fuels clinical anxiety is the behavioral component (aka, compulsions, which can be internal or external).
Compulsions associated with anxiety include excessive mentally reviewing situations; avoidance of feared situations; time-consuming worrying about the future; or other behaviors geared toward finding certainty about a situation.
If you have clinical levels of anxiety, you have compulsions.
Contrary to popular belief, compulsions are not limited to OCD. All anxiety disorders have some level of compulsive behavior and thought processes.
Even if you do not meet criteria for an anxiety disorder – all HUMANS have some obsessions and compulsions! Everyone can benefit from this work. You might Google things; ask for reassurance; replay that conversation with your coworker 100 times before going to sleep; or wonder constantly if you offended someone.
If you have been diagnosed with generalized anxiety disorder, the “flavor” of the types of things you fear *might* be different than with OCD – but in general, these two diagnoses are more similar than they are different.
Although everyone is different and there are always exceptions, generally speaking, stress management strategies will help you feel good, but they are not going to help you with the core of what drives compulsions.
In order for obsessions (worries) to get better, we have to treat the compulsions.
People often get stuck trying to use logic to assure themselves that their fears are irrational. While reasoning is initially a part of the treatment process to help you discern what situations truly require action vs. what is the noise of anxiety, you cannot logic your way out of anxiety by disputing your thoughts entirely or using coping skills to avoid these thoughts.
The key to reducing anxiety is to progressively face the things that you fear head-on. A very effective, evidenced-based model for doing so is called Exposure and Response Prevention Therapy. Let’s consider an example.
Let’s say that you have a lot of fear about making a mistake that you can’t take back. You might be scared that you’re going to send an email with typos in it to your boss. Before sending an email, you re-read the email countless times before sending, and then check it again several times even after sending. You still fear that you did make a mistake because you don’t trust your own memory, so you approach your boss and try to get a sense of whether or not they seem annoyed at you in a search for further evidence that things are okay.
Even if your boss was in a good mood and did not seem put-off, you might still go home worried that maybe they didn’t actually see the email yet, so you do another re-read before going to bed. You might end up losing sleep because you’re replaying that conversation with your boss over and over in your head, and also trying to imagine your worst fear happening tomorrow so that you’re mentally prepared if things do go badly.
You might try to consider “evidence for” and “evidence against” this thought that you made a mistake in an effort to convince yourself once and for all that nothing bad did happen or will happen. You might also work on breathing skills to calm down. So why don’t those methods work for this particular scenario?
When you are caught in a loop like this where you are seeking certainty, there is no amount of thinking, checking, or reassurance that will permanently and completely close that loop.
There is always lingering doubt that you missed something. You might feel better taking a few deep breaths, but it is only a matter of time before anxiety pops back up.
The solution? Radically accept the uncertainty about the situation. Say things like, “Maybe I did mess up, maybe I didn’t. I’ll have to deal with that if a problem arises, but right now there is no problem known to me.” You make a conscious choice to stop engaging in compulsions and accept that some things are just not knowable & will unfortunately remain uncertain no matter how hard you try to get clarity.
Uncertainty is the answer that none of us want, but all of us need when it comes to treating anxiety.
Accepting uncertainty paired with reducing compulsions creates measurable changes in the brain! When you stop engaging in compulsions, your brain learns that it does not have to be “on” all the time for an emergency.
You learn through experience that the bad thing often does not happen, and if it does, that you handled it better than you thought you could (the scientific term for this is called inhibitory learning).
You learn to tolerate embrace the positive side of uncertainty – what if it goes way better than you thought?
You get live life dictated by your VALUES, instead of your fears.
You get to experience so much more freedom and joy.
Exposure work can be hard, but if obsessing and engaging in compulsions and avoidance worked, you would have found your answers by now and there wouldn’t be anxiety.
Aren’t you ready for another way?
There is so much life to be lived and a lot of hope for you if you’ve been struggling with OCD or anxiety. I’m rooting for you in your path forward!
Resources for Anxiety and OCD:
If you or a loved one are struggling with anxiety or OCD, I’ve got a list of resources to point you in the right direction!
Check out my website at barbshepardcounseling.com (linked below) to learn all about the differences between Generalized Anxiety, OCD, and Panic Disorder, as well as evidenced-based treatment strategies.
“All the Hard Things,” hosted by Jenna Overbaugh, provides incredible free content with everything you would ever want to know about anxiety or OCD.
Nathan Peterson provides a self-paced course on Anxiety and OCD treatment that is extremely comprehensive and helpful! This might be for you if you are having a hard time finding an OCD specialist in your area; if therapy is not financially accessible to you right now; or if you are already in therapy, but interested in learning more outside of session.
OCD online directory:
OCD is a very nuanced diagnosis that requires treatment with someone who has training and experience with Exposure and Response Prevention Therapy. Fortunately, there is a directly that can connect you to therapists in your area, and many insurance are also accepted!
“Stopping the Noise in Your Head” by Reid Wilson is a MUST READ for anyone with anxiety.
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