You and your therapist create a hierarchy of feared situations, which you experience gradually, starting from the least feared to the most feared. For instance, Bilek said, if you’re afraid of needles and getting shots, your list might include: viewing pictures of needles; watching videos of people getting shots; going with a loved one to the doctor to watch them get a shot; and letting your doctor show you the needle before getting your own shot.
The key is to accept the presence of anxiety, instead of fighting it (even though fighting is our knee-jerk reaction). Kissen shared this example: You’re at dinner. You start experiencing the symptoms of a panic attack. Your thoughts are screaming, “My head feels weird. I can’t believe this is happening. AGAIN. I hate this. I need to get up! I need to leave!” Instead, you tell yourself, “I know I’m getting anxious. I don’t like this. My brain thinks I’m in danger, but I’m not. I’ll ride this out” (since leaving only provides temporary relief but exacerbates your anxiety for next time).
“By working with a therapist to face your fears, you can learn that what you are afraid of is usually unlikely to happen; you are better at coping with anxiety than you expect; and you are better at coping with negative outcomes that you expect, as well,” Bilek said.
“You learn [that anxiety] is something you don’t need to run from,” Kissen added.
Anxiety makes it physiologically hard to be social, friendly and comfortable around others.
When you’re anxious, your brain and nervous system are on high alert. They’re scanning for dangers, threats and criticism. “You never feel fully safe, good enough, or OK, said Ann Marie Dobosz, MA, MFT, a psychotherapist who specializes in anxiety, perfectionism, depression and self-criticism in San Francisco.
When you’re anxious, the ventral vagal system—which Dr. Stephen Porges calls the social engagement system—isn’t functioning at full speed, Dobosz said. Which messes with our ability to interact with others. Specifically, “the ventral vagus nerve sends signals to and from your face, ears, and corresponding parts of your brain, allowing you to read facial expressions, understand subtle differences in tones of voice, make eye contact comfortably, judge others’ intentions, and all sorts of things that make you ‘good’ at being social.”
This means that when you’re anxious, it’s harder to tell if someone has a sarcastic tone or a friendly tone, and if someone is calm or irritated. The signals from your ears and eyes don’t reach your brain as effectively as they do when you’re not anxious; and your brain doesn’t interpret them as accurately, said Dobosz, also author of The Perfectionism Workbook for Teens: Activities to Help You Reduce Anxiety and Get Things Done.
Because anxiety boosts our cortisol levels and says we’re in danger, we also read neutral situations as threatening, she said. Dobosz shared this example: Your colleague walks past you with a blank expression, and says “Hello.” If you’re in a calm state, you interpret this as neutral or even pleasant. If you’re in an anxious state, you interpret this as unpleasant or judging.
Plus, we have a harder time doing the things that others interpret as friendly, such as smiling, making eye contact and softening our voice, she added.
The social engagement system also helps us distinguish between background noise and human voices. When your nervous system is on high alert, your brain focuses instead on the noises around you, Dobosz said. “So when you are anxious, it can be physically hard to hear conversations—voices get jumbled together and background noises are overwhelming and distracting.” And naturally, this amplifies your anxiety.
Anxiety can inspire us.
When you’re struggling with anxiety, you probably see it as a curse. You despise it and want it to disappear. But anxiety can be a catalyst for building better habits, and changing our thinking in healthier ways, according to Helen Odessky, Psy.D, a clinical psychologist and author of the book Stop Anxiety from Stopping You: The Breakthrough Program for Conquering Panic and Social Anxiety.
“The surprising thing is that sometimes painful feelings can signal change if we let them guide us; we can build upon our strengths and develop new skills for resilience to future challenges.”
For instance, recently, Odessky was talking to a client with health anxiety. He had a serious childhood illness and felt anxious about the future. For him using humor and finding different perspectives, even during really difficult moments, was pivotal.
“I know when we are nearing the end of treatment when a client says: ‘I had no idea that I could do this; panic or anxiety had me thinking that my life was going to be inherently limited and I am now expanding my life to include more adventure, more opportunities at work—this is more than I could envision,’” Odessky said. Which happens when we move out of our comfort zones, both externally (by again facing our fears) and internally (by thinking differently).
The most rewarding part of treating anxiety, Odessky said, is exploring how she and her clients can remove the barriers that are holding them back and “expanding into making room for more opportunities—and that is often the result of practicing new habits.”
If you’re struggling with anxiety, consider seeing a therapist who specializes in anxiety disorders. Sometimes, we don’t seek professional help because we worry that it means that something is really wrong, or we’re really broken.
And that is a terrifying thought. So we struggle in silence.
However, as Kissen said, you can come in for one or two sessions; therapy doesn’t have to be a lifelong commitment. Think of it like getting a trainer to learn how to use a gym’s equipment, she said. “A little bit of help can go a long way.”