News Flash

I was quoted in an article on CNN about a recent research article showing that an 8 week mindfulness course was as good as escitalopram for treating anxiety. Here is some additional information about anxiety.

We can think of four types of anxiety. Mindfulness will help relieve one type of anxiety, but it will not help with the other three types.

Anxiety: Unease and Difficulty

Anxiety can come from two sources: Unease and Difficulty. Briefly, unease is an uncomfortable feeling that comes from desire and aversion. Desire is wanting something we do not have. Aversion is having something we do not want. Unease is the feeling associated with those.

Difficulty comes from our assessment of the demands we face compared to our assessment of the resources we have to meet those demands. More demands or fewer resources means higher difficulty.

Difficulty and unease are two components of stress and interact with each other and our body, causing a large number of effects. Anxiety is one of them.

4 Types of Anxiety

Unease high, difficulty low

The first type of anxiety occurs when unease is high but difficulty is low. The unease is not about any imminent danger but rather about numerous situations that might occur, commonly called “what if’s”. This is a core feature of “generalized anxiety disorder.” This kind of anxiety responds well to mindfulness because we need to ignore the anxiety. The anxiety is just an uncomfortable feeling and the anxious thoughts are just thoughts. We get anxious about the anxiety, and that is a reinforcing loop that makes the anxiety worse. Mindfulness breaks that reinforcing loop and the anxiety decreases. We can call this “The Ancient Art of Not Making Things Worse.”

We don’t need to use mindfulness to relieve this type of anxiety. Any activity that has the following three characteristics will be helpful.

• The activity is not unhealthy
• The activity is enjoyable
• The activity does not involve stress about a score or outcome.

Another technique that is extremely simple, and that doesn’t require any formal training, is to remind ourselves that it is safe to feel the anxiety.

Unease artificially high

The second type of anxiety occurs when unease is artificially high because we, or other people, or advertising companies convince us to want things that are not helpful, or that make our lives more difficult in the long run.

In this case we need to reflect on what we are trying to obtain and appraise the value of that in light of our core values and long-term goals. This takes reflection and judgment. Sometimes we need to talk with others who have more experience or wisdom to find guidance. Mindfulness is not helpful for this kind of anxiety. Mindfulness involves acceptance and non-judgment. For this type of anxiety we need to judge, or discern, which thoughts and emotions are helpful and which are not. We need to then focus on the helpful thoughts and emotions (such as gratitude) that reduce our inappropriate levels of unease.

Difficulty artificially high

The third type of anxiety occurs when unease is high and difficulty is low but perceived as artificially high. This occurs because we often overestimate demands or underestimate resources. The old saying “Don’t make mountains our of molehills,” refers to this tendency.

The solution for this type of anxiety is to assess our demands and resources more accurately. Cognitive and behavioral techniques are helpful for this type of anxiety as they include testing and correcting our assumptions about the difficulty of a situation.

We can also use cognitive techniques to change the context of the unease. For example, this can make anxiety become excitement.

• Anxiety is unease and the thought “I can’t do it.”
• Excitement is unease and the thought “I can do it.”

Difficulty truly high

The fourth type of anxiety occurs when unease is high because difficulty is truly high. This occurs when we have barely sufficient or insufficient resources to meet important demands. Such situations include

• People facing insecurity about housing, food, medical care, or safety
• People with children who are struggling with medical, mental health, or scholastic difficulties
• People facing insurmountable demands at work

Many people have this type of anxiety. They are the working wounded, not the worried well. In these situations it would be abnormal not to be anxious.

This type of anxiety does not respond to mindfulness, and mindfulness can actually make the situation worse. “Acceptance without judgment” is dangerous for someone who is facing insecurity about food, clothing, shelter, medical care, or safety. Telling people who are being hammered by their environment to “accept without judgment” can be a form of abuse, as described by Ronald Purser in his book McMindfulness.

For people with this type of anxiety, therapy is useful when it helps them be find resources and utilize them more efficiently. Therapy also helps when the therapist can use their social standing to reduce demands on the person or help them obtain resources. For example, as a physician I can often help a patient have a reduced workload for a period of time so they can have some relief and heal. Or, I can let a patient know about community resources and advocate for them to obtain these resources.

We need to remember that we are a resourceful species. We survived the Ice Age with spears and torches. Creativity and cooperation are our greatest strengths, and methods that facilitate those will be helpful.

Summary

The four types of anxiety can co-exist. Each uses a different type of intervention. When the appropriate intervention is used, then we are more likely to deal with our anxiety effectively.