The adaptive nature of anxiety

Let’s think about what it would have been like to be a cave person in order to understand the evolutionary utility of the anxiety response. 

You and me, cave people, are sitting next to each around a fire, discussing our recent drawings on our cave. The fire is warm and the conversation is calm, yet engaging. The feeling we both have is one of calm and ease. 

Suddenly, there’s a loud sound just 20 yards away! 

Both of our limbic systems immediately respond. Our hearts start pumping, our blood pressure increases, our pupils dilate, we stop digesting. Sweating, we’re now ready for action. These physiological sensations occur before we’re thinking and as our minds catch up, both due to the noise and due to the increase physiological sensations, our minds start generating all kinds of catastrophic possibilities. 

“Is it a tiger? Is it a bear? Where are our children and are they safe?” 

We’re both on our feet, starting to search for the source of the noise and prepare to take action or run away depending on the threat. 

Step out of this imaginary scene for a second… what do you think about the response you and me, as cave people, just had? Was it silly, stupid, or shameful? Even if there is no threat coming, would you judge us as foolish and irrational? Or, do you think that the sensations, thoughts, and urge to behave were all understandable reactions, even highly adaptive reactions? 

Back to the scene… 

As we start to search around, it turns out that our friend made the sound. She dropped a pot on a stone and it made a loud sound. 

When we hear this news from our friend, we’re so relieved. Our hearts stop racing, our blood pressure starts to go down, our pupils and digestive systems go back to normal, and we stop sweating. The thoughts about tigers, bears, and our children pass by and we no longer have the urge to search for danger. We go back to the fire and our conversation and enjoy the evening. 

This is an example of our effective fear circuitry in action. Just like we didn’t force ourselves to have the sensations, thoughts, and behavioral urges associated with fear, we didn’t force ourselves to stop having that experience. When we were certain that we weren’t in danger, our fear system relaxed for us. There were so many threats in every day life for the early human that our species would not have survived if it relied on us to be responsible for turning fear on and off. 

How does this relate to modern difficulties with anxiety? 

Imagine if you and me, as cave people, heard the loud noise, had a fear response, but then never got certainty that it was our friend that made the sound, not a tiger or a bear. A normal, healthy, and adaptive mind might continue to have catastrophic thoughts and urges search for the source of the threat. 

The modern equivalent is occurring when an individual struggles with anxiety. Our minds are so intelligent at this point that the possibilities we can imagine for what will happen in the future, for good or for bad, are endless. And life is filled with endless uncertainty. If we imagine it, we can fear it. 

As modern humans, given that most of the time that our fear is triggered we will not actively be in danger and we will not be able to get immediate certainty, we must intentionally practice new ways to respond to our minds. Acceptance-based cognitive behavioral methods offer a set of learnable skills that help us cope effectively with the inevitable uncertainty inherent in human life.

What is an anxiety state?

As we think more about achieving wellbeing, let’s discuss the most common feeling with which people have trouble:

Anxiety is a normal, healthy emotion that includes thoughts, sensations, and the urge to behave in specific ways. It occurs after your fear circuitry is triggered in the presence of ongoing uncertainty. 

Our fear circuitry is a highly perceptive, adaptive, and primitive part of our brain that kept us alive as a species and is up against different challenges in the modern world. When fear is triggered, there is a pattern of sensations, thoughts, and urges that come with it that are adaptive. Specifically: 

Sensations present during fear (aka fight-or-flight response): Heart races, blood pressure increases, pupils dilate, sweating, shortness of breath, and digestion rapidly decreases. 

Thoughts present during fear: Catastrophic, worst-case scenarios are generated. Thoughts are experienced as “sticky” or as if the presence of the thoughts means that they are actually occurring. This is called thought-action fusion (TAF). Although thought-action fusion is also “irrational,” it is important to recognize that thought-action fusion in the presence of real danger is very adaptive. Pulling your hand away at the same time (or even before) you have the thought “my hand is touching fire” is an adaptive example of thought-action fusion. 

Urges to behave present during fear: The combination of the sensations that fear generates plus the sticky catastrophic thoughts drives you to respond to what you experience either through “fighting” (aka problem-solving) or “fleeing” (aka avoidance). 

Fighting or fleeing has been incredibly adaptive throughout human history and when fear is actually alerting you to danger, either problem solving or avoiding the situation is the appropriate response. 

However, many situations that trigger the fear response in modern life are not actually dangerous situations, but rather uncertain situations. If you misinterpret either the uncertainty or the sensations, thoughts, and urges that occur during the fear response as an indication of danger itself, what you do in response to your fear will increase and maintain your anxiety state, turning it into an anxiety disorder.

So, an anxiety state is an emotion that triggers flight-or-flight sensations, catastrophic thoughts, and the urge to problem solve or avoid.

What are the different ways to think about relating to your thoughts?

Throughout the brief history of psychology, there have been many schools of thought regarding how thoughts relate to wellbeing.

Below is a very brief summary of the beliefs about thoughts that the various theoretical orientations assume. Every theoretical orientation starts from a complex understanding of human experience and skilled clinicians of every modality effectively use their theory to direct their interventions. I refer here to the clinical distinction of what the major theoretical orientations assume about the nature of thought and how it influences their interventions: 

Psychoanalytic/psychodynamic – Analyze your thoughts, bringing awareness to what they are, what they’re connected to, and why you have them. As you bring insight and awareness to your thoughts, you become more connected to yourself, work through your feelings, and experience greater wellbeing.

Behaviorism – Change your behavior. Regardless of your thoughts, your change in behavior will result in an increase in wellbeing. 

Cognitive behaviorism – Change your thoughts in order to change your behavior. Change in thoughts from this perspective occurs from bringing insight and awareness to your thoughts and then challenging the irrational thoughts that lead to maladaptive behavior. More effective behavioral options occur as an individual challenges their irrational thoughts. They experience greater wellbeing as a result of both fewer irrational thoughts and more effective behavior.

Acceptance-based/Mindfulness-based cognitive behaviorism – Relate effectively to your thoughts in order to increase your options for behavior. Wellbeing comes from the ability to shift thoughts and behavior flexibly based on the present moment experience.

From this perspective…

Analyzing a thought or feeling to try to find its meaning can get the person “stuck in their story.” It decreases their ability to contact the present moment and respond flexibly to the current context of their lives. Behavior change alone is not sufficient for wellbeing, because the way in which the person relates to their circumstances informs their sense of wellbeing. Finally, challenging thoughts often gets people stuck in their thoughts because their minds immediately generate more reasons why the initial irrational thought might be true. This fuels more uncomfortable feelings and doesn’t breed more flexible behavior. 

Acceptance-based cognitive behavioral methods use mindfulness to help people get distance from their thoughts, watching their thoughts as an observer. From the perspective of an observer, it does’t matter whether or not thoughts are rational or irrational, fused with a feeling or not, you can still choose flexibly which thoughts you want to act on. 

More simply, wellbeing occurs when…

1. Analyze thoughts.  (psychodynamic)

1. Change behavior.   (behaviorism)

2. Change thoughts and behavior.    (cognitive behaviorism)

3. Relate effectively to thoughts and change behavior.  (acceptance-based/mindfulness-based cognitive behaviorism)

With this theoretical foundation, let’s discuss what anxiety is and to relate to it effectively.

How is a healthy lifestyle related to my sense of wellbeing?

In the search for wellbeing, many people try all kinds of interventions to help themselves feel better before seeking psychotherapy. They or their friends and family see they aren’t acting like themselves, that they are sleeping, eating, drinking, and exercising differently. They are tense and irritable or withdrawn and isolating themselves more often. People try committing to exercise, eating better, drinking and smoking less, sleeping regularly, meditating, putting “boundaries” around work. Sometimes this brings relief and restores a person’s sense of well-being. I am not against any of these healthy lifestyle behaviors. 

I want to talk about what’s occurring when healthy lifestyle behavior changes don’t “work.” Let’s discuss what’s happening when no matter how healthy a person’s lifestyle is, he or she still doesn’t have a sense of well-being. Or, no matter how much a person wants to commit to certain behaviors, he or she can’t seem to commit on a regular basis.

Suffering or wellbeing occur based on how you relate to your mind and body, not from what you do. It’s not what you do, but how you do it. 

People who relate to their thoughts, feelings, and sensations with openness, compassion, and courage do not have the desire to engage in self-destructive behaviors. Self-regulation in the form of balanced sleeping, eating, exercising, working, and socializing occurs naturally, because there’s no fight to be or feel a certain way. 

In contrast, people who relate to their thoughts, feelings, and sensations with fear, distrust, anger, guilt, and shame will attempt to avoid themselves. The behaviors they choose in the attempt to avoid themselves often offer immediate relief but in the long-run intensify the feared thoughts, feelings, and sensations. Self-regulation is difficult and feels forced. The constant effort is burdensome and it gets harder and harder to maintain balance. It feels like willpower is required to maintain balance and self-regulation. This becomes a self-fulfilling prophecy, because the more willpower the person uses to maintain equilibrium while avoiding uncomfortable thoughts, feelings, and sensations, the more willpower is required. 

Many individuals are so used to using effort to control their thoughts, feelings, and sensations, that they don’t even know that there is another option. Relaxing their effortful control of their thoughts, feelings, and sensations feels terrifying and threatening; they worry that if they embraced this posture, they would “give up,” “lose control,” or something else catastrophic would occur.

Fortunately, relaxing one’s attempts at control of their internal experience and relating to one’s thoughts, feelings, and sensations with compassion and courage is a learnable skill. It is not an inherent personality characteristic  that some people have and other people do not. Some people have biological and environmental life circumstances that make it easier to relate to themselves with compassion and courage, but overall, it is a learnable skill set. 

If you’re having trouble regulating your mood, anxiety, and behavior, rather than committing to a specific plan and forcing yourself to stick to it through willpower, it is worth it for you to assess the way you feel about your thoughts, feelings, and sensations. Work on opening up to your internal experience with compassion rather than criticism. This takes time and practice. Healthy lifestyle changes will likely occur as the result of facing internal or external pain with courage and compassion, not willpower.

What is wellbeing and how is it achieved?

Many people seek psychotherapy because they just don’t feel good. They say they feel stuck or that they don’t feel like themselves. They feel tense and keyed up. They can’t stop worrying about work, money, or their relationships. Many say they’ve been sleeping too much or waking up throughout the night. They’ve started drinking or smoking more often. They’ve started eating less healthfully and they never exercise. They have no sense of energy when they wake up in the morning and instead feel dread and fear about what’s coming next. Some people can articulate that they feel lonely, sad, disappointed, confused, anxious. Many others just feel a vague sense of numbness and fatigue. They just don’t feel well.

Sometimes there are external circumstances, like the death of a loved one, a divorce, or a stressful transition, that triggered their change in thoughts, feelings, and behaviors. It is just as likely that there is no external circumstance that explains the change. 

Modern evidenced-based psychological theory understands psychological suffering to be the result of the individual’s experience of herself, including internal thoughts, sensations, feelings and urges, as she responses to external circumstances. Put simply: 

Psychological suffering = physical or psychological pain +  psychological resistance

Whether the pain occurs due to a tragic, discriminatory, or chronically stressful life circumstance or a thought or feeling that is unpleasant, the pain becomes suffering if the individual resists against it, avoiding it or/and trying to get rid of the internal experience itself. 

From this perspective, wellbeing is a way of life characterized by an absence of resistance to unpleasant or painful thoughts, feelings, and sensations. Wellbeing cannot be forced. When there is no struggle against what is uncomfortable, there is more room for movement of thoughts, feelings, and sensations. More movement of mind creates more opportunity for pleasant states, including happiness, joy, and a sense of calm. 

Because the mind is in the habit of protecting itself from pain, oftentimes an individual isn’t even aware of the thought, feelings, sensation, or urge that they fear and avoid. Through questions and observation, we help individuals identify what they fear and make a plan to open up to it, rather than adding more avoidance and resistance. 

Psychotherapy does not rescue or protect individuals from pain, but it can help you respond and relate to the inevitable pain that humans experience with courage and compassion. As you get in the habit of facing painful thoughts, feelings, sensations, and urges, your suffering decreases and your sense of wellbeing increases.