When Good Anxiety Goes Bad

By | Dec 04, 2012

Moment‘s 2012 Elephant in the Room Contest, in partnership with the Andrew Kukes Foundation for Social Anxiety, asks readers to tell us how anxiety has affected them, their family or the Jewish people in general. We spoke with Elna Yadin, a psychotherapist at the University of Pennsylvania’s Center for the Treatment and Study of Anxiety, about the medical basis and treatment of anxiety. Below is a lightly edited transcript of the conversation.

Can you tell me about the medical basis of anxiety? Do you think the public sees anxiety as a medical condition?

We in the profession see it as a medical condition. My background is in experimental neuroscience and then clinical psychology. I definitely look at anxiety as a medical condition with a strong genetic component, with an environmental/experiential component. Take the latest storm, Sandy. People who were genetically predisposed to be more anxious are going to be worried more about something like that. Sometimes even when there’s no stimulus, people with anxiety will imagine all the possible ways in which something could go wrong. Most people have it other way around—they think everything’s going to be okay unless proven it’s not going to be okay. Anxiety has a huge array of presentation—it could be very specific, like a fear of dogs, or it could be fear of many things.

But having some anxiety is a good thing, right? When does it become problematic?

We’re all born with fears, and anxiety has to keep us safe. People who don’t have anxiety actually do bad things, or take unnecessary risks, so some anxiety is excellent to have. It is an anxiety disorder when it interferes with a person’s functioning, or when it’s exaggerated or thought about a lot. Biological things we really don’t have to think about much—people don’t have to think about breathing, or heart functioning, or being warned when there’s danger. People with anxiety feel they have to pay attention, be more vigilant, take precaution. I always tell patients that being careful is okay, but being scared to do things is a bit of a difference.

You work with children who have anxiety. How does anxiety manifest in them?

In children it’s a little bit simpler, both because of their cognitive ability to project to the future, but also because of their experiences. It’s amazing how little kids can anticipate things going badly. If somebody has a specific phobia—a fear of animals or loud noises or things like that—you can see at the age of about two or three, and then there’s separation anxiety in children, which is early. Genetic predispositions are the way we come into the world. Some things can be modified; just because they’re genetic doesn’t mean they don’t get modified. If we notice it early on, we can help them become less anxious adults. Sometimes they’re just corrections from life; people learn lessons—not everything needs therapy. If they find out time and time again that they were scared they learn, “I guess I was a little wrong about that.”

Do you think the public has a good understanding of anxiety?

It’s on the way to getting better. “Better” would be that everyone understood that it’s not volitional—that people don’t want to be anxious, that the natural tendency would be to not be scared and if they are, and they’re then changing what they do, it’s not willfulness. What we want people to understand is that they need help to undo some of these tendencies, or they need new ways of dealing with them. We understand more about mechanisms in the brain now, and there are organizations like the National Alliance on Mental Illness who talk about mental disorders as situations that have to do with brain condition. The natural anxiety that we all have is overworking in the brain of an anxious person. Most people will do is either avoid the whole situation [that is making them anxious] or, if they can’t, they’re going to do what we call safety behaviors. In health anxiety, a safety behavior might be looking things up to see if they are symptoms of a serious disease, or visiting the doctor a lot. These typically don’t work very well, because the anxiety doesn’t get fulfilled by those answers.

What is a better way to deal with anxiety?

The better way—and this is not new, this is something every culture knows—is when you’re afraid of something, you have to design a way to approach the thing you’re afraid of, unless it’s objectively dangerous. What we want to do is approach the situation in a gradual and healthier way. What will happen is a new learning will occur, which could come in a variety of ways. It could be, “It’s not as bad as I thought it would be,” or, “The thing I thought was going to happen actually didn’t happen,” or, “I was very anxious, but now I’m not.” Those are a few of the cognitive shifts people. If that happens, then they don’t have to stay away from the situation, but need to practice approaching. Practice makes better; I don’t like perfect, because that’s bad, too.

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