It sometimes feels like anxiety is ever present these days. Whether it’s public events such as war or disease that cause anxiety, or more personal triggers such as public speaking or spiders, anxiety plays a role in the lives of most people to some extent. It’s when that anxiety becomes unmanageable and starts to encroach on our ability to live the life we want to be living that anxiety becomes something you may want to seek treatment for.

When looking to treat anxiety, one of the most important things is to clarify the difference between anxiety and fear.

Fear is the emotion we feel when we encounter a direct threat, and in general it is considered adaptive. A car speeding right at us, an angry person yelling at us, feeling an earthquake, all of these are examples of things we might interpret as direct threats to our health, and we’re likely to be flooded with the urge to fight or flee. Sometimes, when we don’t feel like we have the ability to do either of these options, we can freeze in an attempt to minimize attention and/or damage. In all cases, however, there is a real, immediate threat to our well-being.

Anxiety, on the other hand, is the emotion we feel when the brain anticipates a threat that isn’t present at that moment in time. An upcoming public speaking engagement, worrying about a loved one’s safety, or being afraid to leave the safety of your home, these are all examples of things that we might become anxious about, but in truth we can be anxious about anything. Anxiety can be useful, because it may lead us to prepare for a challenge, or be cautious when doing something with potential risks. However, it can also be debilitating when our anxiety stops us from doing something potentially rewarding, causes us to fight, flee, or freeze in the face of something that isn’t actually dangerous, or plagues us with an amorphous sense of worry at all times.

One of the most insidious things about anxiety is the way it prevents us from living a rewarding life. Most often, this occurs through the cycle of avoidance. This will frequently begin with a negative experience with the source of our anxiety. Re-encountering the source, or even hearing a reference to it can reignite the negative feelings felt at the original encounter, and the person tries to get away from it. Because when the person avoids the source of anxiety, they feel better (less anxious), they become more likely to avoid that source in the future. And because they never have any contradicting experiences of the source (positive or neutral emotions), the source of their anxiety becomes more threatening over time.

For example, I am afraid of deep water, which I trace back partially to a bad experience as a teenager. Understandably, I felt fear during this event, and now hold negative associations with deep, unclear water. For a time afterward, I was nervous around lakes, and refused to go into water where I couldn’t see the bottom, and even got nervous on boat rides. Eventually, if this fear hadn’t been challenged with swimming lessons, and other more positive experiences, this nervousness may have expanded to include pools, beaches in general, or even bathwater. Because I felt less anxious when I avoided the water, and more anxious when I approached it, the water posed a potential threat to my mental well being.

While in some cases, phobias can develop out of genuine threats to our safety, patterns of anxiety and avoidance can develop from any event that we interpret as threatening to ourselves, our goals, or our social relationships.

How do we work through anxiety?

My approach to working with anxiety boils down to two steps:

• Increase ability to cope
• Take action

Increase ability to cope

The first step is to increase your ability to cope with the unpleasant emotion of anxiety. While the form this takes must be tailored to the individual, this can often include learning breathing exercises, grounding exercises, meditation, and mindfulness training, and then learning to use these tools in the midst of intense emotion. Essentially we are trying to ensure the emotion of anxiety doesn’t paralyze you so that you can begin to work through it.

Take action

For anxieties that are focused on a specific experience or topic, taking action means some form of graduated exposure. We would work collaboratively to generate a plan that allows you to begin to break the pattern of avoidance and diminish your anxiety by creating new, different experiences, while also ensuring that you feel safe and in control throughout.

Some anxieties are difficult to confront directly, such as anxiety around climate change, or social injustice/systemic oppression. In these cases, it becomes important to increase feelings of personal empowerment, either in the form of joining causes relevant to the anxiety to effect change at higher levels, or by increasing the ability to effect change on a more personal level.