Treating chronic anxiety involves two things: 1) addressing the symptoms of anxiety--worry, difficulty concentrating, difficulty sleeping, etc.--that are disrupting a person’s life and 2) addressing what anxiety means to the person who’s experiencing it. While it may seem that symptom relief should be enough to relieve chronic anxiety, addressing the meaning of anxiety often makes a greater difference in reducing it in the long run.
Jane Rubin, Ph.D., talks about the emotions that underlie her patients’ struggles with anxiety. She explains that understanding the shame that often accompanies chronic anxiety is one of the important keys to alleviating it.
What Feelings Do Your Clients Commonly Express About Their Anxiety?
People with chronic anxiety are usually very hard on themselves. They often feel that their anxiety is irrational and that it means that there’s something wrong with them. For example, people with social anxiety think their anxiety is a sign that other people are picking up on what’s defective about them, and that people are going to reject them because of their supposed defects. Similarly, people who suffer from obsessive-compulsive disorder are convinced that they’re “crazy” because they have to perform rituals before they leave their house in the morning, or because they have catastrophic fears that, they feel, won’t make sense to anyone else.
In my experience, it’s much easier to address the symptoms of anxiety when patients can come to the point of genuinely understanding that there’s nothing wrong with them. This begins to occur when patients realize that, as irrational as it may seem to them, their anxiety actually makes sense. It has a meaning. Understanding that meaning is liberating for them because they no longer have to carry the shame of feeling that their anxiety means that they’re “crazy” or that something vague and undefinable is “wrong” with them.
How Does Understanding The Meaning Behind Anxiety Promote Healing?
I want to be clear from the outset that, for many people, there is a biological component to their anxiety. This is certainly true for the more severe forms of OCD, but social anxiety and other forms of anxiety often respond quite well to medication, as well. So I don’t want to be understood as saying that addressing the meaning of anxiety is the only way to effectively treat it. However, my experience has been that, even when medication is effective at reducing the symptoms of anxiety, the shame that accompanies anxiety is still active and still needs to be addressed for patients to experience a significant reduction in their anxiety.
For example, I’ve seen a number of patients with social anxiety who were shy as children. Instead of responding empathically to their children’s shyness, their parents criticized them for it, The parents often forced their children into situations that exacerbated their discomfort without giving them any tools to manage their distress.
Sometimes these parents had their own discomfort with social interactions. Their children’s discomfort reminded them of the shame they felt about their own discomfort. Instead of examining these feelings of shame, these parents shamed their children. This made my patients feel that their shyness meant that there was something wrong with them. Once they felt that there was something wrong with them, they were even less inclined to want to participate in social interactions because they were sure they were going to be humiliated or rejected.
In the same vein, many of my OCD patients had parents who were very critical of them. The parents responded to even the tiniest aspects of my patients’ behavior--the clothes they chose to wear, their table manners, their facial expressions, and so on--with withering judgments. Often these parents were very anxious themselves. But, because the shame they felt about their own anxiety was so intense and felt so unmanageable, they transferred that shame to their children.
In most, if not all, of these instances, my patients had a biological propensity towards OCD. Medication has absolutely helped them. But it’s been at least equally important to help them recognize that their need to check the stove twelve times before they leave the house--or whatever compulsive behaviors they feel they need to engage in-- and their fear that something catastrophic will happen if they don’t, makes perfect sense. Something catastrophic did happen when they didn’t perform perfectly. Their parents shamed them and they felt terrible about themselves. They’ll do anything, no matter how “crazy” or “irrational” it seems, to avoid that feeling.
What Does The Way Forward Look Like For Chronically Anxious Clients?
For most chronically anxious patients, treating the symptoms of anxiety is just one part of the process. The other is to address the underlying shame about the anxiety itself.
Our culture often encourages us to look for a quick fix. This quick-fix mentality encourages us to think that the symptoms of anxiety--or of depression, or of other emotional difficulties--are the only things we should focus on. But, if we only focus on the symptoms, we miss the way those symptoms have affected a person’s self-esteem. Those self-esteem issues remain even when the symptoms have been reduced. And they can cause those symptoms to reappear if they’re not adequately addressed.
My goal for my patients is that they not only feel less anxious but that they feel better about themselves in general. This means accepting that anxiety is not a judgment of who you are as a person. It’s not an indication of your worth, your value, or your lovability. It doesn’t mean there’s something wrong with you. It’s not irrational. It’s a feeling that makes sense given how you experience the world. The more you can understand and accept that experience, the more you’ll be open to other less constricting, ways of experiencing things, and the more you’ll experience consistent relief from anxiety.
Are you struggling with chronic anxiety? Please click to learn more about anxiety treatment with Jane Rubin, Ph.D.
Jane Rubin, Ph.D., is a clinical psychologist in Berkeley, California. She works with individuals in Berkeley, Oakland, the East Bay, and the greater San Francisco Bay Area who are struggling with depression and anxiety. She also specializes in working with people who are trying to find meaning and direction in their lives.