Anxiety about Anxiety

Anxiety about anxiety is a nearly universal feature of the anxiety disorders. Many of my clients with anxiety issues arrive saying that their anxiety started in regard to a particular domain—health, work, relationships—but then blossomed into anxiety about anxiety. Their anxiety is no longer about the content area from which it originated. Instead, the client is now fighting a much more ominous enemy, an invisible enemy that exists only in the mind. They want to know “When is this damn anxiety going away?”

Since so much of anxiety is manifested physically, clients begin to dread the appearance of the symptoms. A quiver in the throat, a twinge in the stomach, a pain in the chest—every biological fluctuation signals the possible resurgence of the anxiety monster. The symptoms themselves are detected as threats and become signals that anxiety is returning. The person begins to monitor their symptoms to assess how well they’re doing, to assess the threat level. Their persistent monitoring shrinks the scope of attention down to just the symptoms. Breathing, heart rate, trembling, it’s all on the radar. So are the cognitive symptoms, like worry and dread. Imagine that the person were to step outside themselves, perform a quick assessment to get the measure of their anxiety, and then return to their anxiety. Having done their assessment, they know anxious they should become. “Oh, I’m seeing lots of symptoms, I must be really anxious.”

Panic attacks are probably the most intense example of anxiety about anxiety. Fortunately, panic attacks do not last long. The body simply cannot sustain the level of arousal associated panic indefinitely. But while the attack is occurring, it’s absolutely terrifying. Many attacks are the result of clients talking themselves into an attack. They begin monitoring their symptoms, most often their heart rate. Perhaps they notice their heart beating just a little faster than normal. This is detected as threatening. “Oh god, I hope I’m not having a panic attack.” Their heart starts beating a little faster in response to this thought, which is detected as more threatening. “Oh God, it probably is an attack.” Most attacks quickly escalate, peaking within ten minutes. The attacks are literally created by anxiety about anxiety. Ironically enough, the fight or flight response is mobilized in response to symptoms of the fight or flight response, a vicious circle.

Another example comes from Generalized Anxiety Disorder, where worry is the most prominent symptom. Chronic worry is time-consuming and exhausting. Chronic worry is so aversive that clients begin to worry about worrying. Productive worry, where the client is actually trying to solve a problem, is always about something, about some situation in the world, some potential stumbling block, some kind of loss. Worry about worry is unproductive, by definition.

When the severity of anxiety reaches the level of anxiety about anxiety, it’s a good idea to begin befriending anxiety rather than fearing or avoiding it.