Mental health issues in America have growing at a staggering rate. During the 90’s when I was a teenager, most of my friends and peers were unhappy. This all changed with the Millennial Generation. Those who reported feeling “very happy” increased significantly among Millennials. And yet, we see that there’s been precipitous drop in happiness among people born after 1995.
In a major survey administered by the American Collegiate Health Association, college students are now more likely to say they feel overwhelming anxiety and that they felt so depressed they could not function.[1] Many experts believe we’re in the middle of the worst mental health crisis in decades with teen depression and suicide skyrocketing since 2011.
Our genes say it all
Now most people believe that genetics and brain chemistry determine mental health. Sonja Lyubomirsky, a professor of psychology at the University of California, Riverside, authored a book called The How of Happiness. She wanted to answer questions such as: “How much do life circumstances and genetics play a role in influencing happiness?” She took measurements of happiness among identical twins (who share the same genes) and fraternal twins (who shared a similar upbringing). And she studied people who experienced catastrophic life events. She came up with this pie chart showing how much genetic predisposition, actions- thoughts and circumstances factor into our happiness.[2]
According to her research, genetics play a decent factor of 50%. Our genetic or happiness setpoint determines which side of the glass half full/glass half empty divide you fall. In fact, how you interpret this data tells you which side of the divide you’re on. If you think, “50% is pretty significant, I’m screwed.” You’re a glass half empty kind of person. No matter how you look at it, her findings suggest we’re not enslaved to our genetics. What’s surprising to me is that only 10% of life circumstances play a role in our happiness –a car crash, winning the lottery, etc. More on that in a couple weeks. The final 40% seems based on all kinds of actions, intentions and habits that people develop. Unlike the other stuff, that’s the part we can control. That’s great news. People who struggle with depression and anxiety often describe feelings of hopelessness that they will never break out of. I believe that even in serious cases of General Anxiety Disorder or Major Anxiety Disorders, the combination of medication and taking your thoughts captive can greatly help you with anxiety.
Not to mention, the modern discovery of neuro-genesis shows that what you think about and what you do, can actually change your brain chemistry. For example, brain scans of adults and children have shown a link between an enlarged amygdala (part of the brain associated with processing emotion) and higher anxiety risk. But what you do and how you think can impact your brain. Here’s an interesting study I pulled from Jefferey Schwartz’s book, You Are Not Your Brain,
Drawing on Dr. Schwartz’s strong belief that the mind can change the brain, the UCLA researchers asked people with [Obsessive Compulsive Disorder] OCD to participate in a research study where they either took medication or learned our Four Step approach to dealing with the intrusive, negative messages…The team scanned people’s brains before treatment and ten to twelve weeks after they had been following our method or taking medications. Much to our delight, they found that the people who used our Four Step method had the same positive changes in their brains as the people who took medications to treat their OCD. These incredible brain changes occurred because of our mind’s ability to change our brains (i.e., how we focus our attention)…Recent research in Germany replicated our findings. Those researchers found that OCD patients’ symptoms decreased significantly when they simply listened to an audio CD that explained our treatment method.”[3]
In this article, we want to focus on overcoming anxiety. Before we begin with strategies for overcoming anxiety, we should look at twelve strategies that don’t work.
The Dirty Dozen: Twelve Strategies That Don’t Work
This comes from psychologist Robert Lehy’s book the Worry Cure which takes a Cognitive Behavioral Therapy (CBT) approach to anxiety.[4]
1. Seeking reassurance
Maybe you worry that you don’t look as good as you wish. After all, who does? So, you try to garner compliments about your looks from people. Or you worry that the guy you met at a party who yawned while you were talking means he thinks you’re boring.
Seeking reassurance doesn’t work because you can always doubt the reassurance later. Maybe your friend is trying to bolster your ego by telling you that you look fine, but she really believes that you are looking worse than ever. As we shall see, relying on reassurance will keep you from learning to live with uncertainty. Therefore, this strategy is destined to fail because it’s impossible to obtain certainty. What’s worse it will make you check over and over again to get more reassurance.
2. Checking over and over
You try to reduce your anxiety by checking to make sure that everything is OK. You think, “I may have forgotten something,” “If I can catch something early, I can prevent worse things from happening.” The key elements of checking are the following: 1) If I check, I can reduce uncertainty. 2) I cannot tolerate uncertainty. “I’m pretty sure I put my laptop in my bag when I left the coffee shop, but I need pull my car over to make sure.” 3) If I catch it early, I can prevent worse things from happening. 4) I can’t rely entirely on my memory. “I’m pretty sure I locked the door, but maybe I’m misremembering.” 5) I can never be too careful. 6) It’s my responsibility.
Imagine that your worrying because your boyfriend didn’t text you back immediately. After 5 minutes, you check your phone to see if he texted you. Maybe your phone was on silent. Ten minutes later, you get on Find My Friend to see if he’s in town or if he’s somewhere with limited reception. He’s in town. One hour later, you wonder if your text messaging isn’t working. So, you ask a friend to text you something to see if it’s working. You think, “If I check, then I’ll stop worrying.” But what was really bothering you is the thought, “If he doesn’t text me right away, then it means he’s dumping me.”
Your checking was driven by the thought that you would feel reassured by getting his message immediately. Checking gives you the illusion of taking control by finding out what was really going on. Some people will even sabotage their dating relationships because they think: “If I just end things, I don’t have to worry anymore about it ending.”
Checking is a compulsion, a behavior you use to decrease your anxiety. Obsessive thoughts or a worry drive compulsions. Or the checking might involve examining your skin daily for any signs of cancer. You check, you don’t have any worrisome spots and feel relieved. Or you check and see that a mole looks odd, so you run to the doctor and ask for a biopsy. The doctor reassures you it’s nothing. You feel better for one hour. But then you wonder where this doctor went to medical school and whether she is as smart as you used to think she was.
Checking can never address your fundamental concern: “I can’t stand uncertainty.” So you spend a lot of time and emotional energy checking, and you reinforce your belief that you need to check to be safe. What are the benefits? You feel better for an hour, but then you check again.
3. Trying to stop your thoughts
Most worriers have heard this advice from well-meaning friends or family members. You might feel better for about ten minutes if you’re lucky. But most of us who’ve tried to do this know it doesn’t work.
Let’s try something. Everyone, close your eyes for a second. Close your eyes for a second. Close your eyes. Come on, man. Let’s close ’em. You’re the only one. Now try to conjure an image of a white bear –like the cute fuzzy white bear in the Coca Cola commercials during Christmas– that kind of white bear. Now that you have this thought of a white bear, I want you to stop thinking of white bears. Whatever you do, don’t think of any white bears. What just happened? You started thinking about white bears.
Psychologist David Wegner found that attempts to suppress thoughts of white bears actually led to an increase in these thoughts after the suppression. Thus if you tried to suppress images of white bears for ten minutes, you will have a substantial increase after the ten minutes is over. He asked his subjects to ring a bell every time they saw a white bear. Subjects saw a white bear about once a minute on average.
Thought stopping finds its basis on the idea that you cannot stand having a certain kind of thought—say, an obsession or a worry. It confirms your idea that these thoughts are harmful or will lead to you losing control.
Thought stopping doesn’t work because you inevitably experience thought rebounding. This occurs because you cannot eliminate thoughts that are in your mind—you cannot erase your memory. Not only that, but you actually have to pay attention to the thought you are trying to suppress! Therefore, next time you have an anxious thought, you shouldn’t suppress. You need to pay attention to it. More on that later.
4. Collecting information
When you worry about something, you might go out and collect as much information as you can. Afterall, “Information is power” and “I’m just after the facts.” But even if you’re simply gathering a set of facts, you might be collecting a biased selection of facts. They may be facts that are not only misleading but useless. This is because you often overestimate risk, you try to confirm your negative thoughts, you see trends that don’t exist, and use irrelevant information.
You overestimate risk
In collecting information about a threat, you are really trying to evaluate risk: “How likely is it that something bad will happen?” But we almost always overestimate risk when we are anxious.
First, calculating risk is a complicated process. Let’s imagine that we are trying to calculate the risk of airplanes crashing. Ideally, in order to calculate future risk we should do the following: (1) collect all of the information about past accidents (how many times airplanes have crashed in the past); (2) collect information about the amount of exposure to this risk (the number of times people have flown); (3) determine whether there are new conditions that increase or decrease this risk (technological improvements decrease the risk, and terrorism increases the risk); and (4) estimate how negative the outcome will be (in this case, getting killed is a highly negative outcome).
Unfortunately, when you estimate risk, you almost never use these rational thought processes. In fact, psychologist Paul Slovic found that you are likely to estimate risk by relying on several irrational rules of thumb:
How we often misuse information to overestimate risk[5]
Accessibility: If I can recall the information easily, it must be very relevant (we can recall images of planes crashing).
Recency: If there is recent information, it must be more likely (a plane crashed at a local airport last week).
Powerful images: If I have a strong image of this, it must be more likely (we saw an image of the plane burning).
Emotional thinking: If I am anxious, it’s more likely (our emotion “tells” us that it is more likely to happen).
Severity of outcome: If it could be really awful, then it is more likely (we imagine that we die in the crash).
Personal relevance: If it’s relevant to my plans, it’s more likely (we are planning on flying tomorrow). Sit back, relax and enjoy your flight.
Thus, when we search for information we are seldom objective. In fact, we almost never look for the most important information—how often does the predicted outcome not occur? Thus, if you have a fear of flying, how often do you collect information about planes landing safely?
Second, your information isn’t relevant. Let’s say you notice one day that you have a headache. You go to the WebMD and start researching neurological disorders. Maybe you’re having a stroke or an aneurysm. By the time you are finished, you’re convinced that you need to arrange for someone to adopt your cat.
But the information is useful only if it is relevant. For example, relevant information about the headache is whether Tylenol will help. Another piece of information might be, “What percentage of people have headaches at one time or another?” Let’s see…It’s 100 percent.
When you go to the Web and check out all of the diseases associated with headaches, you are driven by the irrational rules of thumb I mentioned earlier.
Third, you try to confirm only negative thoughts. When you worry, you try to find out if a negative prediction could come true — “Could I have cancer?” As a result of this, you are driven by what’s called “confirmation bias.” If you are worried about having cancer, then you will seek out information that suggests you do have cancer.
Fourth, you see trends that don’t exist – Take a day trader who sits in front of his monitor looking at stocks. He thinks, “I’ll see the trend before everyone else.”
In a fascinating book, Fooled by Randomness, investor and statistician Nassim Taleb points out that individual stocks will vary randomly daily and that real trends might not show up for months or years.[6] The investor sitting there watching his monitor is looking at noise but interprets it as useful information. Watching the screen every hour of every day leads you to see patterns that are not really there.
When we collect information about our worries, confirmation bias drives our information gathering and interpretation. Thus, if you are worried that someone seems annoyed with you, you are biased toward all the negative information about how that person acts toward you. You fill in the blanks when someone makes an ambiguous statement or you may interpret an ambiguous facial expression as angry or judgmental.
5. Avoiding discomfort
People commonly avoid things they’re worried about or procrastinate with things that make them anxious. If you’re worried about completing your homework, you avoid doing it. If you are worried that you’re not attractive, you avoid parties.
Avoiding things that make you worry works in the short term. It reinforces the belief that you are not competent to handle these problems, and this makes you even more worried about them in the future. Furthermore, you do not have the opportunity to find out that you can handle things on your own. You have no chance to disconfirm your negative beliefs.
6. Numbing yourself with alcohol, drugs, and food
Anxiety and depressive disorders are connected to an increase in alcohol abuse, drugs, and food. If you’re worried that you will lose your job, you overeat to feel better. If you worry about people ignoring you at a party, you have several drinks to “take the edge off.”
The great appeal of numbing and escape is that it works immediately and it’s easily available. And you can put off the cost— for now. You can feel high and avoid thinking about life in the real world for a few hours. But you’re putting off the costs till later.
Numbing yourself with these substances tells you that you cannot handle your worries or your feelings. Numbing yourself never allows you to examine your thoughts to see how irrational they are. You can run away from your feelings—numbing yourself with these substances, but the problem is that you won’t be able to really find out what is bothering you and solve problems in your life. As a result, you’ll have two problems—the anxiety and the self-defeating behavior that you use to cope with your anxiety.
7. Overpreparing
You worry that you have to give a talk next week. Although you know your content well and have considerable expertise on the topic, you begin to worry, “What if my mind goes blank? What if someone asks me a question that I can’t answer?” You’ve worked on this material and read what needs to be read…but you don’t know everything. You’re not perfect. So, prepare your talk right down to the last word, so that you can read it from your paper. You get up there and read it to the group and…well, you’re really boring.
You were worried that speaking extemporaneously will cause you to forget your points. You didn’t forget, but you sounded mechanical. So next time you overprepare even more and rehearse. And guess what? You’re still boring.
Being overprepared feeds right back into the belief that you have to be totally in control of your worries or everything will fall apart. It also feeds into your worry that if you are not perfect you will sound like an idiot. And, of course, you equate –pausing, or going off track– with not knowing everything.
Ironically, researchers found that speakers who were rated higher in quality actually prepared very little right before the talk. They just felt they knew the material. The speakers the audience liked least were the ones who prepared the most right before the talk.
Overpreparing doesn’t work because it is never possible to be completely prepared. Most importantly, it reinforces your belief that you have to be perfect and know everything in order to feel safe.
8. Using safety behaviors
These are things we do that make us feel momentarily safe and secure. Safety behaviors are very common and we often don’t realize we’re engaging in them.
For example, I may fear losing control of my car and go over the side of a bridge. So, I avoid bridges, turn off the radio because it distracts me, slow down, avoid looking over the side. These safety behaviors give the illusion of control.
Safety behaviors are important in maintaining fear and worry. They only reconfirm that you cannot handle the situation on your own and that it will remain dangerous unless you “protect” yourself with these behaviors.
9. Always trying to make a great impression
You might worry about how you look, whether you will have anything interesting to say and whether you will say something stupid. So you worry that “If I don’t make a really good impression in everything that I do, then people will think less of me.” If you believe that you always have to really impress people, you will anticipate being judged by the harshest critics—and worry accordingly.
10. Ruminating—chewing it over and over
I cover this more in “Battling Negative Intrusive Thoughts,” but I will say that rumination isn’t exactly the same as worry. Worry involves predicting what will happen in the future, while rumination involves a review of what’s happening now or what happened before.
If you ruminate, you believe that if you think about your problem you will find a solution and stop feeling bad. But this belief is completely false. According to Susan Nolen-Hoeksema in the Journal of Abnormal Psychology, “People who ruminate are far more likely to be depressed and anxious, and they are more likely to have reoccurrences of depression and anxiety.”[7]
11. Demanding certainty
This one is very similar to the first two. We will never gain 100% certainty. To quote Leahy: “Since anything is possible, looking for certainty will guarantee only one thing—more worry.”[8] Living with uncertainty is living in the real world.
12. Refusing to accept the fact that you may have “crazy thoughts.”
Many people worry over thoughts that seem out of character. Almost everyone reports having “crazy” thoughts about things that are disgusting, illegal, or violent.
We often interpret these thoughts as a sign of losing control and going crazy or we feel ashamed and guilty.
Worriers of all kinds believe that their thoughts or impulses are signs that something really bad is about to happen. For example, people with a panic disorder worry that their thoughts of a panic attack predict a panic attack; people with OCD believe that their thoughts about losing control predict they will act violently or inappropriately. Worriers also tend to believe that their thoughts will lead to action and consequently fear their “crazy” thoughts.
Many people believe that having certain thoughts means that they are immoral, disgusting, or uniquely messed up. They presume these thoughts reveal something about their character or sanity. However, your thoughts do not determine your character and sanity. They’re determined by what you do.
Not all worry is bad
You can convert your worry into action. Your worries seem to leap far beyond the information that is in front of you. Imagine you’re sitting at your desk, looking at the work that you have to do and you begin to worry. You jump to conclusions: that you will never get all the work done, your boss will get angry with you, and that she will fire you. Then you worry that you won’t get another job for months, your savings will run out, and you’ll go deeper and deeper into debt.
Notice how these worries have nothing to do with what’s in front of you. You have a desk in front of you, filled with folders, which contain work you need to complete by the end of the day. Now you can’t control what your boss thinks. But you can control whether you do a good job completing the tasks right in front of you. And this it may influence your boss’s perspective of your performance.
Steps to Overcoming Anxiety
1. Thought Flooding or Exposure Therapy
As we said earlier, simply telling yourself, “Stop” while you’re feeling anxious doesn’t work. Rather than telling yourself to stop worrying, which creates thought rebounding, we should take notice of our worries.
Psychologists suggest worriers learn to engage in thought flooding. With flooding, you take your worry “I might lose my job” and instead of avoiding thinking about it, you come to terms with the possibility. So you tell yourself, “I might lose my job,” “My boss may let me go,” “My store may close leaving me unemployed.” As you flood your thoughts with your worry, you come to realize that you can handle the thought if something bad happens.
With more serious disorders, such as OCD, psychologists may sometimes prescribe exposure therapy. A friend of mine was diagnosed with OCD when she was little. She was afraid of toilets. She wasn’t worried about them being dirty, she was worried about them overflowing. Apparently, it happened once and freaked her out. Her therapy consisted of using the bathroom at least once during school instead of waiting till she got home and drawing hundreds of pictures of toilets.
Now what blew me away as I read these books and resources was how we see a form of “thought flooding” in ancient biblical wisdom. For example, if you read the Psalms, the writers engage in thought flooding. They don’t run from their worries. They imagine the worst that could happen. Take Psalm 27, for example:
When evil people come to devour me, when my enemies and foes attack me…Though a mighty army surrounds me, even if I am attacked…Even if my father and mother abandon me… (Psalm 27:2,3,10)
And yet, the reason he could accept these possibilities was because of his belief in God.
The LORD is my light and my salvation—so why should I be afraid? The LORD is my fortress, protecting me from danger, so why should I tremble? (Psalm 27:1-2)
2. Accept Limitations
One of the driving forces behind worry and anxiety is that you must know everything, plan for everything and solve problems that could possibly exist in the future. You refuse to accept the limitations of what you can do and what you can control.
There are a number of limitations that we need to accept in order to give up worrying about things. We can accept that there may not be the answer, so we can live with ambiguity and complexity. We can accept that we can settle for less than what we want, in order to appreciate more of what we have. We can accept that some things are just outside of our control. And we can accept that some problems may not be solvable and that we will just have to live with them.
3. Accept Uncertainty
Worriers equate the unknown with danger. However, uncertainty is actually neutral with regard to outcome. Just because I do not know what will happen in a situation, it does not follow that the outcome will be negative. They’re simply unknown. I also do not know the positive outcomes that will occur. Rather than focus on the unknown and equate it with danger or bad outcomes, you should focus your attention on what you do know.
Intolerance of uncertainty is the core issue for most worriers. Psychologists found that worriers cannot tolerate not knowing something for sure. In fact, one worrier told the researchers that “he would rather know a negative for sure than be uncertain about a positive.” Worriers keep looking for a perfect solution, an answer to every possible question they can ask, and a clear prediction for every possible what-if. In the absence of this certainty, they keep worrying until they find it.
Worriers also avoid confronting the emotional impact of their experiences. This is because worriers seldom get to the point of actually facing their worst fears. Moreover, since worriers are trying to think about how to solve all the problems, they do not get to the point where they feel the emotion. Worry and searching for certainty is a form of emotional avoidance.
The more you can tolerate uncertainty, the less worried you will be. In fact, people who were able to train their mind to tolerate uncertainty were able to reduce worry and anxiety immediately, significantly helping 77% of chronic worriers.[9]
4. Gratitude
According to recent research, consistently practicing gratitude trains our brains to attend selectively to positive thoughts and emotions, which reduces anxiety and feelings of apprehension.
In one experiment, researchers divided 80 adults 60 years and older into three groups. They asked one group to write gratitude notes and words of positivity, another was asked to write about their worries, and the third group was given a neutral task. After completing the task, they exposed the groups to stimuli arousing anxiety.[10]
Results showed that participants of the first group who wrote gratitude notes showed fewer symptoms of anxiety than the other two groups. Now, it amazed me as I was studying this topic how these steps resemble ancient biblical wisdom for overcoming anxiety. Check out what the Apostle Paul says in his letter to the Philippians.
Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus (Philippians 4:6-7).
Notice he doesn’t just say “Stop worrying!” He says present your requests to God. According to the Bible, we assume a posture of humility when we pray. When we pray, we’re acknowledging our limitations in controlling a certain outcome and it implies that we’re uncertain about what will happen. Notice too, that Paul says that we ought to pray with “thanksgiving.” So this snaps together well with the research from secular psychologists.
BUT, it’s not enough to accept uncertainty, our limitations and express gratitude. You see, if we simply accept uncertainty, our limitations and express gratitude, it doesn’t address the underlying threat. For example, if you are not earning enough income to pay your bills, how does accepting the uncertainty of what will happen relieve your anxiety? If you’ve made all of the necessary cuts to your spending and made a budget and you’re still falling short on your bills, how does accepting your limitations allay your worries? If you express gratitude for the good things in your life, how does that change your worry about paying your bills?
The biblical view offers us the certainty of God’s loving involvement. Jesus tells his followers,
Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? (Matthew 6:25-26).
Though we don’t know the outcome and are limited in what we can do, God isn’t bound by those limitations. Not to mention, he promises to take care of our needs. More than this, the Bible says he has demonstrated his commitment to graciously provide for our needs by sending his son Jesus. Romans 8:32: He who did not spare his own Son, but gave him up for us all—how will he not also, along with him, graciously give us all things? The Bible teaches that God took on human flesh, came to earth and paid an awesome price to provide us eternal life. If God gave his most prized possession for us, how much more will he provide for our basic needs?
[1] American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2018. Silver Spring, MD: American College Health Association; 2018.
[2] Sonja Lyubomirsky, The How of Happiness (New York: Penguin Press, 2007).
[3] Jeffery Schwartz, You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life (New York: Penguin Press, 2011), 3-4.
[4] Robert Leahy, The Worry Cure: : Seven Steps to Stop Worry from Stopping You (New York: Three Rivers Press, 2005), 47-78.
[5] Paul Slovic, The Perception of Risk (VA: Earthscan, 2000).
[6] Nassim Nicholas Taleb, Fooled by Randomness: The Hidden Role of Chance in Life and in the Markets (New York: Penguin Random House, 2001).
[7] Susan Nolen-Hoeksema, “The role of rumination in depressive disorders and mixed anxiety/depressive symptoms.” Journal of Abnormal Psychology, 109(3), 504–511.
[8] Leahy, Worry Cure, 75.
[9] Dugas R. Ladouceur, et al. “Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial” in Journal of Consulting and Clinical Psychology, 68, 957– 964.
[10] Alison Killen & Ann Macaskill “Using a Gratitude Intervention to Enhance Well-Being in Older Adults” in Journal of Happiness Studies. 16. 10.1007/s10902-014-9542-3.