Breaking the Anxiety Cycle

To overcome anxiety, break a link in this vicious cycle.

Generalized anxiety disorder (GAD), in adults and youth, is characterized by persistent, excessive worry. If the problem started and ended with a worry, it might not be such a big deal. Instead, people with GAD get bogged down as one worry leads to another and another.

What Perpetuates the Anxiety Cycle?

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Worries, some of which might actually be solvable, are maintained for several reasons. First, certain worries might persist because of biased thinking. This could involve an overestimation of the likelihood of a bad outcome or an exaggeration of just how bad the bad outcome will be. Some worries are strengthened by negative thoughts about oneself, such as the belief that one would be completely unable to cope with uncertainty or an undesirable outcome.

Second, worries can persist because of how information in the environment is processed. A person with GAD may selectively tune in to information that supports the worry and ignore evidence that refutes it. Memory can be selective too; in some cases, people with anxiety problems have difficulty even recalling data that is inconsistent with a particular worry.

Third, worries persist because of the ways to which they are responded. Individuals with untreated anxiety problems tend to respond to their fears by trying to (1) suppress the worry, (2) seek reassurance that nothing bad will happen, or (3) avoid situations that might trigger the fear. Unfortunately, these strategies can make people feel terrible and then reinforce (i.e. strengthen) the anxiety rather than weaken it, thus creating a difficult-to-break cycle.

The Cycle of Anxiety, and How to Break It

Anxiety Cycle (click to open in a new tab).

Take, for example, the worry that “My boyfriend is going to break up with me.” This is an intrusive thought that is actually quite normal for a person to have. It might come up ‘out of the blue’ or in response to a specific situation. However, an overly anxious person would appraise this thought as very meaningful, review all the reasons why this thought might be true, try to reduce the anxiety in the short-term (effectively strengthening it in the long-term), and feel terrible. Thus, the belief becomes even more significant and is experienced more frequently and more intensely than in someone without an anxiety problem.

The worry cycle for this example might look something like this. To overcome anxiety, this vicious cycle needs to be broken.

Acceptance

One way to break the cycle is to learn to accept that not every intrusive thought is signaling a legitimate reason to worry; simply put, not every thought is true. Instead of trying to wrestle with beliefs, acceptance-based techniques involve identifying the thought, labeling it (“worry” or “judgment,” for example), and being mindful of the moment that gives rise to the belief as well as the moment when it begins to recede from awareness. For more on the principles of mindfulness, see this related post.

Questioning

Another strategy that can effective break the link between biases in thinking and information processing is cognitive restructuring, a cornerstone of a treatment approach called Cognitive Behavioral Therapy (CBT; Please see this introduction to CBT to learn more.). Cognitive restructuring offers a way to critically evaluate potentially distorted thoughts, like “He’s definitely going to break up with me” or “I cannot go on without him,” by asking a series of questions about the belief that can encourage a more balanced view of the relevant facts.

Exposure

Finally, exposure is tool that would break the anxiety cycle by eliminating reliance on ineffective anxiety reduction strategies. The basic concept of exposure is to lean into anxiety by confronting, rather than avoiding, anxiety-provoking situations to learn by experience either that nothing terrible will happen, or that bad outcomes are in fact manageable (and might even have an upside). After or while facing a fear, it is critical not to engage in any safety behaviors that might “undo” learning; this is sometimes referred to as response prevention. For more on how to get the most out of an exposure exercise, read here.

Exposure exercises for the example above would include intentionally disagreeing with a boyfriend or imagining what it would be like to get into a major argument. Repetition really helps with exposure, so it would be important to disagree with some regularity or to imagine the major argument again and again – until it all becomes more boring than anxiety-provoking. The response prevention component would be to do these things and not ask whether or not your boyfriend is mad, so as to learn to live with uncertainty.

While the cycle of anxiety is, indeed, vicious, breaking even one link can go a long way to diminishing worry and the anxiety to which it leads.

References

Abramowitz JS, Deacon BJ, & Whiteside SPH. Exposure Therapy for Anxiety: Principles and Practice. New York: The Guilford Press, 2011.

Leahy, RL. Cognitive Therapy Techniques: A Practitioner’s Guide. New York: The Guilford Press, 2003.

Beck, JS. Cognitive Therapy: Basics and Beyond. New York: The Guilford Press, 1995.

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