Dear Dr. Goldberg,
“Is there any cure for anxiety, or are people with anxiety disorders stuck with it forever?”
This is such an excellent question and really gets to the heart of anxiety as an emotional and physiological construct. The simple answer to your question, although it may disappoint you, is “no.” There is no cure for anxiety. But in order to understand this answer, let me emphasize a few points about the origins of anxiety and the adaptive function of the anxiety response. First of all, every human being experiences anxiety, in the same way that every human being breathes, or sweats, or feels their heart pounding during exercise. This is because anxiety, like other human functions, is a hard-wired, adaptive response that is meant to preserve the integrity of the body. In this case, anxiety operates to protect you, and alert your body to potential threats within the environment. In the time of cavemen, with gnarly saber-toothed tigers running about, this was a very useful thing! Without so much as a conscious thought, the caveman’s body recognized an impending threat, and turned on a finite number of systems meant to save him from certain doom. This included increased heart rate, increased respiration, sweating, the release of cortisol, increased adrenaline, and myriad other physiological functions. Today, we talk about this constellation of involuntary physical reactions as the “fight/flight” response. Consider it the physiological equivalent of the catch-phrase, “Let’s get ready to rumble!” More important to our discussion, these responses are inevitable, adaptive, necessary, and to cure you of them would be analogous to removing your skin.
Of course, people don’t like feeling all of these things, and the involuntary nature of anxiety is more than a little discomforting, particularly for those of us who constantly want to be in control. In addition, sometimes it can be hard to interpret what our bodies are doing. After all, there are no more saber-toothed tigers! The modern contrivances of men and women have made our present lives quite safe and comfortable, so why this continued triggering system? Well, in some ways, the fight/flight response is a vestige of our primitive past – an emotional appendix, if you will, that has fewer opportunities to shine. However, we do continue to need occasional warnings that something threatening is looming on the horizon; like when someone cuts us off in traffic. The trick is separating the threatening from non-threatening events so that we don’t needlessly evoke our anxiety response. For instance, in the case of panic disorder, the fight/flight response is often triggered following the misinterpretation of minor physical aches and pains. Someone may feel a sudden twinge in their chest, and begin thinking, “what if I’m having a heart attack?” This thought, in itself, brings on the physical symptoms of anxiety (e.g., racing heart, difficulty breathing, sweating) which appear to support the initial concern. Next thing you know, the person is at the hospital getting an EKG, when in reality, there was nothing wrong with them. When we misinterpret the anxiety response, or tell ourselves that we NEED to control it, CURE ourselves of it, or make it GO AWAY, we are ironically making things much worse.
So, what should you do then? I encourage my patients to change their relationship with anxiety. Rather than focus on curing anxiety, we work toward accepting that, sometimes, we will feel anxious. Everyone does. And when that moment comes, the challenge is to control the negative thoughts and behaviors that accompany anxiety. As I am fond of saying, Anxiety is not your enemy. It is a hard-wired response that everyone experiences. WORRY and AVOIDANCE are the enemies! The goal is to treat anxiety like an unwanted party-crasher. An in-law. An acquaintance that we can uncomfortably tolerate for the time that they’re with us. To say to anxiety, “I don’t like you and you don’t like me, but we’re going to have to live with each other.” And while anxiety is visiting, we need to develop better tools for managing the discomfort it creates.
Of course, when your anxiety begins to interfere with aspects of your daily life, such as relationships, work, and school, you may need professional guidance to learn how to manage the physical and emotional discomfort more effectively. For this I recommend cognitive behavioral therapy which has been shown to be immensely helpful for settling the anxiety response. For a list of CBT providers in your area, check-out the Psychology Today website. Thank you for the wonderful question.
- Dr. Goldberg