More than Just Jitters: A Harvard Professor Examines Anxiety Disorder

From the Lecture Series: The Science of Mindfulness—A Research-Based Path to Well-Being

By Ronald D. Siegel, Psy.D., Harvard University

No matter what you call it—misgivings, nerves, apprehension, unease—we’ve all experienced a form of anxiety at some point in our lives. But when “jitters” don’t go away or turn into something more substantial, you may have an anxiety disorder.

Woman having anxiety in public
(Image: Tero Vesalainen/Shutterstock)

There is almost always some baseline of anxiety happening in the body and the mind. Sometimes it is little fears and sometimes it is big ones. We tend to want to avoid a painful experience, and in the process of avoiding it, we end up stuck in a loop that keeps us trapped for a long time. In some people, this can become a debilitating issue—one that is difficult to understand or relate to.

Creating an Anxiety Disorder in Just a Few Simple Steps

Most anxiety disorders develop through what is called escape-avoidance learning. You can create an anxiety disorder in just a few simple steps:

First, you must enter a situation, like a supermarket, for example. Let’s say that you’re walking down the cereal aisle. The strict biological determinists or some behaviorist will say anxiety tends to arise at random. Other mental health professionals say, you know, I don’t really believe it’s so random, but the process is often unconscious.

Mental health professionals believe anxiety is an unconscious process not random. Click To Tweet

As you walk down the cereal aisle, say you remember an incident that happened when you were five or six years old with your brother at the kitchen table involving Cocoa Puffs. It’s long since been repressed because it was a painful experience you had as a young child. But there you are walking down the cereal aisle and unconsciously you happen to spy, out of your peripheral vision, the Cocoa Puffs. It’s enough to bring up a little bit of anxiety because this is how associational memory works. It just takes a small trigger to be able to connect us back to something that was a difficult experience.

This is a transcript from the video series The Science of Mindfulness: A Research-Based Path to Well-Being. Watch it now, on Wondrium.

Thus, anxiety is going to arise. We find anxiety unpleasant, so most of us try to take steps to get rid of it, especially if we have misattribution. For example, you may start to think, uh-oh, maybe I’m having a cardiac problem. Or, uh-oh, I’m getting short of breathI may have trouble breathing. Or, uh-oh, I’m going to have a real anxiety episode.

You may want to flee the situation. Chances are you’ll leave the cereal aisle. You may even leave the supermarket entirely and go out into the parking lot.

Once you get into the parking you will likely feel better and the anxiety will abate. This reduction in anxiety is called negative reinforcement.

Learn more about befriending fear, worry, and anxiety

Negative Reinforcement

Negative reinforcement is a principle in learning theory about the reinforcement that comes from removing an unpleasant experience such as if you are being hit over the head with a hammer and your performance of a certain behavior stops you being hit over the head with a hammer, you will be more likely to do that behavior the next time because it feels good to have the negative experience stop.

Once this is negatively reinforced, what do you think is going to happen the next time that you enter the supermarket, even if you don’t go near the cereal aisle? You are going to have a thought that goes something like, gosh, I hope I don’t feel the way I did the last time I was here.

the same old thinking and disappointing results, closed loop or negative feedback mindset

That’s going to be enough to get a little bit of anxiety going in your mind and body; once a little bit of anxiety starts going, you’ll have another thought along the lines of uh-oh, it’s happening again. Chances are you will get into the same loop, leave again, receive more negative reinforcement for fleeing, and after a while, you might start avoiding the supermarket entirely.

This behavior and maladaptive thinking can extend to other things. You could start avoiding the post office and other locations. This can work its way into full-blown behavior called agoraphobia, which is the fear of going out into the world. But even if it doesn’t get to that state, most of us develop these patterns, in little ways, around things that we’re afraid of and we start to avoid.

Learn more about anxiety and mood disorders

Why Therapy May Not Help

There is a little-known fact about anxiety problems, and that is that people with anxiety disorders are often more accurate at appraising risk than people without anxiety problems. Let’s look at an example of how this works.

A person with an anxiety disorder might be driving down the highway and a thought might occur to them:

Hm. I am hurtling through space at 60 or 70 miles an hour in a tin can. This is an inherently risky position. One moment’s inattention on my part, on the part of another driver, on the part of my mechanic, or even the highway crew, and I am going to be killed or maimed. You know, this feels scary. I think I will take the side roads.

Now, a person without anxiety problems gets into a car and thinks:

I am in a well-engineered automobile. I am certain that the designers and engineers at the manufacturing company were thinking about my safety at every juncture and not letting concerns about profit, loss, or expense get involved in their decisions about design features.

And that fellow over there in the next lane screaming red-faced into his cell phone, he’s paying attention. He’s thinking about my welfare. My mechanic, I trust them fully, and that sweet, pungent, smoky aroma that I get must be incense that he burns in the garage that helps him to pay better attention. 

Furthermore, I know from my own experience, as well as talking to others, that substance abuse is extremely rare in my culture, so it would be very unlikely that any other drivers might be impaired at this moment. I’m enjoying my drive.

The problem is that people with anxiety disorders notice that life is fragile and it’s dangerous to be alive, that at any moment bad things can happen very readily to good people.

This becomes an issue in psychotherapy, because often what happens is a psychotherapist will hear a person with anxiety talking about their difficulties and the therapist, being well-meaning, will try to talk the person out of it, will try to point out that, well you shouldn’t worry about this. It is a low-probability event and you should be OK.

Psychologist filling documents during a psychological session
(Image: RossHelen/Shutterstock)

The person with the anxiety disorder, if they have a good relationship with the therapist, they think, oh my therapist is a nice man or lady. He or she is in denial. I will just go along until we can change the topic and talk about something more interesting and useful to me.

Learn more about emotion regulation disorders

Components of Anxiety

Given this, how can we possibly help people with anxiety problems? Well, we can start by examining the basic components of anxiety. Researchers and clinicians alike have identified three of these components.

  • First, there is physiological arousal, which happens in our body when adrenalin starts pumping around.
  • Second, there is a cognitive and emotional part. Our conscious thoughts include all the future-oriented thinking and fear, and the accurate and inaccurate risk appraisal that we have just discussed.
  • Finally, perhaps most importantly, there are behavioral aspects; these are the avoidance and rituals, the things we do to try to not feel anxious.

How might we treat this? What would the answer be? The general answer in modern psychology is exposure and response prevention.

Consider an example of how this works. It has been said that by the mid-1980s, there were no seniors left at North American universities with untreated snake phobias. This is because they had all been recruited for studies in the psychology department.

The Snake in the Office

The students would be invited to come into the lab and the researchers would sit them in an office and just talk to them. They would tell the student that there was a snake locked in a cage down the hall.

In the early days, they used to think that it was necessary to do something called reciprocal inhibition—in other words, to train the student to do something so that they should feel less anxious. When the student starts going uh-oh, what kind of snake, they would start teaching them relaxation training and things like that.

They have since learned that it’s not necessary to teach the student relaxation training. All you must do is stay with the experience long enough until the anxiety abates by itself.

What you do is you talk to the student, describe the snake, answer their questions, and wait it out. Wait until nothing happens and eventually the anxiety starts to abate.

Then, you move the snake a little bit closer, and you tell the student, well, now it’s in the next office. They get anxious again, you wait for it to calm down. The essential thing is to get to the point where you can bring the snake into the office.

You have the snake in the cage and the student sitting in front of it. The next step, which of course is the hardest, is you must remove the lid of the cage, take out the snake, and have the student handle the snake.

If, as a researcher, you’ve had sufficient foresight as to choose a non-venomous species, if you do this several times, the student loses their snake phobia. The fear response becomes extinguished because they experience that nothing terrible happens.

Learn more about anxiety and fear

Mind(fulness) Over Matter

Human head with white birds flying from head, freedom and relax mind
(Image: GUGAI/Shutterstock)

When people come into therapy for anxiety problems, they are not actually interested in handling the snake, by and large, or whatever the equivalent might be. People want us to eliminate the anxious feeling. Instead, what the therapist does, in a mindfulness-oriented approach, is to increase their capacity to bear it, to change their relationship to the experience.

Doing mindfulness practice regularly allows opportunities for anxious feelings and impulses to be accepted and integrated so that we no longer fear and resist them. Then, the source of anxiety abates.

Common Questions About Anxiety Disorder

Q: What are common symptoms of anxiety?

Signs of anxiety most often include nervousness, excessive worrying to the point of distraction, trembling, rapid heart rate, sweating, and fatigue.

Q: What cures anxiety?

Anxiety can be treated with therapy, natural remedies, and medications. Many trials of each may be necessary before finding a treatment that works for the individual.

Q: Is it true that anxiety disorder is all in your head?

Anxiety itself is entirely in the head; however, anxiety can lead to physical symptoms that harm one’s quality of life and can even be life-threatening.

Q: What medications work for anxiety disorder?

SSRIs (antidepressants) are generally prescribed for long-term treatment while benzodiazepines can be prescribed for short-term help.

This article was updated on June 14, 2020

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