A recent conversation with a patient (call him Bill) brought up a pattern we’ve seen before: his anxiety scores on tests for levels of anxiety have not improved, but Bill reports that he is feeling more in control of his life, the anxiety has less power over him now.
Like many people with severe anxiety problems, Bill uses procrastination and avoidance as primary strategies to control his anxiety. In fact, our experience shows that avoidance may be the real problem. Many people have similar levels of anxiety about their lives, but do not let it spiral out of control into constant worry or even a panic attack. What patients who struggle with anxiety need is to learn to face up to and deal with the stressors in their lives.
In Bill’s case, he is seeing a therapist who uses exposure therapy specifically for his anxiety. He reports that he meets with the therapist on a video call and lists a few tasks or jobs that he’s been avoiding. Then, he says, “we do that” and then discuss the emotions that come up while facing up to what he’s anxious about. He says they are usually driving at pretty much the same points each time, which is consistent with what we know about anxiety and avoidance: frequent practice is required to overcome long-established patterns.
Using this approach, Bill says “I do feel like I’m better able to handle getting through stuff” but it still feels like he’s climbing the same mountain over and over again. We pointed out that with exposure therapy, you are actually working on more difficult challenges as time goes on, so the fact you face it the same way each time masks the fact that you’re using new skills on bigger problems.
We’ve said it before, and we’ll say it again: mental health is a marathon, not a sprint. But people who make themselves “just do it” every day do experience real progress and greater control in their lives.