If I Am Diagnosed With Anxiety, Can I Ever Trust My Gut?
The answer is YES and I will tell you why
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Early in my understanding of my own anxiety disorder, I had a rude awakening. I was beginning to understand that having anxiety meant having a rigged internal fire alarm. The alarm kept sounding, even when there was no smoke, no fire. I had done a lot of therapy to try to turn that alarm off, and make it so that it only rang appropriately, but nothing was working.
I was coming to terms with the fact that I had to practice disregarding my internal cues that told me to be anxious or fearful in certain situations. But what about when something really WAS wrong or threatening? How would I know the difference? And just as importantly, how unfair was it that other people could trust themselves to know, and I could not?
In my therapy practice, clients very often ask me similar questions. I also saw this dilemma presented recently on social media. The creator stated something along the lines of, “Some people will tell you to listen to your gut, but if you have OCD or Anxiety, then that's not for you.”
It did not sit well with me.
What do we mean by “trust your gut”?
I think when we say “trust our gut”, I think we mean “intuition”.
We all have a sense of intuition that is important, whether you have been diagnosed with anxiety, OCD, PTSD, or any other condition that may temporarily muddy the waters.
The American Psychological Association (APA) defines intuition as “immediate insight or perception, as contrasted with conscious reasoning or reflection.” Intuition involves very little thinking. Anxiety and OCD1 involve over-thinking, over-processing, and excessive engagement with the uncomfortable thought.
I would encourage you not to confuse that anxious alarm system with your gut intuition. You have both. As part of your treatment, you can practice telling them apart.
In some circles of psychology, therapists may be encouraging clients to let go of the idea that they need to listen to their gut. Although it sounds harsh, there is actually good reasoning behind it. I have seen this most often in the treatment of OCD. With OCD, it is challenging for the mind to take a good tool, use it once, and trust the outcome. OCD was historically called the “doubting disorder” because it’s hallmark was a continual questioning and dismissal of evidence in the here and now.
Are my hands really clean? They look clean, but how do I know for sure? Better wash again just to be safe.
Why did I think that? Does that mean I am going to do something dangerous? How do I know for sure? Better avoid just in case.
When this is how the mind is working, then we can see how telling someone to “trust their gut” could quickly become just another opportunity for doubt and compulsion to take over.
Is this my gut or my OCD? How do I know? How can I check, reassure myself, or otherwise eliminate the threat entirely?
To support clients with this, one approach was to encourage them to abandon that line of questioning entirely and embrace the uncertainty. We were told, “you can’t know for sure, so can you take the risk that you might be wrong and challenge your fear anyway?”
Maybe this person is judging me, maybe not, but I am committed to decreasing compulsions so I am not going to ask for reassurance.
Like many things in psychology, when the “embrace uncertainty” approach showed good results, it was adopted wholeheartedly by many in the treatment community. The mantra became very black and white. I suspect this is how we found ourselves encouraging individuals with anxiety and OCD to stop looking to their intuition entirely.
It is true that compulsions and safety behaviors will erode one’s trust in themselves and their senses. So to reconnect with your “gut” you have to do the difficult work of minimizing anxious behavior. Early in treatment, I like to teach clients that although they may have lost touch with their natural intuition in the areas where their anxiety is highest, there are most certainly other domains in which their ability to trust themselves remains intact.
Think about it: what are the questions or areas of life that your anxiety or OCD is most impairing? What are the areas that you find yourself acting with more confidence and trust in yourself?
You do have a sense of intuition, but when your anxious mind is louder, intuition gets drowned out. In this case, it might be helpful to commit to letting go of the need to access intuition when it comes to the particular areas that you are struggling with right now. Not forever.
Anxiety, and the other uncomfortable emotions that can be triggered by OCD, usually come on strong. They are like a punch to the gut, and the emotion sky-rockets quickly. There is often a sense of urgency fueling a need to do something quickly to relieve the emotion. The emotion sticks around longer as the person engages in dialogue, internally or externally, that propels them further down a scary rabbit hole (which I usually refer to as the “scary story”).
On a nervous system level, anxiety disorders activate the threat system known as Fight, Flight, or Freeze. This system developed to protect us from threats in our immediate environment- threats that we can see with our eyes or detect with our other five senses in the HERE and NOW. See a bear, run. If you detect an immediate threat, your threat system will engage and you will act to get yourself to safety.
When folks are grappling with a question of whether their fear is based in anxiety or intuition, they are often worried that they will mistakenly disregard real evidence of danger. But this is unlikely to happen. Even the most effective anxiety treatment in the world is not going to override your threat detection system and have you staring at a bear and deciding “Naw, it’s just my anxiety. I’m fine”
Anxiety disorders and OCD almost always function in a very different way. They are not triggered by clear and undeniable sensory evidence that you are in danger. They often triggered by a thought which symbolizes danger, a “what if” or an image of something frightening or uncomfortable. They often involve a dismissal of what your senses are saying in the here and now (which would suggest that you are objectively safe). It almost certainly relies on dismissal of all the other possible explanations that would indicate that you are ok. This is not the same as the rapid, body-level processing that happens in Fight-Flight-Freeze.
It is also not your intuition. Your intuition probably feels more subtle, and less urgent, than your FFF response. It’s the feeling that tells you that a person who seems friendly enough at first, might not be a safe person. It might occur as a really brilliant idea, seemingly out of no where. It might be a niggling feeling that tells you to get a second opinion at the doctor’s office before brushing off a symptom. There’s not a universal way to identify “intuition” but remember, it’s defined as a way of knowing that occurs outside of our cognitive decision-making processes. That means, less thinking.
Accessing Wise Mind
Dialectical Behavior Therapy (DBT)2 offers some language that can be helpful here. In DBT, we talk about the mind in three parts:
Emotion Mind
Logic Mind
Wise Mind
I think of these as “ways of knowing3”, rather than different parts functioning independently.
When in Emotion Mind, we are understanding our circumstances and making decisions based on what emotion is telling us.
When in Logic Mind, we are relying on rules, pragmatics, and logic to make sense of what is occurring.
Wise Mind is not choosing either Emotion Mind or Logic Mind, it is the ability to listen to the wisdom in what both sides are sharing and making a decision (or coming to an understanding) that takes all of that information under consideration.
If you are trying to learn to live more effectively alongside anxiety and OCD, I encourage you to practice getting in touch with Wise Mind. When Emotion Mind is sharing a lot of anxiety and Logic Mind is saying “this is just OCD, I need to disregard it”, Wise mind can be the thoughtful place from which to hear all that information and make a mindful decision.
Instead of listening for an all-knowing sense of intuition (which is a bit passive) , getting in touch with Wise Mind can be an active process that puts you in the driver’s seat.
In treatment, you are practicing not acting on Emotion Mind. This is not to say we should never act on emotion, it’s just saying that right now, you are in a place where you recognize that fear and other painful emotions are running the show and you are trying to amplify your Wise Mind instead.
Wise Mind can ask:
Is this fear (guilt, shame, etc.) based on something I can detect with my senses in the here and now? If not, this very well may be my anxiety.
Is this fear in one of my target areas, where I know that my anxiety is easily and inappropriately activated? If so, you are probably dealing with anxiety, not intuition.
Am I feeling a great deal of urgency to resolve this emotion? Am I noticing my emotion sky-rocketing quickly, despite the fact that objectively, at this moment, I am safe? Then you are probably dealing with anxiety (no bears!)
The beautiful thing is, the more you refrain from engaging with anxious thoughts and behaviors and practice getting in touch with Wise Mind, the more confident your Wise Mind will become. You will likely be less concerned about how well your intuition is functioning, as you become more calm and clear about how you want to behave, whether anxious emotion is present or not. You will be learning to trust yourself again, not because there is no fear, but because you know who you are; sometimes scared, sometimes calm, always YOU.
Meet me in the comments!
How do you define “intuition”?
Have you also grappled with how to balance listening to your “gut” and challenging your anxiety?
Do you have other strategies or ways of thinking about this topic that you would like to share with others?
A reminder: I invite you to read along and join me for a book discussion of “The Full Catastrophe: All I ever wanted, everything I feared” by
.Please go here to register for the book discussion on May 30th at 12pm EST (US). It’s FREE to participate.
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If you’ve been following along, you are developing quite a tool-kit of strategies for coping with uncomfortable emotions! We’ve covered self-compassion, cognitive defusion, ‘dropping anchor’, exposure, Wise Mind, Radical Acceptance, and more….
Disclaimer: This article is a reflection of my personal and professional experiences as a licensed clinical psychologist. It reflects my current and best understanding of these issues. It is intended to be educational and informative, but is not medical, clinical, or therapeutic advice. Any questions about your personal mental health treatment should be directed to your personal medical professional. You can find a therapist at Psychology Today. Dr. Amber_Writes is a newsletter designed to be informational, entertaining, and engaging. It is not therapy. Following this newsletter does not establish a therapeutic relationship with me. Dr. Amber_Writes, and other written communication by Amber Groomes on Substack, is not a substitute for treatment, diagnosis, or consultation with a licensed mental health professional. I assume no liability for any action taken in reliance on my writing here at Dr. Amber_Writes.
OCD is no longer classified as an anxiety disorder, but I conceptualize them pretty similarly and use similar strategies to treat them. I think everything I am discussing here applies to both.
Linehan, M. M. (2014). DBT (R) skills training handouts and worksheets, second edition (2nd ed.). Guilford Publications.
I did not come up with this phrasing, but I do not know where I picked it up! If you know who first stated it, please share.
I hate how things in the treatment community have become so black and white-this article is a good example of finding the nuance.
Thank you for this. I am constantly trying to discriminate between my anxiety and my intuition. This is so helpful!!!