There Is No 'A' in Anxiety
How high-achievers find themselves stuck
In my psychotherapy practice I work mainly with anxious individuals, and I hear something to this effect over and over again: “Logically I know I am not going to fail, in fact, I usually get the best grade in the class.” And yet they worry that this is the time that it will all fall apart.
By definition, individuals with anxiety are engaging in avoidance, and sometimes that avoidance is significantly impacting their life. When someone is not driving, dating, or leaving the house, the avoidance is apparent to anyone who knows them. More often though, I see clients who appear to be engaging fully with their lives, in fact, they are excelling. They are A+ students, professionals in high-stress careers, or stay-at-home mothers who make parenting and household management look easy. From the outside, you may look at them and think, “Why can’t I be more like her?”
In therapy, these individuals may report just as much intense distress as my clients that are avoiding their fears all together. Despite sleepless nights ruminating about all the worst-case scenarios, they tend to show up, and usually, perform well enough that they could have learned by now that everything is going to be ok. Despite their courage, their anxiety persists. So, what’s the deal?
Maybe you are reading this and think, “that sounds like me.” In addition to your worries about judgement, failure, or rejection, you may experience some of the following:
“Overthinking,” often disguised as problem-solving
A need to be in control, so much so that you are trying to anticipate and manage the emotions and behavior of everyone around you
Difficulty making decisions or committing to a course of action
Physical complaints, like muscle pain, gastrointestinal issues, headaches, and insomnia
Perfectionism
Procrastination
Staying in your comfort zone, like forgoing promotions that you feel unqualified for
A harsh inner critic
Rigid adherence to routines and structure
Irritability or rage due to constant tension
Over reliance on alcohol or other substances to soothe distress and feel normal
Imposter syndrome
I can illustrate this with a personal example. I began taking Spanish classes in the 8th grade and I loved learning a new language. I excelled and continued to take Spanish voluntarily throughout high school. Around this same time, my social anxiety ramped up significantly, with an intense fear of failure and judgment. This fear showed up in my ability to speak up in class, which became impossible. I could get by without speaking out in most of my classes, except for Spanish, which usually graded participation. This makes sense, it’s impossible to learn to speak a new language without, well, speaking it.
I began to sweat my way through my Spanish courses, literally. I dreaded the thought of being called on spontaneously, and carefully planned out my 1 or 2 mandatory participation comments ahead of time. Whenever an assignment required that I speak in front of the class or instructor, my mouth would become so dry that my lips stuck to my teeth. My voice would shake as much as my hands. Despite my misery, I continued to sign up for Spanish class every year, long after I achieved my mandatory language credits. I did the same in college, voluntarily showing up and loathing every minute of it. I even went on a 4 week winter abroad trip to Oaxaca and lived with a Mexican family, all the while terrified of having to actually speak up, and avoiding it as much as possible.
Why didn’t I quit? Despite my fear, I really wanted to learn to speak Spanish! I knew I wanted to be a psychologist in the future, and I hoped to be able to make mental health treatment accessible to diverse and underserved communities. And despite my silence in class, I never earned anything less than A.
What I want to highlight is that in cases like mine, the avoidance is often hidden. On the surface, it appears that the person is exposing themselves to their fear. This is important, because exposure is the cornerstone of anxiety treatment. The antidote to anxiety is to stop avoiding and face the fear. If exposure works, then how come I never learned, no matter how many presentations I gave in Spanish class, that I could handle the assignment, without going mute or getting laughed back to my seat? Why are my clients so afraid of failure or rejection or embarrassment, despite an often long history of achievement, approval, and social success?
Once we look closer at their stories, the problem becomes clear. Showing up to the scary thing is unfortunately not enough. Instead, we must show up and abandon all the tiny, often hidden strategies that we have developed to help us feel safe. We must show up to the fight with no hidden weapons or plan B. Only then can our nervous systems learn that we can tolerate both the thing we fear and the uncomfortable sensations associated with doing it.
How do you feel safe in the face of anxiety?
These strategies, called “safety behaviors”, can be effective in the short term to get the job done. In the long run however, the brain is learning that it can only tolerate the scary task or the distressing feelings with the help of the safety behavior. For example, if you rely on alcohol to ease the discomfort of meeting new people, you may not believe that you can handle a social situation without having a drink. This strategy keeps the doubtful thoughts around and undermines our ability to trust ourselves. Some common safety behaviors include:
Excessive preparation or rehearsal
Rumination- either thinking ahead about all the worst case scenarios or replaying afterwards to check for mistakes
Excessive self-criticism to keep yourself in line
Perfectionism
Excessive checking and re-checking for mistakes
Reliance on others for reassurance or second-opinions
Self-talk that is full of excessive or unrealistic reassurance
“White-knuckling” through the experience to avoid feeling the fear
Numbing the discomfort with substances
Tackling anxiety requires an attitude shift. We have to welcome the distressing thoughts and sensations, allowing them to be there while we take meaningful actions towards what we care about. A “bring it on” approach to anxiety allows the brain to learn that these thoughts and feelings are not a real threat. We can assess the outcome and learn that even mistakes are usually not catastrophic. With time and repetition, we can expect the fear to subside. This is how the real learning happens.
What can you do?
What does this shift in perspective look like in action?
1. Get clear about what you are afraid of
Try to identify more precisely what you are worried about. Are you afraid of saying something inaccurate or ridiculous? Are you worried that others will notice how anxious you are? Are you fearful of ridicule, rejection, or losing your job? Or maybe the fear is more specific, like your hands sweating profusely or your cheeks flushing red.
2. Choose your behavior based on values, not fear
One of the best ways I’ve found to motivate my clients (and myself) to take actions in the face of fear, is to get clear about values. Values are what we care most about. We can use this motivation to guide our behavior, instead of fear. I kept signing up for Spanish class because learning a new language was closely aligned with my values and my identity. Knowing what I know now, I could have used that as motivation to begin speaking up in class which was the only way I would achieve my goal of fluency.
3. Stop white-knuckling and be willing to feel
Anxiety is associated with a feeling of dread or impending doom and a long list of physical discomforts. It makes sense that most of us want to minimize or soothe those feelings. For this to work though, we have to flip the script. You must be willing to feel whatever sensations come up, because this is how you learn that you can feel it and still thrive. Instead of blanket reassurance, tell yourself that these feelings are not dangerous. Open your body to the experience of anxiety by unclenching your fists and loosening your posture, opening your eyes, and breathing slowly and deeply.
4. Leave the safety behaviors at the door
Identify what strategies you have been using to create a feeling of safety before, during, and after an anxiety-inducing activity and eliminate those behaviors as much as possible. This includes internal or mental behaviors such as ruminating and harsh self-criticism.
5. Start small
Commit to using this new approach in easier situations first. For example, if you are struggling to speak up at work, identify where this same fear is coming up for you in other, lower stakes scenarios. Maybe speaking to strangers on the phone, asking for assistance in a store, playing group games at parties, etc. Start small and build your way up to more challenging situations, but don’t drag the process out too long (avoidance can be sneaky like that.)
As far as I can remember, it never crossed my mind to seek out help for what I was experiencing in Spanish class, or my social anxiety in general. I don’t believe I identified my experience as anxiety in the clinical sense, it just felt like who I was. Regretfully, I eventually did give up on learning Spanish. But of course, the fear of speaking up in front of others, and the underlying fear of being imperfect, showed up in other facets of my life again and again.
If my experience resonates, I hope you will identify that this is not your personality, it’s a problem that can be treated. If the steps above feel overwhelming to do alone, reach out to a therapist or psychologist that specializes in the treatment of anxiety. You are already doing challenging things every day; this approach makes sure that all that effort is moving you towards growth and self-confidence.
Some books that I often recommend:
The Happiness Trap by Russ Harris
The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills by Jennifer Kemp
I’m currently reading: How To Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety by Ellen Hendriksen, and I imagine I will be recommending it often!
So helpful, thank you!
I love how you point out that working with anxiety requires a shift in attitude/perspective. Such an important insight. :)