Anxiety – we can do so much more than just cope with it

Anxiety is big business

There is an incredible amount of time and money spent on the management of anxiety disorders in Australia.

Think about all the hours and dollars spent on therapy. Think about the drugs and alcohol used to medicate it, as well as prescribed medications. Think about all the yoga retreats, all the adrenaline based activities used to mask anxiety, all the meditation classes, all the television and streaming shows that people use to numb out to and avoid their every day angst. Think about the compulsive cleaning, the driven exercising, the obsession with clothes, cosmetics and looks pursued to manage negative feelings like anxiety.

Think too of the sick days, the lost productivity, the thwarted career ambitions, the early retirements and truncated careers that are caused by anxiety. Think about the relationship costs caused by loved ones being preoccupied, split off, not present.

No wonder there are so many pathways and so many experts on dealing with anxiety.

In psychology, the main therapies are CBT (Cognitive Behavioural Therapy), ACT (Acceptance Commitment Therapy) and DBT (Dialectical Behaviour Therapy). There are dozens of others besides these, but these are the current mainstays of modern psychology. These are manualised treatment approaches that require the therapist to follow a certain progression of interventions during the therapy session, as well as homework tasks outside of the session.

Experienced practitioners do not stick religiously to these manuals and most therapy is a hybrid of these and more humanistic, person-centred approaches. They are all useful approaches, and many of their strategies are just plain common sense.

However, there are four main points that are often forgotten about in the maelstrom of anxiety and its management. I think they are worth talking about. My hope is that whatever approach you take to manage your anxiety, you’ll do it more effectively and learn more about yourself in the process.

1. Anxiety is normal. We cannot get rid of it.

The reason I want to point this out is that many people come to therapy with an unconscious expectation that the end goal is some sort of nirvana where we always feel composed, relaxed, self-assured, playful, confident and blissful.

Of course, this is impossible. And if it is impossible, then we must learn to live with anxiety in a way where we can down regulate it when we need to. We cannot remove it or escape from it. Trying to do so just worsens anxiety and lowers our resilience in the face of it.

2. We must deal with anxiety head on.

Sometimes languages have hidden truths that even native speakers aren’t consciously aware of. In Spanish, the verb “to cope” is “enfrentarse”. This translates literally to face up to or to confront.

This expression is imbued with truth about how anxiety works. If we confront the thing that we are worried about, we down-regulate it. It doesn’t go away, but we are less overwhelmed, and we develop realistic strategies for moving forward.

We then cope with it.

Let me give you an example.

I had someone come to see me about her overwhelming anxiety about her impending wedding.

She was experiencing panic attacks and didn’t know why. She wanted me to give her a “coping strategy” to help her through the wedding day.

After some inquiring, it became clear that she wanted to get married and was looking forward to starting her new life with her partner.

When I asked her what scenario she dreaded at her wedding, it emerged she was scared her brother would get drunk, become obnoxious and start fights. She feared her brother turning her wedding into a disaster. It seems he had a track record of ruining important moments in her life.

When I asked her if she had talked to him or other family members about her concern, she said she feared her brother would take it badly and that strife might escalate between him and others, thus fulfilling her worst fears. She told me that she preferred to have a breathing strategy or something similar, so she could deal with it on her own without alienating her brother or raising tensions in her family.

I told her I could work with her on a coping strategy, but first I wanted to find out why she felt it was best to avoid dealing with the problem head on and stay worried and on edge. We explored her lifelong pattern of avoiding conflict and of trying to placate others and keep the peace in her loud, argumentative family.

In the end, after a couple of sessions with me, she spoke directly to her brother. He of course was angry and said he would not come to the wedding. At that point she wanted to ask for my fee back.

But then other family members rallied behind her and admonished her brother for being selfish and pointed out his pattern of behaviour. He changed his mind and reassured her that he would be on his best behaviour. In the long run, she had a perfect wedding and did not even need the traditional wedding Valium. Nor did she need a “coping strategy”.

By confronting the situation, setting boundaries in a non-escalating way, her anxiety literally vanished.

3. Anxiety and avoidance are intertwined.

They reinforce each other. (Theoreticians would say that the two things are related in a bidirectional feedback loop). I think the above story illustrates how anxiety leads to avoidance, and avoidance leads to less regulation of your emotions.

The more one is afraid of spiders, the more they avoid them, then the more they scream and hyperventilate when one comes close. As a result, they will be even more determined to steer clear of them or even pictures of them. Their sense of horror about snakes just grows. And so the spiral grows also.

It’s worth thinking about all the things you avoid and how there is an underlying and unarticulated anxiety lying at the base of these things.

A man who always had high libido, after years of marriage, avoided asking his wife for sex because he was anxious and fearful about being knocked back. He experienced a “no thanks” as a rejection of him and, without realizing it, he began to suppress his libido so he didn’t have to experience the thing he feared experiencing- being rejected. As a result, his sex life stagnated and his ability to deal with his wife’s unreliable libido never grew.

A 24-year-old woman has a ritual of checking light switches, taps, appliances, windows. She checks them all religiously several times before she goes to bed, and even then she sleeps lightly and patchily. Her checking is a way of avoiding a deeper, more global feeling that her world is out of control and that she has little mastery of it, and yet her checking behaviour does little to down-regulate these anxious feelings. Indeed, the checking behaviour just confirms the feeling that she has to be constantly watchful to stave off some disaster in her world.

4. We all have one or more existential fears that drive our anxiety.

If we can turn and face what it is, our anxiety will not so automatically and powerfully hook onto maladaptive coping behaviour. Irving Yalom describes four broad categories of driving concerns that we have about ourselves in this world.

They are:

  1. Fear of Death (which is sometimes experienced as a feeling of the abyss or nothingness, but is also sometimes felt as an impending sense of doom. Others can have a preoccupation with getting ill or dying.)
  2. Fear of Isolation
  3. Fear of Meaninglessness (When people are overwhelmed by this, we usually call it an existential crisis – when old methods of making our world meaningful and ourselves valuable no longer seem to hold up.)
  4. Fear of Freedom / Loss of Freedom (This one is interesting because even though we fear losing our freedom and agency, there is actually a fear and dread in exercising our agency. Sartre regarded this as a terrible burden which can drive anxiety and avoidance as much as any of the other three ultimate concerns.)

I once worked with a nurse who presented as having an anxiety disorder. But her biggest problem was that she spent nearly half her pay on recreational drugs. She barely had enough money for rent and food. Talk about an avoidance behaviour (drugs) and anxiety (financial) feeding back into each other!

As we talked it emerged that the reason she spent lots of time using drugs was (and I wasn’t aware before talking to her), “When you use drugs you’re always around people. There is always someone there.” Because she had moved to Brisbane 12 months before and she was constantly doing shift work, she had found it hard to make friends and find people to do things with. Her drug friends were easily available and she didn’t have to think about or feel her loneliness. Even when she could have made proactive steps to join groups and activities, she often stayed away because of her fear of not being good enough for others. Each of us have an ultimate existential concern that drives our anxiety, For her it was the fear of isolation

Like the old saying goes, I wish I had a dime for the number of people who couldn’t leave a toxic relationship. For many of these people it is the sheer terror of stepping out on their own and making a big decision for themselves to leave and then making all the subsequent smaller decisions by and for themselves. Sartre talks about the groundlessness we can feel when we decide to take up our freedom of choice.

But here is the golden rule. When you identify and confront these hidden fears (by talking about them and owning them) they become less powerful. They have less control over us and we are not as driven to avoid them.

There is so much more to say. Next time, I’ll expand on these four existential fears.

Until then, to invert a famous saying…..

May you rise up to meet the road ahead of you.

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Post Covid Blues and Our New Existence

When does the fun start?

Maybe it’s’ just because I am a psychotherapist, but so many people at the moment seem to have either depression or anxiety, or some combination of the two. What’s going on?

We are now emerging from covid. It was the single biggest bane of our existence for two long years. Employment opportunities are everywhere. People are starting to travel again, getting back into their sport and other activities. People are going out and seeing friends and family again. Restrictions are pretty easy to live by. It’s what we have been yearning for all this time.

Things are great right?

And yet…….. so many people seem weighed down by pressure, stress, worries about the future, lack of motivation, not really looking forward to much. So many people are going through the motions, like some dreadful version of the movie “Groundhog Day”

Here are my theories about what is going on.

1) Firstly 2022 has so far been tough. Lockdowns, Warnie, Ukraine, floods, elections, rat tests, more floods, ongoing infections, covid deaths, long covid, isolation, flu endemic etc etc. etc. If you haven’t seen it, Samy J did a great comedy skit for the ABC about Emotional Weightlifting and the trials of 2022.

Emotional weightlifting | Sammy J (S5 Ep4)

Philosophers have said for ages that our sense of the world around us is largely “socially constructed”. That means that what other people say, feel and express has an influence on our own view of ourselves and the world.

For example, imagine for a moment if all forms of traditional and social media suddenly stopped any mention of Mothers Day. Nothing said. No advertisements. No magazine stories. Zilch. Nada.How many of us would hold tightly to that date and observe it. There would be some, but there would also be many who wouldn’t. In my view Mother’s Day would die out as a cultural event within a few years . If I’m right, this would demonstrate the power of social construction.

So when people, media, radios, newspapers, facebook, instagram are full of tragedies, losses, wars, natural disasters, celebrities dying that we feel we know personally – and when it happens to such a concentration as it has this year – it seeps into our soul. And when it mixes with lockdowns and our own fatigue and powerlessness about covid, there is a heavy cost to our mood, our sense of the world being benevolent, and to our usual optimism and feeling of something to look forward to. Even if none of these things have happened to us personally, to our friends, or to our family, it feels as if it pervades our lives and hangs heavy in the air around us.

2) Reality is biting. Actual reality that is. There are very specific, concrete things impacting on us directly. The news media is talking about interest rates, petrol prices, and housing affordability. But I haven’t really read anyone yet who talks about what it actually means to our lived daily lives.

I think it means that people are feeling a mixture of foreboding and fatigue. Most people expect the next 24 months to be tough economically. Most of us anticipate tightening our belts. Many of us are worried about how they will manage financially.

I remember reading a few months ago that economists were predicting the “great shift” – that skills shortages would mean that people would up and go to new jobs and new opportunities, and increased wages. But what has happened instead, is that people have battened down the hatches and are staying in jobs where pay rises have dried up, where there are less resources to do the work with more and more demands. Job insecurity, increased workloads, combined with huge mortgages and rent, have led many of us to stay with the devil we know, stoically holding onto some sense of control in the face of a changing, volatile job market and world in general.

As a result many people tell me they feel trapped.

3) I want to mention a causal factor that is a bit more abstract, but nevertheless, very real.

I don’t think the pandemic has prepared us very well for the world we have emerged into.

I know it was tough and stressful, but I speak to so many people who have fond memories of the first sustained lockdown we had in March to May 2020, especially once jobkeeper came in and everyone had a bit of relief. For many people, their lives contracted, simplified. People felt more connected to their families. Working from home for many people meant less time commuting, and less energy dealing with office politics. Even those who had to continue working on site found they could move more freely, that the pace of demands became more manageable, and they actually felt more productive. People cooked at home instead of eating out. They cleaned their own homes. We stopped consuming according to our neurotic, void-filling habits and culture. In many ways we felt more grounded.

I don’t want to use rose-coloured glasses. We were fearful, we felt constrained, and many of us became socially isolated and depressed.

But we also had just one fear to focus on – the pandemic and overcoming it. This unipolar focus became our meaning and purpose at both a societal and individual level. It meant that, for a time, we had one thing to overcome and endure. It was definable. We tracked the covid numbers, we studied the vaccination rates, we argued vehemently about restrictions but observed them anyway. Just like a war, it defined us for a couple of years. For those two years, we did not think too greatly about all the other amorphous and overwhelming threats in our world. For example, we put our climate change fears on hold, consoling ourselves that the world was consuming less carbon-based energy. Didn’t we all read that you could now see the Himalayas from Delhi because of the reduction of vehicle emissions?

In my view, we put a lot of our existential concerns on hold, pushed them away ……. until we couldn’t any longer.

What can we do?

I am just a counsellor, psychotherapist. I am trained in family therapy and other forms of psychological therapies. I can’t offer you solutions for how the world is, nor even for how it is socially constructed.

But I think we can talk about what existence is for us as individuals and what are some ways of grappling with it.

We may be limited as individuals to change the world around us, but we can have more say about our relationship with the world around us.

Of course it is a big topic but let me just grab a workable chunk for a moment.

Philosophers sometimes talk about our “ultimate concerns”. What that means is that there is, for all of us, some underlying fear or fears that drives us or that cripples us. These underlying fears, or ultimate concerns, are not the same for everyone and their essence and expression is unique to every single one of us.

For Irving Yalom, there are four broad categories of ultimate concerns – 1) fear of death and of our lives ending, 2) concern about purpose and meaning, 3) fear about isolation and aloneness, 4) fears about freedom – both the loss of choice and liberty, and fear of the responsibility that comes with freedom. (Sartre called this freedom “monstrous”)

We don’t often study the ultimate concerns that we have as individuals. Occasionally they bubble up and feel overwhelming to the point of distress. But that is not really the same thing as calmly, methodically reflecting on what ultimate concerns are fuelling our anxiety and depression. We human beings tend to turn away from them, pretending that our here and now everyday dramas are what is really going on.

If we would metaphorically journey down to the underground of our souls with eyes wide open, to our deepest vulnerabilities, we could then relate to the here and now world totally differently.

I’ll give you an example.

I have a client who is very successful. He knows how to create startups and how to make money. The problem was that he became a slave to it. He started a business that he was manning for 16 hours a day. He had various indisputable arguments for not having a life:- for example, “Just another six months and I will be able to get it to critical mass and then I can step back”, or “I’ve got competitors on my tail who are copying my business plan”, or “If I work hard now, I can retire when I’m 50”. There was always some reason to keep working harder and longer, and to see his wife less and less. He became depressed and anxious. He became angry and agitated both at home and in his business. He felt he had nothing to look forward to. He started to feel like a failure because he couldn’t reach his own expectations of himself.

In one of Cormac McCarthy’s novels, the protagonist says we are like busy, overworked craftsmen with blunt and broken tools who must work so constantly and so long, because of our tools, that we have no time to sharpen or fix them.

This fellow was driven by a core existential fear, an ultimate concern, that told him that he was of no worth unless he was uber-successful, that there was no meaning or purpose outside of filling every waking hour with feverish activity (of questionable productivity!). This fear/concern did not let him take the foot off the pedal for one minute, or consider what life might look like if he ever attained his constantly shifting expectation of himself.

His fear/concern was caused by events, traumas and losses in his life. It wasn’t until he stopped and examined them in therapy that he was able to change his relationship with his world….. to choose his lifestyle instead of being driven by his ultimate concern. Outwardly, he didn’t change a lot ….. and he still works and he still makes a lot of money. But he learned to refute the belief that he had to work constantly every waking hour or else some catastrophe would occur. He made sure he did his favourite exercise three times a week. He went offline from his job half a day every week. He took most of the weekend off. He started prioritising his partner. He changed his relationship with his world and no longer felt depressed. He actually enjoyed his work more.

Here’s another one.

Pam worked for the state government in an administrative role where she was overworked and under-recognised. Her role was so out of control, she would stay back to 10pm or 11pm on a Friday without pay to tidy things up. She obsessed about her work at home, ruminating about unfinished tasks and various office injustices. It seemed that the more she met expectations, the more work was dumped on her, and the less was expected of other people around her. I saw her in January after her Christmas break because she was having panic attacks at the thought of returning to the office.

We talked a lot about finding ways of regulating the demands being placed on her. It wasn’t until she confronted her ultimate concern of rejection and isolation that she made progress. Once she recognised that she was trying to buy security by meeting expectations she began to realise the deal she had unconsciously made with the world was very costly to her sense of self and to her boundaries.

She began to learn strategic ways to say “no”, to discriminate between when she could disappoint expectations and when she couldn’t. She accepted there was a risk involved in disappointing people, but also that her over-working was not succeeding in shoring up any special security or reward for her anyway. Soon her panic attacks stopped and she stopped staying back in the office after hours.

Here is one final observation about anxiety and depression.

Psychology is more and more regarding the avoidance of negative feelings as the causation of mental illness, rather than the negative feelings themselves. There are numerous therapies and schools of psychology that are moving in this direction with their own different strategies and tools.

In other words, if we confront and explore our deepest existential concerns regarding our situation, we will find a different way to relate to our world and our problems. For too long, psychology has given people “coping” tools as an attempt to put up with, mask, ignore, or avoid negative feelings and to ignore the real problems of existence.

Here is an interesting piece of trivia. Sometimes language and everyday expressions have a deeper truth embedded in them. The spanish phrase for “to cope” is “hacer frente”. It literally means to face or to confront. It means that at some point in the development of hispanic culture and language, the emphasis was on facing problems, facing threats, dealing with negative feelings front on – rather than soothing or distracting from negative feelings as tends to be the approach of our contemporary culture.

Que lo enfrentes con courage! May you cope with courage!

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Love in a Time of Coronavirus

Managing your relationship through the pandemic

I wrote this a little while ago in the middle of all the lockdowns, while I worked through Skype, Zoom, WhatsApp, Messenger, telephone and any other medium my clients wanted to use. In the next room was my partner also at home working online. Our 12 year old son filled the vacuum with his squealing laughter and the constant screeching of his chair as he got up and down to gesticulate to his computer screen while embarking on virtual adventures with his mates.

Our house had taken on a kind of horizontal divide: we dressed formally from the waist up, boardshorts and tracky-daks below the camera line. Our manicured Skype backgrounds belied the pile of unfolded laundry just out of view on the floor, expanding according to its own exponential growth curve.

I’m a relationship counsellor and I have struggled as much as anyone during this pandemic. But I have some ideas about how to get through this pandemic crisis with your partner.

Continue reading “Love in a Time of Coronavirus”

The Opposite of Depression

I’ve been a counsellor and psychotherapist for 25 years and people are still getting depressed. I read in the Guardian that there are so many people taking antidepressants these days that they are finding the chemicals in the fish stock:- passed on from our bodies and transported from our bathrooms to our creeks and rivers and into our oceans.

I’m going to tell you about a woman who turned her life from cold pizza to hot pizza. But first………

Sometimes I like to play this parlor game. Sitting around with a couple of friends after a glass or two of red wine, I’ll ask them, “If depression is endemic in society, then what would be the opposite of that? What is the opposite of depression?

Continue reading “The Opposite of Depression”

Ideas and Psychotherapy Study Group

There is a new Ideas and Psychotherapy Study Group being formed which you are welcome to attend. Further details will follow but the provisional date is Tuesday 2nd October in West End, Brisbane.

For fuller details please visit

(From L-R: Sigmund Freud, Anna Freud, Virginia Satir, Salvador Minuchin, Peter Fonagy, Carl Jung)

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