Self-Help
& Professional Update:
The
Three Principles*
Can I down what I have learned over the last 30 years
into three basic strategies to address anxiety? That
was my assignment recently, and here, briefly, is what
I came up with. I’ll write this as though I am talking
directly to those who struggle with their form of anxiety.
#1. Focus solely on a new frame of reference, not on techniques.
Shift away from content—“it’s about
my heart/ my debt/ the safety of the plane/ germs”—and
onto the very best strategies to recover from the anxiety
disorder. These strategies should always focus on the point
of view that currently motivates your actions. Most anxious
people have two intentions: (1) to only take actions that
have a highly predictable, positive outcome, and (2) to
stay comfortable. If you apply techniques or skills without
accounting for these implicit goals, you will feel yourself
resisting.
Repetition of a new behavior is essential for long-lasting
change. But your belief system will always trump exposure
practice. If you have panic disorder, maybe you’ve
said, “I go to the grocery store. At least three times
a week! And I stay there, anxious as hell, sometimes for
45 minutes to an hour. But I’m still no better!” Why
isn’t this kind of practice helping? Maybe because
as you stand in the threatening situation, your self-talk
includes, “God, I hope I don’t have a panic attack.
I wish I could get out of here. I hate this feeling.” You
resist because you are driven by a point of view expressed
through this instruction: “Get safe and get comfortable.” That’s
what figure 1 shows. As you move into uncertainty, your mind
starts to say, “watch out!” and you try to
defend yourself through avoiding, struggling against what
you are experiencing, and bracing for the blow.
You need to frame a new therapeutic view toward your problem
and its solutions. When you can change your perception
about how one beats anxiety, you will invent your own ways
to practice facing anxiety.
I’m going to assume that this is your stance: you
do not want to feel uncertain or anxious. Given that, you
have long established a mix of avoiding and resisting that
you believe is the most successful potion to keep uncertainty
and distress from boiling over. Your beliefs are normal
and universal. Everyone seeks comfort. And everyone wants
to feel confident about certain outcomes. Most people who
experience traumatic events—a near drowning, a panic
that resembles a heart attack, blanking out in the middle
of a conference presentation—initially react by seeking
comfort, safety, and reassurance. But your solution to
your problems—avoiding and resisting, and seeking
comfort and certainty—perpetuates your problems.
Anything that is resisted will persist.
Therefore, the best perspective is a paradoxical one:
When facing a problem, go toward uncertainty and distress.
#2. Create an offensive strategy—seek
to be clumsy, awkward, uncomfortable, and uncertain.
You must take on a point of view that is absolutely opposite
to your current beliefs. Your anxious belief is such a
stable, protective, well-constructed fortress that it will
easily subvert softer alternatives.
Here is how a typical client responds to a task I assign: “This
Wilson guy sounds like he knows what he’s doing.
I guess I’ll try it. But I’m worried about
how it’s going to go. I don’t want to get too
anxious. And I hope this is going to work—that it
helps me start feeling better soon. And I hope I don’t
go through what I did last time, when I still didn’t
perform very well.”
This stance is going to directly undermine your therapeutic
efforts. Remember, belief trumps behavior. With anxiety,
the belief is always, “I should defend myself.” Thus,
you are going to tend to back away from challenges with
the aim of staying safe. To take back territory lost to
anxiety, you must push forward aggressively into arenas
where you previously surrendered. Your primary goal is
to generate an offensive strategy. Since anxiety requires
that a person seek out comfort and certainty, you should
voluntarily and purposely seek out the sense of feeling
clumsy, awkward, doubtful, and distressed. “Courage
first; comfort last,” should be your motto.
Understanding this concept intellectually is easier than
implementing it. The best way is to act instead of think.
Adopt rules that you can follow unquestioningly during
your threatening events. Don’t wait until the moment
of threat to choose a response, because your mind tends
to regress back to a defensive mode at these times. Instead,
generate firm rules ahead of time and activate them at
the threatening moment. These rules, of course, are paradoxical.
Consider these points of view as a way to understand what
I am suggesting:
- Shooting for clumsiness is a winning strategy.
- Wanting to feel awkward and uncomfortable will counter
your dysfunctional strategy of trying to get better while
you simultaneously stay comfortable.
- Seeking out uncertainty gives you a competing alternative
to your impulse to become quickly certain of a safe outcome.
#3. Believe you can cope with failure.
The most difficult-to-handle fears are those of catastrophic
consequences. If you are prone to panic attacks, you might
say, “I think I now can cope with a #6-level panic.
But what if I have a #10?! I can’t handle that!” If
you are afraid to fly: “I think I can handle a flight
now, but what if we have to sit on the tarmac for 4 hours?
I can’t handle that!” If you’re socially
anxious: “I’m prepared to give my report now.
But what if they start peppering me with questions? I can’t
handle that!”
These stances will invite you to worry, over-prepare,
avoid, and resist. All of these crutches perpetuate your
anxiety regarding a threat. One strategic mistake is to
rely on attempts to convince yourself that the catastrophic
events you are predicting won’t actually happen.
Why? Because you can never reassure yourself enough. Most
anxious people tend to seek absolute certainty, not relative
certainty.
I remember feeling like I did a bang-up job convincing
one client of the safety of commercial flights. I concluded
with, “Do you have any idea of the probability of
dying on a plane? Think about this: If you flew every single
day of your life, it would take 26,000 years before your
number would be up.” “Yeah?” he said. “But
what about the guy sitting next to me? What if his number
is up!?” You can never get the absolute certainty
you demand.
Even if you could convincingly persuade yourself of the
unlikelihood of a catastrophic outcome, that reassurance
is unstable. In a threatening moment, the anxious mind
races to worst-case scenarios, overriding any softer message
of “it probably won’t happen.”
So, instead of emphasizing the low probability of catastrophes,
it is better to switch your attention to coping strategies.
Most studies of resilience—the ability to spring
back from adversity—indicate that the critical variable
is self-efficacy: my actions count. Here’s the overarching
position I suggest that you shoot for: “Whatever
happens, I’ll handle it.” You don’t necessarily
have to challenge whether the bad event will occur. Instead,
challenge your perspective about that outcome. Albert Ellis,
one of the great pioneering innovators of cognitive treatment,
taught people to degrade events from perceived catastrophes
to manageable events. You have the ability to shift your
perception of an upcoming event from “humiliating” down
to “embarrassing,” from “the end of
life as I know it” to “pretty tough for a while.” To
reach that perspective, I help my clients detail all their
feared outcomes and extend a timeline out into the future,
outlining their possible coping strategies. Clients initially
fight that protocol because to be so concrete increases
their anxiety. But the research is clear: The more specific
you are about the variables associated with a future feared
event, the easier it is to generate coping strategies.
That leads to self-assurance: “I can handle it.”
Figure 2 illustrates this process. The way to push back
against your worries and defenses is to be willing to not
know how things are going to turn out, and go forward anyway. That
is a courageous action: to want uncertainty. And it incorporates
all three of the principles of this article: Lead with
a paradoxical frame of reference, push into your awkwardness
and doubt, and be willing to lose in order to win. That
is your ticket out of your suffering.
*Adapted from Wilson, Reid, “The Art of Persuasion
in Anxiety Treatment.” In Kerman, Michael, Clinical
Pearls of Wisdom: 21 Leading Therapists Share Their Key
Insights. New York: W. W. Norton, in press.
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