As we think more about achieving wellbeing, let’s discuss the most common feeling with which people have trouble:

Anxiety is a normal, healthy emotion that includes thoughts, sensations, and the urge to behave in specific ways. It occurs after your fear circuitry is triggered in the presence of ongoing uncertainty.

Our fear circuitry is a highly perceptive, adaptive, and primitive part of our brain that kept us alive as a species and is up against different challenges in the modern world. When fear is triggered, there is a pattern of sensations, thoughts, and urges that come with it that are adaptive. Specifically:

Sensations present during fear (aka the fight-or-flight response): Heart races, blood pressure increases, pupils dilate, sweating, shortness of breath, and digestion rapidly decreases.

Thoughts present during fear: Catastrophic, worst-case scenarios are generated. Thoughts are experienced as “sticky” or as if the presence of the thoughts means that they are actually occurring. This is called thought-action fusion (TAF). Although thought-action fusion is also “irrational,” it is important to recognize that thought-action fusion in the presence of real danger is very adaptive. Pulling your hand away at the same time (or even before) you have the thought “my hand is touching fire” is an adaptive example of thought-action fusion.

Urges to behave present during fear: The combination of the sensations that fear generates plus the sticky catastrophic thoughts drives you to respond to what you experience either through “fighting” (aka problem-solving) or “fleeing” (aka avoidance).

Fighting or fleeing has been incredibly adaptive throughout human history and when fear is actually alerting you to danger, either problem solving or avoiding the situation is the appropriate response.

However, many situations that trigger the fear response in modern life are not actually dangerous situations, but rather uncertain situations. If you misinterpret either the uncertainty or the sensations, thoughts, and urges that occur during the fear response as an indication of danger itself, what you do in response to your fear will increase and maintain your anxiety state, turning it into an anxiety disorder.

So, an anxiety state is an emotion that triggers flight-or-flight sensations, catastrophic thoughts, and the urge to problem solve or avoid.

An anxiety state becomes an anxiety disorder when you add an interpretation of danger and respond accordingly. Individuals with anxiety disorders believe their catastrophic thoughts and attempt to problem solve or avoid their thoughts, feelings, and sensations.

Although there are other characteristics of each disorder, one way to think about the specific anxiety disorders is by understanding what you misinterpret as dangerous.

Put simply,

Panic disorder is fear of sensations and avoidance of external or internal stimuli that may trigger those sensations.

Generalized anxiety disorder is fear of thoughts, hypersensitivity to uncertainty, and problematic beliefs about the utility of worry.

Obsessive compulsive disorder is fear of thoughts and hypersensitivity to uncertainty, guilt, and disgust.

Social anxiety disorder is fear of sensations and thoughts and fear of positive evaluation and negative evaluation due to hypersensitivity to the possibility of rejection and perceived judgment.

Sensitivity to anxious sensations occurs in all of the anxiety disorders. This trait is called anxiety sensitivity and it is a biological predisposition that runs in families and is passed down through social interactions.

The fight-or-flight response is inherently neutral; it isn’t good or bad. It’s just happening. A performer who frames the way that his heart races before going on stage as excitement is experiencing his fight-or-flight response positively. He will not complain of having an anxiety problem nor will he experience the other problems that occur during the struggle against anxiety.

If you have anxiety sensitivity, you experience your fight-or-flight response as uncomfortable and potentially dangerous. You were likely born sensitive to being over-stimulated. You were likely socialized to fear and try to control your thoughts and sensations, because adults told you “calm down,” “don’t worry,” “don’t think like that,” and “you don’t need to feel like that.” In addition to telling you to control what you think and feel, you likely watched adults express worry when they felt uncertain and avoid when they felt anxious.

Everyone with an anxiety disorder also focuses on the future too much. Having goals and plans is an important part of achieving your potential. If you have an anxiety disorder, you probably spend a lot of your time thinking and worrying about the future, in an effort to manage your intolerance of uncertainty, to the detriment of the present moment.

Worry and unwanted intrusive thoughts can occur in all of the anxiety disorders. Hypersensitivity to uncomfortable feelings like uncertainty, guilt, disgust, rejection, disappointment, and shame are all common across the anxiety spectrum. I believe it is helpful for your long-term relief to have an underlying understanding of the patterns of thoughts and behaviors that all the anxiety disorders have in common and how you can respond differently, regardless of the content of the fear.

Your response to an anxiety state depends on your interpretation of the meaning of that state. The meaning that you could give an anxiety state ranges from danger on one side to opportunity on the other.

People who believe “anxiety = danger” avoid internal and external situations that make them anxious.

This is the primary misinterpretation that you are making when you have an anxiety disorder. It is true that the fear response (including sensations, thoughts, and an urge to problem solve or avoid) is triggered when there is a perceived threat, but the presence of the fear response does not equate to danger.

What’s more, if, through learned behavior, you start believing that the fear response itself is dangerous, you will avoid more and more until your world is very small. For example, if you fear that your sensations will lead to a panic attack you will avoid anything internally or externally that might lead to a panic attack. Or, if you fear having certain thoughts, you will avoid internal or external situations that might trigger those thoughts or perform physical or mental compulsions to make the thoughts go away when they inevitably occur. In both cases, you are misinterpreting the fear response as equivalent to danger. The more you avoid your thoughts and feelings, the more often they will occur.

People who believe “anxiety = uncomfortable, but not dangerous” pursue internal and external situations that could make them anxious and then attempt to do things to cope with the anxiety.

Western society encourages us to think this way. It is a slightly better position than equating anxiety with danger, but the problem with this position is that the attitude still lacks acceptance of whatever thought or feeling is occurring. As long as you feel like you have to work to “manage” what you experience, you will risk getting burnt out by the effort of “staying in control.” For long-term wellbeing, it’s best to learn to open up to whatever thoughts or feelings occur without believing that those thoughts and feelings need to be managed.

People who believe “anxiety = opportunity” pursue internal and external situations that make them anxious on purpose, and then interpret the feeling as excitement.

The most helpful attitude toward anxiety is one where it is interpreted as normal, healthy, and an indication that you are engaging in something challenging and uncertain.

Professional athletes, musicians, and performers all feel the same physiology as the anxious person when they are about to perform. They are able to channel their “anxiety” into high performance because they accept and get distance from their self-doubt and use the physical sensations to urge them towards behavior that is effective in that moment.

Even the anxiety associated with an unwanted, intrusive thought occurring in OCD can be re-interpreted as an opportunity for curiosity towards your mind and how it functions. It can deepen your compassion for yourself and others.

This attitude, about any form of anxiety, is available to everyone and is learnable.

Let’s think about what it would have been like to be an early human in order to understand the evolutionary utility of the anxiety response.

You and I, early humans, are sitting next to each other around a fire, discussing our recent drawings on our cave. The fire is warm and the conversation is calm, yet engaging. The feeling we both have is one of calm and ease.

Suddenly, there’s a loud sound just 20 yards away!

Both of our limbic systems immediately respond. Our hearts start pumping, our blood pressure increases, our pupils dilate, we stop digesting. Sweating, we’re now ready for action. These physiological sensations occur before we’re thinking and as our minds catch up, both due to the noise and due to the increase physiological sensations, our minds start generating all kinds of catastrophic possibilities.

“Is it a tiger? Is it a bear? Where are our children and are they safe?”

We’re both on our feet, starting to search for the source of the noise and prepare to take action or run away depending on the threat.

Step out of this imaginary scene for a second… What do you think about the response you and I, as early humans, just had? Was it silly, stupid, or shameful? Even if there is no threat coming, would you judge us as foolish and irrational? Or, do you think that the sensations, thoughts, and urge to behave were all understandable reactions, even highly adaptive reactions?

Back to the scene…

As we start to search around, it turns out that our friend made the sound. She dropped a pot on a stone and it made a loud sound.

When we hear this news from our friend, we’re so relieved. Our hearts stop racing, our blood pressure starts to go down, our pupils and digestive systems go back to what they were doing, and we stop sweating. The thoughts about tigers, bears, and our children pass by and we no longer have the urge to search for danger. We go back to the fire and our conversation and enjoy the evening.

This is an example of our effective fear circuitry in action. Just like we didn’t force ourselves to have the sensations, thoughts, and behavioral urges associated with fear, we didn’t force ourselves to stop having that experience. When we were certain that we weren’t in danger, our fear system relaxed for us. There were so many threats in everyday life for the early humans that our species would not have survived if it relied on us to be responsible for turning fear on and off.

How does this relate to modern difficulties with anxiety?

Imagine if you and I, as early humans, heard the loud noise, had a fear response, but then never got certainty that it was our friend that made the sound, not a tiger or a bear. A normal, healthy, and adaptive mind might continue to have catastrophic thoughts and urges to search for the source of the threat.

The modern equivalent is occurring when an individual struggles with anxiety. Our minds are so intelligent at this point that the possibilities we can imagine for what will happen in the future, for good or for bad, are endless. And life is filled with endless uncertainty. If we imagine it, we can fear it.

As modern humans, given that most of the time that our fear is triggered we will not actively be in danger and we will not be able to get immediate certainty, we must intentionally practice new ways to respond to our minds. We must drop the struggle with our emotions and practice letting thoughts, sensations, and behavioral urges pass.

Anxiety sensitivity is the fear of arousal-related sensations, arising from beliefs that the sensations will have adverse consequences such as death, insanity, or social rejection.

Think about it as second fear. Whereas first fear is the automatic fight-or-flight reaction that arrives in response to a perceived threat, second fear is the interpretation that the sensations themselves are a threat.

Anxiety sensitivity amplifies the automatic anxiety reaction. The tendency to respond to arousal-related sensations with terror is heritable. Sensitivity runs in families and the thinking patterns that perpetuate terror are socialized.

Taking responsibility for an anxiety disorder requires that you learn what sensitizes you and you make a plan for those situations. The best way to disarm anxiety sensitivity is to get accurate information about your sensations.

Here are some common sensitizing situations and what you can say to yourself when they happen:

● Hungry – “My mind might be sticky because I’m hungry. I should have a snack before I act on these thoughts.”

● Angry – “My mind is building a case, so I probably feel angry. In the presence of anger, rather than fueling my case, I should calm my body down. Then, I should decide whether my anger is a signal or noise, and if I need to take any action.”

● Lonely – “I am alone and I’m starting to ruminate about it. I probably feel lonely. I should allow this feeling, and either reach out to someone or make a plan to reach out to someone soon.”

● Tired – “My mind might be sticky because I’m tired. I should let my thoughts pass until I have a chance to rest.”

● Illness, Stress, Menstruation – “My mind is stickier due to (fill in the blank). It’s okay to be patient with myself as I try not to make my anxiety worse.”

Sometimes accurate information about anxiety disarms it. For instance, learning that you will not faint during an anxious moment can disarm fear about what might happen. When accurate information and perspective about anxiety doesn’t disarm it, try switching to tolerating uncertainty.

Anxiety sensitivity is the fear of arousal-related sensations, arising from beliefs that the sensations will have adverse consequences such as death, insanity, or social rejection.

Fear of fear is common when you are in a neurologically vulnerable state, including being hungry, tired, angry, lonely, and stressed. It’s worth it to make a plan to prevent and manage your sensitized states.

Let’s focus on other thoughts, feelings, memories, and situations that contribute to sensitization. We can try to predict and prevent sensitization, but triggers happen.

The paradox of introspection is that when you are very triggered and sensitized, all the thinking you engage in to try to “figure out” why you’re upset will likely make you more upset. It isn’t your fault. Your amygdala is doing its job searching through memories and fears in an attempt to figure out why it’s happening, how to get out, and how to prevent it again in the future. Many people get caught in this attempt to figure it out and their rumination and worry make them feel worse.

Even if you gain insight every once in a while, the problem is that this type of rumination and worry does not help you in the long term. For long term relief, switch to observing what is happening, not why it's happening.

As you switch to observing what’s happening, you may find that you don’t know what you think and feel. When anxiety is challenging to identify, label, and allow, all other emotions are usually difficult to identify, label, and allow.

Here are a couple of tips to help yourself relate effectively to emotions besides anxiety, without avoidance, rumination, worry, or self-criticism.

● Notice when you are thinking or saying, “I’m upset,” “I just don’t feel good,” “I feel bad or down,” “I don’t like myself or this situation.” Try to identify a feeling word for these states. Take a guess at what someone else in the same position would feel.

● Ask yourself, “If I didn’t feel anxiety, what would I be feeling?”

● Ask yourself, “What 3 words describe what I’m experiencing?”

● If it seems like you are on the anger spectrum of feelings, get curious about whether you are also on the sadness spectrum.

● If it seems like you are on the sadness spectrum of feelings, get curious about whether you are also on the anger spectrum.

Anxious thinking arrives with a whoosh of fear sensations, it feels urgent, and seems like a message or a threat. Anxious thinking also creates unreasonable thinking about stakes and odds.

When you experience non-anxious thinking, your mind is likely good at managing risk and assessing the likelihood of a feared situation. When you experience anxious thinking, your mind decides that even if the odds of something bad occurring is very low, the stakes of that possibility are too high and any risk is intolerance.

Here are a few examples:

It is possible that you will get in an accident while driving. If you approach that uncertainty anxiously, you might decide that the stakes of death or injury by car accident are too high and stop driving. If you approach that uncertainty without anxiety, you will likely assess the relatively small odds of an accident compared to the high stakes of not driving and decide that the risk is worth the chance.

It is possible that your food will be contaminated at grocery stores. If you approach that uncertainty anxiously, you might decide that the stakes of death or injury through contaminated food is too high and take unsustainable, compulsive measures to acquire food. If you approach that uncertainty without anxiety, you will likely assess the odds of the safety measures failing compared to the stakes of not getting groceries in a reasonable way and decide the risk is worth the chance.

It is possible that you have a fatal disease that is currently undiagnosed. If you approach that uncertainty anxiously, you might decide that the stakes of death or chronic suffering due to an undiagnosed health issue is so horrifying that it is worth all of your time, regardless of the odds of it. If you approach that uncertainty without anxiety, you would assess the odds of a life-threatening disease compared to the stake of making constant doctor’s appointments, doing research, and getting constant reassurance. Spending all of your time attempting to protect against a health issue costs you your life anyway. You might decide instead that you can live with it as a possibility.

Perhaps these are areas of your life where you have trouble making values-based judgments about stakes and odds. That is, you have anxious thinking about these topics that arrives with a whoosh of fear sensations, feels urgent, and seems like a threat every time. This anxious thinking might make you feel like these risks are not worth taking.

The reality is that they might not be. It’s true that people die in car accidents every day and it’s true that life-threatening diseases that go undiagnosed have a worse prognosis. When those who don’t feel anxious about the situations above decide that it is safe enough, they are doing it based on a feeling. Or rather, they act based on lack of feeling. People often decide that because they don’t feel anxious and it doesn’t seem like a threat, that it is a reasonable risk to tolerate.

You may find this reasoning intolerable for your content area. I want to challenge you about your logic, though, because there are all kinds of uncertainties that we all live with all the time because they don’t give us anxiety. The uncertainties don’t give us anxiety so we don’t compulsively protect against them. Anything could be contaminated. Anything can suddenly break. Anything could catch fire. Anyone can get injured or sick at any time. You could make a mistake or do something embarrassing. You might just be a bad person. You live your life with all of these possibilities and more. The world you live in is both incredibly dangerous and incredibly safe, depending on that to which you are turning your attention.

Rather than using feelings or logic in any attempt to rationalize the threat of danger, try using your values. All areas of life have some uncertainty to them. You can never be completely certain that you will be safe, healthy, and happy.

Given that reality, what risks are you willing to take in areas where you feel anxious?

What risks seem reasonable in light of what you value in life, even if they don’t feel reasonable according to your anxiety?

You’ll recover from your emotional disorder when you overcome your anxiety sensitivity, or second fear. Anxiety treatment can’t and shouldn’t mean that you’ll never be anxious again. Becoming anxious is a normal, healthy adaptive reaction to doing challenging things with uncertain outcomes. I would never want to take the capacity to become anxious away from you. Instead, I want to teach you to respond to anxiety in a way that helps you rather than hurts you. You’ll overcome fear of fear by inviting in fear when it shows up and choosing to see it as an opportunity, not a threat.

It’s helpful to ask yourself, “If I didn’t feel anxious, what would I do?” and “If I am feeling more than just anxiety, what else do I feel?”

These two questions seem simple, but they target two very important concepts:

“If I didn’t feel anxious, what would I do?” targets values-driven behavior. We’re trying to wade through the anxiety to the values underneath it and act according to that value, rather than according to what our anxiety urgently tells us we must do.

“If I felt more than just anxiety, what else do I feel?” increases our emotional awareness. All emotions feel threatening when anxiety feels threatening. Feelings such as loneliness, sadness, non-OCD guilt, and longing can be data that points us in the direction of values-driven behavior if we allow these feelings to teach us without adding fear and shame.

To increase psychological flexibility, to increase access to value driven behavior, and to increase the capacity to use feelings as data, we first learn to notice, label, and allow anxiety without adding a fear-based layer of avoidance and control.