As I sank into my couch after a long day, I felt that familiar drop in my stomach and flush of heat rise in my face.
“Oh no.” I thought to myself, immediately. “I must be getting anxious. That’s not good.”
That thought was quickly accompanied by another whoosh of fear, and I knew my mind was off to the races.
Years ago, this might have led to a full-blown panic attack. But thankfully, my professional work and years of therapy have helped me learn that this “anxiety about anxiety” doesn’t always have to take over.
Over many years as a psychiatrist and therapist, I’ve found that a combination of principles from ACT (Acceptance and Commitment Therapy) and CBT (Cognitive Behavioral Therapy) can make a real difference. Here’s what I’ve learned, and how you can use it too.
What is “anxiety about anxiety”?
What we think of as “anxiety” is a complex web of thoughts, emotions, and physical sensations. So when people describe feeling anxious about anxiety, they’re often referring to a fear of the physical symptoms or thoughts that tend to come along with anxiety.
Anxiety about anxiety is a sort of “anticipatory anxiety,” sometimes termed “meta-anxiety” or “meta-worry,” in which people fear what might happen when they start to feel symptoms of anxiety.
A fear of anxiety often stems from certain beliefs about what anxiety might mean or how it might affect us. For example, someone might fear that their anxiety will lead to a heart attack, impair their functioning, or make them lose control.
Regardless of the exact message, the underlying beliefs are the same: “These anxious thoughts and feelings are dangerous and I have to get rid of them.”
These beliefs lead us to resist our anxiety, which only makes us focus on it more, magnify it, and adjust our lives to work around it.
The good news is that, while anxiety is inevitable, we do have some control over our beliefs about it and our responses to it.
How anxiety about anxiety becomes a cycle
The fear cycle begins when we buy into these beliefs that anxiety is dangerous and that we have to stay vigilant for any signs of it.
Because we are human, we inevitably notice something. And when we do, we immediately shine a spotlight on it and try to make it go away.
This is a natural survival instinct. Our brains are designed to constantly scan for danger and immediately react at the first sign of trouble.
These instincts work well for external threats, like encountering a wild animal. But when the “threat” is something internal (like our own thoughts or bodily sensations) this strategy tends to backfire.
Avoiding, resisting, or attempting to control our anxiety only strengthens the fear. The more we try to get rid of our anxiety, the more we focus on it and reinforce the idea that it is dangerous.
What you can do
Anxiety is really tough, especially when it becomes chronic or overwhelming. The best thing to do is to talk to a trained professional about solutions that will work for your unique situation. That said, here are a few principles that may help you begin to manage anxiety about anxiety.
1. Notice and challenge what you believe about anxiety.
Start by identifying the thoughts you have about anxiety. Some common examples include:
- “These physical sensations (heart racing, chest tightness, dizziness, etc) might be dangerous.”
- “If I get too anxious, I might go crazy or lose control.”
- “If I don’t get rid of my anxiety, I won’t be able to function.”
When you know what core beliefs you have about your anxiety, you can begin to question them. Ask yourself: Are these beliefs true? Are they helpful? Do I have any evidence for or against them?
Ultimately, remember that thoughts aren’t facts.
2. Foster an attitude of acceptance.
Once we have challenged some of these core beliefs about anxiety, we can practice allowing the anxiety to be there, no matter how bad it feels.
This feels really foreign to most people. After all, the whole point of anxiety is to get us to react. Anxiety is our brain’s way of saying, “Don’t just stand there, do something!” But we already know that our previous reactions to anxiety don’t work. So what do you do when the alarm starts blaring?
You let it. That’s it. You let the alarm blare and you let the anxiety do its thing.
It’s counter-intuitive, but the best thing to do is to allow the anxiety to be there, without resisting it, judging it, or letting it change what you do.
It may seem impossible because the anxiety can feel unbearable. But once we realize that there isn’t any truth to our beliefs about our anxiety, we can safely accept it as unpleasant, not dangerous.
3. Practice mindfulness.
Mindfulness is the practice of paying attention to the present moment, on purpose, without judgment.
It can be hard to engage mindfully with your anxiety when you have all those scary underlying beliefs we discussed earlier. But if you sit with your anxiety and really pay attention, you notice that what is actually going on can be very different from what your mind says is going on.
For example, a mindful approach to dizziness would mean noticing the sensations of head-spinning or lightheadedness, and noticing that those sensations are separate from thoughts like, “I’m going to pass out” or “Something is really wrong with me.”
When we use mindful acceptance to notice our anxiety, we start to look at it with the curiosity of a scientist, rather than the judgment of a critic.
We may notice our thoughts are moving rapidly or our hands are sweaty, but we can avoid labeling those as “good” or “bad.”
4. Gently face the anxious thoughts, feelings, and sensations you normally avoid.
If there is one thing that makes anxiety worse in the long term, it is avoidance.
Avoiding what makes us anxious sends a signal to our brain that the anxiety is justified. Avoidance also means we miss the opportunity to learn that our fears were overblown, or that we were more capable of handling things than we realized.
Unfortunately, we can’t wave a magic wand and forget the way we feel about our anxiety. But we can help our brains develop a new way of seeing those thoughts, feelings, and physical sensations so that they become more rooted in reality.
Building these new connections takes gradual, intentional, and gentle exposure. Your brain needs repeated opportunities to learn that anxiety symptoms are temporary, tolerable, and safe.
For example, someone who fears the sensation of a racing heart can practice running in place (after medical clearance). Or someone who fears that their anxiety might cause them to “go crazy” might intentionally repeat that thought until it becomes boring.
But remember: Exposure works best when paired with an attitude of acceptance. Without acceptance, exposure feels like white-knuckling through your anxious thoughts and feelings. With acceptance, exposure is still uncomfortable, but more tolerable. It’s the difference between riding a wave or swimming against the current.
5. Do what matters.
Ultimately, your job is to not let the anxiety determine what you do.
You can choose to do what matters most, even if you’re afraid it might trigger your anxiety.
When you prioritize what matters, you teach your anxiety that it isn’t in charge—and you don’t miss out on your life because you’re so wrapped up in anxiety management.
Psychologists have described these moments, when you have to choose between what matters most to you and your anxiety, as “choice points.”
Let’s say you join a local running club to meet some new people after a move. But just before you leave the house, you notice that familiar jolt of anxiety through your body. In that moment lies a choice point. You have the choice to move toward your value of doing something new to meet people. Or, you can choose to abandon your plans because of your anxiety, and move away from your value of building new relationships.
When the feelings of anxiety are intense, it may not feel like much of a choice. But remember that your thoughts and feelings are separate from your behaviors.
Final thoughts
None of this is easy.
Changing the way you relate to anxiety is hard work, but it is possible.
Working with a doctor and/or therapist with expertise in treating anxiety disorders can be tremendously helpful.
What matters most is that you’re showing up and doing the hard work. That’s something to take pride in, no matter how messy or slow the process feels.
