Psychology Today Blogs - Anxiety Free

"But what if I'm THE ONE?" How Intolerance of Uncertainty Makes you Anxious

Robert L. Leahy, Ph.D. — Wed, 14 May 2008 13:46:48 -0700

Someone says to you, “But the chances of your getting killed in an airplane crash are millions to one? What are you worried about?” And you reply, “But what if I’m the one?” Or you go to your doctor and she says, “It looks like you don’t have cancer”. You go home and you think, “Can she be absolutely sure?” And then you get a second and third opinion. You can’t tolerate not knowing for sure.

Researchers Michel Dugas and Robert Ladouceur have found that a core feature of worry is the inability to tolerate uncertainty. In fact, some worriers say that they would rather know for sure that the outcome will be bad than left in suspense not knowing for sure. In fact, you may worry in order to “gain certainty”. You look for all kinds of information and possible solutions to every problem you come up with—and then you ask yourself, “Will this solution tell me the answer?” But the only answer that you will accept is absolute certainty. So you reject almost all the answers because they are not perfect and they can’t tell you for sure.

Are you intolerant of uncertainty? Do you reject the evidence that the chances are very, very low? Do you continually demand perfect solutions that will have to work for sure? Do you seek out reassurance and , then, say, “Well, you can’t tell me for sure”? Do you think that if you simply think about a problem--- “It’s possible I could have cancer”—that this means that you absolutely must find out for sure that you don’t?

Chronic worriers often equate uncertainty with a bad outcome. They think that if they don’t know for sure that they would be irresponsible allowing this uncertainty to persist.

What can you do?

First, ask yourself what the advantages would be in accepting some reasonable uncertainty. Would you be less anxious, less worried, and more able to enjoy the present moment?

Second, what are the disadvantages in accepting uncertainty? Does it mean that you are now irresponsible, in danger, letting your guard down? Are these really rational evaluations? Or are you exaggerating?

Third, what uncertainty do you already accept? For example, when you drive, take a plane, eat in a restaurant, interact with someone new, go to a new city, start a new project at work---aren’t you already accepting uncertainty?

Fourth, do you know anyone who has absolute certainty? Anyone? How do they live with themselves? Are they irresponsible or in danger?

Fifth, your thought, “I could always be the one”, is something you fear. Try repeating this thought for thirty minutes every day---as slowly as you can. As you repeat the thought, imagine yourself standing back and observing the words floating by on a stream. Stay with the words. Do this very very slowly. Imagine yourself as a zombie repeating the feared thought. Do you notice that your anxiety goes up and then eventually goes down? Are you becoming less afraid of the thought?

Sixth, what is the advantage of uncertainty? Does uncertainty create novelty, pleasant surprises, new and exciting challenges? How would your life be a dreadful bore if you had absolute certainty?

Seventh, rather than thinking of uncertainty, think about how you can actually solve real problems that really exist. People who fear uncertainty underestimate their ability to solve real problems in the real world. What are some real problems that you have solved? Have some of these problems been events that you didn’t anticipate? Perhaps you are good at solving problems—if they really exist.

Eighth, practice mindful breathing. Spend twenty minutes each day, mindfully watching your breath as you sit in a quiet room. Don’t try to control your breathing, watch to see if your mind wanders. Stay in the moment with your breath. If you stay in the current moment, your worries will temporarily disappear.

For more information on handling your worries, see: The Worry Cure: Seven Steps to Stop Worry from Stopping You

Are We Born to be Afraid?

Robert L. Leahy, Ph.D. — Fri, 09 May 2008 07:19:33 -0700

Are you afraid of heights? Or closed spaces? Or snakes, bugs, and rats? Are you afraid of the water?

Well, you’re not alone. Our prehistoric ancestors had the very same fears—which is why you are alive today.

What are the most common fears that we have?

Our most common fears are of snakes, bugs, mice, bats, heights and water. What do these have in common? They are dangerous.

Let’s imagine that you are the evolutionary designer of a human being. Now, you are going to design a human who can survive in a primitive environment where there are tigers, lions, wolves, and poisonous snakes and bugs. It’s an environment where starvation is the general rule. What will you build into the software in the primitive brain?

You will build in FEAR.

Fear is adaptive because it protects us. More importantly, it protected our ancestors. Our distant ancestors who were afraid of heights didn’t fall off cliffs, those that feared wild animals didn’t get eaten by a tiger, those that ran the fastest left the rest behind---and they survived. So, it is natural to be afraid of many of the things that we are afraid of. It’s natural to have a fear of water---especially if you are a child---because you can drown.

In one study, 77 % of mothers of children who were afraid of water said their children were frightened the very first time they were confronted with a pool or lake water. In fact, the farther away from the ocean you live, the more likely you are to fear water. In another study, they tested kids over and over for years to determine what kinds of fears they had and what happened to them later. They found that kids who had fears of heights when they were younger---were less likely to fall and get injured later. That’s because the fear that was built in protected the kids from falling.

Now this may not seem like news to you, but most psychologists have believed that fears are learned. Some might be learned---but many fears are built in and they protect us. Kids didn’t have a fear of heights because they had fallen. No---they didn’t fall because they had a fear of heights to begin with.

Let’s take a closer look at fear of heights. A classic study, done many years ago, involved the following. Psychologists had a young infant on a table. Between two tables was a transparent plexiglass platform. Now, the baby could easily crawl across this plexiglass---but almost all the kids refused. That’s because the plexiglass gave the impression that they could fall. They had a natural fear of heights.

They also tried to get kittens to cross. They were afraid and they huddled on one side. Then they tried baby ducks. Guess what? The ducks walked across. Not a quack of protest. Why? Because ducks can fly. What’s to be afraid of?

Our fears have been built into us to keep us from getting killed—or from starving. In fact, research suggests that our genes can affect our ability to learn to be afraid.

But you might say, “I didn’t have a fear of heights until last year. And I’m 25? If these fears are innate, then why wasn’t I afraid before?”

Good question. One way to look at fears is that there is a “threshold effect”. Some of your fears won’t come out—won’t be manifested---until your brain has matured, certain hormones kick in, and you’ve accumulated enough stress. This is why panic disorder and agoraphobia generally don’t appear until early adulthood.

One “fear” that is very adaptive is to quickly learn to avoid poisonous foods. Rats and humans learn this after one experience. The research shows that we (rats or humans) almost immediately learn that the reason that we get sick is because of something that we ate---and then we avoid it forever. This is called “one-trial learning” for poison avoidance. We don’t have to “practice” this. If we eat some mushrooms and we get sick, we immediately learn to avoid mushrooms in the future. In fact, many of the changing food preferences for pregnant women are related to the potential toxicity of the foods. Nature doesn’t gamble with pregnancies.

Wouldn’t it make sense to have a fear of starvation? We do. That’s why ---when we are really hungry that we binge. Our ancient ancestors were scavengers---before they were hunters. They would wait for a tiger to kill an animal, eat its meal and then walk away stuffed. Then our ancient ancestors would scurry over, binge on as much of the meat as it could and run away at the first sight of another wild animal. But binge eating made a lot of sense. That’s why our emotional brain kicks in when we are really hungry and we eat quickly—and we eat a lot. It’s also why we often have a preference for sweet or high-calorie foods or carbohydrates. It’s also why some people hoard food. In a primitive environment, it made sense to save excess food—for the long periods of deprivation.

Because of fears of not eating enough—and our natural tendency to overeat given the opportunity--- we are prone to excessive weight gain. Ironically, it would be adaptive for our ancestors to have a slower metabolism---in order to keep on whatever weight they had. The primitive man who had a fast metabolism and just burned off calories---starved to death. People who are overweight today had the most adaptive ancestors---they didn’t need a lot of calories to gain weight. The problem is that we live in a world with what seems like an infinite number of calories available all the time. That’s why our “starving emotional brain” makes us binge when we go a few hours with nothing to eat.

How about fears of open spaces? People who have “agoraphobia” know what this is like. “Agora” means “marketplace” in Greek---but people with this phobia often fear being out in the open---like walking down the street or across a field or in a shopping mall. Why would walking across an open field be frightening? Well, to our ancestors, walking across an open field (especially during the day) meant that any tiger out there could see you. Better to stay in the bushes and hide.

It’s interesting that rats have a fear of open fields and spaces. When they cross a room they prefer staying close to the walls—or under the furniture. This is true outside, too. That’s because when they are outside they are vulnerable to being attacked by cats—or, from the air, by owls and hawks. So, having a natural fear of open spaces makes sense.

How about the fear of closed spaces? Many people fear getting into an elevator---not because the elevator will crash—but because they fear getting “stuck”. Some people fear having the door closed in their bedroom at night. Why would a closed space be so frightening? There are three reasons. First, our ancient ancestors who lived in caves realized that caves are not safe. Imagine you are huddled in a cave at night, you hear the call of the wild outside---- wolves howling. It was very simple for wolves or tigers to go into a cave and kill and eat all the humans. So caves could be dangerous. Second, in a closed space there may not be any means of escape. You are vulnerable to attack by predators and by other humans. That’s why people with agoraphobia are always looking for the exit. When they sit in a movie theatre, they want to sit at the aisle seat—and close to an exit. “I want to be able to get out quickly”. Third, many people with a fear of closed spaces feel they won’t be able to breathe. And, again, this also makes sense. Spaces that are closed can cut off air and suffocate you. That’s why so many people with panic and agoraphobia hyperventilate. Their brain is telling them that they will suffocate---so they gasp for air.

Children have a lot of fears that adults often do not have. Would it make sense for evolution to build certain fears into young children? Yes. Infants have a fear of being left by their parents---especially by mom. Toward the end of the first year of life, this fear gets stronger. And his fear of strangers gets greater. When mom leaves the room the baby cries. If the baby can move, he tries to follow after mom. The baby clings to mom. Why would a fear of mom leaving the room be adaptive? Well, this fear keeps mom close to the child---and mom can not only feed the baby, but protect him from other dangers---such as animals or other people. So babies have a natural fear of being left alone—and fears of the dark. And mothers and fathers have a built-in ability to respond to the baby’s crying by going to the baby and holding it. The baby’s crying is annoying to the mother---and it’s a good thing it is. It assures that the mother will quickly go to the baby to comfort him.The most effective way to calm a baby is to hold it and feed it. And that is the most protective way to relate to the baby. Evolution is smart.

Think about some of your specific phobias. Are you afraid of heights, closed spaces, flying 35,000 feet up in the air, animals, bugs, snakes, rats? Are you afraid of strangers? Are you afraid of walking into a forest at night---alone? How do your fears make sense from an evolutionary point of view?

How could your fears have kept your ancestors alive?

Think about your fears as the right response at the wrong time. The fear worked 50,000 years ago. It’s simply out of date. You’re using outdated software in your brain.

What is Productive Worry?

Robert L. Leahy, Ph.D. — Wed, 07 May 2008 13:22:52 -0700

If you are a chronic worrier you have probably gotten some of this useless advice: “Don’t worry”, “It will all work out” or “You need to believe in yourself”. Worriers seldom find this well-meaning advice to be helpful. In fact, they often find it to be invalidating and they think, “You don’t understand how hard it really is for me.” Or you might think, “It must be really hopeless, if this is the only advice people give me.”

You may have a mixed mind about your worry. You feel it’s “driving me crazy”, but you also think you get something from your worry. Worriers believe that their worry can help them prepare, avoid surprise, or get motivated. You may not be entirely wrong. Like any anxious thought there is some truth in the idea that worry can—to some extent--- prepare you, help you avoid surprises, and motivate you. But the real question is, “How will worry help?” And, “When is it useless?”

I find it useful to distinguish between productive and unproductive worry. Let’s suppose that I am going to Washington, D.C. for a meeting. What is “productive worry”? Well, let’s think of productive worry as a worry that I can turn into an action plan TODAY where this action can reasonably help me solve a problem. So, productive worry could be the following actions: “Get a reservation on the train, get a hotel reservation, bring your flash drive with your power-point presentation, and give yourself enough time to get to the train station.” All of these are actions that I can take TODAY. I can actually do something. So, productive worry is a TO-DO LIST FOR TODAY.

Let’s imagine that you are worried about your health. You notice that you have aches and pains that are unusual for you. You begin thinking, “I wonder if I have cancer”. You form visions in your mind of getting sicker and sicker. You are plagued by “what-ifs?”---such as, “What if the doctor doesn’t diagnose me correctly?” and “What if it’s too late?” It would be foolish to say to you, “Don’t worry, you’re OK.” We don’t know that you are OK. So, what is productive worry? Call your doctor and make an appointment for an exam. Productive worry is prudent action.

Or, let’s imagine that you have an exam coming up next week. You are worried and you think, “What if I fail? What if I get thrown out of school? What if I end up homeless? What if my parents disown me for letting them down?” All of these “what-ifs” are unproductive worries. They are unproductive because you can’t do anything today to solve the problem. Since you haven’t taken the exam, you don’t know if you are going to pass. You don’t have to solve the problem of being homeless today because you have a home today. You don’t have to solve problems that don’t exist. Unproductive worry is about what-ifs that you can’t do anything about. But there are some productive actions that you can take about the exam. You can study. You can set aside time tonight and the night after and prepare.

The first thing I ask people to think about when they are worried is this, “Is there some productive action that you can take today that will help you solve the problem?” If so, make a to-do list and start taking action. Once you take action, you won’t be worried. If your taxes are late, rather than worry about them, start preparing your taxes over the next day. Take action and get out of your head.

In the next blog, I’ll tell you what you can do with all of those unproductive worries. The good news is that we have a lot of techniques that you can use.

Now, ask yourself, “What is the productive action that I can take?” If there is none, then you will have to learn how to accept some limitation and some uncertainty. This won’t be easy to do, but we will go over this in this blog.

Now, get to work!

How Does Your Worry Make Sense?

Robert L. Leahy, Ph.D. — Thu, 01 May 2008 13:04:07 -0700

You may worry that you’ll be late, you don’t look as great as you “should”, your partner is getting bored with you, your finances are drying up, your plane will be attacked by terrorists, and you’ll make a total fool of yourself when you meet someone new. If you are anxious, I’m betting my money on the fact that you are a chronic worrier.

In fact, in one study 38% of people said that they worry every day. Some people say, “I’ve been a worrier all my life”. What’s intriguing about this is that chronic worriers seldom can point to anything really bad that has happened that led to their worry. In fact, 85% of the things that worriers worry about have a positive or neutral outcome. But they continue day after day—year after year—to worry about bad things that almost never happen. How can this make sense?

One way of “making sense” of your worry is to ask yourself, “Can we write a rule-book that describes how you worry?” I think we can.

The Worry Cure Rule-Book

OK. Think about yourself and how you worry. Ask yourself if you are following any of the basic rules of HOW I CAN WORRY EVERY DAY OF MY LIFE. Here are the rules that you probably follow:

If something bad could happen—if you can simply imagine it—then it’s your responsibility to worry about it
Don’t accept any uncertainty—you need to know for sure
Treat all of your negative thoughts as if they are really true
Anything bad that could happen is a reflection of who you are as a person
Failure is unacceptable
Get rid of any negative feelings immediately
Treat everything like an emergency

Oh, yeah. I forgot about the eighth rule. If you’re a worrier, you probably don’t trust your memory anyway---which is another reason to worry. The eighth rule is the one that makes you feel that your worry is driving you insane. It’s this:

8. You've got to stop worrying right now or you'll drive yourself crazy.

Let's take a closer look at these simple, easy-to-follow rules for becoming a first class worrier.

If something bad could happen—if you can simply imagine it—then it’s your responsibility to worry about it. If you’re a worrier, you think that any “disturbing” thought that pops into your head means that you have to dwell on that thought and, if “necessary”, do something about it. If you think you might have left the door unlocked (even though you “kind of remember” locking it), then you have a responsibility to double-check it. Simply imagining something bad happening means—to you—that you have to take action. You not only pay too much attention to your negative thoughts---you think you have to obey them. “I might have made a mistake, so I have to go check it again.” I think of chronic worriers as people who are overly conscientious about their minds. Every thought becomes a commandment.
Don’t accept any uncertainty—you need to know for sure. The research shows that worriers cannot tolerate uncertainty. “I need to know for sure that I won’t get fired” or “I need to know for sure that my lover won’t leave me”. As a skilled worrier, you feel that you have to keep getting reassurance, keep searching for information, and keep “testing” people to MAKE SURE. Since you can never get certainty, you worry some more. You equate uncertainty with irresponsibility, a bad outcome, or simply “unfinished business” that must be finished. “I know the chances are one in a million. BUT WHAT IF I’M THAT ONE?”
Treat all of your negative thoughts as if they are really true. While most other people treat a lot of their negative thoughts as if they were “background noise”, you probably treat your negative thoughts as a sure sign of something bad happening. If you have the thought, “I’ll fail the exam”, you immediately conclude that this is very likely to happen. A thought is equated with an outcome. “I think I might lose my job becomes…. I will lose my job!”
Anything bad that could happen is a reflection of who you are as a person. When bad things MIGHT happen to you, you believe that they absolutely reflect who you are. So, if you worry about failing an exam---- then you believe that the exam is a measure of who you are as a human being. If you are late, then you assume that everyone is going to think that you are totally irresponsible. If there are difficulties at work, then it will mean that you are totally incompetent. Other people might think, “You did well on other exams” or “You’re generally on time” or “There are always some problems at work”. But not you. You think, THIS IS WHO I AM!
Failure is unacceptable. I really should have said, “Imperfection for you is unacceptable”. But, don’t worry. You probably equate imperfection with failure. Not doing well on the exam means—to you—that you will fail in life. And you think, “Everyone notices”. If you don’t get the date that you want, you think, “I’ll always be alone”. Failure—for many worriers—is fatal, flawed, and final. So you worry so that you will be motivated---and not fail---or, so that you will be on-guard, and you won’t be surprised. You worry to catch things before they fall apart. You are being conscientious---at least, that’s what you think.
Get rid of any negative feelings immediately. Like many worriers, you believe that your negative feelings need to be controlled—or, better still, eliminated. That’s because you probably think, “If I don’t stop feeling bad it’ll last all day, ruin my life, and drive me crazy”. Maybe not that extreme. But worriers have very negative beliefs about negative feelings. Non-worriers are more likely to say, “Sometimes I just have a bad mood—but I get out of it. After all, I’m human.”
Treat everything like an emergency. If you don’t know something for sure, you think you’ve got to know RIGHT NOW. It’s urgent. You wake up in the middle of the night and you think, “Will I ever find the true love of my life?” Since you don’t know this at 3 AM, you then think, “I really have to know right now.” You have a hard time putting off knowing. Some people (that is, those people not plagued by worries) can say, “I’ll go back to sleep and deal with that some other time.” Not you. You’ve got to know immediately. Since you are always living in the world of the future that you don’t know, you can’t simply relax and enjoy the present moment.
You’ve got to stop worrying right now or you’ll drive yourself crazy. So here you are worried. And then it occurs to you that your worries might be driving you crazy, making you sick and ruining your life. So you try to STOP worrying. You tell yourself, “OK, Stop this nonsense.” But this doesn’t work. You think that you have to control your worries—so you get angry at yourself for worrying, but this only makes you more anxious and angry. You may try to do other things to control your thoughts---like you might start repeating positive things, such as, “I’m really a good person” or “I believe in myself”, but these affirmations only work for a few minutes. And then you feel more demoralized.

In writing out these “rules” for worriers I am not trying to make fun of your anxiety. But you can see that there is some internal logic, some consistency, in the way you think. You have been using worry to solve problems (that don’t exist), get rid of uncertainty (in an uncertain world), and assure that you will never feel bad or fail. These are impossible goals.

Think about what you think you are getting from your worry. Are you trying to avoid being surprised, are you trying to motivate yourself, are you trying to control your mind? The first step in dealing with your worries is to understand why it makes sense to you.

In future blogs I’ll tell you what to do to turn your worries on their head.

To learn more about the nature of worry and what you can do about it, see my book The Worry Cure: Seven Steps to Stop Worry from Stopping You.

How Big a Problem is Anxiety?

Robert L. Leahy, Ph.D. — Wed, 30 Apr 2008 13:37:58 -0700

The chances are fairly high that either you or a loved one has had a history of anxiety. In any given year about 17% of us will have an anxiety disorder---and over our lives, about 28 % of us will have an anxiety disorder. And, if you have one anxiety disorder, then you probably have two or three anxiety disorders---and, possibly, depression. The most common anxiety disorders are panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder and specific phobia. 49% of the general population has a history of anxiety, depression, substance abuse or some of all three major problems.

Anxiety disorders have effects on your health. People with panic disorder are more likely to have mitral valve prolapse, hypertension, peptic ulcer, diabetes, angina or thyroid disease. In fact, men who have anxiety disorders are also at greater risk for cardiac disorders, hypertension, gastrointestinal disorders, respiratory illness, asthma, and back pain. Women with anxiety disorders are more likely to have a history of cardiac problems, hypertension, metabolic, gastrointestinal, dermatological, respiratory disorders and arthritis.

And anxiety has been increasing. The average high school kid today has the same level of anxiety as the average psychiatric patient in the early 1950’s. We are getting more anxious every decade. Psychologists have speculated about the possible reasons for this increase in both anxiety and depression over the last fifty years. Some of the reasons may be a decrease in “social connectedness”---we tend to move more, change jobs, participate less in civic organizations, and we are less likely to participate in religious communities. People are far less likely to get married, more likely to delay getting married, and more likely to live alone. All of these factors can contribute to worry, uncertainty, anxiety and depression.

And our expectations have changed in the last fifty years. We expect to have a more affluent life-style, we are driven by unrealistic ideas of what we need (“I need the latest ipod!!”), and we have unrealistic ideas about relationships and appearance. In the 1950’s sociologists would write about “The Organization Man” who worked for the corporation for his or her entire career. Today many people would love to have a job that had that kind of stability. And our expectations about retirement also lead us to feel anxious. We now have to rely on our own savings---rather than a company pension plan---to help us survive during retirement.

And anxiety isn’t helped by the fact that we have all the bad news all the time. Turn on your cable stations and you can immediately see the latest catastrophe---sometimes as it is actually happening in “real time”. Bad news sells—and reminds us--- that we can all be in danger. Even though we live longer, have better health care, travel is safer, we are richer, and we have safer cars--- we now think that there is a disaster on the horizon. Because we are constantly bombarded with bad news, we think that we are in greater danger. We may not be in greater danger---but it’s what we think that counts in the way we feel.

No wonder we are nervous wrecks.

In this blog, I hope to give you some understanding about the nature of anxiety and what you might do to help yourself.