In the Blogs: Ten Things People Get Wrong About Anxiety

By Lindsay Holmes 

Perhaps one of the most persistent struggles when dealing with anxiety is what people get wrong about the disorder.

According to Joseph Bienvenu, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University, there are many fallacies when it comes to anxiety disorders, and that can make dealing with it more difficult. 

These misconceptions are a common reality for those who either have the condition, know someone who is battling it or think they may be on the brink of a diagnosis. We've debunked ten of the most common myths about anxiety and panic disorders.

1. Wrong: People with anxiety are feeble.

"Many people think that having this disorder means that they're fearful or weak -- and that's certainly not the case," Bienvenu says. He explains that while many anxiety and panic disorders can stem from fear, that characteristic of the condition isn't the only component -- and it definitely shouldn't be used to define the person.

In an effort to explain what it's like to deal with fear-based anxiety, clinical psychologist Bill Knaus detailed the everyday trials of the condition in a Psychology Today blog post. He describes how anxiety can also manifest from something we're all familiar with: remorse. "Recurring anxieties and fears can feel like walls on each side of a trail painted with murals of regrets," he wrote.

2. Wrong: Having anxiety isn't a big deal.

According to Allison Baker, a child and adolescent psychiatrist and the director of the adolescent program for Columbia University Medical Center, the disorder isn't something to be swept under the rug. Anxiety disorders can accompany or have the potential to lead to other illnesses such as depression and substance abuse problems.

When it comes to children and teens, Baker also says that many kids don't speak up about their anxiety because they don't notice that it's a big deal. "Anxious kids, at the end of the day, they're not the squeaky wheels," Baker explains. "They most often just internalize an anxious experience. They don't raise flags or cause anyone grief, so they kind of get neglected in the process."

3. Wrong: The condition is not that common.

Anxiety disorders affect approximately 40 million American adults per year, which is about 18 percent of the country's population. According to Baker, anxiety disorders are also one of the most prevalent pediatric psych conditions.

4. Wrong: Issues with anxiety stem from a poor childhood.

Another common misunderstanding about anxiety is that it comes from issues deeply rooted in the past. While past experiences certainly can have an influence on anxiety, Bienvenu says this idea is a misunderstanding. "It's not that having a difficult childhood is completely unrelated, but having a difficult childhood can be related to all kinds of things, not just anxiety," he says. "Some people have had a great childhood and still have anxiety."

According to the Anxiety and Depression Association of America, most professionals have the patient focus on the here and now during therapy-based treatment as opposed to reflecting on what has occurred in the past. Studies have also found that practicing being present through mindfulness meditation can help reduce levels of anxiety and mental stress.

5. Wrong: People suffering from anxiety should just avoid whatever is causing their fear.

Instead of running from fear, experts suggest just the opposite. "Avoidance is not a good strategy," explains David Spiegel, Stanford University’s associate chair of psychiatry and behavioral sciences. "Avoiding (what you're fearful of) makes it like it isn't happening -- and the more you avoid it the worse it gets. For people with phobias, the only experience they have (with that particular stressor) is a horrible one but it is possible to normalize it. The more you deal with things that stress you out, the more master you have over them."

In an essay for the New York Times, New York University neural science professor Joseph LeDoux explained that while some avoidance might be helpful in certain cases, general avoidance behavior may only exacerbate the condition. "People with social anxiety problems, for example, can easily circumvent anxiety by avoiding social situations," he wrote. "This solves one problem but creates others, since social interactions are an important part of daily life, including both professional and personal life. But if one is avoiding situations where these cues are likely to be encountered, the opportunity to extinguish fears by exposure never occurs and the anxiety continues indefinitely."

6. Wrong: The disorder will resolve on its own.

"Many people believe that anxiety isn't something worth assessing," Baker says. "But it's important treat anxiety, especially in children and teens. If untreated, it can be associated with an increased risk with depression." There are several methods of treatment for anxiety, including psychotherapy and medication.

7. Wrong: Unwinding with a drink can soothe an anxious person.

Despite its reputation for "taking the edge off," don't expect a beer to relax someone who is struggling with an anxiety or panic disorder. In fact, according to Keith Humphreys, a professor of psychiatry at Stanford University, it may end up only making the condition worse. "In the short term, yes perhaps it will, but in the long term it can be a gateway for addiction," he previously told HuffPost Healthy Living. "It's dangerous in the long term because those substances can be reinforcing the anxiety."

Despite the risks, a study published in the Archives of General Psychiatry found that most people suffering from some form of anxiety try to relieve it by self-medicating with substances. The study revealed that 13 percent of the people who had consumed alcohol or drugs in the previous year did so in an effort to reduce their anxiety, fear or panic about a particular situation.

8. Wrong: Anxiety is only born from a certain fear or trauma.

According to Bienvenu, it's incorrect to think that anxiety mostly comes from a specific experience or fear. While a certain phobia -- like flying or great heights -- can often be at the core of the condition, there's also a genetic basis to anxiety disorders, he says.

According to Spiegel, chronic anxiety encompasses more than just one particular instance of fear and begins to make you less aware of what you're feeling in the moment. "You start to feel anxious about being anxious," he said.

9. Wrong: There's nothing you can say to help an anxious person relax.

There are many ways you can offer to help someone dealing with the condition, Baker says. If you're looking to put someone you know with anxiety at ease, the best thing to do is to ask questions. "Inquire from the person, 'How can I be helpful?' 'What can I do or say that's going to help you in this moment?'" she says. "Take your direction from the person themselves instead of going on the assumption of what they may need from you."

You should avoid certain phrases when speaking with a loved one who may be suffering from anxiety disorder. According to Humphreys, being sensitive to the situation can also help. "The paradox is, (an empathetic phrase) helps them calm down because they don’t feel like they have to fight for their anxiety," Humphreys said. "It shows some understanding."

10. Wrong: It's hard to relate to someone who has the condition.

We've all been caught up in a moment that brings up those pangs of nerves, Baker explains. "We all experience anxiety in some capacity," she says. "It helps us prepare for speaking in public and it motivates us to practice or rehearse; everyone can relate to what that experience is like. An anxiety disorder is when those run-of-the-mill butterflies become a chronic daily experience."

In order to assist a loved one who is suffering from the condition, Baker says it may be helpful to recall some of your own experiences. "Imagine what those would be like in progressive state," she says. "It may make you more empathetic to the situation."

Alexandra Sifferlin Blog: How You Deal With Your Emotions Can Influence Your Anxiety

When faced with a challenge, whether you deny the problems it poses or dive in to solve them in a positive way may determine how much anxiety you feel overall.

According to the National Institute of Mental Health, about 40 million Americans ages 18 and older are diagnosed with an anxiety disorder every year.

To dig deeper into who may be at greatest risk, investigators from the University of Illinois at Urbana-Champaign surveyed 179 healthy men and women and asked them how they dealt with their emotions and how their answers correlated with their level of anxiety in a variety of settings.

Previous studies hinted that different strategies that people use to handle emotional situations could impact how much anxiety they felt in general; those who tended to focus on positive ways of resolving difficult circumstances, for example, experienced less nervousness, tension and negative emotions compared with those who avoided challenging situations and suppressed negative and uncomfortable feelings.

The scientists in the current study, published in the journal Emotion, wanted to explore the relationship further to see whether the more positive emotional strategy could offer more resilience and protection against anxiety than the suppressive approach.

The participants all answered questionnaires designed to measure how much they were focused on achieving goals, whether they tended to control their emotions by reappraising challenges in a more positive way or whether they tried to ignore and suppress difficult feelings.

For example, they rated how closely their behavior aligned with the statements, “I control my emotions by changing the way I think about the situation I am in,” and “I keep my emotions to myself.” They also responded to questions about their anxiety level during different situations such as when giving a report to a group or going to a party.

Comparing their responses, the researchers found that the participants who regularly reframed what was happening to them to view their situation in a better light reported less severe anxiety than the participants who suppressed their emotions in trying situations.

This strategy is called reappraisal, and those who practiced the tactic were more likely to view tough situations as challenges rather than problems, and reported less overall anxiety and social anxiety compared with the participants who tried to ignore their emotions instead.

The results suggest that there may be behavior-based ways of addressing anxiety that people might be able to learn. Seeing difficult experiences as opportunities rather than setbacks requires being flexible enough to find new solutions to problems.

People who tend to take this approach, say the study authors, are goal-oriented and able to put individual situations into perspective, realizing that a single trying situation doesn’t necessarily signal doom.

Those who focus on trying to avoid negative situations, while perhaps being proactive, may open themselves up to internalizing symptoms of anxiety and stress more, which can have harmful effects on health. Suppressing emotions may not allow for a productive outlet for frustration or fear, and that could make those who adopt this approach more vulnerable to anxiety.

But the researchers say the findings don’t suggest that anxiety is an all-or-nothing state. A little anxiety can work to a person’s benefit if it enforces concentration and efficiency, like getting work done on a deadline.

There may also be situations in which different strategies for handling—and even controlling—emotions is appropriate. In some workplace or social settings, for example, having the self-control to refrain from acting out or saying something regrettable could save a job or friendship.

Not surprisingly, the researchers say it’s about being flexible enough to know how much to regulate emotions and learning to be more flexible when faced with challenging situations.

Being adaptive can come more easily to some than others, but many of the strategies for regulating emotions in this way during crises can be learned.

“This is something you can change,” said Nicole Llewellyn, the lead author of the study and a graduate student in psychology at the University of Illinois, in a statement.

“You can’t do much to affect the genetic or environmental factors that contribute to anxiety. But you can change your emotion-regulation strategies.” And those changes could translate into a more lasting resilience against stress.

Karen Horney's Psychoanalytic Theories of Neurosis and the Self

From Wikipedia:

Karen Horney (born Danielsen; 1885 – 1952) was a German psychoanalyst. Her theories questioned some traditional Freudian views, particularly her theory of sexuality, as well as the instinct orientation of psychoanalysis and its genetic psychology. As such, she is often classified as Neo-Freudian.

Theory of Neurosis

(Added note: Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic. The term essentially describes an "invisible injury" and the resulting condition.

The American Diagnostic and Statistical Manual of Mental Disorders (DSM) has eliminated the category of "neurosis," reflecting a decision by the editors to provide descriptions of behavior as opposed to hidden psychological mechanisms as diagnostic criteria, and, according to The American Heritage Medical Dictionary, it is "no longer used in psychiatric diagnosis". Instead, the disorders once classified as neuroses are now considered anxiety disorders.)

Karen Horney looked at neurosis in a different light from other psychoanalysts of the time. Her expansive interest in the subject led her to compile a detailed theory of neurosis, with data from her patients.
Horney believed neurosis to be a continuous process—with neuroses commonly occurring sporadically in one's lifetime. This was in contrast to the opinions of her contemporaries who believed neurosis was, like more severe mental conditions, a negative malfunction of the mind in response to external stimuli, such as bereavement, divorce or negative experiences during childhood and adolescence.

Horney believed these assumptions to be less important, except for influences during childhood. Rather, she placed significant emphasis on parental indifference towards the child, believing that a child's perception of events, as opposed to the parent's intentions, is the key to understanding a person's neurosis. For instance, a child might feel a lack of warmth and affection should a parent make fun of the child's feelings. The parent may also casually neglect to fulfill promises, which in turn could have a detrimental effect on the child's mental state.

From her experiences as a psychiatrist, Karen Horney named ten patterns of neurotic needs.These ten needs are based upon things which she thought all humans require to succeed in life. Horney modified these needs somewhat to correspond with what she believed were individuals' neuroses. A neurotic person could theoretically exhibit all of these needs, though in practice much fewer than the ten here need to be present for a person to be considered a neurotic.

The ten needs, as set out by Horney, (classified according to her so-called coping strategies) are as follows:

Moving Toward People

1. The need for affection and approval; pleasing others and being liked by them.

2. The need for a partner; one whom they can love and who will solve all problems.

Moving Against People

3. The need for power; the ability to bend wills and achieve control over others—while most persons seek strength, the neurotic may be desperate for it.

4. The need to exploit others; to get the better of them. To become manipulative, fostering the belief that people are there simply to be used.

5. The need for social recognition; prestige and limelight.

6. The need for personal admiration; for both inner and outer qualities—to be valued.

7. The need for personal achievement; though virtually all persons wish to make achievements, as with No. 3, the neurotic may be desperate for achievement.

Moving Away from People

8. The need for self sufficiency and independence; while most desire some autonomy, the neurotic may simply wish to discard other individuals entirely.

9. The need for perfection; while many are driven to perfect their lives in the form of well being, the neurotic may display a fear of being slightly flawed.

10. Lastly, the need to restrict life practices to within narrow borders; to live as inconspicuous a life as possible.

Upon investigating the ten needs further, Horney found she was able to condense them into three broad categories:

Compliance: Needs one and two were assimilated into the "compliance" category. This category is seen as a process of "moving towards people", or self-effacement. Under Horney's theory children facing difficulties with parents often use this strategy. Fear of helplessness and abandonment occurs—phenomena Horney refers to as "basic anxiety". Those within the compliance category tend to exhibit a need for affection and approval on the part of their peers.

They may also seek out a partner, somebody to confide in, fostering the belief that, in turn, all of life's problems would be solved by the new cohort. A lack of demands and a desire for inconspicuousness both occur in these individuals.

Aggression: Needs three through seven were assimilated into the "aggression" category, also called the "moving against people", or the "expansive" solution. Neurotic children or adults within this category often exhibit anger or basic hostility to those around them. That is, there is a need for power, a need for control and exploitation, and a maintenance of a facade of omnipotence. Manipulative qualities aside, under Horney's assertions the aggressive individual may also wish for social recognition, not necessarily in terms of limelight, but in terms of simply being known (perhaps feared) by subordinates and peers alike. In addition, the individual has needs for a degree of personal admiration by those within this person's social circle and, lastly, for raw personal achievement. These characteristics comprise the "aggressive" neurotic type. Aggressive types also tend to keep people away from them. On the other hand, they only care about their wants and needs. They would do whatever they can to be happy and wouldn't desist from hurting anyone.

Detachment: Needs eight through ten were assimilated into the "detachment" category, also called the "moving-away-from" or "resigning" solution or a detached personality. As neither aggression nor compliance solve parental indifference, Horney recognized that children might simply try to become self-sufficient. The withdrawing neurotic may disregard others in a non-aggressive manner, regarding solitude and independence as the way forth. The stringent needs for perfection comprise another part of this category; those withdrawing may strive for perfection above all else, to the point where being flawed is utterly unacceptable. Everything the "detached" type does must be unassailable and refined. They suppress or deny all feelings towards others, particularly love and hate.

Theory of the Self

Horney also shared Abraham Maslow's view that self-actualization is something that all people strive for. By "self" she understood the core of one's own being and potential. Horney believed that if we have an accurate conception of our own self, then we are free to realize our potential and achieve what we wish, within reasonable boundaries. Thus, she believed that self-actualization is the healthy person's aim through life—as opposed to the neurotic's clinging to a set of key needs.

According to Horney we can have two views of our self: the "real self" and the "ideal self". The real self is who and what we actually are. The ideal self is the type of person we feel that we should be. The real self has the potential for growth, happiness, will power, realization of gifts, etc., but it also has deficiencies. The ideal self is used as a model to assist the real self in developing its potential and achieving self-actualization. (Engler 125) But it is important to know the differences between our ideal and real self.

The neurotic person's self is split between an idealized self and a real self. As a result, neurotic individuals feel that they somehow do not live up to the ideal self. They feel that there is a flaw somewhere in comparison to what they "should" be. The goals set out by the neurotic are not realistic, or indeed possible. The real self then degenerates into a "despised self", and the neurotic person assumes that this is the "true" self. Thus, the neurotic is like a clock's pendulum, oscillating between a fallacious "perfection" and a manifestation of self-hate.

Horney referred to this phenomenon as the "tyranny of the shoulds" and the neurotic's hopeless "search for glory." She concluded that these ingrained traits of the psyche forever prevent an individual's potential from being actualized unless the cycle of neurosis is somehow broken, through treatment or otherwise.