When my son was born with a congenital heart condition, like any parent, I felt lost. He required open-heart surgery and I felt overwhelming uncertainty for what the future might hold. I understood that the outcome might not be good, but I also knew that a positive outcome was possible if I could provide the best care for him.
At a time like that, it was hard to focus on those positives, but I learned that I could use my anxiety to keep me energised. Knowing that the future was uncertain but that my actions could influence the outcome, my anxiety helped me to function in what otherwise might have felt like a hopeless situation. I believe that anxiety can be a tool to help us to cope with the challenges that life throws at us.
However, for many people anxiety can be suffocating, and has become synonymous with feeling bad.
When I was growing up in the 1980s, stress was the go-to shorthand for emotional discomfort. How's your wedding planning? Oh it's great, but I'm stressed. How is your chemotherapy going? Pretty stressful, but I'm managing.
Today, we seem to be living in the age of anxiety. Google Trends shows that searches for the word anxiety have increased over 300% since 2004. Anxiety is on our minds, with good reason. As much as 31% of the US population will experience an anxiety disorder at one point in their lives, which can range from generalised anxiety disorder to panic disorder and social anxiety disorder – which is one of the most common types.
Outside of medical diagnoses, the word also seems to have slipped into our vernacular. It has usurped stress as our language placeholder for feeling uncomfortable – anxious about giving a presentation, about going on a blind date, about starting a new job. The word has become ubiquitous and absorbed meaning, amoeba-like, to encompass everything from dread to pleasant anticipation. Too often, the mere use of it casts these experiences in a negative light, infusing them with threat and a touch of the not-quite-right.
Then there are anxiety disorders – they are the most common of the mental health diagnoses, more common than depression and addiction. Hundreds of millions of people across the world will be diagnosed with an anxiety disorder in their lifetime. Rates of these disorders, especially among the young, continue to rise, as they have been for well over two decades. Yet, there are dozens of validated therapies, 30 different anti-anxiety medications, hundreds of excellent self-help books, and thousands of rigorous scientific studies. Why have these solutions failed to reduce the scale of the problem so spectacularly?
As I put forward in my book, Future Tense, one reason for this failure is that mental health professionals, myself included, have unintentionally misled people about the nature of anxiety in the past – a misunderstanding that has harmed us. I propose a new, more helpful and hopeful approach to understanding and living with anxiety in the 21st Century – to use it to your advantage.
Negative emotions like anxiety have long gotten a bad rap – irrational at best, destructive at worst. The ancient Roman poet Horace wrote over 2,000 years ago, anger is a short madness. But over the course of the past 150 years, starting with Darwin's The Expression of Emotion in Man and Animals, we have actually come to understand that emotions like anger, fear, and anxiety are more advantageous than dangerous. Like the opposable thumb and language, emotions are tools for survival, forged and refined over hundreds of thousands of years of evolution to protect and ensure that humans can thrive. They do this by providing two things: information and preparation.
Emotions are tools for survival, forged and refined over hundreds of thousands of years of evolution to protect and ensure that humans can thrive
Anxiety is information about the uncertain future: something bad could happen, but something good could still happen, too. Anxiety is waiting for your Covid test to come back positive or negative, or anticipating that difficult conversation with your boss that might go well or might go completely sideways. Anxiety isn't, however, information about certain and present threats – that's fear, like seeing a shark fin rise out of the water mere yards away from where you're swimming. Fear primarily prepares us to fight, take flight, or freeze, whereas anxiety is a civilisation builder. It prepares us to persist, remain vigilant, and act in ways that avert future disaster but also can make positive possibilities into reality.
When we're anxious, not only are we more creative and innovative, but our brains respond with greater focus and efficiency when we face the unpredictable. Anxiety is thus more than the "fear circuitry" of the brain. Anxiety also activates our drives for reward and social connection, impelling us to work for what we care about, connect with others, and be more productive. That's why, from the perspective of evolutionary theory, anxiety isn't destructive. Anxiety embodies the logic of survival.
Yet, evolutionary theory and research have not trickled down into the public consciousness – or into that of most medical professionals. Far from treating anxiety as a potential ally, we treat it like an enemy howling at the gates.
While anxiety disorders can be paralysing, the widespread use of the term anxiety to mean a general ill-feeling is problematic because it means we accept two key fallacies: (a) experiencing anxiety is dangerous and destructive; and (b) the solution to its pain is to prevent or eradicate it. It is a way of thinking that has led us to perceive daily anxieties as malfunctions to fix. Yet, it is only anxiety disorders – when extreme anxiety and our attempts to cope with it interfere with our daily lives – that are recognised as mental health conditions. The emotion of anxiety, in contrast, should be considered healthy and normal – and even beneficial.
The inexorable logic of this disease metaphor requires us to take it even one step further – like other illnesses, from infectious diseases to cancers, until we have suppressed anxiety, we cannot be mentally healthy, just as the mere presence of a cancerous cell means that we're sick.
This disease metaphor traps us rather than uplifts us because it causes us to mistake normal anxiety for a disorder, and to fear, avoid, and suppress any anxious feelings as soon as we experience them.
Unlike an infectious disease or cancer, avoidance and suppression of anxiety will almost certainly amplify it, while simultaneously exacting an opportunity cost by preventing us from finding productive ways to cope and to build skills of emotional resilience. This is the vicious cycle of anxiety, spiralling it out of control: feeling anxiety as dangerous, fearing it, and ultimately fleeing from it through suppression and avoidance.
The harm caused by the disease metaphor for anxiety doesn't stop there. It also blocks us from seeing that anxiety isn't just something to soothe and manage. Anxiety is something to harness and leverage because it evolved to help us persist, innovate, socially connect, and remain hopeful in the face of uncertainty so that we can create a better future.
Anxiety must feel bad to do its job. Even the word's origins, derived from the ancient Latin and Greek words for choked, painfully constricted, and uneasy, reflect this essential unpleasantness. Only something so unpleasant can consistently compel us to sit up and pay attention, can effectively demand that we work hard to avoid future danger and chart a more positive course.
Yet, most of us have learned to avoid and ignore this useful emotion – to our detriment. Think of anxiety like a smoke alarm, warning that the house is catching fire, and priming us to take useful action. What if, instead of running out of the house and calling the fire department we just ignored the alarm, or removed the battery, or avoided places in the house where the alarm was loudest. So, instead of benefitting from the alarm, putting out the fire, and preventing future fires, we just hope and pray the house doesn't burn down.
We can't ignore the role that unrelenting stress and adversity play. Sometimes, life just doesn't let up and any one of us in such situations would feel intense and overwhelming anxiety. But no matter what the cause, listening to our anxiety – believing there is wisdom inherent in what it tells us and that we can use it to our advantage – is the very first step in learning to be anxious in the right way.
Making this mindset shift has a powerful positive impact. A Harvard study, for example, showed that when socially anxious people were asked to do a truly stressful task – give a public speech in front of a panel of judges with no time to prepare – but were also taught to think of their anxious responses as a signal that they were ready to rise to a challenge (instead of a signal of distress) they performed better under pressure. They were more confident, less anxious, and had steadier heart rates and lower blood pressure when focused and engaged.
Engaging with anxiety is often the key to healing. Take research on combat veterans, who reduce their risk of developing PTSD by paying more attention to anxiety-provoking information, rather than distracting from it. Or consider the heart transplant patients who required fewer days of hospitalisation while waiting for a heart transplant and therefore were more likely to qualify for a transplant when they were anxious.
Learning to be anxious in the right way means finding ways to work through it rather than around it, to leverage and channel anxiety to meet goals, and to discern when anxiety isn't useful and practice letting it go. Think of this virtuous cycle of anxiety as having three parts: listen, leverage, and let go.
Listen. Anxiety helps to boost our focus and drive as we close the gap between where we are now and where we want to be. That's why anxiety contains hope – we can see future threats, but also have our eyes on the prize and believe that we can work to make good outcomes into reality.
But for anxiety to achieve this, it has to be uncomfortable so that we sit up, pay attention, and listen to what it's telling us. Terrible feelings, ones that can't be ignored, also make us want to turn away. That's why, when it comes to listening to anxiety, curiosity is our best friend.
Leverage: Finding useful information in anxiety prepares us to channel and direct our energies to work towards goals and pursue purpose. Taking time to think about purpose lifts mood, improves concentration and learning. These benefits can persist for months or even years.
When we channel our anxiety towards pursuing and prioritising purpose, that's when it becomes courage. Anxiety fuels our momentum, unleashes our strength.
Let go. But anxiety isn't useful or straightforward every time. Sometimes, it's slow to reveal its message. Other times, it's pointless – life is truly challenging, and there is plenty of emotion but no useful information. It sends us spinning into the future tense, worried and feeling overwhelmed. The best way to let go? Seek out activities that slow us down and immerse us in the present: read a favourite poem or find solace in music. Check out that new podcast. Exercise or take a meandering walk. Call up one's therapist, or reach out to a friend who always brings a helpful perspective. It's in these moments that we also build the emotional awareness and skills to work through – not around – our difficult emotions, and to seek support when we need it.
Anxious in the right way
In this era of pandemic, political polarisation, and climate change, many of us rightfully feel overwhelmed by anxiety for our future. To cope, we have learned to think of the emotion like we do any ailment – we want to prevent it, avoid it and stamp it out at all costs.
But the fact is we've got it backwards. The problem isn't anxiety. Anxiety is the messenger – telling us that we're facing uncertainty and need to rise to the challenge; or pointing us to ways that our life needs to change or we need support. Instead, one of the key problems is that our beliefs about anxiety stop us from believing we can manage it, from accessing and benefitting from coping strategies and treatments that do exist, and to learn to use it to our advantage. And when our beliefs make anxiety worse, we are at greater risk for travelling down the path towards debilitating anxiety and anxiety disorders.
The key problem for someone diagnosed with an anxiety disorder is not that they experience intense anxiety, it's that the tools they have at their disposal to turn down the dial on those feelings are causing functional impairment. This gets in the way of self-care, working, connecting with others, and living a fulfilling life. Changing our approach to anxiety can help no matter where we are on the spectrum of anxiety. And we're all on it somewhere.
Over 180 years ago, the Danish philosopher Soren Kierkegaard wrote: "Whosoever learns to be anxious in the right way has learned the ultimate." We are all born anxious. The work of being human is to learn that although anxiety can be hard, sometimes terrifying, we can learn to make it an ally, a benefit, and a source of ingenuity. When we rescue anxiety, we will rescue ourselves.