Musings on Uncertainty and the Anxiety-Worry Habit

How do you feel about dental work?

As I write, I sit with a modern poultice of clove in my tooth. Mustard plasters and poultices were the go-to’s for first aid in the ninteenth-century. I have endured dental work involving medicated cement in place of an old filling. This is known as a temporary filling. Having dental work strikes me as a close cousin of the barbaric practices of yore, something to be avoided.

However, I could not avoid a particular jaw and tooth situation, which the pandemic may have created: jaw clenching. Clenching led to some difficulty with a filling. You don’t need details, and really, I apologize for this much detail.

As I prepared for this feat of bravery—sitting in the dentist’s chair and allowing him to perform his barbaric art upon my mouth—I thought about a recent article in Psychology Today magazine by Judson Brewer, M.D., Ph.D. His basic idea was that anxiety and worry are a habit created by a continuous feedback loop. A habit is a conditioned response, as we all know from hearing about Pavlov’s dog hearing a bell, getting a treat, and salivating at the expected pleasure, until just hearing the bell would stimulate the dog to salivate.

These are not Pavlov's dogs.

Source: Hope A. Perlman

A habit of anxiety and worry is also a conditioned response. You feel anxious, so you worry—worry and anxiety are two different things.

Brewer built his research on that of Borkovec in the 1980s, who discovered and posited an element of habit in anxiety. Anxiety is a physical sensation; the sensation triggers worrying (stimulus and response), and repeatedly responding to the anxiety sensation creates the habit of the anxiety-worry cycle.

The apparent glitch in this theory is that worrying is rewarding. Brewer says, in a certain way, worrying is rewarding. Because anxiety is about uncertainty, we feel anxious when things are uncertain. Worrying is the response, and it is reinforced because when we’re worrying, we feel like we’re doing something to address the uncertainty.

Anyone in therapy has probably encountered a gentle admonition from their therapist that worrying about, say, the state of the world makes you feel like you can control it. Or worrying, say, about your daughter driving a twelve-year-old car up and down the Eastern Seaboard can keep her safe. We know, rationally, the worrying doesn’t do anything, but worrying becomes its own talisman. We’re afraid to let it go because there's not much we can control when it comes to daughters or the environment.

The good news is that this anxiety-worry habit can be broken. Brewer argued that modern humans don’t need to feel much anxiety and worry. Contrary to popular belief, it doesn’t keep us sharp and on our toes. It actually makes us feel scattered and creates difficulty concentrating and performing. We should definitely not be proud of our intense stressed states. We should get out of the habit of having them. This is the stuff of Cognitive Behavioral Therapy (CBT). CBT helps us identify our automatic, negative thoughts. Once we identify them, we can choose different thoughts.

According to Brewer, the first step is to recognize that worrying is actually not rewarding. It is the opposite. It makes you preoccupied. It makes you lose sight of your day, time, and personal goals. Worrying is a waste of time and energy and really doesn’t help hold up the world. This Atlas theory of world-holding by worry exhausts us. The world will spin even if we don’t worry. Daughters will drive unreliable cars. Life seems predictable until it isn’t, and then we feel uncertain even if we worry. And even if we don’t.

What a concept. We don’t need to worry. It’s hurtful. This is news to me. I am happy to look at this in a new way.

Anxiety is a different story. Anxiety is a natural, primitive brain response to uncertainty (paraphrasing Brewer). So the next step in breaking the anxiety-worry habit is to respond to anxiety with something that actually is rewarding. Brewer suggested that getting mindfully curious about the sensation of anxiety is one option.

Before making the dental appointment, I was full of anxiety about this toothache and what it would lead to. I was so anxious and worried about it that I had to work my courage up before making the call. Once I did I had much less anxiety. Mindful that uncertainty triggers anxiety and worry, I did the strangely logical thing and asked what would happen when I came for my appointment. As I drove, I noticed that I didn’t feel terribly anxious. Maybe a bit nervous, but not worried. Because I knew what was going to happen, it wasn’t uncertain.

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Of course, a moment later, I did think that being neither anxious nor worried was the sign of impending doom, lamb to the slaughter type thing. My mind traveled to a scenario involving the dreaded chair, being numbed up, and hearing Dr.L say, “I didn’t expect this. I must drill through your jawbone and attach a wire to keep your lower jaw on your head, and by the way, you have no more tooth in that spot, oopsie.”

However, I have been around many blocks in my years, and I recognized this as a habitual anxiety loop. Because I noticed it, I was able to stop it. Remember, it takes time to form and reform a habit. I am not saying I felt pleased about the procedure, but I didn’t feel anxious, just nervous. Nervous is an appropriate, alert state response.

After that was a blur of Novocaine and trying to picture myself on a beach watching dogs frolic. Sure, my tongue felt like a hot dog, and my lips were like potato rolls. And I was sipping a chai latte through a straw, trying not to let any liquid dribble out. But overall, things weren’t so bad because I didn’t make them worse by my habit of anxiety and worry.

Worrying is about desiring, usually about desiring the prevention of a bad outcome. We all know desiring is the root of suffering. Desiring something doesn’t make that thing more likely. It simply reinforces the sense of lack, the wanting in the old-fashioned definition of the word wanting. We all want things to be certain, predictable, and permanent. Wanting means desiring and also lacking. Letting go of thinking things should feel or be different is key to just relaxing in life. Letting go of worry is a habit to establish now.

Or so they say. It’s much easier said than done. However, practicing letting go of worry by becoming curious about how anxiety feels seems doable.

We can all feel as peaceful as this scene. With practice, lots of practice.

Source: Hope A. Perlman

Do I believe anxiety doesn’t have to exist? That it’s evolutionary trash that should be incinerated? Uncertainty is a cousin of impermanence, and we know how we struggle with impermanence. Uncertainty can make you twitchy and on edge. It creates fear of loss, according to Kahnemann and Tversky, and humans fear loss more than enjoying winning, supposedly. So, we value permanence. And we are out of luck because what we get is just the opposite.

Lots of ocean and swimming metaphors surface around this topic. Plus ça change the plus they remain the same is that old French adage, isn’t it? Everything is always changing, so change is a constant. Being certain amidst uncertainty, understanding in a visceral way that everything is always changing can be its own kind of certainty, can’t it? This is the goal of the enlightened, I suppose. We befriend our anxiety in a non-clinging sort of way, and maybe it’ll fade away. But we never lose our edge. We always have to make some minor adjustments to stay afloat. That’s the metaphor. That’s the truth. However, we don’t have to worry about it.