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Anxiety disorders are the most common mental illnesses in the United States, affecting 40 million adults or 18.1% of the population every year (NIMH). Even though this disorder is highly treatable, only 36.9% seek treatment. In many cases, the first episode happens in childhood—the median onset for anxiety disorders is age 11. Some examples of anxiety disorders are: generalized anxiety disorder (GAD), social anxiety, phobias, and obsessive-compulsive disorder.
The one that usually comes to mind when we say “anxiety” is generalized anxiety disorder (GAD). I will mainly focus on this type of anxiety disorder, which afflicts 6.8 million adults or 3.1% of the U.S. population (NIMH). Similar to depression, women are twice as likely to be affected as men. Many people who suffer from GAD wake up and tremendously worry about how they will get through the day. This unprovoked worry might, in turn, cause physical symptoms such as stomachaches or headaches.
Worry is an excellent alarm system that rescues us from threat, but too much of it can lead us to danger. So, when does worry about children, school, marriage, self, the future, or even worry about getting through the day become pathological? The shortest answer is: when it causes significant impairments in important areas of our lives such as work, school, and relationships.
Anxious people differ significantly from non-anxious ones in how they assess future events. The following are some of the most common miscalculations of the anxious mind:
- They overestimate the likelihood of negative future events.
- They underestimate how much power they have over changing negative situations.
- They over-plan to accommodate all possible future scenarios.
- They fail to lower pessimism after success (faulty re-calibration of prediction error).
- They have a hyper-focused attentional system.
- They are blind to available safety options.
When we are uncertain about a specific future event (specifically negative ones) we oscillate between efficient and effective planning strategies. So, we might tell ourselves, “I don’t want to waste a lot of the present moment preparing for an uncertain event, so I will do minimum planning." This is efficient, nonetheless, in the few cases that the negative event materializes, we would be inadequately prepared. On the other hand, we can allow this future worry to consume our present moment, and make sure that we are well prepared for this uncertain “potential” negative event and all its possible iterations. This is an effective (but not efficient) preparatory strategy, because the negative event will most likely not take place. People with clinical anxiety disorders are more biased towards being overly conservative. They do two things: They overestimate the likelihood of future negative events and they engage in elaborate effective but not efficient strategies. Extremely fatiguing laborious brain work.
To add to this, people suffering from anxiety have a low sense of controllability. So, they are not confident about their ability to tackle dangers from future negative events- should they happen. People with no anxiety can feel low control over the outcome of a future event, but they are better judges of the certainty of an event. So, a person with anxiety works laboriously and diffusely to address a “what if …” event at a high psychological cost and at the expense of the present moment.
The brain does this amazing thing all the time: It predicts a future outcome of an event, then if it does not happen, it readjusts its present predictions about the future. So, a person anticipates that they will forget their speech, but they actually end up remembering it. In future similar events, the brain says “last time I did fine, it will probably go fine this time too," and this process is key for building self-confidence. There are brain networks and specific brain chemicals involved in the constant readjustment of our “prediction error." This system is broken in people who suffer from anxiety. So, even though the event goes better than the anxious person expected, they do not readjust their expectations for future similar events.
Another system that is broken in anxious people is the brain’s attentional system. Their attentional system is hyper-focused on threat and negative outcomes. They are hyper-vigilant, always on the lookout for threatening things. The number of things that might be interpreted as negative by non-anxious people is significantly less than an anxious person. So, an anxious person might interpret most neutral events/comments as negative. If a word has multiple meanings, they will likely choose the most negative meaning.
These ongoing elaborate ongoing calculations in the anxious brain, cause a state of hyper-vigilance. In addition, these laborious mental transactions are very exhausting. Anxious people are usually spent on or before 6 pm.
How about finding safety or rescue options once the negative event actually happens? Non-anxious people are able to fish out safety places or find supportive people. Anxious individuals fail to notice any nearby safety options. There are two reasons for why anxious individuals fail to reach out to safety options: they are paralyzed by fear and hyper-focused on the negative event to notice any other details such as nearby help.
These miscalculations cause enormous psychological pain, particularly if paired with at-risk personality types (e.g., highly sensitive personality). Thus, many affected people search for pathological ways to numb or terminate this pain. Anxiety is an intense overwhelming disorder but it is treatable. According to NIMH, only 43.2% seek treatment for GAD. Excessive fear can paralyze a person and stagnate their growth. Regain the power of the present moment and get treatment for your anxiety today.
