Fear is a highly useful, although unpleasant, emotion. We feel fear when we perceive something in the world around us that is likely to cause us harm. Whether it is an out-of-control car, a summons from the boss, a drunk in a fighting mood, or a crashing stock market, we feel the same physical sensation that we recognize as fear. It’s a sudden onset of muscle tension throughout the body, stimulated by the release of the hormone adrenaline. Fear sends the body into a “fight or flight” response, which reallocates most of our blood supply to the large muscles, preparing for intense physical activity. The brain begins scanning all our senses to learn more about the threat and develop a response.

Fear has the purpose of warning us of danger and providing us with the resources of physical energy to do something to prevent the harm. Fear directs our attention to what is going to hurt us, and we get ready to protect ourselves.

Anxiety feels the same as fear, just as unpleasant, usually with reduced intensity and without the sudden onset caused by a perceived threat. We become anxious when we believe that something in our lives will go bad and cause some kind of pain or distress. The threats that stimulate anxiety are uncertain, at some unknown time in the future, based on circumstances that may or may not occur.

So the warning we get from feeling anxious is vague. The body prepares for defensive activity, but it is not clear what we should do. The brain scans intensely to identify what will cause us pain and choose a response, but we find nothing definite. This anxious state can become chronic, with muscle tension, hyper-vigilance, worrisome thinking, and ineffective activity.

Anxiety is usually a complete waste of mental and physical energy, causing fatigue with no useful outcome. Symptoms of one of the anxiety disorders, or anxieties about some situation in their lives, are often the distress that motivates people to seek help from a mental health professional.

One of the approaches to treating anxiety that my patients have found helpful is what I call “converting anxiety into fear.” This consists of examining the general or vague negative thoughts that are causing anxiety to identify the specific threats that can be addressed.

As an example of this process, I recall talking with a woman in her 60’s about her anxiety. She had a history of being “a worrier,” but generally her life had gone well. In the months before she called for an appointment, she had been through a series of health challenges, uncomfortable but not life threatening. Some of the diagnoses she had received were chronic, requiring daily medication. Sensible management of these conditions meant giving up some elements of her lifestyle and adding some new routines. But even with these changes, she was a vital woman with a satisfying family life and many fulfilling activities.

The anxiety that kept her up at night and caused her to feel tense and unhappy focused around the possibility that her future aging process would lead to years of increasing pain and disability. She could envision herself as a pitiful nursing home patient with a life empty of meaningful activity or delight.

The threat of living through years of increasing illness, losing parts of her life that she had enjoyed for many years, and ending up pitiful seemed very real. It made her feel bad to think about it, but she couldn’t stop worrying about it.

I asked if she had talked with her husband and children about planning for a time in the future when she might become very old and sick. She had not wanted to bring up such a dreary subject.

I suggested that she convert her anxiety into fear by carefully thinking through her anticipated problems, losses, and illnesses, facing the fear that each one of them would generate in her. Identifying the specific threats clearly would allow her to think about actions that might prevent or reduce their impact, and talk with her loved-ones about those more hopeful plans.

To start this work, we talked about her joy from gardening. She feared that she might one day have to give up those pleasures. I suggested that she think carefully about how she might participate in gardening as an old, frail woman. Perhaps a younger relative or friend with a garden would be glad to have her help, in whatever way she could, at planting time.

Identifying the feared threats and planning a response which would eliminate or reduce the harm has the effect of taking the power out of the anxiety. Vague future troubles and possible negative situations are faced directly, and the fear generated provides energy to plan strategies or coping mechanisms.

It would be nice if there were a way to eliminate anxiety completely, since it is an uncomfortable, useless feeling. Unfortunately for many people, including myself, we are quite hard-wired to worry about future unhappiness, scanning the world for even the vaguest threat. Learning to identify the real threats and feel our fear can make anxiety-prone people happier, with more energy to give to our important goals and relationships.
Copyright Gregg Dana 2007