You did everything right.
You researched, you asked your doctor for a recommendation, and you went to a counsellor with the goal of finally getting rid of your anxiety.
The counsellor listened and emphasized. She was very nice and understanding. She worked with you on coping strategies. She asked you to believe in yourself. She encouraged you to be kinder to yourself and to practice self-care. She taught you the “grounding” technique. She asked you to practice positive affirmations throughout the day. She also taught you a thought-stopping technique for those times when anxious thoughts enter your mind. You came week after week and usually felt better after the sessions; but the anxiety always returned soon after the session.
You did more research and discovered that you need a therapist that practices evidence-based approaches, specifically, Cognitive Behavioural Therapy (CBT). It was not easy to change therapists, and you needed to re-tell all your problems from the beginning. Nonetheless, you were determined to get better and do the right thing by seeking help.
Your new CBT therapist asked you to complete numerous questionnaires to assess your anxiety. She looked like she knew what she was doing and you started to feel more hopeful. You spent your sessions in a very organized and scientific way – you examined the evidence that confirmed/disconfirmed your fears and calculated probabilities of “bad” things happening. You received worksheets to do both in-session and as homework. The therapist taught you abdominal breathing and progressive muscle tension and relaxation. You diligently filled in the thought records, worry diaries, and identified thinking distortions.
So why did you continue to feel anxious?
You started noticing a pattern. As you were driving home after a session, you felt reassured and relieved; you just calculated the probabilities of the horrible things that can happen, and examined the evidence that supported or disproved them. The probabilities looked very low. That made you feel so much better. After all, it was clear that whatever you were anxious about wasn’t so bad. The odds were in your favor! But as time passed, you started wondering, “What if, no matter how low the chance, this will still happen to me? That would be awful!” And the anxiety came back.
The thought-stopping helped, and with practice you were able to successfully push the thoughts out of your mind. Breathing techniques, relaxation, and positive thinking also seemed helpful. But the “bad” thoughts always came back – with a vengeance.
This left you confused and hopeless. You felt you really gave it your best, but you felt stuck.
You may feel this way if you suffer from moderate to severe anxiety, have persistent intrusive thoughts, or have been diagnosed with Obsessive Compulsive Disorder (OCD). In that case, the following common therapy tools will not work, which wouldn’t be so bad per se, but using them can also make your thoughts and worries more “sticky” and, thus, gradually make your anxiety worse.
Here is a list of common therapeutic techniques that will NOT work for severe anxiety.
1. Thought stopping.
It may involve snapping a rubber band on your wrist or loudly repeating, “Stop!” It may work well for some people, but the effect is very short-lived.
2. Positive affirmations.
A therapist may direct you to practice saying positive or happy statements throughout the day. This may make you feel more empowered at times, but at other times you’ll catch yourself thinking, “Who the hell am I kidding?”
Trying to think about something else instead of the worrisome thoughts.
4. Following the “Laws of Attraction.”
Thankfully, this craze is finally mostly behind us. I recall a time when clients came to me convinced that their thoughts attracted the “good” or “bad” things in their lives. Those people were terrified of bad thoughts. Ironically, this fear caused them to perceive those thoughts as meaningful, and the thoughts became even “stickier.” Truly, what you resist, persists!
5. Coping strategies, such as self-care, self-compassion, and relaxation.
These are awesome and we all need them. Unfortunately, they are not treatments for an anxiety disorder.
6. Examining the evidence for and against the thought.
This specific technique is a part of CBT, is well researched, and often very effective. It can be a helpful addition to the treatment. Unfortunately, it is often practiced in isolation from other strategies and is unhelpful in those cases. To make matters worse, if it is used with more severe anxiety cases, such as Obsessive-Compulsive Disorder (OCD) or Generalized Anxiety Disorder (GAD) and is not combined with Exposure Therapy, it may lead to a worsening of the anxiety in the long term.
7. Calculating the probability of the dreaded thing happening.
Again, it can be helpful sometimes; but if you are anxious enough, this will not resolve your worries. For example, those of us who are afraid of flying know that no matter how low the chances of a plane going down are, this doesn’t help us overcome our fear. Why? Because it’s the mere existence of that probability that makes us fearful, no matter how small the probability is. We don’t really concentrate on how unlikely it is; instead, we really zone in on how terrible it would be.
This could include convincing you that the chances of what you are afraid of happening are low. For example, if you live your life in fear of getting a serious disorder (in the absence of any concerning medical test results), the therapist may try to reassure you that there is no need for concern. Or, she may encourage you to avoid anything that makes your fear worse, such as reading medical articles or visiting a hospital. The treatment can also include examining the evidence (see #6). Even though it initially feels good to believe that you are safe, this feeling never lasts and usually the inevitable “...but what if…?” question creeps back up in a matter of hours or even minutes.
9. Meditation explained the wrong way.
Meditation is a very effective tool in coping with anxiety. Unfortunately, though, many people have the idea that the goal of meditation is to get rid of the thoughts. This misconception usually leads a person to concluding that they are unable to meditate. If this is how you perceive meditation, to salvage the situation, you turn it into an attempt of thought-stopping (see #1). In reality, meditation gives you the opportunity to sit with your thoughts without engaging with them or trying to get rid of them. This gradually teaches you to accept the thoughts as non-threatening events.
10. Advice to avoid stress.
Again, it’s not a bad idea to strive to live a balanced life, but in the context of anxiety disorders, this quest for a stress-free life can quickly lead to avoidance behaviours, which is one of the well-known factors that maintain anxiety in the long run.
All of the strategies listed above can be of great benefit to you if you experience temporary stress or anxiety related to life circumstances. Some of them can also be helpful if you incorporate them into your daily routine as long as you don’t use them for the purpose of getting rid of your thoughts.
But if you suffer from OCD or an anxiety disorder, all of those strategies used in isolation will just lead to those thoughts becoming more “sticky” and persistent. By trying so hard to get rid of them, you paradoxically make them stronger. Through trying to stop them, avoid them, argue with them, or figure them out, you just make them seem important and dangerous.
So, if those strategies aren’t helpful, why do you keep hearing about them everywhere – from friends, on the Internet, and even from therapists?
1. The first reason is that those strategies are often effective in making you feel better in the short term. Unfortunately, their effect is not long lasting. Additionally, the more you do those things with the purpose of getting rid of anxiety, the more you keep your anxiety going.
2. The second reason is that some of those strategies were popular years ago, before we had more solid research about how our brain works. An example of that would be snapping a rubber band in an attempt to stop an unwanted thought. The rationale behind that was that by punishing this “behaviour,” we’d do it less. Somehow, those strategies stuck. However, newer research, especially research on anxiety disorders, neuroplasticity, and exposure methods has led to much more effective therapeutic strategies.
3. As stated above, those strategies can be helpful if you are just going through a difficult period in your life and do not suffer from an anxiety disorder. If this is the majority of cases that your counsellor sees, then she likely finds that they help people to overcome temporary struggles in their lives. This is not the case, however, for more serious anxiety disorders.
“Ok,” you may think, “great. So nothing really works and everything that I thought worked at least a little bit is apparently making my anxiety worse. What do I do now?”
This is your game plan:
1. Accept the thoughts as they are. Trying not to think those thoughts, paradoxically, is a way of thinking about them and inviting them back.
2. Continue to do things that you value in your life, in spite of the thoughts and fear. Don’t fight your thoughts. The more you fight them, the more they will come back. Let the thoughts and the feelings be in the background, and continue taking steps toward your goals.
3. Face your fears. This is often the pivotal component that is missing from therapy.
4. Accept that most things in life are uncertain. Learn to live with the uncertainty instead of spending your life in the never-ending pursuit of more certainty.
5. Start cultivating a completely new attitude toward anxiety, fear, and discomfort. Instead of fighting them, start inviting them into your life and see what happens.
To learn more about anxiety and effective ways of dealing with it in the long-term, read our anxiety blog.
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Anna Prudovski is a Psychologist and the Clinical Director of Turning Point Psychological Services. She has a special interest in treating anxiety disorders and OCD, as well as working with parents.
Anna lives with her husband and children in Vaughan, Ontario. When she is not treating patients, supervising clinicians, teaching CBT, and attending professional workshops, Anna enjoys practicing yoga, going on hikes with her family, traveling, studying Ayurveda, and spending time with friends. Her favorite pastime is reading.