The Discovery of the Oz the Terrible. Anxiety: Part 5/7

This is Part 5 of my series of articles on anxiety.

Remember The Wonderful Wizard of Oz book by Frank Baum?

If you do, you must recall how everybody was scared of the Wizard of Oz. The whole country lived in fear. But the powerful never-seen wizard turned out to be a humbug - an impostor. To reveal that, though, he had to be seen for who he was, - not for who he was trying to pretend to be.

In a similar way, anxiety (and its close relative Obsessive Compulsive Disorder (OCD) trick us into seeing danger in neutral, non-dangerous situations. To cite Oz, the Terrible, "...when you wear green spectacles, why of course everything you see looks green to you."

In the previous part of the article, we talked about how to deal with the first two components of anxiety -  Thoughts and Physical Reactions. Today we will address the third part - the Behaviours.

Remember how Thoughts, Physical Sensations, and Behaviours affect each other? Sometimes, addressing behavior is the most effective strategy for coping with anxiety.

But first,

What are the behaviours that keep anxiety going?

When faced with potentially threatening situation, we instinctively resort to two main strategies:

  1. Escaping / Avoiding (whenever possible)
  2. Trying to keep safe

Ironically, those same strategies that temporarily make us feel better are the main factors that keep anxiety going. While we use them, they maintain anxiety and in many cases make it worse. Gradually reducing and ultimately dropping those behaviours is a huge step to successfully coping with anxiety.

But why? Isn't it good to be safe? And what are those avoidance and safety behaviours anyway?

Initially, avoidance feels very good.

Imagine being anxious in social situations. When you manage to avoid going to a party, speaking in front of a group, or interacting with unfamiliar people, you feel relieved. In the short-term, it feels good. In the long-term, however, avoidance actually feeds the anxiety.

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When you avoid a situation, you don't give yourself a chance to find out that the predicted catastrophe has not happened. You never discover that Oz the Terrible is just a charlatan.

In addition, the relief that you experience when you avoid anxiety-provoking situations reinforces your belief that the situation that you escaped was, in fact, dangerous. Thus, you will be even more likely to avoid it in the future.

Avoidance seems innocent enough at the first glance, but this behavior is truly insidious.

In some cases, avoidance may make your world increasingly smaller. Think about it: if you live in Toronto and are afraid of cows, avoiding cows may not really interfere with your life in any significant way.

But what if you live in Toronto and are afraid of traveling on the 401, the major highway? If you avoid it long enough, you gradually strengthen the belief about the dangerousness of highways and the importance of avoiding them. With time, you may start staying away from 400-series highways, moving then to avoid the smaller highway 7, and later, possibly, even the major roads. I routinely see patients that only came to treatment when they realized that they can't drive anywhere except for their neighborhood. 

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When it is impossible to avoid the situation, people often resort to safety behaviours. Those are little tricks that help them feel a little less anxious. The most common are:

  • Sitting near the exit in a movie theater or a church so that it's easy to escape if anxiety strikes
  • Over-preparing
  • Carrying a bottle of water everywhere to better cope with physical symptoms of anxiety
  • Always having somebody to accompany you
  • Pretending to be preoccupied with the phone in social situations (busily scrolling through the Instagram)
  • Avoiding eye contact
  • Self-monitoring for concerning physical symptoms
  • Asking for reassurance
  • Checking and rechecking
  • Using alcohol, drugs, or food to feel less anxious
  • Watching carefully the tone of your voice and the pace of your speech
  • Saying as little as possible
  • Rehearsing what to say
  • Monitoring body language and trying to look relaxed

Unfortunately, like avoidance, those behaviours increase the anxiety in the long term. And in some cases, in the short term as well.

For example, in social anxiety, monitoring body language, facial expressions, and speech often leads to the person feeling even more awkward. In addition, so many cognitive resources are directed to self-monitoring that not much is left to be able to engage in the interaction.


So how can you get rid of those safety and avoidance behaviours? 
 

As you have probably guessed by now, the only way to break this vicious cycle is to gradually drop the safety and avoidance behaviours.

The first step would be to make two lists - one for avoidance behaviours, and another one for safety behaviours that you use. Take your time doing it, as sometimes we are unaware of those sneaky patterns and it takes time to catch them.

The fears we don’t face become our limits
— Robin Sharma

Some of the behaviours are very subtle and elusive, such as busying yourself with some task when you have to be a part of a group, wearing layers of clothes to hide perspiration, or a turtleneck to try to hide blushing, eating only small meals, speaking quietly, etc.

After you have your lists, assign a number from 1 to 10 to each item of the lists, whereas 10 is the scariest, and 1 is the least scary to drop. Then arrange the lists in order from 1 to 10.

The next step is to gradually drop avoidance and safety behaviours in the order of difficulty. There is no rule as to which list to address first. When I treat a patient, I often suggest we start working on the avoidance list, while temporarily leaving the safety behaviours as crutches to be removed later. However, if you feel like simultaneously dropping the behaviours from both lists - go for it!

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On the other hand, some things on your list may need to be broken into smaller steps.

There are some very courageous people who after learning about how anxiety operates prefer to drop numerous safety and avoidance behaviours cold-turkey instead of addressing them gradually. This is very difficult, but if you feel you are fed up with your world being so small and that you are up to the challenge - definitely try.

So your new mottoes are:

  • Face Fears

  • Avoid Avoidance

  • Screw Safety (behaviours)

And just another bonus alliteration for you:

  •      Cultivate Curiosity

This is how you expand your world and it is a perfect antidote to being held hostage by anxiety and fear.

By now you have learned about anxiety and why it is necessary for our survival, when it becomes a problem, its potential causes, as well as its components, and how to deal with them. And we (hopefully) dethroned the deceitful Wizard.

There is one more thing left. In Part 6 we will talk about something that underlies most of the anxiety disorders: Intolerance of Uncertainty.


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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.


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