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Addicted to anxiety: patients can work toward managing their reactions to harmful anxiety with the 12 Steps.


As a psychologist in private practice, I am sometimes astounded at the persistence of the illnesses of some of my patients. It seems that their illnesses consume them. Sometimes I suspect that they have come to love their conditions and identify with their sick role. Consciously they hate their condition, but secretly they love it, deriving some benefit. Anxiety, in particular, seems to be one of those stubborn, treatment-resistant conditions.

For example, Rachel, a woman who battled anxiety for decades, told me, "I can't even imagine not worrying. I don't know who I would be if I were not an anxious person. It would be scarier for me not to have something to worry about."

Anxiety, sometimes called stress, is the most common and chronic mental health condition in our fast-paced society. It is so rampant that some people think being stressed out is normal. Research indicates that more than one-quarter of adults and nearly one-third of children will experience a clinical level of anxiety during their lifetime. For many, I believe, their anxiety, fear and worry become so persistent that it acts like a drug: exciting, numbing and possessing them.

When I suspect that a patient is addicted to his anxiety, I invite him to consider the following questions:

* Do you feel powerless to stop your anxious reacting?

* Does your life feel unmanageable because of it?

* Does your craving for control interfere with your life?

* Do you feel hopeless for a cure?

If the patient answers "yes" to these questions, it indicates that he is hooked on his anxiety. The anxiety acts like a stimulant drug that interferes with the person living a full life.

Even if all the conventional therapies the person has tried have not cured his anxiety, there is still hope. I use an approach that has helped countless individuals with a variety of addictions: the 12 Steps of Alcoholics Anonymous (AA). The Steps provide a framework for good therapy. I adapt the Steps in the following ways, which can be summarized in four moves.

Admitting powerlessness

When patients come to me, the first question I ask involves their goal in therapy. Invariably they respond, "I want to get rid of my anxiety." They tell me about everything they have done to eliminate it and how nothing has worked.

I then suggest a different approach. "Instead of trying to get rid of it, why don't we try to accept it, work with it and learn from it?" I tell them they are powerless over the flow of their thoughts and feelings, their past and many circumstances in their lives. But I affirm, "You have power over your attitude and behavior regarding your anxiety."

I explain, "Your thoughts and feelings are like clouds that arise and disappear. They come from you, but are not you. You are the blue sky. Your anxious thoughts and feelings are not as solid as you think." That perspective often causes them to pause and think, "That really makes sense."

This first move suggests a clinical question: "What can you learn from your anxiety? What is the message of the pain?"

Having faith in a Higher Power

The anxious mind dwells in a dark cave. It focuses on the negative, on what can go wrong, on "what if" thinking. I remind my patients that they have another mind: a wise, rational mind that views life from the mountaintop. I tell them that they have a power within themselves that probably goes unnoticed because they do not pay close enough attention. It is the power of consciousness.


I invite my patients to become astute observers of themselves. I tell them, "Imagine that your thoughts and feelings flow like a river. You can try to stop the flow. But the waters still get through. You can jump into the stream and be carried along by the thoughts and feelings, drowning yourself. Or you can step back and become an observer."

As observers we can sense our freedom from the control of our thoughts and feelings. We do not have to react and follow blindly our impulses to action. We can stop, think and consider before acting. That is the power of consciousness, whose source is mysterious and unlimited. This power goes by many names: the Life Force, Spirit, Creative Intelligence or Gracious Mystery. Whatever it is called, most of us recognize we are connected to something larger than ourselves.

In becoming observers and experiencing the power of consciousness, patients realize that their anxious reacting cannot control them unless they let it. The awakening of consciousness releases the spirit of their true self. That is the gift of Steps 2 and 3 in AA.

This move suggests another clinical question: "Do you want to trust your anxious mind or your wise, rational mind?"

Seeing anxiety as a symptom

My patients think that being anxious is their real problem because it is so painful. Actually, their anxious reaction is a symptom of a deeper underlying problem. Anxiety arises from a fear of losing what we consider important, even necessary, for our happiness. We may fear losing love, control, status, health, possessions and so forth. What we fear losing reveals what we cling to for happiness.

At the core of anxiety is a negative self-centeredness that craves security. The anxious mind creates the illusion of security by hanging on to fixed pessimistic ideas. It is not the anxiety that is the problem but excessive attachments. We value some things too highly and become terrified of losing them.

I tell my patients, "Pay close attention to your fears. Put into words the thoughts that are running through your head when you are anxious. They will tell you what you value." Standing back as observers, they can then ask themselves if their fears of loss are realistic. Are they trying to protect something that is not really essential to their well-being? Our attachments keep us from being our true self. Such housecleaning is the work of Steps 4 to 7 in AA.

This move proposes a clinical question: "What do you fear losing? What do you hang on to desperately, believing you need it for happiness?"

Following one's values

I ask my patients, "What would you do if you were not so anxious?" They often give me a long list of their desires, which indicates what is important to them. "What keeps you from doing those things?" I ask. "My anxiety," they say, as if it is obvious. I then counter with, "Why do you give your anxiety so much control over your life?"

I challenge them. I tell them they have a choice. They can let their anxious reactions control them, or they can choose to follow a value-directed life. Anxious reactions often come automatically from early emotional programming. Only a conscious choice can change the direction of our life.

I further explain, "Anxiety, although it is distressful, will never really harm you. What harms you are the ways you manage your anxiety. Your fearful reactions make you shrink your life. You withdraw from life to protect yourself. But the real threat is your loss of a meaningful life." My patients begin to recognize that they have disempowered themselves by following the dictates of their fears. Living according to our authentic, freely chosen values is the work of Steps 8 and 9 in AA.

This move invites some clinical considerations: "What do you value in life? How can you pursue freely what is important to you? What interferes?"

Daily practices

I tell my patients they can begin to turn down the volume on their anxiety and reclaim their power by following a few daily practices, which Steps 10 to 12 in AA recommend. The first is to make regular spot checks when they sense anxiety arising. Stop and notice the early tremors of nervousness before they gather momentum and become an avalanche. Second, I urge them to take time for silence, in order to become more aware of the presence of their powerful observing self. They should learn to trust it. Finally, they should pay attention to what they truly value and pursue it. I assure them that their freedom and joy will come in helping others and escaping the self-centeredness of their fearful reactions.

At my suggestion, Rachel joined an Emotions Anonymous group and began working the Steps. She later told me, "It was like a miracle. I'm not entirely free of my anxiety, but I'm not its slave like I used to be."


Dennis Ortman, PhD, has been a psychologist in private practice in the Detroit area for the past 23 years. Previously, he was a Catholic priest for 14 years. He specializes in treating individuals with addictions, and he attempts to integrate psychological and spiritual perspectives in his work. Ortman has published six books on treating addictions and on the trauma of infidelity.
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Author:Ortman, Dennis
Publication:Addiction Professional
Article Type:Personal account
Date:Jun 22, 2016
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