DEALING WITH ANXIETY AND BUILDING SELF-ESTEEM

It is estimated that in the course of a lifetime at least one in four Americans will suffer from a debilitating degree of anxiety or worry severe enough to meet the criteria for the medical diagnosis of an anxiety disorder. But even those who never suffer from a pathological or disabling state of anxiety will, at one time or another, experience excessive levels of worry and anxiety that serve no useful purpose and do nothing but undermine their happiness and interfere with their ability to accomplish their goals.

The human brain is equipped with an elaborate system designed to register the emotions of fear and worry. This system serves an important function—it mobilizes us to respond to danger by setting in motion a complex sequence of biochemical and physiological events. The adaptive side of worry is that it allows us to anticipate danger and take preventative action. So, some types of fears and a certain amount of worry can be healthy. However, feelings of fear and anxiety can persist and even escalate in the absence of an authentic threat, and when these emotions grow out of proportion to any real danger they become maladaptive. Excessive anxiety and worry can, like anger and hatred, have devastating effects on the mind and body, becoming the source of much emotional suffering and even physical illness.

On a mental level, chronic anxiety can impair judgment, increase irritability, and hinder one’s overall effectiveness. It can also lead to physical problems including depressed immune function, heart disease, gastrointestinal disorders, fatigue, and muscle tension and pain. Anxiety disorders, for instance, have even been shown to cause stunted growth in adolescent girls.

In seeking strategies to deal with anxiety, we must first recognize, as the Dalai Lama will point out, that there may be many factors contributing to the experience of anxiety. In some cases, there may be a strong biological component. Some people seem to have a certain neurological vulnerability to experiencing states of worry and anxiety. Scientists have recently discovered a gene that is linked to people who are prone to anxiety and negative thinking. Not all cases of toxic worry are genetic in origin, however, and there is little doubt that learning and conditioning play a major role in its etiology.

But, regardless of whether our anxiety is predominantly physical or psychological in origin, the good news is that there is something we can do about it. In the most severe cases of anxiety, medication can be a useful part of the treatment regimen. But most of us who are troubled by nagging day-to-day worries and anxiety will not need pharmacological intervention. Experts in the field of anxiety management generally feel that a multidimensional approach is best. This would include first ruling out an underlying medical condition as the cause of our anxiety. Working on improving our physical health through proper diet and exercise can also be helpful. And, as the Dalai Lama has emphasized, cultivating compassion and deepening our connection with others can promote good mental hygiene and help combat anxiety states.

In searching for practical strategies to overcome anxiety, however, there is one technique that stands out as particularly effective: cognitive intervention. This is one of the main methods used by the Dalai Lama to overcome daily worries and anxiety. Applying the same procedure used with anger and hatred, this technique involves actively challenging the anxiety-generating thoughts and replacing them with well-reasoned positive thoughts and attitudes.

Because of the pervasiveness of anxiety in our culture, I was eager to bring up the subject with the Dalai Lama and learn how he deals with it. His schedule was particularly busy that day, and I could feel my own anxiety level rising as, moments before our interview, I was informed by his secretary that we would have to cut our conversation short. Feeling pressed for time and worrying that we wouldn’t be able to address all the topics I wanted to discuss, I sat down quickly and began, reverting to my intermittent tendency to try to elicit simplistic answers from him.

“You know, fear and anxiety can be a major obstacle to achieving our goals, whether they are external goals or inner growth. In psychiatry we have various methods of dealing with these things, but I’m curious, from your standpoint, what’s the best way to overcome fear and anxiety?”

Resisting my invitation to oversimplify the matter, the Dalai Lama answered with his characteristically thorough approach.

“In dealing with fear, I think that we first need to recognize that there are many different types of fear. Some kinds of fear are very genuine, based on valid reasons, fear of violence or fear of bloodshed, for example. We can see that these things are very bad. Then there’s fear about the long-term negative consequences of our negative actions, fear of suffering, fear of our negative emotions such as hatred. I think these are the right kinds of fears_; having these kinds of fears bring us onto the right path, bring us closer to becoming a warmhearted person.” He stopped to reflect, then mused, “Although in a sense these are kinds of fears, I think perhaps that there may be some difference between fearing these things and the mind’s seeing the destructive nature of these things ...”

He ceased speaking again for several moments, and appeared to be deliberating, while I stole furtive glances at my watch. Clearly he didn’t feel the same time crunch that I did. Finally, he continued speaking in a leisurely manner.

“On the other hand, some kinds of fears are our own mental creations. These fears may be based mainly on mental projection. For example, there are very childish fears,” he laughed, “like when we were young and passed through a dark place, especially some of the dark rooms in the Potala,⁵ and became afraid—that was based completely on mental projection. Or, when I was young, the sweepers and people looking after me always warned me that there was an owl that caught young children and consumed them!” the Dalai Lama laughed even harder. “And I really believed them!”

“There are other types of fear based on mental projection,” he continued. “For example, if you have negative feelings, because of your own mental situation, you may project those feelings onto another, who then appears as someone negative and hostile. And as a result, you feel fear. That kind of fear, I think, is related to hatred and comes about as a sort of mental creation. So, in dealing with fear, you need to first use your faculty of reasoning and try to discover whether there is a valid basis for your fear or not.”

I asked, “Well, rather than an intense or focused fear of a specific individual or situation, many of us are plagued by more of an ongoing diffuse worry about a variety of day-to-day problems. Do you have any suggestions about how to handle that?”

Nodding his head, he replied, “One of the approaches that I personally find useful to reduce that kind of worry is to cultivate the thought: If the situation or problem is such that it can be remedied, then there is no need to worry about it. In other words, if there is a solution or a way out of the difficulty, then one needn’t be overwhelmed by it. The appropriate action is to seek its solution. It is more sensible to spend the energy focusing on the solution rather than worrying about the problem. Alternatively, if there is no way out, no solution, no Possibility of resolution, then there is also no point in being worried about it, because you can’t do anything about it anyway. In that case, the sooner you accept this fact, the easier it will be on you. This formula, of course, implies directly confronting the problem. Otherwise you won’t be able to find out whether or not there is a resolution to the problem.“

“What if thinking about that doesn’t help alleviate your anxiety?”

“Well, you may need to reflect on these thoughts a bit more and reinforce these ideas. Remind yourself of it repeatedly. Anyway, I think that this approach can help reduce anxiety and worry, but that doesn’t mean it always will work. If you are dealing with ongoing anxiety, I think you need to look at the specific situation. There are different types of anxieties and different causes. For example, some types of anxiety or nervousness could have some biological causes_; for instance, some people tend to get sweaty palms, which according to the Tibetan medical system could indicate an imbalance of subtle energy levels. Some types of anxiety, just like some types of depression for instance, may have biological roots, and for these medical treatment may be useful. So in order to deal with the anxiety effectively, you need to look at the kind it is and the cause.

“So, just like fear, there can be different types of anxiety. For example, one type of anxiety, which I think may be common, could involve fear of appearing foolish in front of others or fear that others might think badly of you ...”

“Have you ever experienced that kind of anxiety or nervousness?” I interrupted.

The Dalai Lama broke into a robust laugh, and without hesitation he responded, “Oh yes!”

“Can you give an example?”

He thought for a moment, then said, “Now, for instance, in 1954 in China, on the first day of meeting with Chairman Mao Zedong, and also another occasion in meeting with Chou En-lai. In those days I wasn’t fully aware of the proper protocol and convention. The usual procedure for a meeting was to start with some casual talk and then proceed to the discussion of business. But on that occasion I was so nervous that the moment I sat down, I just jumped right into business!” The Dalai Lama laughed at the memory. “I remember that afterwards my translator, a Tibetan communist who was very reliable and my great, great friend, looked at me and started laughing and teasing me about it.

“I think that even these days, just before a public talk or teachings are about to start, I always feel a little bit of anxiety, so some of my attendants usually say, ‘If that’s the case, then why did you accept the invitation to give teachings in the first place?’ ” He laughed again.

“So how do you personally deal with that kind of anxiety?” I asked.

With a querulous and unaffected tone in his voice he said quietly, “I don’t know ...” He paused, and we sat in silence for a long time, as once again he seemed to carefully consider and reflect. At last he said, “I think having proper motivation and honesty are the keys to overcoming those kinds of fear and anxiety. So, if I am anxious before giving a talk, I’ll remind myself that the main reason, the aim of giving the lecture, is to be of at least some benefit to the people, not for showing off my knowledge. So, those points which I know, I’ll explain. Those points which I do not understand properly—then it doesn’t matter_; I just say, ‘For me, this is difficult.’ There’s no reason to hide or to pretend. From that standpoint, with that motivation, I don’t have to worry about appearing foolish or care about what others think of me. So, I’ve found that sincere motivation acts as an antidote to reduce fear and anxiety.”

“Well, sometimes the anxiety involves more than just appearing foolish in front of others. It’s more of a fear of failure, a feeling of being incompetent ...” I reflected for a moment, considering how much personal information to reveal.

The Dalai Lama listened intently, silently nodding as I spoke. I’m not sure what it was. Maybe it was his attitude of sympathetic understanding, but before I knew it, I had shifted from discussing broad general issues to soliciting his advice about dealing with my own fears and anxieties.

“I don’t know ... sometimes with my patients for instance ... some are very difficult to treat—cases in which it isn’t a matter of making a clear-cut diagnosis like depression or some other illness that is easily remedied. There are some patients with severe personality disorders, for instance, who don’t respond to medication and have failed to make much progress in psychotherapy despite my best efforts. Sometimes I just don’t know what to do with these people, how to help them. I can’t seem to get a grasp on what’s going on with them. And it makes me feel immobilized, sort of helpless,” I complained. “It makes me feel incompetent, and that really creates a certain kind of fear, of anxiety.”

He listened solemnly, then asked in a kindly voice, “Would you say that you’re able to help 70 percent of your patients?”

“At least that,” I replied.

Patting my hand gently, he said, “Then I think that there’s no problem here. If you were able to help only 30 percent of your patients, then I might suggest that you consider another profession. But I think you’re doing fine. In my case people also come to me for help. Many are looking for miracles, for miraculous cures, and so on, and of course I can’t help everybody. But I think the main thing is motivation—to have a sincere motivation to help. Then you just do the best you can, and you don’t have to worry about it.

“So, in my case also there are of course some situations that are tremendously delicate or serious, and such a heavy responsibility. I think the worst is when people place too much trust or belief in me, in circumstances in which some things are beyond my capability. In such cases, sometimes anxiety, of course, develops. Here, once again, we return to the importance of motivation. Then, I try to remind myself as far as my own motivation is concerned, I am sincere, and I tried my best. With a sincere motivation, one of compassion, even if I made a mistake or failed, there is no cause for regret. For my part I did my best. Then, you see, if I failed, it was because the situation was beyond my best efforts. So that sincere motivation removes fear and gives you self-confidence. On the other hand, if your underlying motivation is to cheat someone, then if you fail, you really become nervous. But if you cultivate a compassionate motivation, if you fail, then there’s no regret.

“So, again and again, I think that proper motivation can be a sort of protector, shielding you against these feelings of fear and anxiety. Motivation is so important. In fact all human action can be seen in terms of movement, and the mover behind all actions is one’s motivation. If you develop a pure and sincere motivation, if you are motivated by a wish to help on the basis of kindness, compassion, and respect, then you can carry on any kind of work, in any field, and function more effectively with less fear or worry, not being afraid of what others think or whether you ultimately will be successful in reaching your goal. Even if you fail to achieve your goal, you can feel good about having made the effort. But with a bad motivation, people can praise you or you can achieve goals, but you still will not be happy.”

In discussing the antidotes to anxiety, the Dalai Lama offers two remedies, each working on a different level. The first involves actively combating chronic rumination and worry by applying a counteractive thought: reminding oneself, If there is a solution to the problem, there is no need to worry. If there is no solution, there is no sense in worrying either.

The second antidote is a more broad-spectrum remedy. It involves the transformation of one’s underlying motivation. There is an interesting contrast between the Dalai Lama’s approach to human motivation and that of Western science and psychology. As we previously discussed, researchers who have studied human motivation have investigated normal human motives, looking at both instinctual and learned needs and drives. At this level, the Dalai Lama has focused on developing and using learned drives to enhance one’s “enthusiasm and determination.” In some respects, this is similar to the view of many conventional Western “motivation experts,” who also seek to boost one’s enthusiasm and determination to accomplish goals. But the difference is that the Dalai Lama seeks to build determination and enthusiasm to engage in more wholesome behaviors and eliminate negative mental traits, rather than emphasizing the achievement of worldly success, money, or power. And perhaps the most striking difference is that whereas the “motivational speakers” are busy fanning the flames of already existing motives for worldly success, and the Western theorists are preoccupied with categorizing standard human motives, the Dalai Lama’s primary interest in human motivation lies in resbaping and changing one’s underlying motivation to one of compassion and kindness.

In the Dalai Lama’s system of training the mind and achieving happiness, the closer one gets to being motivated by altruism, the more fearless one becomes in the face of even extremely anxiety-provoking circumstances. But the same principle can be applied in smaller ways, even when one’s motivation is less than completely altruistic. Standing back and simply making sure that you mean no harm and that your motivation is sincere can help reduce anxiety in ordinary daily situations.

Not long after the above conversation with the Dalai Lama, I had lunch with a group of people that included one young man whom I had not met before, a college student at a local university. During lunch, someone asked how my series of discussions with the Dalai Lama were going, and I recounted the conversation about overcoming anxiety. After quietly listening to me describe the idea of “sincere motivation as an antidote to anxiety,” the student confided that he had always been painfully shy and very anxious in social situations. In thinking about how he might apply this technique in overcoming his own anxiety, the student muttered, “Well, all that’s pretty interesting. But I guess the hard part is always having this lofty motivation of kindness and compassion.”

“I suppose that’s true,” I had to admit.

The general conversation turned to other subjects, and we finished our lunch. I happened to run into the same college student the following week at the same restaurant.

Approaching me in a cheerful manner, he said, “You remember we were talking about motivation and anxiety the other day? Well, I tried it out and it really works! There’s this girl who works at a department store in the mall whom I’ve seen a lot of times_; I’ve always wanted to ask her out, but I don’t know her and I’ve always felt too shy and anxious, so I’ve never even talked to her. Well, the other day I went in again, but this time I started thinking about my motivation for asking her out. My motivation, of course, is that I’d like to date her. But behind that is just the wish that I could find someone whom I can love and who will love me. When I thought about it, I realized that there is nothing wrong with that, that my motivation was sincere; I didn’t wish any harm to her or myself, but only good things. Just keeping that in mind, and reminding myself of it a few times, seemed to help somehow; it gave me the courage to strike up a conversation with her. My heart was still pounding, but I feel great that at least I was able to get up the nerve to speak with her.”

“I’m glad to hear that,” I said. “What happened?”

“Well, as it turns out, she already has a steady boyfriend. I was a bit disappointed, but it’s okay. It just felt good that I was able to overcome my shyness. And it made me realize that if I make sure that there’s nothing wrong with my motivation and keep that in mind, it could help the next time I’m in the same situation.”