I

understanding fear and anxiety

TURNING TOWARD YOUR EMOTIONS

Marc had worked hard to create a financially secure and satisfying life. After years of college and law school, working late nights and weekends, he finally secured an enviable position at a Fortune 500 company as in-house counsel. Frequently reflecting on their early days of scrimping and saving, Marc and his wife, Janelle, truly appreciated the comfort of their beautiful suburban home, the high-quality private school education they provided for the children, and the frequent travel they enjoyed. Unfortunately, it all came crashing down on Black Thursday, the day hundreds of layoffs in the legal business were announced around the world. As the financial pressures have mounted, Marc has become increasingly nervous, irritable, and stressed. His mind is constantly busy with worry about the future and regret about the past. What if he can’t find another position? Who will hire a middle-aged man in this economy? What if they lose the house? How can he explain everything to the kids? Why didn’t he pursue a different career? Why didn’t he save more money? All night Marc tosses and turns, his mind working through all the possible consequences of unemployment. He is exhausted from the lack of sleep and the constant tension in his neck, shoulders, and jaw.

It’s Friday night, and the dorm is booming with activity. The hall reverberates with the competing sounds of blaring music, the whirlwind of activity in the bathroom where everyone is jockeying for a better position in front of the mirror, and the general commotion in the common area as the residents finalize their plans for the evening. Nikki turns to face the wall and pulls the covers over her head as she hears her roommate, Alisha, come back in. Alisha pauses for a moment but then, convinced that Nikki is asleep, grabs her bag and bolts out of the room to catch up with a crowd headed for the party. Nikki feels the sting of Alisha’s sarcastic comment to the group—“My poor roommate seems to be coming down with the flu for the third time this month”—and she feels herself blush as peals of laughter echo through the hall. Nikki never dreamed that she would spend her weekends at college holed up alone in her room. Sure, she hadn’t been a party girl in high school, but she never would have described herself as shy or anxious. Nikki had always done well in her honors classes, and she had a group of close friends who hung out together almost every weekend. But the transition to college had been rocky. Nikki was uncomfortable making new friends, and she kept to herself during orientation. Now everyone had settled into groups of friends, and she was left alone on the outside. Nikki started buying food to eat in her room because she was too embarrassed to sit alone in the cafeteria, where she imagined she would be scrutinized by all the other students. Even her schoolwork was slipping. Being organized and responsible was no longer sufficient. Nikki’s professors expected her to participate regularly in class, and she had two presentations coming up. As the thoughts and images of all the possible ways she could fail as a college student flooded her mind, Nikki felt a wave of nausea overcome her. “Maybe I really am sick,” she considered.

Rob carefully balanced a large cup of steaming coffee as he slid across the backseat of the pickup truck to make room for the rest of the guys on his crew. As usual, Bruce was ranting on and on about some story in the paper that had him all fired up, while George just slouched down in the seat next to him, the brim of his baseball cap pulled down low over his eyes, trying to catch a few more minutes of sleep before they arrived at the worksite. The conversation turned to sports, and usually Rob would have joined right in, but today he felt too jumpy to concentrate. He felt his palms start to sweat, and although he briefly thought maybe it was just the heat escaping from his cup, Rob had a sinking feeling that the constant fear he had been fighting for the last month was ramping up. Rob had been working construction for at least 20 years, and as a kid he had thought nothing of climbing up ladders or crossing beams without a safety harness. Sure, he had once seen coworkers take a bad fall, but he was confident in his own ability to stay balanced and secure. But lately Rob noticed he felt shaky and dizzy whenever he was doing roof work. He had trouble holding on to his tools because his hands were so sweaty and his heart felt like it was going to pound right out of his chest. Even though Rob was too embarrassed to refuse the coffee that Bruce brought him each day, he didn’t drink it, figuring the caffeine would only make things worse. As the truck turned onto the dirt road leading up to the worksite, Rob was filled with dread. He and Mary could barely make ends meet each month without his paycheck. What would happen if his anxiety got worse and he had to quit? Who was going to hire a 45-year-old roofer who couldn’t climb a ladder?

Joan is a stay-at-home mom with four children ranging in age from 6 to 15. Although all the kids are finally in school, with one in elementary, two in middle school, and a sophomore at the high school, Joan’s days are easily filled. Between serving as PTO secretary, volunteering in the school library, and just keeping up with the kids’ activities, Joan has little time for herself. The only appointment she always keeps is her check-in with Dr. Sedona, the psychiatrist who has been prescribing Joan medication for panic disorder for more than a decade. Joan has been anxious her whole life. As a teenager she had preferred a quiet night at home with her family to the parties and sporting events popular with her peers. At her older brother’s urging Joan tried living away at college, but after only a month in the dorms she had experienced her first panic attack. Joan was reviewing her sociology textbook in preparation for a quiz when she noticed the words begin to blur and felt a wave of dizziness and lightheadedness. When her heart began racing and she couldn’t catch her breath, she asked her roommate for help and ended up at the emergency room. Six months later she was diagnosed with panic disorder. Fortunately, Joan hasn’t had a panic attack in more than 10 years, but she still lives in fear that her symptoms will return, and as a result she keeps to her comfort zone. But lately Joan has begun to worry about what will happen as her kids get older and expect more of her. Her daughter is always asking to go to the mall, but Joan refuses, knowing she would feel trapped and panicky if they ventured into the middle of such a large and crowded building. And the only thing Joan’s son wants for his birthday is to attend a concert. But it would be too risky to try to chaperone a group of teenagers in an unfamiliar setting she knows would set off a panic attack. Joan is worried about how she will adapt to these changes and new demands.

If you picked up this book, you are undoubtedly struggling with something you identify as anxiety. It may be that you recently experienced an event that has left you incredibly anxious, like the loss of a job. Or maybe you’re going through a big life transition such as divorce or graduation from college. Perhaps you just noticed that anxiety has been gradually creeping into different aspects of your life, making it harder for you to live the way you want, leaving you exhausted, stressed, and overwhelmed. Maybe you’ve battled anxiety your entire life and wonder if significant change is possible. Or maybe you’ve always experienced a lot of stress and worry but viewed it as integral to your success in life, and only lately have you begun to wonder whether there is another way of being in the world.

Whatever your circumstances, through your personal experiences you likely know a lot about this emotional state—how it feels, what situations are likely to bring it on, and, perhaps most painfully, the toll it can take on your life.

We too have some expertise in understanding fear and anxiety, from our own personal experiences, but also from our extensive research and clinical work in this area. That’s why we hope you’ll allow yourself to learn from our mistakes as you read this chapter and the rest of the book. The faces of anxiety we just showed you may not fully capture what you’re going through. Later in the book we might recommend particular coping strategies that seem counterintuitive or that don’t immediately strike you as likely to be effective for you. We know (somewhat painfully) from our own experience that sometimes all of us prematurely judge and dismiss information that doesn’t fit with how we typically view ourselves and the world. Even as psychologists who study and practice mindfulness—a special type of awareness that allows us to observe our internal states as well as our environment with gentle curiosity and compassion, through a clear, wide-angle lens—we are constantly amazed by the things we learn about our own reactions and behaviors when we allow ourselves to fully consider new and foreign ideas and options.

So, as we present the scientifically and clinically derived general knowledge about fear and anxiety in this chapter, we ask that you carefully consider each point to determine how it fits with your experience. We’ve discovered that turning toward your internal emotional experiences and making connections between what is known in the field of psychology about fear and anxiety and your own private struggles is an important step toward easing your suffering and living life more freely and fully. Every reader is unique, and we firmly believe that you’re the best expert on what is right for you. Give yourself a chance to identify it.

Although the evidence suggests that bringing this new and deepened awareness called mindfulness to fear and anxiety ultimately reduces distress and provides new opportunities, it may seem like a strange thing to do when you’re trying to reduce your anxiety. You’re already painfully familiar with your emotions—wouldn’t learning to ignore them be much more useful? Anxiety can be extremely uncomfortable, so it’s natural to want to turn away from rather than toward it. But as we’ve said, even people who know a lot about anxiety (including those who study and write books on the topic) are sometimes confused by their reactions or unaware of some of the subtleties. An enhanced understanding and awareness of anxiety alleviates a lot of distress and confusion and can often make anxiety itself less overwhelming. So, even though it may require a leap of faith, we recommend that you give the exercises described in this chapter a try. At first you may find that focusing on anxiety and fear makes you feel somewhat more uncomfortable or nervous. That is a natural and normal part of the process. As you incorporate the strategies we present throughout the book, we hope you’ll see a decrease in your discomfort and distress with these emotions.

EXERCISE What do you know about fear and anxiety?

Take a few minutes to consider your thoughts and reactions to the following questions. If you are willing, we recommend jotting down your responses in a notebook.

1. What is your anxiety like? How do you know when you’re anxious?

2. What is the difference between fear and anxiety?

3. Are these emotions adaptive? If so, why do so many people struggle with anxiety?

4. What is an anxiety disorder? How does someone develop a disorder?

HOW DO WE KNOW WHEN WE ARE ANXIOUS?

Claire just moved from Oklahoma to Los Angeles to take a job with an advertising firm. The weekend before she was scheduled to start, her boss invited the advertising group to dinner. Claire sat silent and wooden in her chair, surrounded by a group of young, stylish men and women engaged in animated conversation. Her ears rang with the clatter of silverware and plates and the buzz of conversation punctuated by shrieks and peals of laughter. She watched the waiters deftly move among the crowded tables of the trendy restaurant, delivering eclectic dishes to the eager diners. The minutes ticked past as Claire frantically searched for something to add to the conversation. She felt her anxiety escalating. Thoughts such as “They must think I am a total hick,” “I am sure they regret hiring me,” “I have to stop sitting here like an idiot and say something,” and “I will never fit in here” raced through her mind. She felt a blush creep up her neck, reddening her pale skin, beads of sweat moistened her palms, and her mouth was as dry as cotton. In addition to feeling afraid and embarrassed, she felt a wave of sadness as memories of her friends and family back home passed through her mind. Abruptly Claire stood up and weaved through the crowd toward the bathroom. Moments later her boss came through the door and asked in a kind and concerned voice if Claire was ill. From the privacy of the stall, Claire steadied her voice and through her tears responded, “I think something I ate made me ill. Please apologize to everyone, but I think I better slip out of here and head home.”

EXERCISE What are your personal signs and symptoms of anxiety?—Part A

You probably remember different times when you were anxious or situations that made you stressed at the time. For this exercise, we ask that you reflect on an anxious situation in what might be a slightly different way. Think about a time within the last week when you were fearful or anxious. After you finish reading all of these instructions, close your eyes and replay the situation in your mind as vividly as you can, almost like you are starring in your own movie. Picture the environment you were in, including any sights and sounds around you, except this time, rather than just experiencing the event as it unfolds, see if you can carefully observe your reactions, even if they are totally familiar to you. Bring a new curiosity to your examination. As you put yourself back into the situation, see if you can notice the thoughts that ran through your mind, any physical changes you noticed in your body, and any other emotions besides fear and anxiety that you experienced. Notice your behaviors—things you said or did in the situation. Try to stay with the image for several minutes, then jot down what you notice by making a list of your different responses in each domain (i.e., thoughts, physical changes, emotions, and behaviors). You may want to use a notebook to do this and the other exercises in the book so that you can keep all your responses together.

As Claire’s story demonstrates, signs and symptoms of fear and anxiety appear across all our response systems. Images or memories pop into our mind, thoughts are generated, physical changes occur, emotions arise, and behavioral habits kick in. The specific response we have to an anxiety-eliciting situation is determined by many factors. Elements of the situation, our basic biology or temperament, and our personal history and learning influence our reactions. Different people approach a feared situation in different ways. For example, imagine a person receives an e-mail Sunday night to report to the boss’s office first thing in the morning; a customer has filed a serious complaint. Someone who grew up with a chronically ill parent may cope with his anxious apprehension about the meeting by calling in sick to work. Another person might preemptively quit to avoid harsh criticism. Still another might “white knuckle” her way through the meeting, steeling herself against each wave of anxiety. Becoming aware of your unique signs and symptoms and the situations that elicit them is an important first step toward change.

Although fear and anxiety are expressed through several channels of responding—cognitive, emotional, imaginal, physical, and behavioral—we don’t always notice the varied aspects of our responses. Usually we define our anxiety using a few key symptoms. For example, someone might be very aware that his mouth becomes dry every time he is called on in class. Someone else is tuned in to the way her heart races whenever she approaches or drives over a bridge. If our attention becomes focused narrowly on one or two typical or dominant responses, it is easy to miss more subtle reactions. When we are able to identify our more subtle reactions, we can catch our anxiety earlier and choose how to respond to it more effectively. For many people, physical symptoms are the easiest to notice. We’re usually aware of
only a few key symptoms
of our anxiety. Stepping back and observing our thoughts when we feel anxious can be more difficult. Most of us are not used to treating thoughts as responses; we simply experience them as part of our identity. Observing emotions can also be challenging. Fear and anxiety easily grab our attention and tend to overshadow other emotions like sadness or shame that may also be present and important to notice. Behavioral responses can be both obvious and subtle. Someone might know that she avoids public speaking to keep her anxiety at bay but be less aware that she drinks three glasses of wine each night to avoid lying awake in bed, caught in a web of worry. A salesman who drives the back roads instead of the freeway to avoid the panicky feeling that comes up when tankers thunder by might convince himself that taking the alternate route is a simple matter of preference. Noticing our subtle signs of avoidance is an important step toward reclaiming our lives.

Another characteristic of anxiety that is not always apparent is how responses in one domain can trigger responses in another. While reviewing notes an hour before a test, a student might have the thought, “I am not prepared for this exam.” This thought can set off a chain reaction of physical symptoms like tightness in his chest and rapid, shallow breathing. Increasing his rate of breathing naturally causes his heart to pump faster, which signals to him that he is really getting anxious now. Noticing these physical sensations prompts a cascade of thoughts about how scary and uncomfortable it is to be anxious and how anxiety will surely interfere with his performance on the test. These thoughts prompt the student to close his book abruptly and leave the library in an attempt to escape any cue that might increase the intensity of his fear. In this way, our anxious responses feed one another in an increasing spiral. Our anxious responses feed
each other so quickly that by
the time we notice the anxiety
it feels out of control.Often we do not notice the signs until they are already quite intense and overwhelming, making it much harder to respond effectively to our anxiety.

How can we both be aware that we are struggling with anxiety and also miss some of its signs? Moving toward and paying close attention to painful experiences is not something we are naturally inclined to do. Have you ever done something really embarrassing? We certainly have! And when a memory of what we said or did comes up, often we want to scream “NO!” and push that image right out of our mind. It can be really uncomfortable to remember how we put our foot in our mouth, to relive turning red, to recall the look on the other person’s face. Part of being human is that we are driven to avoid painful experiences. Although this natural tendency toward avoidance is protective, it makes it difficult to notice subtleties in the cascade of responses that make up anxiety. Also, anxious responses often occur quickly and automatically, like an ingrained habit, outside of our focus of awareness.

At the other end of the spectrum, sometimes we dwell on anxious events. We might replay a situation over and over in our mind. Our clients are often surprised, and a bit skeptical, when we suggest that the first step to living a fuller life involves carefully observing anxiety each time is arises. Many people who struggle with anxiety already feel that they are painfully aware of their signs and symptoms.

Purposefully observing our reaction to an anxiety-provoking situation is qualitatively different from our typical way of noticing. If our initial reaction to an anxious thought or a frightening image is to wince and turn away, purposefully observing involves bringing our attention back to it. If our initial reaction is “been there, done that,” like listening to a broken record—same thing over and over again—the challenge Mindful awareness of the
full experience of anxiety
can help us see it coming
and manage it better is to look closer and see if we can find some part of our anxious response that we hadn’t noticed before.

This method of observation—turning toward something that we would usually avoid and taking a fresh look at a familiar response—is a key characteristic of mindfulness, a core skill we hope to help you develop as you work through this book. Mindfulness involves other skills as well, but cultivating a new way of observing is the first step.

EXERCISE What are your personal signs and symptoms of anxiety?—Part B

Consider the list below and find the signs and symptoms that you typically experience with anxiety. You may also want to note those that you haven’t necessarily noticed but you think may be worth looking for as we move forward. It may be helpful to jot these down in your notebook so that you can remember to notice them as they occur during the day.

Thoughts

Worries about what might occur in the future (e.g., “I will fail this test,” “I will be uncomfortable at the party,” “My children will not be happy,” “My parents will become ill,” “I will have a panic attack in the supermarket,” “I am going to get sick from the germs in this bathroom”)

Ruminations about the past (e.g., “I can’t believe I said that,” “My boss was so disappointed in me,” “I wish I hadn’t snapped at my partner that way,” “Running into that dog in the park was terrifying”)

Thoughts about being in danger (e.g., “I can’t do this,” “I am having a heart attack,” “I am losing my mind”)

Critical thoughts about the self (e.g., “I am such an idiot,” “I am so lazy,” “I’m such a procrastinator,” “I am a total loser,” “I am a failure”)

Other thoughts?

Physical sensations

Rapid heart rate

Dizziness or lightheadedness

Sweating

Shortness of breath

Blushing

Trembling or shaky feelings

Dry mouth

Stomach distress

Tension or soreness in the neck, shoulders, or any other muscles

Headaches

Restlessness

Fatigue

Irritability

Other sensations?

Additional emotions

Anger

Sadness

Surprise

Disgust

Shame

Other emotions?

Behaviors

Repetitive behaviors or habits (e.g., biting fingernails, tapping feet, playing with hair)

Avoidance or escape (e.g., turning down an invitation; passing up a promotion; calling in sick to work; making an excuse to cancel a social engagement; leaving an event early; asking someone else to make a phone call for you; taking an alternative route to avoid a bridge, tunnel, or other landmark; using a ritual, security object, or lucky charm to get through an anxious experience)

Distraction techniques (e.g., overeating, smoking, watching television, having a few glasses of wine or a couple of beers, sleeping, shopping)

Attempts to gain power or protect oneself (e.g., communicate aggression, threaten others, assert dominance, express anger)

Other behaviors?

HOW DOES ANXIETY DIFFER FROM FEAR?

Imagine driving through the countryside on a warm, sunny fall afternoon. The trees are ablaze with red and yellow leaves, accented by a brilliant blue sky. A calm peacefulness envelops you as you travel the gently sloping road. Suddenly an eighteen-wheeler comes into view, careening toward you on the wrong side of the road. Your heart jumps into your throat, and you swerve onto the shoulder just in time for the truck to go roaring by, shaking your car with its force. You break out into a sweat, your heart races, and you feel like someone just punched you in the gut.

Fear is a natural and helpful alarm that alerts us to potentially dangerous situations. When we detect a threat, our nervous system immediately kicks into gear and sets off a cascade of responses all aimed to ready us for action. The parts of our brains that respond to threat react automatically, without involving the parts of our brains involved in deliberation or more complex thought. The rate and strength of our heartbeat increases to move oxygen to large muscles in our arms and legs more efficiently and effectively to help us respond effectively to an emergency. At the same time, the current of our blood flow moves away from places where it is less needed (the brain, fingers, and toes) and toward our large muscles. The pupils in our eyes dilate so that we can scan our environment for threats. All of these changes, known as the fight-or-flight response, are aimed at preparing us to either fight off a threat or flee to safety. The physical symptoms of fear that we experience when these changes occur (rapid heartbeat, increased breathing, dizziness) are simply the side effects of our body readying itself for action. Fear can also elicit what is known as the freeze response. This happens when we don’t respond at all in a dangerous situation in the hope that the threat will pass. For example in the wild, if a rabbit senses a predator, such as a fox, it becomes immobile to minimize the chances of detection and capture. Humans can also experience the freeze response under conditions of extreme fear. Consider how we sometimes describe feeling “petrified” or like a statue. For example, an accident victim may remain seated in her car even when freed from the rubble and directed toward safety.

Physical threats are not the only danger cues humans are built to avoid. Sensitivity to possible social threats in our environment is another hardwired survival response. Both animals and humans depend on a larger community for safety and security. For example, wolves survive by earning their place in the structure and hierarchy of a pack. A heightened awareness of social cues is essential for successful integration and acceptance into a group or society.

Because fear of physical and social threats is critical to our survival, this response system is remarkably well developed. It works quickly and effectively without requiring any thought or purposeful effort on our part. Having such an efficient fear response is extremely beneficial. We have a much better chance of survival if we are instantly prepared to defend ourselves against outside threat.

Now imagine that at the end of the week you are responsible for a big presentation at work. Your unit has been underperforming and there is rumor of layoffs. The CEO and VP from corporate are flying out to hear your explanation. Unfortunately, you were alerted to this visit only 3 days ago, and you don’t feel like you have had adequate time to prepare. Worse, every time you get a few hours to work on the presentation your mind either goes blank or spins off in a million directions. You just cannot concentrate. Your shoulders, neck, and jaw are tight with tension, and there is nothing you can do to loosen those muscles. At home, you feel cranky and irritable. You race through the kids’ bedtime story because your mind is filled with budget projections and workload distribution. When you think about the actual presentation, you imagine stumbling over your words, not being able to answer important questions, and letting your whole unit down. You think about all the people whose jobs depend on your ability to get this right.

Compared to fear, anxiety is a more subtle but chronic state. Whereas fear is an automatic response to a threat we perceive as imminent, anxiety involves thinking about or imagining some threat that we could encounter in the future. With fear our response is automatic; there is little need for higher-level thinking. We don’t ponder whether to step out of oncoming traffic; we simply react. In contrast, anxiety is defined primarily by anticipation.

When we are faced with a threat, we feel a surge of fear that peaks in a matter of moments and begins to subside when we are safe. In contrast, an anxious response lingers as we consider and prepare for future possibilities. As a result, anxiety is associated with a general sense of restlessness and irritability. Remaining continuously poised for a possible threat can produce muscle tension, especially in the shoulders, neck, and face. Anxiety is defined
mainly by anticipation. Because our minds are busy considering the future, it is difficult to concentrate on the present while anxious. These cognitive and physical symptoms often disrupt our sleep, leaving us feeling worn out or exhausted.

Although prolonged anxiety can take a significant toll on our physical and mental well-being, the ability to consider possible future threats and prepare for them can also boost self-preservation and success. Considering what sort of questions might be on a test is a useful way to prepare. Imagining a physical challenge that lies ahead can prompt us to exercise and train. Envisioning the damage a hurricane might cause can help us make the necessary arrangements to stay safe.

	Fear	versus	Anxiety
Nature of threat	Immediate		Future
Physical response	Surge of panic		Chronic tension and arousal
Function	Survival		Preparedness

Are These Emotions Helpful?

We are hardwired for fear because it helps us respond to physical and social threats and increases the chances of our survival. We share this basic instinct for survival with many other species. But as humans, we also have some unique characteristics that sometimes disrupt this primitive survival response and cause us stress. The very same attributes that allow us to imagine, problem-solve, plan, and reminisce make it possible for us to be consumed with relentless anxiety.

We can think, remember, and vividly imagine innumerable threats.

Humans do not need to be confronted with a real, immediate physical or social threat to feel fear. Totally absorbed in a good book or engaging movie, The human mind is like
a movie theater that never
closes—always prepared to
show films of what we fear. we feel suspense and apprehension mount as the lead character enters the darkened room and full-blown fear when the villain attacks, even though we know we are safe. The human mind is sort of like a cinema that never closes. Awake or asleep, we can vividly imagine all sorts of potential threats and feared outcomes. We can also rerun an infinite number of past occasions marked by fear and anxiety. Our minds are excellent at conjuring up extremely realistic portrayals of these events.

To make matters worse, we don’t usually rehash embarrassing incidents or imagine future disasters with detachment and objectivity. Just imagining or remembering an event can bring up a flood of anxious thoughts and physical sensations and encourage behaviors such as distraction or escape. Anxiously awaiting her son’s return 2 hours past curfew and imagining a fatal car crash, a mother can suffer the same stomach distress, sweaty palms, and dry mouth she would at the scene of the accident. Lying in bed recalling a botched class presentation, the high school student can experience the same heart palpitations that he endured during class.

The ability to remember and imagine is an extremely valuable human characteristic that has allowed our society to advance in significant ways. Unfortunately, it also grants us unlimited access to an infinite number of feared events. Encountering an endless stream of threats in our minds significantly Mindfulness can help us
know when we’re experiencing
fear and when it’s anxiety—
and how to respond.complicates the fear response, which on its own functions as a basic biological survival system.

Our ability to vividly imagine threats also tricks our brains into thinking that these threats are more likely to occur. Research has shown that people estimate that events are more likely to happen when they can easily visualize them. Evolutionarily, this tendency was protective because, before the advent of photographs, people could more readily picture events they had recently seen in their own environment, meaning these events were, in fact, more likely. If a villager could recall a vivid image of someone getting sick from eating berries, avoiding similar-looking berries was a good idea. But in the modern age of 24-hour news coverage and cell phone video recordings of every tragic event around the globe, we can readily imagine tsunamis, earthquakes, flu epidemics, child abductions, and terrorist attacks, no matter how unlikely they are in our surroundings. Our once-adaptive tendency leaves us vulnerable to a cascade of media-induced fears.

We know there is a future, and we want to control it.

One uncomfortable truth about being human is that we know there is a future and it is uncertain. If we knew exactly what was in store for us, our ability to think ahead and plan could prevent us from falling victim to all sorts of dangers. If we knew a disgruntled coworker would go on a shooting rampage on a particular day, we could stay home, warn our friends, and call the police. If we could predict the future with crystal-clear accuracy, developing a detailed defensive strategy would be well worth the investment of time and mental effort. But given the uncertainty and uncontrollability of the future, such planning is impossible. Effort might be wasted planning for an event that never actually occurred. Or a seemingly well-thought-out plan could go awry because of circumstances beyond our control.

Jade spent hours preparing for a big exam. She faithfully attended class, kept up with the reading, and participated in the study group. Jade created a comprehensive study guide and carefully reviewed it the weekend before the test. In other words, she imagined what taking a final exam would be like and tried her best to prepare for it. Unfortunately, imagining and preparing for an event is not the same as controlling it. What if Jade’s teacher is unreasonable and creates an unfair exam? What if Jade is involved in an accident on the way to school the morning of her exam? What if she develops a migraine during the test? What if her concentration is disturbed by a classmate’s sniffling and sneezing?

Planning and preparing for events in the future is a wise and adaptive strategy. But, as is often paraphrased from the poet Robert Burns, Worry is a sign of imbalance
between anticipating the future
and accepting its uncertainty. “The best laid schemes of mice and men, go often askew.” Part of being human is managing the balance between anticipating the future and accepting its uncertainty. Worry is a sign that the balance has been disrupted.

Worry versus problem solving—how do you tell them apart?

Worry differs from problem solving in a few subtle but important ways. Often we worry about problems that haven’t actually happened yet, which makes it difficult to come up with and implement a viable solution. Also, we tend to worry about things we can’t actually control, which means that no matter how hard we search, or how creative we are, there is no solution that we can enact. Sometimes we worry and ruminate about problems when we are unwilling to take the actions that would be necessary to solve the problem. Worry can sometimes be how we express love and concern, like when a family member is struggling with a chronic illness. But despite our intentions, being consumed with worry can sometimes strain our relationships by preventing us from fully connecting with the people we care about. Although the processes of problem solving and worry look deceptively similar on the surface, problem solving moves us closer to a resolution, whereas worry keeps us spinning in an endless cycle.

Another unique characteristic of worry is that sometimes it is the process, rather than the actual content, that is important to pay attention to. Sometimes we develop a worry habit, such that we approach all kinds of problems with the same anxious apprehension. One sign that we are deeply entrenched in the worry habit is when the focus of the problem to be solved or the threat to be avoided constantly shifts. So one might start the day worrying about running late for work, then refocus on worry over a report that is due, and on the way home worry about getting through a list of chores. In the moment we might be consumed with one worry (running late), but as soon as the problem is resolved a new worry pops up to take its place. Humans can imagine an endless list of problems, which require the continuous generation of solutions. If we are not willing to accept that some elements of the future are beyond our control, some problems unsolvable, we can get pulled into an endless cycle of preparing for any and all possibilities—as Maria was when she heard a news report predicting an overnight blizzard.

Maria searched the Internet for updates on the weather as she anxiously awaited a call from her husband, Bob. She had texted him earlier with news of the storm, hoping he would help her develop a plan for the morning. After about 15 minutes the phone rang, bringing good news. Bob had made arrangements with the couple’s next-door neighbor Doris, who was available to watch their daughter, Kate, if school was canceled. Maria felt a wave of relief, but as she prepared dinner she began to worry about whether she was too reliant on Doris for help: “What if she resents our asking? In the last month I have asked her to watch Kate twice, and we borrowed her snow blower. What if she thinks we’re a bunch of freeloaders?” Maria picked up the phone and called Bob for reassurance. “Doris was fine with watching Kate,” Bob assured his wife. “I think she is looking forward to the company. She said they could drink hot cocoa, play games, and even make a batch of chocolate chip cookies together.” At first the conversation soothed Maria’s fears, but as she reflected on Bob’s words, a slew of new worries emerged. “What kind of parent am I? I can’t remember the last time I sat down with Kate to play a game. And we haven’t baked together since she was in kindergarten. Maybe I should take the day off from work. But what if my boss gets upset? I just took a vacation day last week. And Doris might be offended if I cancel. What if she thinks I don’t trust her? But after all, she is getting older. Does she have the energy to care for Kate? What if she falls asleep while they’re watching television and Kate is unsupervised? What if Kate tries to get the cookies out of the oven and burns herself?” Maria’s thoughts were interrupted by the thump of a car door. She glanced up and was startled to see that it was 6:30, Bob and Kate were home, and she hadn’t even started dinner.

In contrast, Maria’s friend Cassie acknowledges that an overnight snowstorm could close her daughter’s school and complicate her commute to work. To prepare (or problem-solve), she arranges for alternative child care and sets her alarm to go off an hour early to allow for extra time in the morning. By addressing a finite number of problems, Cassie avoids getting pulled into the vortex of anxiety.

Worrying is not a pleasant experience. It consumes our time, interferes with our concentration, and generally leaves us tense and exhausted. Worry pulls us into the future and distracts us from what is happening in the present. If during breakfast we mentally review all the problems we may need to tackle at work, we’ll find it hard to savor the meal or appreciate the company of our family. If talking with someone we are attracted to sets our mind racing to fears of possible rejection, we won’t be able to establish a connection with that person in the moment. If we worry incessantly about the well-being and security of our family, and thus are too keyed up and on edge to enjoy our time with them, we may inadvertently undermine the very relationships we are working so hard to preserve.

We also struggle with worry because it seems to occur outside our control. It seems as if fears of “what if?” take our attention hostage and prevent us from focusing on what matters to us personally. Surprisingly, research suggests that worry can serve a purpose, even if we usually don’t do it intentionally. At first, this idea may seem ridiculous and even invalidating. It may sound as though we can just choose to stop worrying if we are doing it for a reason. If you’ve struggled at all with worry, your experience probably tells you that it’s not that simple. But understanding that worry is a habit supported and strengthened by rewards is an important first step toward loosening its grip on your life.

Every action we engage in as humans has a function or purpose. Even behaviors that we know could harm us in some way, like smoking cigarettes or eating junk food, provide some reward in that they typically serve some positive function. For example, smoking is associated with an increased risk for cancer, but it also serves as a stress reliever. Eating junk food is unhealthy and associated with long-term weight gain, yet it can also provide a temporary refuge from stress or just the momentary pleasure of eating something that tastes good. Unfortunately, reaping the rewards of such a behavior reinforces it, making us more likely to continue doing it. And so the vicious cycle begins: the rewards influence our actions outside of our intentions, making these habits particularly hard to break.

EXERCISE What is the function of worry?

Often we are so distracted by and caught up in our worries that we don’t even stop to consider the purpose of our worry. As you become more aware and mindful of your worry and anxiety, these functions may become clearer. But for now we would like you just to reflect on some possible reasons that you worry. As you read over the list below, consider which items might represent the function or functions of worry for you.

• To prepare for some imagined future event

• To make sure I think through all my options and pick the right or perfect solution to a problem

• To figure out whether there is any solution besides the one that requires me to do or say something I am uncomfortable about

• To feel like I am doing something about a problem even though I may not actually have control over it

• To stop something bad from happening, even though I know it is out of my control

—Superstition: “If I worry, it is less likely to happen.”

—Protection: “If I think things through enough, I can prevent something from happening.”

• To motivate myself to do something I don’t feel like doing

• To avoid thinking about and feeling bad about something else

Many of the reasons we feel compelled to worry can be categorized as attempts to gain control over or brace ourselves for some aspect of the future. For example, Gina worries about her boyfriend leaving her so that she won’t be sad and lonely if he does. Erin worries about her auditions to prevent herself from feeling disappointed if she doesn’t land a role. Unfortunately, it is painful when someone we love leaves us, or when we are disappointed or let down in some way. Worrying can seem like a way to brace ourselves against possible pain, but as we will discuss later, this approach often backfires.

Worrying to stop something bad from happening is a behavior that is reinforced and strengthened over time. If Margaret worries about her daughter Alyson, hoping the worry will protect Alyson from contracting swine flu, and Alyson remains healthy, Margaret will learn that her worrying protects her family. In other words, Alyson’s clean bill of health rewards Margaret for worrying. Worries about events that are extremely improbable (your plane crashing, your fainting in public, or developing a terminal disease) are often maintained this way.

Sometimes it seems like worrying about a negative outcome will motivate us to prepare for it. For example, Jake worries about failing every exam because he thinks the anxiety and fear his worry produces will encourage him to study. Some anxious apprehension can be helpful in focusing our attention and increasing our adrenaline. But, ironically, the anxious responses characteristic of someone who struggles with pervasive and severe worry usually act as obstacles to adequate preparation. If studying is associated with images of failure, harsh and critical self-judgments, shame, and guilt, Jake will be motivated to avoid it.

You might be wondering why Jake doesn’t realize that worry is not working as a motivator. It may be that Jake knows worrying is not motivating him to study, but he blames himself for his failures rather than considering that the strategy may be ineffective. Human behavior is influenced more strongly by the rules we have about how things are supposed to work than by our actual experience. If Jake has learned directly or indirectly that imagining the consequences of failure is the best way to ensure success, he most likely Why do we keep worrying that
extremely rare events will occur
when we see repeatedly that they
don’t? Because we think it was
our worrying that staved them off. will continue to worry despite new evidence to the contrary.

Investigating why people worry has become a focus of interest among psychological researchers. One line of research is aimed at examining whether occasional and problem worriers differ in the reasons they give for worrying. Worrying to avoid negative outcomes and prepare for the future is common across all worriers. Only one reason for worrying was found to be more common among problem worriers. That group reported that they sometimes worried about “minor” matters to avoid thinking about and feeling emotions related to other, more distressing life concerns. For example, Tom worries about the condition of One difference between problem
worriers and occasional worriers:
Problem worriers worry about
minor matters to avoid dwelling
on more distressing matters. his lawn and keeping his shed organized and his gutters meticulously clean to avoid facing some significant problem in his marriage. Similarly, Marissa worries about being late to appointments, asking for directions, and returning items to a store, but she avoids thinking about how lonely she has been since she moved into her own apartment.

To summarize, fear is an extremely useful emotion that maximizes our chances of survival. But our uniquely human ability to imagine future threats, and our natural desire to want to control or avoid them, puts us at risk for chronic worry and anxiety. Worry is often rewarded or reinforced, so once the habit is established it can be difficult to break.

Fear prepares us to respond in self-protective ways but does not require us to do so.

Sometimes our desire to pursue what is personally meaningful may conflict with our biological programming. When we sense a threat, our alarm system readies us for action. We are alerted to possible threat, and we experience physical changes that prepare us to run, fight, or freeze. But a number of personal and environmental factors will influence how we ultimately respond to this potential threat. One significant factor is our personal values or what we find meaningful and fulfilling.

Let’s say you feel a surge of fear as you wait for a job interview. This fear is delivering a message: what you are about to do is important . . . be alert . . . there is some risk here. Mindful awareness can help us
see when we want to override our
biological programming and ignore the
warnings issued by fear and anxiety.
Always heeding these warnings
without question can lead to chronic
anxiety and restrict our lives. A number of behavioral responses to this alarm are possible. You can leave. You can try to distract yourself from your feelings, or talk yourself out of being anxious. Or you can acknowledge the message and choose to go ahead with the interview because what’s meaningful to you in this situation is the recognition that you can’t get a better-paying or more rewarding job without taking risks. And you can’t take risks without feeling some anxiety or fear.

Likewise, the first time you share your true feelings with an intimate partner, it is completely natural to feel afraid. This emotion alerts you that you are vulnerable in this situation—you could be rejected. Yet you may choose to take the risk because being close to others is something you value.

We are constantly challenged to take risks in life domains that we value, such as relationships and work. Our biological programming ensures that these risks will elicit anxious reactions—feelings of vulnerability, anxiety, insecurity, uncertainty about the future. This alarm reaction sets off a series of physical changes that focus our attention and prepare us to defend ourselves or to escape danger. However, in the pursuit of a meaningful and fulfilling life we may choose to override these behavioral tendencies.

WHAT IS AN ANXIETY DISORDER?

If feeling fear and anxiety is a normal part of being human, how much anxiety is too much? When does “normal” worrying become an anxiety disorder?

• Does worrying every day signal the presence of a disorder?

• Is it normal to blush every time you enter a social situation?

• If you were told in the emergency room that you had a panic attack, does that mean you have a chronic psychological condition?

• Is checking to see if the doors are locked at night even though you know you already locked them normal?

• If anxiety and worry run in your family, are you destined to live with an anxiety disorder as a chronic condition because it’s in your genes?

Although fear and anxiety are normal human responses, psychology and psychiatry have come to recognize certain specific anxiety disorders (a quick overview of each disorder appears below). Each anxiety disorder is marked by a unique set of signs and symptoms, but these disorders are not defined solely by the amount or type of anxiety felt. We all differ in our basic temperaments, and some of us are more inclined to respond to situations with apprehension or fear. Someone can be a self-defined worrier, blush in almost every social situation, be prone to occasional panic attacks, or frequently think irrational, anxious thoughts without meeting the criteria for an anxiety disorder. There is one important feature that all anxiety disorders share: the presence of significant distress and/or life interference. When you become seriously troubled by your anxious reactions and/or they prevent you from engaging in important life activities, you may be struggling with an anxiety disorder.

Dina has out-of-the-blue panic attacks, which involve a surge of intense fear, several times a year. Although the attacks are uncomfortable and inconvenient, she is not particularly bothered or alarmed by their occurrence. She hasn’t made any changes to her work or recreational habits, and the panic attacks don’t have any impact on her relationships. In contrast, Christina had one panic attack approximately 8 months ago. It was a horrible experience for her, and she is terrified that it will happen again. In fact, Christina is no longer willing to shop in the supermarket alone. She either waits for her partner to accompany her or picks up what she needs at the local convenience store. Although both women experience panic attacks, only Christina would meet the criteria for an anxiety disorder.

Similarly, Sarah feels nervous when she has to do a scientific presentation. At the beginning her mouth is usually dry and her voice a bit shaky. Sometimes she has thoughts such as “I don’t have anything important to say” and “The audience can tell I am anxious.” But Sarah accepts that these responses are a pretty normal part of public speaking, especially for someone who is a bit shy. Despite the presence of anxious thoughts that say otherwise, Sarah believes she has something important to contribute to her field and values sharing the results of her work with other scientists. Sarah regularly accepts invitations to present her work at conferences around the country. On the other hand, Ivan wishes he could present his work, but he feels like his anxiety gets in the way. The few times he has agreed to speak at a conference, he noticed signs of anxiety creeping up as soon as he pulled his materials together. Each time, he apologized to the conference organizer, claiming he was too ill to present. Ivan’s view is that he can be an effective speaker only if he is anxiety-free. Because of this, he has passed up several opportunities to participate in scientific conferences, and he is concerned about his chances of getting tenure. Both Sarah and Ivan experience some fear of public speaking, but Ivan’s response to his fear, characterized by distress and avoidance, suggests that he may have an anxiety disorder.

Whether you have been diagnosed with an anxiety disorder, you notice symptoms across disorders that seem relevant to you, or you are just concerned about the role of anxiety and fear in your life given the stressors you face, our goal is to help you change the relationship you have with these emotions. Mindfulness practice can reduce the pain and suffering many of us experience in response to fear and anxiety and provide us some freedom to pursue the life directions that matter most. Becoming aware of the nature and function of fear, anxiety, and worry is the first step toward living a mindful and engaged life.

EXERCISE Turning toward your emotions: Paying attention to fear and anxiety in a new way

Over the next few days we would like you to observe your response when you notice yourself beginning to feel anxious or afraid. This method of observation involves turning toward something that we would usually avoid and taking a fresh look at a familiar response. Most likely you have developed a strong habit of reacting to your anxiety with negative judgment and self-criticism, and you probably put a lot of effort into ignoring it or pushing it away. The goal of this book is to promote a radically different way of responding to painful emotions. Naturally, establishing a new habit takes time and practice. At the end of each chapter, after you have been introduced to a new concept related to mindfulness, we suggest an observational practice for you to try. These practices are designed to be progressively more challenging and complex, yet every step is important. A very subtle but critical first step to changing your relationship with anxiety is to practice simply noticing anxious responses when they arise and observing them just as they are. Although it can seem uncomfortable and perhaps unnecessary, we highly recommend that you carry a small notebook and record your responses in it. At this point, just noting the day, the situation you are in, and any anxious responses you notice would be an extremely helpful first step. So you might notice physical sensations, thoughts, or behaviors—just note whatever you are aware of in the moment you realize you are anxious. Below is a list of common questions that people often have when they think about recording their experiences in this way.

Do I have to write things down while I’m in the situation? That seems difficult or embarrassing. Can’t I wait until later?

We strongly recommend noting your responses while you are still feeling anxious. In fact, the earlier you notice anxiety and take a moment to record it, the better. One of the goals of this exercise is to break into the automatic, habitual cycle of anxiety. We want you to develop a new habit, which involves taking a mental step back while you are anxious to check in with your experience.

Do I need to mark something down every time I’m anxious? I’d be writing all day.

We want you to develop some experience with noticing your anxiety in a new way. And the more frequently you record your reactions, the sooner you will break your old habits and begin building new ones. You can decide the pace you want to take (we certainly understand how life can get very busy). We recommend that you stop and record your experience at least once a day as you are reading through the book, although you will benefit more from doing so more frequently. As your new habit develops, try alternating between physically recording your reactions in the notebook and mentally completing the steps.

What if I can’t observe thoughts or behaviors?

Observing your experience takes a lot of practice. We teach you new ways to develop this skill throughout the book. In the meantime, read over the exercise “What are your personal signs and symptoms of anxiety?—Part B” (pages 18–20) and see if you notice any of the responses described there.

Won’t purposely paying attention to my anxiety make me more anxious?

Since you bought this book, we assume you’re already paying some attention to your anxiety. Still, you may feel somewhat more anxious as you initially turn toward your anxiety by noticing and recording it. If you’re used to ignoring your emotions, you may feel uncomfortable noticing how often anxiety appears. It’s important to understand that this initial increase is temporary. It’s similar to when you first take up exercise and your muscles are sore because you’re using them in unfamiliar ways. As the movements become more familiar, the soreness goes away. Similarly, with time the discomfort associated with noticing anxiety decreases.

Also, you will find that paying closer attention to your anxiety helps you notice responses earlier in the spiral, when they are not as intense or distressing.

Finally, we’re asking you to notice your anxiety in a new and different way. People often hypervigilantly scan for signs of anxiety, either to brace for the threats to come or to chastise themselves for having an unwanted response. As you monitor your experience, try to bring a curious, observing stance to noticing your anxiety. The goal is to observe and notice the full range of reactions, not to judge or control them. Over time this new way of relating to your anxiety will lead to these signs being less alarming and overwhelming.

Problems Associated with Different Anxiety Disorders

GENERALIZED ANXIETY DISORDER

• Chronic worry about a number of different events.

• Muscle tension and other physical symptoms.

• No clear target of fear, but worry can be used to avoid pain related to important areas of living.

OBSESSIVE– COMPULSIVE DISORDER

• Frequent consuming, unwanted, frightening thoughts or images that are stronger and more intense than worry (e.g., having the strong sense that you forgot to turn off the space heater, ran someone over, or contracted a deadly virus).

—Habits that take up a lot of time but seem necessary to prevent potential disasters, such as repeating certain phrases over and over in your mind, carefully lining objects up in a certain way, or following strict rules about how to clean.

•Target of fear is unwanted thoughts, images, or urges.

PANIC DISORDER

• Unexpected panic attacks—abrupt surges of intense fear or dread accompanied by strong physical sensations.

• Worry about what the attacks mean about one’s health, safety, and well-being and fear of more in the future.

• Target of fear is bodily sensations.

• Sometimes accompanied by agoraphobia, which involves avoiding places from which it would be tough to escape or get help if a panic attack occurred.

POSTTRAUMATIC STRESS DISORDER

• Develops after someone is exposed to a terrifying, dangerous event that may have made the person feel powerless or victimized.

• Memories of the event are constantly recurring out of the blue, in dreams or in response to reminders of the event. These memories are accompanied by intense fear and a desire to escape.

• A tendency to avoid reminders of events or one’s own thoughts and feelings about the event, as well as feelings of diminished interest in things or detachment from other people.

• Chronic feelings of being keyed up or on edge.

• Target of fear is reminders of traumatic event, both internal (e.g., memories and feelings) and external (e.g., sights and sounds).

SOCIAL ANXIETY DISORDER OR SOCIAL PHOBIA

• Anxiety and self-consciousness in social situations.

— Can be a specific situation (e.g., public speaking) or more general.

• Concerned about being negatively evaluated and judged by others.

• Target of fear is everyday social situations.

SPECIFIC PHOBIA

• Distressing and/or impairing fear of a specific object or situation (e.g., spiders or dogs, thunder and lightning, certain medical procedures, heights).

• Target of fear is individualized.