Remember the classic Mad TV skit where Mo Collins seeks help from Bob Newhart (Dr. Switzer), for her fear of “being buried alive in a box?” After a preposterously brief and dismissive assessment ("well, has anyone actually tried to bury you alive in a box?”) Dr. Switzer simply advises Mo (Katharine) to, 'Just stop it!’ While patently absurd, there is a kernel of truth in this ridiculous advice. Just like the skit's punchline, the best way to calm your nerves might be to stop trying so hard. But, whereas Dr. Switzer flippantly advised Katharine to stop feeling anxious, the better idea is for Katharine to learn how to stop trying to control her anxiety.
Anxiety, especially intense anxiety, often leads us to seek immediate relief. Our brains use various strategies to quell our anxious thoughts and feelings, hoping to achieve a state of tranquility. These strategies may quickly become highly habitual, even unconscious. However, a counterintuitive approach suggests that actively trying to reduce anxiety will paradoxically exacerbate it in the long term. Stephen Hayes, Ph.D., the founder of Acceptance and Commitment Therapy (ACT), refers to this counterproductive tendency as the "control agenda." The idea is that our attempts to control anxiety, while human and understandable, can actually inadvertently reinforce it. This paradox is most evident in obsessive-compulsive disorder (OCD), which affects approximately 3% of the population. According to the DSM-5 ( the diagnostic manual for mental health), a defining characteristic of OCD is the presence of compulsions, repetitive behaviors or mental acts aimed at reducing anxiety or distress. These can be highly ritualized and excessive hand washing, reassurance seeking, or superstitious behavior. While these may appear irrational, these compulsions are essentially attempts to control intrusive thoughts and related anxiety and distress. And while the person may sometimes feel relief after performing compulsions, the urge to repeat them invariably comes back, sometimes stronger than before.
Similar patterns of avoidance and control can be observed in other anxiety disorders. Individuals with panic disorder may avoid crowded places or carry anxiety medication with them at all times for reassurance. Those with social anxiety disorder may go to great lengths to avoid social situations or prepare meticulously for them. While these strategies may provide temporary relief, they actually contribute to the continuation of anxiety. Those with generalized anxiety disorder will worry almost uncontrollably, often not realizing that worry is not anxiety, but a chronic attempt to control anxiety. Psychologists have long understood that worry is actually an unhelpful variant of planning and problem solving, that our brains use in response to uncertainty. Except, unlike problem solving, worry doesn't actually fix anything, and just increases anxiety. The only way to truly deal with anxiety, is to identify and refrain from harmful coping mechanisms
Psychologists have long recognized that these control attempts are not merely symptoms of anxiety but contributing factors. Cognitive-behavioral therapy (CBT) addresses this by helping individuals identify and modify these unhelpful coping mechanisms. Instead of trying to eliminate anxiety altogether, CBT teaches clients to face their fears and learn to tolerate discomfort. This tends to lead to higher anxiety in the short term, but lower anxiety in the long term. That is why the gold standard treatment for OCD, ERP, emphasizes Response Prevention, or reducing and eliminating the performance of compulsions.
The question then arises: why seek therapy if one can simply face their fears independently? Was Dr. Switzer right? Is it that simple? The truth is, that while many individuals are able to manage their anxiety on their own, a therapist can offer many advantages. A therapist can provide a collaborative space to identify and explore the subtle or unconscious ways in which individuals may be inadvertently reinforcing their anxiety. A therapist can also offer hope, support and guidance as clients gradually learn to face fears. And critically, a therapist can help clients develop coping skills and strategies for living a fulfilling life despite their anxiety. By embracing the paradox of anxiety and learning to accept and tolerate discomfort, individuals can break free from the cycle of control and experience greater psychological well-being.
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