Anxious summary

At what point does a “normal” amount of anxiety cross over into a disorder? 

The power to diagnose an anxiety disorder usually lies with a psychologist or psychiatrist. To understand how they make those decisions, we need to take a look at the Diagnostic and Statistical Manual (DSM). The DSM was released by the American Psychiatric Association in the mid-twentieth century and is now the leading guide used to classify psychiatric disorders. 

Wild animals are constantly on the lookout for threats. They have to be. Just a simple journey to forage for food can be fatal if they encounter a predator. 

In the early twentieth century, physiologist Walter Cannon developed the famous “fight or flight” theory. The theory outlined the survival mechanisms animals employ when faced with a threat. If animals are confronted by a predator or some other danger, they will either freeze and play dead, run away, or fight back. 

Imagine how terrifying it would be to walk to the corner store if you felt like each step you took could activate a hidden land mine. Other people just see a peaceful street, while you see danger at every turn.

People who have anxiety disorders are hypervigilant to possible threats. With a specific phobia, like arachnophobia, this vigilance is directed toward a particular object – a person might interpret everything they see or hear as being a spider. And social anxiety disorders put people on high alert in social settings, meaning a fun gathering could instead feel like a minefield of potential humiliations. 

Neuroscientists have learned a lot of what they know about human brains from experiments with animals. By observing how animals like rats respond to threats, they've been able to glean important insights about how human survival systems work. 

In scientific literature, animals who respond to a threat by freezing or attacking have been described as displaying “fear responses.” That might lead us to conclude that animals feel fear just as humans do. But this is a misconception; there is a crucial difference between having a defensive, survival response in the face of attack and consciously feeling fear. 

We’re all familiar with the scene of the therapist taking notes and stroking his beard while his client lies on a couch talking about her childhood. 

These typical scenes are inspired by Freud-era psychoanalysis. But although Freud was one of the first to introduce the concept of anxiety to psychology, current therapeutic approaches are very different. Freud used talk therapy to get to the root of psychological problems rooted in a patient’s past. Today, most therapeutic treatments for anxiety are based on cognitive-behavioral approaches, which are more concerned with how people behave in the present. They explore the symptoms, rather than the cause. 

Exposure therapy has proven to have a 70 percent rate of effectiveness. But there are some shortcomings. 

For one, the extinction of negative associations is very context-specific; something you learn in the therapist's office may not carry over to the real world. You may have virtually practiced entering an elevator from the comfort of a couch, but still be scared of a physical elevator you encounter in real life.

In the cult film Eternal Sunshine of the Spotless Mind, a couple decide to erase each other from their memories after a painful breakup. The rest of the film is spent trying to retrieve those memories. The moral of the story is that while erasing painful memories might bring relief, it also involves losing vital parts of ourselves.

The idea of erasing memories makes people so uncomfortable that it's considered almost taboo as a psychological treatment. In fact, when the author and his colleagues published a paper showing that they'd identified a way to erase traumatic memories in rats, it caused an uproar. 

Millions of people live with anxiety disorders. They lead rich, full, adventurous lives in spite – or maybe because – of all the uncomfortable feelings that anxiety can bring. Research by George Bonanno has shown that people who are able to draw on a range of active coping strategies are very resilient in the face of anxiety. 

For example, a socially anxious person may cope with their discomfort at a party by taking lots of bathroom breaks, or by stepping out to make a phone call. This may seem like avoidant behavior, which we've defined as being negative. But proactive avoidance can be a useful coping strategy that allows people time to regroup and come back to the party without getting too overwhelmed.