Robert L. Leahy is a doctor of psychology, one of the co-founders of cognitive-behavioral therapy. In this book, he talks about the mechanisms of anxiety, why people needed it, how we saw it, and what to do with it now, in today's world.
In the first part of the summary we will look at where anxiety comes from, why it was needed and learn about isolated phobias, panic attacks and OCD.
— We live in an anxiety era
Anxiety gets in the way. It prevents us from living, it prevents us from talking, it prevents us from expressing our emotions and feeling happy; it creates artificial limitations in areas where they might not have been. Leahy calls anxiety the most common disorder.
But no bug in our brains appeared for no reason—and it's the same with anxiety.
Leahy argues that anxiety has helped us survive as a species, and that in general we have lived to this day and evolved to this degree because of anxiety.
...Anxiety was one of the basic mechanisms of survival. That's how nature instilled caution in human
It's important to remember that evolution doesn't seek to make us happy, relaxed, or unfamiliar with guilt. The goal of evolution is survival. And survival depends on only one thing: the transmission of genes to offspring. Genes must be passed on, even if the individual himself has to be sacrificed in the process
We can be terribly timid because in the past an unknown person might kill...
Generalized anxiety disorder is just a modern version of farsightedness. In tribal life, it was such anxious people who could anticipate disasters and prepare for them
Seeing a non-existent lion in an ambush nine times in a row is a harmless mistake. But not seeing it the tenth time was fatal. It turns out that evolution is biased against prudence: it's better for it that we be overly cautious, constantly ready for danger. It prefers that we not relax, that we not let our guard down, even if some danger has not yet materialized. This is essential to understanding
The only problem is that the time when it was vital to be constantly on guard is over. It has recently passed, the firmware in the brain has not yet had time to update, so the reptilian part of the brain perceives the world as daily survival.
The emphasis on the reptilian part of the brain, older than the cortical structures, is made on purpose, because...
Even realizing that fear is irrational, we don't stop being afraid
That is, defeating anxiety by telling yourself “don't worry” is not an option. You have to somehow prove that the context that causes the anxiety is not dangerous. Further down the book, Leahy suggests ways to do this with as little pressure on yourself as possible.
We need... to experience a frightening event in a context that lets us know: what we fear is actually safe
The level of fear is determined not by the situation you're in, but by the interpretation of what's going on
The recipe... for happiness is comfort in the here and now
The author warns right away that it will be scary, you can't make progress without it.
Sometimes discomfort is our friend. It is he who informs us that we are moving forward
You can only learn to swim in water. Let yourself get wet
To overcome something, you have to go through it
In doing so, he explains how to relate to the feelings and emotions that may arise in the course of the work:
Anxiety is not a sign of weakness, it's not shameful, it's not immoral. You don't choose when to worry and when not to worry, because anxiety is part of your evolutionary heritage. In fact, it says that you're very good at seeing dangers and reacting to them quickly
...You have to stop worrying—no, you don't. It's not possible
You're a human being, not a machine. Your emotions should guide you, they help you set goals and regulate your chosen course. Anxiety can indicate what you need in life
His advice is often reminiscent of Eastern philosophies, which suggest seeing thoughts as “just thoughts,” without evaluating them.
Let anxiety do what it needs to do—you should just distance yourself
You don't need to control it [anxiety], you need to accept it. You can treat it like fresh air. Breathe it in. It will not kill you
This is also how he suggests treating life. To go back to the “now,” to think of thoughts as “just thoughts”.
Imperfections, doubts, unpredictability and obstacles are normal
It [perfection] can't be achieved
Indecisiveness is a typical manifestation of this paralysis. We often refuse to act at all until we have “enough information”; but somehow this never happens
You have to get rid of your predilection for absolute certainty. If you continue to play by the old rules, to engage in these mind games, the anxiety will not leave you
Leahy gives the most important warning, too, at the beginning of the book--he says that one cannot get rid of anxiety, only learn to live with it.
— Some have lived with anxiety for so long that they are already used to it
After the author tells us why anxiety was invented, he begins to explain how it works. The main problem is that we think too much. We try to predict probable developments in the future, which causes us to see all kinds of trouble.
We are extremely resourceful when it comes to dangers that threaten us: we can be publicly embarrassed, fail to meet standards, fall ill, fail an exam, faint, catch a disease, make a mistake - the list is really endless... we are looking into the future, trying to imagine what people will think and what could go wrong. But those risks are not visible to anyone but us
If you're in a state of anxiety... you are convinced that you have to anticipate everything, any dangers. The belief tells you: if you gather all the information about what can go wrong, it will allow you to influence the situation
But the dumbest thing is...
When emotions dominate, our ability to determine what's dangerous and what's not is denied
...We think everything is dangerous in general.
There's no such thing as a minor accident, only a full-blown catastrophe
All threats will inevitably come true
which makes us want to get rid of the problem as soon as possible so that we feel safe.
Even if the frightening situation lies in the distant future, something inside you demands that you deal with it right now. This feeling is very familiar to anxious people. From the moment the potential threat is identified and until it is eliminated, rest is out of the question—no rest, no enjoyment, not a drop of attention to other (perhaps even more serious) matters
Allegedly [you] can make bad things not happen. Your mind believes that if you don't control the course of events, everything will fall apart, and therefore your safety depends on your ability to influence all environmental factors
It seems that if something goes wrong, we'll always regret it.
It is especially important to see the contrast in our abilities when we are calm and when we are anxious:
People who tend to be constantly anxious may deal with problems successfully or not so successfully as they arise, but they always underestimate their ability to cope with anything in the future. They can give others useful advice, but when it comes to their own lives, they find themselves stumped
Because the control doesn't really exist.
...[Anxiety] lasts for a while and then goes away. You don't need to control it; in this case control is an illusion
— To overcome fear, you must first awaken it
The following chapters in the book are a breakdown of 6 anxiety disorders. Leahy tries to stick to one plan for the breakdown:
- To tell what the disorder is and how it affects life.
- Show the mechanisms, the “rules of behavior” of a person who is in such a condition.
- To give instructions with explanations of how to be.
The first of the disorders is specific phobias.
Specific phobia is a fear, which, for no apparent reason, is attached to a certain stimulus. The stimulus can be anything: a situation, an environment, an object, a sound. People with an isolated phobia try with all their might to avoid contact with anything that gives them fear.
People with anxiety disorders and specific phobias in particular adhere to so-called “protective behavior”—such behavior that they think will protect them from danger. This can be anything—some habits, rituals, etc.
The problem with protective behavior is that it interferes with “living a normal life”. It can be so obtrusive that it will cause a lot of inconvenience. But the person will still find it difficult to give it up, because every time he or she uses such behavior and nothing happens to them—in the brain there is a pattern: “This behavior protects me from danger”.
Are based on a deep instinctive desire to control the situation, even when in reality it's impossible
... And the more often the behavior is “used” and “protected,” the stronger the habit, the stronger the belief that this behavior works—the more often and more stubbornly the person will use it.
- Identify exactly what it is that you are afraid of.
- Describe your guarding and avoidance behavior.
- Formulate a motivation for change. To overcome any fears and anxieties, you must first weigh what it will cost and what benefits overcoming it might bring.
- Arrange a hierarchy of fears by level of intensity. List the situations that make you afraid, from the least frightening to the most terrifying. Assess the rationality of your fear. Ask yourself if you are willing to bet money that your fear will materialize.
- Experience the fear in your imagination. Leahy calls this “exposure therapy”-when we intentionally place ourselves in a context that causes anxiety, but which we can stop at any moment. The easiest way to start is precisely by imagining such a situation and moving up the hierarchy of fears from the bottom, increasing the “intensity of the stimulus.” “Don't rush, don't try to smooth out the angles”—the author states that the main thing is not speed, but how convincing the picture in your head turns out to be.
- Practice meeting fear in real life. In the same way—starting at the bottom of the hierarchy, going up.
- Follow a long-term strategy.
The author also advises to remember that.
You can worry about something and still do it
...Because of anxiety, it always seems that you need complete certainty about a situation, one hundred percent certainty. But it doesn't exist in our uncertain world...
Protective behavior only supports your fear, prevents you from fully experiencing it by imitating a feeling of security. You can overcome your protective behavior by, for example, consciously doing exactly the opposite of what you are drawn to
When you drown out fear by drinking or taking medication, your mind begins to connect safety with desensitization, when in fact there is no such connection
If you decide to have short exposure sessions, schedule them to be repeated regularly, preferably several times a day, daily
You can't overcome fears in one attempt—it's a lifelong job
Be patient—as long as you stay on track, you're progressing, no matter how successful you are right now
- You can take the anxiety out.
- In the long run, if you keep doing the exercises, your anxiety will diminish.
- You are not a coward. In fact, your fears are probably adaptive mechanisms.
- Your fears are not related to underlying problems.
- Your reservations about exposure therapy are understandable, because you're being asked to do exactly what you would normally avoid.
- Panic attacks always go away on their own
Panic attack is an anxiety attack about what is going on in a person's body. It can be called a fear of one's own sensations. When a panic attack occurs, the sensation is lack of oxygen, heart beating fast or too fast, ringing in the ears, shivering, dizziness, chills or fever, sweating, feels like choking, feels like throwing up.
Agoraphobia is a fear of places that can cause panic attacks. Agoraphobia differs from isolated phobia in that it is not related to a fear of danger per se. People suffering from agoraphobia fear that the reactions of the mind and body to these dangers will get out of control.
Panic attack arises not only as a result of typical primal fears, but also as a result of the feeling that one's reaction to that fear will be catastrophic—that is, it is fear of fear
The first panic attack usually occurs for no apparent reason and is interpreted catastrophically. Because of this, hypervigilance intensifies.
- Determine what it is you are afraid of.
- Describe your guarding and avoidance behavior.
- Think about what will motivate you to change.
- Determine a hierarchy of fears.
- Assess the rationality of your fear.
- Experience the fear in your imagination.
- Practice facing the fear in real life.
- Adhere to a long-term strategy.
For the first point, Leahy advises:
List the circumstances that make you anxious: confined or open spaces, heights, tension, waking up at night, airplanes, elevators
You need to write down the typical thoughts that go through your head when you're nervous or frightened
To deal with guarding behavior, remember that:
Guarding behavior makes a person feel safer, but rarely prevents panic attacks
To achieve your goal, you will have to do things that will take you out of your comfort zone. You won't have to immediately do anything that seems unpleasant
It's also worth remembering that fears are often irrational:
Panic thoughts are triggered every time by false beliefs about panic attacks and their symptoms
Avoidance will make us feel better right now, but will only reinforce the belief that the world is essentially a dangerous place. So you'll become addicted to anxiety avoidance because you'll be convinced that you won't be able to get over it
If you feel a panic coming on, repeat to yourself: “Panic attacks always go away on their own.”
- The ability to receive uninvited guests is a major weapon in the hands of one who wants to become a zen thought warrior
Obsessive-compulsive disorder, OCD is characterized by the development of intrusive thoughts, memories, movements and actions, as well as a variety of pathological fears. Obsessive compulsive disorder is defined as recurring intrusive thoughts or images that a person finds unwanted or unpleasant and tries to get rid of.
The author describes life with OCD as follows:
Chronic anxiety causes nausea, irritable bowel syndrome, fatigue, pain, problems concentrating, indecision, and feelings of hopelessness
Very often worry makes people lose the ability to do what they really need to do
Your anxiety seems to freeze you out - the future is too frightening and you're not doing as much as you could be, you're not communicating as much as you'd like to
The root of the evil, according to Leahy, is an obsession with control:
The person with OCD feels that she can't control these thoughts
It's her desire to get rid of them [the obsessive thoughts] that's the problem
Usually OCD patients develop an excessive sense of responsibility for their own thoughts, a need to do everything possible to make sure that they don't hurt anyone else. In other words, OCD, like many other anxiety disorders, has to do primarily with worrying about what's going on in the mind. It's a fear of one's own thoughts and feelings
People with OCD, Leahy says, think as follows:
My thoughts are not normal. My head is filled with very strange ideas. Other people would never think that. There must be something wrong with me
I have to be perfect. It's just unbearable when things don't go exactly the way I decide. The slightest mistake could set off a chain reaction, and everything would collapse
I'm responsible for everything. It's my fault if bad thoughts do arise; I have to take responsibility for them, so that nothing bad happens
I need complete certainty.
Leahy even cites a “set of rules” which, if followed or thought of in a similar way, can make one's OCD look bad:
- Nobody else has these strange thoughts and feelings.
- Keep track of your thoughts and feelings—you absolutely must evaluate them all.
- Explore the content of your obsessive thoughts.
- Consider your thoughts as abnormal, evil, crazy, or dangerous. You will become ashamed of your thoughts, you will never share them with your loved ones.
- Accept that your thoughts will lead to action or that they are in fact already reality. This is called a merger of thoughts and actions.
- Try to suppress all unwanted thoughts.
- If you can't suppress or banish “abnormal” thoughts, that's a “bad sign.”
- When the “abnormal” thoughts return, conclude that you are no longer in control.
- Keep trying to neutralize them.
- Continue to neutralize the “bad” thoughts until you feel satisfied. Keep performing the compulsive actions until you can say to yourself, “Okay, that's enough, it worked, I'm not so worried anymore.”
- Reinforce your compulsive belief that you need to perform rituals to get rid of dangerous thoughts.
- Avoid any situation that might trigger intrusive thoughts.
Done! You are admirable... in observing ritualistic behavior that leads to more anxiety.
All kidding aside, getting rid of this behavior is surprisingly difficult. Thoughts constantly pop up, “what if?”, “how did that happen?”, and so on. It is difficult to work with them, because it is not clear which of them really deserves attention.
The principle is roughly the same as for the other disorders.
- Determine exactly what it is you're afraid of.
People with OCD usually find it easy to cope. Their fears require constant attention, they invade and have a huge impact on their lives
- Describe your guarding and avoidant behavior.
This is what OCD patients find very difficult to do. The fact is that their symptoms are essentially their guarding and avoidance behavior
Exposure therapy (both in the imagination and in real life) is the key to overcoming OCD
It's not likely to be pleasant at first. Once you decide to confront your compulsions, your anxiety will increase for a while. After all, you've reinforced a lifelong habit of submitting to the frightening messages of your mind, making sacrifices on the altar of fear
- Formulate a motivation for change.
- Change your attitude toward compulsions.
Make sure that suppressing thoughts is ineffective
Make sure that thinking can't change reality
Allow thoughts to flow undisturbed Try not to track or control your thoughts
Change the way you think about intrusive thoughts
Change the nature of your relationship with your obsessions
Imagine that obsession is just a guest at your party. There are many guests, and the obsession is just one of them. Let him hang around. Life will go on anyway... You can build your relationship with your obsession very differently if you perceive it as a silly character in need of attention
Swim with the flow of obsessive thoughts. Don't try to control compulsions - better to observe them from the sidelines... If you're patient, you can wait for the moment when another compulsion floats by. Because they always come and they always go
Don't suppress the thought—on the contrary, return to it more often If the thought “I might lose my mind” scares you—repeat it for 30 minutes every day
Establish a hierarchy of fears.
Evaluate the rationality of your fear.
Although logical reasoning alone is unlikely to get rid of deep-rooted obsessive thoughts and rituals, it's still helpful to look at your fears from a rational point of view
How likely is it that of all the immense number of people living in the world, you are the one who has something so wrong with you?
Experience the fear in your imagination.
Practice encountering fear in real life.
The number of exposure therapy approaches you can set yourself. The more of them you plan and actually go through, the better prepared you will be for the inevitable return of intrusive thoughts. Controllable conditions are easy to create: you can touch something you think is dirty and not wash your hands afterwards; turn in a report before you have time to double-check it thirty times. But don't forget that the situations you create shouldn't seem so simple. They should be based on something that increases your anxiety
Practice just putting them [rituals] off to begin with. If you can't bear that the furniture in the room is unevenly arranged, wait 20 minutes before correcting it
Don't forget that rituals are usually pretty rigid and you can only break them down by gradually making small changes
- Stick to a long-term strategy.
Most people with OCD are unlikely to ever completely get rid of intrusive thoughts and actions. But that doesn't mean it's impossible to get out from under them. The important thing is that your intrusive thoughts no longer prevent you from living a full and meaningful life. The important thing is to understand the importance of acceptance: to let thoughts and intrusive actions just be, without giving them too much importance
Don't forget that even if you manage to reverse OCD now, it doesn't mean that problems will never arise in your life again—you can't be immune to them
In the second part we'll talk about generalized anxiety disorder, sociophobia and post-traumatic stress disorder. Stay tuned.
- Anxiety Free by Robert L. Leahy
- Second Part of the Summary
- The Subtle Art of Not Giving a F*ck by Mark Manson
- Red Pill by Andrey Kurpatov