What I Wish I Had Known About Anxiety

Mar 29, 2021 / Behavioral Health

By Samuel Nordberg, PhD
Chief of Behavioral Health

Like many people, I have struggled with anxiety at times in my life. In my early twenties, it paralyzed me for a time. I felt guilt and shame at my inability to overcome my fear and anxiety. I thought myself a coward, who would never break the cycle of panic, avoidance, and fear that trapped me in my apartment. In the early 2000s there were so many things to be afraid of in New York City. I couldn’t find my way out on my own.

It took me about a year of hard work, courage, and training, but I did begin to get a handle on my anxiety. I started working as an EMT in Brooklyn, I enrolled in a psychology training program at Columbia University, and gradually built the skills and confidence to manage my anxiety. It never left. I still manage it today – but my life is full, and rich, and happy.

Now, one of my favorite clinical activities is running a therapy group called Anxiety Skills 101. To be fair, it’s really more of a class than a group. In it, I try to tell folks all the things I wish I had known when my anxiety started spiraling out of control. We work together to build understanding, and practice skills for managing anxiety and worry. In the last month of the class, members take their skills out for a spin by challenging themselves to do something that their anxiety has prevented them from doing. I have witnessed poets deliver their work to audiences for the first time, heard singers perform, and watched business folks get on a plane for the first time in years. The group reminds me of my own struggles and triumphs, and I’ve condensed some of the major themes here.

Here’s what I wish I had known about anxiety right from the very beginning:

Nothing is broken.

In the anxiety skills class that I run, group members often comment, “It is so helpful to see other people who are struggling with the same thing I am and don’t seem broken.” Right now, roughly 1 in 5 Americans are quietly struggling with an anxiety disorder and are so good at covering it up that most people have no idea. If you are one of them, know you are not alone. Know, also, that there’s nothing fundamentally wrong with you – your anxiety system is just out of whack.

Anxiety is a natural product of a cognitive system (worry and fear) and a physiological system (adrenaline and cortisol) that was evolutionarily designed to keep us safe. Almost every human experiences anxiety on a spectrum. Some of us are more anxiety sensitive than others – meaning that we feel it more intensely, or have a system that triggers earlier than others might. But we all feel anxiety, and feeling anxious isn’t the problem. It’s as natural as breathing.

Here’s what’s happening when you feel anxiety: your brain identifies something it perceives as a threat (could be a tiger, could be a meeting with your boss, the list is infinite); your brain tells your body that there is a threat to your safety by activating the threat-response system we all have; then your body floods with adrenaline which triggers a physiological response designed to help you fight the threat or run from it. Your heart rate surges, and blood flows from your brain, gastrointestinal system, and reproductive system, into your major muscle groups (this can feel like jitters, tingles, a sense that you have to DO SOMETHING; often people misinterpret this as a heart-attack). You automatically begin breathing up in your chest, to draw extra oxygen (this can result in light-headedness, dizziness, and pain in the center of your chest).

All of these physiological changes would be great if you had to run from a tiger, but they’re really unhelpful if you’re trying to focus on a speech, or keep your cool in a meeting with your boss. In today’s world, there are so many scary things that aren’t threats to our physical safety, yet we will have the same powerful response we did 10,000 years ago. So, all this to say, first and foremost, there is nothing wrong with you when you feel anxiety. You aren’t broken.

Here’s how things go wrong.

Often, our amazing threat-response system becomes a problem. This is critically important to understand, because once we understand our own unique anxiety, we can then understand the best way to deal with it.

We often build up threats in our mind to the point where our anxiety about them is overwhelming. Let’s say we worry about attending a social event – meaning that our brain conjures up scenarios (like being embarrassed, or not knowing what to say and being judged) – that produces fear. That fear, as the event grows closer, can activate your threat-response system (which is designed to protect you from what you fear) and flood you with adrenaline. Blood flows, heart rate surges, you breathe faster… it all feels pretty awful. And a sneaky habit forms – you decide not to go, or to leave early. And, you feel relief! Our brains are smart, and designed to learn. When you feel relief, your brain says, “A ha! Avoiding the social event made us feel better. Let’s reinforce the neural pathways that made that happen.”

The next time a social event looms, your brain is ready with the solution – “Don’t go! We felt awful the last time we went. Staying home is better!” You stay home. You feel relief again. The reinforcement machine that is our brain can slowly, through multiple repetitions, or suddenly, through one terrible example, increase the amount of threat you associate with something – in this case, social events. This increased fear results in increased threat-reaction, which makes us want to avoid the situation even more. When we avoid, we reinforce the fear. Over time, this becomes stronger and stronger. Our world shrinks. Our ability to challenge our fear diminishes. We start seeing tigers all over the place and, without making a conscious decision to do so, we have built up our fear, anxiety, and avoidance to the point where they interfere with our lives.

All of this happens subtly, and not because our threat-response system is broken, but because we are using it for the wrong threats.

All of this is reversible.

I wish, more than anything, someone had told me this when I began to struggle with my own anxiety. Instead, I had a psychiatrist tell me that my anxiety would have to be managed with drugs for the rest of my life. Not true. While medications are a viable way to take the edge off of anxiety in the short-run, they are not required for anxiety management once you build the skills necessary to do so.

Anxiety is one of the things we are better off treating with education and skill training. With a therapist, an app, or a book as your guide and coach, you can develop an understanding of your anxiety and then build a training plan to help you deal with it. In my anxiety skills group, I try to equate this to weight lifting. If your goal is to become stronger, you set a clear target and you make a plan to get there. You start with lower weight, and then you start increasing weight gradually, until you hit your goal.

Managing anxiety is no different. It requires good form (skills and understanding), a sound plan (how you will gradually expose yourself to your fears without overwhelming yourself), and a lot of practice. Some of us can do it on our own. Some need a group, or a coach (therapist) to help guide them. The bottom line is this: if you put in the work, you will get better at managing your anxiety.

Never stop trying.

Don’t give up. Anxiety is, by its very nature, frightening and intimidating to take on. Facing our fears is hard, when so much of our instinct (and innate programming) is to avoid things that make us afraid. It may take you years to figure out what skills and changes work for you (it took me three) but it will be worth it. Don’t settle for a life where your excellent brain and threat-response system runs amok with your goals and happiness.

I am not suggesting that we can eliminate anxiety – I still have a panic attack every two years or so – but I am saying that we can manage it to the extent that it doesn’t rule our lives. It takes work – hard work. So don’t give up. Keep looking for allies, and mentors. Find a coach to keep you accountable. Treat it like a sport, or like learning a language. Don’t expect immediate results. Expect to be rewarded for hard work and repetition.

Here’s a place to start: we’ve recorded 12 podcast versions of my anxiety skills group, condensed to 30-minute segments, which are free to you here. These cover the “greatest hits” of the skills and knowledge that help most with anxiety management. The podcasts require daily work on your part, but all the handouts and worksheets are available here. Give it a look and see if it fits your style of learning. If not, we in Behavioral Health are rolling out more anxiety skills classes, run by different folks, so that more Reliant patients can engage in that work. Let your primary care provider know you’re interested, and we’ll work on getting you connected with one that works for your schedule.

What I Wish I Had Known About Anxiety

About Samuel Nordberg, PhD -Chief of Behavioral Health

For Dr. Samuel Nordberg, it was the events of September 11th, 2001 that led him to ultimately decide to become a psychologist. “On that day I was at work in the World Trade Center,” he explains. “9/11 more or less changed my life. I decided to leave my job in the financial industry and pursue something that would give me more meaning and purpose in my life.”

Dr. Nordberg eventually decided to go back to school,...

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7 Responses

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  1. Posted by Kimberly Allen

    I appreciate the article and will be sure to listen to the segments. I agree that one must build skills. I recall my psychiatrist’s comments when all of the sudden I had anxiety about riding in elevators. He said, “Don’t ride up 20 floors at a time. Start easy. Start with two or three floors…” Indeed, over a course of time, I build my skills. Thanks for being such a great leader and such a transparent one. You encourage me to continue on. Keep writing and speaking and sharing! Because when you do, I do! And thanks for the mention of not giving up. I agree. It is not the thing to do. As business leader and mental health advocate Garen Staglin always says, “Onward!”

    February 19, 2024 11:41 am Reply
  2. Posted by John platt md

    Nice piece,

    April 19, 2021 11:50 am Reply
  3. Posted by anne

    This was very helpful. I was treated with medication for 20 years (clonazepam). It was easy and it worked until I stopped last year. I was addicted and didn’t know it. My nervous system may never return to normal. I am learning to live with anxiety without medication or alcohol which was my ‘back-up”.

    April 2, 2021 9:27 pm Reply
  4. Posted by Adam R.

    Dr. Nordberg,

    I wanted to thank you for this article – I am weeks away from completing my Master’s in Clinical Counseling Psychology and I found this article extremely helpful! I actually used this article in two of my sessions and one of your recorded sessions on mindfulness with clients. I appreciate your honesty and vulnerability with the topic of anxiety and I fully believe that it lends to the credibility of what you have to say here. This article really helped me frame anxiety to a client on the Autism Spectrum, as you easily weaved the cognitive and physiological aspects of anxiety in a way that was very easy for this client to understand. I also found this article personally helpful and something I plan to refer to when my own anxiety surfaces. Thank you!

    March 31, 2021 3:49 pm Reply
  5. Posted by Jack Morrison

    Dr. Nordberg,
    I got an email from Reliant yesterday with a link to your article “What I Wish I Had Known About Anxiety”. The timing was PERFECT, as I had just come back from a visit with my PCP, Dr. Usha Rallapalli, where we discussed my starting a program to help with my Anxiety. Just reading your article made me feel better, as I was one of those who had the symptoms of “jitters, tingles, a sense that you have to DO SOMETHING”, and “misinterpret this as a heart-attack”.
    Dr. Rallapalli told me that Behavioral Health would be contacting me, which is great. And I’m glad I no longer think I am “broken”.
    Thank you,

    March 31, 2021 10:00 am Reply
  6. Posted by Glenn

    I experienced this in the late 90’s . Work related instances were frightening. Yes I decided to do the flight scenario never letting anyone know what I was feeling. I decided to run to relinquish my fright. I felt if I could run two miles then when it came time for that frightening moment I could deal with it. It was my heart beating so fast in that fight or flight moment It worked and my confidence resonated. Just run and endorphins will manifest change from within. I defeated public speaking by knowing your product and educating the listener. I hope this will help someone out there. I do know the feeling and it’s terrifying hugs to all

    March 30, 2021 6:32 pm Reply
  7. Posted by Chuck K.

    I found your experiences most enlightening and meaningful, and plan to download the 30 minute segments available along with the worksheets.

    Thank you for sharing ,

    March 30, 2021 2:38 pm Reply

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