- Treating anxiety as a disease isn't working. Although treatments exist, rates of anxiety disorders continue to rise.
- This is because this disease model blocks us from learning to cope with anxiety.
- Until we jettison this faulty model, our struggle with anxiety disorders will only worsen.
It’s a simple fact: Nobody likes to feel anxious. Anxiety is among the most pervasive and reviled of human emotions. And since it’s unhealthy, we all agree, we should prevent and eradicate it like any other illness. An entire economy has sprung up to aid us in our efforts: from self-help books and holistic remedies to pharmaceuticals and cutting-edge talk therapy. And yet, the fact is that we remain a profoundly anxious society, with rates of anxiety disorders soaring. A third of us will suffer from debilitating anxiety disorders in our lifetime.
Why isn’t all this working?
Because anxiety isn’t the problem. The problem lies in our beliefs—the disease story of anxiety taught by mental health professionals such as myself—that truly set us up for failure. These beliefs prime us to cope with anxiety in ways that make it worse, block us from benefiting from treatments when we need them, and prevent us from reaping the many benefits that this difficult emotion has to offer.
In my book, Future Tense, I argue that the only way forward is to challenge the disease story and understand that anxiety is a feature of being human, not a bug. Anxiety isn’t going anywhere, because it is not an illness to be eradicated or defeated. Rather, it’s a powerful emotion that evolved so that we could learn to put it to good use.
Anxiety is good for us, even though it feels bad.
This all begs the question: How does the idea that anxiety is a feature rather than a bug apply to the experiences of people struggling with anxiety disorders?
There’s no doubt that anxiety feels bad. And so it’s natural to think that this painful, sometimes overwhelming feeling is a clear cause for concern, or that it's a sign that there’s a malfunction—of happiness or mental health—that needs fixing. This logic leads us to what seems like another inescapable conclusion: we should treat anxiety as a disease, to prevent, suppress, and heal, like we would cancer or Covid.
But this disease model of anxiety is fundamentally wrong: based on old, inaccurate ideas about what anxiety is and why it evolved the way it did. This old story goes something like this:
“Anxiety is an evolutionarily outdated emotion that used to be protective for prehistoric humans. It was mainly useful for surviving things like saber-toothed tigers and natural disasters. It’s protective because it’s just like fear, and boils down to the three F's: fight, take flight, or freeze. When there are no saber-toothed tigers and we feel anxiety anyway, it’s a useless emotion that backfires by triggering an overactive stress response. The result—our health takes a big hit, both physically and mentally. We must therefore free ourselves from anxiety whenever possible.”
This story is mostly wrong. First, decades of biological and psychological research show that experiencing moderate anxiety, even on a daily basis, does not damage us, just as moderate amounts of stress don’t damage us. Second, treating anxiety as something to fix, suppress, or avoid is the surest way for it to spiral out of control. Third, anxiety goes far beyond the protective “3 F’s”. By being uncomfortable and energizing, anxiety makes us sit up and pay attention. It tells us what we care about and it prepares us to do productive things to manage uncertainty, avert negative outcomes, and optimize positive outcomes.
Research shows that anxiety primes us to seek social support (e.g., by triggering the social bonding hormone oxytocin); motivates us to pursue rewarding goals (by triggering the release of the “feel-good” hormone dopamine); and supercharges the quality of creative thinking by making us more persistent and innovative.
So treating anxiety as a disease sets us up to do all the wrong things when it comes to managing anxiety, and creates huge opportunity costs when it comes to leveraging anxiety to our benefit.
Is anxiety really a “triumph of human evolution”?
Anxiety and anxiety disorders are not the same thing. Until we make that distinction, I can see why you might feel that I’m going too far in these ideas.
Anxiety is a normal and healthy emotion that people commonly experience. It’s felt along a spectrum, from mild and barely perceptible unease to intense and overwhelming panic. Unlike fear, which is the emotion we have when we face certain and present danger, anxiety is apprehension about the uncertain future, where something bad might be coming around the bend, but good outcomes are also possible—like waiting for test results to come back from the doctor, or getting nervous about a big job interview. So, anxiety alerts us to potential danger but also gives us reason to hope.
This dual nature of anxiety means that we’re only anxious when we care about the future. It also means that anxiety exists because of one of the pinnacles of human evolution—the ability to imagine, plan, and prepare for the future, and to simultaneously hold in mind that something bad could happen at the same time that something good is possible. Anxiety is a crucial tool for envisioning the future we want and working to make our positive goals into reality.
Here’s the difference between anxiety and an anxiety disorder: We can go through periods of intense, daily anxieties and still not be diagnosed with an anxiety disorder. A disorder is only diagnosed when our ways of coping with anxiety—whether with worries, avoidance, panic, withdrawal, or obsessiveness—are out of proportion and disrupt our ability to function in our professional and personal lives. When we say that we’re in the midst of a public health crisis of anxiety, we don’t have it quite right because the problem isn’t anxiety —the problem is how we come to cope with it.
These problematic ways of coping with anxiety usually involve avoidance—like never leaving the house, quitting a job because we fear a negative evaluation, or self-medicating with drugs or alcohol to dull our emotional pain. They also involve the belief that we can’t cope with anxiety, that any feeling of anxiety is a call to panic. Ample research shows that when we instead are curious about our negative emotions, like anxiety, and learn to name them and make sense of them, they become more manageable. In an anxiety disorder, it’s the cycle of anxiety and avoidance, rather than the anxiety itself, that is the true problem.
I’d give anything to have my exhausting, overwhelming anxiety go away.
It is exhausting. When any of us cope with strong feelings of anxiety, or go to therapy for an anxiety disorder, we are dedicating ourselves to extremely hard work. But we can build endurance. To do so, we have to stop avoiding anxiety. It's a habit that might have been learned over years, even decades. It will take time to change. No therapist—except dangerous quacks—will ever tell you that the goal of therapy is to prevent or destroy all anxiety. An anxiety-free life is an impossible goal. Instead, a good therapist helps us tune into helpful anxiety, distinguish it from unhelpful anxiety, develop new, productive coping strategies, and figure out which thoughts and behaviors are part of the problem.
Most people struggling with anxiety aren't running away from it, but fighting through it every day.
Anxiety disorders cause an immense amount of suffering. At the same time, some of the ways we fight through anxiety are helpful and some can be unhelpful. For example, the idea of fighting with anxiety is much less helpful than being curious about anxiety, seeing the advantages it can confer, and understanding the nuances of what it is and what it isn’t. Don't like anxiety. But own it, so it doesn't own you. Acknowledge it, and believe that it’s a part of you. That's how we gain mastery. Treating anxiety as a disease or enemy only blocks us from that goal.
What if I’ve gotten therapy, worked hard, and medication helps me actually do the work in therapy?
Anxiolytic medications (the most commonly prescribed are benzodiazepines) can help those suffering from an anxiety disorder. For some, it is among the best options. I would never tell you to stop taking medication.
But, unfortunately, most of us aren’t being taught to use these powerful medications safely or effectively. Decades of research are unequivocal: Benzodiazepines are most effective when they are used temporarily to treat a diagnosed anxiety disorder and in combination with cognitive-behavioral therapies.
Many people, however, aren’t given the opportunity to evaluate whether and how medication is the right choice for them. Medical professionals overprescribe them, giving them to people who even mention feeling worried or anxious and allowing patients to use them chronically, without ensuring access to other therapies.
Many doctors fail to inform patients of their significant risks: They are highly addictive, difficult to withdraw from, and are the second leading cause of overdose deaths, right after opioids. Yet, since the 1970s, the mental health ecosystem has been flooded with these dangerous medications. Drugs like Xanax are a multi-billion dollar industry. Between 2002 and 2015, there was a 67 percent rise in prescriptions—accompanied by a quadrupling of overdose deaths. Many of us have come to take them casually, like aspirin for a headache, to block overwhelming feelings, and without the benefits of therapies that help us build enduring coping skills.
Taking medication is not a failure, just like being anxious isn't a failure. But the medical profession has failed many patients in its irresponsible prescription of benzodiazepines as a treatment for anxiety disorders.
Bottom line: The disease model of anxiety isn't working. Until we jettison this faulty metaphor, our struggle with anxiety disorders will only worsen.