Deconstructing the anxiety epidemic


Anxiety is an epidemic. An estimated 40 million adults have symptoms of anxiety. America spends $42 billion a year on treatment of the condition. Women are 60 percent more likely to develop anxiety than our male counterparts. The average age of onset is 11 across genders. These numbers are terrifying to me as a clinician, a woman, and a mother.

But is there anything we can do to slow these statistics from what seems to be an endless climb north? Or, are the intergenerational symptom patterns that emerge within families simply a case of genetic destiny?

This blog is designed to strip anxiety down to the studs and reveal some of the intricate scaffolding systems that provide structure to the anxious process. Namely, we will examine the role of avoidance, rumination, and speculation in the eventual onset of a full-blown anxiety disorder.

Anxiety moves in circular motion, although you are constantly spinning you are never truly gaining traction and moving forward. The good news is that anxiety is highly amenable to change.

Let’s break down a few of the patterns at the epicenter of the larger anxious process:


Rumination is a prolonged state of cyclical worry and negative internal dialogue. Rumination is akin to brooding. Usually, this brooding takes on the flavor of having done something wrong or having been wronged. As you observe this style of thinking, notice that ruminations almost never reflect something positive. Ruminators will often also exhibit interpersonal styles that are marked by a propensity to be the victim and have other co-dependent dynamics that entangled them in a web of disempowerment.


The speculator is constantly looking into the future to source out the possible signs of danger. These people forecast the future most often with a flavor of doom, suspicion or dread. The speculator views the untapped horizon with apprehension and suspicion. The speculator is most vulnerable to catastrophic thinking patterns, which are at the epicenter of more acute anxiety disorders. I urge you to view this style of thinking as a component of anxiety. If you read this and find that you too exhibit these traits, I’d encourage you to begin to observe when you shift into the speculator role and explore why you are using this style of thinking at this moment in time.


Avoidance operates paradoxically. On the one hand, it is highly effective. The act of avoiding the uncomfortable feelings results in immediate reduction of discomfort. That’s why I refer to it as effective. But don’t mistake effective for healthy. On the other hand, avoidance is a crippling style of coping. Left unchecked it usually results in significant emotional and interpersonal limitations.

Here’s the fine print on the avoidance contract: First, avoidance debilitates. In order to maintain distance from the feelings you are trying to avoid, you have to engage in more and more avoidant behaviors. Like the aperture on a camera lens the scope narrows proportionally on the left and right as it closes in on a more myopic view, avoidance follows the same philosophy when it comes to managing your feelings. As you effectively protect yourself from any of the unpleasant feelings you wish to escape, you simultaneously and proportionally narrow your ability to feel and absorb intensely pleasant feelings. Over time, you will feel less discomfort, I suppose, but you will also feel less love, less bliss, less deeply connected to people in your life. The aperture closes proportionally until you are left with a narrow and myopic emotional scope. You will be comfortably numb.

Second, the more you narrow your emotional aperture, the more you participate in atrophying your ability to tolerate your feelings in general. The ability to tolerate feelings is a muscle. It’s an achievement that starts with an intricate and delicate dance between infant and caregivers and continues throughout our lives as we adapt and re-adapt to our changing environments. The more you exercise this muscle, the stronger and easier it gets. The more you avoid your feelings, the more the muscle atrophies and the harder it is to tolerate any sense of emotional discomfort-hence the term “dis-ease.”

So what can you do to shift these long-held patterns?

1. Work with a skilled clinician to gain more insight and observe how your mind and brain work. Initially, all you have to do is observe your process. What kind of thought patterns emerges before, during, and after you feel acute levels of anxiety?

2. View therapy as the emotional equivalent of working out. It’s your opportunity to train your mind and brain. Remember, if we want to get better (healthier) train to your weaknesses. Don’t train to your strengths. You are already proficient at the things that come easily to you. I provide the space for people to increase the bandwidth you have to tolerate your feelings.

I am purposely using the word tolerate because that is the threshold I want you to (re)calibrate your interior world to. The goal is not to feel happy all the time. The goal isn’t to avoid your unpleasant feelings. The goal is to learn how to stay present in them.

3. Commit to doing mindfulness for twenty minutes a day for one month. I suggest breaking it up to two ten minute segments. I’ve written elsewhere about my preferred style of mindfulness.

Sarah Sarkis is a psychologist.

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