A Behavioral Look at Anxiety and How It’s Holding You Back

I, a person with basically every single anxiety disorder, recently had a conversation with a close friend that struck some chords for me. We’ll call him J. J is one of the millions of American single dudes struggling with loneliness. He’s an awesome guy that any lady would be lucky to be with: Smart, hilarious, talented writer, neurodivergent – but spends all of his time either at work or at home. We both believe J’s person is out there, and he knows it’s going to be pretty hard to have his meet cute if he just stays home all the time, but when I asked if he had been trying to go out and meet people, he said the following:

“I have no plans beyond going to work and out to eat. I am hoping grad school will expand my circles in a meaningful way. I really struggle with the online thing, like the actual signing up. It’s kind of petrifying on multiple levels. (…) There’s also this part of me that feels like it’s an admission that I don’t already know her, haven’t met her, and won’t. I understand the illogical basis for that, but it still feels… like a bad move.”

That description felt familiar. Therapists had recently tasked me to make an effort to meet new people, as my friends were spread across the country, and the majority of my closest friends, J included, were back in my home state. This had resulted in extremely similar conversations in my own brain. However, I’d had the privilege of sharing those brain conversations with a therapist who could help steer me in helpful directions. So, I presented J with a question.

Are those real barriers or just your Anxiety Brain?

I asked J if any of those things he mentioned were actually stopping him from going out and meeting people, or was it just his anxiety brain stopping him, and those were the explanations he came up with. Understandably, he replied with “I don’t know the difference.” 

As behavior analysts, treating anxiety tends to be a little out of our scope. Sure, there are behavioral things we can apply to support someone’s anxiety treatment. We have (or at least should have) some understanding of the brain and its chemicals and how those chemicals can affect behavior, but we would not be able to ethically write a treatment plan for “anxiety.” Anxiety is not a behavior, and describing behavior as such would be mentalistic. It is, however, a real thing that I think most of us relatively rational people can agree does exist. It’s just a private event, and how do we measure private events? 

Well, unless they’re our own or someone is hooked up to a device that measures brain activity, we can’t. That’s where clinical psychologists come in. What we and clinical psychologists can both measure is verbal behavior; however, clinical psychologists have more training in making evaluations as to what some of those private events may be based on a person’s verbal behavior. I don’t have formal training in clinical psychology, but I do have a lifetime of lived experience with anxiety. As a result, I also have many years as a consumer of clinical psychological services. These experiences have shifted the verbal behavior I engage in about my private events. Hearing my friend describe his thought process, I found myself tacting them in similar ways. 

A disclaimer before someone tries to tact the rest of this as a giant confession to multiple ethics violations: I was NOT providing any clinical services, behavior analytic or otherwise, to my friend. Amidst the various essays I sent nerding out about behavior and brains and stuff was one explaining the difference between my training and that of a therapist, as well as the ethics preventing me from providing meaningful treatment even if I did have the right training. I strongly recommended that he seek out a qualified therapist, but that, as a friend who loves and cares about him, I would drop some science and be there for him as much as I could, as a friend with a some relevant education and knowledge. 

The same goes for you, dear reader. This article is meant as a behavioral explanation based on my own experience and what I’ve learned after years of therapy. This is not meant to serve as a treatment plan or replacement for therapy. If you find yourself relating to these behaviors or thoughts, please seek out a qualified therapist who can address your specific, individual needs. 

Now to drop some science.

An Example from my own brain

Like many in my generation, I hate phone calls. It is a lifelong hatred. As a child, in the ancient days before texting or even cell phones, I would literally just be bored all day sometimes because it was more immediately reinforcing than picking up the phone and inviting a friend over – much to my parents’ chagrin who then had to listen to me complain all day about being bored. A play date with a friend was obviously far more reinforcing, but it was delayed, and between me and that delayed reinforcer was some response effort, and a series of immediate aversives. 

I would have to pick up the phone, dial a number, and wait an unpredictable amount of time before someone might pick up. Even worse: the person who picked up might not even be my friend! It might be a sibling or – gasp – a parent! I would have to talk to a parent and ask to speak to my friend. Kids today, they don’t know anything about this struggle. Then, if for some reason my friend wasn’t available to hang out that day, I would have to do the process all over again to try to find a friend who was available. So, there was an unpredictable amount of aversives in this series, and it wasn’t even guaranteed that any of it would end in reinforcement.

Even as an adult, if something requires a phone call, I will find all the reasons to put it off: I’m tired, I’m working (and apparently lunch breaks don’t exist), I’m busy, I don’t have time. I’ve cooked dinner instead of ordering pizza before over this – and that had a guaranteed reinforcer at the end!

Outside of my brain, it’s pretty easy to see that none of those “reasons” I gave actually stop me from making a phone call. Most calls I would need to make take less than 10 minutes. I can do that on my lunch break or even step away for a few minutes. Even in our line of work, there’s pretty much a 100% chance that no one will die if we step away for 10 minutes or less. Still, I find a lot of neurodivergent people, especially the ADHD-flavored kind, can relate to these experiences. Those experiences can also create a pretty long learning history of other people tacting these behaviors with mentalistic things like “lazy,” “not trying hard enough,” “making excuses,” etc. There’s probably some extra icing thrown in too, like “it’s not that hard,” “it’ll take less than 10 minutes,” “literally it’s taking longer to avoid it than it would take to just do it.” 

Here’s the thing, anyone in our field should know that it’s not that easy. If it was easy, the person would be engaging in the desired behavior. If they’re not, especially if they are lamenting a lack of access to reinforcing consequences, it stands to reason that it must be “that hard.” 

Ironically, J had also been avoiding a phone call: he really needed to make a dentist appointment– a classic example of a “simple” task that should take less than 10 minutes. J has dental insurance and lives in an area with access to multiple potential choices for dentists. So why is it so hard?

Why It’s So Hard Part I: How language sabotages us

Our learning histories don’t just affect our outward behavior, they also affect our neurology. This is why things like trauma create overgeneralized behaviors and continue to affect people long after the contingencies have changed. We’ve got two systems piloting these meat suits we all live in: The brain and the mind. Current science doesn’t really know what the mind is. For our purposes, we’re going to refer to the mind as our private events: Thoughts, sensations, inner dialogues (if you have one), etc. This is distinct from the biological processes completed by the physical organ known as the brain. 

To oversimplify for the sake of metaphor, both of these systems talk to us, but the brain’s “language” is chemicals and electricity, and the mind’s “language” is words, feelings, and pictures. When we’re faced with a task or situation that’s aversive for whatever reason, the brain releases chemicals that give us private sensations. Let’s stick with the phone call example. When I know I need to make a phone call, my brain releases the anxiety chemicals. 

Unfortunately, I don’t speak chemicals. I speak words. 

The role words play in our behavior cannot be overstated. It is well known that the words we use, the languages we speak, and the cultures within which our language was shaped all work together to frame our perception. Our perception is how we interpret and understand our environments. The more words we have, the wider our ability to perceive and understand both the external and the internal environments. This also contributes to how talk therapy can be effective, and is at the heart of acceptance and commitment therapy (ACT) through relational frame theory. The words we use can also throw wrenches in our ability to benefit from things like ACT and talk therapy. 

When we experience private events, we engage in verbal behavior about it in order to make sense of it. Since we don’t speak chemicals, our mind has to try to translate it for us to the best of its ability through its learning history and with the vocabulary it has. Anxiety chemical means “danger!” The mind receives the “danger” chemical and does a quick scan of the world. Since our brains and its structures haven’t really kept up with the times as society has evolved, the first thing the mind is going to look for is what’s coming to eat us in that moment. If there’s nothing coming to eat us, there must be some other reason for the danger signal. So, there must be some other reason for us to avoid the thing. I must be…

Too tired.

Too busy.

Too crunched for time. 

Most likely, your mind’s learning history includes other people’s tacts for these behaviors. So you may then get:

I’m too lazy.

I’m just a failure. 

I can’t do anything right. 

Let’s look at it through the good ol’ 3-term contingency: 

Antecedent: Aversive task 
Behavior: Insert your own avoidance behaviors here – e.g. complaining to your parents that you're bored, or going to make dinner instead of ordering pizza 
Consequence: Avoid aversive task

But there are other contingencies in place:

Antecedent: Anxiety chemicals 
Behavior: Verbal behavior about avoidance behaviors (rationalizing) 
Consequence: Escape anxiety chemicals

or to dig deeper:

Antecedent: Aversive sensation about avoidance behaviors (guilt) 
Behavior: Verbal behavior about avoidance behaviors (rationalizing) 
Consequence: Escape aversive sensation (guilt)

There’s also one more player in the mix.

Why it’s so hard part II: The Matching Law

Let’s revisit J’s avoided phone call to the dentist. He has two potential contingencies with different reinforcers:

Given the possible dangers evident by the potential aversive consequences of Door #2, why didn’t J choose Door #1? I directly asked him if he was really willing to risk his teeth falling out by delaying this. J provided the following response:

So far, I have proven willing to do so. (…) I really want to avoid going in and being judged for having a bad mouth.”

Along with this reasoning, he also hinted at a history of feeling judged by doctors for other things when he went in for medical appointments.

Yeah, hard relate to all of that. Medical care in the US is a nightmare. Anyone who’s a member of any other group remotely marginalized in the US (femme, LGBTQ, overweight, person of color, etc.) who’s ever had to seek out medical care for anything other than a check-up or common illness can probably relate to this. However, I still had to pose this question: do you know for a fact they’re going to judge you if you go in?

J’s response:

Look, you.

When I reminded him that he had literally asked for this by coming to me for advice, he admitted he was hoping for something more along the lines of a “magic wand and fairy dust.” Well, of course he did. Who wouldn’t want to wave a magic wand and both escape the anxiety chemicals and access the larger and objectively healthier reinforcer? Most of us have been faced with a scary situation in which we had to rely on experts because we had no tools with which to solve it ourselves. In those situations, I’d be willing to bet everyone has wished– even hoped– there could just be a magic wand.

If you haven’t been there, I hope you are aware that the life you’ve lived is both extremely rare and extraordinarily privileged. 

J, like all of us at one time or another, chose Door #2 because it maximized his reinforcement and minimized his effort. The delay, the response effort, the potential for aversive consequences preceding any reinforcing ones, all of that reduced the reinforcing value of Door #1. It’s the same reason J didn’t seek out a therapist. Why go through the response effort of finding and contacting a therapist, then the response costs of having to lay out these painful thoughts and feelings, and pay a fee when you have a friend who may have a magic wand? Just getting your mind to even admit these things about your brain is a whole other mountain of response effort and, depending on your learning history, a whole other set of aversive sensations or consequences. Faced with the choice of all of that or the faint possibility of a magic wand, I know I’d take the bet on the wand, and probably have in different situations.

How to Stop It

In my personal experience with my own anxiety brain, the best way to combat it was to teach my mind to translate the chemicals and tact those private events differently. Anyone can do this, assuming their learning history has ever contacted these alternative tacts or translations. My friend J’s had clearly not. I would argue most people’s haven’t unless they’ve had the education and training and/or the privilege of accessing a competent therapist. Even then, there’s a myriad of reasons it may not have come up or the person may not yet be able to do it independently. It’s a monumental effort no matter how much you’re able to engage in verbal behavior about it. Sure, I can do it now after decades of training, but it’s still a hell of a lot easier as an outsider looking into someone else’s brain.

I hear ACT can really help build those skills, but unfortunately my understanding of that side of ABA is pretty rudimentary. Yes, I know I need to fix that. Yes, I’m probably engaging in some avoidance behaviors about it. Because it’s fucking hard. Those are all difficult to admit, and that’s the point here. In order to overcome the anxiety chemicals and engage in the behaviors that lead to the bigger, better reinforcers, you have to engage in some verbal behavior with some hard truths. When anxiety brain is stopping us from doing something important, the first hard truth is that none of the barriers that allowed us to escape the bad feelings produced by the anxiety chemicals are real. 

In ACT, this would be called Acceptance and Defusion. Without better training in ACT, my best advice is to practice honestly and objectively tacting your behavior. Start with behaviors that are lower stakes. 

“I’m going to avoid eye contact with my neighbor, pretend I don’t see them, and go to the next aisle to avoid them because I don’t feel like talking to anyone.” If that produces anxiety chemicals and guilty sensations, maybe add, “It doesn’t mean I don’t like them, it just means I don’t have the energy/spoons/desire to interact socially right now, and that’s OK.” 

There’s a good chance that behavior of honestly tacting your own private events will result in some reinforcing chemicals from your brain. Plus, you’ll get to avoid an unwanted social interaction and possibly even escape the aversive brain chemicals that make you feel bad about it. Hey look! A magic wand!

My second piece of advice is possibly and even lower response effort: check out How to ADHD. Even if you don’t have ADHD, there are some really helpful tips in there along with simple and accessible explanations. I can’t recommend it highly enough. 

My last piece of advice though is reiterating what I said above: if any brain chemicals or stopping you from living your fullest life, seek out a qualified mental health professional. 

But if you’re just a nice lady looking for a smart, funny writer who would like to touch your butt, gimme a shout, I know a guy.