When Bad Circumstances Make Anxiety Vanish
I have generalized anxiety disorder, but in times of true crisis, my anxiety seems to disappear.
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As I stepped into my grandmother’s empty home, the stillness and silence unsettled me. I saw an A-line skirt pattern on the table. She and I had planned to sew skirts and scarves with colorful floral fabric the following weekend. My stomach dropped.
Two days before, she had collapsed in her bathroom. The stroke she had was too massive to recover from. Over the next week, we all stayed with her in the hospital, making sure she was as comfortable as possible and surrounded by those who loved her most.
My grandmother, at 91, had been active and independent. She occupied most of her time by hand quilting, and we thought she would’ve appreciated having one of her quilts with her at the hospital. But she had made nearly 100 of them. Which one would I pick? Instead of overanalyzing it, I simply walked into her house and chose one I knew she loved—a red-and-white quilt made up of tiny heart prints.
Typically, a decision like this would fill me with immense anxiety. I have generalized anxiety disorder (GAD), which means I obsessively worry about anything and everything. Tasks as small as negotiating a freelance rate and selecting an outfit for a wedding cause me anxiety, and the worry only intensifies with the importance of the task.
But I wasn’t worried about choosing a quilt. In fact, I was completely calm.
Shortly after my grandmother passed away, I went in for a minimally invasive shoulder surgery intended to clean up inflammation due to rotator cuff tendonitis. Upon waking up in the operating room, I was told that my doctor also did a surgery that was much more intense to fix my bicep tendon.
Instead of having a simple, three-day recovery, I would be in a sling for a month and wouldn’t regain full use of my shoulder for five months. The surgeon very briefly mentioned the possibility of this surgery in my pre-op appointment, but did not by any means explain the magnitude of it. I was completely caught off guard. I couldn’t drive for a month and I missed various work deadlines, not to mention the feeling of isolation I developed from all of the unexpected time I had to spend alone.
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While recovering from surgery and grieving over the loss of my grandmother, I noticed something peculiar. My anxiety was at an all-time low. Prior to these two crises, I almost always had a lurking, low-level sense of anxiety each day. I was typically somewhat tense and rigid, often unable to catch my breath during times of real panic. But now, I experienced hardly any anxiety.
I started a book about anxiety around this time: First, We Make the Beast Beautiful: A New Journey Through Anxiety by Sarah Wilson. The book uses compelling first-person narrative and research to explore how we think about anxiety. “When we’re thrust into it, we anxious folk can often deal with the present really rather well,” Wilson writes. “As real, present-moment disasters occur, we invariably cope, and often better than others. At funerals, or when I’ve fallen off my bike, or the time I had to attend to my grandmother when she stopped breathing, or whenever a major work disaster plays out leaving my team in a panic, I’m a picture of calm.”
This passage described what I’d been dealing with perfectly. But the whole idea seemed counterintuitive. Wouldn’t someone with crippling anxiety feel more anxious during times of distress? Not necessarily, it turns out. “It absolutely does make sense to me that somebody who may worry excessively in some situations can find themselves very well-equipped in others,” says Margaret Distler, a psychiatrist at the UCLA Anxiety Disorders Clinic.
Distler says there are a handful of reasons why this might occur. For one, anxiety is adaptive, she says. People with anxiety often have thoughts that are focused on worrying about negative outcomes, and therefore they have behaviors to mitigate these negative outcomes. People with anxiety do things like check and recheck work, problem-solve and make lists, all in an attempt to ensure a good outcome. In situations of true crisis—a family emergency, loss of a job, things like that—people with anxiety are very well-equipped to gather those resources, to be sharp thinkers with good problem-solving skills, and to kind of worry about outcomes in a way that really helps them, Distler says.
Another explanation for this phenomenon is based in the nature of worry itself. Distler says that in the world of cognitive behavioral therapy (CBT)—a type of psychotherapy often used for people with GAD—worry is a behavior. It’s an active process, Distler says, that uses language and one’s thoughts to problem-solve and think about potential outcomes to situations.
“When there are actual problems, you don’t have to use the language and that process as much because you’re actually taking action,” Distler says. “So it’s a different behavior. Instead of doing the worrying, which is one behavior, you’re replacing that with action.”
Prior to speaking with Distler, I thought perhaps I was dealing with these crises well because I was, for lack of a better term, busy. My anxiety is at its peak when I have nothing to do—when I’m stuck inside on a snowy day, for example, or when I’m sitting idly at the doctor’s office. (Many psychologists, including Distler, support the idea that lacking a full, stimulating, and structured schedule can exacerbate anxiety.) I spend so much time ruminating during times of calm, I wondered if it was possible that being thrust into these crises simply didn’t leave enough mental space for me to worry.
In addition to her role at UCLA, Distler works at the VA Medical Center. She told me her patients’ stories of anxiety were reminiscent of the concept I was exploring. The veterans she works with described an ability to function well in extreme, life-or-death combat situations with little or no anxiety. But once they returned to civilian life, many of them struggled with panic attacks while driving home on the freeway or sitting in a meeting. “I think there is a precedent for having anxiety disorders under times of relative calm and being very functional under really trying situations,” Distler says.
There's a paucity of research in this area. There is, however, one study from 1996 that explored the physiological response to stress in patients with GAD and patients without GAD.
Distler says the study, which was published in the journal Biological Psychiatry, found that patients with GAD tend to be more activated, meaning they typically have higher blood pressure, a higher heart rate, and higher states of arousal in general. They also had less reactivity to stressors, which could imply that they're always activated. “The thought or hypothesis was that perhaps [people with GAD] are just better poised in a time of crisis,” Distler says. “They’re already ready to act.”
When my anxiety is at its peak, rational thinking goes out the door. I imagine the worst-case scenario for every potential outcome, and the terror consumes me. In First, We Make the Beast Beautiful, Wilson explores the concept that perhaps anxious people are under control in a crisis merely because they’re relieved the compulsive worrying is gone.
“Real disasters are a cinch compared to the shit we make up in our heads,” she writes. “Actually, they’re a relief. When the future does arrive, we’re always okay.”
The past year of my life has included several crises. In addition to my grandmother passing away and me recovering from unexpected surgery, I was laid off from my full-time job and close family members of mine had tumultuous experiences of their own that I helped them work through. Through all of it, I take solace in knowing that despite my GAD, I will be able to handle whatever comes my way, and likely quite well.
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