Anxiety: Avoidance, reassurance and safety behaviours

In this episode:

• Venessa, hosting the conversation

• Tim, Mind Coach and Anxiety Therapist

• Dr Rittick Mukherjee (Rick), Consultant Psychiatrist

Venessa: Anxiety isn't just a feeling, it's something people respond to, avoiding, checking, seeking reassurance, and these are known as safety behaviours. We use them to protect ourselves from threat, and they can feel relieving in the moment, but sometimes the very things that feel protective can end up reinforcing the anxiety.

When anxiety was high for you, what kind of safety behaviours showed up?

Tim: Okay. So when I was going through all of my social anxiety, the thing that I would do a lot of, I'd just nope out of events that were coming up. I'd do a lot of planning to go, and what I was going to wear and how I was going to be and who I was going to talk to and that kind of thing. But then at one point, I'd just be like, "I think it'd be easier if I just didn't do it." And I'd have horrible FOMO.

I'd really want to be there, and I'd really want to be interacting, and I felt like I desperately should be there because everyone else was there that I knew. But it just felt too overwhelming to do it.

And then, of course, when I wasn't going, it was just making it harder to go to the next one.

Venessa: That's interesting. So it wasn't like it reset each time. It would build and build and build and get even more difficult to go, would you say?

Tim: Yeah, because you're spending more and more time away from the thing that you feel is challenging. So it just becomes a bigger mountain each time. It just became all too easy then to shrink my world a little bit and just stay, "I'll just stay at home then."

Venessa: Wow. Okay. So Rick, why do avoidance and safety behaviours feel so compelling to someone who has anxiety?

Rick: Well, when somebody's experiencing high anxiety, it's like fear, and there's a part of the brain called the amygdala which gets activated, and that's like the alarm centre of the brain. So a person's heart rate will go up, a person's breathing will get shallower and quicker. They'll probably feel warm and sweaty.

They're approaching a situation where they're thinking about something which is causing them fear and anxiety. They're getting those bodily sensations, and the natural response to fear is to seek safety. So that's what they tend to do.

So they then will experience an immediate relief from that absence of fear, and we actually call that negative reinforcement because that's the removal of something unpleasant, and it's a powerful reinforcer. So following that negative reinforcement, there'll be an increase in dopamine, which will also bring some relief, and people are going to very likely continue that behaviour because of that negative reinforcement.

Tim: In our mind, like you say, we've avoided a disaster by not going. So our mind rewards us by saying, "Yeah, we definitely did the right thing there." And I was very aware of that when I was going through all of this.

Your mind is saying, "Yeah, that's obviously the only way we stayed safe from that was that we didn't go." The avoidance was the solution to that.

Venessa: That's so interesting. So you get this reassurance by avoiding, but how long does that actually last?

Tim: Well, I think as we said before, because you're living in the future, what could go wrong, rather than in the present, it doesn't last long at all. Because I was constantly living the possible thing that could go wrong, it was always there.

Ultimately, though, what I needed to understand at that time, I needed to know nothing bad was going to happen.

Venessa: Mm.

Tim: And I needed to know, actually, it doesn't matter if it does.

Venessa: And if that was specifically around an event, let's say, the social aspect of it, and you avoided it, and you felt fine. Yeah... it felt great.

Tim: Yeah.

Venessa: What brings it back again? Is it someone posting about the event? Is it being invited to another event? What brings that anxiety around the social back again?

Tim: I think it's just contemplating the next time you have to interact. It depends, from an individual's perspective, what you regard your triggers to be.

Because what tends to happen is that, yeah, we might all be comfortable, or we can accept that, okay, I want you to go and speak in front of this room of 100 people.

Venessa: Mm.

Tim: Okay, we can all accept, oh, I'm going to feel nervous about that, aren't I?

But then gradually, what happens when you're avoiding situations is the degree of stakes gets lower and lower for you to be triggered.

So then it becomes, oh, going to a party. Hmm, that might be difficult for me. So you avoid that. And now it's just like, oh, if there's too big a group at school, if we're all at lunchtime, and there's a big group of us talking, all suddenly I'm getting very quiet now. I don't like this.

And then suddenly it's just your close group of friends that you start to feel uncomfortable with.

I remember there was one weekend when I was young, I couldn't be more than about 15 or 16 years old, and we were all going around my friend's house just to hang out. His parents were out. They said, "Yeah, you guys can come around, just watch TV, play music, whatever you want to do." And there was only about five of us, and they were my close group of friends. It was a five-minute walk from my house.

I arrived about five minutes later than we said we'd get there, and I'd rung the doorbell, and nobody answered the door.

And I just assumed they were all hiding from me. I was devastated.

And I started to walk home, and I remember the sinking feeling in my stomach that I thought these people were my friends, and they just hid from me so that I would go away.

Venessa: Mm.

Tim: And then on the way home, I bumped into them coming back from the corner shop. They'd just all got there and said, "Shall we go and get some snacks?" But that should've been like, "Ah, joy. I was mistaken." But there was a bit of me thinking, "Yeah." That could have been the case though, couldn't it?

And that was what stayed with me from that experience, was how I felt the possibility of rejection rather than, "Oh, I was being silly."

Venessa: Okay. So Rick, can you explain why safety behaviours don't settle anxiety long-term, even if it seems helpful in the moment?

Rick: These are short-term measures to reduce anxiety because you're not realising that you've got within yourself confidence that you're of value and of merit to the situations, what we call internal locus of control, that inner sense of self-confidence, and you're relying on people providing reassurance or indeed just avoiding the behaviour.

You're not gaining that inner confidence.

The point being is that people's imaginations of what can happen is usually much worse than what actually is likely to happen or would happen. And so the reason why this gets worse and worse is because you don't learn that actually you're better at interacting than you think you are.

People are more interested in what you have to say. You can come up with a funny anecdote.

And so you don't get that confidence, and if you're not getting that confidence, then your imagination of those terrible outcomes starts to become more real and you actually can start to believe your own false narratives really.

Tim: I think you're right, though. I think if we want to get better at something, like interacting socially, let's do more of it.

Rick: Yeah.

Tim: Because that's what we do...

Rick: Practice.

Tim: ...when we practice, don't we? But we just deprive ourself of that practice because we're worried that we won't be perfect straight away.

We're social creatures, but we have to learn the cues, and we have to learn how to do it. So if you just avoid it, you're inevitably creating this chasm between where you want to be and where you actually are.

Venessa: So Tim, what do you wish others around you without anxiety understood about why anxious people have safety behaviours?

Tim: Well, what I kind of wish people did understand is that though we're calling it anxiety, for somebody that's dealing with that, it's very much fear, because they're regarding the thing that other people are finding perfectly normal and ordinary and things they can cope with easily, people that are dealing with anxiety are looking at them and saying, "That's really threatening to me."

If a tiger jumped into this room right now, we'd probably all go into a state of panic, and we'd probably accept that as an appropriate response. We wouldn't say, "Oh no, I'm having a panic attack in the midst of this tiger attack." You'd be like, "No, panic is the appropriate response here."

And I wish people sort of understood that for someone that's dealing with a lot of anxiety, so if it's social, the group of people is the tiger. If it's health anxiety, going to have medical tests is the tiger. If it's general anxiety, it might be a whole number of different triggers that represent the tiger. It's the thing that we regard to be the life or death thing, the situation that we can't deal with.

So for example, when I was just transitioning from leaving school to going to university, it was the first time I'd lived away from home on my own, and other people around me were talking about this big adventure, finally leaving home, getting out on their own, and going to uni. They're going to have a great time. I was terrified.

It just seemed like the most daunting thing in the world.

I only went down the road to Kent University, and I live in Kent, so that I could go home every weekend, whereas other people just seemed to find it tremendously exciting. I was like, "No, this is my tiger happening right now in front of me."

So I just wish people would realise that we're not malfunctioning. We just perceive the stakes to be a lot higher, and rather than adventures, we're seeing them as trials.

Rick: We would all get terrified in a terrifying situation, which is generally terrifying, but it's when that situation has become something quite commonplace, like a party, a work event, having some tests, going on public transport.

So when it has become an everyday thing and the person's thoughts are not in keeping with the evidence and the reality of the situation, that's when they can do with help, and they can do with self-reflection and understanding about what we do call anxiety conditions, but which could be called fear conditions, and find ways to sort of reset and then get greater confidence and, as we said, practice working up to those situations, understanding them more, having a plan and strategy.

Venessa: Brilliant. So if someone was watching this thinks, "I recognise some of these characteristics in myself," Tim, what would you want them to know, and how would you encourage them to be kinder to themself?

Tim: Okay. Well, you've said it there, be kind to yourself, because I think we beat ourselves up, and we see ourselves as having a shortcoming or like an illness. And I think it's worth reminding ourselves that this is just an emotion we're feeling here.

Yeah, it's much more intense than we would like it to be, but it's ultimately understandable as well.

Sometimes we perceive it to be random, but it's not. There's reasons for it.

So being kind to yourself and allowing yourself to feel the way you feel in that moment, that can help massively. But the thing I think most people could do with leaning into is recognising a very simple truth, that their ability to cope is far greater than they're currently crediting themselves.

People talk about the what if this, what if that scenarios.

You know the answer to that question. What if the bad thing happened?

You would deal with it.