How to Break the Anxiety-Worry Habit; Handling Uncertainty, another Musing on Impermanence in the Form of Uncertainty.

Readers, how do you feel about dental work?

As I write, I sit here with a modern poultice of clove in my tooth. Yes, I said poultice, as in the old-fashioned plaster poultice that is so often applied to injuries and wounds in nineteenth-century English literature. In Jane Austen, for example. Mustard plasters and poultices were the go-to’s for first aid back then. Well, Readers, I have endured some dental work involving medicated cement in place of an old filling. This is known technically as a temporary filling, but I prefer poultice. Having dental work always strikes me as a close cousin of the barbaric practices of yore. In other words, it is something to be avoided. 

However, I was unable to avoid a particular jaw & tooth situation, which may have been (definitely WAS) created by the pandemic: jaw clenching. Clenching led, apparently, to some difficulty with a filling. You don’t need details, and really, I apologize for this much detail. Who needs it? It’s not even the point of my blog post.

As I prepared for this feat of bravery—sitting in the dentist’s chair and allowing him to perform his barbaric art upon my mouth—I thought about a recent article in Psychology Today magazine by Judson Brewer, M.D., Ph.D., professor at Brown University and clinician. His basic idea is that anxiety and worry are a habit created by a continuous feedback loop. A habit is a conditioned response, as we all know from Psych 101 or just hearing about Pavlov’s dog hearing a bell, getting a treat and salivating at the expected pleasure, over and over until just hearing the bell would stimulate the dog to salivate. 

These are not Pavlov's dogs

A habit of anxiety and worry is also a conditioned response. You feel anxious, so you worry—worry and anxiety are two different things. Brewer built his research on that of Borkovec in the 1980s, who discovered and posited that there is an element of habit in anxiety. Anxiety is a physical sensation; the sensation triggers worrying (stimulus and response), and that responding over and over to the anxiety sensation creates the habit of the anxiety-worry cycle. 

trigger-behavior-reward

The apparent glitch in this theory is that worrying is rewarding. Do you find worrying rewarding? Well, Brewer says, in a certain way, worrying IS rewarding. Because anxiety is about uncertainty; we feel anxious when things are uncertain. Worrying is the response and it is reinforced because when we’re worrying we kind of feel like we’re doing something to address the uncertainty. 

Anyone who’s been in therapy—and there should be more of us, if you ask me, but then that’s the business I’m going into—has probably encountered a gentle admonition from their therapist that worrying about, say, the state of the world, makes you feel like you can control it. Or worrying, say, about your daughter driving a twelve-year-old car up and down the Eastern Seaboard, can keep her safe. We know, rationally, the worrying doesn’t do anything; but worrying becomes its own talisman. We’re afraid to let it go, because frankly, when it comes to daughters or the environment, there’s not much we can control. 

The good news is that this anxiety-worry habit can be broken. Judson Brewer, M.D., Ph.D, argues that we modern humans don’t need to feel much anxiety and worry. It’s not helpful. Contrary to popular belief it doesn’t keep us sharp and on our toes. It actually makes us feel scattered and creates difficulty concentrating and performing. So we should definitely not be proud of our intense stressed states. We should get out of the habit of having them. This is the stuff of CBT—cognitive behavioral therapy. CBT helps us identify our automatic, negative thoughts. Once we identify them, we can choose different thoughts. 

So, according to Brewer, the first step is to recognize that worrying is actually not rewarding. It is the opposite of rewarding. It is unrewarding. It makes you preoccupied. It makes you lose sight of your day and your time and your personal goals. It makes you wrinkled, grey, and old. Okay, no, that’s not true and Brewer didn’t say it. Life does that to you, if you’re lucky (a topic for a different day, perhaps). But anyway, worrying is a waste of time and energy and really doesn’t help hold up the world. This Atlas theory of world-holding by worry just exhausts us. The world will spin even if we don’t worry. Daughters will drive unreliable cars. Life seems predictable until it isn’t and then we feel uncertain. Even if we worry. And even if we don’t. 

What a concept. We don’t need to worry. It’s not helpful. In fact, it’s hurtful. This is news to me. I am happy to look at this in a new way. 

Now, anxiety is a different story. Anxiety is a natural, primitive brain response to uncertainty. (Again, paraphrasing Brewer). So the next step in breaking the anxiety-worry habit is to respond to anxiety with something that actually is rewarding. Brewer suggests that getting mindfully curious about the sensation of anxiety is one option. I am sure there are others, but that’s what I have for you for now.

Before making the dental appointment, I was full of anxiety about this tooth and this ache and what it was going to lead to. I was so anxious and worried about it that I had to really work my courage up before making the call. Once I had made the call, and Svetlana in Dr. L’s office called me back, I had much less anxiety. This was because, Readers, mindful that uncertainty triggers anxiety and worry, I did the strangely logical thing and asked Svetlana what the heck was going to happen when I got there for my appointment. Armed with as much info as I could tolerate, I headed to my appointment. Since I had spoken to Svetlana, I had much less uncertainty about what was going to happen. As I drove, I noticed that I didn’t feel terribly anxious. I noted that perhaps I felt a bit nervous, but I wasn’t worried. Because I knew what was going to happen. It wasn’t uncertain. 

Of course, a moment later, I did start to think that perhaps being neither anxious nor worried was the sign of impending doom, lamb to the slaughter type thing; the unsuspecting woman headed to disaster. My mind traveled to a scenario involving me in the dreaded chair, numbed up and hearing Dr.L say, “Oh dear, I didn’t expect this and now I must drill through your jawbone and attach a wire to keep your lower jaw on your head and by the way you have no more tooth in that spot at all, oopsie.” However, Readers, I have been around many blocks in my many years and I recognized this as a habitual anxiety loop starting up. Because I noticed it, I was able to stop it. Mostly. Remember, it takes time to form and reform a habit. I am not saying I felt completely happy about the coming procedure, but I didn’t feel anxious, just nervous. Nervous is an appropriate, alert state response. 

After that was a blur of Novocaine and trying to picture myself on a beach watching dogs frolic, and then the scent of clove wafted into my nose. Sure, my tongue now feels like a hot dog and my lips are like potato rolls. And I am sipping a chai latte through a (contraband, evil) straw trying not to let any liquid dribble out. But overall, things weren’t so bad, because I didn’t make them worse by my habit of anxiety and worry. 

Worrying is a kind of holding-on. Worrying is about desiring, usually desiring the prevention of a bad outcome. We all know desiring is the root of suffering. Desiring something over and over and over doesn’t make that thing more likely. It simply reinforces the sense of lack, the wanting in the old-fashioned definition of the word wanting. Wanting means desiring and also lacking. Letting go of thinking things should feel or be different than they are is key to just relaxing in life. Letting go of worry is a habit to establish now. 

Or so they say. It’s much easier said than done. However, practicing letting go of worry by becoming curious about how anxiety feels seems doable. 

We all want things to be certain, predictable, and permanent. Too bad, us. In fact, according to an article I read called "Decolonizing Social Work," permanence is a Western value. 

Do I believe anxiety doesn’t have to exist? That it’s evolutionary trash that should be incinerated? Uncertainty is a cousin of impermanence, and we know how we struggle with impermanence. Uncertainty can make you twitchy. You are always on edge. It creates fear of loss, according to Kahnemann and Tversky, and humans fear loss more than we enjoy winning, supposedly. So, yeah, we value permanence. And yeah, we are out of luck, because what we get is just the opposite. 

Lots of ocean and swimming metaphors surface around this topic. Plus ca change the plus they remain the same is that old French adage, isn’t it? Being certain amidst uncertainty, understanding in a visceral way that everything is always changing can be its own kind of certainty, can’t it? This is the goal of the enlightened, I suppose. We befriend our anxiety in a non-clinging sort of way and maybe it’ll fade away. But we never lose our edge, we’re always having to make some minor adjustments to stay afloat. That’s the metaphor. That’s the truth. However, we don’t have to worry about it. 

We can all feel as peaceful as this scene. With practice. Lots of practice. 

Musings on Impermanence: Annals of Success and Life

    Readers, I am a creature of habit. I like to eat the same breakfast from the same bowl and drink the same coffee from the same mugs. I have done this on the regular, as they say, for quite some time. Now, I sometimes change my habits, but for the last several years, I have eaten the same breakfast nearly every day (steel-cut oats). And mid-morning, I drink a cup of coffee. I use the same lovely, handmade mug, of a set of two, given to the husband and me for our wedding. And I use the Moomintroll bowl given to the 19-year-old some time ago by her uncle—the Moominbowl. Indeed, that bowl was given to the 19-year-old so long ago, I had conveniently forgotten that, technically, the bowl was not mine; she reminded me not long ago that she would be taking that bowl with her when she moves out—a startling reminder of more than one truth, if I am completely honest. Daily, unless the dishwasher cycle prevented me, I reached for the bowl, I reached for the mug. 

One morning, I reached for the mug, and I thought to myself, Self, we have had these two mugs for a very long time, as long as the husband and I have been married, and they are unique mugs and special, and isn’t it amazing that they have lasted this long. 

    Well, Readers, you are all clever, so you know what happened. It didn’t happen exactly next, but it happened soon after. Having survived seven moves, two children, one dog, and the arrival of two puppies, one of the two mugs went kaput. 

    I once had a housemate who referred to precious objects as “on preservation.” Her precious objects were somewhat dubious in quality. A broken teapot, for example, was on preservation. As were some quite worn items of clothing. She fully embraced wabi-sabi. But, and here again, I must be honest, I totally understood what she meant. “On preservation” meant worn or used almost to not wearable or useable anymore; since the object was beloved, though, she would mete out the times she used the thing, so it would last longer. I realized that I did the same thing. Combined with my other propensity to hold off on using something new, almost until I forgot I had it, so it would always be new, this meant the period of using an object freely and without concern was truncated at either end by anxiety about keeping the thing. 

    However, since that time of the slightly nutty but enjoyable roommate, I have tried to take to heart my Aunt Wisdom’s maxim about things: Don’t Pickle It. I have written about this maxim before. It reminds me that a thing is a thing and it’s only of use if I use it. So enjoy it. Use it. Appreciate it. 

    Shortly after dropping one of the precious mugs, I reached for the Moominbowl. Ever since the 19-year-old mentioned taking that bowl with her when she leaves home, I had thought about that statement and felt, maybe, a frisson of guilt mixed with a soupçon of devil-may-care as I prepared my oatmeal in it. Perhaps that is why shortly after the mug bit it, the bowl dove to the floor and smashed itself into smithereens.  

On Preservation and Don’t Pickle It are two approaches to dealing with something unbearable about life: things don’t last. Life is impermanent. Don’t Pickle It is probably the healthier approach; you enjoy a thing until it’s worn out, and then let it go. On Preservation is about hanging on to it, probably past its usefulness. 

    Let us not forget Save It Forever, which is the dumbest of all, for reasons so obvious I don’t need to elaborate them. Do I? A girl I knew in fourth grade got a birthday cake in the shape of a heart that was decorated so beautifully she didn’t want to eat it. They put it on the mantel and let it sit there. I don’t know for how long. Maybe her brother’s boa constrictor ate it after he got loose. I didn’t go to her house after that.  

Old mug, new Moominbowl

    Now that I’m down to one mug of the pair, I am tempted by on preservation. The Moominbowl was irreplaceable, I discovered to my guilt; however, I found a very nice substitute, same size, same shape, different images. It took about eight hours for the 19-year-old to notice the new bowl when she returned for the summer. I think twice before using it, but I still do. Not every day, though.

    The point is, we get attached to things, and sometimes the attachment is out of proportion. Attachment is what relationships are made of, but so is change and impermanence. To successfully navigate life, we have to come to terms with this paradox. My way is not especially unique or healthy. However, I know a couple of things. Habits are important because they make life easy; they also give it a kind of permanence. This is reassuring, unless the habits become rigid or obsessive, used to ward off thinking about things like impermanence and change and how scary those things can feel. A cake should be eaten. A shirt should be worn. A teapot that is broken? Unless you have the pieces and can repair them with gold and turn it into kintsugi, it should be allowed to go. Even then, you will have to say goodbye to it someday. 

Recollecting Impermanence

Hello, Readers. Since last I wrote, the beloved pooch has died. This is terribly sad, and I notice his absence everywhere, for example when I wake up and no longer have to step over a large, sleeping dog. Or when I peel a carrot, and I realize he is not waiting patiently on the doormat for me to toss him the ends. It’s sad and we are all grieving, and yet it was inevitable that we would outlive him, barring unforseen circumstances.To avoid this situation, I would have had to adopt a tortoise, I suppose, but they’re not much good for midday walks. 

Impermanence has, therefore, been on my mind. The truth of impermanence is one of those truths to which we pay lip service. We know life is short, and that change is the only certainty in life, but we usually only know it theoretically, or intellectually, not in a bone-deep way. Yet knowing the deep truth of impermanence is key to appreciating what’s happening right now. Understanding impermanence is the doorway to wisdom, so they say. They, in this case, being Buddhist teachers. 

Buddhist philosophy feels impermanence is so important that everyone, layperson or monk, should contemplate it daily in the form of the five daily remembrances. They are as follows:

1. Just like everybody, I am of the nature to experience illness. I cannot avoid sickness
2. Just like everybody, I am of the nature to grow old. I cannot avoid aging. 
3. Just like everybody, I am of the nature to die. I cannot escape death. 
4. I am the owner of and heir to all my actions. 
5. I must be separated and parted from all that is dear and beloved to me.

Those last two are listed in different order, depending on the translation.

—Upajjhatthana Sutta 

I’m not going to lie, these seem like a bummer. Number five is really hard to take, these days. I lost an earring down the bathroom sink the other day. I swear that thing committed harakiri, because otherwise there is no explanation. Unless it is that my ear holes have stretched and sagged along with everything else on my person? But I mean maybe the earring disappeared to get me to pay attention to the blog post I’ve delayed writing for days. Was this not karma showing me the truth of this contemplation? Really, it’s very sad, this truth. In the way I understand the practice, by facing this idea daily, I am to become less grasping after stasis and more accepting of the true nature of life, that it is transitory, from the briefest mental image or thought, from the strongest emotion to the longest life. Once I accept this, I suppose, I am free from a layer of sadness and anxiety about the inevitable changes, and this extra space allows me to appreciate what is before me more fully than I do when I am worried about something or someone slipping away. Earring. Dog. Daughters. Life. 

I may be a little tender on this reflection, considering the dog, considering that we’ve just dropped the younger daughter at college for the first time. The elder daughter will soon decamp from our comfortable pandemic bubble for a job in Boston. My sister the psychoanalyst is one year older today, which means I am, too. And none of your “she’s only one day older than she was yesterday” folderol. Sometimes the milestones hit you. 

Here’s a secret. I’ve found that when I contemplate these five remembrances, I feel a bit of relief. It’s just the teensiest bit of relief, more of a minute relaxation deep in my gut. I think it has to do with letting go of some of the struggle to collect and keep everyone and everything dear near. I think it has to do with releasing some shame around aging, illness, death, responsibility, and loss. I think there is shame around these things sometimes. We feel that if we experience them, it is our fault for not managing well enough in the world. We didn’t exercise enough, or eat the right food in the right amounts. We didn’t appreciate the gravity of our choices at the time and could have chosen better. Maybe you don’t feel that way, Readers. If so, I am glad for you. For me, I have found it so. Which means, that counterintuitive as it seems for me, these recollections do help me be more comfortable. 

I was informed that my earring, a thing I hold dear, was most likely retrievable from the trap under the bathroom sink. I marshaled my resources to figure that out—by which I mean I texted the husband, who said he would do it when he got home from work.

The husband did indeed find my earring. So what does that mean? It means that sometimes things from which we are separated come back to us. As Sting told us, back in the early 1980s, “If you love something, set it free, free, free.”

Sting’s lyric doesn’t exactly apply to losing an earring. It might apply, however, to letting your child leave for college, and your other no-longer-a-child child leave for a new phase of life as a college graduate working for peanuts and trying to make the world a bit better. By "letting your child" I don't suggest I have any choice in these things. The letting is internal.

However, because of the covid, the new college student will indeed be coming back to us. Her college is only allowing the first years one semester on campus. The rest of the academic year will be remote learning, so that the older students can have a semester there. Oy. Such is the ever-changing nature of things. 

Meanwhile, Readers, I started full time graduate school for social work this week. At the ripe old age of one thousand and ten, I am returning to school for a master’s degree, with a plan to become a therapist. I don’t know if this is wisdom or foolishness, embracing of life, or denial of time passing. Nevertheless, I go forward. I cannot escape illness, death, or aging. I cannot avoid responsibility for my choices or letting go of all I love. Okay. So be it.