Anxiety and Self-trust

I recently wrote a blog article for Anxiety & Depression Association of America’s OCD sig that touched upon the concept of self-trust as a major obstacle of folks living with anxiety and OCD. I hope to expand upon that idea more in this post, along with sharing some of the various frameworks for evidence-based treatment out there for sufferers.

In general, most people come to therapy because they have lost their ability to trust…whether it’s trusting their own decision making or themselves. No one is immune to anxiety. It’s something everyone will experience at some point. For those lucky to not feel it on a daily basis, it might be the feeling you get before a job interview or waiting to hear important news. Anxiety isn’t all bad and can be a reasonable experience in specific contexts.

Everyone also has intrusive thoughts at times: unwanted, weird, wacky, gross, disturbing, violent, sexually curious, etc. The difference between someone with anxiety & OCD and people without: is that most people can acknowledge the thought and move on pretty quickly…and not question their identity or self-concept as a result. People with anxiety and OCD will continue to assess and appraise their thoughts or react strongly in response to the thoughts.

Thoughts often happen so fast that people may not realize the story they are constructing about the future, or themselves, which may be leading to further sensations in the body and rumination (obsessing) about the feared outcome. These thoughts (including feelings, images, sensations and urges) might be impacting a person’s ability to trust their own senses, intention, desire, feelings and memory…but it’s really a lack of trust in who they think of themselves to be (self-concept). If I trust that I’m a responsible human who is competent and resilient…I’m not going to fear accidentally leaving my stove on and killing my neighbors. In the Inference-Based CBT approach, this is essential to unraveling doubt and restoring confidence.

When people have anxiety they are doubting something. This is different than uncertainty. Uncertainty is information not yet known (Kamal & Burke, 2011). As Kate Goldhouse puts it: “We don’t know if the sun is going to come up tomorrow, but we have no reason presently to doubt that it will”. Not knowing information is something certainly can cause someone to feel anxious, but it will quickly resolve once the information is known. This is different than doubt. Doubting is a mistrust of information, fear (O’Connor & Aardema, 2011). Doubt leads to more doubt and is not easily resolved, even with information.

Here’s some ways that anxiety with doubt can sound:

Did I say or do the wrong thing? They could be offended or upset with me.

I don’t know what’s going to happen and don’t want to deal with anything stressful.

It’s possible the worst thing could happen.

If I am attracted to someone else, that would be like being unfaithful to my loving partner.

It just doesn’t feel right.

Something is going to go wrong, I just know it.

How can I be sure about ______ (insert super bothersome idea)?

I could be more at risk for getting sick.

In Inference-Based CBT, obsessional doubts are understood to have a story behind them and the way a person is applying their OCD logic/reasoning is confused, causing them to turn away from reality and their true self. People with inferential confusion (possibility>probability) are neglecting here-and-now information (observation, existing knowledge, inner sense, common sense) in favor of the doubt story. When you receive or neglect information in favor of the scary potential…you are in obsessional territory. There’s so much hope in this approach to anxiety & OCD treatment!

In ERP, a core fear is the idea that all a person’s worries can be synthesized into a concept that they are trying to avoid or prevent: avoiding emotion, being alone, being bad, death/dieing, ruining or suffering. Greenberg (building upon Yadin’s UFO concept) posits avoiding emotion as one of the core fears that drives a person’s symptoms. The core fear would not be present if a person trusted themselves: back to self-doubt.

In Greenberg’s Rumination-focused ERP, he suggests un-learning the belief that thinking about the problem will lead to any kind of solution…leaving the only solution to be giving up trying to solve it! Rumination is a choice, not something happening to you, which positions you in a place of power to fight back against symptoms. The first step is being able to identify when you are obsessing, unlearn any limiting beliefs about the helpfulness of thinking about it further, and then: stop, just plain stop. Go live your life. If you weren’t worrying, what you be doing? Go do that.

Learning about anxiety, OCD and the treatment options is really important for the advocacy and representation of sufferers. Hope this helps and please do continue to learn more!

Best,

Sarah

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.