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Taking Control of Anxiety is essential reading for anyone who suffers from anx-
iety disorders and for those who treat such individuals. It is filled with practical,
evidence-based suggestions on ways to reduce anxiety and enhance well-being.
Moore, who is one of the leaders in the field, deserves kudos for including work-
sheets, exercises, inspiring quotable quotes, and appropriate cautionary notes.
—Don Meichenbaum, PhD, author of Roadmap to Resilience: A Guide for Military,
Trauma Victims and Their Families; Research Director of the Melissa Institute for
Violence Prevention, Miami, FL
Moore has done a superb job explaining how to become proactive in managing
your anxiety. He speaks in the voice of a storyteller and teacher with an easy-
to-read, authoritative, and reassuring style. Part mentor, part fact giver, and even
part cheerleader, Moore provides empowering information and action-oriented
tips on how to participate in your own recovery from anxiety or how to help a
loved one.
—Stephen M. Stahl MD, PhD, Professor of Psychiatry, University of California,
San Diego; Honorary Visiting Senior Fellow, University of Cambridge, UK;
Editor-in-Chief, CNS Spectrums
This book is a gem. It provides practical exercises in a very readable manner that
helps anxious individuals manage their worry and get their life moving forward
positively. Share this book with anyone you know who struggles with anxiety
and worry.
—Jeffrey E. Barnett, PsyD, ABPP, Professor and Associate Chair, Department of
Psychology, Loyola University, Maryland, Baltimore
Moore helps people with various anxiety-related problems understand why they
are struggling, and he presents useful strategies for regaining a sense of control.
His writing is very conversational and reassuring and the weekly experiments in anx-
iety reduction are particularly engaging. All readers will find at least some of these
suggestions to be very helpful as part of a consistent anxiety-reduction strategy.
This book can be used on its own or as a workbook for clients in psychotherapy.
—Richard Tedeschi, PhD, Professor of Psychology, University of North Carolina, Charlotte
BRET A. MOORE
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Acknowledgments ix
Anxiety: An Introduction 3
Chapter 8. Can’t I Just Stay Away From the Things I Fear? 157
vii
Index 227
viii
There are many people who make a book like this possible. I would
like to thank Maureen Adams for helping me develop the original
proposal. I have valued her help as an editor for many years. I am
grateful for the dedicated and highly skilled staff at the American
Psychological Association, including Daniel Brachtesende, Jennifer
Meidinger, Nikki Seifert, Ron Teeter, and David Becker. I would
especially like to thank Susan Herman for her helpful edits and sug-
gestions on early versions of the manuscript. I am also indebted to
the many experts who have shaped my thinking about anxiety, par-
ticularly its varied manifestations and most effective interventions. I
have had the privilege to work with and learn from pioneers like Art
Freeman, Don Meichenbaum, Stephen Stahl, and Art Jongsma. I am
also grateful to those with whom I have not worked but whose writ-
ings have influenced my understanding of anxiety. The most notable
are Edmund Bourne, David Barlow, Jon Kabat-Zinn, David Burns,
Aaron Beck, and Judith Beck. The foundation of this book is based
on the ideas, theories, and research of these individuals.
ix
If you are like most people, you can identify with the stories
of Lori, David, and Marie to some degree. Perhaps you can identify
with more than one of them. They are average people, who for var-
ied reasons, are confronted with anxiety. Anxiety is as much of the
current American culture as are reality television, online shopping,
and cell phones. It is interwoven into our collective psyche so much
that we spend billions of dollars each year trying to understand it,
minimize its impact on our daily lives, or get rid of it completely.
We worry about our careers. We stress about meeting next month’s
mortgage or rent. We obsess over the neatness of our homes. And
we stay up late at night wondering whether we’ve forgotten some-
thing we should have done today or should do tomorrow. We can’t
help ourselves—it’s just part of who we are. But the good news is
1
All case examples in this book are fictional.
WHAT IS ANXIETY?
understand a certain point, I let you know. The key point to remem-
ber is that anxiety is a complex emotional and physical phenomenon
that takes different forms for different people. And, most important,
you are not powerless against it.
At times, anxiety gets an undeserved bad rap. Just like alcohol, fast
food, and slot machines, most everything is harmless in moderation—
Anxiety is no different. Actually, some anxiety can be helpful. Not
unlike Goldilocks’s appreciation for perfectly warmed porridge, a
“just right” amount of anxiety can bring about contentment. It also
improves physical and mental performance, counters fatigue, and
motivates people to do things they would otherwise avoid. Through
its various physical manifestations, anxiety plays an important role in
communication. It can let someone know that we feel uncomfortable,
nervous, or even afraid. Without saying a word, it can communicate
“I need some space” or “I’m not comfortable with what you are say-
ing or doing.” This may be particularly true (and helpful) for members
of some cultural groups that are less comfortable vocalizing concerns
or emotions to people outside their close social network. Anxiety can
also communicate interest and attraction to another person. A man
whose voice trembles every time he’s around an attractive woman or
a teenage girl who giggles, avoids eye contact, and blushes in the pres-
ence of a potential prom date are prime examples. The problem is
that it’s difficult to define what that right amount of anxiety is. The
amount that’s optimal for you may cause someone else to shut down.
Regardless, anxiety is a good thing
if you can find the right balance.
So, when is anxiety consid-
Some anxiety can be
ered a problem? It depends. As
helpful.
I mentioned earlier, anxiety is a
Now that you know that day-to-day anxiety effects almost every-
one, you may be wondering, how many of us go on to develop a
full-blown psychiatric disorder? According to the National Institute
of Mental Health, approximately 18% of American adults have
If you see a mental health professional for your anxiety, chances are
you will be given a formal diagnosis, and maybe more than one.
2
National Institute of Mental Health. (n.d.). The numbers count: Mental
disorders in America. Retrieved from http://www.nimh.nih.gov/health/
publications/the-numbers-count-mental-disorders-in-america/index.
shtml#Anxiety
3Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Preva-
4
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing.
10
5
Kinderman, P. (2013, January 17). Grief and anxiety are not mental illnesses.
BBC News: Health. Retrieved from www.bbc.co.uk/news/health-20986796
6
Jayson, S. (2013, May 12). Book blasts new version of psychiatry’s bible,
the DSM. USA Today. Retrieved from www.usatoday.com/story/news/nation/
2013/05/12/dsm-psychiatry-mental-disorders/2150819/
7For more information about the DSM debate, read the Psychology Today
blog post “DSM–5 in Distress,” by former DSM task force chair, Allen
Frances, MD: www.psychologytoday.com/blog/dsm5-in-distress
11
Panic disorder involves recurring panic attacks, which are short peri
ods of intense feelings of fear and apprehension and a variety of physi
cal symptoms, such as racing heart, sweating, and trembling. Generally,
the symptoms come out of nowhere, and even though it may seem like
some specific threat is looming, there isn’t one.
Specific phobia is the excessive and highly distressing fear of specific objects
or situations. The person avoids the objects or situations at all costs as a
way to fend off the associated distress. Common examples include fear of
flying, heights, snakes, spiders, and blood/needles.
12
Biology
Anxiety is hardwired into humans’ physiology and for understandable
reasons. As we trekked across our largely unexplored planet thousands
of years ago, we did it alongside a variety of threats. We shared our
space with hungry and vicious animals, inhospitable fellow humans,
and climates that would stress even today’s most prepared hikers. With-
out an internal warning system, early humans would have likely been
faced with extinction. Luckily, the fight-or-flight system came to be.
The fight-or-flight system is an extremely complex, highly sen-
sitive, and intricately balanced biological process. Prompted by a
cascade of chemicals and electrical impulses, our body prepares for
one of two actions when faced by a perceived threat: defend against
the threat or run away. When this happens, a variety of adaptive pro-
cesses occur. The heart pumps blood to the muscles faster, which pro-
vides the increased nutrients needed to duke it out or split. Our vision
narrows to focus better on the threat so that we don’t get distracted
by unimportant stimuli around us. And breathing becomes deeper
and more frequent to deliver increased oxygen to the system. Once
the threat is gone, however, or at least when we believe it is gone, an
opposite process occurs in which the body regains its balance.
The fight-or-flight system has been encrypted into humans’
genes and passed down from generation to generation. Unfortu-
nately, the system’s biological software has not been updated for the
modern world. For some people, the alarm goes off in the absence
of a real threat (e.g., seeing a snake behind the glass at the zoo) or
for no apparent reason at all. The fight-or-flight system is discussed
in more detail later in Chapter 8.
Our brain structures, and the chemicals that keep them func-
tioning, also play critical roles in anxiety. The primary inhibitory
13
Environment
There is a great deal of truth to the old saying “You are a product of
your environment.” Your early childhood experiences within your
family, school, and with friends have as much to do with who you
are today as any chemical or part of the brain. Take parenting, for
example. Parents who are overly critical, neglectful, rejecting, or too
protective can inadvertently create anxiety for their child. Children
who grow up in homes where one or both parents have frequent
and intense mood swings learn to “walk on eggshells” so as not to
accidentally “cause” the next outburst. Then there are early expe-
riences outside the home. Children who are repeatedly bullied by
14
other kids learn to view the world as a hostile and dangerous place.
Perfectionistic teachers or other authority figures model obsessive
behavior and set expectations, which often cannot be achieved. And
childhood abuse and trauma, which can occur within or outside of
the home, can cripple a child emotionally. All these situations carry
into adulthood and can lead to lifelong anxiety.
Your current environment also contributes to your anxiety.
If you’re under tight deadlines at work or having money problems,
then you are likely anxious. If your relationship is on the rocks, or
if you’re concerned that you’ll never find the “right” person, then
you are likely anxious. If you are dealing with a sick parent or child,
then you are likely anxious. I could go on for pages, but my main
point is that life continually throws relationship, work, family, and
social challenges your way. To varying degrees, each and every one
adds to your anxiety. And without a break from the chronic stress,
your body and mind will suffer the consequences.
Psychology
The psychology of anxiety is relatively simple. How you perceive,
interpret, and label people, situations, events, and, well, pretty much
everything else, greatly contributes to your anxiety. For example,
two mothers get home after a hard day at the office; both have the
same voicemail on their answering machines: “This is Ms. Smith,
Johnny’s teacher from school. Please give me a call when you can.
I’d like to talk with you about your son.” Knowing that Johnny has
been working extra hard at school, the first mother becomes happy
and excited. She is convinced that Ms. Smith is calling to say how
hard Johnny’s been working and that his grades are improving. The
second mother is immediately overcome with a sense of worry and
dread. She believes the only reason Ms. Smith could be calling is
to tell her that Johnny’s grades are getting worse. And if that’s not
enough, he will have to be held back a grade.
15
Everyone deals with stress and anxiety. It’s part of our evolution-
ary and cultural makeup, and at times, we all have periods when
our stress and anxiety levels go up. So in that sense, this book is for
everyone. What everyone doesn’t have is a clear understanding of
16
how, when, and why anxiety becomes problematic. This book will
help you gain an awareness of the many techniques available to help
manage the more troubling aspects of this normal and ever-present
biological, psychological, and sociological phenomenon.
This book focuses on anxiety in adults. If you are concerned
about a child in your life who may be struggling with anxiety or a
related mental health issue, some of the information in this book
will be pertinent and some may not be. For more information on
children with anxiety, I recommend How to Find Mental Health
Care for Your Child by Ellen Braaten.8 Likewise, if you are an older
adult or are considering buying this book for friend who is an older
adult, you should be aware that various conditions specific to aging
and anxiety (e.g., retirement from work, memory loss and dementia,
physical limitations, loss of peers and loved ones to death) are not
covered in the case examples. Consider checking out the American
Psychological Association’s (APA’s) Public Interest Office on Aging
resources for information on anxiety specific to older adults (http://
www.apa.org/pi/aging/index.aspx).
Walk into any bookstore and you’ll find an aisle of self-help books
a mile long. Within seconds, you’ll be bombarded with promises
to eliminate your depression in 14 days, tips on choosing the right
mate, and how to overcome your addiction without even leav-
ing your house. In our fast-paced, give-it-to-me-now culture,
we want everything to be simple, quick, and effortless. However,
this approach doesn’t always work, especially when dealing with
extreme levels of anxiety, depression, or whatever may be bothering
8
Braaten, E. B. (2010). How to find mental health care for your child. Wash-
ington, DC: American Psychological Association.
17
This book has 11 chapters. The first seven chapters take you through
various coping strategies for anxiety that focus on your mind, then
your body, and then your environment. Later chapters offer specific
information to target more specific issues of fear and panic.
18