Whenever a client comes to work with me on their anxiety issues, I always ask what they think is causing the anxiety.
Typical answers are:
- Low self-esteem
- An unhappy childhood
- Relationships struggles
As I listen to these theories, I nod my head knowingly because I understand that to my client it feels like these things are causing their anxiety.
But what I’ll have to help them see eventually is that those things are not the actual causes of anxiety in their lives. Not directly, anyway…
There Is Only One Direct Cause of Anxiety
See, all these apparent causes of anxiety like stress or low self-confidence aren’t causes so much as predisposing factors. Indirectly, they may make you more vulnerable to the one thing that directly causes anxiety: worry.
Here’s an example:
The extreme criticism you received from your parents as a kid isn’t causing your anxiety as a 42-year-old giving a presentation at work. But it’s entirely possible that as a result of your childhood experiences with criticism, you developed a habit of obsessively trying to understand how everyone around you felt about you.
As an 8-year-old, that was probably the best you could do to cope with your parents’ extreme criticism. But if that habit of worrying about what other people think sticks around into adulthood, it’s very likely to cause anxiety in the present.
Many things lead to worry, but only worry leads to anxiety.
A few more examples:
- Stress doesn’t cause anxiety. But when you’re stressed out, it’s harder to suppress your worry and stay focused. And when you get lost in worry, anxiety is the result.
- Low self-esteem doesn’t cause anxiety. But as a result of your low self-esteem, you may lack confidence in your decision-making. Which means that when asked to make a decision, you start worrying about what will happen if you make the wrong decision, which is what actually makes you feel anxious.
In short: Worry is the only direct cause of anxiety.
If you want to be less anxious, you should focus primarily on reducing your habit of worry because that’s the only direct cause of your anxiety—and often it’s the only part you have control over.
Oh sure, just stop worrying… Easier said than done!
It’s true: breaking free from a long-standing habit of chronic worry isn’t easy. But it is possible.
Like any habit, the habit of worrying can be broken. And as a result, you can feel much more at peace and less anxious and overwhelmed.
The trick is to understand how worry really works…
Worry vs Anxiety vs Stress
Before we go any further, let’s take a quick minute to define some key terms:
- Anxiety is an emotion resulting from a perceived threat or danger.
- Stress is your physical response to a perceived threat or danger.
- Worry is unproductive thinking about a possible threat or danger.
Let’s use an example to illustrate…
Suppose you’ve got a big presentation for work coming up tomorrow. As you’re walking down the aisle at the supermarket getting food for dinner, you see an advertisement for chocolate ice-cream on the end of the frozen goods section. This reminds you of your boss who has the rather eccentric habit of eating a pint of chocolate ice-cream during meetings.
At that moment, you immediately feel a storm of painful experiences:
- Your shoulders feel tense, your grip on the grocery cart tightens considerably, you feel a little warm—maybe even sweaty—and you notice your heart rate jump.
- You start imagining yourself giving the presentation tomorrow, picturing how awkward you’re going to be and inarticulate. You can literally hear your boss’s overly critical voice pointing out flaw after flaw in your ideas. You begin envisioning how you should probably just quit tomorrow morning and start looking for a new job.
- In the blink of an eye, you went from calmly strolling through the supermarket to feeling nervous, then anxious, and now almost on the verge of panic.
As you can see by the way I divided things up, there are really three distinct classes of experiences happening to you when you’re anxious: There’s your physical response, your mental response, and your emotional response.
In short, you can think about it like this:
- Anxiety = Emotion
- Worry = Thought
- Stress = Body Sensation
While it’s helpful to disentangle the emotion of anxiety from its mental and physical counterparts, we also need to think about the relationship between these three parts. Because while it feels like they all hit you at once, there’s actually a specific order in which they happen.
Worry Always Comes Before Anxiety
When you’re feeling anxious, the experience is usually that all this stuff is happening at once: You’re feeling anxious, worrying, and stressed simultaneously.
In reality, the causality happens like this:
- Trigger. Something in your environment triggers you. In our example above, it was the advertisement for chocolate ice-cream. Side Note: Things in your “internal” environment can trigger you as well—a memory, for instance.
- Interpretation. Almost immediately after this, you have some kind of thought about what that trigger means. For example, the immediate thought or interpretation that blitzed through your mind after seeing the ice-cream ad might have been: “Oh no, I forgot that my presentation is tomorrow.” Importantly, this initial worry is often so fast that you don’t even notice it.
- Emotion & Body Sensations. In any case, that initial piece of worry then leads to a fear-based emotion like nervousness or anxiety as well as a physical stress response that includes things like muscle tension or increased heart rate.
This is the first cycle of your anxiety. But keep in mind that often the first cycle leads to many more cycles.
For example, now that you’re feeling anxious and stressed, you might have another worry along the lines of “Can other people in the store tell that I’m anxious?” Which leads to an even greater degree of anxiety (perhaps bordering on panic now) as well as a stronger stress response.
Then you have another worry like “I can feel my heart racing… that’s not normal. Oh my God, am I having a heart attack?” Which leads to a lot more anxiety and even stronger physical signs of stress.
The key thing to see is this:
Even though it’s cyclical, anxiety is a fundamentally linear process, with the mental act of worry always preceding the emotion of anxiety.
Theories of Emotion, Old and New
That thought always precedes emotion is actually a well-established principle of human psychology called cognitive mediation—and it applies to all of our emotions, not just anxiety or fear. It means that cognition, or thinking, always mediates or comes between a trigger and our emotional response.
For example: If someone cuts you off while driving, their car going fast and passing you isn’t what causes you to feel anger. Instead, it’s your interpretation or thinking about what they did—“That jerk is gonna kill someone!”—that causes the emotion.
Side Note: Through conditioning, a trigger can lead directly to a physical response without any cognitive activity in between. So, it’s possible that if you have a lot of anxiety associated with ice-cream, an advertisement for ice-cream could directly produce a physical stress response. This is analogous to a reflex. But importantly, you won’t experience an emotion like fear or anxiety until you have some form of thinking or cognition.
While this principle of cognitive mediation was codified scientifically in the mid-twentieth century, it’s actually been around as an idea for millennia. In fact, it’s arguably the core principle of the ancient Greek and Roman philosophy stoicism.
As the stoic philosopher Epictetus put it:
It’s not what happens to you, but how you react to it that matters.
Of course, none of this is to say that your thoughts are literally the only thing that matters in terms of how you feel. Obviously our environment and what happens to us do exert an effect on us.
The critical distinction here is that things like our past or our environment or other people can at most have an indirect effect on our anxiety. Stress, poor sleep, conflict with your boss, trauma, a neurotic personality style, low self-esteem, and all the rest indirectly lead to anxiety in that they predispose us to worry. But it’s worry and only worry that leads directly to the feeling of anxiety.
This is a critical idea to internalize if you want to actually become less anxious.
You Can Only Change What You Can Control
All these distinctions between worry and anxiety, for example, or indirect vs direct causes of anxiety, aren’t just academic curiosities. Your ability to effectively manage your anxiety in a healthy way depends on having a high degree of clarity about them.
And the reason is control.
The biggest mistake people make with their anxiety is that they try to control things they don’t have control over.
Going back to our ice-cream example, the key inflection point in the timeline wasn’t being triggered or that first worry about “Oh no, I forgot that my presentation is tomorrow.” The fact that you happened to get triggered and had an automatic worry about it that that led to some anxiety… There’s not much you could have done to avoid any of that.
The critical turning point is what happened next: Worrying more about feeling anxious, what other people would think, having a heart attack, etc.
Once we feel anxious, most of us understandably want to feel less anxious. So we try to control our anxiety—either by fixing it through thinking more about it or trying to escape it and avoid it altogether. The problem is you don’t really have direct control over feeling anxious. Once you’re anxious, you’re going to be anxious for a while.
You can’t fix an emotion any more than you can tell the sky to stop raining.
What’s more, by trying to control this fact (anxiety) that you can’t actually control, you’re very likely to cause the opposite effect and make it worse:
- When you start analyzing your anxiety and trying to “fix” it, you usually end up worrying more, which leads to bigger and longer lasting anxiety.
- When you try to run away from your anxiety, that signals to your brain that anxiety is itself a threat, and so you get anxious about feeling anxious.
So, if I can’t fix my anxiety or avoid it, what am I supposed to do when I feel anxious?
So glad you asked! Nothing.
Once you feel anxious, the best you can do is not make it worse.
Look, you can’t just make yourself feel better any more than you make the rain into sunshine. That’s not the way the world works. Similarly, you can’t make yourself feel calm any more than you can make all the adrenaline flowing through your system disappear.
The reason is simple: You don’t have direct control over your emotions or your physiological response to stress.
Similarly, you can’t go back in time and change the fact that you slept like garbage last night, inherited a personality that makes you susceptible to worry, or had a mother who didn’t love you like you think she should have.
It’s incredibly tempting to try and change or avoid painful things like unhappy memories, uncomfortable emotions, or painful feelings. But the act of trying to change or avoid them only makes them worse in the long-run.
Instead, the next time you feel anxious, ask yourself this question:
What do I actually have control over?
While you can’t directly control your emotions or most of your physiology, you can always control your attention—what you chose to focus on and think about.
And controlling your attention is the key to controlling your worry, which is the one thing directly causing you to feel anxious.
If You Want to Control Your Anxiety, Learn to Control Your Worry
The best way to avoid major bouts of anxiety is to do two things:
- Accept initial moments of anxiety as unfortunate but not something you can control.
- Take responsibility for the one thing you do have control over: your attention and whether you chose to feed your anxiety by continuing to worry or not.
Obviously, this is easier said than done.
But like any skill, the key to getting better at controlling your attention is practice.
And like any skill-building endeavor—from learning the piano to negotiating corporate contracts—you need practice. And the only way to practice long enough and consistently enough to have positive effects is if you make that practice into a habit and routine.
If you want to feel less anxious, commit to habits that will help you worry less.
What are some good habits for learning to worry less?
The single best habit I’ve found to break your worry habit and lower your anxiety long-term is called Scheduled Worry →
Summary & Key Ideas
If nothing else, I hope this essay has nudged you to think a little bit differently about the relationship between anxiety and worry in your own life. And to think about the question of what causes anxiety with a little more nuance.
To review, here are the key ideas:
- Anxiety, worry, and stress are fundamentally different things. Anxiety is an emotion. Worry is a form of thinking. And stress is a physiological response.
- Worry is the cause of anxiety. While many factors from the way you were raised to how much sleep you got last night can indirectly affect your anxiety, worry is the only direct cause of feeling anxious.
- To feel less anxious, control your worry, not your anxiety. You can’t directly control your emotions, including your anxiety. And trying to do so usually backfires. But you can always control your attention, including the choice to elaborate on your worries or let them go.
- If you want to control your worry, commit to habits that train your attentional control. A mindfulness practice is one of the most powerful ways to improve your skill at controlling your attention—and therefore your worry and ultimately your anxiety.