Luana Marques.

HarperCollins Publishers


Feeling anxious? Stuck? Problem is psychological avoidance

Professor of psychiatry Luana Marques says in new book that too many mistake symptoms for underlying problem

8 min read

Adapted from “Bold Move: A 3-Step Plan to Transform Anxiety Into Power” by Luana Marques, associate professor of psychiatry at Harvard Medical School, founder and director of Community Psychiatry PRIDE at Massachusetts General Hospital. Reprinted with permission from HarperOne, an imprint of HarperCollins Publishers.

Challenges — big and small, obvious and nuanced — can leave us feeling weary, afraid, lonely, sad, anxious, overwhelmed, and just plain stuck. Often, clients ask me: How do I get rid of my anxiety? Why am I so stuck? How do I get out of this rut? Why doesn’t this sadness go away? Is it really possible to live a bold, fulfilling life?

Jake is the CEO of a Fortune 500 company.  If you were to meet him on the street, you would never know that he had grown up with very little, because all you would see is a sharp, handsome white-collar worker with perfect manners, eloquence, a pressed Armani suit, and an air of confidence that you could spot a mile away. Yet here he was in my office, describing his crippling feelings of anxiety. He had always been a somewhat anxious person, but lately his anxiety had felt unbearable.

We started simple. “What is this anxiety like?” I asked him.

“Like I’m about to explode!”

“Explode? Really?”

“Yes! Explode! My heart pounds, I feel dizzy, it’s hard to focus, the world closes in … all at the same time. I feel like I’m about to have a heart attack. But I have had my heart checked a million times, and there is nothing wrong with it.”

“How do you manage these nearly combustive moments?” I asked.

“I do whatever it takes to make myself feel better. At work, I cancel meetings or have my COO run them, telling people I have another important meeting with an investor.”

In a quieter voice he told me, “I lie, but I just don’t know what else to do in that moment. When I get home, I’m often so drained by anxiety that I’ve just stopped exercising altogether. I try not to have that glass of wine, but honestly, I don’t last past 8 p.m., and by the second glass, I feel so much better. Then I’ll spend hours in front of the computer, working.”

He paused. “Well, I tell myself I’m working, but I’m really just staring at the computer, zoned out, drinking to drown my anxiety. Then I eventually fall asleep and wake up even more anxious than the day before. This is too much! I’m telling you. You need to get rid of this anxiety. I can’t stand it anymore!”

Jake understood — correctly — that he was at a breaking point, but he misunderstood the reasons why. If I magically took away Jake’s anxiety, he believed he would be fine and would be able to engage with his work without a problem. To some extent he is correct: a lot of unpleasant emotions (anxiety, fear, sadness) will paralyze us and keep us stuck. But would Jake be better off if all of his anxiety disappeared? He would likely be able to focus more on work. But would he be concerned enough about his wife’s safety to remember to have the car’s brakes checked? Or would he have the motivation to put in extra hours to prepare for a big business pitch? Maybe not. Unpleasant emotions are like pain receptors, which are designed to alert us to things that could be harmful or dangerous, like touching a hot stove, and without them we would get burned. So, although painful, anxiety itself can be adaptive and signal something important to us.

Jake is not alone.

Everyone I have met in my career wants to get unstuck and live a fuller, healthier, and bolder life. Yet, in their attempts to get unstuck, I find that my clients are looking in the wrong places. Often, clients want me to get rid of their anxiety, stress, burnout, sadness, fear, or hopelessness. However, while these emotions are painful, they are most often a symptom and not the root cause of our challenges.

Put differently: imagine that you developed a high fever, and to address it you took Tylenol. Would your fever come down? Very likely. But how long would it stay down? That would depend on what your body is fighting. If you have a mild cold, acetaminophen would help and you might be all set after a few days. However, if you have a bacterial infection, Tylenol would bring the fever down yet not cure the infection. Instead, you might need a different class of medication, such as an antibiotic. The Tylenol would only address a symptom (fever) without curing the underlying problem (infection).

Anxiety is only one of the fevers that my clients report.

Stress, burnout, difficulty concentrating, marital distress, financial worry — these are real, painful experiences, but what is leading to these problems?

What I have learned throughout my life, clinical work, and research is that there is one common denominator that tends to get all of us stuck, and that is what I call psychological avoidance.

Psychological avoidance is any response to a perceived threat that brings immediate emotional relief but comes with long-term negative consequences. Put simply, avoidance gives us fast but temporary relief from discomfort but keeps us stuck in the long run.

Throughout my career, I have found it challenging for my clients to understand that avoidance is our figurative infection, because often discomfort itself (e.g., anxiety, stress, sadness, burnout) feels like the primary problem. Remove the discomfort and life would immediately get better — seems straightforward enough. Yet, the problem is not the discomfort itself but how we respond to that discomfort.

Psychological avoidance has a real long-term cost because it will always rob you of the chance to live a bold life and prevent you from reaching your goals. Once you start to avoid, you need to keep avoiding again and again to push away the discomfort that, like a villain in a horror movie, just won’t stop coming at you. By avoiding, we are teaching our brains that the only way we can manage challenging situations is by running away instead of facing them, which reinforces our need to avoid. Each time you avoid, you will feel a bit better, but feeling better and being better aren’t the same thing!

The reality is that all our avoidance tactics are unique to us, and regardless of how creative, interesting, or seemingly helpful they might be, they always keep us stuck. So, to be able to overcome avoidance, we must first learn what it looks like in ourselves. For some, avoidance means reaching for a drink at the end of a long day. For others, it is finding an excuse to cancel plans.

Although our avoidance tactics might come easily to all of us, they are not without a cost.

The prices we pay for avoiding are as unique as we are — relationships crumble, dreams are pushed aside, health declines, work performance dwindles. And, unfortunately, as I see with my clients, the prices are usually high.

Our brains are complex machines that are comprised of many small regions. These regions communicate with one another through a system of networks. Above all, the networks in our brains are programmed to keep us safe, by detecting danger, predicting possible (especially negative) outcomes, and learning what does and does not work in various situations.

All these biological changes are intended to increase your likelihood of survival by preparing you to respond: to “fight, flee, or freeze.” This primal brain response is very adaptive, but it is not always correct. Your brain snaps into action to protect you — even if that threat is just a perceived threat.

When we lack proper training, avoidance is a force far more powerful than any of us can handle. And because biology largely drives our discomfort, there is no way to completely eradicate it. However, if we hope to truly eliminate our symptoms (anxiety, stress, burnout), we must first treat the infection (avoidance).

Anxiety is painful, but it is not what is keeping you stuck. Taking a moment to identify your unique method of avoidance is your first step to overcoming it. Once you are able to do that, you’ll be well on your way to living a bolder life.

Copyright © 2023 Luana Marques