When Is Anxiety Healthy?

Embracing the unknown.

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If you’ve been struggling with intense anxiety, panic attacks, uncontrolled worry, or an anxiety disorder, the idea of healthy anxiety may seem like an oxymoron. How can anxiety ever be a healthy, useful emotion when your experience of the emotion is intense personal distress, a sense of being out of control, and a runaway mind that’s flooded with terrible possibilities?

But even if your anxiety often is excessive, persistent, and has reduced your quality of life, is it possible there are other times when you’ve been able to put your anxiety to good use? Have you lost sight of your experiences of healthy anxiety? Are you better at handling anxiety than you think? This is a question I’ve been pondering while working on a second edition to a workbook on anxiety written with Dr. Aaron T. Beck called The Anxiety and Worry Workbook.¹ Anxiety, it turns out, is not as straightforward as you might think. Let’s take the example of Ava who experienced both healthy and unhealthy forms of anxiety.

Ava’s Anxieties

Ava always seemed to be anxious about something. It often started as soon as she woke up. Her mind would race about all the demands of the new day and she’d have that overwhelmed, sinking feeling in the pit of her stomach. Then throughout the day she’d have waves of anxiety crash over her when she’d suddenly be reminded that her children might be harmed or injured at school, her husband’s job insecurity, their precarious financial situation, their strained marriage, her sister’s cancer, and the list seemed endless. Ava’s anxiety surges were definitely unhealthy as she became mired in her distress and the uncertainties of life.

But Ava was highly successful at work and she had many good friends. She was a regional sales representative for a multinational company that required her to hit difficult sales goals, pitch products to new customers, and participate in contentious meetings. Ava often felt anxious as she faced the many demands of her challenging job. Sometimes the anxiety was intense, and she felt many of the same physical symptoms she had with unhealthy anxiety. But the work anxiety was different because in this context Ava was able to put her anxieties to good use. She called this anxiety “being stressed,” and she used it as a source of energy and determination to solve the many challenges faced in her work life. Ava was using healthy anxiety to her advantage at work. Like Ava, is it possible you get anxious in certain situations, either at work, home, or social settings, and you’re able to put your anxiety to good use?

The Three Legs of Anxiety

From treating hundreds of people with an anxiety disorder, I've learned that triggers for our distress are often quite unique. What one person considers a highly anxious situation that must be avoided, another person with the same anxiety disorder can face that situation with little difficulty. So, whether we have healthy or unhealthy anxiety depends less on the situation and more on how we deal with it. Imagine that anxiety is like an old three-legged milking stool. The stool’s able to support your weight only if all three legs are present. The same with anxiety. You’ll experience anxiety only if three psychological processes are present.

• How we think: the way we interpret or evaluate situations, the predictions we make, and what we think about our ability to cope are critical in determining our emotions.
• How we feel: the way we interpret the physical symptoms associated with anxiety will determine how well we can tolerate these uncomfortable feelings.
• How we act: the way we respond to anxious situations has a powerful impact on how quickly we feel relieved and the speed of anxiety’s return.

The Making of Healthy Anxiety

We can see how anxiety can be useful in dealing with life’s problems if we consider its three components.

• The healthy anxious mind: Anxiety occurs when we perceive a significant threat or danger to our personal safety or vital interests is quite likely. In healthy anxiety, we recognize there is the possibility that something undesirable could happen, but we adopt a more realistic perspective. We accept that a worst-case scenario is possible, but that a less severe, more moderate, negative outcome is more likely. Ava, for example, recognized that a large contract she was working on could fall through and threaten her quarterly sales numbers. But rather than think she’d never get her year-end bonus, Ava reminded herself that other opportunities would likely come her way before the end of the year. The mantra of the healthy anxious mind is “be evidence-based, anchoring threat evaluations in what’s most likely rather than what could be."
• The healthy view on feelings: Even when anxiety is mild, we experience physical symptoms. Increased heart rate, muscle tension, a churning stomach, chest tightness, and shallow breathing are just a few signs of feeling anxious. The healthy anxious mind does not view these symptoms as dangerous but rather learns to tolerate the uncomfortable feelings, knowing they will ebb and flow in their own time.
• Healthy actions: Maintaining healthy anxiety requires the right response. Rather than focus on creating safety and comfort as quickly as possible, you directly confront the problem at hand. Procrastination, escape, and avoidance are not your preferred modus operandi. Instead you confront uncomfortable situations and use the anxiety to sharpen your attention on the difficulty at hand. You take a problem-oriented approach rather than an emotion-focused orientation.²

Anxiety is not always the enemy. You are already using anxiety to energize your response to many of life’s challenges. As discussed in my next posting, there are lessons to learn from healthy anxiety that can be used against its unhealthy alternative.