One Possible Cause and Cure for Your Anxiety

Current circumstances may not be the key cause of anxiety.

Posted Jul 25, 2019

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When we are anxious, we tend to look into recent issues for our answer to why this uncomfortable emotion is occurring: Why is my friend not calling or texting me lately?  Is my boss going to ask too much of me? 

Is my romantic relationship in trouble?  It is rare that we look farther back in time to our childhood or adolescence for the answer to the "Why-am-I-anxious?" question. 

It seems even rarer when we are feeling anxious to look, not for incidents that worry us, but instead to those incidents that have made us very angry.  In other words, we do not usually connect our feeling anxious now to earlier incidents that made us angry.  Yet, research is emerging that suggests this: If we have had irritability in the past, then we might have anxiety in the present.

By the term "irritability," I mean a kind of anger that is enduring, over half a day for weeks or more at a time.  Irritability is similar to what I have called toxic anger or the kind of anger that is so deep and so long-lasting that it starts to affect our health (Enright & Fitzgibbons, 2015).  Anger itself is not at issue here.  We all can have this temporary sense of displeasure, of feeling that we have been treated in an unfavorable way.  Such anger, if caused by other people's unfairness to us, shows that we have self-respect; we should not be treated in such a way.  Yet, if this feeling of antagonism remains and deepens, it can turn to its toxic form in which we are feeling disrupted inside and this becomes more of a habit. 

We need to break that habit as the research by Stringaris and his colleagues shows.  For example, a review of the literature and meta-analysis of 24 studies concerning youth shows a relationship between irritability (toxic anger) and mental health challenges over time (Vidal-Ribas, Brotman, Valdivieso, Leibenluft, & Stringaris, 2016). The authors make this important statement in the abstract of their journal article: “We found that irritability forms a distinct dimension with substantial stability across time, and that it is specifically associated with depression and anxiety in longitudinal studies.” In other words, deep anger (toxic anger/irritability) that begins in childhood or adolescence can lead to anxiety in adulthood (see also Stringaris & Taylor, 2015).  

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Source: KuanShu Designs

This kind of anger, irritability, in childhood and adolescents apparently is common.  For example, using the interview method in the United Kingdom, Pickles et al. (2010) showed that irritability has a prevalence as high as 19.1% in boys and 23.9% in girls based on what now is called the Isle of Wight study. Importantly for our purposes here, the Isle of Wight study did report that such enduring irritability in youth is related to unfavorable psychological outcomes in adulthood.

In his 2011 literature review, Stringaris makes the point that the importance of irritability in adult mental health challenges is only recently emerging in the psychological literature.  The presence of irritability, for example, in the Diagnostic and Statistical Manual of Mental Disorders (by the American Psychiatric Association) is under-represented, which means that irritability as a contributor to such challenges as anxiety can be missed by mental health professionals.  

In my own experience, as well as the experience of my long-time colleague, Dr. Richard Fitzgibbons, irritability because of past unjust treatment by others is a significant factor in current symptoms of anxiety and depression (Enright & Fitzgibbons, 2015). 

When a person is treated deeply unfairly by others, initial anger characteristically emerges.  If this is not resolved, then one major effect of the injustice, stemming from the initial anger, is the development of irritability/toxic anger that eventually can lead to the symptoms of anxiety and even depression.  If the injustice from the past is not identified and if the effect of toxic anger is not cured, then it may be difficult to treat the anxiety itself. 

In other words, it is important to diagnose the distal (long-time-ago) anger if the proximal (occurring now) anxiety is to be cured.  Once the original severe injustices with the challenging effect of toxic anger are diagnosed, we then can proceed with a cure for that persistent anger: Forgiveness Therapy

Forgiveness Therapy is an empirically-verified treatment, shown scientifically through randomized experimental and control group clinical trials to reduce mental health symptoms now, including anxiety, as clients learn to forgive those who treated them badly (again, please see Enright & Fitzgibbons, 2015).  

Forgiveness Therapy includes first understanding what forgiveness is and is not.  To forgive is to make a deliberate choice to be good to those who are not good to you.  This does not mean automatically reconciling or abandoning a fair solution to the injustice. In Forgiveness Therapy, clients try to see the injuring other people in a much broader way than only the unjust behaviors.  For example, clients are challenged to see the woundedness and the inherent worth in those who behaved unjustly, which can lead to empathy and even compassion in the clients for these others.  As clients bear the pain of what happened, they become conduits of good toward the offending persons, as well as to others on whom the anger might be displaced. 

Forgiveness Therapy has been effective with a wide variety of people who have suffered grave injustices such as female incest survivors (Freedman & Enright, 1996), women who have been in abusive marriages (Reed & Enright, 2006), people in drug rehabilitation (Lin, Mack, Enright, Krahn, & Baskin, 2004), and early adolescent females in Pakistan (Rahman, Iftikhar, Kim, & Enright, 2018).  Because forgiveness always is the choice of the one who was wronged, Forgiveness Therapy never should be even subtly imposed on any client.  

A key question in beginning Forgiveness Therapy is this: Where should I start in identifying incidents from my childhood or adolescence that may be contributing to my anxiety now?  To aid you in this, I have developed in my book, The Forgiving Life, what I call the Forgiveness Landscape Rating Scale. 

You are asked to think of people who have been deeply unfair to you, from your earliest memories up to the present time. 

You rate the degree of hurt you feel now toward that person and event.  Then you rank these people/incidents from least hurtful (but still hurtful to you) up to the most hurt. 

You can start to forgive those lower in the hierarchy as practice in forgiveness, which gets you ready for "the big ones," those incidents and people who have gravely hurt you.  As you forgive those who caused such hurt in you, your current anxiety very well may begin to lessen, as has been the case in our scientific studies.

Of course, not all anxiety is caused by unfair treatment by others from one's youth.  Other causes include narcissism, or an entitlement that is not realized, which leads to unhealthy anger which contributes to the current anxiety. 

This can be countered with the practice of the virtue of humility.  One could be angry because of past incidents that have nothing to do with others' acting unjustly, such as, for example, a tornado that destroyed one's home. 

This can be countered with the practice of acceptance of the situation or transcending an excessive attachment to the home. 

Other causes can be biological, including an inherited nervous system that is more sensitive than most people's.  Yet, when there is injustice from the past, it is important to recognize this, identify the person(s), courageously acknowledge what happened, and if you so choose, to initiate forgiving those who have wronged you.

References

Enright, R.D. (2012). The forgiving life.  Washington, DC: APA Books.

Enright, R. D. & Fitzgibbons, R.P. (2015). Forgiveness therapy. Washington, DC: APA Books.

Freedman, S. R., & Enright, R. D. (1996).  Forgiveness as an intervention goal with incest survivors.  Journal of Consulting and Clinical Psychology, 64(5), 983-992.

Lin, W.F., Mack, D., Enright, R.D., Krahn, D., & Baskin, T. (2004).  Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. Journal of Consulting and Clinical Psychology, 72(6), 1114-1121.

Pickles  A, Aglan  A, Collishaw  S, Messer  J, Rutter  M, Maughan  B.  (2010). Predictors of suicidality across the life span: the Isle of Wight Study.  Psychological Medicine, 40, 1453-1466.  

Rahman, A., Iftikhar, R., Kim, J., & Enright, R.D. (2018).  Pilot study: Evaluating the effectiveness of  forgiveness therapy with abused early adolescent females in Pakistan. Spirituality in Clinical Practice, 5, 75-87.

Reed, G. & Enright, R.D. (2006).  The effects of forgiveness therapy on depression, anxiety, and post-traumatic stress for women after spousal emotional abuse.  Journal of Consulting and Clinical Psychology, 74, 920-929.

Stringaris, A., & Taylor, E. (2015). Disruptive mood: Irritability in children and adolescents. Oxford, UK: Oxford University Press.

Vidal-Ribas, P., Brotman, M.A., Valdivieso, I., Leibenluft, E., & Stringaris, A. (2016). The status of irritability in psychiatry: A conceptual and quantitative review. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 556-570.