Tyler Slay’s Blog

- Written by Tyler Slay

These stories are completely fictional but realistic enough to represent real client cases.

Michael never struggled with anxiety until he contracted a severe stomach virus in high school and had to go to the ER for fluids. He nearly passed out two or three times, and the ER staff treated him without much compassion. Now, he finds himself washing his hands until the skin is irritated and painful to avoid catching anything. He struggles to enjoy social events because he fears contracting another virus. He has started avoiding some events he really wants to attend because of this, obsessively tracking potential sources of contamination. It’s exhausting, but he doesn’t know how to stop or understand how others can be so nonchalant about germs.

Kate grew up in church. Her parents are some of her best friends, and they are easygoing and supportive. She has never felt pressured to be a leader, perfect, or anything she’s not. She was at the church every time the doors were open and genuinely enjoyed being there. The calls from speakers to repeat a prayer to become a follower of Jesus never bothered her until one day something changed. She began to question whether she did it right, whether she felt remorseful enough about her sins, or if she was just trying to avoid going to hell. She started looking for Bible verses that reassured her of her salvation, which was a good step. However, this became her sole focus, and she couldn’t stop thinking about it. She would ask pastors about her concerns, and while their reassurance was helpful for a short time, she would soon be overwhelmed by anxiety and doubt again. Going to church no longer felt enjoyable; it was just a reminder of her uncertainty.

Brad recently joined a men’s group at church. He has struggled to make friends since all his college friends moved away, and his wife knows how much he needs community. He knows it too. Everyone in the group is nice and inclusive, but he doesn’t feel like one of the guys. They talk about sports, woodworking, politics, and hunting. Although he has some interest in these topics, he’s always been more of a reader and an avid indoorsman. He wants to join them at deer camp and ball games, but he experiences an internal resistance he doesn’t understand. In high school, he had bad experiences with immature friends who couldn’t accept that he wasn’t a typical jock. Now, he labels himself an introvert who doesn’t need friends, but he knows that’s not the whole truth. Really, he’s still grappling with past rejection and hurtful comments. He protects himself by not allowing himself to get too close to others who might cause him to feel rejected again. He wants his desire for friendship to prevail, but he often thinks about finding excuses to avoid attending. His loneliness makes him anxious, and going to the group makes him anxious as well. He feels stuck.

What can we learn from these vignettes? If nothing else, we need to recognize that anxiety is complex! These are ordinary people who are stuck, and full recovery will likely require more than just medication, therapy, a good book, a vacation, or an encouraging conversation.

I want to briefly introduce three “processes” that might be behind each of these cases so we can know where to start the healing process. Hopefully, this will provide some insight into your own anxiety or the anxiety of someone you care about.

Sometimes anxiety results from what I call a "Bottom-Up" process. This is where something in our physical, embodied experience is causing or worsening our anxiety. You see this with Michael, where being physically ill caused him such discomfort that he went to extremes to avoid feeling that way again. A physical issue caused a thinking and feeling issue. Sometimes, we have a predisposition toward anxiety that intensifies due to a bad medical experience, exhaustion, illness, caffeine intake, medication side effects, hormonal changes, a neurodevelopmental disorder, a neurological injury, or just an over-busy schedule. Some people believe every problem has a medical, lifestyle, or dietary cause, while others have never considered it. I believe that this Bottom-Up category is worth examining closely, but it’s not worth obsessing over. Sometimes the answer is there, and sometimes it’s not. Again, we are multifaceted and more complex than we realize.

The second category to consider is what I call a "Top-Down" process. This is where the person cannot stop thinking about something distressing. You see this clearly in the way Michael can’t quit thinking about getting sick, and Kate can’t stop thinking about her salvation. This is the person who is on vacation, has slept for ten hours, palm trees are swaying in the breeze, and everything is in order, but they still cannot mentally disengage from something worrisome. Sometimes they are preoccupied with just one topic, and sometimes it’s as if they are worried about every little thing that could go wrong in every situation. This person could be struggling with Generalized Anxiety Disorder or Obsessive-Compulsive Disorder. They have a thinking problem that causes a feeling problem (and sometimes frustrating behaviors), and they need interventions to help them experience the joy of mentally disengaging from that problem.

The final category is what I call a "Relational" process. This is when our anxieties stem from, or are amplified by, a relational wound of some sort. By relational wound, I mean someone important to us hurt us emotionally—whether they intended to or not. In my opinion, this is the root of most anxiety. Not everyone has an identifiable thinking disorder (Top-Down) or physical triggers (Bottom-Up) that lead to anxiety, but we all have relational wounds. You see this most clearly in Brad’s story, where he struggles to feel like part of the men’s group despite their inclusiveness. However, Kate and Michael are not exempt from their relational wounds being part of the reason they struggle with OCD-like symptoms.

The person struggling with anxiety due to a relational wound has typically experienced repeated feelings of powerlessness in influencing significant people or situations in their life—an overwhelming loss of agency. Now, their anxiety is aimed at avoidance or control of problems that represent the way they were wounded. What could that mean in plain language? The perfectionist who is preoccupied with winning every award at work and school made a decision a long time ago that they would never feel like their life is out of control again after experiencing social rejection in middle school. The person who has anxiety about standing up for themselves or stating an opinion never felt like their attempts to argue were heard or respected. Both of these people could be completely unaware of the connections between their anxiety and their stories. They are really fighting shadows—things they have already lived through but are still trying to avoid or control in their current world. Their anxiety is a repetition, a representation of that old wound—now placed onto a new topic or person.