On Edge: A Journey Through Anxiety starts with the worst: our protagonist is 20 years old, and she thinks she is dying. For those who have had a panic attack, the feeling will be a familiar one—a racing heart, blurry vision, various symptoms that often cannot be explained by the circumstances. And like author Andrea Petersen did, many will go a significant amount of time before getting a diagnosis (if they ever get one at all)—that they’re not having a heart attack, but that they suffer from some type of anxiety disorder.
A longtime health, psychology and neuroscience reporter for The Wall Street Journal, Petersen’s story combines her own experience with a history of research into anxiety disorders, as well as the latest work treatments being developed. This balance makes for a compelling read; it’s personally relatable to those who have had similar experiences, highly informative on an emotional and factual level to those who have not. (And, for a book about such a serious subject, it has plenty of light moments.) As Petersen explains, one in three Americans 13 and older will have an anxiety disorder at one point in their lives, and for women, the numbers are even more startling.
What is anxiety? In essence, fear of the intangible, of the future. “Besides being constantly ready for crisis, anxious people have a hard time with uncertainty. What if? What if? What if? Is the endless refrain of the anxious mind. Uncertainty far too easily morphs into inescapable catastrophe,” she writes, words that will be familiar to many who have found themselves derailed in some way by worry, by an inability to stay in the moment. When you’re alone in your head, it can be hard to take stock of what your brain is doing; what Petersen’s managed to do is to cull down an incredible wealth of personal and professional knowledge into a narrative with as many clear patterns and takeaways as is possible in such a murky domain.
As Petersen acknowledges, she was a lucky one, finally diagnosed after a painful year of hospital and doctor’s visits. And though she continues to have ups and downs, she has health insurance and a support system to guide her. Much of the emphasis of her book is how her story is both universal and rare because of these factors; she cites by way of example how black people have been found to have anxiety disorders at lower rates than white people, but that when they are diagnosed, the care they get is often inferior, and their suffering subsequently more severe.
I spoke with Petersen last week about the different strategies used to treat anxiety—which range from meditation to therapeutic strategies to drug developments—why rates of anxiety disorders are higher among women, and how anxiety can be impressed upon children and shared among adults. Our conversation has been lightly edited for clarity and condensed for length.
JEZEBEL: I read your excerpt in the Journal, and was like, oh man, I want to talk to her about this. How has this book not been written before? But it hasn’t!
ANDREA PETERSEN: Well, anxiety has been sort of the step-child of mental illness for a long time, both in terms of actual funding for research and also I think just in awareness. I think that is changing, but I think sometimes people think it’s not as serious as maybe some other disorders. I’m not trying to pit disorders against each other, but I do feel like it’s finally getting some attention, which is a good thing. Because I think what’s interesting is there’s more research actually showing that anxiety is a kind of gateway almost; researchers are realizing that things like depression, bipolar disorder, various anxiety disorders—they often start as anxiety. And they often start in childhood. So if we can target that, we might be able to prevent some of these other disorders from developing. And from hijacking people’s lives before they’ve even started.
Going into this, I started to think a lot about how many books there are about depression; for so long it wasn’t talked about but I think it’s more readily discussed now, and there’s clearly a lot of research into it. I’m wondering if you felt that depression has been more substantively covered in writing.
I think so. There are some things out there about anxiety, but I don’t think it’s gotten the coverage that certainly depression has. And this is not to say that depression doesn’t deserve it, I think it totally does and I think all mental health issues need more light shed upon them, and I think stigma is still a real thing and we still need to chip away at that. I think it’s getting better, and it’s a good thing that more people are being open about their mental health issues. It’s incredible the number of people, especially young celebrities, that are talking more openly about seeking therapy and about what they’ve gone through.
When and how did the book come to be? Obviously you’ve been writing about health for a long time.
I’d been thinking about it, it’s probably been about 10 years, honestly. I’d read The Noonday Demon, and I was sort of blown away by Andrew Solomon’s wonderful melding of memoir and his own experience of depression with this deep dive into the research. And I thought, well, anxiety needs that same treatment. Scott Stossel did a wonderful book, My Age of Anxiety, that did that but I didn’t know that when I was doing mine [laughs]. But anyway, as you know from reading my book, it took me about a year for me to be diagnosed. And by the time I was, the thing is, anxiety feeds on itself. And what often happens is that people with anxiety, then they sort of develop avoidance behaviors. I had a panic attack in line at a coffee shop; well, I better not stand in the line anymore. I better not go to a coffee shop. And then by avoiding those things, it reinforces the idea that those things are dangerous. Your world can sort of get smaller and smaller.
So I had been thinking about doing this for awhile. And also, for people who don’t have anxiety issues, it can be hard to describe it and explain it. I was like, I need something that I can just show—and I’m sure if I’m feeling this way then I’m sure other people are feeling this way too. So there was that desire to kind of provide empathy and an insight to other people with anxiety issues and to illuminate the issue for people who love people with anxiety issues. As a health reporter, I was starting to write a lot of mental health stories. And I was realizing that this is an especially a really exciting time in anxiety research. There’s all these very cool advances in neuroimaging and genetics that are really unraveling some of the mysteries of the ancient mind and pointing the way. There are some exciting new treatments on the horizon. So I realized, both I feel like the experience of anxiety needs to be illuminated, [but] I also wanted to share these incredible research findings that are happening that I thought people could benefit from.
It took me awhile to really do it because I was afraid of what people would think. And particularly, how it would affect my career. Not that I was worried about being fired or being demoted, or anything like that. I knew I worked with very caring people, but I was more worried that people might try to protect me, actually, that somehow they might be worried about me and sort of worried that they might need to ease up a workload or maybe steer me away from certain stories or—I had no idea how it would play out. And then also, how I would be perceived as a journalist, particularly as a health journalist. Would I be too close to the story? That line between journalism and advocacy. So it took me to the point where I’m like, okay, I’ve got 20 years of work experience, I’ve written hundreds of stories for The Wall Street Journal, I now feel like I have a track record that I can… I just felt more confident about doing it. And also I realized that I needed to do my part in terms of tapping away at averting stigma.
This is something I grapple with a lot, which is, at what point do you consider your story worth elevating over the stories of the people you’re trying to talk about?
I definitely grapple with that. It’s like, why is my story so special? And I don’t think it is. And I think maybe that’s why, I think a lot of people with anxiety, I’m hoping they can relate to what I’m relaying, but we all see things in stories. And obviously something needs a narrative for thread to convey it. And I know my story better than anybody else’s. So this is the one that I felt like I’d best be able to tell.
I was particularly interested in your descriptions of Cognitive Behavioral Therapy (CBT) [which focuses on confronting negative thoughts with rational thinking] and Acceptance and Commitment Therapy (ACT) [which focuses on accepting and distancing yourself from negative thoughts] and how they’re considered different approaches. Because in essence, they seem (to me) to be doing the same thing; they’re trying to recenter the way you view the world, right? They’re trying to make you look at your life differently.
Most researchers I’ve talked to believe that probably the most critical element of both of the treatments is exposure. And that is when you systematically expose yourself to the things that you’re afraid of. And so CBT does it kind of more explicitly, like, okay, you are going to create a fear hierarchy. Like for me, I was really afraid of when my heart rate would kick up and I would be worried that I was going to have a heart attack. And so I would actually have to go up a couple flights of stairs and let my heart rate kick up. And then I would go up two flights, and three flights. So increase the intensity of it. And with ACT, it does the same thing but it just reframes it not in terms of the fear hierarchy, but as a way of reaching personal goals. Each approach can resonate with different people. Also ACT does more explicitly include mindfulness techniques, though a lot of CBT practitioners are incorporating mindfulness and meditation and yoga in that as well. So there’s a lot of overlap.
Most psychologists I talked to believe that really the exposure element is really the key in terms of actually getting a clinical benefit. But then there’s also research looking at meditation and mindfulness even independently on its own. And there are some good results with that as well. For me personally, I find that meditation—which I’m actually terrible at, I try, but oh man is it rough. But yoga for me, which a lot of practitioners call it a moving meditation, focuses my mind. I have a hard time just sitting, because then my mind just jumps all over the place. Which I know, that’s normal, but then I get frustrated, and it’s not good. For me, those practices are very important to prevent relapse and to keep me healthy. But when my anxiety is at a fever pitch, if someone told me to go meditate I’d be like, yeah, no. When my anxiety is really at a high level, what works for me is CBT and medication.
The degree to which physicality can get you out of your own head and clear it and break you out of patterns, I think that’s really fascinating, especially because it does get to a point where it doesn’t always work. You do hit this point where it feels like you’re fighting yourself.
Yeah. Right. Right. And the thing is, it feeds on itself. So what I’ve realized for myself, I don’t ever want to go back to the place where I’m on my parents’ sofa for five weeks. So that’s very motivating, knowing what my anxiety can do to me, so that if I start feeling it get out of control, I really try to address it pretty aggressively just so it doesn’t get to that level again.
Something I think about a lot is, what do you consider a personality trait, something that you would be better off accepting about yourself, and what are the things that you’re like, this is fixable, this is changeable, I can work on this? Because I think sometimes I get to a point where it’s almost frustrating to think that I’m going to be fighting something innate about myself for my entire life.
Well, how I think about it is that, I’m never going to be a laid back person. I’m just not. I mean I’m not wired that way. I’m always going to be prone to anxiety. And also, anxiety is a normal human emotion. A certain amount of anxiety is actually a good thing. It motivates us to study for tests and prepare for presentations, to go to the doctor if we’re feeling funny. It’s where it rises to the level of impairment, then it ceases to become a personality trait. It becomes an illness when it’s preventing you from living your life the way you want to live it. And then of course the DSM has tons of criteria about each different anxiety disorder, what constitutes each one. And there are temperaments that are more prone to anxiety issues than others. There’s a temperament called behavioral inhibition, you can see it in babies as young as four months old, this high-reactive temperament, it’s how babies react to novelty.
[In her book, Petersen describes how babies who respond aggressively to new things have been found to be more anxious and reticent later in life. Some researchers have been successfully working with children to help change those behavior patterns.]
Yeah, that was so interesting to me.
And high-reactive babies, they tend to turn into behaviorally-inhibited toddlers and children, and then those are much more prone to anxiety disorders. But even these prevention programs, or programs to treat these behaviorally inhibited kids, they don’t tend to change temperament. These kids are not all of a sudden going to become hugely extroverted. But being introverted and being shy isn’t a disorder unto itself. There are plenty of incredibly successful people who are shy and introverted and they’re warriors. And there’s plenty of evidence that we need those kind of people, because they’re noticers, they’ll warn people of impending catastrophe. Or they’re the ones who are tinkering in their garage and creating the next new invention, or whatever. So really it’s about the issue of impairment. So that’s how I distinguish between what’s something that I need help for and what’s just accepting who I am. Does that make sense?
Yeah, totally. I think you explore that when you talk about the ways that these tendencies help your job. Especially what you wrote about how parents are encouraged to worry, that it’s socially acceptable for parents to be anxious.
Actually, not just socially acceptable; as we were talking, I was like, oh my gosh, does she think I’m a terrible mom for being kind of blasé that my kid is puking?
[Petersen was caring for her daughter who was home sick during our interview.]
No, definitely not. [Laughs]
But there is this, especially when you’re a new parent, the internet is just a black hole of worry, you can get yourself completely bent out of shape about all the things you can potentially worry about. Is there BPA in that? Where’s that toy made? Becoming a parent, I actually thought that the world, or my surroundings, my social circle, had caught up with the inner workings of my mind, that now it was socially acceptable, even an imperative to be worried all the time.
Similarly, something I think about a lot with regards to journalism, is, so much of the thing that tends me towards worry and obsession and analysis is the thing that makes me good at my job. You notice patterns, you can remember something that someone said years ago and come back to it—that is all stuff that constantly, day-to-day benefits me in my job. But then personally, drives me insane.
Right, right, yes. Also not being satisfied with the initial answer. And especially if you’re trying to talk to people who don’t want to talk to you, being persistent. And for me, it was also the competition. Like, oh my god, am I gonna get beat on a story? That anxiety about performing, it fuels. And then, after a certain point, it becomes paralyzing.
Some of what you wrote about regarding parenting—and the research that has been done about why there are so many more women that have been diagnosed with anxiety than men—felt very chicken-or-egg. Are women more anxious because we condition girls to be that way or because they have this proclivity to be and then are set up to be for life? It’s one of those things where it’s hard to tell where it starts and ends.
Right, and I think you’ve hit the nail on the head, I don’t think anyone knows for sure. There’s some evidence that hormonal factors may be at play, that fluctuating estrogen levels might contribute, but there’s also this really interesting research looking at how we raise little girls and little boys. Where boys are much more likely to be pushed to be independent, girls are much more likely to be protected even when they don’t want to be. These studies that were done in Canada about these kids on the playground were totally fascinating, about how parents respond to their children playing on a playground and how parents actually will physically help girls, even when they don’t ask for it, even when they don’t need it, much more than they will for boys. With boys they’ll actually encourage them to be independent. And what message is that sending? They’re sending the message that the world is a dangerous place, girls, you’re not capable on your one. It’s pretty easy to see how those messages can feed into anxiety.
You talk about how anxiety affected your romantic and platonic relationships, about people being “spooked” by anxiety, particularly the degree to which we do know that when people are anxious or when people are depressed, being around them does make it spread, for lack of a better word.
Right, “emotional contagion” is what psychologists call it—that emotions are catching. We tend to mimic the expressions on other people’s faces, we know that when you make an expression it actually can induce the emotion, so anxiety can pass from person to person. So in my experience, I had a couple of instances where friendships broke down. I had a relationship with a boyfriend who could not deal with my anxiety. I really feel like it was fear that somehow I was going to drag him down with me, that literally it was catching. That my fear was going to somehow infect them and it was going to constrain their life in the way that it seemed to be constraining mine.
The other thing that is really, I think, the most heartbreaking part about anxiety and relationships, and I talk about this, for me, is how it’s an isolation chamber and it can sort of separate me from the people that I care about, because that sort of exhausting internal monologue of worry just doesn’t leave a lot of space for other people. And it’s hard to sort of really connect when you’re in that worry spiral and it can make you really self-involved. Especially with a young child, if I’m trying to play dolls with my daughter and only 20 percent of me is listening because the rest of me is in a spiral about something. So that’s challenging.
There are some upsides to anxiety in relationships, at least I’ve found that. Because it makes me ask for help, it makes me vulnerable, and I feel like that has sort of deepened my relationships and I think also has made me better able to empathize with all different kinds of pain too. So it’s not one or the other. I’ve seen how it can enrich, actually, relationships, as well as tax them.
Obviously you’ve been doing health research for a long time before you started doing this book, but how much research did you set out to do for the book where you were learning new things and diving into areas you hadn’t explored yet?
Oh, a lot. What I realized is that anxiety is a huge subject. It was hard to corral this huge—you should see my apartment, I just have piles and piles of research studies. There’s the history of anxiety, which is fascinating itself, so there’s the history of treatment, there’s the history of diagnosis. I was looking at everything from what neuroscientists were doing in terms of actually understanding what anxiety looks like and the path it travels in the brain, to the gender stuff we talked about, to new non-drug treatments, to new drug treatments. Each one of these topics was massive amounts of research associated with it. So it was a lot (laughs).
And I could have kept going for a really long time if I hadn’t had a deadline, which is why deadlines are good things, especially for people who are anxious and feel like they have to know everything about a subject in order to write about it authoritatively.
Yeah, as you said, melding a personal narrative, and a historical narrative, and then a scientific narrative, that’s a lot of things to fit into one book.
All of those were interesting to me, I thought those were all important to include, so I’m just hoping that I’ve been successful in weaving those together.