Anxiety? Nature never makes anything without a reason. Everything in the evolutionary history of man and animal has a positive goal. Most psychological symptoms develop from an excess amount of something good which, in the wrong context, becomes something painful and disturbing. This goes for the feeling anxiety, too. In this article from the '' series, we use some aspects from the eponymous self-help program to explain how excess anxiety develops, and how to solve this problem with anxiety.

What is the function of the feeling of anxiety?

Anxiety is an emotion or feeling.

The function of any 'emotion' or feeling is to cause a useful behavior which can help us to live, or even just survive, in the wilderness. The word 'emotion' comes from the Latin verb 'emovere', which means 'to set in motion'. A feeling or emotion is used to set a behavior in motion.

For example, the emotion 'love' will make people come together. The feeling of anger will cause behavior which moves people apart. We can see that every emotion has a useful function.

Then what is the function of the feeling of anxiety?

Anxiety stimulates avoidance behavior. Anxiety is a useful feeling which - normally - helps people to avoid real danger. This increases the chances of survival in the wilderness, in dangerous situations. When a person comes across a hungry tiger, fear is a healthy reaction because it will cause behavior which helps to avoid the danger.

Anxiety is an emotion which is caused by positive and negative stress. Without stress, anxiety does not exist! This is logical, because in life-threatening situations the stress-mechanism (adrenalin and the sympathetic nervous system) is activated to prepare the body for the life-saving fight, flight, or freeze response. Anxiety is never found without stress, while stress without anxiety does happen. To some extent one could say that anxiety is a specific subtype of a stress reaction. This insight is important for treating anxiety. One needs to treat the underlying stress in order to get anxiety under control.

Figure 1: The evolution of healthy anxiety

How does the vicious cycle of anxiety disorders develop?

Anxiety becomes unhealthy when it occurs when in imagined or perceived danger, or in situations in which there is nothing dangerous at all.

Danger leads to healthy anxiety

Healthy anxiety rarely happens, and when it happens it does not last long. After the danger disappears, one recovers with the help of the parasympathetic nervous system which calms down the underlying stress response (heart palpitations, sweating, high blood pressure, ...).

Perceived danger leads to unhealthy anxiety

Unhealthy anxiety quickly becomes chronic or dormant because it is no longer linked to a real danger which requires a flight response, but rather to perceived danger.

A vicious cycle is developed: an internal thought, an image, a wrongful interpretation, or fear of fear becomes the trigger which causes anxiety. The person responds to the imagined anxiety. This leads to flight behavior from a normally non-dangerous reality. Avoiding a normal or useful reality such as an elevator, or a plaza in agoraphobia, leads to a lessened feeling of control over your own life. Consequences of this loss of feeling of control include tension, anxiety and stress.

Figure 2: The vicious cycle of anxiety disorders

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Problem in red: perceived danger is the source of the vicious cycle.

Solution in green: the access gates through which to break the vicious cycle, with the use of self-help

  1. Breaking through the perception of imagined danger
    1. Diverting attention from unwanted thoughts, images,
    2. Reframing interpretations
    3. Reconditioning for desired thoughts, images & interpretations
  2. conquering flight behavior or avoidance behavior by 'moving on' right away
  3. Breaking through fear of fear by accepting the fear itself

 Different types of anxiety:

1 ° Anxiety for an imagined or worrying thought: there is not even presently a corresponding reality.

Example: Fear of flying is often the result of the thought 'this airplane could/might crash'. Or from the image of an airplane crash which one imagines or remembers from a photo report.

2° Anxiety because of a wrongful interpretation of reality: there is a reality but it is harmless.

Example: Someone in a relationship with a partner who does not often speak about his feelings, might interpret this as: "he does not say that he loves me, so he probably does not like seeing me that much". This interpretation can lead to insecurity or anxiety. If can, for example, be based on a prior experience of an ending relationship with someone who did not share their feelings a lot. Another possible interpretation could be: "He comes from a family where people do not talk about their feelings as long as everything is okay, so that fact that he is not talking about his feelings is probably a positive sign".

3° Fear of fear: one is not only anxious for the initial reality or thought, but also for the fact that one is anxious in the first place, or the fact that one anticipates the anxiety which may arise.

Sometimes it can even be so that the reason which initially caused the anxiety (e.g. a robbery, an accident, or rape) is gone in the present, while the fear of a feeling of anxiety still exists. The feeling of a loss of control plays an important role in this component of anxiety.

Example: Someone with a traumatic sexual experience in the past is in a new sexual loving relationship. Rationally, this person knows that their partner is completely different from the past offender, and is not even scared of intimate contact in itself anymore. However, they do remember the anxious feelings and blockades from past relationships, and become anxious that these feelings of anxiety will return in this new relationship. While nothing might be wrong with the relationship in itself, the fear for fear can slowly grow until it fully paralyzes the person psychologically, resulting in that the new relationship can be impacted over time. This makes the fear of fear even more scary, and the person loses all feelings of control over this anxiety.

Most often there is a mixture of the different types of anxiety at play. Yet, it can still be useful to ask which type of anxiety is the most dominant. By asking this question in itself, one already starts to put anxiety into perspective.

The treatment of Anxiety

I. The diagnosis: what type of anxiety are we looking at?

Is there anxiety or stress at play?

It is important to firstly measure the level of anxiety or stress, and to note down the scores. One can do this by taking the free online self-test at and to fill out the score. While following the online self-help program, this is done automatically for you by the computer program itself!

Are we speaking of danger or imagined danger?

In the previous paragraph we could see how perceived danger could lead to unhealthy anxiety or an anxiety disorder. The first part of dealing with the anxiety, is deciding whether one is speaking of a healthy or an unhealthy anxiety.

The following questions can help with this:

  1. Is there a real risk or danger?
  2. Can that which I fear cause damage?
    1. How many euros, life years, or human lives could this damage entail?
    2. Can this danger be severe or life threatening?
    3. If yes, is it repairable or reversible
    4. If repairable or reversible, do I have the means or possibilities or contacts necessary to make this reparation happen? How many working hours or euros would this cost me?
    5. How large is the chance that this danger will actually happen? 1 in 10? one in 100? one in 1 000? one in 10 000? even smaller? ... (do not base the answer on a feeling of anxiety but rather on scientific or objective data, sources, or experts)
    6. Are we, instead, speaking of an imagined or perceived danger?

Anxiety or ‘fear of fear’?

The next question is how large the component 'fear of fear' is. This is important because people with anxiety disorders have the feeling that their anxiety will not be solved - even when all causes have been removed - as long as the fear of fear persists. A good exercise is to draw a pie chart an intuitively estimate what percentage of your anxiety is caused by real danger, how much is caused by imagined danger, and how much is caused by fear of fear.

Experience dictates that most people with anxiety disorders find that the fear of fear makes up over half, sometimes even up to 80% or 90%, of total anxiety. The real danger is often completely missing in the present. For example, someone with post-traumatic stress after a robbery, can have had real anxiety at that point, but years later in an entirely safe environment, the images and memories of this can cause an imagined danger in the brain.

II. Self-help: The 15 minutes technique

The 3 reference points for 15 minutes of self-help

In figure 2 we can, in green, see the three reference points from which one can break the vicious cycle. It does not matter which of these 3 ways one tries first. It is important to pick one angle and then practise this for 15 minutes each day. After several days or weeks, one can try using a different angle from which to deal with the problem. Later on, you can evaluate which one worked best and continue with this one.

1° Breaking through the perception of imagined danger

When the diagnosis has been made that one is dealing with imagined danger, it is useful to learn how to break through the internal 'trigger' or triggering factor. There are several techniques for this. It is useful to pick the technique which scores best. In online self-help programs, the software helps in making this decision. If not, one can try every technique for a few days until one finds the technique which works best.

1 - Diverting attention from unwanted thoughts and images

The simplest method is to divert attention from the negative thoughts, images, or interpretations. Often, simple tools like listening to favorite music, going for a walk, or having a good conversation with a friend, make for useful measures of help. The anti-worrying techniques from the previous article in this '' series or the anti-worrying exercise from the self-help program, or alternatively even the stop-technique found on are useful for this. Often we are unaware of the tens of small tricks which we subconsciously already know. Then, a software program can help you to gain insight into yourself as to what helps you stop negative thoughts or worrying.

2 - Reframing interpretations

Learning to recognize and change negative interpretations is very difficult on your own. This is why it is recommended to speak to your friends and to ask them how they interpret these same situations. This is useful especially when one picks friends who do not themselves suffer from unwanted anxiety. By speaking to them and seeing how they view that reality, one can look at new interpretations and make them one's own. Multiple conversations are often needed, because taking over someone's perspective often takes time.

Each time when one feels anxiety coming on, one can look at it from a different perspective by asking questions like: "How would by friend interpret these situations?" or "What questions would they ask themselves?"

3 - Reconditioning unwanted thoughts into wanted thoughts

The third method for getting rid of negative thoughts or pictures, is to look for positive thoughts, quotes or images which can replace the negative ones. This can be done as follows: one makes a list with the most important negative thoughts or images in the left column, and writes down a positive thought or image in the right column which can act as some type of antidote to the old unwanted thought.

This way, each time anxiety arises, one will ask oneself: "what is going through my mind right now?" and that thought or that image can then be replaced by concentrating on the positive thought or image from the list. This si best repeated during 30 days, because a new habit is automated by the brain after 30 days of daily training. The online self-help program '' will effortlessly lead you through this exercise!

2° Conquering the flight behavior

With real danger, anxiety decreases by fleeing from the life threatening situation, like we could see in figure 1 in the PDF.

From figure 2 we learn that this same flight response for imagined danger (perceived danger) leads to insecurity and the feeling of a loss of control over one's life. This often even goes together with a loss of confidence. This therapy aims to do the opposite of what happens here, by dealing with what it is which one postpones (procrastinating behavior) or flees from (flight behavior). This way, one practises to break through the anxiety which follows the flight behavior. It is best to practise this anti-flight behavior or 'persistent behavior' during a period of 30 consecutive days so you can persist through whatever it is which causes your irrational anxiety with a new habit.

3° Overcoming fear of fear

Last but not least, one must overcome the fear of fear. Sometimes it is so that the fear of fear suddenly disappears with the help of the previous exercises. With chronic complaints of over 6 months, however, this is often not enough: one must pay attention specifically to overcoming the fear of fear. All the previous techniques can be used here, really, but then the fear of fear must be used as the subject rather than the cause of the original anxiety.

Sometimes it is enough to ask yourself the question: "what I feel right now, is this fear of fear? Or is this fear of a perceived danger?" each time you feel anxiety coming on. It can be so that answering this question during a period of 30 days, each time anxiety arises, will be enough. If not, it is best to experiment with a combination of the previous techniques, or get assistance from the online self-help program or a qualified doctor or therapist.

Anxiety? Closing remarks

By doing the online self-test on every week, one can evaluate which of the above angles bring you to your goal of reducing anxiety and anxiety disorders most quickly.

The specific exercises in this article aim to reduce the anxiety of perceived danger and the fear of fear. A healthy dose of anxiety for real danger, however, should not be treated. Anxiety is originally a healthy feeling which aims to cause a healthy avoidance response in case of danger.

We concluded already that anxiety is a specific type of stress. This means that reducing the general stress level in your stress test is just as important as reducing your specific anxiety. Different techniques and insights which we found in research regarding the online self-help program which can help you with this have been described in previous articles in his series on burnout, panic, and confidence.

If you have questions, positive experiences with the use of these techniques or even suggestions for themes which you want us to take up in future articles, please let me know. I will read them all with great pleasure.

Paul Koeck, MD

Read/download the original article in full in Dutch (pdf): Overcoming anxiety in 15 minutes per day