So much of recovery from an anxiety disorder and/or OCD is in distinguishing the “what is” from the “what if.”  Your brain tells you something scary. Your threat-alert system is triggered, and you experience those familiar, uncomfortable sensations: butterflies in the stomach, headaches, dizziness, etc.

How do we know if this is a real or a perceived threat? How do we know if my fear is rational?

It’s a bit tricky to answer.

First, let’s talk a bit about the word “rational.” When we label a fear — or any thought really — we tend to attach a judgement to it: rational is good, and irrational is bad. We then try to resist or run away from the bad. Practicing mindful awareness, however, is practicing the art of acknowledging the fear or thought without judgement.

The Problem Isn’t the Fear. It’s Our Response to It.

And when we try to resist thoughts and fears, they persist.

For example, a thought crosses your mind that says, “I have cancer.” It’s true that you could have cancer. In reality, we all could have cancer.  That’s an unsettling thought, and I’m noticing how my stomach tightens even as I write this.

Here’s where people can get entangled in their experience. Just because my brain spit out this thought doesn’t mean it’s a fact. Just because I’m feeling physical sensations in response to the thought doesn’t mean that’s “a sign” that something is wrong.

If there’s nothing objective to give cause to the thoughts, my job is to acknowledge and accept how I’m feeling in that moment while I go on with my day.

If, however, you’re someone with health anxiety, it may be much harder to detach from the “what ifs” (“that’s so irresponsible and feels so wrong”) and let the feelings ride out. Instead, you may head right to Dr. Google, seek reassurance by seeing different doctors, ask your friends and family for advice, or check your body repeatedly. You want to “know for certain” you don’t have nor are you going to get cancer.

And this plays out over and over.

When the Fear Is Irrational.

Some fears are irrational given the person’s context. if I’m scared of getting bitten by a snake, scorpion or spider but live in a major metropolitan area, this fear is so unlikely given my context, it’s labeled as irrational.

If we’re hiking in the Sonoran Desert in August, that fear is more rational. I don’t know that it’s probable you’ll get bit, but it’s certainly more possible than when you’re in the city.

Possibility vs Probability

Jon Grayson, PhD, one of the most well-known OCD therapists, said “safety is just a probability statement.” (Your Anxiety Toolkit podcast ep. 181, March 18, 2021).

I love this, because it helps ground us a bit. When people get anxious, they go from a probability thinker to a possibility thinker. All of a sudden, things seem or feel riskier even though the objective danger may not be. They then treat their thoughts as facts (thoughts typically filled with assumptions and distortions) and use emotional reasoning, or how they feel as evidence of something, to make decisions. If I feel anxious, it means it’s dangerous.

In order to live a meaningful life, we have to accept risk. Discerning between what’s possible and what’s probable can help us know when our fear is rational.

To help, here are a couple of thought starters. These can help get us thinking about what feels risky and what feels excessive.

Example 1

What about the person who’s scared of contracting HIV but is in a monogamous relationship and doesn’t have a job where they regularly come into contact with HIV infected blood? They’re so worried about getting HIV that they avoid public restrooms, avoid doctors’ offices, have trouble being intimate with their partner, will only eat in “clean” restaurants? Is their fear rational? What about their response?

Example 2

What about the nurse who is also scared of contracting HIV and works in the emergency department? She wears 2 pairs of gloves, checks her gloves excessively for needle sticks, has been to infection control several times, because she didn’t know if she was stuck or not. She wanted to be sure she didn’t need prophylactic meds and won’t bring her “dirty” clothes into her apartment, because they could be contaminated. Is her fear more rational? Is her response excessive?

I think most of us can agree that the first example seems excessive since their infection risk is so low. In the second one, however, the risk is higher, though still relatively low — but her response is excessive. Both are spending so much time and energy trying to feel safer. To those of us who worry a lot, these examples illustrate the loop. You feel unsafe, so you engage in various physical and mental acts to try and make that feeling go away.

It’s exhausting and ultimately unsuccessful. You not only feel unsafe but often you end up feeling even more unsafe than you started out feeling.

It’s wasted time and energy. This is the cycle we want to help break free from. And it can be done.

If you’re in Ohio and are looking for a therapist, please reach out. If you’re out of state, check out the IOCDF or ADAA websites for providers in your area.