• Feelings of anxiety and compulsive behaviours are connected

  • Therapist Roger Fife explains why this is, and what can be done to help

  • If you are struggling with OCD or anxiety, find a therapist here 

Many people experience bouts of anxiety, and these can feel distressing, debilitating and overwhelming at times. For some people, anxious feelings pass, and a sense of calm returns.

However, the people I tend to meet in my consulting room are generally finding that their anxious feelings have been around for a long time, and anxiety is affecting their life to such a degree that they are finding it difficult to cope. They need some help with understanding why they feel so anxious, some assistance in processing their raw feelings, and some containment while we gradually work at uncovering the root causes of their anxiety and any associated emotional conflicts, which are often held at a more unconscious level, and need to be gradually revealed and understood.

Because anxiety can feel so difficult there can be a natural desire to escape from it, and sometimes this is attempted via behaviours that are compulsive in nature. I want to try and think with you about some of these behaviours, what we can understand about what they might mean, and how therapy can be of use in treating the compulsive behaviours, and alleviating levels of high anxiety.

But firstly it might be important to ask what anxiety actually is.

What is anxiety?

Anxiety can mean many things and be experienced in a wide variety of ways. It is, in a way, an alarm bell going off telling you that something’s not quite right inside, that all is not entirely well within your mind. Anxiety can be disconcerting, frightening and confusing. It can feel debilitating and paralysing.

Anxiety can also be felt as physical symptoms such as: numbness, shortness of breath, bowel problems, nausea, dizziness, sweating and a generalised sense of fear or phobia.

Anxiety may be felt as a sense that things are out of control. Feelings of panic and fear can be overwhelming. There can be a deep sense of dread, that life is unbearable and just too difficult. And over time, persistent anxiety can lead to depression, withdrawal, and a desperate desire to escape from something that just feels unmanageable.

Compulsive behaviours

As a result of anxiety, there can be an unconscious drive to escape. And for some people, there is a move towards behaviours, actions, thoughts and strategies that can gradually become more compulsive in nature. So, for example, things like sex, food, alcohol and drugs can be used in a compulsive manner as a way to escape from anxiety.

Pleasure, excitement, thrill or even just a sense of soothing, can all be experienced when a person engages in something like sex, drinking, taking drugs, watching porn, or eating. Anxiety can, for a while, slip away and be replaced by other sensations, and a state of mind that is in essence a flight from anxiety. However, over time the desired pleasurable effect can become diminished and there is a need to do more to achieve the same feelings of escape, and the behaviour has to be indulged in more often, and for longer periods of time. With time, the eating, or drinking, or sex, or drug taking, becomes more compulsive in nature, and becomes in itself an additional problem, and an additional source of stress and anxiety.

Compulsive behaviours are a problem when they affect a person’s every day life in detrimental ways; and yet, in spite of this, the compulsive behaviour cannot be relinquished. The addictive or compulsive behaviour just can’t be given up, it’s become too important in managing anxiety, and this can lead to a number of problems including: damage to a person’s health, problems with relationships, problems with keeping a job, and lying and concealing the behaviours, while attempting to deny just how damaging they have become to the person and those around them.

A therapeutic solution to anxiety

As I mentioned earlier, anxiety is like an alarm going off, alerting a person to the fact that something is going on inside of them.

In therapy, there is the idea that talking and exploring thoughts and feelings gradually teases out material that has been held at an unconscious level for some time. Emotional conflict, painful memories, traumatic experiences and distressing feelings can all be explored.

Anxiety can gradually be connected to what has been forgotten, misplaced or suppressed. Talking about the things that are confusing, painful or frightening can allow some thinking and understanding to take place. Essentially, that which was unknown (but causing anxiety) becomes more consciously thought about and then understood. This can bring relief.

And with time, the therapeutic relationship and the therapeutic setting can become the place where a person can explore their darkest fears, their most painful memories, their anxieties about life, but now with the help of their therapist, not alone, and perhaps no longer with the need to compulsively escape from their anxiety.

The need for, and the meaning of, the compulsive behaviours can be talked about and understood in therapy. And thus I have found that, gradually, the therapeutic setting can become a more productive and viable place where a client can seek relief from their anxiety.

Talking, sharing, and thinking about problems can become a more active way to work through distressing emotions and troubling thoughts. It can feel daunting to start, and to stay in therapy, but the results can be that a person develops a much greater understanding of why they feel anxious and how they can work more consciously with their emotional problems, rather than having to resort to compulsive behaviours.

So therapy (and the relationship with the therapist) gradually becomes the place where anxieties are explored, emotions are processed and thinking can occur. It may take time, but a loosening of an attachment to a compulsive behaviour will emerge, and a greater emotional resiliency will develop.

When I meet a person who tells me they are struggling with sex, alcohol, drugs, porn, or food and that their behaviour feels compulsive to them, I wonder about what possible anxieties they may be holding. By listening carefully, being attentive to their emotional states and being empathically attuned to their distress, I aim to gradually understand what it is that is so troubling for them.

I hope to process some of the raw emotional distress that the client may hold, and working with the client, I try to develop an understanding of their difficulties, so that whatever has been the source of distress, anxiety and confusion can gradually be revealed, thought about, and ultimately worked through.

Rather than the need to escape from frightening or distressing feelings, a person may begin to talk with me and think about what it is that makes them feel so anxious. The need to engage with compulsive behaviours can be explored by the client and myself, with an understanding that the behaviours may have a deeper root in emotional conflicts, traumatic memories, and experiences that will benefit from being openly talked about.

It takes courage to begin, and sometimes to stay in therapy, but by meeting your fears and talking about your anxieties, then the need to escape may transform into an ability to engage with what is difficult, and to develop the resilience that will allow you to face your life with greater awareness and a capacity to think about yourself.

Roger Fife is a verified welldoing.org therapist in Central London

Further reading

Therapist advice if you're struggling with health anxiety and OCD

How to overcome your anxiety triggers

My journey with anxiety, OCD, and depression

Let's talk about intrusive thoughts and OCD