June 18, 2012, 6:45 p.m. ET
Anxiety Can Bring Out the Best
Researchers Prescribe Just Enough Stress to Ace Life's Tests; Too Little Is Lazy
By MELINDA BECK
You have an important presentation tomorrow but your heart is racing and your mind is serving up a steady stream of what-ifs: What if I'm not fully prepared? What if it goes badly? You're running out of time. The last thing you need is all this anxiety.
Actually, a little anxiety may be just what you need to focus your efforts and perform at your peak, psychologists say.
Somewhere between checked out and freaked out lies an anxiety sweet spot, some researchers say, in which a person is motivated to succeed yet not so anxious that performance takes a dive. This moderate amount of anxiety keeps people on their toes, enables them to juggle multiple tasks and puts them on high alert for potential problems.
"Coaches and sports psychologists have always known that you don't want your athlete to be relaxed right before an event. You need some 'juice' to go fast," says Stephen Josephson, a psychologist in New York City who has treated athletes, actors and musicians.
It can be tricky to achieve. Some overly optimistic people and those with attention-deficit hyperactive disorder may lack enough anxiety to take action. Others—mostly procrastinating perfectionists—must create anxiety-producing situations in order to get anything done.
Regulating anxiety is also difficult because humans' ancient threat-detection system hasn't kept pace with modern man's ability to fret about the future, ruminate about the past and imagine all kinds of terrible scenarios, says Dennis Tirch, associate director of the American Institute for Cognitive Therapy in New York. So the body's primitive fight-or-flight response kicks in even when the threat at hand is a daunting social engagement or a 20-page report.
Of course, too much anxiety can be painful and destructive. Anxiety disorders affect about 40 million American adults—18% of the population—in a given year, according to the National Institute of Mental Health. Only about one-third of them seek treatment. The disorders run the gamut from panic attacks and specific phobias to obsessive-compulsive disorder, post-traumatic stress disorder and generalized anxiety disorder, a random kind of worry described as free-floating and relentless. Sufferers also have a high incidence of depression and physical ailments, including migraines, high blood pressure, heart disease, digestive disorders and chronic pain, according to NIMH.
The terms anxiety and stress are often used interchangeably, although stress includes anger and frustration, while anxiety is typically worry and unease.
The notion that moderate anxiety can be beneficial goes back at least to 1908, when Harvard psychologists Robert Yerkes and John Dodson posited that arousal (as they called it) enhances performance—but only to a point. When anxiety gets too high, performance suffers instead.
The Yerkes-Dodson curve—an upside-down U shape—is still taught in psychology courses, and modern neuroscience has helped confirm it. Studies have shown, for example, that the brain learns best when stress hormones are mildly elevated.
High anxiety can make even simple tasks more difficult, says psychologist Jason Moser at Michigan State University.
In a study published earlier this month in the International Journal of Psychophysiology, he and his colleagues monitored the brain activity of 79 female and 70 male students while they performed a letter-identifying exercise. The students performed equally well at first, but the women who identified themselves as highly anxious had to work harder at it. Those subjects showed far more activity in a part of the brain—the anterior cingulate cortex—thought to be a center of anxiety. And once the worrying women started making errors, they made them at a higher rate than the other subjects, suggesting that the extra effort the anxiety caused was taking a toll, Dr. Moser says.
How do you find the sweet spot between anxiety that energizes and anxiety that paralyzes?
Most therapists see more patients suffering from too much anxiety rather than too little, although withdrawal and lack of ambition can be a hallmark of depression. Dr. Josephson says that overly optimistic people with ADHD often have an insufficient sense of urgency to get things done. One form of treatment is what he calls "motivational interviewing: stressing the negative future consequences of not finishing and explaining that once the task is through, they'll feel a sense of calm and relief," he says.
Another group of people can't get anything done without some level of anxiety. "There are people who subconsciously set life up to give them a thrill, by always being almost late, nearly missing a deadline, spending more than they should," says Marianne Legato, a professor of clinical medicine at Columbia University in New York. "I call them fretters."
Stimulants like caffeine and cigarettes create the physical sense of anxiety artificially by constricting blood vessels and raising the heart beat.
Living with a constant anxiety buzz crosses the line into a disorder when people can't turn it off, or when it interferes with functioning. "Ask yourself: Is it causing significant impairment in my life, and is it causing significant distress?" says Dr. Tirch.
Anxiety is also dysfunctional if it is causing physical tension in the body, or if it is generated by a constant stream of self-criticism, which can be self-fulfilling. Being unable to sleep or relax without alcohol or medication are also red flags.
"Needing a glass of wine to relax is disconcerting," says Dr. Legato. "If you need solace at the end of the day, you are torturing yourself in some way."
Anxiety is especially self-defeating when people focus on the fear itself, rather than the task at hand. The best way to stay in the "sweet spot," Dr. Moser says, is to channel the anxiety into productive activity—like studying and acing the test. "I tell a lot of my patients that Nike really has a great slogan—Just Do It," he says.
Turning anxiety into action is also a major component of cognitive behavioral therapy, which is widely seen as the most effective treatment for anxiety disorders. Identifying and challenging self-defeating thoughts, and gradually facing the source of fears, can provide more lasting relief than antianxiety medications, psychologists say.
"If you have to take Xanax to get on the elevator, you never learn that the elevator isn't something to be afraid of," says Dr. Josephson. "You have to embrace the anxiety to overcome it."
That is often how psychologists help performers overcome stage fright or athletes snap out of a slump. Relaxation techniques such as meditation and deep breathing can bring a toxic level of anxiety down, but harnessing it can ultimately be more effective. Rehearsing a scenario repeatedly can help manage and defuse the fear.
"We'll say to athletes, 'You're going to be anxious. Great. Channel it and use it," Dr. Josephson says. "Being willing to feel some anxiety and not running away from it is huge."
Write to Melinda Beck at HealthJournal@wsj.com
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