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Leaving the Nest: 10 Tips for Parents

It’s back to school time! A new crop of 18-year-olds are leaving home to begin pseudo-independent lives in college. This is the time of year when my inbox is flooded with emails from other clinicians who are using professional list-serves to assemble treatment teams for their patients who are going off to universities in other cities or states.

“Looking for psychologist and psychiatrist in Atlanta for student entering freshman year at Emory. Bipolar disorder diagnosed in February 2011; has been stable on new meds since suicide attempt in June. Patient is very insightful but needs close monitoring.”

“Need treatment team in Boston for incoming freshman at Boston University with 4 year history of bulimia and major depression. Weight is normal but patient engages in binge/purge symptoms 3-4 times per week. Patient has delightful personality but is very entrenched in ED symptoms.”

“20-year-old patient with anorexia nervosa, social anxiety, and OCD just released from our day treatment program needs multidisciplinary treatment team in Chicago as she returns for her junior year at Northwestern University. Patient was discharged at 90% of ideal body weight and is compliant with meal plan. Needs nutritionist, psychologist, psychiatrist, and internist familiar with EDs.”

“23-year-old patient with major depression and alcoholism is entering graduate school at UMass Amherst and needs treatment team. Has 2 months sobriety.”

As I read vignettes such as these, I can’t help but wonder whether it is in the best interest of these vulnerable young people to be away at college. Adjectives like “compliant” and “insightful” and “delightful” seem to be inserted to justify the decision to send the patient away to school and/or to entice clinicians to take on these challenging cases. Qualifiers like “2 months sober” and “90% of ideal body weight” do nothing to quell my apprehension. Frankly, they frighten me more.

Let me be frank: a psychiatric diagnosis is a game changer. Any artificial deadlines, such as an 18th birthday or the start of the school year, are irrelevant. Psychiatric disorders are serious, potentially disabling (think major depression, which is a leading cause of lost productivity in the workplace), even deadly (think anorexia nervosa, which carries a 20% mortality rate). Individuals with psychiatric diagnoses can and do recover and go on to lead productive, fulfilling lives, but this requires prompt, effective treatment and a supportive, low-stress environment for a sustained period of time.

The transition to college presents numerous challenges to even the healthiest and most well-adjusted young people: leaving their hometown, family, and friends; living independently in a different city or state; adjusting to dorm life; navigating new peer relationships and social pressures; managing one’s time and money; choosing a career path and taking academically rigorous courses; assuming full responsibility for nutritional intake, sleep schedule, physical activity, and medical care.

Let’s face it: the typical college lifestyle does not promote physical or mental health. Late nights spent studying or partying, daytime napping, chronic sleep deprivation, erratic eating habits consisting mostly of processed snacks and caffeinated beverages in lieu of balanced meals. Most college students drink alcohol socially, and many drink to excess multiple times a week. Widespread use of illicit drugs as well as rampant abuse of black market prescription drugs as study aids (e.g. Adderall) or sleep aids (e.g., Xanax) is a mainstay of university life. Casual sex with multiple partners, often unprotected and usually under the influence of alcohol, is the norm on most campuses.

Navigating these challenges successfully requires a certain level of mental and emotional stability. Maintaining good self-care in an environment where virtually everyone else practices unhealthy habits requires a maturity and strength of character that is beyond the reach of most 18, 19, and 20 year olds.

I have treated patients before, during, and after college, and have counseled their parents throughout this process. I worked at three different university counseling centers during my doctoral training. During that time I worked with dozens of students struggling with psychiatric illnesses and gained an intimate understanding of what universities do, and don’t do, to support students with mental health problems.

Now, as a psychologist in private practice near two large universities, I treat a number of college students as well as high-school students who hope to go away to college in the near future. I also have a few patients who had attempted to go away to college in the past, but experienced a worsening of symptoms, a full-blown relapse, or in some cases life-threatening complications which rendered them unable to live independently. These are young people who have returned home to the safety of their families and are now going through treatment to repair the damage with hopes of living independently in the future.

I have developed the following professional recommendations for parents of young people with psychiatric illnesses based on these clinical experiences as well as the latest scientific research:

1.) If your child is a junior or senior in high school and hopes to go away to college in the future, begin working with her and her treatment team now to establish criteria to assess her readiness for going away to college. I recommend collaboratively establishing a written plan which includes specific, measurable criteria which the child must meet before she is permitted to leave home.

2.) If your child has had life-threatening symptoms (suicide attempt, drug/alcohol abuse, eating disorder), ensure that her condition is in full remission for at least 6 months prior to letting her go away to college. For example:
– A child with bipolar disorder should have at least 6 months of mood stability without any manic or major depressive episodes.
– A child who has attempted suicide should have a minimum of 6 months without any suicidal behaviors, gestures, or urges.
– A child with a substance abuse problem should have at least 6 months of complete sobriety.
– A child with anorexia nervosa should have at least 6 months of eating independently without restriction while maintaining 100% full weight-restoration with regular menstrual periods.
– A child with bulimia nervosa should have at least 6 months of normalized eating with complete abstinence from all binge/purge behaviors.

3.) A young person going off to college should have, at most, minimal or mild mental/emotional symptoms. For example, a child with an anxiety disorder who has occasional panic attacks, or who feels somewhat anxious at parties around new people, may be able to function well at college, but a child who has panic attacks multiple times a week or who avoids most social situations is not yet ready to go away.

4.) Ensure that your child has effective tools to manage any symptoms that may arise. This may include CBT or DBT skills to manage feelings of depression or anxiety.

5.) Work with your child and her treatment team to develop a self-care plan that includes plenty of sleep, physical activity, time management, and balanced meals and snacks at regular intervals.

6.) Do not rely upon university services (student health center or student counseling center) to provide therapy, psychiatric, or medical services for your child. University counseling centers are not equipped to manage the needs of students with major mental health issues. Most student counseling centers are over-worked, under-staffed, and underfunded. By necessity, most have limits on the number of sessions each student can attend, and most will not support parental involvement in treatment decisions or even communicate with parents at all.

7.) Prior to your child’s departure for college, establish a treatment team off-campus.
– Interview the clinicians over the phone and schedule a family meeting in person with the clinician before the school year starts, during the time you are helping your child move into the dorms. If the clinician is reluctant to talk with you over the phone or refuses to meet with you in person, this is a red flag.
– I recommend selecting a clinician who welcomes individualized, appropriate parental involvement in college students’ mental healthcare. This means working collaboratively with parents based upon the individual patient’s needs in light of her diagnosis, history, and developmental stage, irrespective of her chronological age.
– Ensure that your child signs releases of information allowing you to communicate with the clinician regarding your child’s care (law requires that persons over 18 must provide written permission for a mental health professional to release information to anyone, including parents).
– Use the initial family meeting to provide the clinician with any relevant history about your child’s condition. Written psychological evaluations or discharge summaries from previous treatment providers are very helpful in this regard.
– Work collaboratively with the new clinician and your child to establish frequency of contact, and nature of communication, between you and the new clinician. For instance, I often work out a plan wherein I call parents every two weeks, or once a month, with a general progress report on the patient, without revealing the specific content of sessions (e.g., “Mary is adjusting well to dorm life. She’s had some mild anxiety but she seems to be managing it well.” Or “Annie has been struggling with an increase in depressive symptoms over the past week. I will keep you posted and notify you right away if there is any indication of suicidality or deterioration in functioning.”) Be very clear about the type of information that will be shared between clinician and parents. It is important for the patient to establish a trusting relationship with the clinician and to feel secure that, in general, “what happens in therapy stays in therapy.” It is equally important for the parents to be reassured that they will be notified promptly if the child’s condition deteriorates.

8.) Have a safety net in place. Decide exactly what extra supports will be provided, and under what circumstances, if the child should experience an increase in symptoms while away at college. For example: an increase in symptoms lasting longer than one week may result in the child coming home for the next weekend, or perhaps a parent would travel to stay with the child in a hotel for a week or two.

9.) Have a plan B.
– Work collaboratively with your child and her new treatment team to establish what conditions would warrant a more serious intervention.
– Some situations, in my opinion, warrant a medical leave and an immediate return to the safety of home. For example, a suicide attempt or gesture, an episode of alcohol poisoning, a weight loss of more than 5 pounds (in the case of anorexia nervosa) or a recurrence of binge/purge symptoms lasting longer than a couple of weeks (in the case of bulimia).

10.) Always remember, and reiterate to your child: whatever happens is feedback, not failure.
– A medical leave of absence is not the end of the world. Nor is it permanent. It is simply an indication that your child temporarily needs more support than can be provided in the college setting. It is no different from a young person taking a leave of absence for major surgery or cancer treatment (try getting that done in the student health center!).
– Many young adults recover more swiftly from a relapse compared to the first time they were ill – the benefit of maturity and the motivation of wanting to return to college and independent living can be very helpful in this regard. If your child does well at home and recovers from the relapse, she may be able to return to school away from home the following semester or the following year.
– Depending on the circumstances and the course of your child’s illness, it is possible that the best scenario for her would be to live at home and attend college locally, or transfer to a school in-state and come home each weekend. Again, this is not the end of the world. If her recovery is robust after college, she will still have the opportunity to go away to graduate school or start the career of her dreams somewhere else.

Attending college is a privilege and a gift, not an inalienable right. It is not something that one must automatically do right after graduating from college. Living away from home, apart from one’s primary support system, to attend a faraway school is a privilege unique to American culture, and is not a prerequisite for success in any way. In most other countries, young people who do attend college (and not everyone does) do so locally while living at home until they are married.

Take your child’s psychiatric diagnosis very seriously, and do the right thing for her health. As her parent, it is not only your right but your duty to make these decisions, and you should be supported by a treatment team that empowers you to do so.

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In Defense of Helicopter Parenting

Last month, Time Magazine ran an article about the dangers of over-involved, over-protective parenting (otherwise known as “helicopter parenting” because these parents tend to hover over their children). The article is well-researched, well-written, and very interesting. As a therapist who frequently encounters this phenomenon in the parents of my adolescent and young adult patients, and as a product of this type of parenting myself, I have a few thoughts and observations on the issue.

I agree wholeheartedly with the author that today’s parents are far too over-involved and over-protective, and this is particularly true amongst middle- to upper-class families with well-educated parents. According to psychologist Eric Ericson, the primary developmental task of middle adulthood (ages 30-50) is seeking satisfaction through productivity in career, family, and civic interests. This is precisely the age at which adults are parenting young children and adolescents, and for helicopter parents, their striving for productivity is channeled into their children. Parents’ intentions are good, but the outcome can be problematic. You see, the middle adulthood psychosocial task of productivity stands in diametric opposition to the adolescent developmental task of identity formation. Children need to play, explore, relax, and interact with their surroundings in creative, imaginative ways. Adolescents need to loaf, “hang out,” date, experience “teen angst,” spend quality time with family and friends, develop their social skills, make their own choices (within reason), make mistakes, and learn from them.

Ideally, a healthy person will emerge from adolescence with a solid self-identity, resilience, confidence, good problem-solving skills, and the ability to tolerate discomfort and failure. Having worked in several college counseling centers, I can attest that many kids arrive at college without these skills and attributes. Their lives have been geared entirely towards achievement in academics, arts, and athletics, often not for the love of science or music or soccer, but because their parents pushed them and/or because they believed it would improve their chances of gaining admission to a prestigious college. Quite often, they don’t know how to structure their time, study properly, deal with disappointment, or make decisions independently. Sadly, many of them do not know who they are or what they enjoy.

Helicopter parenting has the potential to be quite harmful to children by increasing their stress and anxiety and preventing them from developing self-confidence, resourcefulness, problem-solving skills, distress tolerance skills, emotion regulation skills, and creativity. Children and adolescents are over-scheduled, over-worked, and pushed to succeed, often at the expense of their emotional health. There is not enough unstructured time for kids to play, explore, or create. There is little room for adolescent identity formation in between AP classes, Princeton Review SAT prep courses, college applications, three varsity sports, band practice, clubs, and mandatory community service hours.

These issues notwithstanding, one problem I have seen far too often in my profession is the tendency for therapists to blame helicopter parents for causing their child’s eating disorder. It is easy to look at over-involved parents and an adolescent’s misguided search for control and identity through self-starvation and conclude that the former caused the latter. But the belief that over-involved, controlling, or enmeshed parents cause children to develop anorexia nervosa (AN) or bulimia nervosa (BN) lacks solid scientific evidence. What’s worse, this belief has the potential to undermine treatment, disempower parents, confuse children, perpetuate deadly symptoms, erode physical and mental health, destroy families, and turn an acute illness into a chronic and disabling one.

There is a correlation between over-involved, over-protective parenting and the development of AN, but correlation does not necessarily indicate causation. If variable A (helicopter parenting) and variable B (child’s development of AN) are correlated, there are several possible explanations for the relationship between these two variables:

1.) A causes B
2.) B causes A
3.) Variable C causes both A and B
4.) Variables D, E, F, G, H, I, J, K, L, M, and N work together in complex ways to influence the development of both A and B.

Let’s examine each possible explanation.

1.) Explanation 1: Helicopter parenting causes children to develop AN. There is no reliable scientific evidence to support this explanation. Ironically, this explanation is touted far more frequently than the others, even by clinicians who specialize in treating eating disorders.
2.) Explanation 2: A child’s AN causes parents to become over-involved or over-protective. There is some evidence to support this explanation. If parents were not anxious, cautious, protective, or hovering before their child developed AN, you’d better believe they will be once their child becomes ill. This phenomenon is not unique to AN. Parents of children with any illness or medical condition naturally worry about their child and do whatever they can to protect her.
3.) Explanation 3: A third variable causes both helicopter parenting and AN in children. There is a wealth of evidence to support the genetic transmission of AN as well as related personality traits. The personality traits that predispose people to developing AN – anxiety, obsessiveness, perfectionism, and harm-avoidance – are largely genetic. In an adolescent female, these traits are likely to manifest as an eating disorder. In a middle-aged, middle-class, intelligent, well-educated parent, these traits are likely to manifest as over-involvement, over-protection, and over-investment in their child.
4.) Explanation 4: A complex interaction of other variables work together to produce both helicopter parenting and AN in children. This is the most thorough, and probably the most accurate explanation. As stated in explanation #3, genetics plays a major role in the development of AN. A wealth of environmental variables are also believed to influence the development of parenting style as well as AN (e.g., level of education, income, culture, peer group, family background, exposure to stressful life events).

I love working with adolescent children of helicopter parents. I require parents to be fully informed and actively involved in their child’s treatment, and helicopter parents slide seamlessly into this role. They are excellent candidates for Maudsley Family-Based Treatment because their anxiety level is high enough to propel them towards action, they thoroughly educate themselves on their child’s condition, they seek out the best treatment and resources, they are vigilant and persistent, they maintain a very high level of involvement and supervision, and they are tremendously invested in their child’s recovery. Misguided, ill-informed, old-school therapists argue that these characteristics caused the child’s AN, and they advise parents to “back off” and allow the child to make her own choices about food and weight and treatment. This approach rarely leads to lasting recovery.

While helicopter parenting certainly has the potential to cause harm, it can also be used to the child’s advantage in recovery if channeled properly. Helicopter parents tend to be wildly successful in Maudsley Phase I (re-feeding / weight restoration), and largely successful in Phase II (helping the adolescent eat properly on her own). Some of these parents are eager to step back in Phase III as their child deals with psychological and social issues and develops a healthy adolescent identity. Other parents struggle to let go when the time comes. With proper guidance from a good therapist, however, most helicopter parents can learn to manage their own anxiety enough to allow their children to blossom and develop as healthy, independent young adults. This does not come naturally for them, but never underestimate the power of the helicopter parent. If the therapist who helped save their beloved child from a life threatening illness coaches them to step back and let go, they’ll do it.

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Lifestyles of the Depressed and Anxious

Despite miraculous advances in science, medicine, and technology, the rates of mental illness in the western world are higher than ever before. For instance, the rate of depression in the United States is ten times higher today than it was just two generations ago. Most mental illnesses are biologically-based and genetically-transmitted, but genes don’t change that fast, and we are biologically quite similar to our ancestors. Prior to the 20th century, human beings faced more risk and hardship on a regular basis than most of us will ever know, all without the advantage of modern science and medicine. But somehow, they were more resilient. How can this be?

Research suggests that many features of the modern lifestyle are toxic to our mental health. Most Americans have at least one, if not many, of the following issues:

• Too little sleep (less than 8 hours per night)
• Not enough exercise
• Insufficient exposure to sunlight
• Insufficient time outdoors
• Hectic, overscheduled lifestyles
• Too little “down time” to relax and unwind
• Poor eating habits (dieting, skipping breakfast, overeating, having too few fruits and vegetables, skimping on protein and dairy and carbohydrates and fats, eating too many processed foods, insufficient intake to meet one’s energy demands)
• High levels of stress
• High levels of caffeine consumption (more than 2 caffeinated beverages per day)
• Excess alcohol consumption
• Use of illegal drugs
• Over-reliance on prescription and over-the-counter medications
• Social isolation
• Underutilization of family and community supports
• Intense pressure (self-imposed and socially prescribed) to achieve and perform

Sound familiar?

Any one of these issues has the potential to trigger a mental illness in someone who is biologically vulnerable. The unfortunate reality, however, is that most Americans are dealing with several of these concerns simultaneously. No wonder we are so depressed and anxious!

Hundreds of years ago, our lifestyles were much simpler and much healthier. Our better habits were reflected in our mental health. Consider the Amish, who pride themselves on resisting societal change and maintaining their 18th century lifestyle. The Amish have very low rates of mental illness. I believe this is largely attributable to their lifestyles: they are physically active every day, they get plenty of sleep, they simplify their lives, they have low levels of stress, they eat naturally and nutritiously without dieting, they are deeply spiritual, they have a strong sense of community, and they rely upon their families, neighbors, and churches for social support.

Consider the Kaluli, an aboriginal hunter-gatherer tribe native to the highlands of New Guinea. Relatively untouched by modern society, their lifestyles closely resemble those of our ancestors. They live and work outdoors, they are physically active for most of the day, they eat naturally and bountifully from the land, they get plenty of sleep, and they rely heavily on their families and communities for support. A western anthropologist who studied the Kaluli people for nearly a decade found that clinical depression was virtually nonexistent in their tribe.

I would bet that many Amish and Kaluli people have biological predispositions for mental illnesses, but these genes are less likely to be expressed in an environment that protects and nurtures the body, mind, and spirit. We are less likely to develop body image problems if we grow up in a society without dieting and without a narrowly-defined, media-promoted, unhealthy standard of beauty. We are less likely to develop eating disorders if we live in a society in which everyone eats, effortlessly and without guilt, the types and quantities of foods that their bodies need. We are less likely to suffer from anxiety or depression if we are well-rested, well-nourished, and well-supported by our families and communities. Our children are less likely to show signs of inattention and hyperactivity if they get plenty of fresh air and outdoor exercise and have minimal exposure to television, computers, video games, and cell phones. We may discover that, if we are truly caring for ourselves, we don’t need a cup of coffee to wake up in the morning, we don’t want to go out drinking on the weekends, and most of our aches and pains will diminish without the use of Advil. We may find that we actually enjoy going to bed at 9:00 and rising with the sun, spending more time outdoors, being more physically active, and letting go of excess stress that weighs us down.

Perhaps our minds are not suited for the modern world. The evolution of our brains has not kept up with advances in science, technology, and other aspects of modern life. I am not suggesting that, in a Survivor-like twist of events, we turn back time and return to our ancestral hunter-gatherer environment. Science and technology and modern society are remarkable in many ways, and I feel fortunate to live in the twenty-first century. I am suggesting, however, that we take a critical look at the way we live our lives and examine the effects that our behaviors and lifestyles have on our mental health. We can learn a few lessons from the Kaluli and the Amish. We can place more emphasis on our own self-care and encourage our friends and family to do the same.

When I was working at a university counseling center, a colleague of mine had a client – a college freshman – who met full criteria for major depression and an anxiety disorder. This young man’s case was puzzling initially because his symptoms appeared rather suddenly after starting college and he had no family history of depression or anxiety. After a thorough evaluation, my colleague recommended a few simple behavioral changes such as improving his sleep hygiene, increasing the number of hours he slept each night, decreasing his consumption of alcohol and caffeine, and increasing his physical activity. Within two weeks of changing his habits, his symptoms had disappeared entirely and he was back to his full-functioning, high-energy self.

The moral of this story is that poor self-care not only triggers or exacerbates mental illness in those who are biologically vulnerable, but it can actually create a syndrome that appears identical to a mental illness in those without a predisposition.

Very few people fully appreciate the value of self-care. Children are taught to excel in school and sports and music and arts and various other extracurricular activities. They are taught to follow the Ten Commandments and keep their rooms clean and mind their manners and look pretty. As they grow older, they are taught to stay away from drugs and have safe sex and watch their waistlines. But who will teach them good mental hygiene? Self-care is either glossed over or ignored completely in school. Many well-intentioned parents don’t model good self-care – they are overworked, overscheduled, overtired, overmedicated, over-caffeinated, and undernourished. These parents may encourage good grades and good behavior, but they are unlikely to instill good self-care habits in their children. Most physicians overlook the role of lifestyle factors in triggering or exacerbating mental illnesses, and they use medication as the first line of treatment, even if the patient’s problem could be addressed more effectively with behavioral interventions. Many therapists do not teach their clients the importance of self-care in preventing and reducing the impact of mental illness, instead choosing to target cognitive distortions or family relations or interpersonal skills. Don’t get me wrong – these issues are important as well – but without the baseline of good nutrition, plenty of sleep and exercise, stress management, and other healthy habits, the client is likely to continue to struggle with some level of depression or anxiety.

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Fear Factor

Regardless of their diagnosis or primary presenting problem, most of the clients I see are struggling with some sort of anxiety. From an epidemiological perspective, this is not surprising. Anxiety disorders affect more than 40 million American adults in any given year and are more prevalent than any other type of psychiatric disorder.

Why are we so anxious? I would attribute it, in large part, to evolution. Anxiety is a universal emotional reaction experienced by all humans and most non-human species as well. Anxiety is a useful trait that has been shaped by natural selection.

Human beings are wired to respond to threat in a self-preserving way. When our body or brain detects danger, our sympathetic nervous system releases adrenaline and prepares the body to defend itself using one of three types of responses: fight, flight, or freeze. In response to threat, our heartbeat becomes stronger and more rapid and our breathing becomes faster and deeper in order to deliver more oxygen to muscle tissues in preparation for fighting or fleeing. Our pupils dilate to let in more light, which increases the sensitivity of our vision and helps us scan the environment for sources of danger. Digestion slows down or stops so as to conserve energy, and our mouth may become dry. Muscle tension increases in preparation for fight, flight, or freeze. All of these bodily reactions were vital in our ancestral environment. They allowed us to fight off predators to defend ourselves and our families. They facilitated us as we fled from all kinds of danger, from wild animals to brushfires to hostile natives. They made us freeze, like a deer in headlights, to aid in scanning the environment for danger, concealing ourselves, and inhibiting predators’ attack reflexes.

For tens of thousands of years, our ancestral environment was brutal. We faced life-or-death situations on a daily basis. Those of us with well-tuned fight or flight responses survived to adulthood and reproduced, passing their genes along to the next generation. Those of us with insufficient fear were less protected and tended to die sooner.

Fast forward to the 21st century. The fight-or-flight reflex is alive and well. If a car speeds towards us as we are crossing the street, we instinctually dart out of the way in a split second. When a masked stranger attacks us from behind, we make a quick jab to his stomach followed by a swift kick to his gonads, then run as fast as we can. These situations, though, are few and far between.

Advances in science, technology, and medicine have obliterated most of the threats our ancestors faced. Compared to people in previous eras, we face far fewer life-threatening encounters. And yet, we are more anxious now than ever before. Our ancestors feared storms, wooly mammoths, tidal waves, plagues, famines, droughts, and vengeful gods. What are we worried about? Our grades in school, our performance at work, our weight and physical appearance, our daughter’s loser boyfriend, public speaking, keeping up with the Jones, conflicts with our friends and partners, the rising costs of gas, swine flu, socialized medicine and Obama’s so-called “death panels.” Even more “legitimate” fears, like global warming, terrorist attacks, bankruptcy, and breast cancer, are probably less likely, less immediate, and less deadly than all our worrying makes them seem.

We do have an evolutionary excuse for this: the sympathetic nervous system tends to be all-or-nothing. It is not always modulated for varying degrees of danger. From a purely physiological standpoint, our bodies may respond the same way whether we are giving an oral presentation in school or being chased by a hungry lion.

Having some degree of anxiety is still advantageous in many ways. A bit of anxiety engenders caution, preparedness, and motivation. Mild to moderate levels of anxiety are associated with better school performance and higher occupational achievement. Anxiety protects us from engaging in dangerous activities, contracting deadly diseases, and acting in ways that may lead to social alienation. Anxiety, like most emotions and characteristics, can be positive when it is understood fully and managed mindfully.

However, the enormous number of Americans suffering from anxiety disorders suggests that something has gone awry with this natural, universal, ordinarily adaptive reflex. The problem, I think, is that in order to be adaptive, emotional responses must fit changing circumstances and challenges. In other words, anxiety is only beneficial insofar as it increases our fitness as a species in the modern world, allowing us to survive and thrive. We’ve been slow to adapt to certain evolutionarily recent threats. Our fears of ghosts, monsters, spiders, and snakes are perhaps a bit excessive. On the other hand, we could probably benefit from more fear of driving fast, cigarettes, and unprotected sex.

We are not slaves to our biology, and evolution is not destiny. The problem with biological determinism is not the biology; it’s the determinism. A number of psychological and behavioral treatments have been shown to reduce problematic anxiety. Through cognitive and behavioral techniques, we can gain insight into the workings of our bodies and minds, develop new ways of thinking, challenge our fears, acquire coping skills, and learn to live mindful, joyful, fulfilling lives that are not limited by anxiety.