Key work events make me anxious. They give me chest pain, a churning stomach and disrupted sleep; my thoughts run through all the mistakes I could make and replay every bad experience in my past. Why put myself through this, I reason, which inevitably means that when, say, a high-stakes meeting is on the horizon, those feelings are worse, more intense, more prolonged. It’s a vicious cycle and one I admit early on when interviewing the anxiety expert Owen O’Kane.
O’Kane doesn’t seem surprised and why should he be? I bet everyone tells him about their anxiety. My dread, avoidance and catastrophising interior monologue are bog-standard these days: research by the Mental Health Foundation in 2023 found that 60% of UK adults reported experiencing “anxiety that interfered with their daily lives in the past two weeks”. We’re anxious about global geopolitics, the climate and the cost of living; our health, jobs, relationships and what strangers think of us. It takes children out of school and adults out of work. It’s an uneasy background thrum everywhere, something I have assumed to be a product of our ill-adapted, threat-seeking brains being constantly confronted with every terrible thing in the world through the shiny rectangles clutched in our sweaty hands (US psychologist and author Jonathan Haidt recently characterised a whole demographic of smartphone natives as “the anxious generation”).
So the title of O’Kane’s latest book, Addicted to Anxiety, and the question it poses (“Have you ever considered you might be addicted to anxiety?”) feel sort of confronting. Is O’Kane saying our anxiety is our own fault? He doesn’t look like a provocateur when he logs on to Zoom – his sweet dog is slumbering in the corner and there’s collage art reading “Love is the answer” on the wall behind him – so I wonder, did he have any, well, anxiety, about how it would be received? “I really agonised about the book and the title,” he says. “Then when I started to write it, I said, no, I believe whole-heartedly this is the book I want to write.” He’s aware it might sound tough. “Did I want people to stop and think and did I want them to catch their breath for a moment? Yes, 100%. Because I don’t think there’s enough of that. There are so many false promises about healing your anxiety forever, never worry again… There’s so much bullshit out there; I just think I don’t want to be part of that.”
O’Kane has seen enough anxiety to know we need something better than the “bullshit”. In his career as an NHS lead psychotherapist, he saw soaring levels of anxiety both in practice and reported in his reading. (“It was really clear that the research was telling us more and more people are anxious, younger population groups, older population groups and everything in between.”) He also observed it in his personal life. “With family members, with people I meet in the street, talking about their kids struggling, or their husband…”
His “aha” moment in terms of framing anxiety as an addiction came when he was running a small NHS anxiety group, which was making promising progress. He told the group that he noticed everyone seemed to be doing well, “I fed back the changes and noticed there was this deadly silence in the room. Then someone joked: ‘That’s made me a bit frightened that you said that.’” Another man, a former drug addict, jumped in. “He said: ‘Bloody hell, I thought it was hard to give up the drugs. But this is bloody addictive.’ The minute he said that, everyone in the group laughed, so they got it. And the thing was, I also got it. I thought, this is the one thing we don’t talk about enough. We talk about the ways you think, what happens in the body when you’re anxious, we talk about the process, but we never really think about that attachment to anxiety.”
O’Kane is at pains to stress that anxiety in itself is not bad: throughout the book, he describes the importance of treating the “anxious self” with compassion and gratitude. “It’s an important part of our humanity,” he says, and welcoming it rather than pushing it away creates a sense of ease and understanding; it’s just doing its job, after all. “Anxiety is designed to protect us and keep us safe. Without that mechanism, we would get into all sorts of bother,” he says.
In his own life, growing up in Northern Ireland at the height of the Troubles, anxiety was “about survival”, he explains. “To let your guard down or not be cautious or not be watching out for the next problem did lead to actual and real danger.” But for him, and for anyone inclined to or wired for high levels of anxiety, it’s easy to end up with “a mechanism that will just keep playing out threat, threat, threat”.
So we’re all anxious beings and circumstances or susceptibilities make us more so, but what makes anxiety addictive? “It’s not an official diagnosis,” O’Kane acknowledges in the book. “There are no 12-step programmes for anxiety addiction.” But anxiety does have a lot in common with mainstream addictions which, he says, “come with a promise: I will make you feel better; I will stay with you; I will get you out of this situation; I will take away your pain.” The mechanisms of anxiety, he argues, make similarly big promises. “I will protect you; I will keep you safe; I will stop bad things from happening. So, who wouldn’t want that? Who wouldn’t think that’s a really good thing to stay attached to?”
There’s a sort of magical thinking involved: we believe our anxiety is essential to keep us safe, so we get hooked on the feelings, sensations and thoughts – the altered state, actually – it creates in us. Anxious people don’t “wake up each day thinking ‘I need my anxiety hit,’” he writes, but they do “attach to their anxiety as if it’s a safety blanket.”
It’s odd to think of what anxiety provokes in the body and the mind – unpleasant physical symptoms, irrational thoughts, self-sabotaging behaviours – as comforting, addictive coping mechanisms, but that’s what they are, O’Kane suggests. They offer short-term relief from threat. “I can guarantee nothing will go wrong if you avoid that dinner party; I can promise you that you won’t feel rejected if you don’t apply for that other job. Those promises are alluring. But, of course, the problem is, the more hooked and attached you become, then the bigger the anxiety becomes and you get caught in this almost circular loop.”
So how do you break that cycle? The book provides a step-by-step guide, helping sufferers to acknowledge and accept their anxious selves, offering DIY techniques for deactivating their physical symptoms, accepting the emotions they are experiencing and detaching from anxious thoughts. Perhaps the most muscular part of the process is tackling what O’Kane calls the “rascals” – the behavioural strategies that offer short-term relief, but actually strengthen your anxiety longer term. These might include making excuses not to confront or do things that make you anxious, getting angry, impatient or argumentative, using substances to dull your anxious feelings, resorting to compulsive behaviours and rituals or constantly seeking reassurance from others.
Why do they need a firm hand? “I guess the robustness is because your anxious self needs to know that you’re in charge. Anxiety is a really powerful mechanism. It’s a life-saving mechanism, so it’s not weak. Negotiating with it has to be equally strong.” This is where the language of addiction is most helpful, O’Kane says, “because most habits are addictive”.
The parallels with addiction and recovery break down for O’Kane around the notion of powerlessness. The whole book – subtitled How to Break the Habit – is about precisely how much power we have over anxiety. “It’s about breakthroughs,” as O’Kane puts it. He has reservations about the notion of powerlessness in mainstream addiction treatment anyway, though he understands people find it useful. But with anxiety, the narrative of powerlessness is particularly unhelpful. “When it comes to this, you’re not.”
His own story is proof of that. In addition to spending his formative years in, effectively, a war zone, O’Kane describes in the book and in a very moving TED talk he gave in 2022, the fear, shame and pain of growing up in Northern Ireland both gay and Catholic and being ferociously bullied and humiliated. In one anecdote in the talk, he describes being called queer and spat on by a group of boys, then instructed by a passer-by to “wipe that off quickly before anyone sees you”. He landed in adulthood, he says, with “primal, hardwired responses to look out for threat even when it’s not there.”
Rebuilding a positive, functional relationship with his anxious self came through therapy and his psychotherapy training; he maintains it with “healthy choices”. O’Kane says he’s “unapologetic” about his wellbeing now: he eats well, maintains good sleep hygiene, plays the piano, walks his dog, exercises and meditates daily, a practice he describes as “a safety check”. He regularly reminds himself: “Whatever is going on in my life, I’m not that thought, I’m not that emotional state, I’m not my ego, I’m not the fear.”
Recovery, he says, is also about “not over-attaching to my story”. That’s apparent when I say I found some of those anecdotes very sad. “I see them differently,” he says. “I just try and see it as, OK, that was my experience and my story… then I had to salvage what I could from that.” His experiences deeply inform his practice, of course, and his special interest in anxiety; he returns often to the phrase “walking the walk” to describe that.
O’Kane didn’t need to include his story at all. He’s a highly respected professional and a bestselling author with a public profile; on the book cover Davina McCall calls him “A force for good”, and Scottish singer Lewis Capaldi, who has Tourette Syndrome and suffers from anxiety, a “Huge help”. But, he writes, he didn’t want to be the “Big Man”, in Northern Irish parlance; the lofty expert. Why was that important? “It’s a big ask, to ask people to explore their own humanity and to make changes in their life,” he says. “If I’m not willing to give some of me in that, I shouldn’t be doing the job.”
I find his writing generous, wise and very persuasive, particularly his description of anxiety as an “intolerance of uncertainty”: he identifies it as a compulsion to control; a focus on past and future to the detriment of the now. But – and it’s probably the rascally part of me asserting itself – I occasionally found myself thinking as I read, isn’t anxiety an appropriate response to the state of the world and a mark of caring about it? If we’re not desperately anxious about everything around us all the time, won’t that stop us from taking action? “The climate is what it is,” O’Kane writes at one point, but does it have to be?
“I never advocate avoidance,” he says. “The book isn’t, ‘It’s all lovely, let’s pretend it’s not happening’; it’s about, ‘We work with what is.’” It would be “sociopathic” he says, not to be distressed by, for example, the recent LA fires, “but it would be equally unhealthy if I spend every moment of my day worrying about that – then I miss so many other parts of life.” Nice as it would be to see anxiety as reflective of selfless concern for the world, in his experience, he believes, “For somebody who struggles with anxiety, it’s never driven by altruism; it’s driven by almost an obsession to try and control what’s happening.”
There’s a danger, too, he says of trying to “justify a highly anxious existence based on the state of the world. If the world’s chaotic and we’re operating from an internal chaotic state, two negatives don’t make a positive.” The aim, rather, is to work on creating what he calls “a steady inner platform” to manage whatever the external world throws at us.
In service of that, Addicted to Anxiety includes a list of “lifestyle stabilisers” including the likes of “get enough sleep” and “try to work in environments you enjoy (there is always choice if you explore it carefully).” This is self-evidently sensible advice, but is it always accessible to everyone? I know anxious insomniacs who would love to get enough sleep and work is about economic necessity above fulfilment for most of us.
O’Kane’s list is evidence-based, he counters; science shows this stuff makes a difference. When it comes to work, “I believe there are choices out there for every single person,” he says. “I meet people who say, ‘I really hate what I do’ and they languish and they stay in it, and I say, ‘I have to be that voice for you: if you’re prepared to stay in that situation at the cost of your wellbeing and health, that’s a choice you’re making.’” In jobs he’s hated, he says, “I’ve always made the decision, even though it hasn’t always been comfortable or practical to move and do something different. I’ve done it because I thought, I’m not compromising. I guess with a lot of these things, when you work in palliative care for 10 years…”
This, I think, is really the inarguable core of his writing: O’Kane has the urgent perspective of someone who has seen, again and again, that life really is too short: “Way too short to play these games with ourselves.” He’s helped 20-year-olds with months to live make decisions about how they want to spend their final days, which gives him a powerful certainty that there’s always a choice. That’s really the message of this book – we don’t have to remain in thrall to anxiety; we have choices. “So much of this is about getting out of your own way.”
Addicted to Anxiety by Owen O’Kane is published by Penguin at £18.99. Buy it for £17.09 from guardianbookshop.com