Compulsively Treating Anxiety

The way we treat anxiety says as much about our relationship with uncertainty as it does about the disorder itself. In the world of anxiety treatment, exposure therapy reigns as a critical aspect of helping patients gradually face their fears and decrease avoidance. Yet, a paradox emerges when any intervention to treat anxiety is implemented with excessive structure and rigidity—it risks reinforcing the very intolerance of uncertainty that fuels anxiety in the first place.

But there’s another, deeper layer to this issue: the relational dimension of anxiety. Therapy does not happen in a vacuum. How anxiety is met—both in childhood and in the therapy room—shapes whether a person learns to tolerate distress or compulsively attempts to control it. If anxiety is repeatedly met with rigidity, emotional unavailability, or coercive control, the person learns that the only path to connection is through self-discipline, perfectionism, and emotional restraint. In contrast, when therapy is an open, nonjudgmental space of both client and therapist—one where all emotional states, even defensiveness and hostility, are met with steadiness—it models a radically different way of relating to fear.

Anxiety begets anxiety—not just within an individual, but between people. When a parent, caregiver, or therapist responds to fear with their own subtle (or overt) anxiety—through rigid rules, emotional distance, or hypervigilant correction—the message is clear: Anxiety itself is dangerous and must be tightly controlled. This pattern is often intergenerational; anxious parents, for example, tend to model avoidance and hyper-control, transmitting a deep discomfort with uncertainty to their children (Affrunti & Ginsburg, 2012).

In rigid, emotionally unavailable relational environments, control becomes the currency of connection. The child learns that intimacy is not about being fully seen or accepted, but about performing emotional restraint well enough to maintain proximity to caregivers. This is not true closeness but rather attachment at a distance—a relational template in which security is conditional upon self-control.

This need for emotional self-discipline often carries into adulthood. Anxiety manifests as an intense need to monitor one's internal and external worlds to avoid misstep. The person fears that if they let go, they might spiral into chaos. But the real catastrophe is often unspoken and far more interpersonal: being seen as messy, uncontained, and therefore unworthy of connection.

Any therapeutic intervention when practiced rigidly can mirror this exact dynamic. When therapy becomes another system where interactions must be carefully managed, it unintentionally reinforces the belief that the world must be controlled in order to be acceptable. If a therapist anxiously ensures that the patient adheres to exposures, tracks progress meticulously, or becomes emotionally distant or quiet when a client resists treatment, the underlying message remains: I will be present with you only if you comply.

In contrast, when therapy embodies an air of allowing—steadfast but non-coercive—it rewrites the anxious relational script. This is where relational security becomes the real intervention, not just the protocol itself.

A therapist’s role is not just to guide exposures but to model a fundamentally different way of relating to distress. This kind of presence is not passive. It is not permissive or chaotic. Rather, it is a non-coercive, grounded authority, the kind that allows space for every emotion without fear of abandonment.

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In relational psychoanalysis and attachment-based therapy, much has been written about the importance of holding—the ability to psychologically contain a person’s distress without rushing to fix or control it (Winnicott, 1960). In the context of anxiety treatment, this really means remaining steady even when the client resists. Instead of pushing compliance when resistance emerges, the therapist invites the client to notice what is happening in their body and mind. If a client is angry, anxious, or withdrawn, the therapist does not demand emotional neatness before continuing. All interventions are simply opportunities, not obligations. If the client refuses, the therapist does not retreat into anxious correction or withdrawal. It also means that the therapist openly acknowledges their own uncertainty, mistakes, and emotional reactions without judgment as they arise in session, demonstrating that imperfection is not a threat.

These principles echo findings in attachment research, which show that secure relationships are not built on rigid rules, but on the felt sense that another person remains emotionally available, even in moments of struggle (Fonagy & Target, 1997). When we treat anxiety as something to be rigorously addressed, we reinforce its power. If, instead, we treat anxiety as something to be experienced within a larger, non-anxious relationship, we model something radically different: that fear does not require immediate resolution, that uncertainty can be held, not solved, and that distress does not make one unworthy of connection.

At its core, anxiety is relational. It is born in environments where distress is met with fear and control, and it is healed in environments where distress is met with presence and steadiness. True security is not found in control. It is found in knowing that no matter what arises; distress, confusion, terror, panic, joy, or hate, can arise and still be held, still be witnessed, still be accepted. If therapy mirrors the compulsive, perfectionistic stance toward anxiety, it will only reinforce the cycle it seeks to break. But if therapy embodies something different—a non-anxious, non-coercive presence—it can offer a real corrective experience.