Many clients with anxiety describe being in a kind of fog at times, feeling unable to do anything much or using escapes like TV or something else passive to distract themselves. Sometimes they wonder where the time went. I usually ask them to look at what they were thinking before they entered the fog and, if they can tell me, I almost always recognize that they've been engaging in irrational thinking that scares them in some way. Then, the task is to find the more rational thought and it's often one that doesn't make them feel fearful or as fearful. I ask them to write it down and refer to it anytime they feel they're entering the fog again or when they realize that they're engaging in the irrational thought again.

This is hard work for the individual and I've found that some people just can't seem to recognize the onset of the fog or get in touch with what they're thinking when the thought is very disturbing, so then the task is to help them develop mindfulness -- increasingly paying attention to more and more thoughts and learning to trace back from any feeling to a thought, as practice for recognizing when an irrational thought arises.Another way to approach this is to ask clients to focus as much as possible on whatever they are doing, in order to develop mindfulness.

I also frequently ask them to switch whatever they are doing to something engaging -- and to focus on it -- if they find themselves walking into the fog. Other people find that recognizing thoughts and challenging them isn't so difficult for them. This method is called cognitive behavioral therapy (CBT)

We know that this "fog" or unwanted absorption in a mindless, passive state of mind is the brain's way of escaping feelings of fear or discomfort. Unfortunately, in this case, the brain betrays us by only making the tendency to escape more frequent and/or causing worse anxiety. Avoidance of fear or anxiety makes it worse. The only way to overcome or decrease fear or anxiety is to face it.

If you need help to face your anxiety, you may need help to do it. Someone trained in anxiety counseling/psychotherapy can help you recognize when and why it's happening and consistently remind you to face it by using a more rational thought or becoming engaged in an engaging activity, or both. Your brain won't easily cooperate because it has been conditioned to take the usual escape route -- actually physiologically conditioned -- so it may well take its usual route until you intentionally fight back over and over and over again. In time, the tendency will disappear as a new route of neurotransmission is established (or even new neurons are created). This plasticity of the brain is what enables us to change these routes.

Although a serotonin re-uptake inhibitor (SSRI) medication can help a lot while you take them, if anxiety is very high, they are best taken while in therapy where you learn and accomplish this re-routing. Then, when you discontinue the medication, you should find that you can do without them. When people with anxiety don't do the actual work, they usually need to continue with the medication. A caveat here; some people will need them to control the anxiety even after they've mastered the re-routing, usually through cognitive behavioral therapy (CBT). We aren't sure why this happens, but it seems that these are people with especially difficult anxiety, such as OCD, perhaps a more complex anxiety, a dual disorder or some particularly resistant anxiety for an another reason. Even so, changes in life style, development of healthy habits, meditation, changes in attitudes or beliefs and other means can often help.

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