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The 11 psychiatric diagnoses that make up the Anxiety Disorders category of the current psychiatric nomenclature center on the manifestation of worry, concern about future threats, ruminations about performance and social acceptance, and avoidance behaviors; paradoxically, as these concerns are emotionally and cognitively experienced and acted on, the level of anxiety rises rather than falls. Anxiety symptoms often begin suddenly within the context of a specific event or challenging situation, yet may persist and manifest in an emerging chronic condition. Anxiety often co-occurs with depression and is linked to a variety of other conditions including substance abuse, interpersonal difficulties, and reduced performance in academic and professional settings.

Although anxiety is becoming more commonly viewed as a disorder with neurochemical origins that is therefore treated with medication, for a significant portion of patients who experience anxiety I believe their symptoms are related to accumulated stress, with the manifestation of anxiety symptoms constituting a stress reaction. A body of research exists indicating an existing and complex relationship between trauma and anxiety. It is this data, and my clinical experience with hundreds of patients who have presented to my practice with anxiety symptoms, that have led to my conceptualization of anxiety as an outcome of accumulated and unresolved stress.

To elaborate, I often tell patients with anxiety that the human mind is a lot like the hard drive of a computer. Each stressful experience, whether it be a minor disappointment or a more dramatic, even tragic, event, needs to be “processed” by the mind. This processing involves digesting the stressful experience or what is known as “metabolozing” it. For the most part, this occurs unconsciously and automatically in the recesses of our mind — unintentionally and completely out of one’s awareness. Metaphorically, the hard drive of a computer does a similar kind of processing: the applications ran on the computer, the websites visited, the various forms of media and so on are managed and liquidated by the hard drive again and again, which keeps the computer running efficiently.

However, the hard drive of a computer cannot process all the bits of material left from the accumulation of all of the computer’s functioning, and my IT consultant tells me that this remnant material becomes fragmented; a lot of fragmentation, he says, negatively impacts the speed and functionality of the computer, which is why he says the major “sweeping” software he uses on the computer to clean it up de-fragments these residual bits. The defragmenter integrates the residual fragments lingering on the hard drive, binding them together then destroying them as a whole unit. He has made the interesting point to me that no tool exists that is able to eradicate individually the millions of bits of fragments that may exist: they must be bound together first before they can be obliterated.

So too with the human mind. Each stress, each difficult event, even experiences of joy and accomplishment, all leave certain fragments or undetectable remnants that have not been fully processed naturally by the mind’s routine processing. Just as with a hard drive, these unprocessed, non-digested fragments accumulate in the background, over months, years, across one’s lifetime. Gradually and insidiously, these interfere and obstruct various components of one’s emotional life and behavior, but often do so covertly, without being detected. This is, for example, the underbelly of resilience. Resilient people often have overcome profound difficulties and hardships to achieve success and fulfillment, yet underneath their accomplishments resides a reservoir of fragmented unresolved experience that is insidiously impacting their functioning.

Ultimately, for all people, not just those who are especially resilient, as the accumulation of fragmented experience approaches a threshold, the mind is unable to manage or re-direct or destroy it. A panic attack is akin to what happens when the desktop of a computer suddenly freezes; the mind, overwhelmed by non-processed fragments, locks up, leaving the body in an activated physiological state that is much more intensive than the more tolerable symptoms of chronic worry, discomfort and distress that may have been in existence for quite some time.

To continue the metaphor, psychotherapy may be understood as serving to be a kind of “de-fragmenter” for the patient’s mind. As the patient recounts and processes key experiences in his or her life with the therapist, the therapeutic processing of this material stimulates new links and connections between experiences, binding them together and synthesizing the fragments into a conglomerate whole. This is often an arduous and difficult task, but in working together the therapist and patient often find a way to persevere through this linking process, with each link creating space in the patient’s mind and enhancing the patient’s cognitive, emotional, and interpersonal capacities.