Practical Tools for a Less Anxious Life - Donald Robertson

In this podcast episode, Donald Robertson delves into the nature of anxiety and its causes, drawing on his background as a clinician specializing in anxiety and now focusing on anger. He explores common misconceptions about emotions, effective treatments for anxiety, and the interplay of cognition and physiology in emotional experiences. The discussion spans exposure therapy, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), experiential avoidance, worry, and the importance of applied self-improvement. Robertson also reflects on the historical and philosophical roots of psychotherapy, particularly Stoicism, and shares insights into the dynamics of anger, its treatment, and its social implications.

How Anxiety Really Works

Donald begins by challenging the simplistic and widespread "hydraulic" model of emotions—the notion that feelings are like a pressure of energy building up inside that must be released or suppressed. He argues that this folk psychology is misleading and that emotions such as anxiety are far more complex. Rather than a formless blob, anxiety consists of a mix of interrelated ingredients—thoughts, feelings, mental images, memories, and behaviors—that combine like a recipe. This cognitive and behavioral "cake" varies significantly between individuals and types of anxiety.

Exposure Therapy and Habituation

Robertson highlights exposure therapy as the most empirically supported approach for anxiety treatment, dating back over half a century. Using the example of animal phobias (e.g., cat or snake phobias), he explains the physiological reactions such as heart rate surges and the powerful urge to avoid the feared stimulus. However, sustained exposure, particularly with encouragement from another person, leads to habituation—where the anxiety naturally declines over time as no harm occurs. This process, akin to classical conditioning, can often be rapid and durable, boasting a 90% success rate for simple phobias with proper application. The evolutionary basis of this mechanism ties back to early humans adapting to recurring but non-dangerous environmental stimuli.

Variability Across Anxiety Types

Robertson differentiates between types of anxiety, such as phobias, social anxiety, panic attacks, and PTSD. He points out that social anxiety involves a cognitive fear of negative evaluation rather than a straightforward phobic reaction. This makes exposure therapy more complex and slower, as the feared stimuli are often internal thoughts or social judgment rather than external objects. Nevertheless, exposure therapy remains effective, with somewhat lower but still substantial success rates.

Experiential Avoidance as a Maintenance Factor

One of the key reasons anxiety may persist despite treatment efforts is what psychologists call experiential avoidance—attempts to avoid or distract from anxiety rather than face it. This includes behaviors like avoiding eye contact, overpreparing for social situations, or obsessively controlling breathing. Ironically, these efforts interfere with normal habituation, preventing the brain from fully processing and extinguishing the anxiety response. Robertson stresses that acceptance of anxiety sensations, rather than suppression, facilitates recovery and long-term change.

The Secondary Problem of Anxiety About Anxiety

Robertson introduces the concept of second-order anxiety, where individuals become anxious about their anxiety symptoms themselves. This is common in social anxiety and panic disorders. For example, fearing that a racing heart signals impending death escalates panic rapidly. Successful treatment often involves learning to tolerate these sensations as harmless, which can be counterintuitive but is crucial for breaking the anxiety spiral.

Reframing Anxiety Sensations

By peeling back the label "anxiety," Robertson encourages people to observe the individual components—physical sensations, thoughts, behaviors—that make it up and to question their interpretations. For example, an increased heart rate during excitement or exercise is normal and not harmful. Learning to normalize and accept these feelings without catastrophic expectations weakens the perceived threat and supports habituation.

Integration with Acceptance and Commitment Therapy (ACT)

The conversation touches on ACT as a modern evolution within behavioral therapy that emphasizes acceptance, mindfulness, and cognitive defusion—distancing oneself from distressing thoughts. Robertson notes that ACT did not appear ex nihilo but built upon earlier cognitive and behavioral developments. Today's CBT practitioners often incorporate acceptance strategies similar to those highlighted by ACT. He emphasizes that acceptance of anxious thoughts and feelings correlates with better mental health outcomes, highlighting a cultural tendency to see anxiety as purely negative that therapy is now challenging.

Limitations and Pitfalls of Self-Help

Robertson critiques the explosion of self-help content in modern culture, noting that despite increased consumption, rates of depression and anxiety continue to rise. He suggests that some self-help techniques are maladaptive or misapplied, and that good advice often requires nuance, proper timing, and sometimes professional guidance. He points out that simple, evidence-based strategies remain the most effective but are underappreciated or misunderstood.

The Nature and Role of Worry

Worry is characterized as a mainly cognitive process involving repetitive, hypothetical thinking about potential problems. Unlike phobic anxiety, worry often does not elevate heart rate significantly but is associated with persistent muscle tension. Paradoxically, worry acts like a disguised form of avoidance, preventing direct emotional processing and maintaining moderate levels of anxiety chronically. Robertson presents worry postponement as a surprisingly effective behavioral technique where individuals delay worrying to a designated time, allowing for more rational and focused problem-solving and reducing anxiety frequency and intensity.

Cognitive Diffusion and Metacognitive Skills

To address intrusive worries that resist postponement, Robertson highlights the importance of metacognitive skills such as cognitive diffusion—observing thoughts as transient mental events rather than truths requiring immediate engagement. Techniques include referring to oneself in the third person when noticing anxious thoughts or simply acknowledging thoughts without elaboration. This fosters emotional acceptance without avoidance and helps to diminish the grip of anxiety.

Managing Visceral Symptoms and Relaxation

Regarding the physical sensations of anxiety, Robertson discusses relaxation techniques, especially progressive muscular relaxation developed by Edmund Jacobson. He explains the "effort error," where trying too hard to relax leads paradoxically to tension, and recommends a focus on letting go of tension rather than forcing relaxation. However, he cautions that relaxation exercises can backfire if used as an avoidance strategy aimed at eliminating anxiety rather than accepting and tolerating bodily sensations.

The Balance of Bottom-Up and Top-Down Approaches

Robertson leans toward cognitive (top-down) explanations and interventions for anxiety while acknowledging body-based (bottom-up) techniques can also be effective. He notes a lack of long-term comparative research on these approaches but suggests that cognitive restructuring and acceptance may produce more durable change by influencing underlying beliefs, while physiological techniques may offer temporary symptom relief.

The Centrality of Cognition in Emotions

Emphasizing the intertwined nature of thoughts and feelings, Robertson echoes the Stoic view that emotions are essentially cognitive in nature. Since we have greater control over our thoughts and beliefs than over raw physical sensations, therapy often targets automatic thoughts, underlying assumptions, and core cognitive schemas to reframe emotional responses and promote healthier thinking patterns.

Misconceptions and Reductionism in Anger

Anger, Robertson's current focus, shares many cognitive and behavioral features with anxiety but tends to be socially externalized. He discusses the reductionist tendency to attribute anger-provoking behavior to a person's entire character (e.g., labeling someone a "jerk"), which impairs empathy and problem-solving. This simplification mirrors social phenomena such as dehumanization, with profound individual and societal consequences.

Self-Directed Anger and Its Detriments

People often direct anger inward, engaging in harsh self-criticism and negative global self-labeling that is demotivating and damaging. Robertson identifies this as the worst form of self-improvement, fostering paralysis rather than growth. Cognitive approaches aim to challenge these negative beliefs and promote more nuanced and compassionate self-evaluation.

Distinguishing Feelings from Beliefs

The discussion touches on the difficulty of defining "feelings" due to their subjective and dynamic nature. Emotions often include strong cognitive components—beliefs and appraisals—making them more than just physical sensations. Robertson draws from Stoic philosophy, which defines emotions in terms of desires and beliefs about impending good or harm, highlighting that understanding this can empower greater control and clarity.

The Voluntary and Involuntary Aspects of Emotion

Emotions contain involuntary physiological and psychological components, but there are semi-voluntary elements such as muscle tension or behaviors that can be consciously managed. Acceptance strategies help address uncontrollable parts of emotion, while behavioral choices allow some control over the emotional experience. Awareness of this blend is essential for effective therapy.

Simplicity and Compliance in Therapeutic Techniques

Robertson emphasizes that the most effective therapeutic strategies are often simple enough to fit on the back of a business card, facilitating compliance and integration into daily life. The best interventions are those that people can remember and apply consistently, addressing a frequent limitation in psychotherapy where complex techniques are neglected outside sessions.

High-Effect but Difficult Therapies

While exposure therapy is highly efficacious, certain forms—like exposure and response prevention for OCD—involve confronting highly aversive situations and have high dropout rates. This highlights the challenge of balancing effectiveness and acceptability, sometimes requiring intensive or supported treatment formats to enhance compliance.

Applying Therapy Outside the Consulting Room

Robertson advocates for behavioral experiments and real-world exposure exercises beyond traditional therapy settings, such as social anxiety clients practicing interactions in public spaces. These activities break down avoidance in meaningful contexts and enable skill application. Shame-attacking exercises borrowed from Albert Ellis and the Cynics use humor and deliberate embarrassment to combat social fears.

Lessons from Ancient Philosophy and Stoicism

The episode connects modern therapeutic concepts to Stoic philosophy, which viewed emotions as cognitive and taught techniques for managing proto-emotions before escalation. The Stoics promoted voluntary hardship, continual self-observation, and premeditatio malorum—visualizing potential adversities—to prepare emotionally and cultivate resilience. These ancient practices parallel mindfulness and acceptance strategies in contemporary therapy.

The Problem of Compartmentalized Self-Improvement

Robertson critiques modern self-help habits where individuals acquire coping skills but fail to generalize or apply them under stress. He likens this to leaving tools unused or meditation practiced only in isolation. Consistent mindfulness and self-monitoring are necessary to integrate skills into everyday life, avoiding the trap of compartmentalization.

Anger as an Opportunity for Change

Noting that CBT achieves about a 70% success rate in treating anger—which he suggests is higher than for many other disorders—Robertson argues anger management should be prioritized as it has immediate risks to self and others, and improving it facilitates broader psychological change. Despite this, anger remains understudied in popular self-help due to stigma and reluctance to acknowledge it.

Anger's Relation to Other Emotions and Its Social Role

Anger often masks more vulnerable feelings such as hurt, shame, or anxiety. It serves as a coping mechanism to regain a sense of power or distract from pain. Robertson recounts a story highlighting anger's antisocial nature compared to pro-social emotions like sadness, which elicit support. Recognizing anger's roots assists in therapeutic processing.

The Distraction Function of Anger

Anger redirects attention outward, thereby shielding individuals from painful internal states and vulnerabilities. While this provides short-term relief, it impairs empathy and constructive problem-solving, potentially escalating conflicts.

Cultural and Social Dynamics of Anger

Robertson acknowledges cultural differences in anger expression, noting surveys where Americans report more frequent anger than Canadians or Japanese. He connects modern social media to increased anger and polarization, lamenting the disappearance of civil discourse and the rise of hostility in public dialogue.

Declining Interest in Psychoanalytic Approaches

Reflecting on his early career, Robertson shares his reasons for moving away from psychoanalytic and psychodynamic therapy. He found much of the theory arcane, unscientific, and detached from clinical reality, with examples of bizarre interpretations diminishing its credibility for him. He contrasts this with the clearer research base and practical efficacy of CBT and related approaches.

Personal Journey and Philosophical Alignment

Robertson recounts his own transformation from a highly angry youth to someone drawn to Stoicism and CBT. His experience reinforces the value of therapies that combine philosophy, cognitive restructuring, and behavioral change. He underscores that therapeutic frameworks resonate most when they authentically align with individual beliefs and experiences.

Resources and Continued Learning

Donald Robertson continues to share knowledge through Substack, offering articles and insights into psychotherapy, Stoicism, anxiety, and anger, accessible for those seeking deeper understanding and self-improvement guidance.