Extrovert and Itrovert Anxiety: two original coping strategies

Anxiety is not the same for everyone.

Extroverts and introverts have different ways of manifesting their anxieties; therefore, they have different ways of coping with them.

For the extrovert, anxiety is turbulence, thick clouds of emotions with lots and lots of drama overwhelming everything and everybody around. So loud, convoluted and confusing can an extrovert’s anxiety become, that even she has difficulty finding the reasonable, rational ground. In the throes of such anxiety, it can be very hard to differentiate the ground of reality from the stormy emotional clouds.

An anxious extrovert:

· not shy talking about her feelings, and does it a lot

· is defensive, justifying her point of view over and over again even when nobody challenged it

· seeks constant approval; when that doesn’t come promptly, she becomes annoyed and even irritated

· often thinks and talks in circles, rehashing again and again details of an event or thought as a self-assurance that she did not make a mistake

· her thinking is dominated by fear: fear of not being liked; fear of not succeeding well enough in her intentions or failing miserably; fear of becoming irrelevant or obsolete while being secretly laughed at; and many other nameless, purely subjective fears.

For the introvert, anxiety is like a deep, painful internal churning. The introvert carefully hides his anxiety from other people’s eyes by remaining silent about it. He is often overwhelmed by it. He is ashamed of not knowing how to cope with it. He is overridden with guilt for keeping such a secret from those who love him and could help him, yet the humiliation of having a problem he knows not how to solve stops him from sharing it with them. With silence and time anxiety grows like an infection.

The more he allows himself to dwell in guilt and shame, the more overpowering his anxiety grows. At some point, the anxiety becomes so deeply rooted in his being, that it begins to work its deadly poison quietly and steadily outwards, slowly infecting the whole of the bearer's emotional being. Eventually he often fails to distinguish the real situation from his very distorted view of it.

When I hear one of my patients describing his anxiety in these terms, I think of a medical analogy of his anxiety with a very invasive infection produced by anaerobe bacteria that thrives in closed spaces of the body and in the absence of oxygen. While for most organisms oxygen is essential to their survival, for the anaerobe bacteria it is lethal. These infections can be produced by minor cuts or random contamination so the infected person may not even be aware when it happens. These infections begin in a localized area, but they spread very fast if not treated quickly. Carried in the blood stream, they can end up affecting the entire body and produce very difficult to treat abscesses with a potentially lethal outcome.

When my anxious introvert patients talk about their anxiety, in my mind appears this image of a figurative abscess produced by a highly aggressive “anxiety bacteria.” It is as deadly for the mind as the poisonous effect of an anaerobe abscess is for the physical body. The question then becomes: How much damage has the “anxious bacteria” already produced in my patient’s mind and emotional life?

What can the extrovert and the introvert do to quiet the mind and get rid of anxiety?

If we continue the metaphor, we can find two different ways to deal with it:

a) "Clouds or Ground" --for the extrovert with anxiety

b) "Fresh Oxygen" --for the introvert with anxiety.

The "clouds or ground" method helps the extrovert bring the calming winds of reason into their emotional storm. Getting in touch with reality and reason is calming because reality is nearly always better than what an anxious person fears--the worst case scenario—which is intensely feared but seldom happens in the real world.

If you are an extrovert suffering from too much anxiety, ask yourself “What is real?” It is a simple question people with anxiety don’t usually ask themselves. Their anxiety has substituted itself for and has become their reality. As the anxious emotions cloud every thought, the anxious extrovert becomes confused about what to believe: what he feels is true or what he reasons is true. Questioning anxiety distorted reality and contrasting it with rational reality is an important reality check exercise. It can greatly reduce the power of anxiety over mind and allows the power of your own mind to grow and take over the thought process instead. That’s why, when in doubt, call for help and trust your rational mind. Under the calming, steady wind of reason, the clouds of anxiety part and it becomes easier to separate the agonizing worries from reality--the airy, emotional "clouds" from the solid “ground" of reality.

"Clouds or ground?" To an extrovert suffering from anxiety, this can become the key question to confront the anxiety and diminish its power.

As soon as you question your anxiety, its convoluted clouds start to clear and the solid ground of reason begins to appear.

For the anxious introvert, I recommend using the "fresh oxygen" method.

How does a doctor in an emergency room treat a closed abscess produced by anaerobes? He opens it up. The most deadly antibiotic for these bacteria is oxygen. If the abscess is still localized, opening and cleaning the wound usually is enough to save the patient.

For the anxious introvert, the mental abscesses produced by anxiety also need to be opened and exposed to the refreshing “oxygen” of realistic thinking. Allowing the anxious feelings to surface, overcoming the shame and guilt they produced, and discussing them openly with loved ones or a therapist or a counselor or a very good friend is the equivalent of feeding “fresh oxygen” into an anaerobe abscess and sterilizing it. The anxiety ceases to hurt as much; and when confronted with an objective perspective of reality, it greatly diminishes in strength.

If you recognize yourself as an introvert dealing with anxiety, you may consider opening up about it-- initiating and conducting an objective reality check. Because of the subjective nature of anxiety, it will not survive rational thinking. Trust what your rational mind recognizes to be true, and the anxiety will loosen its grip on you. If you continue on this path, you will eventually clear all the fears and anxiety away from your mind until they no longer can hurt you. And if some new form of anxiety or fear tries to sneak in again, instead of nursing it in silence, you will know how to give it a healthy dose of “fresh oxygen” so that it will not be able to poison your mind again.

I hope these suggestions make sense to you. Try them and see if they are right for you. Feel free to modify them so they better fit your own needs. I am eager to hear your feedback about the experience.

Using the FingerPaint application on my iPad, I have done all the drawings in this post. I hope you have found them helpful and fun.

Visiting Kathmandu

Is a series started by the inventivity of Unknown Mami. She is amazing. Check out her blog! Click on the image of "Sundays In My City" and you will see other travel stories along with her own.

A visit to Kathmandu, the historic capital of Nepal is an adventure. It feels like going back thousands of years in time visiting the historic heritage places, many dating from 1000 AD and earlier, and it feels like a contemporary booming town visiting the modern areas of the city, which explodes with modern buildings built at a break neck speed, internet access everywhere, tremendous traffic and ubiquitous cell phones.

The Durbar Square,UNESCO World Heritage site, is considered the heart of the old town. It has been in active use since 1000 AD.

Here people continue to live in the "old ways," women still spending hours staying in line to get water from the water well.


The streets are lined up with shops selling Kashmir shawl, silk, hand made paper and many other things.

The ruins, palaces and temples, are monumental.

People who live there and and the visitors from around the world mingle among the ruins as a matter of fact, making this ancient place part of the present life, keeping the past alive.



Another water well. While women stand in line, they often chant or socialize.

Manufacturers of Durbar Square are master wood-craftsmen, transmitting their craft from generation to generation. They carve the wood so skilfully that it looks like lattice or lace.







Powerful mythical animals, like this lion, are placed as guardians at the entrances of the temples and palaces.



Another impressive site is The Great Stupa of Boudhanath, one of the largest stupas in the world. The Boudhanath neighborhood is home to many Tibetan and Sherpas refugees who have built homes, shops and restaurants around it giving it a Himalayan feel. This is the most frequented site for all Buddhists living in Nepal. There are scores of pilgrims circumambulating (walking around the stupa in a clockwise fashion) and chanting.


On each side of the stupa is painted a face with eyes looking in the four directions. They symbolize the eyes of the Buddha looking at the world and seeing it for what it really is. There is the third eye, in the middle of the forehead, symbolizing the divine power of God. In the middle of the face is a symbol that could be interpreted as the nose but it is also the Nepali symbol for number "one," which for Buddhists represents the one and only way out of suffering in life--following the Buddhist path.





Another important site is Swayambhu. It is believed that the history of the Kathmandu Valley begins with Swayambhu, a sacred spiritual site dating from the fifth century AD. It is believed that the site was chosen by the Bodhisattva Manjusri who marveled at the beauty of a lotus flower he saw growing in the lake that used to be here. The stupa and the temples around it have been built, neglected, rebuilt, destroyed in 1349 by a Muslim invasion and built again over the centuries.

Here is a panoramic view of the sacred mountain.




There are also many stands selling trinkets.


A beautiful Buddha statue dating few centuries ago. Right next to it, a contemporary painter selling his work.

The site is also the home of many wild monkeys who lived here for centuries. They are very playful with each other but don't appreciate the interference of tourists. For our safety, we followed a well known tourist rule: admire but don't touch.



I hope seeing these pictures rekindles your spirit of adventure and places Kathmandu on your map of interesting places to see, smell, taste--be there and experience it.

Guideline 1--Self-knowledge/Self-awareness: the third segment of the Better Than Cured Self-Guide E-course

The third segment of the Better Than Cured Self-Guide has been sent to those who subscribed for the e-course. Subscribing is easy: anytime you wish, you can enter your name and e-mail address in the sign-up box, and you will start the e-course from the beginning.

Thank you for being patient with me while I was working on this segment. At the same time, I was also working on another very important project for me. I have recently decided that I will transition to a paperless office. Taking advantage of the electronic medical records and electronic prescribing technologies, I have started this transition about ten days ago. Also using a scanner an a big shredder, I am now well on my way and I believe the transition will be completed soon.

I hope you will find this segment useful. I included here an excerpt from it, for those who have not yet signed up for the e-course but are curious about it.


Better Than Cured--A Six Point Self-Guide to Healing and Happiness
A Seven Part E-course

Guideline 1: Self-knowledge/Self-awareness

Everything begins with you. You are your own best means to create a happy, successful and balanced life for yourself and to extend that well-being for the benefit of others. You are at the center of your own inner world. By learning who you are, you can find your way to healing and happiness.

Self-knowledge and self-awareness are two mental processes at the foundation of knowing who we are—a complete sense of self.

Gaining self-awareness means becoming more objective observers of ourselves. It implies evaluating and contrasting our current behavior with our internal standards, beliefs and values. We need to compare and contrast our speech with our actions. It also means getting into the habit of paying attention to ourselves--to our feelings and our thoughts and our bodies. Practicing self-awareness sharpens our emotional intelligence and working memory, increases our abilities of reasoning and processing information.

Gaining self-knowledge helps recognize how we think of ourselves. It helps us realize our own identity, our true meaning, what makes us special, what motivates us in life, and how we appear to others.

Both are prerequisites for creating wholeness and happiness. Without self-awareness and self-knowledge, how can we possibly know what makes us feel good or how to make good choices? Without knowing what we want, how can we make plans to get there? And if we can’t build the life that we want, how can we ever be happy? If we don’t make an effort to get to know ourselves, how can we surpass our sorrow, guilt and ignorance in order to grow and evolve into better, kinder, happier beings?

From a spiritual point of view, gaining self-awareness and self-knowledge are the means to get in touch with our inner self and core being. They are means to actively find a way to rest our worries and catch our breath in the comfort and privacy of our own self. It means becoming fully aware of what is going on in our inner and outer world. These are important avenues toward balance and happiness in our own heart, where this transformation begins. From there, we can extend them to others through kindness and compassion—another important way to give our lives meaning and universality. How can we do all this? By opening our mind’s eye to observe and learn.

From a personal, individual developmental point of view, improving self-awareness and self-knowledge lead to building a renewed identity, realizing one’s true potential, understanding and utilizing effectively one’s strengths and talents, enhancing one’s quality of life and fulfilling aspirations and dreams.


Why are we even talking about gaining self-awareness and self-knowledge?
Because without self-knowledge there can be no self-improvement and no way forward. And without accepting the fact that everything changes inside and outside of ourselves, we will always be afraid of exploring the world outside of our limited patterns to make any progress. Accepting that we change along with the world that surrounds us will help us learn how to more consciously direct that change. Deny the possibility of change or try to stop it, and you will always find yourself fighting against the current, always trying really hard and unsuccessful to get things “your way,” always frustrated when that doesn’t happen. Accept change as inevitable, and you will swim along with the flow of your inner and outer world, the very current that was about to pull you under.

To read more, you are welcomed to sign up for the e-course.

Consider the e-course diagram and try adding to it words, pictures or drawings inspired by this section of the Self-Guide. You can e-mail it to me anytime you wish, even if it is only a work in progress.

Don't forget that you can leave your comments at the end of this post. I look forward to your thoughts.