The most common thing I get asked after gigs is: ‘Are you really that anxious?’
It’s never a hostile enquiry, but I think it gets asked for two very different reasons.
My answer is always: ‘Yes, absolutely. Worse, in fact.’
Then comes one of two follow-up questions.
Follow-up #1 goes: ‘Really? But you seem so confident!’ sometimes delivered with an air of benevolent skepticism, as if I’m a stage magician refusing to break character after the curtain drops. I suspect they mostly mean it as a compliment – that I ‘hide it well’.
And they’re right to be skeptical, given that I’m choosing to disclose the information on stage, to a crowd whose relationship with me is, in part, financial. There are clear incentives for a cis-male, middle-class, able-bodied, straight white performer to emphasise his membership of a social outgroup – i.e. the mentally ill. I might be disingenuously painting myself as an underdog in order to make myself more sympathetic, or my presence on stage more heroic, or to syphon off some of the supposed countercultural cache of the romanticised outsider.
In other words: when I talk about my anxiety, am I indulging in the privilege equivalent of carbon offsetting?
I never thought of myself as anxious. I just thought I was experiencing a series of temporary stresses. Once this is over, I thought, I’ll be okay. I just have to get through the next week.
When whatever it was – moving house, going through a breakup, bereavement, trying to fund a new show – was more or less resolved, I’d justify my anxiety by telling myself I was still recovering. You’ve just been through a very stressful time, I’d tell myself, no wonder you’re exhausted.
Then something new would arise. Pretty soon I noticed there were no gaps between the times where I was ‘under extra stress’. And actually, my life was (and is) wonderful. I had almost everything I could reasonably ask for.
So why did my heart feel like someone had fired a tear gas grenade into a crowd of Barbara Cartlands?
Come with me, brave traveller, for a simulated panic attack. They come in a variety of flavours, but for today we’re going to settle on Panic Attack: Clare Edition. This is a sweet little mod that dials back the ‘am I having a heart attack? Am I going to die?’ element of the classic PA in favour of more raw-throated screaming.
The more analytically-minded amongst you will immediately discern that nothing in the scenario that follows is worth getting anxious about.
So you start off feeling a bit foggy. Imagine waking up without enough sleep, without your morning coffee – that ‘head stuffed with shredded newspaper soaked in hamster piss’ feeling. Thoughts come slower. Cognition is that little bit harder. Maybe add the tiniest intimation of a headache. There’s no anxiety at this stage – just a general miasma of stupidity. You have been bonked on the head by a cartoon coconut and don’t yet realise that the resulting amnesia has made you forget not to be terrified of pointless shit.
Next, you think about the day’s tasks. In fact, fuck it. You think about the year’s tasks. You think about your life’s tasks. You picture them all piled up in front of you – manage your relationship, engineer a steadily more successful career, cope with physical decline and the inevitability of death.
No. Come on now. You shake off the spectre of all these very real things and just try to focus on what you need to do this morning. What was it again? The fogginess in your head makes it hard to concentrate. You need to send some emails. You need to work on your latest chapter. You need to learn that new poem. You need to do some exercise. You need to do some tidying. You need to meditate. You need to read those two non-fiction books on the French Revolution as research. You need to buy some stuff for lunch. You need to put some washing in the machine.
Gnngh. That is too many things. The novel feels like the most important, but are you really likely to pump out any decent lines while you’re worrying about all these undone tasks? And what about doing that research? Isn’t that likely to inform what you write? Shouldn’t you wait? Isn’t it best to hold fire until you’re inspired?
Your chest feels a bit tight now. You’re very aware that you can’t achieve everything on your mental list today, and that even if you sat down now and rattled out the best fiction section of your life, you’d still have only inched towards your target.
Maybe you should do the exercise first. That’d clear your head. But you’re hungry. Maybe it’s low blood sugar. But if you eat, you can’t go for a run – that always makes you feel sick. So what should you do? Eat, and then work on your writing? But is that a way of putting off the run? Wouldn’t it be better to run now, then have a clear, unbroken writing session? There was something else you were meant to do today. It’s nagging at you. You’ve forgotten something important.
Your wife is trying to speak to you. She’s asking you something. You glance up and your heart is pounding and you have a headache. What is it?
She just wants to get past you, to reach the washing machine. But hang on, wasn’t doing some washing one of your things to do today? But you were just trying to remember something else. Wait a minute.
She asks if you can move so she can get past.
Just wait. You hold up your palm. Just… give me a second.
You were trying to think of something but it’s all gone fuzzy. What were you supposed to be doing? What’s going on? The day’s barely started and already you’re in a muddle. You can’t cope.
Your wife moves to squeeze past you.
JUST GIVE ME A MINUTE!
Please. You’re panting now. You can’t seem to get the air in. Please. If she’d just give you a minute, just to work out where you are. You can’t breathe. You can’t concentrate. Your head is pounding.
Please don’t be annoyed with me. Please just give me a minute, I can’t… Oh God. Not another panic attack. You’ve had such a good run without them. Not now. The thought makes your chest cramp and your head spin. Please. Just let me calm down.
She’s annoyed at you for shouting and you feel bad but also you can’t breathe and you need help but now you’re not only confused but you’re guilty and upset and resentful and this thing is swelling inside of you and it’s come on so suddenly and you’re definitely going to have one now, it’s too late, you’ve failed, you’ve screwed it up and you can feel your throat closing and the room spinning and you’re so afraid, so absolutely terrified and it feels like everyone’s watching you and judging you and they’re right to because you’re an emotionally incontinent idiot and NOTHING’S ACTUALLY HAPPENED WORTH BEING AFRAID OF SO SHUT UP SHUT UP SHUT UP SHUT UP
This is a good point to start screaming. Really push from the diaphragm.
If you find yourself running out of steam, remind yourself that you have singularly failed to manage your anxiety and now you, a grown adult, are shrieking and crying and snotting like a toddler. For no reason. Picture loved ones, friends, work acquaintances or – best of all – strangers and enemies, watching you like this, and reacting with a mixture of disappointment, disgust, or cruel amusement. Bring back that mental to-do list and emphasise the impossibility of accomplishing even one item. Wallow in self-pity then furiously castigate yourself for wallowing in self-pity, and imagine others sighing and saying ‘Look at him – wallowing in self-pity.’ Remind yourself you have no real problems and thus no right to feel like this. Tell yourself you are unworthy of sympathy and compassion. Scream some more.
Or, to put it another way:
Imagine you’re engaged in enthusiastic coitus (your choice of partner/s). Just as you achieve orgasm, your rectal wall is perforated by a 12-inch steel nail hitherto concealed in the mattress. You scream and scream and experience no pleasure and everyone around you thinks you’re weird and no one really understands how much pain you’re in.
I’m not sure I’m really getting this across.
Okay – what it isn’t, is a seizure. It’s not something that blamelessly descends upon me. It arises out of a succession of fuck ups I make – little things I tell myself, little precautions I fail to take. The responsibility, ultimately, is mine.
I know some people experience panic attacks exactly like a seizure. Often that’s the first presentation – they go to the doctor or A&E because they think they’re having a heart attack. They’ve never felt like that to me. They’ve always arisen out of worries or sudden stresses, spiralling. Panic attacks have always been unmistakably about fear.
Bring me the person who invented the portmanteau ‘Manxiety’ and I will happily upend a basin of lukewarm urine over their head.
Fuck you, broadsheet hacks. Fuck you and your spurious trend pieces. They demean us all.
As if anxiety is so inherently feminine that you have to regender the word to get it to apply to men. What a horrible, disfiguring thing to do to our men, to imply that their feelings of fear, anxiety and worry – universal human emotions – are somehow aberrant. What a horrible, disfiguring thing to do to our women, to imply that fear is somehow their lot, to deny them ownership of supposedly masculine emotions like anger, aggression, rage.
Everyone, whether they identify as male, female, genderqueer, or whatever, has a right to ownership of the full suite of human emotions. I mean, obviously, right? Fucking obviously. Yet culturally, fear is often characterised as inherently female, and anger as inherently male. This kind of moronic, completely unscientific binary thinking impoverishes everyone. And in any case, the two almost always come as a package. Angry people are usually masking a huge payload of vulnerability and fear. Fearful people are usually, deep down, really, really fucked off.
I recognise the positive intent behind such articles – to try to erode masculine prejudices against weakness and fear in order to save male lives – but far better to reach out to people by emphasising our common humanity rather than shoehorning real suffering into yet another twee faux-zeitgeist piece. ‘HUMANS HAVE HUMAN FEELINGS’ is not newsworthy. Plus ‘manxiety’ sounds really annoying. You just know we’re barely months away from a piece about the new epidemic of panic disorders in pensioners, ‘Granxiety’.
Sorry. It just makes me so mangry.
I started having panic attacks when I stopped self-harming.
I know self-harm is a loaded term and I feel weird about using it, because people associate it almost exclusively with self-mutilation. I never thought of it as self-harm because I never cut myself. When I got upset or hyper-anxious I would punch myself in the head as hard as I could, over and over. Obviously it hurt a lot, but it was calming. It felt good to punish myself because, in those periods, I genuinely hated myself and my inability to feel normal. It wore me out and pretty soon the fear would be replaced by this drugged, woozy stupidity. I couldn’t concentrate, it was hard forming sentences, and it left my head bruised.
But it felt better than panicking.
Eventually, people who loved me suggested, rather sensibly, that hitting myself in the head was a suboptimal strategy for dealing with my problems. So I stopped. Without a way of releasing all that building anxiety, I began to have panic attacks.
It should tell you something about how horrible a panic attack is, in the moment, that someone would rather repeatedly belt themselves in the skull rather than have one. When they’re happening, they feel like the worst thing I’ve ever experienced.
They’re not as bad as all that, of course. They don’t physically hurt you. They cause no more lasting harm than a bad dream. But in the moment that you’re having one, they’re unbearable.
I tried going on medication for my anxiety. I had no effect except that I gained weight, and I began to worry that, if I forgot to take my pills, I’d have a panic attack the next day. If I was feeling this bad while on them, I reasoned, how trouser-pissingly cack-handed would I be without them?
One night, I was staying in a hotel before an 18-hour flight when I realised I’d left my pills at home. I’d just read that suddenly coming off meds while doing a long-haul flight could trigger a psychotic break. In a moment of brilliant originality, I started having a panic attack. I phoned around but I couldn’t find anywhere who could sort out my prescription, and in any case I could barely speak I was so terrified. In the end, my wife drove overnight from Norwich to Heathrow to deliver them to me, then turned round and drove home, had half an hour’s sleep then went to work. She is… I have no words. But you get the idea. She is the Best Person.
I’m not criticising anyone who uses medication to help manage their moods. Often it’s the rational, responsible choice. If I found a pill that stopped my anxiety without any horrible side-effects I’d jack in all this flouncy self-development crap in a second. I took some codeine for a headache last week and the resultant floaty calm left me friendlier, more resourceful and feeling deeply optimistic. It was like my best self had risen to the surface. Perhaps, I thought, I should just take codeine every day. I mean, whoever heard of someone getting addicted to painkillers?
I’m not above shortcuts, but only if they work long-term.
It’s been two years now since I quit drinking. There are a few reasons why I decided to stop (crap decisions made while pissed being one of them) but the main reason was that the shaky, hollow comedown of the hangover offers excellent campaigning weather for panic demons. I was hungover a lot.
Without booze, my depression has pretty much disappeared. But in its place has risen acute anxiety. It turns out that, in the short term, alcohol is a helpful way of muffling those anguished anxious voices. ‘Tomorrow will look after itself,’ we used to say, cracking open another bevvy. There’s a crazy optimism to drinking which I miss.
The problem with panic attacks isn’t so much the panic attacks – although they are debilitating, humiliating, and deeply unpleasant – but the fear of panic attacks that starts to develop. I found myself losing confidence in my ability to do even the simplest of tasks without spiralling into panic. I would avoid answering emails if I thought they might be stressful. I put off writing to avoid the dispiriting feeling of writing badly or not being able to come up with any solutions.
The exhaustion that comes in the wake of a panic attack only exacerbated this. And everyone around you says: ‘Take a rest. Don’t push yourself too hard,’ but they don’t explain how you’re supposed to do that while paying the bills or keeping up with the kind of nourishing activities that stimulate your mind and help build a solid bedrock of self-esteem. So you’re struggling to manage basic everyday tasks and failing while feeling guilty both for pushing yourself so hard and for sacking it off to play Pokémon when it becomes overwhelming.
The standard advice – especially in CBT courses – is ‘don’t be afraid of having panic attacks’. Well thank fuck for that. What shrewd, timeless wisdom. If only I’d considered that possibility. Look, here’s my guide to avoiding farming accidents: ‘Don’t allow your arm to become caught in a thresher.’
It’s almost as if… brace yourselves… panic attacks were an irrational, maladaptive response to stressful stimuli. Saying ‘Don’t be afraid – there’s nothing to be afraid of,’ might seem like helpful, compassionate advice, but please remember – people with anxiety disorders might have trouble managing fear, but we’re not stupid. I know there’s nothing to be afraid of – or at least, that fear does not materially help me overcome the problem – and yet, sometimes, I am still extremely afraid.
As well as quitting alcohol, I have tried Cognitive Behavioural Therapy, medication, hypnotherapy, self-help books, relaxation CDs, regular exercise, talking therapy and meditation. Each of these has been eagerly presented to me at some point as ‘the answer’.
I’m really happy for you if you’ve suffered from severe anxiety in the past and one of these methods has helped you manage or cure it – lots of people swear by CBT, for example – but, for me, none has yet brought it under control.
That’s not to say the process hasn’t been positive. In January, I tried going for a run and had to stop, wheezing, after five minutes. My mouth tasted all coppery and I felt winded for the rest of the day. I’m now running an average of 11k a day, 6 days a week. I’m lifting triple the weight I started with. Doing exercise hasn’t stopped my panic attacks, but it does give me something positive to focus my energies on and it probably means I’m slightly less likely to die at 44, clutching my chest and saying the word ‘bargle’.
Talking therapy has helped me feel a lot better in myself. I think I’m unusual in that I hated CBT. I was being hammered by several panic attacks a week and I felt like I was going mad. I’d go to a scheduled appointment with a therapist doing CBT, explain a bit about what I was going through, and they’d get out a photocopied worksheet with ‘Stages Of The Panic Cycle’ written on it, and ask me to work through it.
You know what? I’d have quite liked in that moment for them to just say: ‘Bloody hell, Tim. That sounds rough. I’m sorry you’re going through that.’ CBT touts its practicality, which is why it’s been so widely adopted, but in my experience an overemphasis on flowcharty solutions has elbowed out the very humanity which is at the heart of good therapy.
CBT also emphasises lots of homework, such as noting down your feelings when you have them, keeping diaries of problems and difficult thoughts, rating predicted enjoyment of events versus actual enjoyment, etc. If one of your key anxieties is failing to manage your workload, you can see how adding a significant extra string of tasks – all of which involve engaging with difficult, painful feelings – would be problematic. CBT seemed to assume I possessed skills necessary to recovery, rather than explaining how to develop those skills.
Significant portions of each session were spent filling out surveys rating how I felt in terms of anxiety and depression. This is because I was getting CBT through the NHS, where mental health support is chronically underfunded and different schemes are constantly having to prove their efficacy through empirical evidence. Specifically, they want to show that you have been missing days of work because of your illness and thus, by curing you, their intervention has benefited the economy.
This is what you get when you allow the National Health Service to come under the cosh of myopic, ideologically bankrupt incompetents like the Tories. If someone like me – a guy with lots of familial and social support to cushion me, who suffers from a deeply unpleasant but relatively manageable issue – finds the system unhelpful, slow, frustrating and cold, just imagine how many far, far more vulnerable people it is failing, sometimes fatally.
Unfortunately you don’t need to imagine, there is plenty of data on underinvestment in mental health provision in the UK. You can sign a petition to protest this here. Lots of skilled, compassionate people are struggling to provide care in a neglected, cash-starved system. It sucks. We have the power to change that.
Talking therapy has not stopped my panic attacks, but it has helped reduce their frequency, duration, and after-effects. Most crucially, it has made me feel like a human being again. Having someone impartial listen and respond with genuine human empathy, made such a fucking huge difference. I can’t explain how important it has been to finally get to talk about it to a neutral listener without fear of alienating or boring or shocking or disgusting someone. I felt like, without realising it, I’d been waiting for the chance my whole life.
Meditation is not a magic bullet. It’s not really about relaxing, either.
I try to meditate every day, but it can be hard to make the time, especially with that anxious part of your mind that is forever turning on its heel, Columbo-like, forefinger raised to say: ‘Just one more thing.’
So I let myself be satisfied, sometimes, with only getting 10, or 8 minutes. Sometimes I manage 30 minutes a day for a whole week. Sometimes I get an hour in.
The problem is, the more you expect it to do something, the less it does. Meditation is about watching your thoughts and letting them be as they are. There’s no mystic trance state and it’s actually thoroughly mundane.
It can be hard at times, and I’ve heard some anxiety-sufferers say they can’t meditate because it gives them panic attacks. I understand that totally. Meditating leaves you alone with your thinking. It denies you so many of the distractions that help one avoid unpleasant thoughts.
It’s not a terribly flattering practice. During and after meditation, I’m acutely aware of how busy my brain is, about how quick I am to take offence or rush to judgement, of how much time I spend lost in egotistical fantasies or worrying over unlikely doomsday scenarios.
But I suspect it’s an important one. At its best, meditation is like Bullet Time for the mind. It slows down all the processes so you can watch them happen. So you can recognise them as processes.
There’s still some unease around meditation and its associations with religion and pseudo-mystic hokum, and – despite some promising studies linking meditation and mindfulness with increased neuroplasticity, resilience to stress, and even illness recovery rates – I think a certain amount of skepticism regarding the big claims that have been made is appropriate.
I continue to meditate with a spirit of sincere inquiry (well, okay – and with the occasional twinge of smug piety). It feels like a practical, proactive response to my condition, but I don’t pretend it’s the only answer and I certainly can’t advocate it as a ‘cure’ because it hasn’t proven so for me. The most I can say is that it helps.
I’ve never attempted suicide but I’ve felt suicidal many times. Exhaustion and feelings of worthlessness and terror can grind you down. I’ve spoken to the Samaritans twice, and both times it brought me some relief. Rereading that it sounds a bit like I phoned up and wanked off. I didn’t. But the chaps I spoke to both times were very nice and I’m sure if that’s what I’d needed they wouldn’t have begrudged me it.
I’m not advocating you toss yourself off to suicide hotlines but if you’re feeling very low or desperate do remember there are lots of resources out there. The mental health charity Mind has a really good website, with lots of resources that can help, even if you’re just feeling a bit overwhelmed and could use some tips. Of course the Samaritans have a website, which contains their phone number if you need someone to talk to.
It’s very easy to feel ashamed of mental health problems, even if you believe that they shouldn’t be stigmatised. We often hold ourselves to a very different set of standards than we would a friend or loved one.
When me and my wife had just moved in to our new house, I had a panic attack. The next-door neighbour came round because she thought I’d fallen down the stairs and was screaming for my life. That was how we met her.
I felt mortified. I felt totally ashamed that I’d made such a fuss and I felt so sorry for her, someone who’d had her day disturbed by an idiot yelling, and who was probably now worrying about the nutter who had moved in next door.
In the end she was very understanding and nice about it.
I still feel awful and embarrassed, but, y’know. If you want to live in a world where people who suffer mental health issues aren’t made to feel subhuman, you have to start talking about your own issues as if you are a worthwhile person who deserves understanding and dignity. I didn’t mean to make a racket, and I’m trying my very best to get better.
My friends and family are amazing and supportive. They know I struggle and it’s not a big deal to them. They love me for who I am and sometimes they even take the piss out of me for it. That’s important to me. I don’t want anyone treading on eggshells on my account. Unless I’m recording some kind of complicated sound effect.
Sometimes, when I read other people’s accounts of suffering with anxiety, I still catch myself thinking ‘oh for fuck’s sake, get over yourself.’ It’s hard to shake that feeling that anxiety is more than faulty wiring or maladaptive habits, but a failure of character.
Especially when it’s me doubled over on the floor, clutching my throat, begging for it to stop.
Sometimes people with panic disorders experienced a traumatic event or a particularly difficult period in their life. Sometimes there was no particular trigger. The etiology doesn’t really matter.
Feeling compassionate towards someone with a panic disorder – or indeed any problem – doesn’t require labelling them or accepting that they’re helpless or divesting them of responsibility for their own welfare. I know I’m the only person who can do the work that will help me manage my problematic emotions. I’m as guilty of periodic self-pity as anyone, and it’s especially easy to fall into that trap when you’re feeling tired and low.
But I don’t cling to anxiety as an identity. I look forward to a day when the most I can say on stage is ‘I used to suffer from panic attacks’. No one would choose this. Trust me.
How do you perform on stage if you’re so anxious?
Good question! It does make it harder.
The worst anxiety tends to come days or weeks before the gig, when I worry about organising transport or getting there on time or that nobody will show up or that someone in the audience will be aggressive or that I shouldn’t be going away because I should be spending more time with my wife or I have too much to do or that I don’t have enough new material or that my material is too new and untested or that the gig will exhaust me so much I won’t be able to cope the next day.
When it comes to the actual gig, the performance acts as a heat sink for all those worries. I can push them into it and let them fuel me. It’s actually a rare period of relief, like chundering your guts up after a long spell of nausea. And afterwards there’s that post-vomiting high, too, where I feel serene.
Like any drug, there’s a comedown – once the high wears off I get sluggish and stammery, and the next morning I’m usually exhausted. But while it lasts it’s fucking ace. It’s like crack, and the process you have to go through to acquire it is almost as convoluted and expensive, and involves just as many nights sitting in strangers’ skanky living rooms at 3am, pretending to be interested while they talk bollocks.
So, do I use my anxiety to try to manipulate my audiences?
I mention it on stage because it makes a good talking point and it positions my persona and it briefly lowers my status, which makes the audience feel good by comparison so they start rooting for me. All entertainment is a form of benevolent manipulation. People have come into the room to see a show. There’s an implicit contract.
I also mention it because I’m not a very good actor and if I didn’t address it they’d see me pacing and sweating and shouting and would think I’d been hoovering lines before the gig. (some people still do, in fact; after a school gig last month, a boy came up to me and gave me the greatest half-compliment I’ve ever received: ‘How much caffeine do you have to drink to get so awesome? My friend says you’re on drugs.’)
I mean, even writing a post like this is largely performative. I’m doing it, in part, in the hope that it’ll make you like me. I’m also terribly worried it’ll have the opposite effect and make me seem like a whining, emotionally incontinent, pretentious, attention-seeking fraud.
But that’s the risk you take when you make stuff and share it. Anyway, at the beginning I said there was a second follow-up question.
Sometimes, after people ask: ‘Are you really that anxious?’ and I say: ‘Yes. Absolutely. More so,’ their shoulders drop, and they exhale, and they smile.
‘Me too,’ they say.
This happens, on average, every other gig. ‘It really helped to hear you talking about it,’ they say. Then we have a conversation about anxiety, trade symptoms, anecdotes. It’s lovely. It makes me feel a lot less lonely. The people I talk to invariably seem rather nice, and encountering proof that one can be both anxious and nice is surprisingly important.
Because, if it’s true of them, maybe it’s true of me.
Every time I’ve heard someone who suffers from anxiety talk about their anxiety, whether publicly or one-to-one, it has helped. It makes me feel less weird, less inhuman, more hopeful.
And that’s a big reason why I continue to talk about it on stage, and why I’ve chosen to be as honest as I can about it here. I’m sorry that it’s such a long post, but I haven’t talked about a lot of this stuff directly before, and I felt like it was important to give as true a picture as possible. If you think I sound whingy, or self-absorbed, or like a dick, you’re entitled to your opinion. You might even be right!
Lots of people suffer from anxiety, stress and worry – the Stress Reduction courses I went on were packed. Sometimes you might not identify what you’re experiencing as anxiety – often it manifests as irritability, impatience, chronic procrastination, or insomnia. Stupid as it sounds, I hit myself for years without realising what I was doing counted as self-harm or was anything but normal.
Your problem doesn’t have to be serious for you to address it. I’m not saying you should pathologise the perfectly normal ups and downs we all experience and which are part of the richness of being alive, but if you sometimes feel anxious and you’d like to look at ways of coping when you do, that is a perfectly legitimate reason to start exploring. It’s not a competition, and you don’t have to wait until you’re on the kitchen floor sobbing before you have the right to ask for help.
I don’t know the One True Path to beating anxiety (I suspect it differs for everyone) but I do believe that the more we talk about this, the easier it gets for everyone.
Unless of course my association with anxiety forever taints it, like Clarkson wearing Levis. In which case I can only apologise for my selfishness.
I am doing a stand-up poetry show about anxiety called Be Kind To Yourself, Aug 2-24 at the Edinburgh Fringe. It’s free. By all means don’t spread the word, but bear in mind that my anxiety is largely triggered by fear of disapproval and failure.