Case Study 1 — Jordan: The Thing He'd Been Managing

The Vocabulary

Jordan had never called it anxiety.

He had called it being driven. He had called it caring about the work. He had called it standards, or thoroughness, or simply the kind of person he was. He had, at various low points, called it exhausting — but even then, privately, as a complaint about himself rather than a description of something with a name.

Reading the chapter on anxiety in the context of a year of genuinely examining himself — the self-regulation work, the values clarification, the sleep changes, the first real conversation with Dev about the children question — he read the description of subclinical GAD and had the specific experience of recognition.

Excessive, difficult-to-control worry about a wide range of topics. Catastrophizing: the tendency to rapidly escalate from uncertainty to worst-case outcome. Anticipatory anxiety functioning as a chronic background condition.

The recognition was not alarming. It was, strangely, a relief.

He had been managing anxiety. The managing had worked, in the sense that he had built a career, maintained a relationship, navigated a significant professional transition. But the managing had been expensive — the over-preparation as a safety behavior, the difficulty letting positive feedback land (because landing it meant reducing vigilance), the 3 AM wakings that were, he now understood, the anxiety presenting without the daytime management infrastructure in place.

He had been treating the anxiety as a feature. It was a feature. But it was also a problem.

The First Appointment

He made the appointment with the psychologist — Dr. Nalini — after canceling twice. The cancellations were, he noted with some irony, themselves an anxiety response: anticipatory anxiety about what he might find out, dressed as scheduling conflicts.

The first session was assessment. Dr. Nalini was direct and unhurried.

She asked about the history — when he first remembered the worry being a dominant feature of his internal experience. He traced it back to high school: the night-before-exam review sessions that went to 2 AM not because more preparation was genuinely needed, but because stopping felt dangerous. The first internship, when he had spent three hours the night before a presentation rehearsing every possible question. The accumulated safety behaviors that had formed a layer of protection between him and the anxiety — and, incidentally, between him and the full experience of his own life.

"The preparation helped," he said. "I performed better when I prepared."

"For some things, yes," Dr. Nalini said. "What happened to the anxiety itself?"

He thought about it. "It didn't go away. It transferred to the next thing."

"That's the distinction. Preparation is a useful strategy for genuine performance demands. As an anxiety management strategy — as a way to make the anxiety stop — it doesn't work, because the anxiety's function isn't to signal that you need to prepare more. It's to signal threat. And once the threat system is calibrated at that sensitivity, no amount of preparation makes it feel sufficient."

Jordan looked at her. "How long have you known that this is what I've been doing?"

"About twenty minutes," she said. "You're very good at describing your own patterns. I suspect you've been analyzing yourself for a long time."

"Since approximately graduate school."

"Analysis is also a safety behavior," she said. "Understanding the mechanism doesn't change the mechanism. It's important, but it's not sufficient."

The Avoidance Inventory

Dr. Nalini asked him to track his avoidance behaviors for two weeks. Not dramatic avoidances — not things he refused to do entirely — but the small ones. The email he drafted and redrafted instead of sending. The conversation he mentally rehearsed for hours before having it. The decision he delayed because more information might reduce uncertainty (when no additional information would actually change the decision). The feedback he didn't give a team member because it might be received badly.

Two weeks. He filled four pages.

The patterns were unmistakable: - High avoidance of situations where he might be perceived as wrong or insufficient - Moderate avoidance of situations with genuine uncertainty (decisions without clear right answers) - Mild but consistent avoidance of situations where he might need to ask for help or admit a limitation

Each avoidance was accompanied by a justification that felt, at the time, like prudent deliberation. He had been very good at making avoidance look like thoughtfulness.

Dr. Nalini reviewed the inventory: "You're not avoiding easy things. You're avoiding things where the threat to your self-image is highest. Being perceived as wrong. Not having the answer. Needing someone else. What's the common theme?"

Jordan thought. "Control. Or — no. Appearing to have control. The actual situation is less important than how I look in it."

"That's the social evaluative threat dimension. The amygdala is most sensitive to the situations most relevant to your particular vulnerability. What made social evaluation the vulnerability?"

He told her about the family. Achievement-oriented, emotionally cool. His brother Marcus as the implicit benchmark. His father Edward's comment about writing not being a thing you build. The way love had been, if not conditional on performance, at least most legibly expressed through recognition of achievement.

Dr. Nalini listened. "The anxiety system learned the rule: your worth is demonstrated through performance, and failure of performance risks your worth. That's a very efficient anxiety factory."

"I've been feeding it my entire career."

"You've also built a career with it. The goal isn't to eliminate it — some vigilance, some preparation, some care for quality is genuinely useful. The goal is calibration. So it fires when there's actual threat, not at the background frequency of 'always.'"

The Exposure Work

The exposures Dr. Nalini designed were smaller than Jordan expected and harder than they looked.

The first: in the next leadership team meeting, allow himself to be uncertain about something without resolving it immediately. If asked a question he didn't know the answer to, say "I don't know — I'll find out" without the usual thirty-second recovery performance of pivoting to related things he did know.

This happened two weeks into the work. A VP in a planning session asked for the specific uplift from a segmentation change in Q3. Jordan didn't know the precise number. He knew it was positive. He knew the ballpark.

He said: "I don't have the precise number here — I'll send it this afternoon."

The VP moved on. The meeting continued. Jordan noticed the spike of self-consciousness — the anticipation of judgment — and noticed that it fell. Not immediately. But within four minutes, he had stopped monitoring the aftermath and was engaged in the next agenda item.

Afterward, he wrote in his learning journal: No one cared. The threat assessment was two orders of magnitude above the actual social consequence. This is what Dr. Nalini said would happen.

The second exposure was more significant: a one-on-one with Rivera in which Jordan shared his anxiety about an upcoming board presentation without framing it as concern about the content or strategic positioning. Just: "I'm anxious about how this will land."

Rivera blinked. "You seem so — I mean, you always seem prepared."

"I am prepared," Jordan said. "I'm also anxious. Those can both be true."

A pause. Then Rivera: "I get anxious before the team meetings where you're presenting new direction. I've never told anyone that."

"Why?"

"Because I thought I was the only one."

The Cognitive Work

The cognitive restructuring work was slower than the behavioral exposures, and in some ways harder.

The basic structure: identify an automatic thought that was producing disproportionate anxiety, examine the evidence for and against it, generate a more accurate alternative.

Automatic thought: "If I'm not the most prepared person in the room, they will question my fitness for this role."

Evidence for: Jordan couldn't identify a single instance where a colleague had questioned his fitness because he hadn't known something.

Evidence against: Multiple instances in which genuine uncertainty — acknowledged directly — had produced respect rather than judgment. VP Chen at the segmentation question. The CFO moment in Chapter 26 where he hadn't known the LTV methodology and the outcome had been a better technical foundation for his team, not a demotion.

More accurate alternative: "Appearing uncertain in some situations carries social risk that I have consistently overestimated and that evidence does not support."

Dr. Nalini was careful to note that cognitive restructuring did not make the automatic thought stop occurring. It made Jordan's response to it more calibrated. The thought still arrived. He was increasingly able to greet it with something like: "There you are. Let me check whether you're accurate."

Dev

Dev noticed something in April — about two months into Jordan's work with Dr. Nalini.

They were having dinner, and Dev mentioned something that had happened at work — a design review that had gone sideways in a way that left Dev feeling like a step backward. A small thing, not a crisis. Dev was processing it out loud.

Jordan listened. He did not immediately begin solving. He did not shift the conversation to logistics. He said: "That sounds demoralizing."

Dev looked up. "Yeah. It was."

"Did you figure out what happened?"

"I think so. I just needed to say it first."

A beat of quiet. Jordan: "I'm noticing I didn't immediately try to fix it."

Dev: "I noticed that too."

"It's something I've been working on. In the therapy. The anxiety — one of its expressions is that I manage others' distress by solving things, because sitting with distress is itself a threat signal for me."

Dev set down their fork. This was one of those moments — Jordan had been having more of them — where something that had previously been opaque became visible.

"You manage my distress by solving it because you're afraid of it," Dev said.

"Not afraid of your distress specifically. Afraid of what it means that I can't make it go away."

"What does it mean?"

"I don't know. Maybe that I'm not sufficient. That I can't protect you."

Dev was quiet for a long moment. "I don't need to be protected from things that are hard. I need you to be there while they're hard."

"I'm starting to understand the difference," Jordan said.

Discussion Questions

1. Jordan's anxiety had been managed through preparation and over-performance — safety behaviors that provided relief without addressing the underlying calibration problem. Why might high-functioning anxiety — anxiety that is "working" in the sense of producing good outcomes — be particularly difficult to identify and address?

2. Dr. Nalini described analysis as a safety behavior: "Understanding the mechanism doesn't change the mechanism." Jordan is deeply analytical. What does this insight suggest about the limits of self-reflection as an anxiety intervention, and what does it suggest about the role of behavioral work (exposure) alongside cognitive work?

3. The exposure of saying "I don't know — I'll find out" produced a spike of self-consciousness that resolved within four minutes. How does this illustrate the inhibitory learning mechanism of exposure, and why is completing the exposure (not leaving the situation early) critical to the therapeutic effect?

4. Jordan's automatic thought ("If I'm not the most prepared person in the room, they will question my fitness for this role") had no supporting evidence when examined. Why do cognitive distortions persist even when they consistently predict events that don't occur? What does this suggest about why cognitive restructuring alone is insufficient?

5. The conversation with Dev about managing distress through solving — "You manage my distress by solving it because you're afraid of it" — connects Jordan's anxiety to his relational patterns. How does this illustrate the way anxiety can express itself interpersonally, and what might changing this pattern produce for both Jordan and Dev?