The Fire Extinguisher You Can’t Live On
I remember the first time I met her. She was sitting in the corner of the exam room, hands folded, almost too neatly, as if she was trying to hold herself together with nothing more than posture and politeness. On paper, her case was simple: generalized anxiety disorder, history of panic attacks, prescription for Xanax.
But in practice, it was something much heavier.
As we talked, she confessed to me that she had stopped taking Xanax “as needed” and had started taking it like a scheduled medication—every morning, sometimes again in the afternoon, whether she felt anxious or not. She described it as her “insurance policy,” a guarantee she wouldn’t feel panic sneak up on her.
I understood the temptation. Anxiety has a way of not only hijacking the present but also haunting the future. What if the panic attack hits at work? What if I can’t drive home? What if I can’t face people? That’s pre-anticipatory anxiety—the fear before the fear itself. It’s the body pressing the accelerator before the car even starts moving.
Xanax, in her words, “fogged the windshield.” It dulled the racing thoughts. It numbed the pounding heart. It gave her space to breathe.
But it also taught her something dangerous: that she couldn’t breathe without it.
As a nurse, I see medications as tools, not crutches. And so I leaned into teaching.
“Your brain,” I told her, “is like a busy highway. When anxiety builds, it’s as though every lane is full of traffic speeding at 100 miles per hour. Cortisol and adrenaline are the ones pushing down on the gas pedal, and the cars just keep coming.”
She nodded—she knew that highway well.
“Now, Xanax works by releasing GABA, the chemical that throws fog onto the road. The fog forces drivers to slow down because they can’t see. It works, yes. But if you schedule that fog every single day, do you know what happens? You never learn how to control the traffic on your own. You become dependent on the fog. And worse—sometimes the drivers get used to it, and then you need more fog just to get the same slowdown. That’s tolerance. That’s dependence. That’s not healing.”
Her eyes fell to the floor, but I pressed on, gently.
“What if instead of fog, we taught you to work the traffic lights? To regulate the flow? To notice which cars don’t even belong on the road?”
That’s where we began—training her in anxiety, not medicating her away from it.
I explained pre-anticipatory anxiety for what it truly is: a story her brain writes before reality ever happens. It’s the prediction of danger. The “what if” machine revving up. And while Xanax quieted the machine, it never unplugged it.
So together, we practiced.
• Breathing techniques to tap into the parasympathetic nervous system.
• Cognitive reframing to challenge the catastrophic “what ifs.”
• Mindfulness exercises to bring her back to the present moment, where danger was almost never actually occurring.
• Gradual exposure to situations she feared, so her nervous system learned: I can survive this. I don’t need the fog.
I watched as she slowly shifted. At first, she clung to her bottle like a lifeline. But as the weeks passed, the bottle stayed in her purse longer and longer. She began using Xanax as it was intended—a rescue, not a routine. And she began to trust herself again.
The lesson I left her with is the same one I leave here:
Medication can be the fire extinguisher when your mind bursts into flames. But you cannot live holding down the lever of an extinguisher, flooding every corner of your life in chemical fog. The extinguisher saves you in the moment—but the long-term solution is learning why the fires keep starting and how to keep them from consuming you.
Xanax can put out the panic. But only you—through training your mind, understanding your body, and confronting the roots of fear—can stop the cycle of pre-anticipatory anxiety.
Because survival is not the same as living. And living is what you were made for.
- Adam Scott
Original Publish: September 5, 2025
