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Anxiety - Fearing the Fear
"Every danger loses some of its terror
once the causes are understood"
William C. Styron
What is Anxiety?
As yu probably know, everyone experiences anxiety. In fact, it is a biological response that is necessary for our survival. If we are under attack, we need to be able to fight back or escape the dangerous situation as quickly as possible in order to survive. Our bodies are wise and, when we see or hear or feel signs of danger, our brains react very quickly - releasing certain chemicals that get our hearts beating fast and send a surge of energy to our limbs, so that we can fight or flee. The blood flow to our rational brains decreases (as this is a moment when we need our physical strength more than, say, our analytical rational skills), and it also decreases from our digestive systems (as the important thing at that moment is not to digest whatever food we might have previously consumed, but to run or escape!). This is called our 'fight or flight' response. A very mild level of anxiety might also be necessary and healthy for our growth and development, so if we are preparing for an exam or an interview or something that is important to us, a certain level of arousal is healthy, as it gives us the energy and enthusiasm we need to prepare and perform better, for our own good, if it something of value to us. If you were too relaxed or passive in a situation like that, you might not be so focused and enthusiastic, and that might impede you to perform to the best of your ability at that moment. So it is easy to see how anxiety, when appropriate, can be very beneficial. When anxiety becomes something that is unhelpful though, that's when we run into trouble.
Why does anxiety become unhelpful?
Sometimes, we get anxious not because of a real external threat, such as a danger to our survival or our growth but, instead, we experience anxiety because of something internal (like something we tell ourselves through our thinking). The problem is that our brain does not know the difference between a real external threat and an internal irrational threat, it just perceives the signals of 'danger' and immediately reacts with the 'fight of flight' response. This means someone could be sitting in the safety of their home, have certain distorted thoughts about something that might happen, our brain reads these as there is an actual (and very real) impending danger, and next thing we know, our body is reacting as if we were being chased by four hungry lions. If you are reading this and you have ever had a panic attack, you will know exactly what this feels like!
Most people (even if they have never had panic attacks of severe anxiety) have experienced this reaction to something internal in its milder form, such as when having to do a big presentation or speech in front of a lot of people - in reality, in this situation there is no threat to our survival or growth. In fact, even if we were to make a big mistake, we could use this mistake to learn and grow. But, if this is something we find a bit scary, our brain just perceives the signals we send it of 'danger' and, if we get very anxious, we might have a really unpleasant experience, not enjoy the presentation, and we might actually not really do it as well as we would have if we were calmer. In this case, the threat is actually more internal - perhaps we care too much what people think of us, or we are putting an unrealistic expectation on ourselves to be perfect, or we continuously catastrophes and visualise ourselves falling, or freezing or making huge mistakes…
In its more serious forms though, unhealthy anxiety can present in many forms, such as Generalised Anxiety Disorder, Panic Disorder, Hypocondria,… It can also be experienced alongside depression or OCD or many other mental health issues. When anxiety is severe, the person can experience a constant level of anxiety, sleeplessness, physical problems, IBS related problems, depression, low-self esteem, severe panic attacks, etc. In these cases, the anxiety can be triggered by specific events (such as going to a crowded place, a social event, work, school, etc.) or it can be pervading all areas of the person's life. When it is triggered by something specific, the brain has just learnt to pair that particular 'thing' with the 'fight or flight' response - so this is an automatic reaction that happens almost on its own, even when just the thought of facing the trigger situation arises. This is not the person's fault, it has just become something automatic (like for example, salivating when you see or smell a dish you know you love. Your brain knows you have had this dish before, it knows it is linked with pleasure and enjoyment in the mouth and it pairs the smelling and seeing with salivating). With unhealthy anxiety, a certain way of thinking (negative, catastrophic, irrational) is paired together by the brain with the scary situation. The more these two things happen together repeatedly (scary situation with distorted thinking) the more the 'fight or flight' response gets entrenched, and the more the scary situation is avoided, and the whole chain of reactions gets entrenched (scary situation plus distorted thinking plus 'fight or flight' response' plus avoidance). It is like a vicious cycle that feels impossible to get out of.
Avoidance is found to be another symptom of anxiety, in that the person learns to avoid any stimulus that is scary. So one might avoid any situations that can trigger anxiety (social gatherings, crowded spaces, supermarkets, or even work, school or college). This avoidance, even though the person is doing it as a way to help themselves not suffer, has been found to backfire: it makes the anxiety worse in the long run. The more a situation is avoided, the more the brain believes that the threat is real (as opposed to irrational) and the less we know how to cope in such situations. Another way of avoiding is to avoid the experience of fear itself.
What do you mean by fearing the fear?
What can happen sometimes is that the anxiety we experience is ultimately not about the external scary situation itself, but about experiencing anxiety or a panic attack in that situation. So, if a person's anxiety is triggered by social situations or crowds, the person is actually not so much afraid of the crowd itself, or the people in the social situation, but of having an attack or having anxiety in that situation. Another possibility is that one might even develop anxiety about the anxiety itself, and use avoidance as a way to help themselves, but this, again, backfires. So, for example, one might suddenly feel a heart flutter or a little tension in the chest, get afraid that this means a panic attack is on its way, have an aversive reaction to that ("Oh God, this is horrible, I won't be able to stand it" of " I want this to stop" of "I don't want to feel this"). This aversive reaction can actually cause the panic attack to happen. So ultimately, it is the fear itself that is feared. The physical sensations of the 'fight or flight' response become the trigger in themselves. It is important to understand the told that this aversion or avoidance reaction plays, in that it is key to maintaining the anxiety and making it re-ocurr time and time again. It is like a paradox: the more we avoid and fear the fear itself, the worse it gets. But the whole reaction has become so engrained, that it probably now feels that it is out of control and that it all happens on its own with any conscious choice on that person's part.
So what helps?
Recently it was discovered that the brain has a quality called neuroplasticity, which means that the brain can behave a bit like a muscle. The more a certain way of thinking and operating is repeated, the more this becomes automatic. This is what caused the problem in the first place, but it also means we can practice other healthier ways of thinking and behaving repeatedly, so that these also become a little more automatic. So there is plenty of hope. Perhaps the best thing to do when you start experiencing this is to contact your GP, so you can discuss your options with them and decide for yourself what suits you best. Some people find medication really useful (antidepressants can be prescribed or else anti-anxiety medication, although some kinds of the latter can be addictive, and can only be taken short-term). For other people though, medication does not really help, or they might prefer another approach. For these people, interpersonal therapy, CBT and mindfulness-based approaches can be very useful. Other very important factors that help are taking good care of oneself through exercise, a healthy diet, not too much alcohol, enough rest and healthy relationships. Also, reading books on the subject and practicing Yoga can be very beneficial. Yoga has very useful relaxation and breathing techniques that some people find very helpful, and it also keeps the body fit and supple. It is a shame that many Yoga classes have so few men in them… perhaps some people still place a little bit of stigma on Yoga, or perhaps it is seen as something a little 'alternative' or 'fluffy'. Yet, research has shown that, together with other life changes, it can be a very effective way to deal with anxiety. Cutting out coffee and stimulants is another very effective thing to do for people with anxiety. We are not implying that doing only this will get rid of the anxiety, but what we are saying is that these things can be implemented as part of other life-style habits, and together with some therapy or external support, in order to help manage anxiety.
Therapy, CBT and mindfulness-interventions all help in different ways, and different people have different preferences. With counselling (or interpersonal therapy), you might be able to figure out what in your past has set off the way of thinking that might underlie your anxiety, also the feeling heard and understood can be very beneficial and help you have a more compassionate and healthy relationship with yourself, and also working out a healthier lifestyle with your therapist. CBT is more action based, so you might work out (through the use of exercises you would do with your therapist) what kind of disorted thinking and core beliefs are underlying the anxiety, and get help to challenge and ultimately change these thoughts. Also in CBT, you can work out a step-by-step action plan, where you start to expose yourself (very slowly and in manageable, doable steps set by yourself) to the scary triggers, so that eventually these lose their power. In Mindfulness-based therapy, you would learn to become more comfortable with the physical sensations of anxiety, and to be able to let go more easily of the distorted thinking that comes up automatically when a trigger is present. You would learn meditation practices that you can then do by yourself, as a way to manage your anxiety.
If you have any questions about any of those therapies, please feel free to contact us.