Emotion: Anxiety

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry. These disorders alter how a person processes emotions and behave, also causing physical symptoms. Mild anxiety might be vague and unsettling, while severe anxiety may seriously affect day-to-day living.

Anxiety, and its close cousin fear, are both considered emotions. While there is considerable overlap between these two terms, there are some important differences. Fear is generally considered a primary emotion. In contrast, anxiety is considered a secondary emotion that represents the avoidance of fear (including the avoidance of fear-producing stimuli). Primary emotions refer to emotions that are recognisable through facial expressions. Primary emotions can easily be interpreted by an observer and exist across different cultures. These primary emotions are: happiness, anger, sadness, fear, surprise, disgust. Sometimes we have secondary emotions, an emotional reaction to an emotion, for examples: feeling angry when you experiencing shame or feeling angry when you have a shame response (e.g., hurt feelings). Secondary emotions, such as anxiety, are not readily recognisable to an outside observer. Secondary emotions are generally considered an internal, private experience.

The most important distinction between fear and anxiety is the timeframe. Fear is the response to a danger that is currently detected in the immediate, present moment of time. In contrast, anxiety refers to the anticipation of some potential threat that may, or may not, happen in the future. In other words, fear is a response to an immediate danger in the present moment of time, while anxiety is associated with a threat that is anticipated in a future moment of time. Anxiety reflects the anticipation of fear and represents an adaptive attempt to prevent the fear-provoking circumstance from occurring. In an anxious state, people are readying themselves and preparing themselves to cope with a future problem or dilemma that they anticipate will cause some kind of harm if not prevented from occurring. In this respect, anxiety is a normal, beneficial emotion.

When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming danger sets off alarms in the body and allows evasive action. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings.

The danger causes a rush of adrenaline, a hormone and chemical messenger in the brain, which in turn triggers these anxious reactions in a process called the “fight-or-flight’ response. This prepares humans to physically confront or flee any potential threats to safety. For many people, running from larger animals and imminent danger is a less pressing concern than it would have been for early humans. Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction. Over time, with repeated exposure to basic survival threats, our ancestors' nervous systems began to evolve in a manner that made the fight-or-flight response automatic and immediate.

In modern times, we may not encounter the same sorts of danger our ancestors had to face. Nonetheless, we still encounter threats in our daily lives that make the fight-or-flight response useful. Present day examples include physical threats (being attacked by a mugger); social threats (being ridiculed or embarrassed); and mental threats ("blanking-out" on a difficult exam). Unfortunately, a problem arises when the fear response is triggered but there is no actual threat in our environment. Thus, the response serves no useful purpose. This is called a false alarm. False alarms will be share in more detail in another post. For now, it is simply important to recognise that without a certain amount of fear in our lives, our survival becomes more difficult.

Anxiety disorders

The duration or severity of an anxious feeling can sometimes be out of proportion to the original trigger, or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as “having recurring intrusive thoughts or concerns.” Once anxiety reaches the stage of a disorder, it can interfere with daily function.

Symptoms

While a number of different diagnoses constitute anxiety disorders, the symptoms of generalised anxiety disorder (GAD) will often include the following:

  • restlessness, and a feeling of being “on-edge”

  • uncontrollable feelings of worry

  • increased irritability

  • concentration difficulties

  • sleep difficulties, such as problems in falling or staying asleep

While these symptoms might be normal to experience in daily life, people with GAD will experience them to persistent or extreme levels. GAD may present as vague, unsettling worry or a more severe anxiety that disrupts day-to-day living. The Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) classifies anxiety disorders into several main types.

In previous editions of DSM, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, the manual now no longer groups these mental health difficulties under anxiety.

Anxiety disorders now include the following diagnoses:

Generalised anxiety disorder: This is a chronic disorder involving excessive, long-lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with the disorder are not always able to identify the cause of their anxiety.

Panic disorder: Brief or sudden attacks of intense terror and apprehension characterise panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly, peaking after 10 minutes. However, a panic attack might last for hours.

Panic disorders usually occur after frightening experiences or prolonged stress, but may also occur without a trigger. An individual experiencing a panic attack may misinterpret it as a life-threatening illness, and may make drastic changes in behavior to avoid future attacks.

Specific phobia: This is an irrational fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause. A person with a phobia might acknowledge a fear as illogical or extreme but remain unable to control feelings anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.

Agoraphobia: This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or in which help would not be available if a person becomes trapped. People often misunderstand this condition as a phobia of open spaces and the outdoors, but it is not so simple. A person with agoraphobia may have a fear of leaving home or using elevators and public transport.

Selective mutism: This is a form of anxiety that some children experience, in which they are not able to speak in certain places or contexts, such as school, even though they may have excellent verbal communication skills around familiar people. It may be an extreme form of social phobia.

Social anxiety disorder, or social phobia: This is a fear of negative judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult.

Separation anxiety disorder: High levels of anxiety after separation from a person or place that provides feelings of security or safety characterise separation anxiety disorder. Separation might sometimes result in panic symptoms.

Causes

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

Possible causes include:

  • environmental stressors, such as difficulties at work, relationship problems, or family issues

  • genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves

  • medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery

  • brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain

  • withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes

Understanding other emotions

Emotions are simply a normal part of the human experience. As such, they are neither good nor bad. What happens afterwards determines whether we experience a particular emotion as good or bad; i.e., the changes in our feelings, behaviors, thoughts, and physiology. At this point, you may be wondering, "What could possibly be good about fear and anxiety? Don't these emotions just make people feel miserable?" Well, the answer may come as a quite a shock, but fear and anxiety are actually very important emotions. When it comes to human survival and achievement, anxiety and fear actually motivate us to take necessary action, as mentioned above. Without fear and anxiety to prepare our minds and bodies for automatic action, we would be at risk for some very serious, negative consequences. So, while the experience of fear or anxiety may at times be an unpleasant one, we can see that without these important emotions we'd actually be far worse off.

At the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state of being. It is often associated with changes in feelings, behaviour, thoughts, and physiology. Anxiety, like all emotional states, can be experienced in varying degrees of intensity. For instance, we might say we are happy. A more intense expression of this same emotion might be an experience of joy. But unlike the emotion "happiness," which has several different words to convey these differing levels of intensity (e.g., intensity ranging from happiness to joy), anxiety is a single word that represents a broad range of emotional intensity. At the low end of the intensity range, anxiety is normal and adaptive. At the high end of the intensity range, anxiety can become pathological and maladaptive. While everyone experiences anxiety, not everyone experiences the emotion of anxiety with the same intensity, frequency, or duration as someone who has an anxiety disorder.

In trying to understand what feelings (primary emotions) could be underneath your anxiety. If you allow yourself to be open to the possibility that you are hurt, disappointed or grieving, rather than anxious, you are taking great leaps forward in understanding yourself, having greater emotional intelligence and having the ability to make efforts to improve your situation based on other underlying feelings.

If you are left with some sort of fear, then your anxiety is likely in the right place. Give this a try and see if it can reduce your worry, and help you make life changes that will actually alleviate the true negative feelings you have, rather than miss your experience and cause continued worry for “no reason,” as many people with GAD tend to do.

Can therapy help with the physical and emotional effects of anxiety

Just as therapy can help address the emotional impact of anxiety, it can also help people manage physical symptoms. Addressing anxiety causes and triggers will generally lead to improvement of all symptoms, physical or mental.

People who experience physical symptoms of anxiety will typically work with a therapist who helps them identify and address possible causes or triggers of anxiety. Specific types of therapy, including cognitive behavioral therapy (CBT) or exposure therapy, can help people learn to address anxiety in the moment and learn potential methods of reducing anxiety in daily life.

But therapists can also offer guidance on specific ways to address physical symptoms. These might include:

  • Breathing exercises to cope with hyperventilation

  • Coping skills and lifestyle remedies to manage pain or headaches

  • Relaxation techniques to decrease muscle tension and pain

  • Tips to better manage stress and help prevent various physical symptoms from developing

Because many physical signs of anxiety do resemble symptoms of serious health conditions, it’s always wise (and recommended) to talk to a doctor about any concerning physical symptoms, especially if you have any doubt about what’s causing the symptom.

This is particularly important with chest pain. Since chest pain occurs during heart attacks as well as panic attacks, it’s often best to talk to a medical professional even when you feel certain anxiety has caused the pain. Once they’ve ruled out a heart attack or similar issues, talking to a therapist can be a helpful next step.

Five things to help you feel calm enough to get to your first therapy session
  1. Get an idea of what kind of therapy/ therapist you’re looking for/ get a sense of who the therapist is.

  2. Talk to the therapist on the phone first if important for you. Most therapists are happy to offer a free 15-minute consultation before booking a first session, and they’ll answer questions or concerns you may have.

  3. Find out what their treatment would involve during your first session/ assessment.

Try a combination of these 8 ways to foster the relaxation response and reduce anxiety

1. Acceptance

Have you ever noticed that when you try and fight it off, your anxiety digs its heels in stubbornly and gets more resistant?

Don’t forget, it’s only been trying to keep you safe. When you remember this, and accept it, you might notice your anxiety beginning to dissolve.

And even if your anxiety stays intense, just keep accepting that it’s there, without trying to change it.

Importantly, don’t avoid a situation or place because you feel anxious when you’re there. Avoidance will actually make the problem worse, not better. (If you notice that you’ve been getting into habits of avoidance, do seek support).

2. Notice your feelings

When anxiety floods us, it can be quite hard to notice any other feelings.

But one of the best ways of regulating anxiety is to become aware – as your own observer – of all the feelings you notice in your body (scan it with your eyes closed). These can range from the purely physical (I have an itch on my back) to the more emotional (such as feelings around the heart and gut).

If you can, talk to someone about what you’re experiencing, as you are experiencing it. Make sure they know that they are not expected to do anything about it, or make it go away; their role is to be there by your side and listen.

Finding words for feelings – whether physical sensations or emotions – engages a part of the brain that helps with calming the fight-or-flight response.

Another very helpful thing when you’re anxious can be to focus your attention on your feet and legs, really trying to notice all the sensations, from the tiniest to the broadest (grounding yourself).

3. Movement

This is a really important one. When you exercise, those stress hormones are mopped up and used, so you can return to a more peaceful state. Do it when you’re feeling anxious – rush up and down stairs, or go for a quick jog around the block if you can.

And also see if you can fit more movement into your week, generally. Walking swiftly for just half an hour, most days, can be as beneficial (or better) for your mood as antidepressants.

4. Breathing

Getting your breathing to work for you and not against you is really important.

Sitting calmly and upright, make your breathing slower, with the out-breath slightly longer than the in-breath, and a little pause between breaths. See if you can get it so your tummy rises and falls with each breath, but your chest doesn’t move all that much. This is a good one to practise when you’re feeling okay, so it comes easier when you’re feeling anxious.

Breathing is such a basic, natural thing that many people find it hard to realise how powerful it is.

But it really does have a profound effect on your physiology, and your emotions.

Shallow, fast breathing makes you more anxious; slower, deeper breathing can really help to calm you.

5. Reassurance

It’s a good idea to remind yourself that even though you may be having symptoms that can in themselves feel frightening, it’s an anxiety attack.

Ask your doctor to teach you how to distinguish the symptoms of a heart attack, and those of an anxiety attack, and write this down. Keeping the information written on a card that you carry around will mean you will be in a better position to reassure yourself when necessary.

Often people also fear that their anxiety symptoms may be a sign they are going mad.

Again, speak to your doctor. It’s much more likely that any ‘going crazy’ feelings are a temporary symptom of anxiety.

6. Mindfulness

This has been shown to have real benefits for all sorts of difficulties associated with anxiety.

You can find lots of information online, for example here: https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/

And a brief guided one here: https://www.southwindtherapies.com/copy-of-services

However, mindfulness is not entirely risk-free, so if you have had any mental health problems in the past, check with your doctor before you try meditation or mindfulness. They may suggest that you work in conjunction with a therapist or mindfulness practitioner who can help you work at a safe pace.

7. Calming words

At a time when you are not feeling anxious, have a think about what calming words you’d ideally like to hear from someone when you are in the middle of an anxiety attack.

See if you can find a form of words that feels ‘right’.

Write them (or ask a loved one/ friend to write them) on a card that you can carry around, ready for reading to yourself when you feel anxious.

8. Use your creativity/ ideas

1. Try a few affirmations: but the trick is to choose ones that both accept the difficult thought and also affirm your worth. It’s very important to include both of these two aspects. Use the word ‘and’ to link them, not the word ‘but’ (‘but’ has the effect of cancelling out one of the parts and weakening the affirmation).

2. How about focusing deliberately on the difficult thought when it comes up? With the difficult thought in mind, let your awareness drop down into your body. See if you can get a clearer image of it. If the difficult thought was an animal, or a colour, or a shape, or a house, what would it be? What qualities would it have? Could you paint it, draw it, or use play-dough to depict it? Sometimes we use far more energy trying to avoid a thought, than it would take to embrace the thought and see what we can learn from it. This sort of approach is far better than avoidance, and can help take the power and sting out of our fears.

3. Getting stuck in to any activity that you find really absorbing puts you in a state that psychologists call ‘Flow’: where for a while you almost lose track of time and just immerse yourself in an experience. Gardening, fixing something, cooking, or reading a novel: it all depends on what works for you. Try wetting some thick paper and dripping watercolour paints on to it, and enjoying what the colours do as they meet. Or find an interesting object, such as a shell or a piece of driftwood, and concentrate on drawing it, using charcoal or soft pencil. Make sure you give yourself permission to accept your drawing (however imperfect it may appear) instead of criticising it – this will make the exercise much more effective.

4. Get a blank notebook, and fill it with a mixture of writing and images. Don’t aim for neatness or perfection: this is a private place where you can splurge. Write about the painful thing, but be imaginative and write about it from different perspectives. For example, when you did the embarrassing thing that has been making you cringe in shame, what might the scene have looked like to the bird who was sitting on a nearby branch watching? Or imagine a very wise, loving old person – what might they have to say to you? Your aim is to take the ‘heat’ out of the difficult thought, and see it as part of the wonderful, varied tapestry of living. Still difficult, perhaps, and still important – but no more so than many, many other elements that make up your experience.

5. Sometimes when we are trying to avoid painful or persistent thoughts, we think it will help to keep busy, give ourselves too much to do, and generally get a bit stressed. But the stress could actually make things worse. Instead, take yourself kindly by the hand and allow some nurturing, calming things into your life. A yoga or pottery class, knitting, or just half an hour spent walking in a forest, park or by the river, can help get some balance in your life, and make you more resilient and able to handle the difficult stuff.

6. Wrestling with an unwanted thought can be like thrashing about in quicksand: you just get stuck further and further in. Instead, try observing your thoughts. Get still, calm your breathing, and picture in your mind a circus ring, or a parade, with performers walking round or along. Each one is holding a sign with your difficult thought on it. See if you can simply watch them go by, accepting what they are and letting them move on. Don’t argue with the signs, and don’t try to make them disappear: just watch them. You may begin to feel calmer after a while.

7. Distraction might help in the short term, as long as it doesn’t become your main way of dealing with difficult thoughts. But remember: it’s actually best to distract yourself with one thing, and not jump from one focus to another. Try doodling with a pen. Start with a flower motif, or a geometric shape, and let your doodle grow and develop. Try not to judge it – remember, a doodle can really be anything. See if you can just enjoy the ways the doodle gradually takes shape. Let yourself get absorbed in the swirls, the dots, the lines, the zig-zags. This isn’t time-wasting: this is you making a peaceful space for yourself where you can just be, and not have to fit into anybody’s idea of who and what you “should” be.

Conclusion

When you’re feeling anxious, first remind yourself of what’s going on in your brain and body. If it’s possible, practical and appropriate to do some vigorous movement, do that first run up and down the stairs a couple of times, or go for a walk outdoors.

If not, concentrate on slowing and deepening your breathing. Then add in the other techniques mentioned above. You’ll get best results if you’ve also been practising in-between times, when you aren’t feeling strong anxiety, so it might be a good idea to make a plan for daily anti-anxiety practice. Practice self-care too, so that you maximise your resilience. And reduce your caffeine intake – some people are more sensitive to caffeine than they realise. Simple changes can make significant differences.

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© 2020 by Rozie Pilkington

London Borough of Bromley