Anxiety; Where fear takes over

Anxiety; Where fear takes over

Anxiety is a very broad term. There are many types of anxiety. Along with depression it can be clinically classified as one of the primary mood disorders.

There is a normal, low level of anxiety that is essential to healthy living. For example healthy anxiety before an exam helps us to prepare for it. Unhealthy anxiety before an exam could prevent us from doing any preparation and we may even avoid the exam altogether.

For this blog I am focusing on unhealthy clinical anxiety. This has been identified as:

the negative  anticipation  of some potential threat that may, or may not, happen in the  future

For some this anticipation can be very debilitating, even life threatening.
Anxiety can be managed by short term medication use and long term psychological strategies. To understand how this is possible we first need to develop a good working knowledge of what anxiety is and its causes.

Types of Anxiety

It is estimated that in Ireland about 11% of people suffer with clinical anxiety at some stage in their life. It is easier to see how common anxiety is when we consider the range of conditions that anxiety covers.

The most common form of anxiety is Generalised Anxiety Disorder. This is where the person may have periods of anxiousness around certain aspects of life that are not in themselves explainable.
The various phobias are forms of anxiety. The phobia is thought to be a representation of a deeper fear.
Post–Traumatic Stress Disorder is an anxiety caused by the reexperiencing of a previous very stressful event.
Obsessive Compulsive Disorder is an anxiety based behaviour. The person believes that if they don’t continue doing their ritualistic behaviour something extremely negative will happen to them.

Other types of anxiety disorder are panic attacks, separation anxiety, social anxiety disorder and paranoia. Psychosis can be experienced if the anxiety is severe and is continuous over a period of days or weeks.

What is Anxiety in every day life?

I will approach this from the following headings:

• How we physically feel
• Our emotional wellbeing
• The preoccupation of our thoughts
• Our beliefs about ourselves and the world around us
• Our behaviours

Physical
When experiencing extreme stress the heart pumps faster to bring vital supplies to the body to react quickly. This makes the person feel palpitations in their chest.
The person’s breathing will become irregular. In acute anxiety short shallow breaths are common. This could result in fainting as there is not enough oxygen getting to the brain.
The digestive system may slow down resulting in constipation or cramps – or the opposite, you may develop diarrhoea. Butterflies in the stomach are classic symptoms.

A very common physical symptom of anxiety is sweating as our body temperature rises and the body secretes various hormones and proteins.
Hormones are produced into the body to enable the body to successfully respond to immediate stress. Noradrenaline and adrenaline are the hormones that give the body the almost instant ability to respond to acute anxiety. This is the fight or flight response.
They also help the brain release more serotonin, a neurotransmitter.

Emotional
Anxiety causes the person to feel irritable, nervous or on edge. They become very negative expecting the worst from the area they are anxious about.
This may cause tearfulness which can lead to increased anxiety. Their self esteem goes down as they lose hope in their ability to function well in society. Our relationships may deteriorate as paranoia sets in or we withdraw from those who may challenge us about being anxious.

Thoughts
An anxious person will be very preoccupied even obsessed about their anxiety. Due to a sense of lost control they will try to overcompensate by regaining control in an allied area. A phobia of closed spaces could mean they try to work outside as much as possible.
False perceptions of the threat causing the anxiety are typical. The belief that acting in an anxious manner will help is itself a false perception. The more serious the anxiety, the stronger the belief is in the false perceptions supporting the anxiety.

Beliefs
Anxious people have very negative beliefs about themselves. They believe they can not stop their anxiety. Even though they realise they alone can stop their anxiety. Realising these two facts can make them feel quite hopeless.
Spiritually they see little value in faith in anything to get them through apart from their own will power or the support of trusted people such as a very close friend or a counsellor.

Behaviour
An anxious person will exhibit repetitive, obsessive behaviour as an attempt to soothe their anxiety. They may also practice avoidance of what makes them anxious.
It is possible that this avoidance behaviour could become an obsession in its own right. Involving very exaggerated strategies to avoid all contact with anything that could represent the subject of the anxiety.

Causes of Anxiety

Nobody develops a full blown panic attack over night.
Anxiety grows slowly in the persons personality. Anxiety starts with a seed of a doubt, a paranoid thought, a fright. When this seed is combined with physical, psychological and social pre-existing vulnerabilities anxiety disorder can result.

So what are these pre-existing vulnerabilities?

Earlier I stated extra serotonin is released in the brain in response to anxiety. People with low levels of serotonin or who don’t absorb serotonin are more prone to mood disorders such as depression and anxiety.
It has been said that personality types are partially genetically inherited. Personality types that are more laid back and not goal directed are less likely to develop anxiety disorders. Where as goal driven, highly alert people are.

For many anxiety represents a loss of control. Our degree of control is a perceived reality. If we perceive we are losing control over a situation it is because it looks like the threat is stronger than our ability to control it. This lack of control could be learned from our reactions to stressors in childhood.
Over time patterns of thought arise around the stressors and negative automatic presumptions are made that lead to ongoing anxiety. This anxiety distorts our appraisal of the stressor and therefore cognitive distortions set in. Primarily we underestimate our ability to cope with the reality of the stressful result. Also we overestimate the threat posed by the initial stressor.

It is likely that some anxious reactions are learned from the environment. Especially the childhood environment.
If as children, we experience abuse from authority figures we often respond to this in a very anxious manner. We may continue to express this anxiety whenever strong authority figures are present in our later life.
We could experience anxiousness due to role models in our past. They may have told us or demonstrated to us that anxiety is a correct response to a stressor, eg heights. In other words we can pick up anxious behaviour from others.

A lot of our of anxiety today is really a transference of our anxiety from the past.

Is Anxiety cured or managed?

As we understand the word cure from a medical view point, no. Anxiety can not be cured.
So what do we do?
Is there hope?
Yes there is hope.
We can learn to overcome anxiety in the present just as we learned to learned to be anxious in the past.

Whether medically, psychologically, or more likely a combination of both there are opportunities to live a life where anxiety has been minimised and is now manageable.
In my professional experience clients with anxiety want to go straight to learning coping mechanisms. These are valuable but generally are the last intervention in working with an anxious person.

Medical interventions
It is generally believed that on their own medications only work for the duration of the time in which they are taken. Antidepressants are used because they help the brain absorb more serotonin. Anxiolytics such as Valium are given only briefly due to their highly addictive nature. By quickly producing more gamma aminobutyric acid, they help to slow down the brain function and so lessen anxiety.
Medical support for anxiety is generally a support for the psychological work to be done.

Psychological approaches
Firstly the counsellor and client together identify what the underlying issues are. Awareness of underlying problems is key to resolving most psychological issues. The foundations of anxiety can be eroded by logical questioning.
The person questions whether their initial reactions to the initial stressor were appropriate?
Did others involved behave in an unhelpful manner? To what degree is the person responsible for their behaviours? The main area of responsibility is the person’s own reactions to the stressor. We need to relearn positive reactions that do not lead to anxiety.

Learning to react more constructively to anxiety inducing events has to be done in the present. The counsellor identifies with the client how the old assumptions and behaviours from the past are no longer entitled to control his emotional reactions in the present.
Once that vital principle is established the client and counsellor work together to identify the specific symptoms the client wants to work on.
They then both devise situation specific strategies for weakening the effect of each of the symptoms. This strategy is then practiced in the clients real world and refined in the session till it is deemed by the client to be no longer problematic.
The client needs to practice vigilance in recognising if symptoms of the anxiety return. If so, it is just a matter of further refining the coping strategies to adjust to any new situations.

Another important function of the counsellor is his/her role to believe the client can achieve a resolution even when the client can’t see it.
The counsellor role models a new way of reacting for the client to learn from and make their own.
Believing in the client when they are failing to believe in themselves is one of the greatest gifts a counsellor can ever give a client. It is a gift of faith.