Understanding and managing anxiety

Updated 3rd January 2023

+ Sometimes you feel as if you are about to die. You may be afraid you are having a heart attack, or that you are going mad

+ You dread social situations. You worry you will say something offensive or that you will be boring, or weird

+ You constantly think you are going to die. You check yourself all the time. You Google your symptoms. You go to the doctor. But nothing reassures you.

+ You worry about everything. Your partner, the kids, the house, finances.

 These are signs that anxiety has taken over your life, restricting you and preventing you from realising your full potential. To be more precise, it has spilled over in your mind. Because anxiety is not a mental thing; it is a physiological thing, something that happens in the body. We will get to what I mean, but for now, let us focus on the different anxiety disorders as they are diagnosed in psychology and psychiatry. 

What is anxiety?

Anxiety is a physiological response to threat. The body prepares to respond to danger. The adrenal glands release a hormone called cortisol which initiates the anxiety response.

The aim here is to get the muscles ready for action, for example to avoid being eaten by a sabre-toothed cat* or jump out of the way of a bus. But the cause for anxiety is usually something we do not register consciously. It is the emotion that is triggered based on our assessment of the environment. if we see a predator, we should experience rage, which will provide us with the energy to neutralise the threat. However, if we assess that experiencing the emotion and enacting the impulse attached to it (here, attack) would be dangerous, we suppress the emotion and experience anxiety instead. 

• Heart rate increases to pump oxygen rich blood to the muscles, and palpitations can sometimes happen

• Blood is drawn away from digestive organs leading to dry mouth, feelings of nausea, “butterflies in the stomach, needing to use the toilet (the anal sphincter relaxes)

• Blood is drawn away from the brain leading to dizziness

• The pupils dilate leading to blurry vision

• Muscles tense up in preparation leading to headaches, muscles aches, & shaking

• We sweat more to cool the muscles

These days the trigger for anxiety is much more likely to be social. We fear our emotions will lead us to transgress in some way even if that is not true. For example, if we have learnt early in life that expressing anger, which is the energy needed to set boundaries, leads to people pulling away, having a healthy experience of anger can lead to the anger being suppressed and anxiety being experienced instead. 

We tend to become concerned with the anxiety response when it starts to interfere with the life we want to live. Psychiatrists “diagnose” people with an “anxiety disorder” if it meets this criterion and has also been going on for a significant period of time. Suffering from habitual activation of the anxiety response can have detrimental effects on our physical well-being because of the accumulation of cortisol. It weakens the immune system, can result in physical pains, play havoc with the digestive system, and stop you from getting a good night’s sleep.

To have an anxiety disorder simply means that your anxiety tends to manifest in a particular way in the mind. The usefulness of these labels has long been debated, especially as people do not fit these categories neatly. However, if you can hold them lightly, they can be useful in making a start in understanding anxiety and helping you feel that you are not alone.

Types of anxiety disorders

 

Panic disorder with or without agoraphobia

This involves panic attacks or bursts of anxiety that seem to come out of the blue. The problem here is the response to the experience of anxiety itself. People initially, if very fleetingly, notice some of the signs of anxiety and become frightened that are having a heart attack, suffocating, collapsing, or going mad. Agoraphobia means that we stop going out because we do not want to be in situations we cannot escape from.

Here, there is secondary anxiety that tells we at risk of death. What triggers anxiety in the first place is usually unclear, hence the out of the blue impression (wait until Part 2 for this one).

Social Anxiety or social phobia

This involves fear of negative judgement by others. Anxiety is often triggered by thoughts preceding social events (“they will think I am weird or boring”). Anxiety is telling us that we are at risk of being excluded and abandoned by our social group.

Health anxiety

This involves fear of getting ill or dying. It can also manifest as fear of going mad. Anxiety is telling us we are at risk of losing ourselves.

Generalised Anxiety

This involves anxiety about everything and anything. Finances, something bad happening to the kids, something bad happening in general. Anxiety is telling us we are at risk of losing something important.

Counselling and Psychotherapy for Anxiety

One way to help people in one of these groups is with the principles of Cognitive Behavioural Therapy (CBT). CBT focuses on what keeps the anxiety going once it has started and aims to disrupt maintenance factors. It is often more helpful if you generally have good relationships, belong ideally to just one of the above groups, and haven’t suffered from anxiety for too long.

CBT for anxiety

According to CBT, thoughts lead to feelings, feelings lead to behaviours.

 For example, in social anxiety:

Thought: “People are going to think I am boring”, leads to

Feeling: Anxiety, which leads to

Behaviour: Avoid specific situation

It is usually not difficult to see that the behaviour can keep the thoughts going. If you do not expose yourself to the social situation you do not gain contradicting evidence and therefore are likely to have the thoughts again next time. In other words, you are unlikely to find out that maybe others do not see you as boring. We call this behaviour (avoidance) a “safety behaviour” because it is employed to prevent a feared outcome. Safety behaviours often have the opposite effect. They keep worrying thoughts and the feeling of anxiety going.

How the anxious mind keeps the ball rolling

Depending on what form your anxiety takes, it may be maintained in different ways and this series will explore these in more detail. However, it is very important to keep in mind that when we become anxious our thinking changes. It becomes much more black and white, devoid of nuance and appreciation of complexity. This is because the mind believes that thinking is can interfere with your safety. You just need to get out of the way!

Psychologists often call the kind of thinking that we have when anxious “cognitive distortions” or “thinking errors”. This is because they do tend to often distort reality, but think about this as your mind simplifying things to keep you safe.

Some examples:

Catastrophising/worst case scenario thinking: If I faint everyone will laugh at me and no one will ever speak to me ever again.

Fortune telling: If I do this she will definitely say that.

The problem is that these kinds of thoughts increase anxiety further! And this in turn fuels the thoughts further.

Managing anxiety

One of the things we can do when we are feeling very anxious is use our breathing to soothe ourselves. This can be a more fruitful approach than trying to think our way out of the situation when our thinking is streamlined and will actually lead to more anxiety.

Please note that this exercise does not reduce anxiety to zero and in fact on of the points I will make consistently in this series is that trying to “get rid of anxiety” (or any feeling and any thought, in fact) does not work and is another safety behaviour.

What I invite you to do is to use this exercise in order to feel more grounded and be able to resume or initiate an activity that provides meaning and value to your life (e.g. meeting a friend, going back to work, resuming cooking etc).

If you have gone through significant trauma, breathing exercises may increase your anxiety and it is probably sensible to speak to your GP and explore psychotherapy options which will involve a safe setting to develop the right strategies for you.

A breathing exercise to soothe the anxious mind

The exercise is very simple to do (although it involves complex mechanisms, with big names like the vagus nerve and heart rate variability).

1. Breathe in to the count of 6. Through the nose. See if you can use your diaphragm so that when you breathe in your tummy rises rather than your chest (chest breathing is quite swallow and can actually increase anxiety -this is what happens in panic attacks). You can try closing off one nostril while you do this.

2. Hold the air in for 4 seconds.

3. Breathe out through the mouth. Imagine you have a spoonful of very hot soup in front of you and you are trying to cool it down. Let the air out slowly to the count of 6 again.

Repeat for 3 minutes.

Try t do this at least once/day, and practice it when you are feeling more settled first, when it is easier to master. Give yourself time. Like any skill it takes time to learn.

Review

So today we have:

• Explained why anxiety feels the way it does

• Described some common anxiety bundles called the “anxiety disorders”

• Shared the CBT model: thoughts->feelings->behaviours

• Introduced the concept of safety behaviours as something that keeps the scary thoughts and anxious feeling going

• Introduced the idea that avoidance and trying to get rid of feelings are two of the most common safety behaviours

• Introduced a simple, yet powerful soothing strategy using your very own breath 🙂

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*A very common misconception among health professionals is the use of the sabre-toothed tiger as an example of the fight or flight response. It is in fact called a sabre-toothed cat or Smilodon Fatalis.

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In the meantime, if you want to talk about your anxiety with a psychologist in London that knows his anxiety terminology, get in touch by emailing me at nikos.tsigaras@kensintgoncounselling.com. 07805945233 if you’re old fashioned.