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.
Anxiety can affect both your mind and body. When worry, fear or physical symptoms interfere with daily life, an assessment can help you understand what is happening and what support may be useful.
What is anxiety?
Anxiety can involve the body’s stress response, including a faster heartbeat, sweating or muscle tension. These sensations can feel alarming; they do not tell us, on their own, what is causing them.
Anxiety may relate to current pressures, past experiences, health or several factors together. In my approach, we also explore whether difficult feelings in relationships contribute. This is one way of understanding anxiety, rather than a universal explanation.
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Heart rate increases to pump oxygen rich blood to the muscles, and palpitations can sometimes happen
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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)
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Some people notice dizziness or light-headedness. New, severe or unexplained symptoms need medical assessment rather than an assumption that anxiety is the cause.
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The pupils dilate leading to blurry vision
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Muscles tense up in preparation leading to headaches, muscles aches, & shaking
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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.
Persistent anxiety can affect sleep, concentration and everyday life. A clinician can assess the pattern of symptoms, their duration and impact, and consider other possible causes. A diagnosis can help guide treatment, but it does not describe everything about a person.
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
Cognitive Behavioural Therapy (CBT) is one approach to anxiety. It explores links between thoughts, feelings and behaviours, including patterns such as avoidance that may keep anxiety going. Treatment choice should reflect your needs, preferences and assessment.
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).
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Breathe gently through your nose if comfortable, without forcing a deep breath. Let your shoulders relax.
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Use a comfortable rhythm; you do not need to hold your breath or reach a particular count.
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Let the breath leave gently through your mouth. If counting helps, choose a pace that feels easy.
Repeat for 3 minutes.
Practise when you feel settled. Stop if focusing on your breath makes you feel dizzy or more distressed. The NHS guide to breathing exercises offers a simple starting point.
Review
So today we have:
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Explained why anxiety feels the way it does
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Described some common anxiety bundles called the “anxiety disorders”
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Shared the CBT model: thoughts->feelings->behaviours
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Introduced the concept of safety behaviours as something that keeps the scary thoughts and anxious feeling going
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Introduced the idea that avoidance and trying to get rid of feelings are two of the most common safety behaviours
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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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I offer individual therapy for adults in Kensington and online. You can book a free 15-minute introductory call to discuss whether working together might be helpful.