Anxiety conditions are extremely common, affecting 10-20% of people in their lifetime, with women more susceptible than men. In most cases it is also extremely responsive to talk-therapy, as long as it is future-oriented and helps the client develop their awareness and resources, rather than exploring the causes and concerns of the problem.
The trouble with anxiety is that it begets anxiety. Normally we can control this, we challenge our worries with reasonable thoughts and explanations. But under certain circumstances we lose this ability; anxiety gets a hold and we feel powerless to regain our composure. Anxiety is driven by fear, an emotion so powerful that it is difficult to challenge.
Anxiety consists of worrying thoughts coupled with physical and emotional arousal. This natural constellation of effects is part of our innate survival response; when the brain perceives a threat it sets a sequence of physiological responses that prepare us for action (fight or flight), the mind on the alert, the body ready to respond to an emergency.
So far so good, everything is working as it should. But when we’re anxious the mind becomes hyper-vigilant, which in turn ensures that emotions and body stay aroused. This sets up a self-reinforcing cycle of vigilance-reaction-vigilance… where the mind arouses the body and these physiological responses feed off each other, perpetuating the cycle. Constant and severe arousal means that it gets harder and harder to ‘switch off’. Sufferers speak about perpetually feeling on the alert, on the edge of their seats and unable to relax.
What’s actually happening when anxiety becomes uncontrollable is that we become highly attuned to threat and, overstimulated, the mind constantly surveys the horizon for signs of danger. As the process continues our internal alarm system is triggered by ever smaller threats, while the body takes longer and longer to return to its normal resting state.
This is a self-perpetuating cycle where worry and arousal cannot be shut off. Anxiety develops its own logic and appears to take on a life of its own. The results are not just a heightened state of worry and accompanying discomfort; it can generate a whole spectrum of other effects like tension, fatigue, loss of confidence, moods and irritation, and more.
What are you afraid of?
Although people believe that the starting point for their anxiety is their thinking, which then triggers an emotional and physical response, it highly likely that it is the other way round. Emotions have been called ‘Nature’s call to arms’ – they are there to get us to act (LeDoux 1999). Once the anxiety cycle has embedded itself an emotional response, with the accompanying physical sensations, is easily triggered (by now, no threat has to be present as the anxiety response has now taken over). As soon as we notice the feelings we start to put meaning to the experience and this is where we start to explain the reasons to ourselves for our discomfort and anxiety. Needless to say, these explanations are always driven by the false logic of anxiety.
Anxiety is driven by threat, but that threat is generally existential (related to one’s survival). What’s more, it can be real, like an actual event, or perceived, such as when we misread someones intention. The faulty logic of anxiety is driven by a set of emotions of which the the primary one is fear. A close second to this is mistrust, of everyone and everything that the highly alert and worrying mind sees as a threat.
There’s an old joke that illustrates this type of logic:
There was an old man who, first thing every morning, would sprinkle a white powder on the roads around his house. His neighbour, after years of watching this strange behaviour, asked him why he did it.
The elderly man answered that it was “to keep the elephants away”.
The neighbour said “But everybody knows that there are no elephants wandering the streets here!’, to which the old man retorted “You see, it works!”
It is hard to reason with circular logic.
What doesn’t work
Behaviourally, as well as finding life more of a struggle when we are anxious, we are also likely to avoid what we think is triggering it. Sensible as this seems, this strategy can soon become part of the problem, as we start to associate our avoidant behaviour with anxiety.
Trying to suppress it, beat it or avoid anxiety not only doesn’t work, it makes it worse. All that happens is that we become locked in a struggle with ourselves. After all, we are both creating the anxiety and resisting it. Put another way, you can’t overcome anxiety by thinking about it, when our thinking is governed by anxiety.
The physical and emotional feelings that typify chronic anxiety are persuasive and we become convinced that there is a cause outside ourselves. Worrying, searching for an explanation, wishing things were different, not giving in, attempts to beat the anxiety… These ways of thinking merely reinforce the problem because they keep us focused on it.
What does work
Anxiety is a stress response, albeit a highly exaggerated one. We literally have to learn our way out of it. A lot of the advice on dealing with with stress can also help with anxiety. Consider exercise, yoga, tai chi, relaxation, breathing exercises, for example. Some older treatments followed the route of desensitisation, requiring gradually increased exposure to the trigger situation. While this can be effective, there are many ‘threats’ that we can never be exposed to (because they are existential), so we can’t rehearse in this way.
Getting over unwarranted anxiety requires a complete change in strategy from the normal (anxiety provoked), attempts to manage and control the symptoms that people generally try. Instead the focus should be on acceptance and changing our beliefs and expectations. We literally have to ‘learn our way out’ of the problem to discover that anxiety cannot control us once the cycle has been broken.
That is easier said than done, of course, especially if you are feeling anxious. Many sufferers either don’t seek help or if they do, they go to their GP. Often though, effective therapy is not available. Medication should only be used as a stop-gap; it will suppress symptoms and make life more manageable, but it won’t fix the problem.
If you are anxious then you are likely to feel nervous about trying anything new, like therapy. Still, if you opt for the right therapy it will be worth the effort. Research has shown that most cases of recurrent anxiety can be treated successfully and quickly with the right approach.
Choose carefully and avoid anything that focuses on the anxiety or understanding the root cause or reasons it occurs. Instead, therapy should focus on learning how to identify and manage the factors that contribute to it. It should be collaborative, solution-oriented, have a future focus and aimed at developing client skills and resources.
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This post draws on the references below. As I wanted it to be accessible and readable I have not referenced all the points that I have made, but all can be checked against these references.
LeDoux, J., (1999), The Emotional Brain; The Mysterious Underpinnings of Emotional Life, Phoenix, New York.
NICE Quality Standard QS53, Anxiety Disorders, available at http://bit.ly/1vEiuYm (accessed 1/09/14).
Shiraldi, G. R., (1997), The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth, McGraw-Hill, New York.