Ask our therapist: All about anxiety
What is it? Why do I have it? How do I rid myself of it?
It is part of our fear response – and for good reason. It needs to be incredibly strong to make us react as quickly as possible, whether that is to fight the threat or run away whenever we detect danger.
All animals have it. It’s part of what we call “Fight or Flight” and it’s built-in as a survival mechanism to keep the animal alive. As we are animals too, we share this natural trait. The first step to understanding what anxiety actually consists of is to see it as being made up of two elements:
A biological overreaction happens when you feel anxious and go into a full physical bodily readiness – to fight or run for your life – when there is nothing about to kill you. Your heart rate jumps to a very high level, your blood pressure subsequently increases, sweating is more likely, digestion stops, and your immune system is suppressed. There are more physical reactions or symptoms that I’ll discuss later on, but these are some of the main indicators of a biological overreaction.
With a mental overreaction, you are telling yourself through your mental processes that you are in grave danger when you are not.
You might be thinking “I don’t tell myself anything” “I wake up with anxiety, I haven’t even thought of anything” or “when I worry or think of bad things that could happen, they are possible, it is not irrational”
All I can say to these thoughts is that if you are having a physical “life or death” reaction to something that you are simply thinking about, and you are not literally in “a life or death” situation, then it is, in fact, an overreaction.
One of the scariest things about anxiety is the physical symptoms, and understanding what is going on inside your body is a tremendous aid in reducing that anxiety. If you are experiencing a “life or death” feeling, then your brain will look for an explanation when the symptoms arise. If there is no lion about to eat you, then the brain will come up with something else, for instance, “my chest is tight, there’s a pain, I can’t breathe, it must be a heart attack or COVID19”, “I feel dizzy, I can’t think or focus, it could be a stroke or tumour”, “ I’m sweating and trembling, something serious is wrong with me”. There are many other, what appears at first glance to be plausible, explanations. We can get even more carried away and think “was it that text I sent yesterday, have I offended her?”
It’s tough to deal with the intense discomfort of a full-blown panic attack, or the constant background dread when you feel that something bad is about to happen. Once again, knowledge is power – knowing why you feel so uncomfortable helps put that discomfort into perspective.
I see a subtle difference between fear and anxiety even though they may feel the same. Fear is what you are experiencing when the situation is threatening right now, when danger is present. Like being eaten or chased by a lion. It is felt as panic. Panic, even if it was not about real danger, like seeing a spider or being trapped in a lift, can become the main thing that is feared in the moment. Panic disorder, for example, is being anxious about panicking.
Anxiety is about anticipating danger or threat. It’s about thinking about what could happen in the future. The thoughts usually being with “what if…”
Either way, the body is programmed, without being instructed to by the conscious mind, to react to signals of danger to become the most efficient fighting and running machine possible. Huge physiological changes happen in the body making it super quick and strong. These changes are what we find so uncomfortable.
When you know why you have muscle pain, shaking, headaches or sweating, you can begin to counteract your panic about your physical symptoms. Knowing that your dodgy tummy or nausea is linked to anxiety helps inform you that it’s time to do something to reverse this physical state. When the brain is in a state of panic or anxiety, the centres of the brain that are responsible for focus, problem-solving and concentration are impaired so that your survival part of your brain can dominate to keep you safe. This can make you feel spaced out, frustrated and confused.
Other functions not necessary for immediate survival are also dialled down so that energy and resources can go to the heart, lungs and muscles. These include physical repair, so cuts or injuries. Secondary to immediate danger is fighting infection, so the immune system is suppressed leaving you more vulnerable to viral, bacterial and fungal infections. I see a lot of people with IBS and I immediately begin investigating their anxiety and stress levels. Everyone I have encountered with IBS has some form of worry, stress or anxiety.
The body is only meant to be in a state of “fight or flight” for a short period of time until the danger has passed because it is physically taxing on the body’s systems. However, constant exposure to stress hormones such as cortisol and adrenaline that initiate these physical changes can cause longer-term problems. Sleep, libido and energy levels can be affected with long term stress or anxiety.
While short term stress reduces inflammation, long term exposure to the stress hormone cortisol can cause a cascading inflammatory response in certain areas of the body. This can account for increases in occurrences of IBS, eczema, asthma, cardio-vascular problem, rheumatoid arthritis, memory loss and a number of stress-related diseases such as Addison’s disease and Cushing’s disease.
Mental Over Reaction
This is pretty difficult to accept sometimes. When you feel a strong emotion like anxiety, you believe it is justified; if you feel scared then there must be something to be scared of. This is called emotional reasoning. The anxiety, of course, is a very real thing that you are experiencing, even though only you can feel all the physical sensations and the intensity of the emotion. It is your reality so you conclude that “there is no smoke without fire” and “I must feel anxious for a reason”. You then conclude it is because of a real or possible situation and anxiety is an appropriate response. We all do it to varying degrees.
What if I tell you that you needn’t feel anxious about anything, particularly if that thing hasn’t happened yet and that there is a way of thinking that you can adopt that over time becomes second nature?
Your Belief System
Your belief system is what makes up your inner narratives, which are the stories you tell yourself about yourself and the world. We have different sets of beliefs for every situation we come across, some we are conscious of and some we are not. It’s not just the situations in life that determine how we feel but largely how we interpret and see those situations. Let me demonstrate.
A: Activating Event
You have a thought of missing the plane
B: Your Belief
Slightly frustrated and concerned.
This is what we call a rational belief. It recognises that you are in a negative situation and it is appropriate to feel negative. It is in line with the real world, its truthful and it makes sense. It recognises that once stuck in a traffic jam, then you are jammed. It keeps the ‘badness’ of the situation proportional i.e. it is a negative situation, however, there are worse situations to be in. It also acknowledges your emotional and physical robustness to tolerate such a negative situation.
On the other hand, a highly emotionally charged reaction would be constructed of the following:
A: Activating Event
You have a thought of missing the plane
B: Your Belief
Anxiety and rage.
This belief is irrational. It is deliberately painting the situation in an exaggerated light. The narrative begins with a demand; a rigid insistence that if you want to be on time you, therefore, have to be! There’s an expectation in that sentiment that it needs to happen. It is irrational because it is untrue. Just because you think something is right it does not mean it is a fact, or that it must come true. The world just doesn’t work like that. When you say something is worse than what it is, it is an untrue statement, so therefore irrational. To say something is the worst thing that could happen to you when it is clearly is not is also not in line with reality. I could quite happily come up with a number of worse scenarios for you to be in; beginning with getting pulled into a combine harvester while sunbathing in a cornfield.
If you use the irrational way of thinking regularly then you will generate high levels of anxiety.
Common irrational thinking: “I must get to sleep or I won’t function tomorrow. What if I get coronavirus, I mustn’t get it or I will end up nearly dying and then not be able to get on a ventilator. The economy is going to crash and no one will have jobs. I can’t bear to be locked down and not see people I want to”
Other forms of anxiety arise from a fear of negative judgement, usually from usually whose opinions matter to us. It could be friends, bosses, parents or people out and about. Everyone is different from whom they seek approval from.
Wanting approval and feeling comfortable in social or “performance” related situations is normal. Saying you must have that approval, or must not look stupid, must not be rejected or must meet expectations will create a sense of pressure in your mind. The brain interprets this pressure as a threat then responds with the emotion of anxiety. With anxiety then comes the release of stress hormones such as cortisol and adrenalin and you feel the physical symptoms, such as shaking, sweating, butterflies and inability to think of what to say.
This photograph stirs up so many uncomfortable memories that include avoiding presentations at university and then at work. It wasn’t until my 30s that I overcame the incident when I was eight-years-old in assembly and got stuck on what I was reading. The headteacher was nearby and after a few excruciating minutes came to help me with the word I couldn’t read. The rest is a blur.
If you talk to yourself (and believe that talk) in ways that cause anxiety, then you are not taking responsibility for your feelings. I told a very nervous client that it wasn’t the presentations he had to make that were making him anxious, but the beliefs he had about the presentation. He was not very impressed with this until I pointed out that if it was the presentation’s fault, how come his colleagues weren’t anxious too. We discussed that difference was the way each of them thought.
Becoming aware of your inner dialogues and what it is you are saying to yourself is very important. Sometimes our rigid demands and catastrophizing are subconscious and other times they are so conscious of them that they are almost mantras “I must not fail! If I do my life is over!”. What we also do, quite often, is judge ourselves if we don’t get what we demand. For example, “I must say something interesting, if not it means I’m stupid” or “If that person ignores me it’s because I’m not cool”.
When we put ourselves down and rate ourselves as less worthy because of some condition that doesn’t meet our demands then we are likely to feel anxious beforehand or embarrassed and ashamed if it happens.
Behaviours that tend to occur when someone is anxious are usually unhealthy because they reinforce the cycle below. They do this by encouraging more thinking errors and increasing anxiety.
Procrastination, is an avoidance technique, of putting off what would serve you better doing now, till later.
Pure avoidance such as not going to social functions, or leaving the house is quite common to avoid the discomfort. Avoiding speaking up so as not to say something stupid is also avoidant behaviour.
Using behaviour to feel better
To eliminate anxiety by facing the things that cause anxiety is ultimately the only way to overcome it. This exposure can be gradual and/or with the help of a professional. Some people have managed to face their fears on their own by sheer determination and “faking it until they make it”.
Understanding anxiety and how to begin tackling it is the first step to not only feeling better but getting better. I have only given a brief overview; however, hopefully, you got some helpful insights. Please drop me an email if you have any questions and I will do my best to answer them.
Sian is a cognitive behaviour therapist and also a clinical hypnotherapist, having trained at Goldsmiths College, University of London and the College of Clinical Hypnosis. Four years ago Sian relocated her Harley Street practice to her native North East after 26 years in central London. Sian now runs her private clinic in Gosforth and also owns a training academy to help organisations with stress reduction. Sian’s approach is to help people become their own therapists, whether they come to see her for panic attacks, depression or OCD (she covers a wide range of emotional and behavioural issues).