Let’s talk about anxiety. Anxiety is a part of our physiological makeup. It is something we all have and it’s a part of everyday life. When we think of anxiety, we often immediately think of nervousness, a fast pulse, and sweaty palms. You might even think of panic attacks. However, the fact is that anxiety can be all of those things and more, or none of those things; and is one of the most misunderstood biological responses that we have.
Anxiety and panic have become part of our everyday vocabulary and are associated with something negative. It is not infrequent that one might hear someone say, “I’m freaking out right now,” or “I’m having a panic attack.” Not that panic attacks aren’t real, because they are, but often what people are referring to is an uncomfortable level of anxiety or heightened arousal and not a true panic attack or emotional decompensation. What one might not know is that some anxiety is a good thing.
Anxiety, and how it is experienced, is not the same for everyone. For some people, the anxiety response is relatively benign, for others it is overwhelming, and then there’s everyone in between. Whether one suffers from debilitating anxiety and panic, or has anxiety that is relatively low, anxiety plays an important role in one’s well-being. If the anxiety is at a level where it interferes with one’s quality of life, there are many types of treatment that can help.
What is Anxiety?
From a strictly neurobiological level, what we colloquially refer to as “anxiety” is the body’s physiological response to a stressor of some kind. It is a response rooted in the primitive “fight or flight” survival response that kept our ancestors safe from predatory threats both present and anticipated. Even though we don’t need to worry about running from a T-Rex today, the response remains part of our makeup and serves an important purpose. Anxiety can help us avoid situations we know are risky even if they haven’t happened yet. Sometimes though, anxiety can get ahead of itself.
It is important to note that fear and anxiety are not the same, but are similar. Fear is a reaction to a detected danger. Anxiety is the anticipation of a potential threat that may or may not happen. The difference is subtle but important.
Your nervous system is at the heart of it all. When faced with a stressor that the mind perceives as a potential threat, it activates a cascade of responses. The mind doesn’t discriminate between real or imagined threats. It simply responds in order to protect itself from a perceived threat. Powerful neurotransmitters are released via the limbic system preparing the body for the “fight or flight”.
That arousal is powerful and sends adrenaline and other neurotransmitters surging. This surge increases arousal and this is what accounts for much of the unpleasant sensations (increased heart rate, rapid breathing, sweating) associated with high anxiety. When the threat passes, the body returns to a more relaxed state but it can take a while for the sensations to pass.
There’s also a psychological component to anxiety. When faced with real or perceived threats, the mind makes certain assumptions and perceptions. Thoughts might race, they may be accurate or inaccurate, and the threat may be real, perceived, present, or anticipated. How someone reacts to a situation depends, in part, to how they perceive the situation. Not everyone will respond in the same way.
Some people seem almost immune to intense anxiety. Others struggle with overwhelming bouts of anxiety that just won’t go away. What it boils down to though is knowing the difference between the physiological response that we all have and what would be considered an anxiety disorder.
Who is at Risk?
Anxiety disorders are the most common mental illness in the U.S. and worldwide. It is estimated that about 40 million adults, or 18.1% of the U.S. population, are affected each year. The World Health Organization (WHO) reports that 1 in 13 people are affected globally. Women are twice as likely as men to develop an anxiety disorder.
It’s not uncommon to see someone who has both anxiety and depression. Nearly 50% of people diagnosed with depression are also diagnosed with an anxiety disorder. Children are also at risk for the development of anxiety disorders. 25.1% of children between 13 and 18 years old will experience an anxiety disorder. Research shows that when left untreated, these children are at increased risk for poor academic performance, poor social engagement, and at greater risk for substance abuse.
If someone in your family suffers from anxiety, chances are you may too. Looking specifically at the genes thought to be associated with Generalized Anxiety Disorder (GAD), research has found that GAD has a heritable risk of about 30%. GAD is also closely related genetically to other kinds of anxiety such as separation anxiety, social phobia, and panic. Having this genetic predisposition doesn’t mean you’ll have problems with anxiety or even develop an anxiety disorder. It simply means that you may be more susceptible.
Certain personality and temperament traits have been found to play a significant role in both individual differences in response to stress and susceptibility to develop stress-induced anxiety disorders. Personality traits are behavioral predispositions that influence how someone responds to something across time and circumstance.
Human personality is typically considered to comprise of five major dimensions:
- Openness– one’s degree of intellectual curiosity, creativity, and preference for variety
- Conscientiousness– the degree of self-discipline, personal responsibility, and achievement
- Extraversion– one’s assertiveness, sociability, talkativeness, and the tendency to engage with others
- Agreeableness– degree of ability to be compassionate and cooperative towards others
- Neuroticism– one’s degree of vulnerability to unpleasant emotions like anger, anxiety, and depression
Certain traits such as pathological worry, fear of uncertainty, or neuroticism have been associated with a higher risk for the development of an anxiety disorder.These individuals might be seen as constantly busy, high-strung, Type A, controlling, or overly vigilant. In children, traits such as timidity, shyness or introversion have been associated with the development of anxiety problems.
Exposure to certain environmental situations have been linked to anxiety disorders.
- Negative or highly stressful life events
- Adverse events in early childhood (ACES) such as the loss of a parent
- Early childhood sexual trauma
Experiencing any of these doesn’t mean that you will automatically develop an anxiety disorder. These events are simply associated with a heightened vulnerability to the effects of anxiety. Twin studies suggest that genetic predisposition is the foundation but does not alone determine outcome. For some people, their genetics, individual traits, and experiences merge to create a vulnerability. How that combines is not completely understood. Knowing your risks is the first step to managing anxiety in healthy ways.
Signs of an Anxiety Disorder
Sometimes, anxiety becomes so bothersome that it affects our ability to function effectively. Missing work, not being able to concentrate, avoiding people or places can all begin to take a toll on well-being. When functioning is impacted, an anxiety disorder should be considered.
Anxiety is not a single disorder, but rather, a group of disorders. The Diagnostic and Statistical Manual of the American Psychiatric Association(DSM 5) identifies and designates diagnostic criteria for mental health disorders. The most common anxiety disorders include:
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Social Anxiety Disorder
- Specific Phobias
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
The trigger or focus of the anxiety is different for each type of anxiety and symptoms will vary. Having said that, the common theme is an increased difficulty managing the anxiety response.
General symptoms of anxiety can include:
- increased heart rate or palpitations
- rapid breathing
- restlessness, difficulty sitting still
- trouble concentrating
- difficulty falling asleep
Depending on your type of anxiety, you may also experience:
- panic attacks
- unwanted thoughts or memories that intrude into your daily awareness
- intense fear of certain things or situations
Even if you’re not diagnosed with an anxiety disorder, anxiety can sometimes be problematic. Whatever the origins of your anxiety, your experience will likely be different from someone else’s.
A Word About Anxiety Attacks and Panic Attacks
Anxiety attacks are something a lot of people experience especially when facing something particularly stressful.An anxiety attack is a growing and overwhelming sense of apprehension, worry, or fear. It tends to build slowly and intensify as the worrisome event or situation approaches. Some of the most common symptoms include:
- dizziness or feeling faint
- feeling short of breath
- sensations of hot flashes or chills
- feelings of worry or dread
- feeling restless or jittery
- tingling sensations
Once the event or trigger passes, the symptoms tend to subside. In the treatment section, we will talk about what you can do if you find yourself experiencing an anxiety attack. Anxiety attacks are sometimes mistaken for panic attacks and vice versa. However, a panic attack is very different.
Unlike an anxiety attack that builds slowly, panic attacks come on suddenly accompanied by intense fear and more severe anxiety symptoms that can be very frightening. Panic is also accompanied by an intense fear of dying and a sense of detachment from the world (derealization) or oneself (depersonalization). It is not uncommon to hear someone describe their experience as feeling as if they were going to die.
This intense experience creates fear of having another panic attack and sets off a cycle of fear and avoidance. The fear can cause you to start avoiding certain places or situations, fearing another attack. Some people only experience one panic attack. If you have more than one, it is important to seek the guidance of a mental health professional who can assess the situation. Like anxiety, panic is treatable.
The first step in treating anxiety is determining your particular type of anxiety. Different types of anxiety respond to various kinds of treatment. A licensed mental health professional can assess your situation and help you to determine the best treatment options. Treatment options can include medications, psychotherapy, lifestyle changes, and stress management.
Physicians use several types of medications to treat anxiety. Each type of medication has its own set of risks and benefits. These are issues to discuss with your healthcare provider. Current research supports the use of SSRI antidepressants in the treatment of anxiety. Studies have found that these medications often result in significant symptom reduction and are well-tolerated.
Psychotherapy or “talk therapy” is quite effective for people with anxiety disorders. Like any treatment intervention, to be most effective, the therapeutic intervention must be specific to the person’s anxieties and needs.
Cognitive Behavioral Therapy (CBT) is one of the most popular and most effective approaches to treating anxiety. CBT helps people learn new ways of thinking, behaving, and reacting to their anxiety triggers. Some specialized types of CBT, like exposure therapy, have been developed to treat specific types of anxiety.
Most studies support the use of medication and psychotherapy. What the particular combination of interventions might be is a decision best made between the provider and the patient.
Lifestyle and Relaxation
You might not immediately associate changing your lifestyle with improving anxiety levels but it is true. Things like smoking, poor diet, not getting enough sleep, and stress can send anxiety levels skyrocketing.
Research has found that making small changes like getting exercise, eating well, sleeping well, not smoking, and practicing relaxation can dramatically improve anxiety. Stress-reduction and relaxation strategies, in particular, seem to have a profound effect on anxiety. Regular practice of things like yoga, Tai Chi, and mindfulness meditation results in a significant reduction in anxiety and may have additional health benefits.
A specific type of mindfulness meditation, Mindfulness-Based Stress Reduction (MBSR), has been shown to improve general mental health as well as reduce trait and state anxiety symptoms. Mindfulness-based interventions, including MBSR and Mindfulness-Based Cognitive Therapy (MBCT), have been found to be particularly helpful in reducing anxiety and depression symptom severity for many people.
Dealing With Anxiety Attacks
Experiencing anxiety can be an unpleasant, stressful, and even debilitating. The next time you feel that familiar building sense of anxiety, try these tips:
- Stop what you’re doing. Find a quiet place to sit. If you’re driving, pull over.
- Practice acceptance. Recognize and acknowledge your symptoms. This helps you to normalize what’s happening and not see it as a catastrophe.
- Practice deep breathing. When we get anxious, breathing becomes rapid and shallow. Take some slow deep breaths from the belly. Place your hand on your belly as it rises and falls.
- Relax your body. Muscles get tense when we’re anxious. Notice and intentionally relax tense muscles.
- Have a chat with yourself. Speak out loud and look in the mirror if you need to. Your thoughts might be racing. Slow them by reminding yourself you’re okay. This feeling will pass.
- Use a grounding technique. Grounding is a mindfulness technique that can help you to remain anchored in the present and not remain in the anxious state. Some grounding techniques to try:
- Count something: the dots on the curtains, the paper clips on the desk. Just count.
- Sing a favorite song.
- Write something: your thoughts, your grocery list. Just write.
- Notice things around you. Notice all things that are blue. Name them.
- Pet a furry friend or even hold a stuffed animal. Tactile sensations can be soothing.
Anxiety can be troublesome or downright intrusive. The good news is that there are many potential solutions out there. When you understand your blend of anxiety, you can implement strategies that can make a big difference in your quality of life, quickly and efficiently. For help or information, reach out to your healthcare provider, and don’t forget to just breathe.