Understanding and managing anxiety: Part 1

Once you are anxious, the quality of your thinking changes. You are much more likely to have further thoughts, each of which, further fuels the anxiety.

In this post, I am going to look at anxiety from the lens of how we relate to ourselves. Part 2, which will follow, looks at anxiety in terms of how we relate to others.

 

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 “fight or flight” 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:

  • 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. All of this is normal if very unpleasant.

However, we become concerned with the anxiety response when it starts to interfere with the life we want to live. We tend to “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.

We can say that anxiety can become organised in predictable ways and sometimes people fall in one group, sometimes in more than one.

 

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 intially, 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 Disorder

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.

 

Generalized Anxiety Disorder

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.

 

What seems central in most anxiety disorders is loss of control.

 

One way to help people in either of these groups 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.

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 behaviorus often have the opposite effect. They keep worrying thoughts and the feeling of anxiety going.

 

Managing anxiety

Depending on what form your anxiety takes, it may be kept going 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 dangerous. You just need to get out of the way.

Psychologists often call the kinds of thoughts that we have when anxious “cognitive distortions” or “thinking errors”. This is because they do tend to distort reality often, but think about this as your mind playing it safe and trying to get you to act by overlabouring the point.

 

For example:

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.

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.

 

So today we have:

Explained why anxiety feels the way it does

Described some common anxiety bundles called the “anxiety disorders”

Shared a rule of thumb: 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@relationshipsinmind.co.uk (if you want to come to my Liverpool Street practice) or nikos.tsigaras@kensintgoncounselling.com (if you can access High Street Kensington). 07805945233 if you’re old fashioned.