What is anxiety and what maintains it?
Feelings of anxiety normally manifest as unease, worry, or fear about something with an uncertain outcome. It’s a response to our natural instinct to protect ourselves from threat or perceived threat. Everyone has feelings of anxiety about something at some point but for some, these feelings can seem uncontrollable. In many cases the response can be physical which is why sometimes anxiety is not considered a mental illness.
Anxiety disorders exist separately and can be the cause of considerable distress and disability. Example of anxiety disorders are phobias, obsessive compulsive disorder (OCD) and general anxiety disorder (GAD).
Anxiety is about extremes, thinking the worst will happen, it will be terrible, horrible, the end of the world, instead of concerning, unfortunate, unpleasant or difficult. The more extreme the thought the worse the anxiety will be. Labelling the thought can then be the cause of more extreme thoughts as the original disturbing thought is compounded.
One of the difficulties is that it’s very hard to ignore thoughts, but they are just that, thoughts not premonitions and not evidence you must act on. Anxiety is a not problem of danger, it’s a problem of worrying about danger.
It may help to think of your anxious thoughts as a separate person, a person who is trying to protect you. The amygdala (a small complex structure of cells in the brain) is responsible for putting us on alert. We are naturally always on alert because our amygdala (or Bob as I call it) is trying to protect us. Bob sends up a flare, an anxious thought, anxious thoughts lead to anxious feelings which lead to protective behaviours to reduce the fear. The anxiety is reduced until the next time Bob sees a threat.
Bob is like a smoke alarm, doesn't know the difference between burnt toast and your kitchen burning down. How you deal with the alarm is up to you. Ask yourself each time you feel alarmed "is it burnt toast?"
What we need to learn to do is accept Bob as a friend, listen to our friend and be prepared to sometimes say thanks but no thanks. Anxiety is maintained when we believe every alert in our brain is actual danger. It is up to us to respond to the alert in the most appropriate way. Sometimes we need to tell Bob, “thanks, but you're not needed in this instance" and other times it will be "thanks Bob I needed that warning".
There are some other processes which can cause and potentially maintain anxiety.
Can you recognise any of these in your life?
Disruption
External factors such as loss of employment or could be uncertainties about life decisions such as divorce. Other factors could be excessive demands placed by work or family or even more subtle events such as realising important goals are unattainable. Internal sources could be a lack of understanding about anxiety itself and a belief the problem lies elsewhere.
Vicious cycles
Short-term vicious cycles are created by responses to threat which compound and reinforce the belief of threat, hence creating a cycle. Constantly looking for evidence that ‘confirms’ worst fears will escalate and perpetuate the problem. Long-term vicious cycles include the impact of anxiety problems such as avoidance of social, work, or other leisure activities perhaps resulting in unhappiness, leading to use of alcohol or other substances to cope.
Failure to confront
After confronting long-standing fears, some do express “it was a bit of an anti-climax”. In other words the fear of fear was worse than the actual issue. That’s not to say that we should all go out and face our fears head on as to do so may cause irrevocable harm. Confrontation must be appropriate, timely and supported by a trained professional.
Lack of awareness
Sometimes all that is needed to help someone with anxiety is education. The physical symptoms of anxiety can be extremely frightening. Occasionally manage the physical symptoms and explaining the reason for them can be enough to combat the issue.
Focus on the self
Having a mental health difficulty can be all consuming especially with anxiety as there tends to be distressing physical symptoms. A large proportion of life may be taken up with fear and attention to bodily sensations. The more anxious the person becomes, the narrower the focus is on the self which instigates hypervigilance and inadvertent seeking out of threats, which creates the short-term cycles described above.
Absence of satisfying alternatives
A life organised around avoidance of threat is at least organised. Avoidance can be sustained tolerably if it doesn’t disrupt life to any great extent, for example, a fear of flying could be maintained by travelling by train, boats etc and never facing up to or confronting the fear.
Instrumental factors
It’s fair to say that sometimes our loved ones can maintain the anxiety by condoning avoidant actions (such as the flying example). A more subtle way is that the individual themselves maintain the anxiety because it receives sympathy and attention which would otherwise be lacking.
Anxiety in the form of General Anxiety Disorder or GAD is thought to affect 3% of the UK population, however it is also thought that 1 in 10 of us will suffer from anxiety at some point in our lives. It is also believed that there are many individuals living with anxiety without seeking treatment or recognising the condition.
First of all, try making friends with “Bob”. Recognise when Bob is right or wrong about the alert and really ground yourself in the reality of the situation as opposed to where ethe fear is taking you. Look for alternative explanations as to what is causing you distress.
If you are finding this impossible then seeing your GP should be a priority. Counselling can help you to retrain your thinking so that your response becomes appropriate and adequate for each situation.
references from: Counselling for anxiety problems, (c) Richard Hallam 1992