Anxiety

Anxiety a very common reaction that everyone will experience from time to time.

The role of anxiety is to warn and protect us against danger. What we call anxiety is a collection of thoughts, feelings, behaviour and bodily sensations. One way to understand anxiety is to think of it as the way humans respond to various threats. In this way anxiety is very similar to the fight or flight response.    

Many people would have heard of the flight or fight response. The flight or flight response is set of reactions that occur on our bodies in response to danger. The fight or flight response evolved to protect people from physical threats, such as animals and other humans. Thousands of years ago humans would often be faced with physical dangers. In response to these threats the person could either stay (fight) or flee (flight). 

Sometimes waiting around to make that decision would have been fatal. For example, it would have made more sense to run from a wolf or a bear! It is perhaps for this reason that the fight or flight response evolved as a set of automatic reactions that occurred very quickly. In response to a threat the fight or flight response is activated and a wide range of changes occur in the body. Some of these are: 

• Increased heart rate
• Increased breathing rate
• Adrenalin release
• Increased blood glucose level
• Blood diverted to the major muscles
• Focused attention
• Reduced desire to eat and sleep 

These flight or flight symptoms are almost exactly what occur in the body when someone becomes anxious. In other words, what we call anxiety is a modern version of the fight or flight response.  

Some people might find that if they experience low levels of anxiety they might not notice the symptoms at all. This is especially the case for people who have been anxious for much of their life. These people may just assume that the feelings they have and the way they experience things are quite normal when in fact they may no longer notice that they are actually quite anxious. For almost everyone, however, as their anxiety increases so the symptoms become more obvious. 

Anxiety and threat

As you can see the fight or flight response, or what we more often now call anxiety, serves a very important role in protecting people from danger. It is probably one of the major reasons why humans survived as a species. Humans are actually very good at learning about what things are threatening or dangerous, and this too has helped us to survive. However, the types of things we now have to deal have changed dramatically in the last few hundred years. For many of us our challenges are not so much about dealing with physical threats. Instead the problems we are faced with are more about dealing with social, emotional and psychological difficulties. We do, of course, have to deal with threats to our health, but these still not the types of physical danger that the flight or fight response was designed to tackle.  

Social

• Finances 
• Relationships
• Family issues
• Earning a living
• Employment 
• Raising children

Emotional

• Feeling down
• Feeling happy
• Worry
• Emotional trauma
• Loss
• Grief

Psychological

• Self esteem
• The future
• Guilt
• Status
• Success/failure
• Blame

Health

• Exercise
• Weight control
• Diet
• Infections
• Chronic illness
• Death

As the above table shows, we now have to deal with many threats that are not simply physical. Of course, many people cope with these problems as part of day to day life. However, at different times a person may find that they more or less anxious about the problems in their life. 

When anxiety goes wrong

Clearly anxiety can be quite helpful when it serves to protect to people from danger. The natural reaction is to try to reduce anxiety when it arises. This means either finding a solution to the problem or reducing the anxiety somehow. Anxiety is helpful when it alerts us to problems we then work to solve. However, sometimes anxiety can become too much to handle. At these times people often describe themselves as feeling stressed or overwhelmed. If anxiety occurs suddenly and rapidly we often call it a panic attack. 

When anxiety becomes too strong it actually gets in the way of solving problems. At these times the person may start to avoid things in order to cope with their anxiety. When this happens they usually avoid the very situations that would allow them to deal with the cause of their anxiety.   

Anxiety is a problem if we overestimate the potential for a situation to cause us harm. Throughout hour lives our experiences shape us and determine how we react. So, for example: 

If a person has low self esteem then being challenged might provoke anxiety

If a person is assaulted they may fear certain places or going out at night time

If a person is worried about their family they may become anxious about losing their job

If a person has experienced rejection or worries about what other people will think of them then they may be anxious in social situations

All of these are examples of how anxiety can cause problems. It is important to remember that the reason for becoming anxious about something may have been totally justified in the first place, but it is the on-going nature of the anxiety, or the tendency for it to affect you across your life, that causes the problems.   

People differ in their anxiety levels

There are many reasons why people differ in their anxiety levels. Some of these include: 

Genetics

Some people are simply born with a tendency to be more anxious.

Childhood

Events during our childhood will influence how anxious we become as adults. They will also influence the types of things that make us anxious. So, for example, if someone is bitten by a dog as a child they may grow up with a fear of dogs. On the other hand, if someone grows up without sense of security they may be generally quite anxious. 

Parenting style  

Generally speaking, anxious parents tend to raise children who become anxious. In child clinical psychology, for example, children treated for anxiety tend to have anxious parents.  

Life events  

As adults life events will affect our anxiety levels. Threats to things that matter to us, such family or friends, will increase our anxiety and as the extent of the threats increase so will the level of anxiety. There is often no need for something to be actually going wrong for a person to become anxious. It is usually the perception or expectation of a problem that causes anxiety. 

On course all of these things interact to create the overall anxiety level. So a person with a genetic tendency towards anxiety is more likely to react with anxiety when they think that something will go wrong compared with a person without the genetic tendency.   

Characteristics of anxiety

Anxiety is understood as a combination of attention, thoughts, feelings, body sensations and behaviour. 

Attention

People with anxiety tend to pay more attention to things that they perceive as a threat. So, if you are anxious about dogs you may be attentive to barks, smells, or the noise of an animal running up behind you. People with social anxiety, on the other hand, tend to pay more attention to people’s faces and are more responsive changes in other people’s social behaviour.   

Thoughts

People with anxiety tend to over-estimate the potential threat of a situation. These over-estimations occur in two ways. Some people will tend towards one type of over-estimation while others will use both. 

Over-estimation of the likelihood that a bad thing will happen

When this occurs people tend to think that there is a higher risk of something going wrong. For example, the person with the dog phobia thinks that most dogs are dangerous while the person who has been assaulted thinks that going out at is night always dangerous. 

Over-estimation of the personal cost of a bad thing that actually happens

A second type of thinking associated with anxiety involves over-estimating the cost of a bad thing should it happen. There are many negative events that do actually occur quite often. For example, people often find that things go wrong in social situations. A person may say the wrong thing or they may meet someone who they just do not ‘click’ with. However, people with anxiety tend to over-estimate how bad the feared situation will be. They may think, for example, that it is terrible that someone does not like them. They may also think that this will reflect badly on their current relationships. In practice, however, these events often have less impact than is feared. 

Feelings

Anxiety is generally experienced as fear or apprehension. Low levels of anxiety will be accompanied by weak feelings but higher levels of anxiety generally involve strong feelings. When the feeling of anxiety becomes too great people often feel an overwhelming urge to get away from wherever they are (flight). These strong feelings may also lead to panic attacks (see panic handout).  

Body sensations/the effect on the body 

The common bodily symptoms of anxiety include:

• Heart racing
• Shortness of breath
• Chest tightness
• Dry mouth
• Muscle tension
• Butterflies
• Nausea
• Dizziness or light-headedness
• Choking or smothering feeling
• Hot or cold flushes
• Feeling faint
• Trembling or shaking
• Sweating
• Tingling feelings or numbness in hands and feet 
• Mind focused on the anxiety
• Feeling confused
• Feeling disorientated or unreal

Prolonged anxiety, like prolonged stress, which is a very similar to anxiety, can lead to:  

• Feelings that you are unable to slow down or relax
• Anger
• Feeling that things often go wrong
• Inability to focus or concentrate
• Poor sleep
• Fatigue
• Feelings of boredom
• Sexual problems
• Headache
• Loss of appetite 
• Ulcers
• Pain, especially lower back pain
• Constipation
• Over-under eating
• Increased alcohol or drug use

Behaviour

Avoidance is very common in anxiety. People avoid the things that make them anxious in order to reduce their distress. Sometimes avoidance can be obvious, for example when the person who has a dog phobia crosses the road when they see a dog or when the person who has been assaulted refuses to go out at night. 

At other times the avoidance can be very subtle indeed. This is called covert or sneaky avoidance. It can often be very difficult detect covert avoidance because people build up a network of things in their life that serve to maintain the avoidance. Someone who has social anxiety, for example, may fill their life with obligations, such as study, housework, overtime at work and so on, in order to avoid social activities. Alternatively they may avoid promotion at work because it involves making presentations or being on display to others. People also often justify their avoidance to themselves quite well. For example, they may tell themselves that the thing they are avoiding really didn’t matter to them at all. 

A third form of avoidance involves what are known as ‘safety signals’. ‘Safety signals’ are things in our life that we use to keep us feeling safe. Lucky charms are a form of safety signal because people who believe in them feel more relaxed when they have them. In more extreme some people will not do certain activities at all unless they have ‘safety signals’. So, for example, people who suffer from panic attacks sometimes will only go out if they have someone with them. Similarly, people who suffer from chronic health problems will often not go out unless they have a support person with them. In this second case needing a support person may be justified. But more often than not the behaviour is actually driven more by anxiety than by a genuine need.    

Avoidance and anxiety

It is common for people to think that it is ok to just avoid the things that cause them distress. The following diagram explains why this is not a good idea to avoid things that make you anxious. 

  SHAPE  \* MERGEFORMAT       

Initially when you avoid something you subconsciously tell yourself that: 

• The feared thing may well have happened
• The reason it didn’t happen was because I avoided it
• I am not able to cope with this problem

As the avoidance continues so a cycle of fear and avoidance develops and slowly becomes stronger and stronger over time. In the end you may see no other way of coping with your anxiety because on many occasions you have reinforced to yourself that (a) the thing you are afraid of is highly likely to happen; (b) it would be very bad for you if it happened; and (c) that you could not cope with it. 

Treatment of anxiety

Different approaches are required depending on the type of anxiety. So, for example, panic attacks are treated differently from the fear of failure. However, the principles are very similar regardless of the type of anxiety. They involve working out the thinking associated with the anxiety, managing the emotional distress, and reducing any avoidance. All of these things can be achieved by developing certain skills that have been shown to be very effective for managing anxiety.  

That was pretty unpleasant but I got through it. Now I know I can get through it again

No Avoidance

Feared Event

Didn’t Happen

Didn’t Happen

Happened

Avoidance

The feared thing didn’t happen because I avoided it

I over-estimated to probability that it would happen