What is Anxiety?
Anxiety can be described as a feeling of nervousness, fear or unease. It is completely normal to feel anxious at different times in our lives such as before sitting an exam, giving a presentation or doing a job interview. However, when anxiety feels overwhelming, recurring and distressing to the extent that it is preventing us from doing the things in life that matter the most to us, then it might be time to talk to a therapist.
Worry is a future-focused thinking style that often accompanies anxiety and is characterised by “what if…something bad happens” or “what if…I won’t be able to cope”. Worrying is a normal thinking style that our mind uses to help us solve problems and respond to our fight or flight responses to stay safe. However, when worry becomes persistent, excessive and feels uncontrollable then it can become overwhelming and debilitating in a person’s life. When we believe our worry is uncontrollable, it can lead us to start ‘worrying about our worry’, such that that it is harmful to our wellbeing, both physically and mentally.
Feelings of anxiety in the body is a response to the fight or flight response and the symptoms of anxiety are the same as the effects of adrenaline in the body such as feeling dizzy/lightheaded, shallow breathing, racing heartbeat, feeling sweaty, cold hands, shaky knees, feeling nauseous or butterflies in the stomach. These experiences of adrenaline or anxiety can be extremely distressing if they are ongoing and persistent in our lives.
Dugas and Robichaud compare these physical sensations of anxiety as a feeling of ‘uncertainty’, that feeling in the belly or chest that something is wrong or something bad is going to happen. Having a fear or intolerance of uncertainty is a maintainer in the vicious cycle of anxiety and worry. We will tend to worry about something (‘what if…’) to gain more control or certainty over a perceived future threat, and to prevent something bad from potentially happening. CBT treatments aim to help someone to find ways to become more tolerant of experiences of uncertainty in their everyday lives. This can result in an overall reduction in anxiety and worry.
TYPES OF ANXIETY
There are many different types of anxiety and CBT as an evidence-based psychotherapy is recommended by the Nice Guidelines for all anxiety disorders (https://www.nice.org.uk/guidance/qs53).
Generalized Anxiety Disorder (GAD)
According to DSM 5 Generalized Anxiety disorder involves ‘persistent and excessive worry’ about a number of events or activities (e.g. finances, work, school, family) to the extent that it affects our daily activities. It can manifest in our lives through symptoms such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping.
This is extreme self-consciousness due a fear of being judged negatively in social situations. It is also known as social phobia or excessive shyness. Someone with social anxiety will maintain an excessive inward focus on the strong physical sensations of anxiety inside the body. This self-focus is perceived as extremely threatening due to a fear of embarrassment and ultimately keeps self-consciousness going for a person. A socially anxious person will tend to avoid social situations, and when in social settings use safety strategies such as avoiding eye contact, looking at their phone or standing near the door or in the corner to alleviate the symptoms of anxiety. It can involve pre-anticipatory anxiety or excessive worry at the thought of having to into a social situation, and afterwards lead to focusing negatively on the on what might have gone wrong. Some of the thoughts that people experience when faced with social anxiety include ‘they will laugh at me’, ‘they know I’m embarrassed’ or ‘I looked like an idiot’. Social anxiety can often accompany difficulties with self-criticism and low self-esteem.
DSM 5 describes Panic disorder as an intense experience of fear or discomfort lasting for up to ten minutes whereby symptoms can appear to occur suddenly. It can also be understood as a ‘catastrophic’ misinterpretation of bodily sensations which includes an intense fear that something awful will happen. Thoughts include ‘What if I’m dying?’ or ‘What if I’m going crazy?’.
What is happening during a panic attack is that the amygdala or the fear centre of the brain falsely interprets a false alarm that something immediate and catastrophic will happen. It then sends signals to the adrenal glands to release large amounts of adrenaline as an activity of the fight or flight response. I associate this as the brains way of sending a signal to the adrenal glands to ‘release the soldiers’ to help us to fight, flight or freeze in response to a threat. The problem with panic is that instead the brain sets of a false alarm that something extremely and immediate bad is going to happen. However, it is a perceived threat rather than a real one, but it feels so intense and frightening that the person will start to avoid activities that where they fear they may have a panic attack. It can be extremely distressing and debilitating for someone to experience recurrent panic attacks. It can really prevent someone from doing the things in life that matter to them.
According to DSM 5 someone experiencing a panic attack could experience some of the following:
Palpitations, pounding heart, or accelerated heart rate
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Feeling dizzy, unsteady, lightheaded, or faint
Fear of losing control or “going crazy”
Fear of dying
Agoraphobia is a fear of being in open or enclosed spaces, being in public places or in crowds, especially where escape may be difficult or embarrassing (DSM 5). This might precipitate fear of the onset of a panic attack. Often, it can lead to someone avoiding places where they may fear having a panic attack.