What is anxiety?
Anxiety is a form of arousal, with physical symptoms no different from arousal of other kinds, such as excitement or anger, but accompanied by a feeling and thoughts of imminent doom. It is the same thing as fear but generally describes something milder.
The physical symptoms of arousal are caused by adrenaline which causes:
- Raised heart rate and strength of pulse
- Raised breathing rate and depth
- Muscle tension and trembling
- Sweating
- Nausea, which may lead to vomiting
- An urge to urinate
- Stomach churning, which may lead to bowels opening
- Hair standing on end
There are other changes inside your body as well which you may not feel such as increased acid in your stomach and raised blood pressure
Arousal in all its forms, whether anxiety or excitement, serves a purpose for you which is to prepare you for whatever physical challenge you may be about to face. Excitement prepares you to perform with alertness, energy and drive. Anxiety prepares you to protect yourself, either by fighting or running away. Arousal can flip very easily between anger and anxiety/fear.
The causes of anxiety
On the whole, anxiety has psychological causes, meaning that it is usually an emotional reaction to things and not caused by a physical illness or disorder. However, there can be physical causes for anxiety, such as an overactive thyroid gland or an overactive adrenal gland (where the adrenaline comes from). These physical disorders need to be treated and they have to be excluded before assuming that anxiety is simply psychological and so it is very reasonable to consult a doctor to get checked up.
The psychological causes can be anything, ranging from everyday stress and worry to life threatening danger. In every case, your body is trying to prepare you for a threatening situation. This can be a real nuisance if the situation is one of everyday stress because it’s hard to avoid – everyone experiences stress in their lives and getting anxiety symptoms simply makes coping with it harder.
The situation gets even more complicated if you misinterpret the symptoms of anxiety for a physical illness. This is easy to do. The raised heartbeat and the breathlessness can make you fear that you are having a heart attack. Muscle tension can cause aches and pains, particularly head, neck and shoulder aches. Overbreathing can make you dizzy and faint and feel you might be having a stroke or might collapse in public and need emergency help. If you mistake your symptoms for a physical illness, you may find that investigations by doctors make it worse because they do not firmly exclude a physical cause, leaving you wondering what they might have missed.
This pattern of stress, caused by life problems, which then lead to new fears of illness or collapse, can cause a spiral of worsening symptoms as you try to take precautions. People may start to avoid situations where they fear the symptoms might recur and cause an emergency, such as being alone, going to crowded public places, taking exercise which makes you breathless and speeds your heart rate or simply being far from a safe place such as home. Agoraphobia, social phobia and other patterns of avoidance follow, severely limiting your life.
Treatment of anxiety
Physical treatments
There are some medications that relieve anxiety. Tranquillizers, such as diazepam and temazepam, work but they are addictive and withdrawal can be very difficult. They are only good to use for a day or two at most.
Propranolol, which slows the heart and reduces tremor can be useful to cope with an anxiety inducing situation, such as shortly before a particularly stressful event, but should not be taken regularly.
Antidepressants can help a lot but have side effects such as sleepiness, dry mouth, problems with eyesight, problems having an orgasm and weight gain. They can cause withdrawal symptoms if taken for more than a week or two.
The best treatment is psychological.
Psychological treatments
Your brain is designed to immediately learn to run away from, fight or avoid stressful or dangerous situations. It is much slower to unlearn that fear and avoidance. Although it learns to be afraid immediately it unlearns only slowly. Psychological treatment teaches your brain to stop being stressed or afraid but can only succeed slowly.
Exposure treatment involves exposing you to something or a situation that you have become afraid of, step by step, learning to stay calm with each step.
For example, to overcome a spider phobia, the first step is to be exposed to, perhaps, a drawing of a spider and staying calm. Once the drawing isn’t frightening any more, then a photograph of a spider and step by step, via small dead spiders to large living ones, at every step learning to stay calm and relaxed.
The same process would apply to agoraphobia where the patient is afraid of crowded public places. Depending on what the person feels able to do, you might start with simply going out of the front door into the street. Step by step the tasks get more difficult and end up with the person going into a crowded supermarket, for example.
One of the key elements is that exposure at each stage needs to last long enough for the anxiety to recede, which may be an hour or more. In the agoraphobia example, above, that would mean going out into the street and staying out until any anxiety has gone.
Exposure has to be repeated because you will always relapse a bit between each exposure session and only gradually will the anxiety decline and eventually stop.
Cognitive behaviour therapy is based on exposure therapy but with added attention paid to the thoughts and fears that accompany the physical symptoms. The task is to learn to recognise the symptoms as being anxiety and not the heart attack/stroke/imminent collapse you feared and label them correctly when they happen. You learn and practice ways of thinking and reassuring yourself to counter the fears that anxiety brings.
After treatment
Exposure treatment and cognitive behaviour treatment will work as long as it is done thoroughly enough and for long enough. One important principal, though, is the benefit of ‘over learning’. This means going beyond the level of treatment you need to cope with the situations that previously caused anxiety and expose yourself to situations that are even more stressful or frightening. The point is to teach you to cope with more than just the essential situations and to reduce everyday stresses or cues for anxiety to be well within your capacity.
Some people are born with a vulnerability to anxiety and may relapse into anxiety again when under stress. It is useful for such people to become really expert at controlling anxious thoughts and responding in a healthy way to anxiety symptoms so that they are not significantly impaired by their vulnerability and can lead a full and enjoyable life.
