What is Anxiety?
There are many ways of answering this question, so let me add mine to the already long list. Anxiety is our natural flight-flight response to a perceived threat. It is rarely a reaction to an external life threat, and is usually experienced because we are concerned we might experience an overwhelming, unwanted emotion.
Let’s take a simple example. We are anxious before our driving test. Why should this be? At the simplest level we can say “I don’t want to fail it”. But this does not really answer the question as to why we become anxious. That is wrapped up in the consequences of failure. Yes, it’s inconvenient to fail. But what emotion is associated with that? For some it might be that the examiner is projected as a parental figure who has the power to give or withhold. We don’t want to displease them or we might not get what we want. For some it’s the wider social implications of failing. More specifically, feeling like a failure among peers and people whose judgements affect us. For others still, they pride themselves on achieving and to risk contemplating failure feels threatening. It’s their own identity at stake. The root of all these examples is the threat of failing, and specifically of feeling the embarrassment and shame of being a failure.
When I use the word anxiety, I do so in a rather nebulous way. While some researchers take out microscopes to break down anxiety into different types of anxiety, I move the lens outwards and I consider that nervousness, worry, excitement, panic, stress, tension and restlessness are all inter-related expressions of the condition which presents as anxiety. If you prefer to use another word, that’s totally fine!
The Physiology of Anxiety
It is generally accepted that anxiety is body’s fight-flight-freeze system becoming activated. We are on high alert. This is our Sympathetic Nervous System (SNS), and is an evolutionary feature of vertebrates. It it our response to danger and gears us up for action through releasing cortisol, raising blood pressure, abandoning less essential systems such as digestion, and tensing the musculature. This is understandable for most life forms, whose primary concern is to stay alive. Lizards, as far as I am aware, are not concerned about being a failure. So how come it’s triggered so easily in humans? Thousands of years ago, humans existed like other animals, and would be out hunting for food, whilst being equally concerned that they avoid becoming food for other creatures. There was likely only relatively little attention given to needs as we understand them today. Our SNS kept us alive, quite simply. On bigh alert. Survival.
However, almost unique to humans, staying alive has taken another facet. For the early years of a human’s life, we are totally dependent on others to provide our needs over and above a supply of milk. By comparison, many young mammals are running around within hours of being born. But humans are entirely helpless. The human condition requires a social dependency to stay alive, especially towards primary care givers, archetypically the mother. Humans are hard-wired to be loved. And as humans mature to adulthood, they learn to survive without the need for care givers. Nevertheless, humans rarely abandon these survival strategies completely. Being socially accepted is important to a human. Many of us will know what it feels like to be excluded, abandoned, rejected or bullied and the threat of any those things happening is enough to trigger our SNS. Will people still love us if we fail our driving test? Our rational mind says: Yes, of course. But messages from our unconscious mind reveal that it is a concern.
Anxiety first aid
Before discussing how we might look after ourselves to help mitigate anxiety, what can we do if we are already in an anxious state? Let’s look again at the physiology. The SNS releases cortisol, the stress hormone, and we are stuck between fight or flight. We could fight – become angry, for example, or take other affirmative action. But that is rarely productive although it can be highly satisfying at the time. We could flee – run away actually or metaphorically – such as burying ourselves in work or simply cancelling that driving test.
The good news is that the body has its way of countering the cortisol. This is the Parasympathetic Nervous System (PSNS). The PSNS is associated with endorphins, which can be thought of as reversing the effects of cortisol. These hormones are the body’s natural painkillers. They bring about relaxation, restore digestion and dilate the otherwise tensed blood vessels. In short, we feel better. So how do we activate the PSNS?
The PSNS is especially focussed on the vagus nerve which runs from the cranium down the spine, and it responds to relaxation. That might seem counterintuitive, as we would like it to bring about relaxation when we are stressed. However we can help start the process by practising a few activities. These include:
- Mindful breathing, yoga, tai-chi, dance etc.
- Physical activity, especially if we stay mindful of the body rather than simply exerting ourselves, which may add to the adrenaline.
- Good company. Someone to physically soothe us would be nice but many benefits can be found simply by being in the company of others. We might not feel very socially desirable but being with people we trust can reduce anxiety.
- Laughter.
- Whatever you find meditative, such as a warm bath, your favourite music, or a religious practice, if not meditation itself.
Moving from anxiety into an activity can feel hard. Our mind tells us we need to stay alert and it can feel disrespectful to these messages to turn our attention away. But that is exactly what we must do to get past the threatening messages (sometimes called our “inner critic”) which seem to know every piece of mental gymnastics under the sun to keep us alert.
Avoiding depression
Earlier I referred to a third outcome to the activation of the SNS. Not just fight and flight, but freeze. It is a defence against anxiety, in fact, so strictly speaking is not on the same axis. In fact it is likely connected more to the PSNS. This “freeze” feeling of paralysis and introspection, once set in, brings about depression while we remain on high alert. We feel socially separate from others and we resort to shutting ourselves off from the world. Some people may not emerge from a darkened room for days on end. Others will still function in a workplace or in a social setting, but we experience them as having no emotional connection with us, as if they are in a glass box. And they will feel like they are alone in a world that does not understand them.
Whereas anxiety is transitional – we can’t really make a decision at all without a degree of anxiety, no matter how subtle – depression feels far more permanent. Getting out of depression is beyond this article but let’s quickly consider depression as an outcome of getting out of anxiety.
Curiously, getting out of “freeze” largely means introducing a bit of anxiety. Some people have fidget toys, which help activate awareness of the body. Exciting foodstuffs like mints or a sparkling drink might help (but probably not an alcoholic one). Or a quick blast of something you find hilarious or exciting. The important factor is to reconnect with the world while you are still aware of what’s happening and before you launch into a Game of Thrones binge in your bed. Essentially, stimulate the senses either physically or socially. Then move on to the anxiety-reducing strategies above.
Therapy
In therapy, I deal a lot with anxiety. While some of the feedback might be to help the person out of the crisis with practical advice such as that given in this article, most of what I will work with involves the nature of the perceived threat. What is it like to fail that driving test? My next article will cover this. The thing is, the therapeutic experience alone is what brings about much of the healing.
Many people refer to “social anxiety” as an issue. But anxiety is almost always social, even if it comes about when alone. The perceived threat almost always has social elements to it. Being with a therapist helps us experience what it’s like to be socially acceptable. To be attended to, regardless of what we’re presenting. To turn back to the language of the helpless infant, it’s a chance to experience unconditional nurture (read “love”) despite being in a socially distressed condition.
Medication
A GP will likely prescribe an anti-anxiety or anti-depression drug when consulted with the symptoms described here. This alone can create its own anxieties. We might feel like we are giving in, or that we are less of a person for requiring these drugs. Added to this is the danger that we might be taking them for years, perhaps forever. I would encourage anyone consulting a GP to always have an “exit strategy” in mind and to stay engaged with discussions. The meds can help a great deal when we are in crisis. But they are mind-altering drugs and rarely do they target the neuroreceptors responsible from our anxiety or depression withour some collateral effects. People report a loss of sex drive, a lack of enthusiasm to participate in social situations, and a reduces sense of self. The dosage and the formulation is important here, and if one formulation doesn’t help, the GP will likely recommend another. It’s not an exact science, and very much a try-it-and-see approach before a suitable formulation is found. And they often take 4-8 weeks to take effect.
I would never advise someone to avoid medication. But I would always encourage them to be an active participant in their recovery and certainly not expect being perscribed that “magic pill” they dream of.