Anxiety management

Here is an article I wrote about understanding and treating anxiety disorders. It is long and may not be of interest to people who do not suffer from these difficulties. Nevertheless I decided to make it comprehensive so as to be of most benefit to those who are affected by them, either directly or indirectly.

It was written for an upcoming publication to be produced by Phobies-Zéro, a self-help organization for people suffering from anxiety disorders.

I am scheduled to give a talk on anxiety disorder this afternoon during a conference organized by the Anxiety Disorders Association of Canada and thought it would be a good time to post this article.

I will also post a French translation.

Anxiety Management

WHY ANXIETY?

Pain and bears

Do any of us enjoy feeling anxious? I doubt it. Just like physical pain, anxiety is something unpleasant. Nevertheless, it serves an important purpose – it keeps us alive.

Just as we feel pain when something is wrong physically, anxiety is what our body feels when there is a threat to it. Anxiety tells us: Do something! Protect yourself!

This protective instinct makes a lot of sense in the natural world. If you were ever walking through a forest and came upon a bear, you would feel a tremendous amount of anxiety. This is a good thing. The adrenaline rush that came with the anxiety would give you the best chance of surviving. You would use it to run as fast as you could. If you were trapped, or if the bear was overtaking you, you would pick up a branch or a rock and attack. This is called the fight or flight response and it is seen in all animals.

In our modern world anxiety keeps us from driving too fast around a curve, or standing too close to a ledge, or carelessly playing with razor blades. It is also what makes us go to the doctor to have that lump checked, or have our brakes looked at by a mechanic. Basically, when we worry about things, we tend to be much more careful, and we avoid danger.

The imaginary bear

If the bear is not real, but you think it is, your body will react the exact same way. People who struggle with anxiety disorders have bodily reactions that are pretty normal. It is their interpretation of danger that is out of whack! Their bodies act as if there is a bear in front of them when in fact the bear is only in their minds.

Residual danger

No matter what we do, we can never be completely safe. Some residual danger will normally remain. If I drive within safe limits I am less likely to die than the speeder, but I can never be sure. If I can live with that, I will be able to drive and function normally. If I can’t live with that and want to be absolutely sure, I’m stuck. I either have to avoid driving altogether, or I have to find some other way to control the threat.

WHERE DOES IT COME FROM?

Should I question my life?

One mistake people make when they start to struggle with anxiety is to question their lives. They believe that something must be wrong with their relationships or their careers and believe that this is at the root of their anxiety. While this can be a factor in making us more anxious, and can indeed be the root of the problem for some people, it is usually not the case. Life stress is a factor that worsens anxiety. It can even trigger a first panic attack, but it is not normally the real cause. The true cause can be found in how the body responds to a stressor (the anxiety) and how that response is interpreted.

These reactions and interpretations do not have a single source. Human beings are far more complex. We are the result of our biological make-up and of everything we experience in our lives. Here are some of the main sources of anxiety.

Your instinct

Certain fears are innate and made sense at some time in our development. Many fears ensured our survival and became instincts that are now part of our genetic make-up. Ten thousand years ago, for example, it was good to be afraid of heights because tree limbs could break and rock cliffs could give way. Humans needed to be wary of wide-open spaces where they could be easy prey. Being crowded meant the possibility of being trampled. Being away from familiar surroundings made us vulnerable to unknown dangers. Snakes and spiders could be venomous. Double-checking things reduced risks. Being concerned with what others thought of us increased the likelihood of finding mates.

Today, we can see these instinctive survival roots in many forms of anxiety disorders such as agoraphobia, social phobia and obsessive-compulsive disorder.

That was millennia ago, and while we needed the fears to survive back then, they don’t make as much sense in our modern society. These days, tunnels are reinforced with steel and are unlikely to cave in. Plus they are unlikely to house a lion.

You will also notice that many people are afraid of snakes despite never having been bit by one, while people are rarely phobic of stoves despite having been burnt many times. This is a testament to the fact that we develop anxiety disorders in areas that have an instinctive root far more easily than in areas that are affected by experience alone.

Your temperament and your genes

If you have more than one child – or if you have pets, or siblings, or uncles – the first thing you notice is how different each one is, even when they come from the same parents. These differences can be seen at a very early age. This is because we are all born with our own temperaments – our own genetic variation in the make-up of our characters. These differences can be seen in the crib. Some of us seem headstrong, others more passive. Some of us have tremendous curiosity while others seem disinterested. We are all different. Some of us are simply more anxious than others. That’s just the way we are.

The common personality trait in individuals who are prone to anxiety disorders is the way they think in absolute terms. They don’t easily let go. As we saw earlier, residual danger remains in most circumstances that create anxiety. This fact clashes with people who think in absolute terms and creates anxiety disorders.

Your environment

We are influenced by everything in our environment. This includes things we observe, things we are taught, and things we experience. This has an impact on what we see as dangerous and how we interpret events.

Our attitudes are greatly influenced by our families, our schooling, our friends, and our society. We would be very different if we were raised in different countries and by different parents.

Let’s take the example of families. A parent’s job is to protect us. They do this by teaching us what is good, what is bad, what is safe, what is dangerous. It isn’t hard to imagine different messages coming from them. For example, one parent might send a child with a sore throat to school, while another might go straight to the doctor’s office. Who is right is debatable. Nevertheless, there is a very good chance that the second child is more likely to worry about health as an adult than the first.

The same goes for experiences outside the family. The child who is teased in school, for example, is more likely to become a socially anxious adult.

WHAT FORM CAN IT TAKE?

When is a fear a disorder?

While anxiety is normal, there are many different degrees of it. In normal doses it protects us. When it is excessive, it imprisons us.

The two criteria that are used to distinguish between normal and problem anxiety arepersonal suffering and loss of function. If your anxiety is so strong that you are constantly preoccupied by it, or if it affects your ability to function normally – at work, or socially or in other areas – then your anxiety would be considered a disorder.

You may not like going to the dentist, for example, but if it doesn’t stop you from getting your teeth fixed, you have just a fear. If, on the other hand, you don’t sleep for two days before your appointment, or worse yet, if you ignore your cavities completely because of your fear of the dentist, then you have a phobia. Similarly, you may not like speaking in front of a class but if you drop out of school because of it, you have an anxiety disorder.

The fear: Crowds, dogs, disease, airplanes, fish bones…

The complete list of fears seems endless. These may include buses, metros, elevators, snakes, cats, spiders, elevators, heart attacks, choking, strokes, blushing, shopping centres, sweating, being far from home, being looked at, failing, rejection, and…well you get the picture.

You may be pretty discouraged by your multiple fears, but in reality, the picture is a much simpler one. In fact, all fears can be grouped into three broad categories.

1. Death or illness: The first of these is the fear of death or illness. People with this fear might be afraid of having a disease such as cancer, of having a heart attack or stroke, of dying in a car or plane crash, or of being harmed.

2.  Insanity: The second major fear that is commonly seen is the fear of insanity or of “going crazy.” Many anxiety sufferers may be afraid of losing their minds, of spending the rest of their lives “locked up,” or of doing something horrible such as harming their children or of steering into oncoming traffic.

3. Being judged: The third major fear is the fear of social ridicule. People with this fear might be afraid of blushing, of fainting at work, of making mistakes, of being laughed at, of saying the wrong thing, or simply of looking nervous in front of others.

Many people have fears that fit into two or even all three of these categories.

The fear of fear: The imaginary bear revisited

If we were to go back to the simple picture of anxiety in the bear example, it can be summed up like this:

When something threatens me (a danger), my body reacts with its protective response (anxiety, also known as the stress response). This makes me do something inresponse (run away, or defend myself, or control the threat in some way).

But what if I’m afraid of my own reaction? What if I am afraid of having a heart attack, for example? Then the heart attack becomes the bear. If I enter a classroom or a metro car where I have had problems in the past, I will surely be scared of it happening again. Since my body responds to any threat with anxiety, this would increase my heart rate. I would notice this and be afraid that the heart attack was more imminent. This would be interpreted by my body as a threat, thus causing a further increase in my heart rate.

In this example, the anxiety response becomes the danger that the body responds to like any other danger – that is, with more anxiety. This is the classic fear of fear seen in most people with anxiety disorders.

Avoid, verify, control…Do whatever it takes

Anxiety is a simple response. When there is the threat of a bad thing happening, we must control it. Our efforts to control the threat will define the type of anxiety disorder we have.

If a threat can be physically avoided, most of us would. This is a typical phobic response. People afraid of elevators, for example, will simply take the staircase. Those afraid of germs will avoid touching doorknobs. Those afraid of being laughed at will avoid situations where they are the focus of attention.

Sometimes we cannot run away. People afraid of germs, for example, may not always be able to avoid doorknobs. In such cases, they will wash their hands to undo the threat. Hypochondriacs will go see their doctors or seek reassurance from the Internet whenever they have a symptom. In reality, these are other forms of avoidance.

Sometimes people will try to avoid threats by controlling circumstances. For example, if they need groceries and can’t avoid going to the mall, they will try to control the danger by putting in place various mechanisms that serve to reassure them. To do so they may carry a mini-bottle of gin in their purses, or ask a friend to accompany them, or only shop in familiar stores, or wear cool clothes so as not to sweat, etc.

Sometimes the threat is with our own thoughts. Certain individuals, for example, have horrific thoughts – a form of obsessive-compulsive problem where sufferers are plagued with unwanted images or thoughts. Since it is difficult to control thoughts, these individuals usually try various methods of controlling them such as “positive thinking” exercises. They may also spend countless hours searching their minds or their circumstances for reassuring answers.

No matter what the threat is, those with anxiety disorders will always do what the rest of us do. They try to control threats in any way they can – they avoid, they try to prevent, they resist. These strategies rarely work against fear and they never work against the fear of fear.

OVERCOMING ANXIETY DISORDERS

Avoidance of real dangers is good but avoidance of imagined or exaggerated dangers isn’t. It just imprisons you and makes you miserable. There is no point in cheating when it comes to anxiety by trying to avoid it. All you end up doing is confirming to yourself that there was a danger there to begin with. Your goal is simple: Prove to yourself that there is nothing to be afraid of!

FACE YOUR FEARS

Most people with anxiety disorders know very well what is truly dangerous and what is exaggerated. It may not be easy but they must learn to face the ones that are not dangerous. By facing their fears most people with anxiety disorders can overcome them.

This can be done gradually. There is no need to torture yourselves. Just remember one thing. Never leave a situation while your anxiety is high or rising. This will only worsen the fear. If you can’t stay, then back off a little and wait. When you feel better, then you can leave. Better still, go back to where you were when you panicked.

Facing you fears – exposing yourselves to the physical sensations that scare you, or to the places where they normally occur – almost always works. If it doesn’t, it is probably because of what you are thinking. Some people may think that they were just lucky to get through it – “thank God I had someone with me, or my water, or my mints, or my pills, or my facecloth” – or that they succeeded only because it was a good day. The goal is to learn that there was nothing to be afraid of, and not that you were lucky! You did not escape danger. There was none there to begin with.

Remember Pavlov’s dog: It is important to keep one thing in mind when it comes to facing fears. If you have had many panic attacks in certain situations, your body will develop an anxiety reflex. Just like Pavlov’s dog, after a while our bodies develop strong reactions in response to sights, smells, sounds and other sensations associated with our experiences. For example, even if you are no longer worried about panicking in a restaurant, the ambiance, or the smell of the grill, or the sound of glasses clinking, can all trigger panic sensations. It may take many trips back before the reflex begins to extinguish itself. Be patient and don’t be discouraged.

FOCUS OUTSIDE YOUR BODY: Let your body and mind do their thing

People with anxiety disorders are so worried about their bodily reactions, or of their thoughts, that they are constantly focussing on them. This does nothing except make things worse. As we saw earlier, if we are afraid of our reactions, our anxiety response will kick in and only make them worse.

Think of what happens if you run up a staircase. For a while you will feel strong symptoms similar to a panic – your heart will race, you will sweat and maybe even feel shaky. Yet within a few minutes everything is back to normal. What did you do for those few minutes? Nothing. Your body took care of itself. The same is true when you are anxious. What makes anxiety last are your efforts to control it. By trying to resist anxiety, you are inadvertently feeding it.

Obsessive thoughts work the same way as physical sensations. Everyone has crazy thoughts or images in their minds from time to time. They do not reflect “secret desires” or subconscious drives. They are usually just a reflection of fear. Those who don’t worry about them quickly forget them. Obsessive individuals, on the other hand, constantly try to control them. This feeds anxiety and makes the fearful thoughts worse.

Anxiety is NOT a sign of insanity or of illness. Let your bodies and minds be. They might react to certain situations or thoughts, but they will quickly get back to normal. Do nothing and your body will take care of itself! So will your mind.

Learn what you can and cannot control

The final target of anxiety management is to change your belief that you have no control. In fact, you have all the control you need, just not as much as you would like.

Ultimately we must learn that anxiety cannot be completely controlled and that it is normal to feel anxious. Bad things do happen. Anxiety helps us control risks and minimize their occurrence. Unfortunately, there are no guarantees. People who have trouble letting go – those who seek absolute control – have a hard time with this reality. Their efforts to ensure safety only backfire. Since nothing can be controlled with absolute certainty, any effort will fall short and make it seem that the danger is closer. This increases anxiety.

Remember, if there is no danger, it doesn’t matter if you have no control.

A simple truth

There is a simple truth about anxiety disorders that has profound implications - people only panic when they don’t want to, and they never do in situations where it doesn’t matter. This is because the biggest part of anxiety is created by our efforts to control it. By accepting to feel anxious from time to time, the fear of fear – which makes up 95% of the panic – never comes.

A simple choice

If you were to be offered a choice between cancer and the fear of cancer, which would you choose? Most people would choose the fear of cancer. From the outside it is easy to see that one is a real disease and the other is “just a fear.” But what if you had the fear? How would you feel? Would you not feel as bad or even worse than the person with cancer?

To overcome an anxiety disorder you must remember that anxiety is a fear of a bad thing, it is not the actual bad thing. There is a difference between cancer and a fear of cancer. One can kill you. The other just makes you miserable. Don’t fight it and it won’t.

Tagged as anxiety disorders, anxiety management, treating anxiety.

Posted in Anxiety.

Posted on 19 Apr 2009