Chapter 1:Understanding Your Anxiety
The foundation to overcoming your anxiety is understanding it, and understanding what sustains it. It might be tempting to skip over this section and jump straight into the strategies. Please don’t do this; this knowledge is the basis for the effectiveness of the rest of the strategies in this book. Imagine you were trying to fix a car or an appliance. You wouldn’t just start randomly tinkering without first identifying the actual problem, and making sure you understand how it affects the rest of the system. Similarly, you need to understand your anxiety and its effects on your system – your whole mind and body – before you can effectively deal with it. The more you can understand about your anxiety the better, and the easier it will be for you to overcome your problems. That’s why this first skill of understanding your anxiety is so important. If you were coming to see me in my clinic, this is exactly where we’d be starting.
Why Do You Need to Understand Anxiety?
Some people are aware and acknowledge that they have a problem with anxiety. Others are taken aback upon realizing that their physical experiences are due to anxiety. It can be really perplexing to grasp that anxiety can cause such symptoms; have you ever felt this way? Part of this confusion stems from not fully understanding your anxiety. Once you grasp the nature of your anxiety, you’ll realize that its presence is more logical than you might originally have thought.
Imagine walking through a forest on a foggy day, where the path is riddled with obstacles like rocks and fallen branches. You can only see a few feet ahead, and everything appears blurry and indistinct. This is what it’s like when you lack knowledge and understanding of a situation, obstructed by hazy and unclear thoughts about anxiety. When the sun breaks through the fog, the path ahead is brilliantly lit, revealing all its intricate details. You can see clearly, and no longer stumble blindly. The same goes for gaining knowledge and understanding about how your anxiety operates. With knowledge and understanding of how your anxiety impacts you, the path ahead of you becomes illuminated, making it easier to navigate and overcome your struggles. The clarity gained from this information allows you to see what you’re dealing with, and guides you towards recovery.
You’re here because at some level you accept that you have a problem with anxiety. You might feel some doubt about this acceptance at times, but that’s okay, it’s part of how anxiety operates. Your problems with anxiety didn’t just come out of the blue; there is a reason for them. Sometimes, something has happened to alter the way you think, feel and react to things. As you develop a better understanding of your anxiety, you’ll be able to see the inextricable links between your thoughts, feelings and behaviours. You’ll also gain insight into the working of your brain, and how this impacts both your physical and mental state. We’ll look at causes of anxiety, so if you’ve ever asked yourself ‘Why me?’ then you might find the answer in this chapter. We will also discuss anxiety triggers, and you’ll learn to identify those that are personal to you. In addition, this chapter covers the factors that contribute to the maintenance of your anxiety, keeping it going. This includes a detailed explanation of why you may have become trapped in what seems like a never-ending loop. We’ll focus on these cycles that maintain anxiety to bring about significant changes. So, let’s get started!
What Do I Mean by Anxiety?
Anxiety is a feeling, an emotional, psychological and physical experience. You don’t need me to tell you that we all experience anxiety sometimes; it’s a normal part of life. Anxiety is essential to our survival, and it enhances our performance when we need it to. We need anxiety to work for us, so it boosts our functioning, rather than impairing our ability.
When anxiety becomes a problem, it interferes with normal day-to-day life. This might be general anxiety, health anxiety, feelings of panic or social anxiety. Throughout this book, for ease, I’ll mostly refer to these collectively as anxiety or anxiety-based problems unless a distinction is required for any tasks or case examples. Anxiety becomes a problem for many people when it’s persistently present in the absence of immediate danger, and when there’s no need to be primed for fear. Experiences like this can leave you feeling terrified without due cause. When there’s too much anxiety, it’s constant or it keeps kicking in when there’s no need for it to do so, it’s become a significant problem.
Your Brain and Anxiety
The fear pathway starts in your brain, which is wired to react instantly to danger. Fear is an absolutely essential function of the brain, keeping you alert, alive and well. Your brain reacts to suspected danger so it can ensure your safety and survival. Part of understanding your anxiety is learning about what happens in your brain when threat strikes. Your brain has a number of regions that process fearful stimuli – this is the brain’s fear network. The two important structures within your brain’s fear network that we’ll talk a little bit more about are the thalamus and the amygdala. In short, the thalamus receives sensory information, and the amygdala processes a fear response.
The thalamus has many vital roles in your body: it regulates consciousness and alertness, and relays sensory information, as well as motor signals. You can think of the thalamus as an information relay station. The sensory information your thalamus receives includes things like what you see, what you hear, physical sensation (touch), and what you taste. Basically, this means all your senses except smell, which goes somewhere else: the olfactory cortex.
The thalamus relays information to the amygdala to trigger a response. The amygdala plays a crucial role in regulating fearful emotions. It does this by processing emotions and memories that are associated with fear and anxiety. The amygdala is very sensitive to signals of threat, and it’s also involved in attaching emotional meaning to your memories. It matches incoming information to past memories, and can process non-threatening events as threatening, based on memory associations that you may have made. This can happen unconsciously and outside your awareness.
If your amygdala perceives something as threatening it activates various pathways that lead to the production and release of stress hormones. The primary stress hormone in your body is cortisol. Adrenaline (also known as epinephrine) is another hormone released by your body in response to fear. Both these hormones lead to dramatic changes in your body, affecting your heart, your breathing and your muscles, and putting you on guard. When this happens, there are literally hundreds of reactions that can take place in various parts of your body. These result in physical, mental and behavioural changes. This is the fight or flight response, also known as the stress response or fear response. This neurobiological response prepares your body and mind for action, whether that be fight or flight. Your brain will initiate this response regardless of whether you’re in actual danger, and it will react even when the threat is not real, because its job is to ensure your safety and survival. When was the last time your body did this?
Simply contemplating the things that frighten you can be enough to initiate these responses. What thoughts or situations evoke such a reaction in you? Sometimes, even specific words can cause this fear response to kick in. On occasions some of my patients have even tried to ban me from using certain words in their presence, words like heart attack or cancer or vomit, because of how strongly associated these words are with their anxiety. Conquering avoidance behaviours like these is a crucial part of beating anxiety, and I’ll show you how to do this in Chapter 8 (see page 266).
Horror movies are another excellent example of the fear response being triggered in the absence of actual danger or threat. During a suspense-filled movie scene, your palms can sweat, your heart rate can increase, and your muscles even tense up, despite there being no real danger to you. These intense sensations are not an indication that anything is wrong with you, they’re a result of your brain’s innate programming. In the case of a horror movie, once your brain has evaluated the situation and realized that you are not in danger, it turns off this fear response. These instantaneous reactions are essential to your survival. Dangerous situations usually need rapid action: they don’t fit well with thinking and pondering, which would be a waste of valuable time if you were actually in danger. The stress response relaxes once the perceived danger has passed, and your body returns to a more balanced state. When people suffer with anxiety problems they experience prolonged feelings of threat, which don’t fully subside. This can cause your body to remain in a heightened state of fear, and can keep the stress response going for longer periods.
Fight – Flight – Freeze
The three different reactions to the stress response are fight, flight and freeze.
• Fight is when you confront and manage the threat through necessary action.
• Flight is when you flee or escape from the situation to avoid the threat.
• Freeze is a response to fear that causes temporary paralysis, making you stay still and watchful.
Everybody responds differently to frightening situations: the response that your mind and body make is personal to you. It will be based on the situation, learned behaviour, personality factors and your thoughts at the time. Regardless of its specific make-up, the strategies in this book will help you feel calmer.
What Anxiety Does to Your Body and Mind
Anxiety creates hundreds of sensations and experiences, with each person having a unique occurrence of these, which may include bodily sensations, psychological experiences and behavioural changes. The bodily changes come in the form of physical sensations experienced in all parts of your body. You may experience sensations that are fairly constant, they may come and go, and they may also switch between different types. Fear-related sensations can come in waves of repeated attacks as well. Psychological changes relate to the way you think, perceive and how your emotions change. Behavioural changes refer to actions taken by you; the things you do.
As we’ve already learned, the fear response is supposed to be adaptive and helpful to you. All the changes associated with the fear response are supposed to enhance your performance and prime your body and mind to deal with potential threats. When the fear response is working as it’s supposed to, the changes in your body and mind are sudden and intense, but short-lived, and everything is supposed to settle when the danger has passed. It’s when these reactions don’t switch off that the fear response leads to problematic anxiety. You’re no longer at the peak of enhanced performance for threat management; instead your body and mind have become too stressed.
This type of stress can cause these changes to become more consistent and unpleasant. Because the fear response has gone on too long, your mind and body are overstressed, and with this your ability to cope can deteriorate. Anxiety can cause your thoughts to become persistently negative, making you even more fearful, which in turn causes your sensations of anxiety to become more pronounced. Can you see how bodily changes and psychological changes fuel each other? You can get stuck in a vicious cycle of unbearable physical discomfort and psychological overload. This makes it difficult for you to stay calm and in control; even though you’ve tried to tell yourself to be sensible, it just doesn’t work.
Many of the sensations brought on by anxiety can be alarming. Yes, they’re uncomfortable and frightening, but you need to remind yourself that these are your body’s reactions to stress. Understanding how your body can react when it’s experiencing chronic or high levels of anxiety will help you take a different perspective. If you’re worried about identifying typical symptoms and sensations of anxiety, it might help you to refer to the comprehensive list at the end of the book (see page 368). This list includes almost all the bodily, psychological and behavioural changes that are commonly associated with anxiety, and all those that I’ve seen in my clinical practice. Please don’t be alarmed by the sensations on the list. While some may appear unusual to you, remember that you’re unlikely to experience all of them, and it is also unlikely that you’ll develop completely new ones. If you’ve been struggling with anxiety for some time, your body has already established a personalized response to it. I hope this is reassuring to you.
So now for your first task. For each task, you will need to jot down your responses to the questions or instructions, so have either a notebook or digital device with a notes app handy. Your first task is pretty straightforward.
TASK 1How does anxiety affect me?
You’ve learned that anxiety creates sensations in your body, and that psychological and behavioural changes occur alongside these. Your first task is to identify how anxiety affects you in these three areas. Consult the Common Symptoms and Sensations section on page 368 to help you with this task. By way of example, I’ve listed the symptoms experienced by my patient Margo.
Physical
Take note of the physical reactions you experience during anxiety. Margo experiences heart palpitations, breathlessness, and feeling hot and dizzy.
Psychological
How does anxiety affect your thoughts and mental state? What goes through your mind? Margo becomes fixated on catastrophic thoughts and she can’t stop thinking in disastrous terms, believing that something bad is about to happen to her any minute.
Behavioural
Note down the behavioural actions taken by you, the things you do as a result of your anxiety, such as avoiding certain situations or seeking reassurance. In Margo’s case she avoids going out alone, avoids exertion and asks for constant reassurance.
Things That Trigger Anxiety
So here we’re talking about triggers, as distinct from causes, which we will get on to next. What do I mean by triggers? Something can happen to trigger an increase in the intensity of anxiety, a spike which may eventually go down, after which you’re either free from anxiety – or you’re back to your ‘normal’ or resting level of anxiety. Triggers can be internal, arising from within you – a thought, a sensation, an emotion, images that pop into your mind or reminders of past events. Triggers that are external are things that happen outside of you: situations, things other people say or do, things you see, hear and so on. It’s important that you recognize and understand your triggers: you will need to know them in order to be able to do something about them. Getting a good grasp of them is crucial because it’s your triggers that will often cause you to react in ways that maintain your problems with anxiety. Triggers are very different for each person, but there are some common ones listed in the table below.
TASK 2Identify your anxiety triggers
Have your notebook or digital notes handy.
Chronic anxiety can remain at a low-intensity resting level. Triggers, internal or external, can cause this anxiety to intensify. Understanding your triggers will help you see what you react to. Looking at the triggers in the table above, and considering other triggers that I may not have listed here, take a note of those that apply to you. We will be working on these reactions later.
Why Me?
Have you ever wondered why you are experiencing anxiety like this? This question might have crossed your mind numerous times and you might already have a clear understanding of the reason behind it. On the other hand, you may be puzzled about why this is happening to you. Countless factors contribute to the development of anxiety problems. The root cause can be related to an anxious temperament, your personality and psychological traits, or past experiences which have shaped your mind to function in a particular way. Your family history could also play a role. In some cases, something may have happened to make you more vulnerable to anxiety problems, such as a childhood experience or even a traumatic event. Situational factors can also be a cause, where you were doing fine until a particular life stressor disrupted your sense of safety and stability. The outbreak of the Coronavirus pandemic was one such stressor that affected many people.
Even though some causes are known, it can still be difficult to know exactly what causes anxiety problems. For some people it can seem like their problems have come out of the blue without any obvious cause. Some people develop problems with anxiety when life appears to be going pretty well, and there isn’t a clearly identifiable cause. Whatever the cause of your anxiety problems, the strategies in this book will help you. I’ve learned from my clinical experience that while causes can give us great insight into why, it’s the application of the various strategies that brings real progress. If you don’t know the cause(s) of your anxiety, I caution against getting hooked on trying to find out, and suggest that you instead focus your resources on recovery and the application of the strategies in this book.
Based on my clinical experience, the known causes of anxiety typically fall under certain categories. However, it’s uncommon to identify a single causal factor that independently contributes to the development of anxiety. Instead, multiple vulnerabilities can often interact with each other, leading to the anxiety problem. Let’s explore some of these.
Temperament and personality
Your temperament and personality shape how you respond to things around you. If you have an anxious temperament, you may have an increased sensitivity and responsiveness to situations that seem uncomfortable. This heightened sensitivity may cause you to withdraw from these situations, leading to reduced self-confidence and negative perceptions about your coping abilities. This may compel you to avoid more things, which in turn worsens the problem. Avoidance is a common coping mechanism used by people with anxious or sensitive temperaments to navigate life; we’ll see more of this in Chapter 8 (see page 266). People who have perfectionist tendencies can be at an increased risk of experiencing anxiety problems, as well as those who are easily overwhelmed by stressors. Additionally, people who desire control over their environment or personal circumstances can also be more vulnerable to developing anxiety problems.1
Copyright © 2023 by Dr Kirren Schnack. Copyright © 2023 by Jouve UK
