By Brian Robinson.
When it comes to recovery there is no better place to start than with an understanding of what anxiety is and how it works. This acts as the perfect backcloth and our understanding will point us towards exactly what we need to do in order to recover.
To understand anxiety and panic we need to know the general scheme of things. This means understanding how it works in a basic form. Knowing exactly what goes on in the brain; understanding how the limbic system or the amygdala works; analysing how stress hormones perform; does not hold the potential to deal properly with anxiety. And indeed, we can often get lost in the complexity of these types of understanding.
For example, we all know how a telephone system works. You pick up the receiver and you get a dialling tone. How would it help if you knew exactly what went on at the exchange? How would it help if you knew the exact voltage of the phone line? You may argue of course, that we should simply call a therapist in the same way as we would call an engineer if our phone stopped working. However, in the case of anxiety the answer lies within, and fortunately for us, we have a brain and a nervous system that self-corrects. All we have to do is create the right conditions that will allow and encourage that process to happen.
So what is anxiety and panic? Luckily, there is no mystery about that. Anxiety is not an illness in the accepted sense of the word: it is a disorder. Things have got out of their normal routine or order. We are not under attack from a virus; we haven’t been invaded by a bacterial infection; and nothing is malfunctioning inside. In fact, just the opposite is true. Systems in our body are doing precisely what they have evolved to do. They are trying to keep us safe. The problem is, these systems are quite radical and have huge implications in the way we experience life. And for that reason, they are systems that should only be activated when appropriate and absolutely necessary.
What is Anxiety?
Anxiety in the broadest sense is a reaction to perceived danger. A system or systems in the body have concluded that the sufferer is in serious danger, and when that happens, a system usually referred to as fight or flight becomes energised. Fight or flight exists for two main reasons. The first is to act as a spur to action. The emotion which we refer to as anxiety gives us the distinct feeling that something is wrong. Something is about to happen and it encourages us to flee or escape from that danger.
The second function of fight or flight is that of facilitator. Once aroused, fight or flight causes stress hormones to be released in the body and these work to boost energy and stamina levels which in turn allow us to run faster. These same stress hormones would certainly help if it came to a fight. We would be able to fight harder and for longer. However, the emotion of anxiety does not seem to boost courage levels, in fact, it does just the opposite. Flight is almost always the safer, smarter option. So at the most basic level, we can say that anxiety is a condition which both encourages and facilitates escape.
What Are Panic Attacks?
People who suffer from anxiety can also have panic attacks, and likewise, people who have panic attack disorder can feel general anxiety. It is not clear if anyone knows why some people fall into general anxiety while others suffer from panic, but there are some distinct differences between the two.
A panic attack is usually more intense than general anxiety. The sufferer may experience a rush of profoundly unpleasant physical and psychological symptoms. The physical symptoms could include sweating, a pounding heart, churning stomach, chest pains, a thumping head or rapid breathing. These symptoms may vary from person to person, but they can be very dramatic and of course they are very real. They are not imagined symptoms.
The psychological symptoms could include things like thoughts of impending doom, terror or intense fear; thoughts that you might be going mad; that you might be having a heart attack or a stroke; or thoughts that you might be dying. It could be argued then, that a panic attack is a much more of a spur to action than general anxiety. It is a dig in the ribs, rather than a tap on the shoulder.
Panic attacks are always more clearly defined than say a general episode of anxiety. They usually peak after about ten minutes, and then subside after a further twenty minutes or so. It would be unusual for a panic attack to last more than an hour. It is possible, however, for panic attacks to come in waves where you get one after another. But that is not common. Because panic attacks are so intense, they do not generally go on for any significant length of time. It would not be possible or sensible for the body to maintain this very high state of alertness for lengthy periods.
Another characteristic of a panic attack is that it can appear out-of-the-blue with no obvious reason or trigger. One minute the person may be feeling absolutely fine: the next they are in a state of high panic. These are sometimes referred to as ‘sudden-onset’ attacks.
Panic attacks can also be more inward-looking than general anxiety and this is almost certainly due to their intensity. This is where you begin to think that something has gone wrong inside, you are going mad for example, or you have become ill. These attacks can happen months apart, or they can be more regular. And, because they are so powerful and troublesome, they are often followed by a period of intense worry. Unsurprisingly, the worry usually centres on the fear of having another attack.
Causes of Anxiety & Panic
The experts seem to be more or less in agreement that it is almost always a complexity of things that leads to anxiety or panic. It is usually a convergence of several factors which finally lead to us falling over the anxious cliff. There are other ways to put this, for example, we could suggest it is caused by a series of different things, or by a build-up of several different stressors. The problem with all these descriptions, is that if we see things as very complex, we automatically assume that the solution will be complicated too. Fortunately, this is not the case, if anything, the solution can be too simple to be true.
Although the causes of anxiety are often varied and arguably complicated, the natures of the conditions themselves are fairly straightforward. As has already been said, nothing has gone wrong. All we need to do is to restore the natural inner order. The other thing to bear in mind, is we don’t necessarily have to undo the causes of anxiety. We fix what we can: we compensate for what we can’t: and we tweak anything else in-between. Solutions, however, usually involve a certain amount of commitment, determination and a good work ethic. And the reality is, that often the sufferer may have to dig really deep in order to find these resources.
Many experts now suggest that genetics can play a significant causal role in anxiety. And quite frequently, it is found that sufferers point to at least one anxious parent, brother, aunt or uncle. And quite naturally, the idea that anxiety has a genetic root will often cause the person to feel they are stuck with their condition. They come to believe that being in a state of fear is an intrinsic part of their nature. However, the evidence of recovery rates now suggests that sufferers can compensate for any predisposition by making specific changes to the way they operate. They may have to change the way they manage stressful situations, and they will almost certainly have to take more control of their thinking or their emotions. These types of positive changes can have a radical effect on how we feel and be more than enough to compensate for any genetic disposition. Perhaps at some point in the future we will identify the anxiety gene and this may change everything. However, it wouldn’t be a good idea to rely on that happening anytime soon. Anxiety requires us to deal with it now. And there is never a bad time to get started.
It is also undoubtedly true that our environments as we grow from childhood into adulthood can feed into the anxiety equation. Anxiety may become an issue at an early age due to our experience as children, or we may develop anxiety problems later in life as a direct result of our early environment. The effects of environments on individuals seem to throw up conflicting patterns though. Some people who come from very unhealthy backgrounds seem to go on to flourish in adulthood; while others who come from privileged backgrounds sometimes struggle. There doesn’t seem to be a straightforward correlation between cause and effect, or at least not one that is self-evident. This suggests that while there may be an environmental element to anxiety, we do not necessarily have to be determined by it.
There are exceptions though. If a child were to suffer some form of abuse at a critical stage in their early psychological development, this could lead to difficulties in later life. In that case, the person might need a psychologist to help work through the abuse. And likewise, if a person has suppressed a traumatic event that happened at some point in their past, this may also need the help of a psychologist to help apply a proper process to that traumatic event.
Transitions crop up frequently as triggers for anxiety. An example of one would be when a young person leaves home to go to university, or when an older person retires at the end of their working life. These transitions can disrupt routines and effectively place the person in a different world; a world filled with different people; or a world where the person no longer has a meaningful role. Some people seem to take these transitions in their stride, while others worry about them to the degree that can lead to anxiety and panic.
Stressful life events can also tip us into a panic. Divorce, moving house, redundancy, are all happenings of sufficient magnitude to cause us to worry and lead to unhealthy levels of stress. We wouldn’t be human if we were unaffected by such circumstances, and much can hinge on how we react to these major life events.
It is also worth mentioning that our fundamental nature or character can play a significant role in anxiety disorders. People vary in sensitivity and some may take things to heart more than others. Anxiety sufferers often describe themselves as thinkers; they may regard existence as something defined more by what goes on in their head rather than what they do with their life. Some people have higher survival instincts than others and may be more risk-averse. They may not be the type of people who indulge in extreme sports. Others may be perfectionists, and when people or outcomes fall short of their expectations, this can sometimes lead to significant problems. The list goes on. However, this doesn’t necessarily mean we have to change our essential character to recover. We would not want the sensitive person to become cold, or the perfectionist to ditch their standards altogether. It does mean, however, that we have to be aware that these character traits can present problems, and therefore, have to be managed rather than let run free.
There are also some medical conditions that can cause us to become anxious and some of these are worth mentioning. Thyroid problems, some inner ear conditions, illnesses which affect the lungs or heart can be a hot spot. And indeed, any serious illness could have the potential to cause us to worry and become stressed. The worry may arise consciously, or it may be that a part of our brain triggers an anxious reaction in which our conscious mind plays little or no part. This reaction to illness is natural and normal, but there is usually scope to manage our reaction to illness better.
The above is not meant to be an exhaustive list of all the causes of anxiety. It is merely to make the point that they can be varied and it may be a mistake to search for a single reason. And likewise, we do not have to dig too deep into these causes to understand or be able to deal with them. The focus should be on how we can fix things: and not on finding out how things have gone wrong. The most important question to ask here, is can we see a link between many of these causal elements? We need to ask if there is a common denominator.
Fortunately, we do not have to look too hard or too long for our answer. All those who suffer from anxiety will have high physical tension levels. And physical tension is fed by emotional and psychological tension. All sufferers will have thought patterns or emotional profiles which feed into their condition. Let’s not describe these thoughts and emotions as negative, but we should certainly describe them as unhealthy. We may not wittingly or deliberately adopt these unhelpful traits, some of them will spring naturally from the anxiety, but none the less, they will figure in the problem and they have to be addressed. Acknowledging the role of thoughts and emotions is absolutely fundamental to recovery. And even if you do not believe that these unhealthy patterns have caused the anxiety, it is still the case that proper and sustained recovery only happens when unhelpful thoughts and emotions are tackled.
Tension Affected Systems
We have already stated that anxiety is not an illness, it is a disorder. What happens is that systems in our body have become affected by high tension levels and are activated inappropriately. So, we need to know what these systems are and have a rough idea of how they work. Explanations for anxiety usually point to the peripheral nervous system. This is the part of our bodies that controls the autonomic functions such as breathing, blood pressure, heart rate and so on. The peripheral nervous system involves two responses, the stress response and the relax response.
The stress response is known as the sympathetic nervous system, and amongst other things, it reacts to tension. The relax response is known as the parasympathetic nervous system and comes into play when the body is at rest and where there is no threatening or dangerous situation. When aroused, the sympathetic nervous system will initiate the flight or flight response, and that’s what we experience when we become anxious. Fight or flight involves the release of certain stress hormones, and this can make us feel very fearful and panicky. The feeling of having to act or do something can be quite overwhelming and that’s the way it’s meant to be.
We refer to this state of affairs as anxiety, but in fact, anxiety is a very simplistic term which attempts to cover what is an all-embracing state of affairs. It is much more than an unpleasant emotion. Fight or flight leads to quite radical physical, emotional and mental changes; changes which can virtually take over everything. When fight or flight is engaged, dealing with the assumed danger takes priority over everything.
Physical symptoms can include a loss of appetite, loss of sex drive, pounding heart, headaches, dizziness, sweating, feeling faint, a heightened sensual awareness, the urge to empty bowels and bladder. There are hundreds of different symptoms and these are real and can be very dramatic. These changes emerge as our system adapts to meet the challenges of the supposed threat.
Mental symptoms could include such things as racing thought patterns, negative over thinking, ruminating, catastrophising, what if this or that might happen, or feelings of being unreal or disconnected from the world. The latter is sometimes referred to as depersonalisation or derealisation.
Emotional symptoms will include fear, low mood, panic, feelings of impending doom, a loss of interest, loss of confidence, lack of motivation etc. The sufferer could even begin to believe they are going mad. And very often, the sufferer will confuse low mood with depression. However, a lowering of mood due to anxiety is not the same as depression.
Quite often, the sufferer will see these changes as an attack, and they believe that recovery involves taking a stand against some malevolent force which is trying to cause them harm. If we adopt that attitude, the risk is we could end up at war with ourselves. Anxiety is best seen as the actions of a well-intentioned but misguided friend. Our job is to get the message across to this friend that we are okay, and that we are not in danger. The road to recovery should not be a warpath.
Although in the strict sense it is true that nothing has gone wrong with the nervous system, that is not to make light of the fight or flight response. It is a system designed to operate for short periods of time, but only enough time to allow us to escape. When it becomes engaged for lengthier periods, the body becomes more and more stressed, and this makes for an unhealthy focus. Everything becomes centred on the presumed danger and dealing with that, while other everyday things become less of a priority. Our bodies always perform and heal better when we are relaxed and not under stress.
This basic view of anxiety, which suggests it is a condition related only to the peripheral nervous system, is also a bit of an over-simplification. It does not allow for much involvement of the brain and this can lead to some confusion. For example, the peripheral nervous system is not a thinking system. It does not know what goes on in our mind. Yet, a single negative thought can see our anxiety levels to go into meltdown? How can that be? This thought-provoked anxiety is sometimes referred to as ‘anticipation anxiety’.
The obvious explanation for this is that the brain is always involved to some extent. At the very least, it has an awareness that fight or flight has become activated, and more likely, it too goes into a heightened state of alertness. The two systems then collaborate together to deal with the supposed danger. So, we can be fairly confident that the two systems concerned with anxiety and panic are the sympathetic nervous system and the central nervous system which includes the brain.
The next question we have to ask is why have these systems become engaged in the first place? We already have a rough idea of the causes, and we know that tension is a critical factor; but what is it in the body that actually triggers the fight or flight response? The clue to this lies in how we label this part of the nervous system. We refer to the sympathetic system as ‘the stress response’. When the body becomes physically stressed, and when stress levels reach a certain critical level, the escape response automatically engages. It’s as simple as that.
However, tension is a better word to describe what triggers anxiety. We often say there is such a thing as good stress and bad stress, and many people quite like the idea of being stressed to some degree. But let’s be clear about this, there is nothing desirable about the sort of stress we’re talking about. The word tension is much less ambiguous, and most people would agree that being tense is not something they would strive towards or aspire to.
This idea that high tension levels lies at the root of anxiety is vital to remember if recovery is to happen. And it also gives us another important definition, i.e. anxiety is a disorder caused by high physical tension levels. This is vital because we now know that we have to reduce tension levels and that means we have to become more relaxed. In everything we do, we have to ask, am I reducing tension or am I producing tension? Anxiety simply cannot exist in a relaxed body. It is only activated when the body becomes stressed or when there is a situation of real danger. The question we now have to ask, is have we got that right? Is it really as simple as that?
One thing that might confirm this idea is the effect which tranquillisers have on the body. Tranquillisers are muscle relaxants and are also known to reduce anxiety levels. Once we take a tranquilliser, our muscles start to relax and we begin to feel a bit better. Unfortunately, the effects of tranquillisers are only temporary, and as they wear off the muscular tension and the anxiety returns. It is also worth mentioning, that tranquilliser relaxation is not a natural way for the muscles to become relaxed. It is an artificial and unnatural route and therefore does not amount to a fix.
We also know that tension is the natural reaction to danger. If you were to meet a gorilla on your way out of your supermarket, you would immediately stop dead in your tracks and become very tense. This type of appropriate tension is initiated by the brain. Our senses alert us that danger exists, and so the brain increases tension levels dramatically and then fight or flight automatically becomes engaged. And when the threat passes, when you realise the gorilla was nothing more than a life-sized cardboard cut out, tension levels fall again dramatically and you begin to feel normal again.
This hopefully gives us a clearer understanding of how anxiety and panic work, and what happens in the body when tension levels rise. It is worth noting, that tension comes into play in two different ways. The tension in our body that springs from unhealthy thought patterns tends to build up over the weeks and months before we become anxious. This becomes a background tension which doesn’t change much day-by-day, week-by-week. And then there is the tension initiated by the brain, which can manifest itself within the body instantly, and dissolve away naturally once the danger is passed.
This idea of tension working in different ways is well worth bearing in mind as it helps to explain how we experience anxiety. I sometimes refer to this as type 1 or type 2 tension. It may even help to explain how panic attacks disorder work. In those individuals, background physical tension levels may be below the critical level for much of the time, and therefore they do not feel anxious for much of the time. So when they have a panic attack, this could be more to do with a whim in the brain, rather than high background tension reaching a critical level. This, however, is only a theory as to how panic may fit into the general scheme of things. It should not be seen as an explanation as to how things work.
The vital thing to remember, is we not only have to reduce physical tension levels, we also have to deal with the causes of tension. And for most people, what goes on in the mind is the single most significant factor in high tension levels. With some people emotions have a significant role to play. However, emotions are always bound up with thoughts. You cannot experience a powerful emotion without accompanying thoughts being triggered.
We know what anxiety is. It is a mechanism which exists naturally in our bodies and is designed to help us escape from danger. We know what panic is. It is the same as general anxiety, but it acts more as an intense spur to action. We know the systems involved. The peripheral nervous system is the system in charge of fight or flight and it is the facilitator. We also know that the brain can induce fight or flight if it feels the need. And we know the brain is always involved to some degree with anxiety and panic. We also know what triggers anxiety. It responds only to high tension levels. These may have built up gradually in the body through unhealthy thought patterns. Or tension levels may be heightened by the brain if it feels the need. We also now know the two main pathways to recovery: tension reduction and thought management. Or in other words: relaxation therapy and cognitive therapy.