Anxiety
June 24, 2024 • 7 min
Anxiety – what is, why do I have it and what should I do about it?
First things first, anxiety is normal. In evolutionary terms it has been key for our survival. It’s only a problem when there’s too much of it, we’re experiencing it really frequently or in situations where it doesn’t fit or feel proportionate. It would be healthy for example to feel anxious just before a job interview. If you’re feeling really anxious while you’re brushing your teeth or feeding you baby your natural alarm system may be a little out of kilter. We can think of it like a car alarm – super useful, but if it’s going off in a gust of wind the system needs soothing. Natural remedies include grounding activities, eating well and noticing and unhooking from anxious thoughts.
Persistent anxiety is caused by a variety of factors. Experiences we had growing up, especially if our home environments were volatile or we witnessed or suffered violence, make us vulnerable to feeling on edge and hypervigilant. The context in which we’re experiencing anxiety is important, is there one large thing weighing heavy on us (e.g. the job interview) or perhaps a feeling of cumulative anxiety – are we spinning lots of plates and are there a few too many things to think about and remember? It’s helpful to know what might have led us to feel anxious, in CBT the most useful work happens in understanding what is keeping it going, maintaining our difficulties.
Biological changes occur when we’re afraid. If you think about something you’re scared of for a moment you’re likely to notice some changes in your body. If our minds sense a threat our bodies respond. It doesn’t matter if the threat is real our minds are powerful, creative and trying to keep us safe. We are wired to survive, not thrive, and have a tendency especially when stressed to be on the lookout for trouble. We automatically produce adrenaline and cortisol – stress hormones designed to give us new depths of energy and strength to out run or fight our difficulty. This is known as the fight flight response. Lots of changes occur in the body very quickly, and while they’re widely understood it is hard in the moment not to take these changes as proof of danger. This is known as ‘emotional reasoning’ in CBT. I feel awful – things are awful! Although we all have the same threat reflex we tend to notice and experience it quite differently. Heart pounding, breath fast and shallow, tension in muscles, butterflies and toilet urgency and sometimes headaches or changes to our vision. All these changes are designed to help our body pump more oxygenated blood to our muscles so that we can outrun or fight the threat, to remain focussed on the threat and to be able to escape. Importantly our thoughts also become threat focussed, which can be enough to produce more adrenaline getting us stuck in a cycle of anxiety and overwhelm.
Anxiety is sometimes understood as being proportional to the perception of danger, rather than the actual levels. When our bodies are full of adrenaline and cortisol, we are not designed to be optimistic. From an evolutionary perspective we have done well as a species not to be relaxed around threats, or perceived threats. If we think we heard a predator and we’re sleeping outside for example, we’re unlikely to be over optimistic about our chance of survival and nod off to sleep happily. Our ancestors experiences are encoded in our bodily responses. If you’re experiencing diarrhea, headaches, palpitations, tension in your jaw back and neck, these could be symptoms of anxiety.
Once we realise that the worst is not going to happen, why doesn’t anxiety always tail off? We know through extensive rigorous research that there are some really common maintaining factors in anxiety disorders, i.e. when anxiety becomes problematic to a clinical level. Imagery plays a really important role in anxiety. It’s common to have intrusive thoughts and images, if we take these as facts and don’t question them they understandably have a strong impact on our nervous system and what we feel like doing next. In fact our thoughts are not facts, and we can afford to take a passive stance, noticing them, letting go and coming back with all our senses to the present moment. Worry and rumination is known to maintain anxiety as we get stuck in that feedback loop between adrenaline in the body and anxious thought, both feeding each other and continuing to grow. We worry because we’re anxious and we’re anxious because we’re worried.
The urge to avoid sources of anxiety is really understandable, it’s like wanting to take your hand off a hot iron. However a huge breakthrough in the treatment of anxiety disorders in the 1960s was the discovery of a process called ‘exposure and habituation’. Through repeated gentle exposure to our fears they diminish over time, we habituate to them, we learn that we are safe and the next time we approach the same situation will produce less adrenaline, and be able to soothe ourselves more quickly. If you’re really anxious going to work for example, staying at home for ten days will only strengthen this. I know it’s easier said than done but gently and kindly confronting our fears builds feelings of self efficacy and reduces anxiety over time. We can do this in a graded and gentle way.
Safety behaviours are another really interesting concept in CBT that we understand can maintain our anxiety, making it more problematic for us. These vary as much as people do but are basically anything that we do when we feel anxious, to stop the worst from happening. For example always using headphones on the bus, having impossibly rigid rules for ourselves about how and when we leave the house, deal with social situations or manage being in crowded places. This produces something called a disconfirmation effect. We never get a chance to learn that the worst didn’t happen, unconsciously we think we prevented it with our safety behaviours.
Our focus of attention narrows when we are anxious. We’re threat focussed, access more threatening or difficult memories and images and this produces strong emotion. We can counter this by deliberately trying to broaden our attention, using mindfulness activities for example to tune into sounds around us, bringing attention to the soles of our feet or practicing deliberately accessing a pleasant and safe image. These grounding exercises can be powerful tools to step out of fight or flight, and back into the parasympathetic nervous system. A much nicer place to making decisions from.
Reassurance seeking is so understandable in anxiety, but the clue is in the name. It’s not assurance, we need it more than once so it cannot be working very well. If you’re leaning on other people for reassurance in a way that doesn’t feel helpful and is putting pressure on your relationships, you might want to consider gently seeing if you are able to do this for yourself. Can you sit with the anxiety for a little bit, allow it to be there? Probably you know really what you need to do. I believe that whirring anxious thoughts get in the way of our true instincts. If we can let the storm in the body and mind blow over we’ll know what to do.
Uncertainty can be hard for us humans to tolerate, but this is a skill we can endeavour to get better at over time. If we’re finding it hard to tolerate uncertainty this can make us feel anxious in our bodies, minds and feelings. This is something that we can get better at with practice, it’s a muscle which can be strengthened.
If we’ve been through trauma anxiety can feel quite overwhelming. The body’s threat system is trying desperately to keep you safe. Old wounds can be reopened in pregnancy in a way that is painful but allows long term healing and growth. If you’re experiencing regular flashbacks to what you went through and nightmares this is too much to deal with on your own and you must speak to loved ones about your feelings and please consider getting some professional help (ideally with an accredited CBT or EMDR therapist). Grounding exercises will help.
You probably have a good sense already of what can help you feel less anxious. Personally I know that if I exercise regularly and meditate I have a much wider tolerance for stress, and it’s less likely to feel overwhelmed in body and mind. Pleasurable activity, time outside, with loved ones, rest and enough healthy nutritious food are all helpful. Be curious about how you notice it in the body, your thoughts and remember that it’s only trying to keep you safe, it just might be a little bit over zealous. If we can avoid bracing against anxiety this is helpful. You might even play with speaking to it. “oh hello anxiety, there you are in my chest! I know you’re only trying to help but I’m safe thanks, and have everything I need’. Affirmations and images which help you conjure feelings of safety can be really helpful, as well as believing that doing hard things is good for us and helps us build resilience over time. Be kind to your anxiety and yourself. I hope there’s something in here that has felt helpful for you.