Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. Today, we discuss another common condition, anxiety, and the many ways that it seems to manifest
TOPIC OF THE MONTH
ANXIETY
“If you trade your authenticity for safety, you may experience the following: anxiety, depression, eating disorders, addiction, rage, blame, resentment, and inexplicable grief.”
― Brené Brown
Much like last week, we will cover another condition which everyone is familiar with– and may have experienced themselves– from a perspective that is less publicly presented.
Anxiety, at least as we colloquially understand it, is a necessary part of life. Anxiety, abstractly, is why you don’t drive 200 MPH on a residential street, why you don’t freejump off a building, or why you don’t try to fight a bear. Anxiety is the reason we are deterred from these situations, and that clearly makes it a very crucial evolutionary mechanism! This being said, I don’t think I need to explain where the other side of the coin creates a very double-edged sword.
The key element to anxiety to remember from the start is that the root is valid, and therefore the body is going to react as such. This is why we can’t “simply calm down” in these moments, and what creates such difficulty in reregulating when anxiety does strike. While our end goal is to find ways to reregulate, we can use medications to lower sensations, and many anxieties can wax and wane over time. The most crucial strategy, however, is becoming comfortable with our own bodies and functioning sensations. As is put well in the title of Sarah Wilson’s book on the matter, First We Make The Beast Beautiful.
DEFINING ANXIETY
‘Anxiety’ is an interesting word, and due to this we have to provide multiple definitions to best describe it in earnest.
Anxiety from the most basic form describes “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.” We also can use the term in ways such as “anxiously waiting” or “anxious to hear about something”, which have more positive connotations in the sense that they describe tense excitement rather than a negative feeling around the situation. This definition is definitely on the right track, but does not do full justice to the condition of anxiety, and can be easily conflated. Feeling worried about the results of an important test, feeling dread in response to very difficult news, or being nervous about hiking through the dark can certainly be described as anxiety, but in reality this is the natural response which exists for survival.
Clinically, anxiety can be described as a nervous disorder characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior or panic attacks. This definition may be going too far on the other end of the spectrum, with many shades of gray in between.
The answer to what anxiety is may be more rooted in the experiences that a person is having and how discrepant that feeling is from the expected, culturally or socially normative response. Figuring this balance out can be tricky, which is probably connected to the difficulty that we can have in recognizing anxiety. To use an example: arachnophobia describes an intense fear of spiders– sometimes to the point of complete dysregulation and disruption of functioning. While these extreme reactions are seen as maladaptive and may impair quality of life, the root is still valid as we SHOULD fear spiders to some degree because our ancestors that did not… were not able to pass their genes. This further highlights the value of becoming comfortable with our emotions, as we ideally will find a way to know our own barometer to determine personal anxiety levels and assess whether a threat is real or anxiety-based.
A SIMPLE BUT COMPLEX RELATIONSHIP BETWEEN ANXIETY AND TRAUMA
So let’s go back to the root cause of anxiety, which is traumatic experience. To use the most explicit example, we will look at the development of PTSD in response to going to war. Long periods of extreme hypervigilance as well as witnessing of traumatic events leads to the body eventually expecting this level of caution at all times, and this is why so much difficulty arises in day to day functioning when the caution is no longer needed. We can take this explicit example and apply it to a multitude of situations– whether it be traumatic childhood upbringing, a difficult job or relationship, or even smaller, less noticeable situations such as a bad association with a specific food due to a negative experience that we had simultaneously. It is important to remember that intensity of traumatic experiences are determined by the experiencer, and though we may not think something would have impact, we have plenty of evidence that shows there is no litmus or threshold for trauma and can never know for sure how much impact an event can have.
We can look at this as simply as “when we expect something, we begin to prepare for it”, but obviously this is far too basic to fully explain the concept. We can look at anxiety as seeing every walk in the dark as a haunted house – while we know that the danger is there, we do not know when to expect it, and therefore brace for the worst, whether it is coming or not. Sometimes, this is crucial. Most of the time, we are not actually in a haunted house. Our nervous system does not want to let go of this approach because the result could be fatal, and this continues to be the truth whether we can logically override this or not.
While we can identify times in which the anxiety is not serving us, we also may not be able to escape the peripheral feelings that come along with it.
THE MANY TYPES OF ANXIETY
Anxiety is classified into multiple subtypes.
PTSD, or post-traumatic stress disorder is derived as a reaction to a very traumatic experience or chronic exposure to unsuitable environments.
Generalized Anxiety describes chronic anxiety, worry, and tension without obvious trigger or specifically identified traumatic response.
Panic Disorder describes a more random and unpredictable pattern of anxiety which is typically characterized by intense and quick fear escalation as well as physical symptoms.
Social Anxiety describes anxiety symptoms in either specific (public speaking, etc) or general social situations, typically includes excessive self-consciousness
Obsessive Compulsive Disorder refers to compulsive, ritualistic behavior that soothes in response to anxiety around the compulsions.
While all of these are helpful for classification, it is also important to remember that, as always with this blog, these diagnoses are not all encompassing and can present very differently symptomatically.
THE MANY FACES OF ANXIETY
Anxiety presents in many forms.
“Anxiety” proper can be described as involuntary feelings of fear, worry, panic, dread, or similar emotions without easy means of coping (for example, being “jump-scared” creates a spike in emotion, but this quickly subsides). The following are the most prominent mental symptoms:
As far as less noticeable symptoms, anxiety can also manifest as irritability, restlessness, fatigue, insomnia, or even be misattributed to another emotion, typically anger. Particularly in cases where a situation is not suitable for fear-rooted emotions (think about someone trying to be a “tough guy” in a situation which they feel scared, or acting apathetic or critical of “how dumb they are” in response to wanting to watch a scary movie), anxiety can also be a stigmatized response that we try to avoid.
Further, physical symptoms that range from headache, stomachache and other somatic issues all the way to full blown panic attacks can result in response to anxiety. Uptick in heartbeat, sweating, shaking, and other nervous physiological reactions are also associated with anxiety. These are typically the symptoms that lead individuals to recognize their condition, as we can much more tangibly see a problem from a physical standpoint than a mental one. While these symptoms are most commonly first treated as such, it is also important to consider potential medical reasons when experiencing these types of responses.
WHAT IS A PANIC ATTACK? AN ANXIETY ATTACK?
One aspect of anxiety that remains generally misunderstood is the idea of panic and anxiety attacks. First and foremost, you do not need to experience one of these attacks to have anxiety, though there is obviously a disposition if one does have anxiety. A panic attack and anxiety attack may look extremely similar, but do have a few key differences.
Most differentiating, an anxiety attack occurs in response to a perceived stressor or threat. While a panic attack can be triggered, this response will also frequently happen randomly. Panic attacks will typically have a sudden onset, intense presentation of disruption, detachment, or even brief depersonalization, but fortunately will subside after a few minutes. By contrast, anxiety attacks will build gradually over time, have a wider range of symptomatic intensity from mild to severe, and may last for longer periods of time.
If you have never experienced panic symptoms, they can be extremely scary and are, by definition, extremely overwhelming. Common mental symptoms include the feeling of a loss of control, detachment from surroundings, and sudden and intense fear that one is about to die. Physically, we may feel chest pain, dizziness, nausea, numbness, tingling in extremities, shaky, feverish, or short of breath. For Colorado readers or perhaps more accurately, visitors, some panic/anxiety attack symptoms can present very similarly to certain presentations of altitude sickness.
In my own experience, as well as that of clients and many others, these attacks can be harder to realize when experiencing them than the very obvious way that they seem to present. I will experience full body numbness and tingling, sometimes to the point of not being able to speak due to this feeling in my face. Others have reported panic attacks as feeling violently ill, feeling they have left their body, or feeling that they are about to “explode from the inside with no way to stop”. While these experiences are extremely overwhelming and may feel as if they are leaving long term repercussions, it is mostly important to remember that these intense feelings do pass and can be seen as a “computer crash” of the nervous system rather than actual structural damage.
A final interesting consideration with panic/anxiety attacks is the idea that while we may feel more comfortable over time experiencing them, we also create a situation I refer to as ‘anxiety about anxiety’, meaning that after one panic attack, we may suffer an additional layer of anxiety that they will occur again.
ANXIETY AND RELATIONSHIPS
Anxiety can also, unsurprisingly, play a massive role in relationships. In fact, anxiety could potentially play the single largest role in relationships, as often our underlying insecurities and complications amongst what we feel anxious about can manifest into the barriers faced by the relationships themselves. While we may be able to address issues such as worries, concerns, and vulnerability in our relationships, there is also the underlying pull of where our own anxiety may be worrying us. It is important to remember this when conflict or confrontation arises, as usually there is some interplay of anxiety.
Anxiety may also create rifts in how we are viewing relationships internally, as previous negative experiences are likely to create hesitation and caution even if not necessary. Anxiety presentation and panic attacks may feel like a sensitive issue for some, creating more emphasis on finding a partner who is understanding of the condition. Along with this, it is important to remember that communication is the most important aspect in reducing misunderstandings.
From the outside, it is also paramount to show support and look to provide safety and comfort in response to anxiety rather than try to “fix” or “end” the anxiety. It is important to validate the anxiety that is happening and also show that we are just here for support and that de-escalation will arrive soon.
ANXIETY MANAGEMENT
YOU JUST BREATHE!
If only things could be this simple! Surely, breathing techniques are a great way to reduce anxiety as we can increase oxygen flow to the brain and give ourselves a more clear headed approach towards situations. Unfortunately, treatment goes further than this.
Distress tolerance is the leading solution, and is certainly effective, but this takes many years to master. We can do so by becoming more comfortable with large emotions, learning the best acute coping strategies, such as breathing, taking time for self, doing grounding exercises, etc, and reframing our approach on anxiety from an ominous, lurking beast to a creature that we learn to live alongside.
Creating healthy habits and thought patterns are also effective measures in managing anxiety. A routine such as weekly exercise or consistent creative outlets are very helpful for the benefits provided by each activity, but further beneficial just for the structure alone. Having some measure of routine itself can create predictability and reliable emotional support, and taking autonomy over our environment can make for a very grounding feeling that can boost confidence.
Though it is important this option be taken in stride, some anxiety can also be alleviated by slow, mild exposure to fears in efforts to reframe anxious perspectives through experience. Exposure therapy works to alleviate anxiety by slowly becoming more comfortable with fears (ex: if someone has a fear of heights, first starting at 3 feet up, then at 10 feet, then at 20 to try and slowly reduce negative feelings). This can also be done in a less direct way, such as trying things that give us anxiety but with a supportive partner, or in tandem with elements that will make us feel more comfortable, and similar situations.
If anxiety is particularly debilitating, SSRIs have shown to be effective in managing daily anxiety that is so severe that it begins to affect many realms of life. In collaboration with therapy and other self-improvement activities, this can be helpful in retraining the brain away from unhelpful anxious patterns. In the case of extreme spikes in emotions, there are also medications that can quickly diffuse symptoms to relieve discomfort. While these are helpful in emergency situations, I have also heard stories in which people began to experience less anxiety around panic just due to the awareness that a solution could be implemented in a worst case scenario.
CONCLUSION
So while we may all be very familiar with anxiety… it may also be lurking in areas that we haven’t necessarily identified as such. The idea of anxiety as a concept may not be as difficult as accepting that anxiety has a lot more influence on our functioning than we may be able to realize. Letting go of control is one of the single most challenging aspects of humankind, and from certain viewpoints, anxiety is bringing that lack of control to the forefront. While we will NOT gain any control from this perspective, we may feel more relief and comfortability when reframing anxiety.
While distraction tactics, avoidance of triggering situations, and medication are all very effective ways to manage anxiety when it happens, sustaining our wellbeing alongside anxiety comes from comfortability in these emotions. While we may never become a less anxious person, we can become a person who can adequately manage our anxiety. When we learn to manage great adversity, our tenacity, appreciation and persistence skills only become stronger.
WHAT’S COOKING FOR NEXT MONTH
EMOTIONAL INTELLIGENCE
Next month, Nick will discuss emotional IQ and what it really means in regards to our lives.
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