• Dr. E Farrell

Anxiety: What it is and how to get it under control

It's estimated that around 40 million adults and a third of teens suffer from anxiety disorders. Anxiety is one of the most common mental health complaints in the U.S., second only to depression. Anxiety is usually linked to worry, and pretty much all of us worry now and again; but, when anxiety begins to interfere with your ability to function normally at school, at work, socially or in other areas of your life, it can be considered to be a disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association is considered to be the authoritative guide for determining the diagnosis of a mental disorder. According to the DSM-5, an anxiety disorder is different from regular anxiety or fear in that it involves a persistent state of worry about future negative events. There are many different types of anxiety disorders, including but not limited to social anxiety disorder (fear of being negatively evaluated or embarrassed in social situations); phobias (fear of specific situations or objects); and panic disorder (recurrent unexpected panic attacks.)

The one you are probably most familiar with is Generalized Anxiety Disorder (GAD), which occurs when anxiety is persistent, difficult to control and impairs your ability to function in important areas of your life. Symptoms can include restlessness, fatigue, loss of concentration, irritability, sleep problems, muscle tension and other bodily complaints.

Anxiety can also involve symptoms seen with panic disorder, such as experiencing a sudden increase in heart rate, sweating, trembling, nausea, vomiting, tingling, dizziness, and pressure or pain in the chest. If you experience these types of symptoms, you should first check with your medical provider to rule out an underlying medical condition.

Anxiety usually has a cognitive origin. It is part of a normal process ordinarily designed to help us respond to threats, so we should not want to eliminate the response completely, but to reduce anxiety so it works the way it is supposed to work in our lives. To illustrate this point, a study was conducted that tracked the anxiety levels of college students over time. This study found that students that said they had no anxiety performed more poorly on tests than classmates that reported moderate levels of anxiety prior to tests. The students with some anxiety studied more than those who reported no anxiety; however, on the opposite end of the spectrum, students that reported severe anxiety performed the worst. High levels of anxiety can interfere with the ability to retrieve information from long term memory and interfere with an individual's problem-solving skills.

Excess anxiety can cause significant impairment. In a word, living with it day after day can be "exhausting" and many people suffering from anxiety also show signs of depression. Some individuals with anxiety self-medicate by turning to alcohol or drugs to cope. This only provides short term relief. Medication prescribed by your physician can help manage physical symptoms, but in order to find a long term solution for persistent anxiety, it's necessary to address the cognitive processes that are triggering it in the first place.

Why is this happening?

Knowledge is power especially when it comes to our health, so a bit of background on anxiety is an important part of learning how to control it.

In addition to the Central Nervous System (the brain, spinal cord and optic nerves) we have an Autonomic Nervous System (ANS), which regulates certain bodily functions and consists of two parts: the Sympathetic Nervous System (SNS), which primes your body for action, and the Parasympathetic Nervous System (PNS), which calms you back down.

When you feel threatened, whether the threat is real (I'm in trouble with my boss) or imagined (what if I end up losing my job?) a part of your brain called the Amygdala, which is your emotional center, sends a message to your Sympathetic Nervous System to “power up” your “Fight or Flight” system, which then triggers the release of stress hormones including adrenaline to prepare you to respond to the threat. Thinking about a threat then arms you to deal with it, even though hasn't even happened yet....even though it may never happen.

If you’ve ever been on a thrill ride at an amusement park or been to a scary movie you’ve probably experienced an adrenaline rush. You might experience a fast heart rate, become short of breath, dizzy, have tingling fingers, or even feel pressure or pain in your chest area.

In situations like that described above, you'd likely experience this adrenaline surge, laugh it off, and quickly return to normal. Why? Because the way you interpret the situation and what you tell yourself just happened affects how quickly your parasympathetic nervous system calms you after a fright.

If we were to monitor your vitals during an anxiety attack, you'd see a similar reaction to what you'd see if we monitored you during a thrill ride or a scary movie. The difference, really, is that the way you interpret the situation determines how quickly that response dissipates. If you become frightened not by the situation but by what's happening to you, then you don't calm down as you would when you tell yourself "it's just a ride" or "its just a movie". Instead, when you become frightened by what's happening to you, your body releases more adrenaline and anxiety becomes even more heightened. An individual can experience this cycle several times a day, leaving them feeling mentally and physically drained. At this point, it's common for an individual to feel as if they are losing control or "going crazy".

How to control it!

The key to managing anxiety is to recognize that it is linked to thoughts. The truth is that our thoughts control our life, and an accumulation of negative experiences can sensitize us to the point where day in and day out we are on guard because we believe that bad things will happen to us if we don’t stay alert. These thoughts can become automatic, occur outside of our awareness and feed emotional states such as anxiety and depression. If you are telling yourself over and over throughout the day that you are in danger, your brain is going to react to that by arming you to deal with that danger, whether perceived or real.

While medication can help by managing brain chemistry, anxiety will continue to be a problem if the underlying cause isn’t addressed, and the underlying cause often has to do with what you are telling yourself that is triggering your threat system again and again and again.

Psychotherapy is an effective way to learn how to cope with excess anxiety in your life. Some of the ways you can learn to manage anxiety include:

  • Cognitive Behavioral Therapy (CBT) to help you identify and change the dysfunctional patterns of thinking that can feed anxiety. By practicing CBT techniques, you can begin to see changes right away.

  • Relaxation techniques that help reduce stress and anxiety, and specific relaxation exercises to reverse the physical symptoms that occur with anxiety and panic

  • Learning ways to effectively cope with difficult emotions

  • Learning mindfulness, the ability to take time to be present focused rather than to dwell on past regrets or live in continual anxiety about the future.

#anxiety #Panic #CBT

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