Anxiety is the term used to describe a set of emotional, physiological and behavioural responses that you experience when your brain detects a threat. Receiving a diagnosis of anxiety is when you experience the symptoms of stress when there is no danger present, and your symptoms continue and interfere with your daily life.
Dr Elaine Ryan
Page last reviewed and updated by Dr Elaine Ryan on
11th May 2020
- What is and what causes anxiety?
- Stress Response
- How do I know if I have anxiety?
- Self help and treatment options
If you would like my help I have an online self help course that is available to start right away.
What is and what causes anxiety?
Anxiety starts in your brain when it overreacts to a stimulus. To explain this in a way that shall be useful to you, it is worth having an understanding of fear, and the fight/flight response.
To understand what anxiety is, I find it useful to draw from evolutionary psychology as it allows me to see that anxiety is an adaptive response that should be useful, but our intelligence gets in the way! Let me explain.
In the short video above, I start by showing you how your brain should respond when it detects a threat. When your brain detects a threat, you receive the energy needed to prepare for danger, and you calm down when the threat has passed.
How does this threat detection system create anxiety?
In primitive man, the stress response activates once a threat (predator) is detected. The stress response gives him the energy to fight the predator or run away – hence why we talk about the fight or flight response.
Once he is out of harms way, his body calms down again. This quick burst of energy, in my mind is not anxiety. Instead, it is more akin to fear, and this is a significant difference, as I shall explain now.
Modern-day man detects a threat, such as worrying about money and his stress response gets activated. He still gets this big burst of energy, but what he is now experiencing is anxiety, as opposed to fear.
What causes anxiety?
There are different pathways in your brain that can result in the anxiety you experience, but each involves an alarm bell ringing to activate your stress response. I touch on the pathways in the video below.
The alarm bell can be activated by a ‘thinking’ route, where your thoughts and worries can make you anxious, and by a quicker way, where your brain remembers to be worried.
You were not born anxious.
Things had to be repeated ( or practised) for you to feel anxiety when it is not necessary. You undoubtedly did not do this on purpose.
Your brain is primed to pay more attention to negative experiences rather than positive ones, as the negative ones may harm you.
For example, you worry about being late and feel stressed, anxious or angry at being stuck in traffic; your brain is alert to this adverse situation. The dangers that your brain is responding to are no longer life-or-death situations, but day-to-day experiences.
- Money worries;
- All the ‘self-talk’ that goes on inside your head.
Your anxious brain is always on the lookout for possible ‘danger.’ When there is no real danger there, your mind takes over, and worries, races; you expect the worse.
Physical symptoms, maybe even panic attacks develop. The pathway in your brain for anxiety becomes stronger. It can connect your worries with the physical symptoms in your body.
If you worry about a meeting or dread going somewhere in case you have anxiety, your brain pays attention to this. New pathways are created relating to anxiety. Now if someone mentions the ‘meeting’ or the place ‘you dread going’ your anxiety pathway is activated, and your brain can give you everything related to anxiety.
Your worries, the physical symptoms, they all appear automatically, just like reading this page. You can now feel anxiety in many situations and not know why.
You have your automatic pilot for anxiety.
What your brain pays attention to becomes real.
You are now living with an automatic stress response
What is a stress response and a relaxation response, and why they are essential?
Let’s take the example of sitting in your favourite armchair after dinner. If your brain and body are working well for you, it will do the following:
Your rest and digest nervous system will give you a relaxation response, to relax your body and help you to digest your food. You feel comfortable and relaxed. The relaxation response is what helps you to kick back and unwind from your day.
Suddenly there is a loud bang in the other room.
Your brain takes over and gives you a stress response to make you feel alert and able to move quickly to see what has happened.
One second you are almost asleep, and the next your heart is pounding, and you are in the other room. Does that sound familiar? One second you feel ok, and the next, you feel stress or anxiety?
You see that your dog knocked over a stool and you calmly walk back to your favourite armchair.
Soon your heart rate has slowed down, and you are feeling comfortable again, as your nervous system has replaced the stress response with a relaxation response (rest and digest.) You fall asleep.
This is how our nervous system should work for us, giving us stress when we need it, and relaxation at other times. However, if you experience any form of stress, you will be feeling the effects of the stress response in many situations where you do not need to.
You may find it difficult to kick back and relax and feel the benefits of the relaxation response as you are on constant high alert – getting the stress response too often when it is not needed.
Your brain is primed for stress and associates the small things in life with anxiety. Each time you encounter them, your mind gives you stress.
I would like to reassure you that science shows that you can change the way your brain is working for you. Your brain changes during your life depending on the thoughts that you have and how you react to all the different experiences that you encounter in your life.
How do I know if I have anxiety?
You shall be suffering with a set of symptoms (that I shall discuss in more depth later in this article) such as racing mind, palpitations, interrupted sleep, that shall lead you to your doctor. Your doctor will check for medical explanations for your symptoms, and once ruled out, they may refer you to a mental health professional who will be able to diagnose anxiety.
The mental health professional will also be able to tell you which type if any, of anxiety disorder that you have.
Different types of anxiety disorders
Generalised Anxiety Disorder
What are the symptoms?
Breathing difficulties and anxiety
Many people feel that they can’t breathe properly during a panic attack or when experiencing high anxiety. It may feel like you are gasping for breath or can’t get enough air into your lungs. You may also feel like you are suffocating or being smothered.
You usually don’t have to think about breathing; you do it automatically. The autonomic nervous system makes sure of this.
The key to restoring your breathing to normal is being able to calm down your nervous system.
During high emotions, the sympathetic nervous system produces a “fight or flight” response, as explained above. It is trying to protect you from danger (although there is no danger there.) It is the sympathetic nervous system that causes your breathing to change. It may also speed up and cause rapid shallow breathing.
You hyperventilate. You are still breathing. Your breath has just changed rapidly, and it feels uncomfortable, but you are still breathing.
Having difficulty breathing is one of the most frightening symptoms of panic attacks. The critical thing to understand is that this response is due to you getting a fear response in situations where you do not need. Your nervous system has become over sensitised.
Chest pain and tightness
This symptom can feel like someone has put a belt around your chest and tightened it.
It can also feel like something is pressing down on your chest or squeezing it. Your heart may be beating out of your chest.
Chest pains such as these are usually why people, like yourself, attend their doctor, afraid that something has happened to their heart.
Once you have received the all-clear, the pain you are experiencing is down to breathing too fast (hyperventilation). Anxiety causes our heart to beat more quickly than is needed, and we overwork our chest muscles, which leads to the sensations that you experience.
Chest pain may cause you to feel alarmed and fear that you are having a heart attack. This fear often makes you panic more. As explained previously, you hyperventilate during a panic attack. When you hyperventilate regularly, you are over-breathing. You are using the chest muscles more often than usual. If these muscles are over worked too often, you will begin to feel chest pain.
Dizziness and Feeling Lightheaded
As you breathe in normally, you are breathing in oxygen and breathing out carbon dioxide. When you are breathing too fast or over-breathing during a panic attack, the levels of carbon dioxide in your blood starts to lower (as you are breathing it out too quickly.)
When this happens, your blood vessels will begin to constrict, which leaves you feeling dizzy.
Palpitations is one of the more frightening panic attack symptoms as you may think that your heart is about to give up.
Your autonomic nervous system controls, amongst others, your breathing and your heart rate. You don’t have to think about it.
During high emotions such as a panic attack, your sympathetic nervous system responds to prepare for fight or flight. It is the sympathetic nervous system that is causing your heart to race.
Although unpleasant, it won’t harm you.
Muscle tightness and pain
Again this is due to breathing faster than is necessary. Carbon dioxide drops which results in tingling and tightness.
Think of it this way. This response is very adaptive when necessary. If you fall and damage your leg, where part of your leg has been cut open, your body will immediately get a stress response and your muscles will immediately tighten.
Your body is trying to protect you, although getting this symptom when nothing has happened to you is understandably worrying.
During a Stress Response, the large skeletal muscles contract, in the neck and shoulder muscles, to prepare you for action. This contraction is what causes your neck, back and muscles to ache. It can also give you a headache.
Fear of dying or losing control
You might have found that your thought processes have changed since experiencing anxiety or panic attacks.
Typically thoughts include:
- I’m going to die
- I’m going crazy
- I’m going to lose control
- Something terrible is happening
- I’m going to have a heart attack.
It’s natural to think thoughts such as these in the beginning. The symptoms you experience in your body, come from a primitive part of your brain. It reacts first and thinks later. If your mind thinks you are in danger, it will not wait for you to think about it and decide what to do. Instead it reacts for you, trying to keep you safe.
Sweating and blushing
When the heart is pumping blood around your body during the fight or flight response, your body cools itself by sweating. Blood vessels move closer to the surface of the skin and cause the redness you see – blushing.
Once you are aware that you are sweating and blushing, especially if it happens in front of others, your thought processes become preoccupied with what you must look like, and whether the other person notices. This, in turn, may make you feel more anxious. Our thoughts are connected to what we feel and can produce symptoms in the body.
This is quite common in social anxiety, and you can read more about this here.
Insomnia and Sleep Problems
Your mind may be racing at night, and you may find it hard to “switch off.” This overactivity of your thought processes will keep you alert and make sleep difficult. You may then worry throughout the day that you will not sleep at night.
This worry is called “anticipatory anxiety.” We make ourselves anxious by worrying about the anxiety we might have in the future. In this case, the future is bedtime.
If your body is alert at night, once you fall asleep, you may wake up frequently in a startled state, due to adrenal.
Other symptoms include
- Trembling and Shaking
- Tiredness and Fatigue
- Digestive Problems, Irritable Bowel Syndrome
- Blurred Vision
- Panic Attacks
Are Anxiety Symptoms different in men and women?
Women are more likely than men to experience anxiety disorders. Some studies have found that men and women may experience panic attacks differently.
Women are more likely to experience shortness of breath and the smothering sensation that is a typical symptom of panic. They are also more likely to feel ill.
Men reported feeling more pain in their stomach and experienced sweating more than women in some studies.
This is not to say that men do not experience the breathing difficulties and that women not to experience increased perspiration during panic attacks. Both men and women, can, and indeed do, experience both.
Anxiety Treatment and Self Help
If you have already had your anxiety diagnosed, you might be offered the following treatments.
If you attended your doctor, you could be offered medication or referred to someone like me ( a psychologist) for talking therapy, but a stepped care approach to anxiety treatment could be implemented.
Step 1: Use of Self Help for Anxiety.
This can include general self-help material such as books and use of guided self-help materials such as CCBT; Computerised Cognitive Behavioural Therapy. I have been working in psychology for almost 20 years and specialise in anxiety and find that self-help is enough for most people.
Step 2: Psychological Anxiety Treatment.
You might attend a psychologist for CBT- Cognitive Behavioural Therapy. CBT is the most well-known anxiety treatment. However, CBT works best for what is known as cortex based anxiety. This simply means that it works best for anxiety that is mostly the result of your thinking brain; i.e. your thought processes and your worries.
However, if you find that your anxiety can arise for seemingly no reason or you get anxious in the same situations, you might have what is known as amygdala based anxiety; this occurs mostly where you experience anxiety automatically or in situations where your brain has remembered to be anxious.
Amygdala based anxiety requires a different type of treatment, one which focuses on helping you to unlearn the stress response in situations where you experience anxiety.
I found that many people benefit from receiving both types of anxiety treatments, which is why I cover both in my online self-help course.
You might have been offered what is called an SSRI which stands for Selective Serotonin Reuptake Inhibitors, but the first point of treatment is generally therapy, as opposed to medication. SSRI’s usually take about 4 to 6 weeks before they ‘kick in’ and are to help to treat your anxiety by increasing your levels of serotonin.
You might also have heard of these medications being shortened to ‘benzos.’ They can quickly help with the physical symptoms of anxiety for some people, as they act as a sedative. They can be highly addictive, and these should be used short term only.
How do I know if I have an Anxiety Disorder
All anxiety disorders have a specific set of signs and symptoms, and it is essential to know what type of anxiety you are experiencing. Ask your self the following questions.
Does the anxiety have an underlying medical cause?
If it does, your experience of anxiety may be cured, by treating the medical condition as opposed to the anxiety
Do you have Panic Attacks, and if so, do you only really experience anxiety during an attack?
If so, you may have Panic Disorder.
If you have Panic Attacks (Disorder) and avoid certain aspects of your life out of fear of an attack
or feeling trapped or unsafe, you may have Agoraphobia
Do you only feel anxious when you have to do something in public, such as speak in public, meet friends in general?
If so, you may have Social Anxiety.
If your experience of anxiety is to do with certain things or situations,
you may have a Specific Phobia
Are you overly concerned with obsessive thoughts or about keeping things clean or hoard things?
If you repeat certain things and feel anxious if you cannot, it may be Obsessive Compulsive Disorder OCD.
If your experience of anxiety is more focused on possible health worries
or if you are frequently afraid that you have a severe illness or may become ill, it may be hypochondriasis
If you have answered the following questions and have come to the conclusion that your experience of anxiety is not restricted to those mentioned above
you may well have Generalised Anxiety Disorder.
More information on anxiety