tired man sitting on floor surrounding by boxes

Anxiety

Anxiety is the term used to describe a set of emotional, physiological and behavioural responses you experience when your brain detects a threat.

What causes anxiety?

Different pathways in your brain can result in the anxiety you experience, but each involves an alarm bell being set off 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 route, where your brain remembers to be anxious.

You were not born anxious.

Things had to be repeated ( or practised) for you to feel anxiety when necessary. You undoubtedly did not do this on purpose. Your brain is primed to pay more attention to negative experiences than positive ones, as the negative ones may harm you.

It is not the anxiety that is the problem but how you think about it and respond to it.

Dr Elaine Ryan

For example, you worry about being late. You feel stressed, anxious or angry at being stuck in traffic; your brain is alert to this adverse situation. The dangers your brain responds to are no longer life-or-death situations but day-to-day experiences.

  • Deadlines
  • Money worries
  • Work or school
  • Relationships
  • Self-talk inside your head

Your anxious brain is always on the lookout for possible danger.’ When there is no real danger, your mind takes over, worries, and 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 with anxiety, your brain pays attention to this. New pathways are created relating to stress. 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 and physical symptoms 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?

Let’s take the example of sitting in your favourite armchair after dinner. If your brain and body are working well for you, they 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 enables you to kick back and unwind from your day.

Suddenly there is a loud bang in the other room.

Your brain triggers a stress response to alert you and move quickly to see what has happened.

One second you are almost asleep; 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, and you feel 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, suppose you experience any form of stress. In that case, you will feel the stress response’s effects 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 a constant high alert – getting the stress response too often when it is unnecessary.

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 want to reassure you that science shows that you can change how your brain works for you. Your brain changes during your life depending on your thoughts and how you react to all the different experiences you encounter in your life.

How do I know if I have anxiety?

You shall be suffering from a set of symptoms (that I shall discuss in more depth later in this article), such as a racing mind, palpitations, and interrupted sleep that shall lead you to your doctor. Your doctor will check for medical explanations for your symptoms. Once ruled out, they may refer you to a mental health professional who can diagnose anxiety.
The mental health professional will also tell you which type, if any, of anxiety disorder you have.

Types of anxiety disorders.

All anxiety disorders have a specific set of signs and symptoms. It is essential to know what type of anxiety you are experiencing. Ask yourself the following questions.

Do your symptoms have an underlying medical cause?

If it does, your experience of anxiety may be cured by treating the medical condition instead of the anxiety.

Do you have panic attacks?

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 in public situations or speaking out?

If so, you might have social anxiety.

Is your anxiety related to certain things or situations?

You might have a specific phobia.

Are you concerned with obsessive thoughts or doing things in a certain way?

If you repeat certain things and experience anxiety, if you cannot carry this out, you might have obsessive-compulsive disorder.

Is your anxiety focused on your health?

If so, you might have health anxiety.

None of the above

If you have answered the questions above, but your anxiety does not fall under a specific category, you might have a generalised anxiety disorder; GAD.

What are the symptoms of anxiety?

Breathing difficulties

Many people feel that they can’t breathe properly during a panic attack or high experience 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 can calm down your nervous system.

As explained above, the sympathetic nervous system produces a “fight or flight” response during high emotions. It is trying to protect you from danger (although there is no danger.) 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 changed rapidly, making it uncomfortable, but you are still living.

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 it. Your nervous system has become over-sensitised.

Chest pain and tightness

This symptom can feel like someone has tightened a belt around your chest.
It can also feel like something is pressing down or squeezing your chest. Your heart may be beating out of your chest.
Chest pains like 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 hearts to beat more quickly than is needed. We overwork our chest muscles, which leads to the sensations we experience.

Chest pain may cause you to feel alarmed and fear that you have a heart attack. This fear often makes you panic more. As explained previously, you hyperventilate during a panic attack. When you puff regularly, you are over-breathing. You are using the chest muscles more often than usual. If these muscles are overworked too often, you will begin to feel chest pain.

Dizziness, lightheaded

As you breathe in normally, you breathe in oxygen and breathe out carbon dioxide. When you are breathing too fast, or over-breathing during a panic attack, the carbon dioxide levels in your blood start to lower (as you are breathing it out too quickly.)
When this happens, your blood vessels will constrict, leaving you feeling dizzy.

Heart palpitations

Palpitations are one of the more frightening panic attack symptoms, as you may think your heart is about to give up.
Your autonomic nervous system controls your breathing and heart rate, amongst others. You don’t have to think about it.
During high emotions such as a panic attack, your sympathetic nervous system responds to prepare for a fight or flight. It is the sympathetic nervous system that causes 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 result in tingling and tightness.
Think of it this way. This response is very adaptive when necessary. Suppose you fall and damage your leg, where part of your leg has been cut open. In that case, your body will immediately get a stress response, and your muscles will 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 of 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 pumps blood around your body during the fight or flight response, your body cools itself by sweating. Blood vessels move closer to the skin’s surface and cause the redness you see – blushing.
Once you are aware that you are sweating and blushing, especially in front of others, your thoughts 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 think and can produce symptoms in the body.
This is quite common in social anxiety.

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

Trembling and Shaking
Tiredness and Fatigue
Digestive Problems, Irritable Bowel Syndrome
Blurred Vision
Urination
Panic Attacks

Are 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 typical of panic. They are also more likely to feel ill.
In some studies, men reported feeling more pain in their stomachs and experienced sweating more than women.
This is not to say that men do not experience breathing difficulties, and women do not experience increased perspiration during panic attacks. Both men and women can, and indeed do, experience both.

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. 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 guided self-help materials such as CCBT; Computerised Cognitive Behavioural Therapy. I have worked in psychology for almost 20 years, specialising in anxiety and finding 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 means that it works best for anxiety primarily due to your thinking brain, i.e. your thoughts and worries.

However, if you find that your anxiety can arise for seemingly no reason or get anxious in the same situations, you might have what is known as amygdala-based anxiety; this occurs mainly 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, focusing on helping you unlearn the stress response in situations where you experience anxiety.

Many people benefit from both types of anxiety treatments, which is why I cover both in my online self-help course.

Medications

SSRI’s

You might have been offered an SSRI which stands for Selective Serotonin Reuptake Inhibitors. Still, the first point of treatment is generally therapy, as opposed to medication. SSRIs usually take about 4 to 6 weeks before they ‘kick in’ and help treat your anxiety by increasing your serotonin levels.

Benzodiazepines

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 only be used short-term.