Anxiety
The bio-psycho-social understanding of the origins of anxiety
The exact causes and mechanisms of anxiety are unknown. Anxiety is a combination of biological and psychological factors, leading to the key question: does anxiety precede its triggers, or do the triggers spark the anxiety? Anxiety consists of 4 components – the feeling of anxiety, the physical symptoms, the thoughts related to the anxiety and the avoidance behaviour. A distinction is made between a reasonable reaction to a limited danger/fear and the more free-floating anxiety that is there without any clear danger signals. There are different types of anxiety and I work mainly with panic anxiety, agoraphobia, social anxiety, PTSD, generalised anxiety disorder (GAD) and obsessive-compulsive disorder (OCD).
The power of thought
When fear and intrusive thoughts merge, they can heighten your sense of danger, leading to a spiral of catastrophic thinking – an ongoing stream of disaster scenarios that feels impossible to interrupt in the moment. Feeling incapable of stopping these overwhelming thoughts can lead to the false belief that they are both significant and real. As a result, they can feel just as distressing as if the imagined scenario were actually happening. This can trigger a freeze or flight response, leaving you feeling paralysed or desperate to escape.
How anxiety starts
Anxiety disorders often begin in childhood or adolescence, but they can also start later in life. These are very common conditions that affect at least 5% of the population. Anxiety disorders vary widely in their severity, ranging from mild cases to those that are profoundly debilitating. In some cases, anxiety is such an obstacle that it can make it difficult to finish education and maintain a job and/or social network, thus reducing quality of life.
Why do we have anxiety?
Anxiety and depression are closely related disorders and occur more frequently in some families than in others. Hereditary factors can therefore play a role in how likely an anxiety disorder is to develop. So if you suffer from anxiety, you may well have a family member who also suffers from anxiety or depression. It’s not because you inherit the disorder itself, but because you may have developed a vulnerability to anxiety. For some, even short-term stress or a few stressful events can trigger an anxiety disorder, while for others it will be a longer buildup or more significant stressors. It is not yet fully understood which psychological and social conditions during childhood increase the risk of developing an anxiety disorder. However, several research findings have suggested that experiencing a lack of control is at the root of anxiety. For example, it could involve unpredictability when dealing with parents and their addictions. Research has also shown that certain personality traits can increase the risk of developing an anxiety disorder. This is particularly true for traits marked by anxiety-avoidance, where individuals tend to exhibit excessive caution, nervousness and a heightened reaction to negative events.
In many cases, the following traits act as triggers for developing an anxiety disorder.
- Conflicts in the family, e.g. divorce
- Unemployment or organisational changes in the workplace resulting in stress
- Physical illness
- Sleep issues
- Deaths in the family
- Work-triggered stress
- In the case of PTSD, it’s exposure to severe and life-threatening events.
Although pinpointing the exact cause of your anxiety can be challenging, my experience suggests that there are often common factors contributing to why your anxiety has become so distressing and debilitating.
For example, you may have:
- Experienced trauma, grief, accidents and/or violent events that are hard to let go of
- Been bullied at school
- Experiences from your childhood that you’ve subconsciously chosen to push away and that now reactivate and surface in certain situations
- Parents who were overly aware of dangers in the world
- Too high expectations of yourself or others. When your internal perceptions don’t align with reality, it can disrupt your inner sense of stability, leading to doubt and uncertainty. Over time, this mismatch can manifest as anxiety.
It’s also possible that anxiety has become a strategy to avoid dealing with a deeper loss or grief. It could also be that you are afraid to feel your emotions because you associate feeling your emotions with being irrational and not in control of yourself. You might be experiencing a fear of anxiety itself or a fear of dying. You may find that you have previously predicted the future based on fear scenarios or believe that you can read other people’s minds. The result is often misinterpretation, and you can easily end up living a life based on conjecture that has nothing to do with reality.
Neurobiology and the amygdala
From a neurobiological perspective, the behaviour and emotions of healthy, well-functioning individuals are mainly regulated by the frontal part of the brain, particularly the prefrontal cortex. This is the part of the brain that consists of reasoning, planning and controlling emotions. With anxiety, you can see that emotion control is taken over by the centre of the brain, called the amygdala. This is the part of the brain that is designed to react quickly when danger is imminent, which happens automatically. This means, for example, that our behaviour is governed by an irrational way of thinking, without control. We become emotionally impulsive and there is an automatic learning of fear and avoidance. In the face of real danger, this is a perfectly reasonable and quite appropriate way to survive in the world. But if our behaviour is generally controlled from this part of the brain, it becomes inappropriate over time.
When the amygdala begins to dominate daily life, it rapidly forms new connections in the brain, leading to the spread of anxiety across various aspects of your day. In this scenario, we see that the amygdala activates the autonomic nervous system, which consists of the sympathetic and parasympathetic nervous systems. It’s crucial to note that this activation is not something we can control through reasoning.
The sympathetic nervous system activates fight or flight responses when there is danger or the perception of danger – whether this is real or not. When the parasympathetic nervous system is active, you will feel safe, and when it has been active for a while, the anxiety subsides and you feel safe again.
Anxiety process
The therapy mainly involves using tools from ACT, EMDR, MSC, Hypnosis and Body and Gestalt Therapy to identify your underlying assumptions and beliefs. We’ll also look at what happens in the brain and body when you suffer from anxiety and what actions it often triggers. We’ll work on motivation, relaxation exercises, breath training/mindfulness (including various meditation practices), acceptance, skill training and relapse prevention. This kind of therapy will often provide new insights; it’s as if you’re giving the anxiety a voice to reveal what it’s all about. A highly recognised psychologist named Marsha M. Linehan calls it “making lemonade out of lemons”.
For example, you will learn:
- How to identify productive and unproductive fear and anxiety
- How to distinguish between the different emotions you experience
- What location your emotions can have in your body – where do you feel what?
- What the anxiety reveals about who you are and what your options are, and how to use this information to your advantage
- To be more in the present moment without letting anxiety stoping you
- To deal with the fear of death
- How to develop the ability to stand up for yourself and become your own best ally during challenging and overwhelming situations
- How to manage and accept reality while committing to personal change that guides you towards greater kindness, self-compassion and gentleness with yourself.
- Relaxation exercises
- Meditation
I offer therapy in the following areas of anxiety:
Panic anxiety. The challenge with panic anxiety is not the panic attacks themselves, but the anxiety and the worrying associated with them. The panic attacks are often recurrent and unpredictable, leading to expectations of new attacks and are combined with a lot of ruminations or worrying about them. Panic anxiety often leads to agoraphobia (see next section). Panic attacks are not limited to a specific situation. The experience of completely losing control of your body often manifests itself in a variety of physical symptoms, such as:
- Heart palpitations,
- Sweating and/or shaking,
- Dry mouth,
- Difficulty breathing,
- Chest discomfort,
- Dizziness,
- Sense of unreality and
- fear of being ill, such as having a stroke and/or heart attack. You may also have thoughts of losing control of yourself, going insane, falling over or fear of dying.
Agoraphobia starts with panic anxiety. Agoraphobia literally means “fear of the marketplace”, a fear of being overwhelmed by another panic attack in places where it’s embarrassing and difficult to escape or get help. Travelling outside the home can therefore create a phobic anxiety that is often associated with panic anxiety. This is often due to a fear of having a panic attack. The disorder mostly involves avoiding public transport, driving, going to the supermarket, being in crowds, going to shops and in some cases being alone.
Social phobia. With social phobia, you may fear being the object of other people’s critical attention or be afraid that you risk embarrassing yourself in front of others. Social phobia can also manifest itself when playing sports or in job interviews and exams. The psychological and physical reactions are often:
- Clammy/moist hands
- Increased heart rate, sweating
- Heart palpitations
- Blushing
- Shaking
- Rapid and shallow breathing
- Nausea
- Difficulty concentrating
- Vomiting and an urge to urinate
Each of these symptoms can become subject to negative interpretations and thought processes, often manifesting in well-developed inappropriate safety behaviours, such as:
- Attempting to avoid the perceived threat by trying not to attract attention
- Avoiding eye contact
- Being overly attentive to what you say and therefore not relaxed in your communication with others
- Consciously trying to suppress the blushing or shaky hands, often with the opposite effect
When you experience social phobic, you will have a highly disturbed self-image that makes you hypersensitive to criticism or humiliation when socialising with others. You often try to avoid these situations to avoid the visible physical signs of anxiety.
Individual phobias – excessive fear of a specific thing or situation, defined by a fear of being in contact with, as well as avoidance of, e.g. specific animals, lifts, dentists, needles, blood, etc.
Generalised anxiety disorder, also known as GAD, is a constant anxiety or nervousness experienced over a prolonged period of time. This could be work- or study-related worries or an excessive anxiety about accidents and illness affecting yourself or your loved ones. You can rationalise that your worries are unrealistic, but you can’t control them, and a constant stream of “what-if” thoughts runs as a loop in your head. Excessive worrying, whether about major or minor aspects of life, can lead to the following symptoms commonly associated with chronic worry:
- Personal health
- Difficulty performing daily chores
- Worrying about the well-being of family members
- Inner turmoil
- Tension
- Heart palpitations
- Sweating or a dry mouth
- Catastrophising thoughts
Keeping worries in check can be challenging. If you have generalised anxiety, you may often respond to these symptoms by seeking reassurance, such as frequently contacting your doctor, friends, or family confirm that nothing is wrong. This may also lead to undergoing multiple medical check-ups, despite the absence of any underlying physical health issues. Generalised anxiety also means that you are often or constantly plagued by physical symptoms of anxiety.
PTSD
Post Traumatic Stress Disorder. You will have recurring flashbacks, especially to places or situations that remind you of the trauma. This is also referred to as trauma recall. PTSD is often caused by experiencing a crisis reaction to a life-threatening event where you were in danger of dying, being maimed or threatened with violence. The trauma is then relived in the mind in the form of nightmares and flashbacks. You may flinch at loud noises and whenever you are confronted with situations that remind you of the trauma. It’s important to emphasise that it’s not only deployed soldiers who get PTSD. Men and women who have been in violent relationships where they have been subjected to abuse of both a psychological and physical nature may also be affected by PTSD.
Typical symptoms include:
- Painful internal images in the form of flashbacks
- Nightmares
- Difficulty concentrating
- Memory problems
- Feeling tension
- A sense of unreality
- Debilitating thoughts
OCD
Obsessive Compulsive Disorder. Obsessions and compulsions are defined as involuntary, distressing thoughts and actions. You will experience anxiety and discomfort when the thoughts arise and further anxiety if the compulsions are not completed. For example, a compulsive behaviour might be to grab the door handle a certain number of times. The main point about obsessive thoughts is that a thought is not an action, but that you can think anything without it meaning that you must end up acting on it.
Obsessive thoughts and behaviour often include:
- Risk of infection
- Hoarding
- Order and symmetry
- Religious themes
Compulsive behaviour often involves:
- Washing rituals
- Hoarding
- Control rituals and repetition rituals
- Mental checks or praying
