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Everything you wanted to know about Anxiety but were too afraid to ask

Anxiety – a little bit can motivate our behaviour in a positive direction, a lot can leave us rooted to the spot unable to move – but what is it, what is happening and can I change it?

Anxiety is believed, evolutionarily to be part of the fight or flight response – low levels of fear is what we call anxiety.  We have all had that feeling of butterflies in our stomach that happens when we are worried about something that is approaching – giving a speech in public if we don’t like public speaking or taking an exam that is important for our future.  These are the physical effects of anxiety that occur when our sympathetic nervous system responds to something in our environment that is perceived to be threatening to us.  Our heart races, our stomach gets jiggly, we might start to sweat, and our thoughts can feel as though they can only think of the negative outcomes involved. For our ancestors that often had to survive in a rather dangerous environment this system was useful as it acted speedily and kept them safe by using these mechanisms.  The feeling of our heart racing has the function of getting blood to the parts of the body that might be needed to escape or fight threat.  To be ready to escape our bodies want to be as light as possible so they need to get rid of any excesses hence the feeling of being sick or needing to use the bathroom.  Our brains biologically programmed to fight for survival focus on the threat and produce thoughts that will help support this system and keep us safe.

All emotions prompt action in us and at low levels anxiety can do this.  It is low levels of anxiety that get us to sit down and prepare for the exam we are about to take or the talk that we are about to give.  It is low levels of anxiety that make sure we look both ways before we cross the road to make sure we are safe.  However, high levels of anxiety can be debilitating and can stop us from being able to process the information that is required to study for the exam or to be able to stand up in front of people and access the words we had wanted to say.

For most of us anxiety is part of our daily life but thankfully we can helpfully experience it and carry on managing to move towards our goals.  However, for some people anxiety can be debilitating and can get in the way of them moving at all.  Anxiety can come in many forms – for example specific anxieties such as spider phobia, the more general anxieties such as obsessive compulsive disorder (the fear that if we don’t engage in compulsions a feared event will occur), the over general anxieties such as generalised anxiety disorder which leads to worrying about worrying, and the trauma induced anxiety of post-traumatic stress disorder.  These are just a few examples of the forms which anxiety can take.

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How does anxiety begin?

For each person this will be different.  We all have differences in our sensitivity to threat which can then trigger our sympathetic nervous system more or less readily bringing on the physical sensations of anxiety.  We also learn about what to fear as we grow up – this can be modelled to us by our caregivers as we learn to understand the world – there is research now supporting the transmission of anxiety between generations.  Part of what we learn from our caregivers is not just the threat in the world but how to best manage feelings of anxiety.  We may learn that moving towards our fear is a way to manage – for example being gently supported to practice a new skill that we are not sure about or being supported to take a risk if we are not a risk taking person.  If we have experiences that allow us to learn that we can approach the things we fear, that we can learn to manage them and learn that the fear reduces as we face it. If you grew up with these messages then you are likely to have effective strategies for managing our anxiety.  However, in a different family environment we may have been taught to avoid the things which trigger worry in us and this can cause us to not have the learning experience described above.  The more we move away from the feared/worry inducing event the greater the fear becomes and the more entrenched our anxiety becomes so the less likely we will be to approach it in the future.  This creates a perpetuating cycle that maintains the anxiety.

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How do you treat anxiety?

Anxiety can be treated with medication and with therapy.  The therapy usually involves approaching the fearful event/thought often in a graded process – moving closer and closer to the more fearful thought/event.

Why does this work?

Anxiety, like all emotions comes and goes in a wave.  The therapy is about being in the anxiety provoking situation and learning that the feared event/thought does not happen/or hurt you and staying there long enough for the emotional reaction to come down and for the person to relax in the situation.  This can also require management of thoughts that keep the anxiety going whilst in the situation as well as physically approaching the feared event/thought.  The use of relaxation techniques alongside this type of exposure is very helpful too.

One of the most effective therapies for the treatment of anxiety disorders is cognitive behavioural therapy (CBT). Other popular approaches are mindfulness based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Our psychologists at The Chelsea Psychology Clinic have been treating anxiety for many years using a combination of all the most contemporary evidence based approaches.