ANXIETY
by Dr. Daniel A. Bochner
Feeling uptight or kind of shaky? Do you have muscle aches,
heartburn, or stomach problems? Do you suddenly lose energy after feeling
alright. Is the stress in your life taking you to the breaking point? Does it
seem like no one does things right, or that you are just too irritable? Are you
worrying a lot? Are you having trouble sleeping? Are you feeling restless, or
does it seem like you can’t sit still? Do you feel just plain nervous? Do your
hands or feet get cold and clammy or start to tingle without cause? Do you
get lightheaded and you don’t know why? Do you find yourself avoiding
certain situations, or sometimes find yourself so stressed in certain situations,
that you think you might actually die from pain in your chest or from
dizziness or from the pounding of your heart? If you are experiencing some,
many, or all of these symptoms, there is a good chance you are dealing with
anxiety.
Although it is very important to be careful about many of these
symptoms because they have causes other than anxiety, or because they can
be dangerous even when they do involve anxiety, when these symptoms are
caused by anxiety, understanding how anxiety works can be quite helpful.
Anxiety actually has a purpose in human beings that is akin to its purpose in
animals. In animals, there is a fight, flight or freeze pattern that occurs
whenever there is something threatening in the environment. While the
animal prepares to either fight, flee or freeze to manage a threat, the animal’s
body makes certain changes. The blood flows to major muscle areas and
away from the extremities and the gut, thus causing cold or tingly hands and
butterflies in the belly. Adrenaline makes the heart pump and puts energy
into the muscles, which become tense, causing headaches or pain in other
muscle areas like the neck, shoulders, or back. Breathing becomes shallow
so the animal can avoid detection, or so it can get ready for an anticipated
blow.
These changes ready the body for danger, but when human beings
experience this reaction, most of the time there is no imminent danger in the
environment. Humans tend to be sensitive to the environment, and react to
it rapidly, even when the dangers to which we are reacting pose no physical
threat. Rather, we react to emotional threat, even when it is rather subtle.
Getting ready to speak in front of a group can cause extreme anxiety and
really there's no physical danger there. But even much more subtle
circumstances can cause significant anxiety. When there is a chance that
someone will be mad at us, or when we think we need to get our work done
more quickly, or when we think we need to rush to get somewhere on time,
or for many people, when we're merely listening intently to what others are
saying...etc., our bodies will react with the fight, flight or freeze syndrome.
We either ready ourselves for aggression, like a mountain lion protecting its
cub, or we freeze up with tension like a raccoon stiffly staring back into
headlights hoping it will not be seen.
Luckily, we are not animals. Equal to the fight, flight or freeze
syndrome (also known as the sympathetic nervous system response), is the
relaxation response (known as the parasympathetic nervous system
response). While the fight, flight or freeze syndrome tends to begin without
our knowledge or control, we can if we wish, initiate its opposite, the
relaxation response, on our own. When we are relaxed, blood flows
throughout our entire body distributing oxygen as homogeneously as
possible. The heart slows down and the muscles lengthen and loosen.
Breathing deepens and we feel at peace. Sometimes we begin to get sleepy.
We can begin the relaxation response simply by forcing ourselves to
breathe deeply for a few minutes (please see article, Breathe!). Most people
who try breathing to recover from anxiety stop their breathing after a few
breaths and then give up because they still feel tense. The trick is to keep
breathing deeply for several minutes (if you become lightheaded you need to
be less dramatic in your deep breathing, or make sure your breaths are truly
deep), while trying to experience a sensation of floating as you inhale and
sinking as you exhale. I have not yet met a person for whom this process,
when taken seriously, does not work.
Several other relaxation techniques include 1. scanning your body for
tension through every muscle group and then loosening your muscles
(eventually learning to pay more attention to your body and loosen the
muscles as soon as they become tight); 2. imagining yourself in a pleasant,
relaxing place, while noticing everything you experience there through all five
senses; and 3. rocking yourself with eyes closed while finding your natural
rhythm. The relaxation response of the whole body occurs automatically
when you do these things and, because it is diametrically opposed to the
fight, flight or freeze response, the tension in your body cannot continue
while you are relaxed. In fact, because the body and mind are part of one
big system, making the body relax also helps the mind relax, and ones
thoughts will typically calm as relaxation continues.
Knowing how to handle the anxiety one already has is helpful, but
knowing how to prevent anxiety could be even better. The prevention of
anxiety requires that its causes be understood. There are really two main
causes. There is some overlap between these two causes, but in their
essence they are very different. The first is that some people have truly
experienced many threats in their environment and now interpret the world
as a threatening place. When a person has experienced abuse, unfair
treatment, or trauma, they use their experience to help keep them safe in the
future. Thus, they interpret many different circumstances as threatening and
will become anxious in many different circumstances. If their experiences
were extremely traumatic, it would be foolish for them to respond
differently. On the other hand, most of the time their traumatic experiences
of the past are not predictive of current experience, or actually cause more
traumatic experience since they tend to make the person accustomed to
familiar, but dangerous, surroundings. Thus, their anxiety is often
exaggerated (please see article, Post-Traumatic Stress Disorder).
The second primary reason for anxiety is that some people have
developed so much feeling of responsibility for loved ones that they too
easily worry that any non-loving feelings within them could be dangerous to
those loved ones (please see article, Obsessive Compulsive Personality and
attend to the “responsibility fragmented individual”). Guilt can grow from
having any self-centered thoughts. Feelings of anger are especially difficult
to tolerate for these responsible people. Any hint in their thinking that they
may have feelings inside them that might damage others makes them become
anxious and worried. They become especially tense if they fear their
potentially hurtful selfishness or anger might become so powerful that they
could leak out and be detected by others.
The anxiety that derives from trauma in ones past bubbles up when
their environment is not in their absolute control, or when others will not
conform to their way of doing things. This type of anxiety response is
typically mixed with a fair amount of anger, and these people can become
emotionally aggressive when life becomes stressful. The second group, in
contrast, typically tries to be kind and good all the time, but because no one
is always kind and good, whenever their unkind and not completely good
thoughts threaten to become conscious, they feel shame and worry about
rejection. This “good person” group also often worries about others, and
they often come to realize that their greatest fear is loss (loss that occurs
because they are “bad” or loss that occurs because others are free to leave or
make mistakes). For either of these groups, when something terrible
happens that is beyond their control, their reaction is often depression and
their anxiety is exacerbated. They have been trying so hard to maintain
things in perfect order or to be as good as they possibly can, that it simply
does not make sense to them that something bad could happen to them.
Thus, it is important to recognize how little control we really have and
to understand that to be human at least partially means to be selfish, needy,
aggressive, hurt, and sometimes fearful. We can only do what we can do.
We can try to be our best and to help those that we love. But we cannot be
perfect. We cannot always do everything right. We cannot control how
others do things. We have to maintain humility about our frailty and our
imperfection and we have to realize that we are merely small cogs in the
giant machinery of life. When we maintain a balanced view of our place in
the scheme of things, and let others share in our imperfect humanity, we are
much less likely to become overwhelmed with anxiety.
It is also important to discuss the chemical components of anxiety. No
one really knows the extent to which anxiety is caused by chemical changes
in the brain or whether the brain’s chemistry changes when someone
becomes chronically anxious. If one can find some relief from disabling
anxiety, it doesn't really matter if its cause is chemical or psychological. No
matter how you view it, it is a fact that there are brain chemistry changes
concomitant with the experience of anxiety. The psychodynamics behind
anxiety are also a matter of fact, whether or not chemistry is involved. The
human emotional system works by certain mechanisms that make people
react with anxiety to a history of traumatic interpersonal experience or
responsibility taking beyond ones control. There are certainly people who
are more prone to anxiety at the chemical level, and they are more likely to
respond with fear, an inability to trust, or a need to hide all selfishness or
anger to avoid overwhelming levels of guilt.
If you are experiencing anxiety, breathe and try to relax. Share your
feelings with others whom you trust. Let yourself be vulnerable with those
you trust. Try to recognize that you are just an infinitesimal being in a huge
interpersonal world. With effort, you might be able to get things to go your
way, you might even be able to stay somewhat safe, but you can't truly
expect to have any real control over anything or anyone but yourself. You
may care very deeply about others, and you may actually know what's best
for them, but you will never be able to prevent them from making mistakes.
You should also realize, however, that most of the time, those mistakes
won't cause horrendous disasters. You must also realize that you are human
and that us humans have selfish thoughts, even mean and angry thoughts,
but only our actions can truly hurt others. You don't have to be perfect in
any way, not in hiding your imperfections and not in doing it all. It's as
simple as this, although it might not seem to be so, you need only be able to
give and receive love and everything will be okay. But that's not always so
easy to do. If you just don’t think you can beat anxiety, there's no shame in
seeking help. If you need to talk, there's no shame in seeking a
psychotherapist. If medicine might help, why hesitate? The truth is, you
need to feel good to be the loving person you need to be. There's also
another truth when it comes to anxiety, everybody gets it sometimes. Reach
out and you will undoubtedly find, as isolated and alienated as you might
feel, you are definitely not alone.