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ARTICLES
- Anxiety:The mental Health Issues of our times,  by Eleanor Caesar  Click Here
- Understanding Hypnosis,  by Eleanor Caesar  Click Here
- Cognitive Behavioural Therapy, by Eleanor Caesar  Click Here

 Anxiety: The Mental Health Issue Of Our Times
By Eleanor Caesar, M.A.Sc., C.Psych.Assoc.

Note: This article is for informational purposes only. It is not meant to be used as a diagnostic tool.

All of us experience anxiety at some points in our lives. Indeed, who has not felt a pounding heart, tightness of the chest or dry mouth before an exam, a presentation, or an important meeting with the boss? But why do some people experience an anxiety so intense or prolonged that they can’t function, or at least have a significant decrease in their quality of life? How is it that their lives come to be so dominated by apprehension and rumination? And what can be done to help those who frequently struggle with this on a daily basis?

Prevalence
Anxiety disorders are certainly common. According to the World Health Organization they are the most prevalent form of psychological disturbance in every country in the world, usually affecting about 20% of the population.
The majority never seek treatment.

Anxiety vs. Fear
It should be understood that there’s a distinction between anxiety and fear. Fear is a very primitive, biological, hard-wired response to an immediate, external threat (eg. We suddenly see a venomous snake in our path). Fear has been essential to our survival as a species. It is a response that is immediate and remarkably effective, allowing us to either fight the threat or flee from it.
In contrast, anxiety is focused on the future (eg. What if I see another snake?) It is defined by anticipation and apprehension, created inside our own mind with the help of a vivid imagination.

What is Normal vs. Abnormal Anxiety?
Abnormal anxiety is marked by several features, including:

• Significant distress and impaired functioning in life
• Excessively worrisome thoughts that are not substantiated by reality
• The anxiety has been long-standing over time
• There is “stimulus hypersensitivity,” ie. an intense, exaggerated response to the feared object or situation
• The response to the fear has been avoidance.

This extreme anxiety can show itself in many forms, leading the medical profession to develop different diagnoses including: Panic Disorder ( unexpected panic attacks); Generalized Anxiety Disorder (excessive worry about a number of events or situations); Social Anxiety (anxiety in social situations); Obsessive Compulsive Disorder(unacceptable, intrusive thoughts, images or impulses); Post Traumatic Stress Syndrome(recurring memories of a prior terrifying event); and Phobias (fear of a specific object or situation).

Selective Attention to Threat
Common to most anxiety sufferers, however, regardless of whether or not they have an anxiety disorder is a selective attention to threat. The individual’s mind becomes so preoccupied with

negative “what if’s” (eg. What if the audience hates my presentation?) he or she fails to contemplate or experience the non-threatening parts of the event. (eg. It can be exhilarating to share information I think is interesting with other people.) Obsessive contemplation about the feared thing or situation becomes the norm which takes time and energy away from the development of positive experiences in their lives.
Indeed, preoccupation with anxiety affects personality, self-image, social connections, work, and all other aspects of life. The result can be a steady erosion of the connectedness of the individual to their strengths, abilities, and that part of themselves that is capable of “figuring things out.”

What Makes Some People More Anxious Than Others?
The understanding of how some people develop anxiety more easily than others has evolved over time. It is now widely accepted that there is a significant genetic component, that some people are born with a biological vulnerability to anxiety. In particular, panic disorder runs in families.

However, genetics is estimated to account for only about 30% of the development of anxiety. Environment, including life events, and learning account for the other 70%. One’s early family environment for example, is critical in its potential impact on messages a child picks up regarding anxiety and how to handle it. Extreme life events such as being the victim of excessive or prolonged trauma can physically damage the body’s alarm system, leading to the system’s hypersensitivity that can be triggered by the most minor event. It is believed, however, that the single greatest factor in the development of worry and anxiety is perception, in other words, how we convince ourselves we are at risk.

Biology and Psychology: A Hand-in-Glove Relationship
In order to understand how we can convince ourselves into thinking we are at risk, it is helpful to know what happens physically during a stressful event and how this impacts some people psychologically. The two systems of biology and psychology work together to set up a pattern of anxiety and avoidance.
 
There’s no question we are biologically programmed for fear. In a frightening or alarming situation (let’s use the snake on the path again), the brain initiates the stress response automatically by releasing adrenalin and a steroid called cortisol. These two substances fuel the body to ready it for action, ie the “fight or flight” response, to kill the snake or run from it. (As a side note, unfortunately this response can sometimes be triggered by mistake by erratic neurons firing in the brain, like a short-circuit. This is experienced by people whose panic attacks come “out of the blue.”)

At the same time, a small almond-shaped organ in the brain called the amygdala, quickly forms associations between the frightening situation and danger, pain or distress. It remembers all aspects of the situation: it remembers any sounds that may have been present, ie. rustling in the grass or a rattle, sights ie. the colour or shape of the snake or the colour of the grass in which it was hiding, any smells where the event took place etc., and when reminded of any of these in the future, sends out 5-alarm panic signals even when no threat is there.

Now back to the immediate and real snake on the path: Presuming the individual quickly backs away from the snake to a safe distance, what happens then psychologically is crucial. We have the capacity to reassure ourselves, thereby calming our hyper-alerted Sympathetic Nervous System by saying something to ourselves like, “Wow! That was close. Good thing I saw it in time and was able to avoid it. I’d better be a bit cautious for the rest of this hike. Maybe I’ll research snake bite prevention or cures when I get home. But for now, let’s resume my walk.” On the other hand if this person says to themselves, “OMG I could have been killed! How many others are out there? If it was on this path it could be on any path, anywhere. I’m utterly defenceless, I could be attacked at any time. I’m going home and will never walk on a path again.”

What has happened in the latter case is a classic set-up for anxiety: an overestimation of threat plus an underestimation of one’s ability to do anything about it. Then throw in avoidance and you have the beginning of an anxiety disorder.

Another way we can set off the body’s alarm system ourselves is with the help of our all-too-vivid powers of imagination and recall. We can virtually “relive” the experience any number of times, anywhere, flooding our systems all over again with adrenaline and cortisol.

A threatening experience, of course, does not have to be physical. It can be, and much more frequently is, social as well, since we are just as hard-wired to fear social rejection as physical threat.

In fact, in studies done on stress over the years, speaking in front of an audience scored consistently as one of the most feared situations imaginable. Why is this? It is due to fears of being laughed at, being judged or ridiculed by a group. People who suffer with Social Anxiety experience just such fears, making social functions, meeting someone new, or attending a class an agony rather than a pleasure.

Ironically, many people mask their fears very well, again due to the concern of being seen as “crazy” or “weak”, intensifying their feelings of isolation and the belief they are somehow flawed. Their self-perception becomes increasingly self-critical, adding yet more misery to their lives.

Treatment / Intervention
Regardless of which therapy an individual decides to pursue for help with anxiety, be it Cognitive Behavioural Therapy, Mindfulness, Acceptance and Commitment Therapy, Narrative, or Insight-Oriented Psychodynamic Therapy to name a few, most address 4 features most anxious people have in common:

• Fixation on the future and a need to control it.
• An underestimation of their abilities and strengths.
• Excessive stimulation of the Sympathetic Nervous System.
• Erroneous thinking and assumption.

Fixation on the Future and the Need to Control It
The intolerance for uncertainty and the need for absolute predictive control is a hallmark of the anxious person. In fact though, what is needed is not control or the ability to see every conceivable consequence of an action, but rather, the ability to be flexible, to be able to bend and “go with” whatever arises. The present needs to be brought to consciousness and the focus of consciousness shift to the positives of the moment.
Underestimation of Abilities and Strengths

Hand-in-hand with the above is the necessity of developing greater self-confidence in one’s abilities and strengths, to know, should some negative event occur, that one will be able to cope and deal with whatever it is that arises.

Excessive Stimulation of the Sympathetic Nervous System
Most therapies, too, address the heightened alarm response in the body that is triggered with even minor events or imaginings. In this regard, learning techniques to calm one-self down quickly can be helpful, or at least to experience the sensations in a different way, as espoused, for example, by mindfulness training.
Erroneous Thinking and Assumption

Finally, the numerous errors in thinking that people believe to be true need to be “held to the light.” These faulty thoughts and assumptions are the underpinnings of anxiety and cause needless distress. For example, the minimizing of one’s strengths, the catastrophizing of events, (ie. the belief that mistakes or events will have catastrophic consequences), or the emphasis on one’s vulnerability, are common mistakes in thinking the anxious person makes. They ensure the person is held captive to whatever it is they fear. Cognitive therapy with its emphasis on positive “self-talk,” especially focuses on this aspect of anxiety.

Ten Quick Anxiety-Reduction Techniques

- Diaphramatic breathing: Breathe in deeply to a slow count of 4 and exhale to a slow count of 4. Wait 2
  beats before the next breath. Repeat 10 times. The long, slow exhale automatically relaxes the muscles.

- Close your eyes and focus your attention on every muscle in your body from your forehead to your feet.
  Imagine a soft, warm light travelling from one muscle grouping to the next, relaxing and soothing each
  one.

- Purchase or download imagery or music relaxation CDs and listen to them before work or prior to
  bedtime.

- Delay your “meltdown.” Ask yourself if you really need to be anxious right this second, or if it can wait until
  a bit later. Repeat continually.

- Set up a “worry time.” Schedule a time in your day devoted exclusively to worry, perhaps between 7 –
  7:30pm. At the end of that time pull your thoughts back very deliberately to daily living. Reassure yourself
  you can worry again at the same time the following day.

- Get moving. Physical exercise or even just movement is an excellent stress reducer and a major
  impediment to being anxious.

- If possible, develop a plan of action for whatever it is you are anxious about.

- Identify, document and challenge your anxious thoughts and assumptions. See if you can develop a more
  rational, balanced sequence of thoughts.

- Share your anxieties with a trusted friend. Sometimes sharing a worry with someone else can lead to a
  different perspective.

- Keep a daily “positives” journal. Focusing on what’s good in life can give some balance to your days.



( Resources used in the writing of this article include Cognitive Therapy of Anxiety Disorders by David A.Clark and Aaron T.Beck; The Mindful Way through Anxiety, by Susan Orsillo and Lizabeth Roemer; A Brief History of Anxiety, by Patrician Pearson; The Anxious Brain, by Margaret Wehrenberg; Acceptance and Commitment Therapy for Anxiety Disorders, by Georg Eifert, and John Forsyth)

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