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Anxiety: What is it? What causes it? What can I do about it?

Anxiety: What is it? What causes it? What can I do about it?


What is it?

Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life.
People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety is considered a problem when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.
Anxiety is a natural response to feeling threatened or unsafe. Consider that early Human beings date back over 2 million years. According to historical data it is generally accepted that advanced civilisation began to flourish around ten to twelve thousand B.C. The relative safety and security we enjoy today is recent. For our ancestors dealing with truly life threatening situations was an everyday occurrence. Historically that might  be predatory animals who see us as a meal, warring tribes, famine, drought, plague, pestilence, ice age....you name it...as a species we've endured it! Why is this relevant? Well, it's simple. The human being has a powerful built in warning system to deal with these very real threats. This warning system is primitive in nature since it has been with us from the very beginning. In many ways one can say it is a part of the "animal body" and indeed the area of the brain that is associated with the warning system response is often referred to as the "mammalian brain". When we feel threatened in some way, then the warning system is activated and we experience fear, anger or depression. 

Fear/Anxiety - Fear is the feeling that tells us to either leave a situation or to not go into that situation in the first place. The assumption by the animal mind is that we are in danger.  By design therefore fear is necessarily extremely uncomfortable because its purpose is to get our attention so we take evasive action! This is fine when the danger is real, but is crippling when the anxiety/fear mechanism is responding inappropriately to everyday situations and stimuli which really don't require evasive action. 
We can experience anxiety in response to single stimuli (phobia) or we can experience generalised anxiety too (Generalised Anxiety Disorder). Panic is a form of extreme fear which is caused by a build up of anxiety over a period of time which is suddenly released causing a "panic attack". Panic does not exist in isolation (without anxiety generally being present). If you are experiencing panic attacks, then you can take it as a given that your anxiety generally is far too high. 

What causes it?
Excessive stress is the primary cause of anxiety. We experience stress when we feel overwhelmed and any number of factors can cause us to experience stress. Stress is very subjective, and our individual tolerance to stress also varies greatly.   Here are just a few of the most common forms of stress, but this list is by no means exhaustive. The first bullet point here is perhaps the most important cause of stress. 

·         Disempowerment - A lack of power or influence over one's life.
·         Poor sleep (Also a response to stress as well as a cause).
·         Victimisation (Being bullied).
·         Losing a loved one (Bereavement or the loss of a relationship)
·         Family difficulties (Children, sex, divorce, lovelessness)
·         Boredom/Lack of direction in life.
·         A lack of time or energy to do everything that needs to be done.
·         Poor self-image/Lack of self-worth.
·         Negative Thinking
·         Negative Outlook
·         Guilt, Blame and Shame.
·         Financial difficulties (Debt!)
·         Misuse of drugs/alcohol.
·         Work pressure.
·         Illness
·         Loneliness
·         Failing Relationships

We might have included past stress and trauma here too, but I wish to highlight a very important point here. It is true that past hurt and trauma does affect us in the present, but the assumption that we feel terrible today because of something that happened in the past is often misleading. What happens in fact is that what we think and feel today is based on what we have learned in life through past experiences. We experience stress and anxiety when our lives are not working in the present. If however past experiences have taught us that we are powerless in certain areas, then this sense is carried with us into the future. This is known as "learned helplessness", and it contributes strongly to our sense of stress on a daily basis because if we feel "powerless" in any area of life then it means that at a deep level we also feel vulnerable and if we are feeling vulnerable, then we are feeling "threatened". Follow the logic and you will recognise that this is exactly what the "animal mind" is responding to...feeling threatened. In other words, feeling vulnerable creates anxiety. Further though, if we are feeling anxious the unconscious mind seeks to pin this feeling on something. Since the nature of this mind is to search back through past experience for something which pattern matches to the feeling of anxiety it invariably comes up with an image of the last time we experienced a terrible time. Thus, we can easily then make the erroneous assumption that this memory of a terrible time is the cause of our problem when in fact the true cause is that we are lacking control in the present. So it's really important to recognise that although past experience needs to be acknowledged (and possibly worked through therapeutically), it is just as important to make sure that our lives are functioning well in the present, and what this means in real terms is making changes which will bring about more control.

Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk" - a habit of always telling ourselves the worst will happen.

Environmental and external factors

Environmental factors that are known to cause several types of anxiety include:
§  Trauma from events such as abuse, victimization, or the death of a loved one
§  Stress in a personal relationship, marriage, friendship, and divorce
§  Stress at work
§  Stress from school
§  Stress about finances and money
§  Stress from a natural disaster
§  Lack of oxygen in high altitude areas

Medical factors

Anxiety is associated with medical factors such as anemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include:
§  Stress from a serious medical illness
§  Side effects of medication
§  Symptoms of a medical illness
§  Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)
Substance use and abuse
It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from:
§  Intoxication from an illicit drug, such as cocaine or amphetamines
§  Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates

Genetics

It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Brain chemistry

Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety 
What can I do about it?

There are really three options available.

1)  Change your circumstances - If your circumstances are such that you are practically unable to manage them (even if you were not stressed), then those circumstances need to be changed. This might be a tough decision since your choices might involve loss or sacrifice in order to gain your peace of mind, but here it is a question of priorities. Personally I always put my peace of mind at the very top of every list of priorities. Money is no good to us if we're too anxious to enjoy spending it. So working a stressful 70 hour week so you can buy that Audi is a poor trade off if you're too ill to enjoy it! In most peoples lives the choices may be more practical, and it is true that many people face extremely difficult practical situations, but the advice here is to put your mental and emotional health FIRST, and then to seek practical solutions to the situation. Pretty much it's always possible to find a solution when we make a commitment to doing so. Remember the principle of constructive selfishness. Sometimes the seemingly selfish thing to do (putting yourself first for once!) is actually the selfless thing to do, because by making sure your needs are met, you are ensuring that you remain healthy and available for others in the future. Often the problem is that we are soldiering on and kidding ourselves that we can cope with the situation as it is, when actually we can't. Courage can help here. It might be uncomfortable to make changes and yes, other people might not like that you're not willing to be a doormat any more, but trust me...they'll adjust and you NEED to do this for yourself! Enlist help if you need to. Delegate tasks. Ask for support from loved ones, friends, or colleagues. Explain you are struggling with circumstances as they are. Someone else might be able to suggest a solution you can't see because you're too enmeshed. Talk it over with someone. Seek solutions. Practical solutions. You might be surprised how much support is available when you ask for it. Don't be too proud to ask for help. Your mental health really is your wealth in life, and it's too important an issue to feel like you shouldn't bother anyone with it. If you are struggling with your circumstances, do something! Even setting the wheels in motion towards a way out often alleviates a great deal of anxiety. We always feel better when we are working towards a solution even if that solution will take time to achieve. The mind can cope with stress when we know the end of the tunnel is in sight, but what it can't cope with is no movement towards solution at all. In other words, things don't have to be perfect for us to be anxiety free, they just need to be moving in the right direction!


2) Change the way you view/feel about yourself and/or your circumstances - If you are sure that your circumstances are practically manageable, but you are just responding to them poorly, then the problem can be addressed internally. This basically means that your emotional mind (animal brain) is overdoing the response. The first thing to do is to consider ways in which you can practically reduce negative emotional arousal in your life generally. So even if you are finding your negative responses are taking place at work, it can still be due to the fact that there is fundamental stress at home. In practice it's probably both, but again it is important to understand that your general levels of emotional arousal will be feeding directly into whatever difficulty you have. In practical terms this means being disciplined with yourself with regards to how much negative thought and introspection you allow to be present in your awareness on a daily basis. If you were for instance to spend all day thinking about how so and so wronged you last week, you are absolutely creating more negative emotional arousal because the animal brain responds to what is imagined in a very similar way as it would to what actually is. So if we repeatedly imagine a confrontation with Mrs S, then the brain tells the body to get ready for a fight. If you do this thirty times a day, then your body has created fight mode thirty times, and all that arousal doesn't just go away...it sits in your nervous system for the rest of the day (and can overflow into the next day too if our sleep mechanism can't cope with it all!). What this means in practical terms is an increase in emotional arousal which means (when the anger has subsided) .....yes...more anxiety! Let's be clear. We can choose whether we will go over and over something or not. So anything you are continually re-running at the mental level which provokes negative feelings has to go! It may take time and practice to become proficient in learning to let things go but it IS the way out of anxiety. If you want out of your anxiety, this step is CRUCIAL!


Sometimes, we feel genuinely blocked with regards to how we are seeing a certain situation. Then it is not only about introspection (the things we are choosing to focus on) but it is instead being generated from the deeper levels of awareness - the unconscious mind. Here we have that principle of past experience impinging on our feelings. The unconscious mind automatically scans current experience against past. If the message it holds from past experience is that the current situation is threatening, then anxiety is produced to create an avoidance mechanism and we have a sense of disempowerment. Changing the way we think and feel about things is really the basis of recovery from anxiety. A very important area to consider when healing anxiety is developing kindness and compassion towards ourselves. If we are at war with ourselves; If we have a fundamental dislike for ourselves, then we have a problem, because disliking oneself causes terrible internal conflict. Being unwilling to forgive oneself for something that has happened or something you have done is a sure fire way of becoming anxious. Having an internal war going on at any given time also creates a feeling of being unsafe, and then to top it all off as a result of all the internal hatred we are experiencing we can have self-punishment thrown in for good measure! Solutions are discussed in the "help" section of this site. This is another area where the help of a good therapist can make all the difference. 3) What we truly cannot change we must accept- This really needs little explanation as a principle. We have to take our cue here from inspirational people, and remember that people are extremely resilient when they choose to be. There is always a positive perspective available if we choose to open ourselves to it...even if that perspective is purely philosophical. It is a difficult fact of life that there sometimes exist tragic circumstances. We have to find a way through such things. It is our will to accept what we cannot change that will dictate the depth of our suffering and our peace. As difficult as the situation may be we must recognise that non-acceptance will only add to our suffering. Again, commitment to healing is what begins the process.

Anxiety Attacks & Anxiety Disorders
it’s normal to feel anxious when facing a challenging situation, such as a job interview, a tough exam, or a blind date. But if your worries and fears seem overwhelming and interfere with your daily life, you may be suffering from an anxiety disorder. There are many different types of anxiety disorders—and many effective treatments and self-help strategies. Once you understand your anxiety disorder, there are steps you can take to reduce your symptoms and regain control of your life.

Understanding anxiety disorders

Anxiety is the body’s natural response to danger, an automatic alarm that goes off when you feel threatened, under pressure, or are facing a stressful situation.
In moderation, anxiety isn’t always a bad thing. In fact, anxiety can help you stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming, when it interferes with your relationships and activities, it stops being functional—that’s when you’ve crossed the line from normal, productive anxiety into the territory of anxiety disorders.

Do your symptoms indicate an anxiety disorder?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder.
§  Are you constantly tense, worried, or on edge?
§  Does your anxiety interfere with your work, school, or family responsibilities?
§  Are you plagued by fears that you know are irrational, but can’t shake?
§  Do you believe that something bad will happen if certain things aren’t done a certain way?
§  Do you avoid everyday situations or activities because they cause you anxiety?
§  Do you experience sudden, unexpected attacks of heart-pounding panic?
§  Do you feel like danger and catastrophe are around every corner?

Signs and symptoms of anxiety disorders

Because anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything.
Despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:
§  Feelings of apprehension or dread
§  Trouble concentrating
§  Feeling tense and jumpy
§  Anticipating the worst
§  Irritability
§  Restlessness
§  Watching for signs of danger
§  Feeling like your mind’s gone blank

Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.
Common physical symptoms of anxiety include:
§  Pounding heart
§  Sweating
§  Stomach upset or dizziness
§  Frequent urination or diarrhea
§  Shortness of breath
§  Tremors and twitches
§  Muscle tension
§  Headaches
§  Fatigue
§  Insomnia

The link between anxiety symptoms and depression

Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand-in-hand. Since depression makes anxiety worse (and vice versa), it’s important to seek treatment for both conditions.

Anxiety attacks and their symptoms

Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger— getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.
Anxiety attacks usually peak within ten minutes, and they rarely last more than thirty minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of anxiety attacks include:

§  Surge of overwhelming panic
§  Feeling of losing control or going crazy
§  Heart palpitations or chest pain
§  Feeling like you’re going to pass out
§  Trouble breathing or choking sensation
§  Hyperventilation
§  Hot flashes or chills
§  Trembling or shaking
§  Nausea or stomach cramps
§  Feeling detached or unreal

Generalized anxiety disorder

If constant worries and fears distract you from your day-to-day activities or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue. 

Anxiety attacks (Panic disorder)

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls or confined spaces such as an airplane.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over. 

Phobia

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia.

Social anxiety disorder

If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event. 
 Self-help for anxiety, anxiety attacks, and anxiety disorders
An easy-to-follow recipe for feeling safe and reducing anxiety.
Not everyone who worries a lot has an anxiety disorder. You may be anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much coffee.
The bottom line is that if your lifestyle is unhealthy and stressful, you’re more likely to feel anxious—whether or not you have an anxiety disorder. So if you feel like you worry too much, take some time to evaluate how well you’re caring for yourself.
§  Do you make time each day for relaxation and fun?
§  Are you getting the emotional support you need?
§  Are you taking care of your body?
§  Are you overloaded with responsibilities?
§  Do you ask for help when you need it?
If your stress levels are through the roof, think about how you can bring your life back into balance. There may be responsibilities you can give up, turn down, or delegate to others. If you’re feeling isolated or unsupported, find someone you trust to confide in. Just talking about your worries can make them seem less frightening.

Self-help for anxiety attacks and anxiety disorders #1: Challenge negative thoughts

§  Write down your worries. Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you experience anxiety, write down your worries. Writing down is harder work than simply thinking them, so your negative thoughts are likely to disappear sooner.
§  Create an anxiety worry period. Choose one or two 10 minute “worry periods” each day, time you can devote to anxiety. During your worry period, focus only on negative, anxious thoughts without trying to correct them. The rest of the day, however, is to be designated free of anxiety. When anxious thoughts come into your head during the day, write them down and “postpone” them to your worry period.
§  Accept uncertainty. Unfortunately, worrying about all the things that could go wrong doesn’t make life any more predictable—it only keeps you from enjoying the good things happening in the present. Learn to accept uncertainty and not require immediate solutions to life’s problems.

Self-help for anxiety attacks and anxiety disorders #2: Take care of yourself

§  Practice relaxation techniques. When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce anxiety symptoms and increase feelings of relaxation and emotional well-being.
§  Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.
§  Reduce alcohol and nicotine. They lead to more anxiety, not less.
§  Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days.
§  Get enough sleep. A lack of sleep can exacerbate anxious thoughts and feelings, so try to get 7 to 9 hours of quality sleep a night.

When to seek professional help for anxiety disorders

While self-help coping strategies for anxiety can be very effective, if your worries, fears, or anxiety attacks have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.
If you’re experiencing a lot of physical anxiety symptoms, consider getting a medical checkup. Your doctor can check to make sure that your anxiety isn't caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you’re taking.
If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety attacks and anxiety disorders. The therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.

Treatment options for anxiety disorders

Anxiety disorders respond very well to treatment—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most anxiety disorders are treated with behavioral therapy, medication, or some combination of the two. Sometimes complementary or alternative treatments may also be helpful.

Behavioral therapy for anxiety disorders

Cognitive-behavioral therapy and exposure therapy are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. Behavioral therapy for anxiety usually takes between 5 and 20 weekly sessions.
§  Cognitive-behavior therapy focuses on thoughts—or cognition—in addition to behaviors. In anxiety disorder treatment, cognitive-behavioral therapy helps you identify and challenge the negative thinking patterns and irrational beliefs that fuel your anxiety.
§  Exposure therapy for anxiety disorder treatment encourages you to confront your fears in a safe, controlled environment. Through repeated exposures to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control. As you face your fear without being harmed, your anxiety gradually diminishes.

Medication for anxiety disorders

Is anxiety medication right for you?

Anxiety medications can be habit forming and cause unwanted side effects, so be sure to research your options. It’s important to weigh the benefits and risks so you can make an informed decision about whether anxiety medication is the right treatment for you.

A variety of medications, including benzodiazepines and antidepressants, are used in the treatment of anxiety disorders. But medication is most effective when combined with behavioral therapy and anxiety self-help strategies. Medication may sometimes be used in the short-term to relieve severe anxiety symptoms so that other forms of therapy can be pursued.

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