Understanding Anxiety
This is a big topic! I know, I have been helping people with Anxiety for over 12 years now. In addition to this, I monitor many anxiety forms and complete additional research into current understanding. I will start with a few bullet points for those who would like to hear something fast, but I must tell you, in most cases Anxiety takes time to reduce.
Some quick points
- I hear this all the time ‘Just make it stop‘. I want to tell you therapy helps and it takes time.
- We all have a level of Anxiety, purely because we exist. We live, we die.
- Normal levels of Anxiety keep us safe. High levels of Anxiety keep us frightened.
- Intrusive thoughts are normal with Anxiety. Why? Habituation and maintenance of that level of arousal.
- Radical self-acceptance removes inner criticism. This will not be intuitive! I am Anxious at this point in time and that’s ok. Easy to say, not so easy to do! Saying it’s not ok will lead to self-checking and self-criticism.
- Change the words for I am Anxious and I am not Anxious, research evidence supports this. I am fully energised or I am de-energised.
- Have some understanding of the hypothalamus pituitary adrenal axis (HPA). Integrate this with understanding the biopsychosocial model. Try to have some understanding of how your thinking and environment maintain your levels of arousal.
- Notice descriptive words and metaphors that you use in everyday life. Are you using words that make things bigger? eg. Forever, everyone, always etc.
- The continually anxious mind, the over-aroused mind, is seldom present. It’s either in the future or in the past, with what might happen and what has happened.
- Getting to the roots of your anxiety can help, how did you get to this point? What has happened to you?
- Anxiety sometimes manifests in the body, turning your focus on what could be wrong, self-frightening thoughts about your health.
- Converting anxiety into excitement keeps you activated even if it seems like a distraction.
Expanding on the quick points
Just make it stop
I would love to just make it stop. The simple fact is this, you need time to decrease anxiety. That time varies between people depending on the level of anxiety they have habituated to. I sometimes use a metaphor for this. Think about a plane coming into land, the landing is initiated way before the runway at a high altitude. The pilot may begin the descent by making fine adjustments over a period of time, slowly the altitude is changed before finally landing. Wanting it to ‘just stop’ is like coming from a high altitude to sitting on the runway instantly.
Additionally, you have several contributing factors to anxiety and these need to be addressed at the same time as working on the anxiety itself. You have the person’s biological state, thinking, linked history, environment and social interactions.
Summarising this, the whole experience of being you contributes to anxiety. Therapy can help you see what can be contributing to your anxiety and help you make the changes you desire.
Existential Anxiety
This refers to the fact that we all have a small amount of anxiety because we exist. Even clinical questionnaires and surveys of a person’s anxiety allow for a certain level of anxiety. Existential therapists such as Irvin Yalom state that four existential truths will create anxiety. We all will die at some point in time, we can never be fully known by another person, life is meaningless (we give our lives meaning), and because we exist we are constantly confronted with choice. Sometimes one or a number of these points become the foundation of a more developed anxiety.
Some people tell me they have no anxiety at all, this is a belief and not a truth.
Safety and Fear
We need some anxiety in order to keep ourselves safe and survive. Just a simple example would be, you need some anxiety when crossing the road. However, the level of anxiety when people come to therapy is often different. Now the levels of arousal have gone to a much higher level. Frequently they are frightened by their anxiety, have self-frightening thoughts or have been shocked repeatedly or traumatised. Now their biology has moved to a level where they are finding it hard to self-soothe.
Intrusive thoughts
Intrusive thoughts are common with high levels of anxiety, this is normal. I know it doesn’t make sense but it can be explained.
Let me cover what an intrusive thought is, everybody will have different intrusive thoughts. This is a thought that tends to make a person feel that they are losing their mind. Sometimes these thoughts are so disturbing that the person is also trapped by the thought, ‘If I tell someone I am thinking this then they will think that I am mad’. The thought will have the power to make the person anxious. This doesn’t seem to make sense! Why would an anxious person keep themselves frightened?
The explanation that I am going to put forward is that the person’s biology has habituated to this level of arousal (biological explanation of this later). The intrusive thought then becomes a sudden alarm which moves them back to the habituated level. In my experience, intrusive thoughts often occur when an anxious person begins to relax.
Nobody wants high anxiety and so they often ask why doesn’t this just go?
In short and a very general answer to this, the braking system in the person’s biology is finding it difficult to put the brakes on. It’s a circle, the act of having multiple stressors or constant anxiety wears out the biological breaking system. Your thinking now unintentionally maintains this biological system’s ‘free wheeling’. It can help if you remember, that your thoughts are not facts, they are constructions by you.
Radical self-acceptance
Radical self-acceptance is not intuitive to people who have anxiety. I sometimes view this as a first step for people who ask me for something quick that will help. It goes like this.
‘Right now at this point in time, I am really anxious and that’s ok’.
A response to this might be, ‘But it’s not ok, that’s why I am here to see you!’. The simple fact is, it’s true, you are anxious right now at this point in time. ‘At this point in time’, these words do not cast you in stone. It’s just a point in time, your experience is now. Why is it ok? Because it’s your current lived experience, a truth.
How does this help? Well, let me go through this in stages. You are trying to make your anxiety go, which in turn will lead to self-checking and even self-criticism. You will keep looking at your anxiety, when you keep looking and checking, this will cause the anxiety to stay. You don’t do this when you use radical self-acceptance, you are saying right now I know it’s there, no need to check. Accepting your current state of being.
Then there is the first pitfall. Oh, I can do this to make it go. No. If you are doing this to make it go then you will be back to self-checking. It would look something like this ‘Right now at this point in time, I am really anxious and that’s ok’, check ‘Has it gone yet?’. This is not acceptance, this is trying to use radical self-acceptance to make it go, not acceptance at all!
Now let me explain another component of this that’s not so obvious, internally you will have some self-criticism. Saying things to yourself ‘You’re anxious again’, ‘Get a grip’ and ‘Why are you anxious again’. These are some possible self-criticisms. Radical self-acceptance disarms the internal critic, ‘Yes I am and it’s ok at this point in time’, ‘I don’t need to get a grip it’s ok right now’ and ‘I accept that I have anxious moments’. Why disarm the internal critic? Because the internal critic will be having an emotional impact on you! Radical self-acceptance softens the internal critic.
I will tell you now, that this is a challenging concept to understand if you are anxious and even harder to do. Therapy can help you with this.
Here is a YouTube video of a monk speaking about his experience of trying to get ‘The Panic’ to go, the monk is teaching meditation but gives an example during the video of trying to accept the current moment. HERE
How you speak about your Anxiety
Research evidence suggests that when people speak about Anxiety they may maintain their anxiety with expectations. Psychologists call this ‘The Expectation Effect’ (David Robson, 2022). Using the word Anxiety has shown that it can reinforce it. The issue is that you are moving into ‘fight or flight’, which means your biology is becoming energised for action. To run or to fight.
The suggestion is to change how you speak about being anxious. I am fully energised (anxious) and de-energised (calm). You are stating the reality in your mind in a less reinforcing and softer way.
The HPA Axis
You are more than just biology! I want to make that clear before speaking about the hypothalamus pituitary adrenal axis. I also want to say I am not a doctor and all my knowledge about this axis comes from university studies related to anxiety.
The HPA axis is like the body’s stress alarm system. When you’re anxious or stressed, it sends signals that get your body ready to respond, kind of like when a fire alarm goes off. Here’s how it works:
- H stands for the hypothalamus (a small part in your brain). It acts like the switch that turns the alarm on.
- P stands for the pituitary gland (right below the brain). It gets the signal from the hypothalamus and sends out messengers.
- A stands for the adrenal glands (above your kidneys). They get the message and release a hormone called cortisol, which is like the stress fuel. Cortisol helps your body stay alert and react to stressful situations.
Normally, once the stress passes, the system turns off. The cortisol level drops, and your body goes back to normal, like turning off the fire alarm.
But, if you’re constantly stressed or anxious, this system keeps running and releasing too much cortisol. Over time, the body’s natural “brakes” that should calm things down don’t work as well. The system gets worn out, so the cortisol levels stay high. This can make your anxiety worse, and it gets harder to relax.
In short, too much stress keeps the HPA axis stuck in the “on” position, which is why managing stress is important to help the system reset.
If your anxiety has reached an unmanageable level then this axis needs some rest, therapy can help. Basically, the Axis braking system has started to wear out. Which can then lead to you remaining in a fight-or-flight state when there is no fight-or-flight situation.
Changing the words you use
Can you change the words? Here are some examples ‘Everybody hates me’, can become ‘a lot of people don’t like me’. Look for words that are making your experience much bigger than it actually is. If your language is big then your anxiety will be big. Now a few examples, ‘It’s been like this forever!’, becomes ‘It’s been like this for several years’ and ‘it feels like I will never ever get out of this’, becomes ‘it feels like I am stuck sometimes’, and ‘I will never find a partner’, ‘I have not found a partner yet’. Try looking at things that you have written or posted online, is the language bigger than reality?
When you change the words you are changing part of your experience.
Being present
There are various techniques that can be used to come into the present moment. This is important because when a person suffers continually with anxiety their mind is seldom present in the moment. Notice your breath, pay attention to it, and be present. One way of watching your breathing is to notice the temperature of the air as it goes in over your lips and the difference in temperature as you breathe out.
I will continue to expand this article each day.