A certain amount of anxiety is normal and inevitable in every life. It ranges from free-floating anxiety – unattached to specific issues or situations – and performance or situational anxiety, to deep existential anxiety. It can cause the same physiological responses as fear. With fear, you know what frightens you: a charging bear in the woods, an earthquake, a cancer diagnosis. Anxiety, on the other hand, may result from cumulative stressors in your various life roles. It’s a cliché that we live in the Age of Anxiety, due to the complexity of modern life. The average person’s stressors are many and varied.
In Western society we have a history of regarding the body as separate from the mind, but this dualism can be misleading. Much modern science supports the notion of a bodymind – a unity of embodiment and consciousness. The physiology of anxiety is a hard-wired stress response. I’ve written previously about the fight-or-flight response that we experience when we perceive ourselves to be in danger. In situations where we find ourselves in physical danger, the instant physiological response – rapid breath and heartbeat, increased blood pressure and blood sugar, tense muscles, etc. – can prepare us to fight or flee, as the situation requires. But sometimes this automatic physiological response can cause us to “choke,” to feel paralyzed or out of control. And if the perceived threat isn’t something you can fight or flee from, your bodymind’s response can be feelings of high anxiety. Triggers for anxiety (or fear) don’t even have to be actual threats. Sometimes they occur simply because we feel threatened or inadequate, even if we’re not truly at risk.
Mild-to-moderate anxiety can sometimes be helpful, if it motivates us to effectively address its causes. You can reduce your anxiety about an upcoming exam if you study hard for it. However, avoidance also works, if only in the short-term, to reduce performance anxiety. But whether anxiety is a spur or a hindrance, it’s never a pleasant experience. One manifestation of high anxiety or fear is phobia – an irrational fear – which often leads to avoidant behavior. The power of phobia is contextual. A phobia about crossing bridges may not be a big problem if you live in the desert Southwest, but may cause significant problems if you live in the Florida Keys. Another common symptom of anxiety is panic attacks, which can also lead to avoidant behavior.
Anxiety rises to the level of pathology when it impedes or disables us. Some people are crippled by their anxiety. I believe that there’s a physiological basis for clinical anxiety, and that people with anxiety disorders shouldn’t be blamed for their disabling symptoms. But I also believe that, to some degree, anxiety is something that we unconsciously do, not just something that happens to us. Irrational thinking is a significant factor that contributes to both normal and pathological anxiety, and cognitive behavioral therapy is an effective treatment for many anxious people. Anti-anxiety drugs like Valium and Xanax can be helpful in the short-term, but long-term reliance on pharmaceuticals (or recreational drugs) to control anxiety only leads to chemical dependency.
To a certain degree we create our anxiety by the way we think. I’ve written about how, when facing a challenge or an upcoming performance, we can either mentally rehearse for failure or for success. And we can make pessimistic assumptions about things we don’t really know, and fear things that don’t really present a threat. Our physiological response to a perceived threat can be identical to our response to an actual threat.
Cognitive behavioral treatment of anxiety disorders involves teaching clients about both the physical and mental aspects of anxiety, and teaching them to distinguish their rational thoughts from their irrational thoughts. The treatment may involve the technique of exposure, where the client is exposed to the thing she typically avoids, or does the thing he usually avoids doing. Treatment often involves “homework” assignments – things to be worked on between therapy sessions – that will help the client to develop new skills and establish new mental habits. The development of insight need not precede relief from anxiety symptoms. Positive behavior change often enables a client’s development of insight into how, and to what extent, he was “doing anxiety.”