High anxiety

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.”

Stress Management

We’ve all heard that prolonged stress negatively impacts our health, but stress isn’t necessarily a bad thing. Dr. Hans Selye, one of the pioneers of stress management, said that stress can be “the spice of life or the kiss of death.” He labeled negative stress distress and positive stress eustress. If we choose to ride a rollercoaster, or to scale a cliff, or watch a horror movie, we’re choosing to experience stress. Stress is an unavoidable fact of life, and a stress-free life would be an uneventful life – boring. Sexual excitement is a form of stress, and we all enjoy an adrenaline rush from time to time, especially if we chose the stimulus that triggered it.

Our autonomic nervous system, which regulates automatic behaviors, has two branches: sympathetic and parasympathetic. Both are involved what Dr. Selye called the “fight or flight” response. Activation of the sympathetic response gears us up, preparing us to fight or flee, whether or not we’re in danger. Heartbeat and breathing instantly become more rapid,  delivering more oxygenated blood to the brain and the extremities. Blood pressure and blood sugar rise, muscles tense in anticipation of action, and you may experience a jolt of adrenaline. After the event or situation that triggered the sympathetic response is past, the parasympathetic branch kicks in, reversing the fight or flight response and allowing us to “rest and digest.” We’re told not to go swimming right after eating a meal, because our blood flow has been re-directed from our extremities to our gut, increasing the possibility of a muscle cramp.

The fight or flight response evolved to help our ancestors to avoid being eaten and to hunt dangerous prey. If you’re a soldier in a combat zone, or a cop, or a firefighter, you may experience it on a regular basis. But although only a few of us in modern society frequently face physical peril – other than heavy traffic – we respond to perceived existential threats, even if we’re not actually in immediate danger. Combinations of financial, social and environmental stressors (How am I going to pay the rent? Is my wife being unfaithful?) can result in a high level of distress, sometimes manifesting as anxiety.

Anxiety is similar to fear, although the causes might be multiple and may not be immediate physical threats. A person having an anxiety  attack may experience their fight or flight response as paralyzing. Once you’ve had one, your fear of having another one becomes yet another stressor in your life. If you only occasionally have fight or flight reactions, stress may not be a significant factor in your health. But if you have them frequently, your health may be affected. But frequent fight or flight reactions aren’t the only stress-related threat. Chronic overstress – having more on your plate than you can handle – can kill.

Stress management doesn’t mean eliminating stress. It means controlling the amount of stress in your everyday life and, where possible, eliminating stressors. There are both physical and mental aspects to stress management. But first you need to identify the sources of stress in your life, your triggers for stress reactions, and how stress affects you.

If you need to practice stress management, start with an inventory of your stress factors: job security and satisfaction, finances, safety, residential issues, and personal relationships. Think of how you might be able to reduce unwanted stress in each area. It may mean some tough choices. Then list the kinds of situations and events that tend to trigger stress reactions. Being aware of your stress triggers may help you to prepare for them or learn ways to avoid them. Become more aware of how you typically respond to stress triggers and overstress. Do you somaticize (physicalize) it into headaches or bellyaches or backaches? Do you stay angry or depressed? Do you worry excessively? Anxiety has many faces , including free-floating (generalized) anxiety, panic attacks, and phobias – including social phobias. After doing this analysis of the role of stress in your life, you’re ready to look at physical and mental stress management techniques.

Physical stress management techniques include breath control, learning to relax your muscles, meditation, self-hypnosis, yoga, exercise, good nutrition, and adequate sleep. Avoid self-medicating with alcohol or other drugs. If you’ve listed rapid breathing as a stress symptom, you can learn to slow your breathing when you’re under stress. This helps to bring the fight or flight response under your control. There are many techniques for relaxing tense muscles, and relaxing the body tends to simultaneously relax the mind. I used to teach clients a method of focusing on the sensations in each of the muscle groups of the body in turn, tensing and relaxing each muscle group until they became aware that they could relax them at will by focusing on the changing sensations. It’s a form of mindfulness.

Learning time management or anger management might be part of your stress management plan. The best single mental stress management I’m aware of – besides meditation, which calms both body and mind – is rational thinking. (I’ve previously published several posts on rational thinking as a learnable skill.) Any stressful situation can be made more stressful by the way we think about it, and the effects of stressors in our lives can be minimized by thinking about them rationally. Failing to achieve something you wanted to achieve doesn’t make you “a Failure.”  Telling yourself that you’ll never get over a loss can be a stress-inducing self-fulfilling prophesy. Thinking that they “can’t stand” something has never helped anyone to cope with distress.

Some stressors can be minimized or overcome, others can be tolerated until circumstances change, by developing coping skills. We can all learn to manage our stress to some degree, if we understand it for what it is and make a conscious effort to control its effect on our lives. Coming up with your own personalized stress management plan and implementing it can help you to become more resilient in times of adversity, and might add years to your life.