SUPPORT: Anxiety – A User Guide – Free Audio Book Available

By Dr Jas, Clinical Psychologist 

Listen to this story here

What is the point of anxiety?

As an experience, anxiety can be deeply unpleasant, exhausting, a crippling and disabling force that stands in the way of us living the lives we want. When we talk about ‘having anxiety’, or ‘anxiety problems’ we are normally thinking about this destructive side of anxiety, something we would understandably like to remove from our lives. So it might seem strange to ask, ‘what is anxiety for?’.

As well as being a label for a problem or disorder, anxiety is a universal emotional experience. We all experience anxiety at times – although we may use other words like scared, frightened, nervous, worried, panicky, apprehensive, or terrified. We have a whole emotional system in the brain and body just devoted to making us feel anxious. This system evolved for a very good reason – to keep us safe. It is our alarm system. If we never experienced anxiety, no racing heart, hyper-focus on danger, or worried voice saying, ‘look out’, we would be in real trouble. We would have no sense of threat or risk, or ability to keep out of their way. Looking at evolution, this anxiety system is an ancient one – lizards, even dinosaurs, would respond in very similar ways to threat. It is a powerful and hard-to-ignore response – a fire alarm is no use to us if it is quiet and easy to sleep through.

However, the problems can come when anxiety gets out of hand, or when our lizard brain response is a bad fit for the kinds of threats we experience in our modern human lives, or when our modern human brains, with their beliefs and worries, get involved in unhelpful ways. We can end up with a fire alarm that keeps going off because there are crumbs in the toaster, or an alarm that we can’t switch off when we realise that the danger has passed. Anxiety can start to dominate lives and stand in our way. Rather than anxiety serving us, we can start to become its prisoner. Sometimes, we might need support or strategies to get anxiety back in its place.

The threat / anxiety response

The basics of the threat or anxiety response in the brain and body might be familiar from GCSE biology, or watching nature documentaries. Many of our have heard of ‘fight or flight’ and ‘adrenaline’. But to get anxiety under control it really helps to understand it.

The threat or anxiety response is triggered when we perceive something as a danger or threat. Our body and mind respond quickly to the threat in a way that prepares us to keep safe from the danger. The preferred option is ‘flight’ (run away or otherwise avoid the danger), but if it seems like we may not be able to get away we might ‘fight’ (often feeling and responding with anger), or if this seems hopeless, ‘freeze’ (play dead, feel numb, shut down). In practise, this means our body releases a big rush of a chemical called adrenaline, which causes a physical response, perfect for running or fighting: heart racing, breathing gets faster, blood rushes to muscles causing jelly legs and to the skin to keep us cool causing skin to flush, and away from digestion leading to stomach lurching (we don’t need to digest our breakfast when we are running for our lives).

Interestingly, this mind/body connection works both ways, so other experiences that can trigger the same physical response (like drinking coffee or feeling excited) can get mislabelled in our brain as a sign of danger and set off a full anxiety response. At the same time as this physical response our mind focuses on the danger. We have to a sense of tunnel focus and hyper-alertness, and we can’t focus on anything else until the danger has passed.

All of these are likely to be familiar experiences for anyone who has ever felt anxious (so, everyone!) or had a panic attack. The problem is that while this response is perfect for lizards escaping predators, it is not so helpful for the sorts of threats that we face in modern human life. We can’t really solve problems like social rejection, worries about our family, or the danger of losing our job by running or fighting. In fact, in many situations, responding in this way is likely to be actively unhelpful. But our body and our lizard brain doesn’t know any better. It is also less useful for long term threats. We quickly run out of adrenaline and start to feel exhausted, while releasing a new longer term stress hormone called cortisol which can leave use feeling run down and damage the immune system.

While it took some time to explain, this response can happen very quickly, sometimes automatically, and outside of our conscious awareness. Actually, this is a really helpful part of the system – it’s no use standing there calculating the velocity and trajectory of the bus hurtling towards us, when we need to jump out the way. However this ‘quick and dirty’ lizard system can understandably be triggered in error. Our modern human brains then race to catch up and make sense of the signal – either to keep focussed on the danger and plan a response (that bang downstairs was an intruder!) or to shut it down (no, it was just the cat).

Our complex thinking brains also give us another option – our anxiety response can be triggered by threats that are not directly there, like worries, ideas, or memories. Both a real attack, the worry that someone might hurt us, or a memory of a past traumatic experience, can all trigger the same threat response. They can also be triggered by complex and subtle perceived threats that our animal brains never needed to worry about – like the dismissive look of someone excluding us socially, or the fear of embarrassing ourselves.

Finally, they can be triggered when we attach a dangerous meaning to a harmless or ambiguous signal. An unanswered message means they hate me (not just they are busy), or my heart racing means I’m having a heart attack (not just that I drank too much coffee this morning).

When anxiety becomes a problem – and some possible solutions

While all of what is described above is a completely normal emotional experience that comes and goes, there is no doubt that for some people, on occassion, anxiety can start to become a real problem. For example, when we experience an overwhelming physical response (panic attacks/ panic disorder); we can’t stop worrying (generalised anxiety); we feel intensely scared of things that can’t really harm us (phobia), or of social situations (social anxiety); when we feel frightened and caught up in own intrusive thoughts (obsessive-compulsive disorder); or we are caught up in reliving and responding to previous traumatic experiences (post traumatic stress disorder).

All of these problems can make us feel awful, physically and mentally. They can stop us from living our lives, as we feel forced to avoid the subject of our anxiety or do other unhelpful things in an attempt to feel safer or block the feeling out. While understandable, these coping responses can become a bigger problem than the anxiety itself. They prevent us from starting to overcome it by learning that the danger isn’t as bad as we thought, or that we are better at coping and more able to overcome the danger than we ever believed. None of this is our fault. We may have had experiences that have left us rightly more wary and alert to the dangers and threats in the world. Some of us just have nervous systems that are more alert to threat or where the threat response is more easily triggered or harder to settle. 

The good news is that anxiety problems or disorders can be managed and overcome. This is where understanding anxiety can be helpful – it suggests some areas where change could help. Solutions to anxiety might address the physical anxiety response (breathing and muscle relaxation exercises). This can provide feedback to our minds using the same mind/body connection mentioned earlier – our mind notices signs of feeling relaxed, and so assumes we must be safe.

We can also use other relaxation exercises and relaxing activities to focus our minds away from danger and on to something more positive. We can learn to see our anxious thoughts and worries as a ‘habit’ and use worry management strategies, or start to challenge them and ask ourselves ‘is the situation really as threatening as I think?’. Most effectively, we can make changes to our behaviour – reducing our reliance on unhelpful coping strategies and avoidance so that we can test out our fears, have positive experiences and develop confidence in our coping abilities. We can also take actions to override the threat response by activating our brains internal ‘soothe and connect’ system, by seeking out care and support from the people we love, or trying to develop a more caring and understanding relationship with ourselves.

Managing or overcoming problematic anxiety can be really tough. Support from the people we love is crucial, but it can also be helpful to seek out professional support. There are good evidence-based treatments for anxiety problems. Cognitive behavioural therapy (CBT) helps us make sense of the thoughts (beliefs, worries and memories), emotions, physical sensations and behaviours that keep anxiety problems going. We can then find ways to make helpful changes to them and respond differently. Research trials have found positive outcomes for CBT for a range of anxiety problems. If you go to your GP looking for help with anxiety, they are likely to refer you for CBT. This might be offered as full therapy, or you might be offered CBT- informed ‘guided self help’. 

Your GP may also prescribe an SSRI medication, sometimes called antidepressants. Other medications may be considered short term which have strong effect on the immediate experience of anxiety (benzodiazepines), shut down the physical response (beta blockers) or help us sleep. However, none of these are generally suitable as anything other than a temporary coping solution, and longer term use may well be ineffective or actively harmful. I am not a medic though, so seek advice and ask questions of your GP or psychiatrist and listen to what they say about this. 

Please do seek support if you need it. Tackling problematic anxiety can be very frightening, requiring us to face fears, move out of our comfort zone and let go of long held coping strategies. Just remember we don’t need to be anxiety’s prisoner forever, and life can be so much better outside of the box we felt trapped in. 

Whether now is the right time to tackle the problem or not, we deserve kindness support and understanding from others and from ourselves.