Anxiety is a natural and usually short-lived reaction to a stressful situation, associated with feelings of worry, nervousness or apprehension.
It typically occurs in new, unfamiliar or challenging situations, where a person feels vulnerable, threatened or where the outcome is uncertain. It is natural to feel nervous or anxious when you’re starting a new job, taking an exam, and if you have financial or health concerns. For people with anxiety disorders, however, anxious thoughts, feelings, or physical symptoms are severe, upsetting, frequent, and interrupt daily life.
Below, Tara Brach speaks honestly and accurately about the presence of fear in the body and the psyche, and how to respond.
There are thought to be 5 basic fears from which almost all of our other fears manifest. These are:
Extinction—the fear of death; of ceasing to exist. The idea of no longer being arouses a primary existential anxiety in all normal humans. You may or may not think about this concept much when you’re a child, but when your own mortality sinks in, it can be frightening. If not your own annihilation, perhaps you’re someone who has a fear of losing a loved one to death.
Mutilation—the fear of losing any part of our body, or our physical health. How about the the thought of having our body’s boundaries invaded, or of losing the integrity of any organ, or of getting injured. Anxiety or phobias about snakes and insects arises from fear of mutilation.
Loss of Autonomy— also known as the Loss of Liberty, or the Loss of Control. It is the fear of being immobilized, paralyzed, restricted, enveloped, overwhelmed, entrapped, imprisoned or otherwise controlled by circumstances beyond our control. It extends to our social interactions and relationships, not just our physical reality. It was Patrick Henry (American Politician) who said “Give me liberty, or give me death” (1775). Fear is often the base emotion on which anger floats. Oppressed people rage against their oppressors because they fear—or actually experience—loss of autonomy and even ego-death.
Separation—the fear of abandonment, rejection, and loss of connectedness or belonging; this is a fear of being not wanted, respected, or valued by another or a group. The “silent treatment,” when imposed by a group, can be devastating. “The silent treatment can feel like a punishment worse than death”. The Fear of Separation can manifest when we think other’s are judging us, or when we’ve behaved undesirably and people shut us out. It may come in the form of shunning, ostracism, social rejection, social isolation, guilt trip, exclusion etc.
Ego-death—the fear of humiliation, shame, or any other mechanism of profound self-disapproval that threatens the loss of our integrity and reputation. It is the fear of losing one’s perception of value, likability, capability, and worthiness. The Ego death, however, means different things to different people and cultures. Some believe it is a “complete loss of subjective self-identity”. People may have a fear of “going mad” or “losing their mind” which is in reference to a psychiatric loss of the ego-self. Jin Y. Park, an associate professor of philosophy and religion, says the ego-death that Buddhism encouragesis the end of our often unconscious and automated quest to understand the ‘self’ as a thing, instead of a process. According to Park, “Enlightenment occurs when the usually automatized reflexivity of consciousness ceases … [W]hen consciousness stops trying to catch its own tail, I become nothing, and discover that I am everything”. Shame and guilt express the fear of—or the actual condition of—separation and even ego-death. The same is true for embarrassment and humiliation.
Anxiety Disorders
Generalised Anxiety Disorder is diagnosed when people meet the following criteria:
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
The individual finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item required in children.
Restlessness, feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
Other Anxiety Disorders
Panic disorder is characterised by the experience of repeated and unexpected panic attacks – sudden surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness. In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.
Agoraphobia involves intense anxiety in situations and places where the person feels it would be difficult for them to get out quickly or get help if needed. This includes situations such as using public transport, being in a lift or a cinema, standing in a queue, being in a crowd, or being outside of the home alone.
Obsessive compulsive disorder (OCD) presents in people as recurring, persistent and distressing thoughts, images or impulses known as obsessions (e.g., a fear of catching germs), or feeling compelled to carry out certain repetitive behaviours, rituals or mental acts, known as compulsions (e.g., handwashing). Some people with OCD have both obsessions and compulsions. These thoughts and behaviours can take over a person’s life and, while people with OCD usually know that their obsessions and compulsions are an overreaction, they feel they are unable to stop them.
Social anxiety disorder is characterised by severe anxiety about being criticised or viewed negatively by others. This leads the person to avoid social events and other social situations for fear of doing something that leads to embarrassment or humiliation.
For people with social anxiety disorder, everyday social interactions cause irrational anxiety, fear, self-consciousness and embarrassment. Symptoms may include excessive fear of situations in which one may be judged, worry about embarrassment or humiliation or concern about offending someone.Talk therapy and antidepressants can help increase confidence and improve ability to interact with others.
Approaches to Treatment
Cognitive Behavioural Therapy
Cognitive behaviour therapy (CBT) has been found to be the most effective treatment for anxiety disorders. CBT helps you change unhelpful thoughts and behaviours that can contribute to anxiety, and aims to build skills to manage anxiety when it arises. CBT for anxiety includes some of the following strategies:
Cognitive restructuring: a technique used by psychologists to help a person to challenge negative thoughts and develop more helpful and constructive ways of thinking.
Problem-solving: a technique used to help a person work through day-to-day problems. Problem-solving has been shown to help people feel more confident tackling life’s challenges, and to decrease general anxiety. Structured problem solving involves identifying the problem, developing a range of potential solutions, selecting one to test out, implementing the solution and evaluating its helpfulness.
Exposure therapy: a treatment in which the psychologist guides the person through a series of real or imaginary scenarios to confront specific fears. Through this gradual process, the person learns to cope more effectively with these fears, and with practice, the anxious response naturally decreases.
Relaxation: a range of techniques such as meditation or progressive muscle relaxation which, when practiced regularly, have been found to effectively reduce anxiety.
Mindfulness
Mindfulness has been found to effective in the treatment of anxiety. In mindfulness, instead of avoiding, withdrawing, or fighting against anxious thoughts, feelings and physical symptoms, the person is helped to remain present and aware of the symptoms, without judging them. Over time, the person becomes more open to and accepting of anxious experiences, less overwhelmed by them, and better able to engage fully with life.
Lifestyle Changes
Lifestyle changes such as getting regular exercise, reducing alcohol and caffeine intake (which can act as stimulants and make anxiety symptoms worse), taking part in enjoyable activities, improving time-management skills and having adequate sleep can help reduce stress and anxiety.
Tips from Australian Psychological Society
Check your Self-Talk
When we are upset and anxious we sometimes say negative things to ourselves. Unhelpful self-talk might include things like, “I’m hopeless”, “I’m going to be terrible at this”, or “I’ll never get this done”. Negative self-talk gets us down, can increase anxiety and can get in the way of us achieving our goals.
Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “I am coping well given what I have on my plate”, “This stressful time will pass”, or “I got through it last time”.
Keep things in perspective
When we are worried and upset it is easy to see things as worse than they really are, and to start anticipating all sorts of problems down the track. Take a step back and look at one of your worries in the bigger scheme of your life. Ask yourself:
am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?
is the outcome certain to happen, possible, or quite unlikely?
if the worst were to happen, what could I do about it?
Sometimes, thinking about how you would cope, even if the worst were to happen, puts things into perspective.
Don’t let anxiety or fear stop you from doing things
Try not to avoid situations which trigger your anxiety, but work on facing these situations. If this seems too difficult, get the help of a psychologist or other mental health professional to work out a plan for facing your fears and increasing your confidence, step-by-step.
Practice relaxation, medication and mindfulness
Practicing relaxation, meditation and mindfulness on a regular basis will allow your body and nervous system the opportunity to routinely settle and readjust to a calm state.
Look after your physical health
Exercise, diet and other health behaviours can help support you to manage anxiety, so it is important to: 1. make sure you are eating well, 2. get regular exercise, 3. avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.
