Anxiety - what is it, and how to treat it when it becomes overwhelming

What is Anxiety?

Anxiety is a natural human emotional state, evolved to allow us to respond to danger. We all experience it, and it keeps us safe. However, sometimes anxiety can start to feel overwhelming – it becomes persistent, excessive and one’s capacity to make rational assessments of the probability or impact of feared events is reduced. These are the symptoms of Anxiety Disorders (AD’s), a common condition experienced by one in six adults – more frequently than this in young adults (see https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/mentalhealth/adhocs/13844depressionoranxietyinadultsgreatbritain22septemberto3october2021). These can take multiple forms – a few common ones are Health Anxiety Disorder (aka Hypochondria), where there is a tendency to catastrophise about one’s health, imagining worst case scenarios about minor or non-existent symptoms, Social Anxiety Disorder where the focus is on fear of being judged negatively by others, and Generalised Anxiety Disorder (GAD) where the focus is more widely spread.

People suffering from AD’s can suffer symptoms including sweating palms, breathlessness and full-on panic attacks. These are distressing, but it’s important to understand that – assuming these are the symptoms of an AD - they are not in themselves harmful or dangerous.      

The good news is that AD’s are treatable. I would like anyone reading this who is experiencing a sense of hopelessness, or fear that their AD will be a permanent part of their life, to take comfort in this. More and more, research indicates that Cognitive Behavioural Therapy (CBT) is the most effective means of addressing them. It does require work – and some of this work will be uncomfortable – but a sense of balance can be restored and the irrational anxieties accompanying AD’s can be managed or even eliminated altogether.

The Neurology of Anxiety

It can be helpful to understand the neurology of anxiety – what is happening in our brains when we perceive danger, how it can be that AD’s emerge, and so point a way to how to treat them.

The brain’s “switchboard” is known as the Thalamus – when it perceives a possible threat (this may be triggered by a physical sensation, a thought, a memory) it sends out two signals to analyse and process this threat. One of these signals goes to the Cortex, the part of the brain which combines all the sense data and “rationalises it”, a process that takes about half a second (fun fact: this means that we all live about half a second in the past, but because we all do, we don’t notice). The cortex will then pass on its rational assessment, its verdict, of whether the trigger is dangerous to the Amygdala, the part of the brain which regulates emotional responses. However, it also sends a signal directly to the Amygdala, bypassing this half-second process. We’ve all experienced this – think of a time when you have been surprised by a sudden noise, or a touch on one’s shoulder – we react immediately, giving us that crucial evolutionary advantage prior to the Cortex offering its verdict.

It is this verdict which determines if we experience anxiety – we may realise the sudden sound is just something falling to the ground for example and the verdict will be that this is not dangerous; but it may be that the sound is an intruder breaking in, so it is. AD’s emerge when the verdict provided by the Cortex is inaccurate – fake news if you will – telling you that something is dangerous when it isn’t. This diagram will hopefully elucidate this:

We can’t control the Amygdala’s response to the direct signal – the first whoosh of fear – nor would we want to. However, the good news is that we can exert some control over the way the Cortex processes these fear triggers.

Avoidance Strategies

What do we do when we experience fear? We look for ways to avoid the experiences that trigger anxiety, and techniques to avoid the feeling of anxiety when it arrives. These may involve distractions, or attempts to control the uncontrollable, you may be conscious of them, you may not be. The problem is that when you have an AD, these avoidance strategies confirm the Cortex’s faulty verdict – they serve to confirm that there is danger where there is none. This reinforces the neural pathways, meaning that next time the trigger occurs, the Cortex will deliver the same verdict, the anxiety will emerge and so on. Thus, a vicious fear-maintaining cycle emerges. The longer it goes on, the more entrenched the pathways become.

Treatment

So how do we undo this? We need to identify, and – slowly – dismantle these avoidance strategies. The example I use with my clients is one close to my heart – a fear of spiders. Spiders aren’t dangerous (or not in the UK at any rate), but I fear them, and I can’t tolerate knowingly being in the same room as one. My avoidance strategy is simple – I leave the room, and try to find someone to capture and remove the spider. To treat this, I need to slowly dismantle this strategy. An immediate dismantling might involve someone picking up the spider and placing it in my lap, but the traumatic response it would trigger would be counter-effective. Instead, a process of de-sensitisation would need to take place, where I tolerate the presence of the spider for longer and longer periods while new neural pathways develop, and my Cortex learns that the spider is not dangerous, and changes its verdict.

Similarly, when treating an AD, we need to identify what the anxiety is, and what avoidance strategies are being practised which are inadvertently reinforcing the AD. A useful tool for identifying the specific anxieties is an Anxiety Diary, where experiences of intense anxiety are journalled shortly after taking place, looking to identify the trigger. We then need to work through what avoidance is taking place, and then initiate a process of “de-sensitising”, where these strategies are slowly dismantled. Neurologically, I hope it is clear now that this will serve to slowly dismantle the fear-maintaining cycle, allowing the space for new neural pathways to emerge which deliver an accurate verdict from the Cortex to the Amygdala.

Does it Work?

In short, yes, but as said above it isn’t comfortable. I don’t relish the thought of spending time in a room with a spider, and this paradoxical leaning into the anxiety, allowing yourself to experience the anxiety without running away, runs contrary to our instincts. We need to engage with the anxiety in order to learn that what we fear is not actually dangerous.

Is it sustainable? The old neural pathways, like old river beds, don’t just close up. They are still there, and it is possible that they could re-emerge. However, the hard work of creating new pathways will have been done.

How Do I Start?

This cognitive approach is best done when facilitated by a trained therapist. The therapist can offer external insights, offer counter-narratives to any catastrophisation that is going on, help identify avoidance strategies, and a treatment plan to dismantle them, offering support through the discomfort and pain that will inevitably result. Meeting once a week for 50 minutes is a proven way of offering the necessary structure, and allowing time for the therapy to work.

If you are suffering from debilitating anxiety, and think that you may like to work with me, email me on piers.hadman@grove-counselling.com or alternatively fill the form in on my website for a free online consultation, where we can discuss your issues and, if you are satisfied, agree when and where we could meet.