Anxiety: When a Useful Emotion Becomes a Problem

• "I was shopping at the mall. I felt good. I was looking at some clothes on a rack, when suddenly, without warning and without any reason, I felt terrified. My heart was pounding. I was sweating. I thought I was having a heart attack."
• "I'm okay in most situations. But my job requires me to make speeches or presentations to large groups of people. I get nervous for hours before one of these events, even though I try not to think about it. When it's time to speak, my hands start to shake. I start to perspire. I'm afraid people will notice, and that makes me even more nervous."
• "I worry all the time. I worry about how I performed yesterday. I worry about what I have to do tomorrow. It interferes with my sleep. Then I worry about how I'll be able to perform without enough sleep. If I get plenty of sleep, I worry that I'm sleeping too much."
• "I wash my hands at least 30 time a day. If I don't, I feel like they're dirty, like I've picked up germs. I know this is silly. My hands are dry and irritated from all the washing. But when I try to stop, I get anxious about the germs again."
• "My Aunt Helen refuses to leave her house. The rest of us in the family have to go buy her groceries. She won't visit us; we have to visit her. When she gets sick, we can't even get her to go to the doctor."

Everybody experiences fears and anxiety. It's a normal part of life. Your sympathetic nervous system has been programmed by evolution to help you protect yourself from realistically threatening situations. When you feel anxious, your body is preparing for action. Scientists have called this the "fight or flight" mechanism. When fear is an appropriate reaction, it promotes your survival and continued well-being. It arouses you to react quickly and with increased energy. It helps you avoid or escape genuinely threatening situations. In moderation, fear or anxiety help you to perform better in social and business situations. Your mind and body are working as they should.

However, when you repeatedly experience fear or anxiety in response to situations that are not objectively threatening; or when the fear you experience is out of proportion to the threat; or when you are so afraid of your own anxiety reaction that it interferes with your performance at work or in social situations; or when your fear keeps you from engaging in the normally satisfying activities of life, your sympathetic nervous system is over-reacting. You have an anxiety disorder.

Anxiety disorders are generally classified into five categories:

Panic Disorder and Agoraphobia

If you have a panic disorder, suddenly, without warning, you may get feelings of terror or physiological reactions associated with anxiety such as heart pounding, sweating, feeling faint, dizziness, trembling, weakness. These events happen repeatedly. If an event happens in a public place or situation, you may develop a phobia of such places or situations, for fear of embarrassing yourself. Because you never know when you might have another panic attack, you may develop agoraphobia, staying home to avoid the possibility of having a panic attack in public.

Obsessive-Compulsive Disorder

Most of us have at least some things that we worry about. Many people have certain routines that they follow daily, such as eating dinner at the same time every evening, going jogging every morning at 6 a.m., etc. However, for some of us, our worries or need to perform certain routines or rituals interfere with our ability to have a normal life. You may have recurring thoughts that are disturbing and generate anxiety. You might engage in repetitive acts of checking. For example, you might fear the possibility that your house will burn down. When it's time to go to work in the morning, you go back four or five times to be sure you turned off all the burners on the kitchen stove. Or you may engage in seemingly silly rituals that make little sense, even to you. The famous inventor Nikolai Tesla suffered from obsessive-compulsive disorder. In order to control his anxiety, he often had to repeat normal acts three times. For example, if he walked around a city block once, he would feel compelled to complete the circuit two more times before moving on to something else. When he ate dinner at a restaurant, he would measure and then calculate with paper and pencil the volume of each item of food on his plate before he could allow himself to eat it.

Post-Traumatic Stress Disorder and Acute Stress Disorder

Modern life is full of stressors. We are equipped to cope with normal stressors such as too many bills, losing a job, or even positive stressors such as having a baby. However, severe stressors such as your house burning down, getting raped, or experiencing an earthquake may overwhelm your normal coping mechanisms. Some people cope with these severe stressors, or traumas, by essentially becoming numb, distancing themselves from the pain and fear. Psychologists call this dissociation. But when the incident is over and life should be returning to normal, they find themselves experiencing symptoms such as flashbacks, nighmares, excessive anxiety, emotional numbing, or avoidance of places or people which remind them of the event. Such symptoms may represent post-traumatic stress disorder or acute stress disorder.

Phobias

Phobias are fears of specific objects or situations, which are either not related to any objective threat or are exaggerated out of proportion to any real threat. For example, you might be fearful of dogs, even if the dog is non-threatening and friendly. Or you might be so afraid of flying that you must restrict your travel to places you can reach by other means. This can happen even though you "rationally know" that flying on commercial airlines is statistically the safest way to travel.

One common kind of phobia is called social phobia. This refers to a fear of certain kinds of social situations, such as speaking or performing before large groups of people, talking to superiors on the job, etc. Social phobias are often very specific. You may experience anxiety in one particular kind of situation, while being perfectly comfortable in most other situations. However, some people may feel uncomfortably anxious in a wide variety of social settings.

Generalized Anxiety Disorder

This form of anxiety disorder is characterized by persistent and unrealistic worries. Worries become the person's customary or habitual response to upcoming situations. Like a hamster running around in a wheel, the mind goes around and around over the same thoughts, never arriving at a solution, often costing hours of sorely needed sleep.

As is probably obvious from the above, there can be considerable overlap among these types of anxiety disorders. Having one type of anxiety disorder can lead to having other types. Persons with anxiety disorders often fear their own fear reactions, "fear of fear itself" (to paraphrase Winston Churchill). They are afraid that their sweating, trembling, or feelings of faintness will be noticed by other people or lead them to behave in embarrassing ways, such as actually fainting. As a result, they begin to avoid social situations where such reactions might occur. Essentially, when you have an anxiety disorder, your sympathetic nervous system is in a constant state of arousal.

Anxiety often co-exists with depression. You may become depressed because of the restrictions that the disorder imposes on your life or you may be depressed and develop an anxiety problem as well. Anxiety can also co-exist with insomnia or another sleep disorder. The body's constant state of arousal may disturb the normal sleep cycle.

Treatments

Anxiety disorders can be successfully treated with psychotherapy. Options for treatment include:

Experiential/Behavior Therapy helps you learn to deal with fear-evoking situations, usually by controlled exposure to them through visualization or, where possible, real life exposure.

Cognitive and Rational-Emotive Therapy help you learn the relationships between thinking, emotions, and behavior, and how to differentiate reality-based rational thoughts from unrealistic thoughts, which lead to unrealistic fears. Irrational thoughts are disputed and replaced by effective thoughts.

Relaxation and Self-Hypnosis techniques help you to calm down physiological reactions to stressful situations to reduce anxiety and bring it under control. With such techniques, you are learning to control the response of your sympathetic nervous system and stimulate your parasympathetic nervous system.

While a variety of medications are now available for helping to alleviate the symptoms of anxiety disorders, medications are best used in emergency situations, since they are highly addictive and without the learning created by psychotherapy, symptoms are likely to recur when the medication is discontinued. Some medications are aimed at altering mood, while others are aimed at controlling the physical manifestations of anxiety, such as rapid heart beat, etc. In addition, medications sometimes have undesirable side effects, rendering them unsuitable as a permanent solution. Additionally, some medications have anxiety as a side effect or withdrawal effect, while others can cause sleep disturbance. Thus, the best approach to treating such symptoms is NOT more medication. The psychological treatments discussed above help you learn skills that will last a lifetime, thus permanently reducing the likelihood of recurrence.

Dr. Carol Low, clinical psychologist, at the Center for Conscious Living is skilled in the use of the proven psychotherapeutic treatments discussed above. Typically, these therapies are used in combination. Therapies are aimed at rapidly decreasing anxiety symptoms, while clients learn techniques to avoid recurrence. The goal of treatment is to alleviate your current symptoms and to teach you self-control methods that enable you to cope with new situations which arise in your life.

With reduction in anxiety symptoms, clients often experience improved self-esteem and a greater sense of mastery over themselves, their lives, and futures. Elimination of unnecessary fear removes artifical, self-imposed restrictions on career choices, social life, and romantic and other human relations, allowing individuals to more fully realize their potentials.