Anxiety and Panic
Understanding our Threat Detection System
Anxiety is a common reaction that we can all experience under times of stress and pressure. For example, we might experience elevated levels of anxiety and arousal before an examination, if we have to give a speech, or if there is increased pressure in our work environment. Normal anxiety and fear are defensive emotions that serve an adaptive purpose necessary for coping and survival. In particular, anxiety and fear can help us to determine the level of threat in an environment and to prepare for risks or challenges or to escape from or avoid an actual danger. However, often people experience anxiety that is more intense or for prolonged periods. Anxiety disorders are characterised by a range of chronic symptoms including “intense apprehension, fearfulness, excessive worry, tension, and uneasiness towards an indirect or perceived threat” (American Psychiatric Association, 1994, p429). Thus, the symptoms of fear or anxiety in anxiety disorders are excessive and not always proportionate to an immediate or direct threat.
Anxiety is often characterised by a number of physical, cognitive, behavioural and emotional responses. Physically we might notice butterflies in our stomach, increased sweating, dilated pupils, muscle tension, or an increased heart rate. These physical symptoms are partly activated by adrenaline and are essentially gearing the body for action. Cognitively, we might tend to ''catastrophize'' and over-estimate the probability of something bad occurring. We might be thrust in to over-thinking, worrying, anticipating, and scanning our memory for examples of when there has been a similar threat. Behaviourally, our alertness increases and we might enter in to fight, flight or freezing responses. If there is an immediate danger these responses can serve us to escape and avoid situations or inhibit actions that might be targeted or rejected. For example, if relational conflict or an argument elicits an intense internal reaction we may then avoid such instances in the future. Emotionally, we might feel deep fear, jittery sensations of anxiety and worry, uneasiness, or a sense of dread. All of these emotional symptoms can be deeply distressing and immobilizing. In order to deal with anxiety we might utilise defences. Defences are cognitive, behavioural, and emotional processes that aim to reduce anxiety and distress. To name a few, defences can include suppression, repression, control, intellectualization and rationalization, dissociation, and avoidance.
Common diagnoses include Generalised anxiety disorder (GAD) which is characterised by “excessive anxiety and worry that is difficult to control. GAD is accompanied by three or more of the following symptoms including restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or the mind going blank, irritability, muscle tension, or sleep disturbance.” GAD can be intensely distressing when the symptoms fail to subside and escalate and lead to worry about worry.
In comparison, to GAD, panic observed during phobias and panic disorder is characterised by a “discrete period of intense fear or discomfort” in which a range of physical and psychological symptoms such as “pounding heart, trembling, sweating, and a fear of dying occur.” Often present in conjunction with panic-disorder, agoraphobia is an anxiety about being in an environment where “escape might be difficult” if symptoms of panic arise. Specific phobia is characterised by excessive fear of a specific stimulus such as spiders.
Obsessive-Compulsive disorder (OCD) is characterised by the presence of intrusive and distressing thoughts and compulsions or actions aimed at neutralising the distress. For example, a lack of order, feelings of chaos, fear regarding harm occurring to self or others, or anxiety around germs and infection might cascade a range of compulsive or defensive checking behaviours. This might include repeatedly checking that all the light switches are turned off or having to clean and order the house before leaving. Similarly, it might involve mental rituals designed to offset some harm being inflicted upon a loved one. In many instances the compulsion does not alleviate the initial feeling of anxiety therefore it is repeated until such point that the anxiety dissipates.
In comparison, social phobia (social anxiety), as the name suggests, is a fear of social performance and negative evaluation or scrutiny from others. This can often result in avoiding social or performance situations that might be the source of criticism or rejection.
Post-traumatic stress disorder (PTSD) is a stress reaction that occurs following the experience of a traumatic event and lasts for greater than one month. PTSD is characterised by recurrent re-experiencing of the traumatic even, increased negative affective experiences, increased arousal such as startle responses, and avoidance of stimuli that remind the person about the trauma. People with acute stress disorder show similar symptoms to individuals with PTSD whereas the symptoms are of a shorter duration (less than one month).
Symptoms of anxiety may also be caused by a substance (e.g. withdrawal from an anxiolytic drug) or a medical condition (e.g. hyperthyroidism). Finally, anxiety disorder not otherwise specified is diagnosed when a person presents with severe symptoms of anxiety that do not meet criteria for another anxiety disorder. Overall, the symptoms of these anxiety disorders can cause clinically significant distress or impairment in social occupational or other important areas.
Research is now finding that there are specific networks within the nervous system that are activated during instances of fear and anxiety. Fortunately, there are a number of strategies and processes that can help us to better regulate and live with anxiety. For example, in some instances deep breathing, mindfulness, and adopting healthy coping strategies can be an important first step to regulating increased physical arousal. Other types of therapy include identifying and challenging unhelpful cognition patterns that perpetuate anxiety. In psychodynamic therapy the underlying emotions, memories, and experiences that cause or trigger anxiety are processed. If you are wanting assistance in managing these symptoms feel free to call on 0451 491 395. (disclaimer: the following article is intended for a general understanding of anxiety and is not intended to substitute professional advice, diagnosis, or treatment from a trained psychologist).