Anxiety - What it is and how it is treated.

One positive thing that has emerged from our connected age of internet and social media, is that we are talking a lot more openly about mental health.

You’ve probably seen lots of threads, posts and memes about anxiety. We now understand that the word ‘anxiety’ has often been misused. It is not simply nervousness or a bit of ‘butterflies in the stomach’, it is a category of mental health disorders which are complex and often debilitating.

We use the word category deliberately, as that’s another myth we’d like to tackle here - anxiety is not just one condition. Anxiety manifests itself in a number of different ways, which often sound similar, but can actually create different disorders.

In this article, we break down what anxiety is, how it can be treated, and what the different anxiety disorders are.

Anxiety is a response to a perceived threat

The common denominator between the anxiety conditions is that the individual is experiencing a reaction to a perceived threat.

For example, an individual with social anxiety - who experiences fear of negative judgement by others - may perceive a room full of strangers at a party as a ‘threat’, whereas someone without that type of anxiety simply sees a room full of people; they may have no reaction, or even a positive one at the prospect of meeting new people and having fun.

For the person with social anxiety, the room full of people registers as something dangerous to them and their body responds as it would to any danger - their heart might race, they may sweat and have the urge to get out of there as quickly as possible.

When we are in danger, the first thing we do is to protect ourselves, and for the anxious person this is no different. Unfortunately, the safety-seeking behaviours employed only serve to reinforce the negative cycle of anxiety.

The safety-seeking behaviour - such as avoiding or leaving a party - reduces your distress temporarily which in turn reinforces the idea that this thing is a threat; even if deep down you rationally know it won’t literally harm you.

The ‘think > feel > do’ of anxiety

We spoke in our last article about the CBT cycle - the idea that our thoughts create our emotions, and our emotions lead to actions or behaviour. Our actions and behaviour in turn affect how we think about things, and so on.

We see this cycle in play in a person with an anxiety disorder. Their thoughts about the situation (eg the party - “I’ll make an idiot out of myself if I open my mouth!”) leads to an emotional reaction (fear, panic) which then evokes a safety-seeking behaviour (make an excuse to leave).

In this example, we can see how the next time a person is invited to a party, they are likely to do the same thing, or even refuse to go in the first place, deepening their negative appraisal of this particular situation.

Pre-existing beliefs

We all have different life experiences, and therefore make sense of the world around us in different ways. We have a set of ‘rules’ in our head for how the world works, based on what we have observed happening to us, and around us, as we grow up. We learn from our parents, our peers and the wider society around us.

We refer to these as our ‘pre-existing beliefs’ and they tend to be formed between the ages of 0 to 18.

Sometimes these beliefs are helpful - they allow us to take care of ourselves as adults and protect ourselves from danger. However, sometimes the rules we create as a result of these beliefs can be restrictive and cause problems if we are unable to separate real danger from something we perceive to be a threat.

For example, maybe as a child you learned to hide if there was an unexpected knock at the door as it could be a debt collector, or a violent family member. As an adult, an unexpected knock at the door may provoke the same emotional response of fear, even though the danger is no longer there.

Same event, different reactions

The same event can have different meanings to different people - or even to the same person on different occasions.

Think of Christmas-time exams in school. Some students worry about these - they know they’re a practice run for the real thing in June and they want to be reassured that they are on course for good results. Others will not be worried at all as they are not the ‘real thing’ - there’s plenty of time to swot up for the summer tests.

At summertime, the same group who weren’t worried may have changed their tune. Same exams, but they apply different context now it’s the ‘real thing’! Maybe the worried group are now relaxed as they did well at Christmas.

It is the meaning and interpretation of a perceived threat that will provoke an emotional impact.

Emotional problems will arise because of the rules a person forms earlier in life which have outlasted their usefulness, and therefore cause problems in the way a person organises and interprets reality

CBT to treat anxiety

Treatment involves a combination of helping a person to make changes in certain situations, including problem-solving and correction of counterproductive beliefs and interpretations - this is a cognitive approach. It involves trying to find ways to help them look at their beliefs and interpretation of a situation, exploring why they hold those beliefs, and helping them look at it alternatively.

A behavioural approach involves learning and testing alternative ways of interpreting their experience. To do this, we might ask them to play out a scenario in their head and describe the worst thing that could happen - to verbalise their worst fear.

People with social anxiety have been known to say they think they might “die of embarrassment” so we explore that, by taking those beliefs and trying to interpret what they actually mean and break them down very literally. Is it possible to actually die of embarrassment? Is it worth trying out the situation to see what actually happens; does your worst fear actually come true when you put yourself in the situation that provokes your fear response?

In Cognitive Behavioural Therapy, we help people try to find different ways of behaving which is consistent with alternative accounts of the problem. An alternative account of the party scenario could be “Maybe you won’t die of embarrassment. Maybe you are worried about what people will think of you because you have low self-esteem after being bullied at school. Is it possible people at the party are not thinking negatively about you? Is it possible they are thinking about themselves rather than about you? Could they even be thinking positively about you?”

It involves gradually introducing someone to a new situation that they fear or perceive to be dangerous, and then building up and building a new behaviour with them.

Anxiety conditions

There are specific disorders in which anxiety presents itself.

Phobia: A person's perception they are in imminent danger from an identifiable situation.

Panic: Interpretation of immediate catastrophic danger indicated by bodily sensations.

Health anxiety: The long-term worry of what will happen; less imminent catastrophic danger but there's still a perceived danger. People will repeatedly present to their doctor with desire for tests, and worry constantly about their own health or someone else’s, eg their child or spouse.

Social phobia: The person's interpretation of immediate negative social judgement; they don’t fear bodily sensations, they fear they will be judged.

Obsessive Compulsive Disorder (OCD): Anxiety about the responsibility for harm, focused on intrusive thoughts.

Generalised anxiety: An overestimation of danger and intolerance of uncertainty; worry about worry - generally presents as the ‘what-ifs’ - “What if I get hit by a bus?”

In the weeks and months to come, we will explore some of these disorders using real-life cases and treatment examples. As always, stories will be anonymised and only shared with express permission.

If you have read anything here which strikes a chord and would like some help for yourself or someone you know who may be experiencing an anxiety disorder, please don’t hesitate to get in touch.

Find out more about how we can help you, and book your free 30-minute phone call with a therapist today. We look forward to hearing from you.