We all deal with anxiety in some form or another, whether it's when you're pulled over by the cops or about to give a speech in front of a crowd. But for some, anxiety is a much stronger, more fearsome force—one that never goes away. But what is anxiety exactly, and what's going on in your mind (and your body) when anxiety strikes? How do you cope when it takes hold?
The National Institute for Mental Health (NIMH) says that over 40 million people in the US over the age of 18 suffer from some anxiety-related disorder, and those are just the people who have been diagnosed, or whose symptoms fit into a pre-described condition. Millions more go undiagnosed.
On the other hand, anxiety itself is a natural human response that serves a purpose. Our goal shouldn't be to dismiss it entirely, just to make it a healthy, manageable part of our lives. Even if you don't suffer from an anxiety-related disorder, you've likely had to deal with it and cope the best way you know how. Anxiety is part of our world, the same way stress, sadness, and happiness are, but the key is understanding how to cope with it, and how to keep it from becoming unhealthy.
To help us get there, let's talk about what exactly is going on in your brain when anxiety strikes, how it impacts us, and then what we can do about it, with the help of some experts.
What Anxiety Is, and How It Differs from Stress
Put simply, anxiety is a sense of fear and apprehension that puts you on alert. Biologically, it's meant to put us in a heightened sense of awareness so we're prepared for potential threats. Unfortunately, when we start to feel excessive anxiety, or we live in a constant state of anxiety, we're in trouble. Our bodies never turn off our fight or flight response, and we live with the physical and emotional effects of anxiety on a day to day basis, even when there's no reason or cause for them.
On its face, anxiety can look like stress; but the reality isn't so simple. Anxiety can arise as a result of stress, but stress can manifest in other ways. Stressors can make a person sad, angry, worried, or anxious, while anxiety is specifically that feeling of fear, dread, and apprehension we mentioned. You may never even know what's causing your anxiety, or in some cases, it can manifest on its own, without any real "trigger" or cause. Stress is often caused by external influences, while anxiety is an internal response. That's part of what makes anxiety intrinsically different than stress, and also what makes it so difficult to manage.
What's Actually Happening In Your Brain When You Feel Anxious
You know the feeling: That tense sensation in your stomach, the heightened sense of awareness you have about everything going on around you, the slight fear or sense of dread—that's anxiety. Before your body feels the effects however, your brain is already at work. The National Institute of Mental Health guide to anxiety disorders also offers this descritpion of the neurological processes at work:
Several parts of the brain are key actors in the production of fear and anxiety. Using brain imaging technology and neurochemical techniques, scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders.
The amygdala is an almond-shaped structure deep in the brain that is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals. It can alert the rest of the brain that a threat is present and trigger a fear or anxiety response. The emotional memories stored in the central part of the amygdala may play a role in anxiety disorders involving very distinct fears, such as fears of dogs, spiders, or flying.
The hippocampus is the part of the brain that encodes threatening events into memories. Studies have shown that the hippocampus appears to be smaller in some people who were victims of child abuse or who served in military combat. Research will determine what causes this reduction in size and what role it plays in the flashbacks, deficits in explicit memory, and fragmented memories of the traumatic event that are common in PTSD.
The feeling of anxiety is part of your body's stress response. Your fight or flight response is triggered, and your system is flooded with norephinephrine and cortisol. Both are designed to give you a boost to perception, reflexes, and speed in dangerous situations. They increase your heart rate, get more blood to your muscles, get more air into your lungs, and in general get you ready to deal with whatever threat is present. Your body turns its full attention to survival. Ideally, it all shuts down when the threat passes and your body goes back to normal.
Where Anxiety Comes from and Where It All Goes Wrong
The effects of stress are well understood, but where does anxiety come from? How do we know that it's time to be "anxious," and where is the line between "feeling anxious" and "suffering from anxiety?" We sat down with clinical psychologist Jeffrey DeGroat, PhD and Roger S. Gil, MAMFT, to find that line.
Dr. DeGroat explained that there are a number of psychological theories as to why anxiety exists. There's the neurological (which we mentioned above), and the psychoanalytical, which describes anxiety as battle between the id, ego, and superego. In this battle, he explains, "anxiety serves as a danger signal to an individual's ego and/or superego that an individual is at an elevated risk to act upon an unacceptable id impulse. In the face of this anxiety, an individual's ego and/or superego respond by attempting to manage an individual's id impulses through elevated means." Essentially, anxiety is a warning sign that you're about to do something you may not want to. There's also the cognitive theory, which suggests that anxiety arises when a person's cognitive distortions, or irrational thought patterns, make them see everything as a physical threat, whether it's an actual physical danger, an annoying coworker, or a police officer on the side of the road. In behavioral theory, anxiety is a learned response due to exposure to frightening or stressful situations.
Regardless of which theory you subscribe to, it's unhealthy when those instincts are turned on constantly. Your body's stress response is something designed to be engaged when needed and disengaged; and constant anxiety keeps us alert and on edge all the time. Persistent anxiety, however, is a problem.
Gil explained that whether it's caused by genetics or being brought up in an environment conducive to anxiety (as in, loud environments or parents and teachers who yell all the time), the problem emerges when your body and brain become "wired" to be on the lookout for potential threats that could come from any direction at any time, real or imagined. Anything that could cause an undesirable emotion, he explained, whether it's fear, frustration, or doubt, could be a trigger for anxiety—and once you develop thinking patterns that reinforce every event in your life as a threat, it becomes a never-ending cycle.
Both gentlemen agreed that it's an issue when you recognize that your anxiety doesn't seem to go away, and you're living with it on a daily basis. This is easier for some people than others though—if you've been suffering from anxiety for so long that it's just part of your personal norm, you may not even recognize that it's an issue, as Gil explains:
Many people have lived in an anxious state for so long that they don’t know any other feeling so they are unaware that they are suffering from persistent anxiety. Recognizing anxiety isn’t easy in these types of situations however identifying its red flags is a good way to start. Are you pessimistic about the most innocuous situations to the point where it keeps you from taking risks? Do you find your mind racing to what possible negative outcomes there could be? Do you immediately attribute some external circumstance to a positive outcome that could be seen as the result of your efforts? If your answer is ‘yes’ to these questions, then you may suffer from persistent anxiety.
For some people, anxiety is situational. It’s normal to feel nervous at the prospect of having to speak in public. It’s not normal to feel anxiety about having a mundane conversation with your barista. Situational anxiety is one of those things that we can only overcome by confronting it. Generalized anxiety is something that can only be coped with by trying to rewrite the pattern of thinking that elicits it.1
Regardless of whether you're living with anxiety or suffering from an anxiety related condition, there are ways to deal with and lessen anxiety's impact. It starts with recognizing the effects of anxiety, and then learning the right ways to cope.
What You Can Do About Anxiety
Once you've recognized the effects of anxiety, it's time to do something about it. You don't have to just try to keep your head above water. There are plenty of tricks and techniques you can use to ease yourself out of an anxious state or defuse anxiety when you feel it rising. Here are a few.
Turn to Relaxation Techniques: Music, Meditation, Exercise, Your Personal Rituals
Learning a few good relaxation techniques will serve you well. For example, simple paced breathing may sound too easy, but it's a great way to coax the body into a more relaxed state. It's something you can do at your desk at work, in your car, and before or after an event. Breathe in for four seconds, and then out for six. Count in your head, and focus on your counting and the sensation of your breathing. Repeat as long as it takes to relax a bit.
Dr. DeGroat suggested visualization as a relaxation technique; which he also mentioned as a coping mechanism for stress. Imagine that you're in the most relaxing environment that you can possibly think of, whether it's at home in bed or on the beach in the tropics. Wherever you think you would be most relaxed, stop and really put yourself there. If you're at the beach, he explained, ask yourself how warm it is, and whether there are clouds in the sky. Are you alone? Is it quiet, or can you hear the ocean? The goal here isn't just to paint a pretty, relaxing picture in your head, but also to get your brain working on those details—the more you do, the farther away your mind will be from whatever's triggered your anxiety.
You can get a similar benefit from music, exercise, or meditation. Relaxing music can take help take your mind off of your anxiety, or help you refocus after an anxious spell. Exercise is similar, but instead of just taking your mind away, it actually has a neurological benefit (as well as a physiological one). Gil explained that the endorphins released in our brains during exercise make us happier, and the feeling of accomplishment we get from regular activity can help curb anxiety. Meditation—especially guided meditation—can also help, since the entire point is to calm the mind and dismiss the errant thoughts that lead to anxiety and stress. Meditation can help you focus on your surroundings or be mindful of the present, instead of letting the background seep to the fore.
Finally, turn to your own relaxation rituals to take the edge off of your anxiety. If you don't have any, create some. They can do wonders for your mental and emotional health, and making sure you have positive habits and rituals you can turn to when you're stressed or anxious will make sure bad habits don't take root.
Track Your Mood to Identify Patterns
We've talked about how useful mood tracking can be, and how to get started before, but Gil explains that it's helpful for more than just clearing your mind and getting thoughts off your chest. It can also help you identify patterns and the underlying causes of your anxiety:
Once a person is aware of an anxious thinking pattern, they can begin to work on interventions to manage their anxiety. One of the first things I have clients do is to keep a ‘thought journal’ of thoughts that trigger their anxiety (i.e. their body’s limbic response to a potential threat). Many times we find that there is a pattern to these thoughts. Anything from the time of day to particular individuals can be a trigger. Once a pattern is identified, then the person can be proactive and make plans for when these triggers are on the horizon.
Does your boss calling you into her office make her nervous? Then recognize this and begin to challenge the thoughts that are making you anxious. For example, tell yourself that you have completed all of your obligations and have done nothing wrong (assuming it’s true, that is). Challenge the anxiety-provoking thoughts by telling yourself that you have not done anything that would warrant a negative conversation (again, assuming that’s true).
Then come up with a “positive outcome thought” by telling yourself that your boss could be calling you in to praise you. While this exercise may not eliminate the anxiety, it will probably help with preventing you from becoming a nervous wreck. In other words, the negative thought train should slow down and not end up taking you to Panic-ville.
For example, if you suffer from social anxiety or awkwardness, keeping a thought journal like this can help you identify the types of situations that trigger your anxiety. If you can paint a clear picture, it's easier to find methods to deal with respond to those scenarios positively.
Talk to a Professional
Talking to a mental health professional (not a general practitioner) about your anxiety is an important step to learning how to cope. Many of us deal with anxiety on a regular basis and just blow it off because we don't want to be perceived as "neurotic," but the truth is that more people suffer from anxiety disorders—or at least persistent anxiety—than you may realize. If you're having trouble dealing with it on your own, see a mental health specialist to talk things out. If you're worried that mental health services cost too much money or may not be covered by your insurance, don't worry, you still have options.
Gil also suggested that you not rule out medication for anxiety. Many people can see a serious benefit from anti-anxiety medication, but he suggests only opting for it in conjunction with talk therapy:
If a person suffers from persistent underlying anxiety and they find that they cannot deal with it on their own, seeing a psychiatrist can be helpful because there are medications that can help their minds stabilize their moods. Coupled with talk therapy (often with a properly-trained therapist), medication is very effective at managing anxiety. Eventually, many people are able to overcome the negative core beliefs that trigger their anxiety and may be able to stop taking medication altogether. I often tell people to do the medication AND therapy thing (not just the medication thing) because the therapy could help them develop behavioral interventions to manage and/or prevent anxiety. Relying solely on medication is like taking insulin for diabetes… it’ll manage your symptoms but it won’t make you any better.
Ultimately, that's an individual decision to be made between you and a mental health professional that you trust, but regardless, if you find that you're having difficulty coping with anxiety, see a professional who can help.
Don't Try to Suppress Anxiety, Learn to Cope Instead: This Isn't a Willpower Issue
Finally, it's important to remember that anxiety is a natural human response. If you're struggling with it, your goal shouldn't be to just make it go away, that's unrealistic. You can't just will anxiety away—if you could, no one would have to deal with it.
As for suppressing anxiety, that’s like expecting your body to not get hungry after not eating for a few days. Anxiety is a normal and necessary emotion that is there to protect us. The key is to identify “unnecessary anxiety”. Unnecessary anxiety can be managed with preventative measure (i.e. exercise and meditation) and by challenging the veracity of the anxiety-provoking thoughts (like CBT does).
Gil explained that your goal instead should be to learn to cope with it and minimize it, and develop the mechanisms to handle it, get your mind off of the things that make you anxious, and go on with your life. Some of the tips we've mentioned will hopefully help. If you see a friend or a loved one who's suffering from anxiety, Dr. Degroat offers these tips:
Talk with them, let them know you've noticed they seem to be stressed recently and you're available to talk if they want. People who are experiencing anxiety may avoid socializing because of their overwhelming worries, leading to feelings of loneliness. If you have a friend who is withdrawing, check in with them often, inviting them to get together frequently. While they may often turn you down, just knowing that they are invited can help them feel more connected. If your friend's anxiety appears to be significantly interfering in his or her life (failing school, no longer socializing, talking about taking their lives), I would immediately contact a crisis hotline,mental health professional, and/or family members of your friend.
Of course, entire books have been written on the topic of anxiety and anxiety disorders, and we could go on describing their causes and potential treatments. Hopefully some of these suggestions can help you deal with anxiety, or identify it in your friends or loved ones so they can get the help they need to cope. Many people who suffer from anxiety disorders or just live with anxiety from time to time are highly functional, so don't think that anxiety is something you can necessarily see on someone's face. It can also often be coupled with depression or other conditions. With the right attention, learning to cope with and minimize unnecessary anxiety is something we can all do.
Dr. Jeffrey DeGroat, PhD is a clinical psychologist.
Both gentlemen volunteered their expertise for this post, and we thank them.