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High Anxiety

By Matthew Doll, Ph.D

Fear, anxiety, nervousness, worry (used interchangeably for the purposes of this article) are not the most comfortable of feelings, yet they are just feelings, signals, and information - nothing more. Fear is simply our brain telling us there may be danger. At times, this is very helpful, like when getting ready to cross a busy street; at other times, this is not very helpful, like when we can’t function because of fear or it causes us to behave in strange and unusual ways.

Part of dealing with anxiety is proper risk assessment. Is there a real concern for safety or not? We don’t want to be totally absent of anxiety or too overly anxious so we cannot function. There is an optimal range for anxiety that varies by the individual. A simple example is to consider sports performance. Performance is diminished if you do not care how you will perform or if you are overly anxious about your performance. If, on the other hand, you are keyed up and a little nervous, but not incapacitated due to your anxiety, performance is enhanced.

Fear Response
We respond to threat or perceived threat in three ways - Flight, Fight, or Freeze. There are two key processes needed for coping successfully with threat. Being aware of our thoughts (cognitive processes) and our physical responses (physiology) allows us to properly assess risk and respond to it rather than react to it. Cognitive Behavioral Therapy focuses on controlling what we are saying to ourselves and behaving in more adaptive ways.

Before we start Focusing on Strengths, Finding Solutions™ for managing anxiety, let’s take a quick tour of some of the ways anxiety can affect our functioning. As individuals, it appears that we inherit a good deal from our parents, in all likelihood there is some genetic coding for anxiety. The environment we grow up in can either heighten this predisposition or lessen it. My current favorite summary of the nature vs. nurture argument is, “Genetic predisposition exacerbated by environmental influences.” We know from research that our environment influences our physical bodies. Consider how stress impacts your system or that there are changes in the brain development of children who witness and/or experience domestic violence (chronically high stress hormones like cortisol impacting on the brain). This is one of the many reasons there is a need for fully funding mental health services in order to decrease our overall health care.

Anxiety Diagnoses
Many forms of anxiety fit into diagnostic categories. Consider the following oversimplified definitions.

1. Generalized Anxiety Disorder: worrying all the time about a lot of stuff
2. Social Phobia: worrying about what others think of us
3. Specific Phobias: can’t face certain things or situations (e.g. heights, snakes, etc.)
4. Post Traumatic Stress Disorder: fear of facing memories of past trauma
5. Obsessive Compulsive Disorder (OCD): fear of something bad happening if we don’t engage in a certain behavior (repeat over and over)
6. Panic Attacks: fear of dying due to being overly focused on our body’s increased distress to fear of dying (repeated until you pass out)
7. Agoraphobia: fear of having another panic attack so you don’t go anywhere and stay in the house
8. Anxiety Disorder Not Otherwise Specified: fear that we can’t really put into our other diagnostic categories

Other disorders can have significant symptoms of anxiety. For example, individuals who struggle with Autism can have significant “melt downs” when expected events do not happen, likely related to over wiring in their limbic system (part of our brain that deals with emotions). Certain forms of depression have an anxiety component in which anxiety and depression are viewed as two sides to the same coin.

Not only can anxiety impact us individually, it can also impact us as a group or even as a nation. Nationally we can see anxiety in terms of our nation’s struggles with fear following 9/11 and our current economic crisis. Terrorism, by definition, is supposed to make us afraid and change our worldview and behavior. It wouldn’t be terrorism if we weren’t afraid. It would just be something some criminals did that killed innocent people. Consumer confidence has been shaken and our economy is “frozen”. (Flight, Fight or Freeze.)

How to Manage Anxiety
We can turn FEAR on itself to manage anxiety as in Dr. Kendall’s metaphor:

• F (Feeling frightened)
• E (Expecting bad things to happen)
• A (Actions & Attitudes to face fear)
• R (Rewards for facing fear)

Knowing why you are afraid of something doesn’t always help you get over the fear. Facing your fear does. Rewarding yourself for facing a fear makes you want to face it again. In order to face our fear we need to change our fearful thoughts & use more adaptive/coping thoughts while changing our behavior so we break the Flight, Fight, Freeze response. We repeat our successful facing of our fear until we no longer have the Fear Response.

The first step is to be aware or “Mindful” that we are feeling frightened (sometimes we act out of fear but do not acknowledge that is what we are doing). We can also start noticing physical feelings such as faster breathing, sweaty hands, heart rate increase, etc. Having this awareness can help us face our fear & pay attention to what we are saying to ourselves, identify what are we expecting bad to happen, & identify what the fearful thoughts are. Actions are things like diaphragmatic breathing (when you breath in & your stomach goes out, sometimes called “belly breathing”).

Diaphragmatic breathing allows for slow controlled deep breathing, which is the opposite of how we breath when feeling frightened. There are also a variety of other strategies we can use to relax our bodies such as active (progressive muscle relaxation) & passive (use of imagery) relaxation techniques.

Attitudes are the more adaptive thoughts we use in place of the fear based ones. Substituting “this is scary but I can handle it” for “we are all going to die” would be a good example. Rewards for successful coping are also very important. We are more likely to do something in the future if we are rewarded for it. Since we want to repeat our coping & break the hold fear has on us, rewarding ourselves (or others) for facing fear can be very helpful.

Facing our fear successfully can be its own reward, but you may also use other types of rewards that are motivating to you. Self help books for anxiety are listed on our website (www.dollandassociates.com), however, if you feel you are unable to cope & would like additional professional help, following up with a clinician trained in Cognitive Behavioral Therapy, who uses empirically based interventions (research supported treatment) to treat anxiety is a great idea. At times, despite our best efforts we may need some additional help to start the process of facing our fears. Remember, the goal is to learn to respond to anxiety rather than react to it.

Upcoming Events and Other Resources

Last chance for Summer Groups
Doll & Associates will once again be facilitating Social Skills groups for children and teens. Groups are starting on June 16th, so call (907-8201) for more information or to sign up.
 

Relaxation CD’s
Progressive Muscle Relaxation CD’s for adults, children, as well as other special issues such as coping with trauma and economic distress are available at Doll and Associates.