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, worries, 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.
The funny thing about worry and anxiety is that it usually feels quite reasonable at the time. “Of course I am worried about flying. There was that plane crash last year.” “Some spiders are poisonous. It is reasonable not to be able to stay in the room with that one.” But you also know intellectually that flying is safer than driving, that most spiders are annoying, but not harmful, and that your nervous system is on hyper-drive. And as much as you reason with yourself, the anxiety seems to get worse. You start to void the thing that you are afraid of. This is a phobia. When you become phobic, it is useful to seek help to learn exactly what sorts of thought changes or physiological processes will actually overcome the phobic response.
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. Some people even fear that they will die from a panic attack, not realizing that this is not a heart attack. It certainly can feel just like one–enough to send you racing to the emergency room. Then, 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. You do not realize that you have now developed a phobia of having a phobia!
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. Social phobia generally stems from a fear of being judged, and can be treated with cognitive therapy. You can learn to be comfortable speaking in public!
Anxiety can become obsessive. While most people have at least some things that we worry about and certain routines that they follow daily, such as eating dinner at the same time every evening, going jogging every morning at 6 a.m., 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; washing your hands a certain number of times or counting things repetitively. Part of you knows it is silly, but another part forces you to participate to feel safe and make the anxiety go away. The thought is an obsession, and the behavior is called a compulsion. These processes can greatly interfere with your enjoyment of your life.
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. This is called dissociation. But when the incident is over and life should be returning to normal, you might find yourself 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. It represents the fight/flight system gone awry. You are stuck in the feelngs of the trauma long after it has ended. To feel better, your nervous system needs to discover that you are now safe.
Generalized anxiety is characterized by persistent and unrealistic worries. Worries become your 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. Get off the wheel; it is not going anywhere! Ah, if only it were that easy. But you can learn to get your mind out of the wheel of excessive worry.
As is probably obvious from the above, there can be considerable overlap among these types of anxiety problems. 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.
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. The primary treatemnt for obsessions and compulsions is called “exposure with response prevention.” This sounds worse than it is. But, to recover, you eventually have to face the things that you fear. Combining cognitive,behavioral, and autogenic techniques creates an efficient means of conquering your anxiety.
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 you 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 that arise in your life.
With reduction in anxiety symptoms, you will experience improved self-acceptance and a greater sense of mastery over yourself, your life, and your future. Elimination of unnecessary fear removes artifical, self-imposed restrictions on your career choices, social life, and romantic and other human relations, allowing you to more fully realize your potential.
Center for Conscious Living
Dr. Carol B. Low Psy.D.
1813 N. Mill St., Ste. E
Naperville Illinois 60563