Anxiety is frequently confused with other feelings, especially fear. You may call anxiety “nerves” or “nervousness,” but that may be the only information you have about the condition.
What Is Anxiety?
The word anxiety has been used since the 1500s and comes from the Latin word anxius, which means worry of an unknown event. Worry then leads to a state of apprehension and uncertainty, which results in both physical and psychological effects.
Although you may not know the difference between anxiety and fear, the two terms refer to entirely different feelings. Fear is usually directed at an external danger. The event you fear is identifiable. You may fear stepping off a curb when a car is speeding by at sixty miles an hour, or when a neighbor’s dog suddenly jumps out at you.
Anxiety has no such easily recognizable source and is often called an unexplained discomfort. You may have a sense of danger when experiencing anxiety, but the feeling is vague, and if asked, you may say your feeling is related to “something bad happening,” or “losing control.”
Anxiety has physical, emotional, mental, and even spiritual effects. Physical effects include shortness of breath, heart palpitations, trembling or shaking, sweating, choking, nausea or abdominal distress, hot flashes or chills, dizziness or unsteadiness. Because anxiety is so uncomfortable, you may convert your anxiety into anger or other feelings. Emotional effects include feelings such as worry, anger, panic, and terror. Mental effects include thinking you’re going to die, or that you’re going crazy or are out of control. Spiritual effects include alienation and feeling detached and out of touch with yourself and others.
What Causes Anxiety?
Everyone experiences anxiety. It is what makes us more human than otherwise, to paraphrase Dr. Harry Stack Sullivan. This psychoanalyst created the Theory of Interpersonal Relations and taught that much mental suffering is a result of communication that is interfered with by anxiety. According to Sullivan, anxiety is a normal reaction to unmet needs and other stresses, such as disapproval (first from parents and then from oneself or others). Anxiety can also be viewed as a protective mechanism that keeps you safe from situations believed to be threatening.
Whether or not anxiety develops into a chronic condition that interferes with your life depends on your genes, your early family experiences, your ongoing stress (which can affect brain activity), medical conditions, toxins you encounter, and drugs and stimulants you take. Let’s examine these in a little more detail.
1. Your genes can contribute to anxiety conditions if you are born a volatile, excitable, reactive type of person who is easily set off by a threat. In this case, you may be especially prone to panic attacks, which are really just your body overreacting by pouring adrenaline out of your adrenal glands and into your bloodstream. This leads to a racing heart, shallow breathing, profuse sweating, trembling and shaking, and cold hands and feet as your body readies itself to either fight or flee. Since there is no real threat, you are left with the chemical reactions flooding your body. Luckily, the adrenaline released during panic tends to be reabsorbed by the liver and kidneys within a few minutes, and the attack subsides.
2. Childhood experiences can contribute to anxiety conditions if you had parents who were overly cautious or critical, if you were neglected, rejected, abandoned, incurred physical or sexual abuse, grew up in a family where one or both parents were alcoholic, or had parents who suppressed your expression of feelings and self-assertiveness.
Jeff, a kindergarten teacher, was sexually abused by his uncle, a pet store owner. Jeff didn’t seem to have any anxiety problems until he turned nineteen, when he developed phobias about animals and heights. He stayed away from high places and animals and was able to complete college and start teaching. Gradually he became unable to leave his house or even his bedroom. He found a therapist who worked with him until he was able to leave his bedroom and eventually his house. He has returned to teaching but continues to see his therapist monthly as a preventive measure.
3. Cumulative stress over many years has also been implicated in the development of anxiety conditions, and a stressful lifestyle that avoids exercise, healthy nutrition, daily relaxation, social support, and self-nurturing activities can put you at increased risk. Years of heavy smoking often precede anxiety disorders, especially agoraphobia, generalized anxiety, and panic disorder. The connection appears to be impaired breathing ability. Your serotonin level may be involved, especially if you develop obsessive-compulsive traits. There is also a theory that reduced levels of gamma-aminobutyric acid (GABA) can contribute to generalized anxiety.
There are numerous medical conditions that can lead to increased anxiety or panic attacks. Hyperventilation syndrome is a condition in which you breathe in the upper part of your chest. This results in symptoms very much like panic attacks, including light-headedness, shortness of breath, dizziness, trembling, and/or tingling in your hands. Hypoglycemia, or low blood sugar level, also mimics the symptoms of panic. Hyperthyroidism (excess secretion of thyroid hormone) can lead to heart palpitations, insomnia, anxiety, and sweating that can add to your normal anxiety. Mitral valve prolapse (a harmless defect in the valve separating the upper and lower chambers of the heart that may cause the heart to beat out of rhythm) occurs more frequently in people who have panic attacks. Premenstrual syndrome (PMS) can worsen panic attacks. Inner ear disturbances can lead to dizziness, light-headedness, and unsteadiness, any of which can add to your anxiety.
Other situations that can set off or worsen anxiety or panic include taking stimulants (cocaine, amphetamines, caffeine, aspartame), high blood pressure, exposure to environmental toxins (pesticides, food additives, lead, chlorine, fluoride, or cadmium, for example), heart failure or irregular heart beats, clot in the lung, emphysema, deficiencies in vitamins or minerals, concussion, epilepsy, parathyroid disease, Cushing’s syndrome, thyrotoxicosis, and withdrawal from drugs (especially tranquilizers, sedatives, and alcohol).
Panic attacks or phobias (persistent and unreasonable fear that results in a strong desire to avoid a dreaded object, activity, or situation) can also be triggered by past traumatic situations.
The Learned Aspects of Anxiety
Learning to be anxious starts very early in life—in infancy, if not before. You learn to sense (or “pick up”) worry when a parent signals disapproval with gestures such as frowning, tightening the lips or jaw, grimacing, or pointing fingers at you. Anxiety is a very uncomfortable feeling, and being around an anxious person can make you feel anxious, too. In this sense, anxiety is contagious.
As an infant, you learned what displeased or created anxiety in your parents, and as a result you fashioned your behavior, and maybe even your personality, to please them. You also acted in the way they approved because it reduced your anxiety—the calmer they were, the calmer you were. You learned the “good me” (what your parents approved of), the “bad me” (what your parents disapproved of), and the “not me” (aspects of living so dreadful or horrifying, at least according to your parents, that they may be dissociated and not remembered in adulthood, even when someone else points them out).
According to Harry Stack Sullivan, a feeling of anxiety is most apt to occur in situations in which your dignity and prestige are threatened by other people, and from which you are unable to escape. This includes embarrassing or unfamiliar settings.
What Are the Effects of Anxiety?
There are varying degrees of anxiety. Your ability to function is dependent on the level of discomfort you experience.
Mild anxiety can be a good thing. Without it, you’d be constantly drifting off to sleep, probably couldn’t hold a coherent discussion or achieve any of your goals. Mild anxiety is necessary for learning to take place. As mild anxiety increases, it can lead to sleeplessness, restlessness, hostility, belittling, and misunderstandings.
As anxiety increases, your perception of what is going on around you decreases. Your hands or underarms may start to perspire, pulse and respiration increase, you may have “butterflies” in your stomach, diarrhea, frequent urination, tension headaches, fatigue, and/or increased muscle tension. You may speak more quickly, or more slowly, than usual.
When severe anxiety occurs, you start to pay attention only to parts of experiences and begin to block out the threat you feel. Learning does not occur at this level of anxiety, and your attention span is short. Your chances of understanding what is happening to you or of taking reasonable action are nil. You may focus on one small detail or on scattered details from many experiences. You may perspire profusely, and your pulse and blood pressure rise even higher. You may breathe rapidly in the upper part of your chest, and your lips and mouth may be quite dry. You may stammer, speak loudly, rapidly, in a high-pitched voice, or be hesitant. You may tremble, shiver, hold a rigid posture or clench your fists.
Panic is the most extreme level of anxiety. You may blow things way out of proportion, may experience terror and feelings of unreality and be unable to communicate with other people. Because the higher levels of anxiety are so distressing, you may convert your anxiety to anger, which can bring you back to feeling in control again, even though your anger is unreasonable. You can also convert your anxiety into withdrawal by calling in sick, canceling appointments, or retiring to bed. You may convert your anxiety into physical symptoms such as high blood pressure, tension headaches, diarrhea, fatigue, or other physical symptoms.
What Maintains Anxiety Conditions
Once you develop a specific way of thinking, feeling, and coping with anxiety, these behaviors can perpetuate anxiety. You can add to you feelings of discomfort by blaming the way you feel on some external happening or some other person. When you do that, you probably feel helpless because something outside of you is responsible for your anxiety. When you begin to take responsibility for your anxiety, you can begin to do something about it.
Much of this book is devoted to helping you learn new ways to cope with anxiety. Although many actions can keep an anxiety condition going, the following are the most common and are the easiest to change:
1. Avoidant Behaviors As long as you continue avoiding situations or objects that cause you anxiety, your anxiety will continue. Avoiding a situation doesn’t eliminate it. You continue to worry and spend a great deal of energy to make sure you don’t have to confront the situation or object. The key to unlearning your phobic reaction is to approach the upsetting situation or object in small steps. Imagery and desensitization are key to this effort and are discussed in chapter 9.
2. Negative Self-Talk We all talk to ourselves in our minds. Sometimes it’s so automatic and subtle you don’t notice it. Self-talk can be positive and encouraging or can be negative and create more anxiety. It is the following kinds of self-talk that must be silenced, including: “What if I have another panic attack?” “I’ll never be able to deal with this!” “What if I lose control of myself?” “What will people think if I lose control?” “I’m having a heart attack—I just know it!” “My legs feel so weak, I can’t walk.” This kind of talking scares you even more and aggravates the physical aspects of anxiety. The good news is that you can learn to stop your negative self-talk and replace it with positive, encouraging messages. See chapter 9 for more information on this topic.
3. Mistaken Beliefs It is these mistaken beliefs that bring about negative self-talk. If you believe you are losing control, you can talk yourself and everyone else around you into believing that it’s true. If you’re programmed to believe life is meant to be hard, then you will think something is wrong when things go your way or people offer help. If you believe the world is a dangerous place and people can’t be trusted, you will live a life filled with suspicion and will veer away from taking the risks necessary to overcome many anxiety conditions. See chapter 9 for more information on mistaken beliefs and how to overcome them.
4. Denial of Feelings When you deny anger, frustration, sadness, and even excitement, you can feel more anxious and not know why. You may have discovered that after you let out your anger or have a good cry, you feel more at ease, calmer. Expressing your feelings is a good way to reduce your anxiety.
5. Lack of Assertiveness Assertiveness is the vehicle that allows you to express your feelings in a respectful but honest way to other people. If you’re not assertive, you may fuss and stew inwardly or avoid the person or the expression of how you feel. You may think it’s not nice to be open about what you want and need because you might alienate the other person. The problem with not being assertive is that it builds resentment and confinement, two feelings that aggravate anxiety conditions. You can learn to be assertive. Find out more in chapter 10.
6. Muscle Tension When you feel uptight, you have tight muscles, and this restricts your breathing, healthy heartbeats, digestion, circulation, thought, and just about all body processes. You may have learned that when your body is tense, your mind races. When you relax your muscles, your mind will slow and calm. Anxiety cannot exist in a relaxed body, so the key is to use relaxation skills to be at peace. Vigorous exercise and deep muscle relaxation can help you remain calm. See chapters 8 and 9 for more information.
7. Lack of Self-Nurturing You may have a deep sense of insecurity due to a parent’s neglect, abandonment, abuse, overprotection, negative criticism, alcoholism, or chemical dependency. Growing up in this kind of household means you never received consistent or reliable nurturing as a child and so you never learned how to take care of yourself in a loving and nurturant way. You probably feel anxious and overwhelmed by the adult demands placed upon you, and this can lead to perpetuating your anxiety condition. Learning to nurture your “inner child” is the way to grow and learn to be a responsible adult. See chapters 9 and 10 for more information.
8. Poor Nutrition Drinking lots of coffee and sodas, eating junk and fast foods, sugar, food additives, foods your body is sensitive to, and eating while doing something else can increase your anxiety. Just eliminating caffeine from your diet (including the caffeine in over-the-counter medicines) can relieve a great deal of anxiety and worry. See chapter 5 for more information.
9. Stressful Lifestyle Lack of time-management skills, not grieving losses and changes, burning the candle at both ends, smoking, drinking, and taking drugs can worsen your anxiety condition and even bring it on. See chapters 5–9 for more information on how to reduce your stress.
10. Lack of Meaning and Purpose We are all spiritual beings. If you’ve lost (or never developed) a sense of purpose for your life, something larger than immediate self-gratification, you will tend to be bored and anxious. See chapter 10 for ways to find meaning and purpose.