Anxiety – the Vicious Cycle

Anxiety defined
Anxiety is the fear that the present or future is too complex and dangerous for a person to survive either psychologically, socially, or physically. In the past they experienced an event or a series of events where they were unable to protect themselves from a perceived danger and they begin to become overwhelmed in future similar life circumstances. Often times these events happened when they were younger or vulnerable. This fear can be so debilitating for some that they either become paralyzed in life and/or avoid new and difficult situations. Hope that new experiences can be different and a desire to explore and grow are destroyed in leu of a desperate search for safety from danger, loss, and/or the heartache of failure.

The Physiological Impact of Anxiety
Anxiety begins as physiological responses led by the brain are experienced in the body. The brain perceives a threat, and the body is triggered into the fight-or-flight response. This ancient survival mechanism is designed to prepare and protect the person. The sympathetic nervous system (also known as our fight-or-flight response) and the hypothalamic-pituitary-adrenal axis (HPA) kick into high gear, readying the body for action. Adrenaline releases into the blood stream, which causes the pupils to dilate in order to allow in more light and speeds up the heart rate. The fast beating heart pumps more oxygen to muscles and other vital organs. The lungs relax to improve oxygen delivery and the adrenaline helps dull the experience of pain. Cortisol is also released and helps the digestive track slow down and the energy stored in the liver is activated into an energy that can be used quickly. The brain and body is ready to respond and preserve the person through action, and the anxious brain often wants to get away.

While this response is beneficial in short bursts, chronic anxiety keeps the body in a heightened state of alert. Over time, this can lead to, and exacerbate, serious health problems such as chronic pain, heart disease, diabetes, digestive issues, and a weakened immune system. Being constantly aware of every danger can be physically exhausting, making it difficult for individuals to function in their daily lives because they have spent so much energy trying to stay safe.


The Emotional Flood
The physiological symptoms of anxiety are often accompanied by a flood of painful emotions. Fear, helplessness, and panic are natural emotional responses to danger. But, these emotions can become overwhelming, making it difficult for individuals to think clearly or make effective decisions. Their preoccupation with escaping the perceived (real and imagined) danger can lead them to have tunnel vision emotionally and they will often avoid situations that lead to emotional pain, which often leads to paralysis.

The emotional distress caused by anxiety can lead to feelings of being out of control and powerless, which can further intensify the anxiety. This can create a vicious cycle where anxiety begets more anxiety, trapping individuals in a constant state of emotional turmoil. In the end, the anxious person’s primary attachment is to their safety and avoiding danger, leaving little room for multiple, competing emotions, which is a mark of emotional maturity and needed for psychological growth. Consequently, they struggle to feel emotionally connected with themselves or to others. By trying to avoid emotional flooding, they can shut down their emotional experience in an attempt to escape emotional pain. Their avoidance of painful emotions makes it harder for them to experience enjoyable emotions.


Development of Negative Thought Patterns
As anxiety persists, it begins to affect the thought processes of the client. Negative thought patterns, such as cognitive distortions, become more pronounced. Cognitive distortions are worries that spiral into terror and reinforce negative emotions. Examples include catastrophizing (expecting the worst-case scenario) and black-and-white thinking (seeing situations in extremes with no middle ground).

These types of negative beliefs become the interpretations of the emotional and physiological responses to anxiety. For instance, someone experiencing a rapid heartbeat might think, “Wow, I wonder if I’m scared about something?” or “That hill must have been steeper than I thought.” But, for the person struggling with anxiety, they may think, “I’m having a heart attack,” leading to further panic. Over time, these negative thought patterns become the default lens that they see the world through, which makes it difficult to break out of.


The Power of Avoidance
In an attempt to find relief from the physiological, emotional, and mental pain of anxiety, many individuals resort to avoidance behaviors. By staying away from the things, situations, people, or places that they find dangerous, they find temporary relief, as it allows them to escape the immediate discomfort associated with the anxiety. Unfortunately, the experience of relief teaches them that their avoidance “worked”, and they continue to employ this tactic in future situations. The relief is temporary, and they continue to use the avoidant behavior, preserving and strengthening the behavior. As time goes on they may feel the need to use even more restrictive methods of escaping their anxiety, which only leads to more restrictive and rigid behaviors.
One primary example of this type of rigidity is the use of an eating disorder to self protect from the outside world and painful emotions and preserve the self. Caroline Knapp in her book Appetites says, “It was easier to focus on my weight and food than to face my anxieties about men and life. My eating disorder became a way to channel all my fears and insecurities into something tangible, something I could control.” And later, she says, “I used my eating disorder to shield myself from the world, to create a barrier between me and the demands of life.” In the end, avoidance prevents individuals from confronting their fears and learning that their anxiety is manageable. By avoiding anxiety producing situations and employing restrictive, rigid control, they miss opportunities to build confidence and reduce their fear over time. This leads to increased anxiety in the long run, as the individual fails to learn to cope with their discomfort.

The Spectrum of Anxiety
Anxiety disorders are among the most common mental health conditions globally, affecting millions of individuals each year. It can show up in a many different ways. Some of those are addressed here.

Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder is marked by chronic, extreme worry about everyday routine life events and activities, often without an obvious reason for concern. People with GAD anticipate disaster and are overly concerned about health, money, family, work, or other issues. They find it difficult to control their worry and may experience physical symptoms like restlessness, fatigue, muscle tension, and sleep disturbances.

Panic Disorder
Panic Disorder is characterized by recurrent, unexpected panic attacks, which are sudden periods of intense fear or discomfort that peak within minutes. This panic often comes when the individual’s is fearful of their environment or their sense of their inability to handle a certain situation overtakes their nervous system. During a panic attack, individuals may experience heart palpitations, sweating, trembling, shortness of breath, feelings of impending doom, or fear of losing control. Some people go to the hospital because they think they are having a heart attack and are dying because the symptoms feel so severe.

Phobias
Phobias are intensely fearful responses to specific objects or situations that are out of proportion to the actual danger posed. Phobias are divided into specific phobias and social phobias. Specific phobias are fears of a specific object or situation (e.g. spiders, darkness, flying, heights, public spaces, etc,). Social phobias are a debilitating fear of social or performance situations where there is intense worry about being judged or negatively evaluated by others, and often there is a fear of embarrassment.

Obsessive-Compulsive Disorder (OCD)
OCD is characterized by unwanted and intrusive thoughts (obsessions) that generate anxiety, along with repetitive behaviors or mental acts (compulsions) that the person feels driven to perform in response to the obsessions. Common obsessions include fears of germs or contamination, unwanted taboo thoughts concerning sex, fear of harming others, and preoccupation with religious judgement. Compulsions might involve excessive cleaning and hand-washing, checking locks, repeating words or routines, ordering things, or carrying out activities in specific order.


Separation Anxiety Disorder
Often thought of as a disorder of childhood, separation anxiety disorder can also be diagnosed in adults. It is characterized by excessive fear or anxiety about separation from home or from those to whom the individual is attached. This fear goes beyond what is appropriate for the individual’s age, causing significant distress or impairment in functioning.

Breaking the Cycle – How Psychotherapy can help with Anxiety
The most crucial element in psychotherapy is the therapeutic relationship between the client and the therapist. When a client builds trust with their therapist, they no longer have to be stuck in their mind alone. Instead, they are able to use the mind of the therapist to gain a new perspective on their physiological, emotional, and cognitive responses to anxiety. Along with having the therapist to help them look at how anxiety is showing up in their experiences, they also do not have to hold their anxiety or the shame of their fear alone. They can explore with the therapist the origins of their anxiety and see how it functioned in the past to protect them.

The safety of the therapy can also be where the client can begin making changes to their behavior in the safe environment of the therapy office. One of the primary methods of working with any anxiety disorder is to begin doing some type of exposure work. By incrementally exposing clients to anxiety-provoking situations, at a rate that gently pushes the client’s threshold of fear, the therapist helps them experience the anxiety and it subsides, which teaches them that the situations they feared are manageable. This process reduces the power of fear and anxiety over time.

As clients achieve progressively challenging goals in therapy, they begin to build resilience. Each success reinforces their ability to handle anxiety, fostering a sense of self-efficacy and confidence. This resilience is crucial for long-term anxiety management as these experiences create a new template for how life can be different than what their body, emotions, and mind expect. With successful management of anxiety, the client develops a new lens through which they view the world. This new perspective allows them to handle previously anxiety-inducing situations with greater ease and confidence, ultimately leading to a more fulfilling and less anxious life.