This is Part 1 of my series of articles on anxiety.
One of the most common presenting problems that patients come to my office with is anxiety.
- Some people are anxious in social situations.
- Others may worry excessively about physical symptoms, thinking that they may have a heart attack or collapse.
- Another common theme is unwanted intrusive thoughts that cause a great deal of anxiety and stress and interfere with the person's life.
- Some people are fearful of specific objects or situations (seeing blood, riding in an elevator, taking a subway, etc.)
- And sometimes people seem to worry about everything! They worry about the safety of their loved ones, health, work or school, and the future.
When I ask those patients at the first session what they would consider a good outcome of our therapy, they usually say: I want to stop being anxious. Interestingly, it does not matter if they are old or young. Kids, teens, and adults all plead for the same thing: NOT. TO BE. ANXIOUS. PLEASE.
And then I go ahead and disappoint them. Taking a chance that I will lose them as patients forever. I tell them the bad news: Getting rid of anxiety is both impossible and inadvisable.
And sometimes I sheepishly add, I'm sorry!
Then I wait and watch. If the patient does not storm out of the office in righteous fear, I consider the prognosis favorable and continue with the good news: Anxiety does not have to remain a problem. You don't have to continue to allow it control your life.
And then I put on my old dusty* CBT-therapist hat and we get to work.
The first step is:
But first a little disclaimer: For simplicity sake, I will use the words Fear and Anxiety interchangeably. But for the word-perfect among you (no, not the Word Perfect software), they are technically not exactly the same.
Fear is a response to an immediate, or definite threat - real or perceived.
Anxiety is a feeling we may get when contemplating a vague and uncertain potential threat, kind of a possibility of a threat. Basically, anxiety is more of anticipation of something bad happening.
So fear is a response to an immediate danger, and anxiety is a response to a possibility of something going wrong in the future.
But honestly, I bet if you are fearful of something, you'll be anxious about it too. And if you are anxious, you must be pretty fearful. So one can (and likely will) lead to the other and they'll probably coincide most of the time. Moreover, fear and anxiety evoke the same physiological response.
There are a few things that you need to know about anxiety:
1. We are Wired to Be Fearful
Anxiety is normal.
Did you know that our brains are wired in a way that makes it very easy for us to be scared? At the center of our brain, in the limbic system, there's an almond-shaped structure called the amygdala.** The amygdala's job is to quickly warn us of danger.
While the positive thinking is a very fashionable and sexy topic these days, let me tell you something not so sexy: We are wired to be negative.
What? How can it be? What about Oprah? And the laws of attraction?
Well, hear me out.
When our ancestors had to decide whether the rustling in the bush meant that there was just a mouse in the bush or a tiger, they had to decide real fast. (And, hopefully, use the amygdala for help).
The negative thinkers among them likely kept thinking time after time that it must be a tiger. Those pessimists also likely kept running away for their dear life every time. If they were always wrong, they either became pretty physically fit or came to become the tribe clown.
The positive thinkers, on the other hand, may have optimistically decided that it must be a mouse. I would be very interested to know if they hoped the Laws of Attraction were on their side. Unfortunately, I will never satisfy my curiosity on this matter. Why? Because even if they were wrong only once, they never lived to tell their tale. Or to pass their genes to future generations for that matter.
Basically, anxiety gears us toward numerous harmless false-positives and helps avoid that one devastating false-negative.
My point here is that we have come by it honestly. We are probably more likely to be the surviving descendants of negative people. Sucks, I know. And a warning: Please don't share this last little factoid with your mother.
2. Anxiety Keeps Us Safe
Anxiety is helpful and adaptive. It is necessary for our survival. It protects us from dangerous situations, from doing stupid things (hopefully), and even from embarrassing ourselves (if we are lucky).
Fear activates our Sympathetic Nervous System, which triggers a "fight or flight' response. When we are in danger, this system takes over, and we are able either to defend ourselves or escape real fast without thinking.
This is what allows us to survive. And this is why I strongly discourage my patients' (understandable) quest for getting rid of anxiety.
3. Anxiety is Common
According to the Anxiety Disorders Association of Canada, the 12-month prevalence of any anxiety disorder is over 12% and one in four Canadians (25%) will have at least one anxiety disorder in their lifetime.
Every living organism experiences anxiety. Even a sea slug has it!
4. Anxiety is Not Dangerous
People suffering from anxiety often believe that it is dangerous and harmful. But the reality is quite the contrary. It is our ally. We just have to not let it get out of hand.
The bottom line is that all of us living beings need anxiety for survival.
I guess, this leaves us with a Love/Hate relationship with anxiety for now.
In Part Two of this article, we will talk about the main causes of anxiety.
*Actually, the said hat never ever gets dusty as I use it daily.
**Really there are two such structures. And for the trivia buffs, the plural form is amygdalae. So we are all the lucky owners of two almond-shaped amygdalae that keep us super-safe!