When people say to me, ‘I have anxiety’, I usually ask them ‘what is anxiety? Why do we get anxious?’ What I often get is ‘it’s worrying…it’s debilitating…it’s horrible…anxiety is when I can’t do anything’. If I ask ‘what is the function of it?’ A typical response a lot of the time is; ‘I don’t know, I just want to get rid of it’. This someone probably has not had a conversation about their anxiety before. Although my interaction with people may be relatively short, I always do my very best to make sure they leave their time with me with a bit of knowledge on what anxiety is. It’s great that there is so much mental health stuff out there and we are living in a time where there are campaigns to end stigma and raise awareness that have done so much to put mental health onto people’s radars. I worry however that the word just doesn’t reach a lot of people. I worry that anxiety, rather than being accepted as part of being human, is seen as something not meant to be there. As individuals, organisations, social enterprises, charities and as communities we all have a responsibility to bring people together, to ensure we are all connected and to ensure we all know a little more about looking after our wellbeing. So let’s learn a little more about anxiety.
So what is anxiety? Anxiety is something your body does that has a whole range of physiological and psychological responses. It turns you up and makes you feel uncomfortable and think in a more narrow and cautious way. It does this because our body is trying to keep us safe and out of danger. There is a very blurred line between anxiety and stress (read blog on stress here). Stress tends to be the physiological responses when faced with a stressor for example, sleep deprivation, having lots on your plate or looming interview where there is a range of physiological changes including a range of emotions including anxiety, but also low mood, anger, frustration, irritability and restlessness . Anxiety on the other hand can come up with or without a stressors and is that uncomfortable feeling that something is wrong and words to describe it might be nervous, anxious, panicky, scared, fear or dread. Alongside these emotions there will be a range of anxious feelings and thoughts with a tendency to worry, overthink, catastrophise and jump to conclusions. Prolonged stress and prolonged anxiety both have a similar impact on our body which can lead us to be burned out, depleted and functioning below optimal. Frequent stress can lead to long term stress and frequent anxiety can lead to long term stress too.
Why do I get anxious? I often reference our emotions as being the end of an evolutionary arms race. Every one of your ancestors was kept alive because of anxiety and the changes it causes to their emotions, thoughts and the rapid decision making and blunt problem solving that anxiety creates. Nature rewarded the careful, cautious and overthinkers and killed off the overly reckless and rash. Evolution doesn’t care about how you feel. It just cares that you survive and pass on genes. So anxiety is an alarm for danger, however it’s not that simple. Being humans with large supercomputers on our shoulders we didn’t get to the here and now just by being anxious about danger, there is a lot more to it. Imagine you are a hunter gatherer 50,000 years ago, living in a world at the peak of an ice age. You are going to have a surge of anxiety when an animal attacks you obviously, but have a think about what else would make you anxious? Running low on supplies, lack of shelter, storm coming in, lack of food, being ostracised from group, how you are seen by others, competition, finding a mate, having an injury or illness, bad memories and trauma, poorly loved ones, the upcoming hunt or gathering season, the other tribes out to get you, and likely a lot more. If you think about it a little more and transcribe these hunter gatherer anxieties over the present day, the stuff that makes you anxious owes its origins to the same sources of anxiety that our hunter gatherer experiences. For example you may be anxious about how others see you, anxious about your home, anxious about security, about making ends meet, the future, past trauma, taking on a new challenge , and so on.
When does anxiety become a problem? Anxiety can just be a sense of anticipation, a sense of nervousness and given an anxious trigger, these symptoms are probably very normal. However, sometimes this feeling of anxiety can be severe and can stop you from doing things completely. It can be severe to the point where you later burnout, where you cannot sleep as well, when your appetite is switched off or you’re binge eating later to compensate for not eating. Anxiety tends to be a problem when it grows and you cope with this growth in a way that probably isn’t addressing the problem. When there is a trigger for anxiety, like seeing a spider on your floor, you deal with your anxiety by getting away, or avoiding the thing making you anxious or maybe you can get help from someone else. Each time you avoid or cope with a problem that isn’t dealing with the problem, guess what, it grows. Next time you see a spider, you’re a little more anxious and need to do a little more to get rid of the anxiety. This forms a cycle. Now you feel a bit more scared of spiders. Next time you’ll probably do the same thing to cope. When anxiety is a problem, it is all about the impact. If your anxiety is impacting your life to the extent where it’s stopping you from doing something, maybe it’s a problem for you. Imagine you are struggling to talk to others and recently have avoided going to social events and don’t engage with colleagues/customers/clients etc. It is starting to impact your social life and work. You can ask yourself a little question to see if it’s a problem. I wouldn’t recommend comparing yourself to others usually, but in order to just get you thinking outside the box Imagine someone in your life who is just a reasonable human, no one exceptional. Just an average Joe. Ask yourself ‘would Mr A Joe be feeling, thinking or doing the same as you? Would they be debilitated by anxiety? Would they be cancelling social events, cancelling seeing clients or avoiding having conversations with people? Chances are they’ll just be cracking on with occasional bouts of anxiety. If you find that you’re doing things a lot different to Mr. A Joe, perhaps there’s a problem.
What anxiety disorders are there? There are quite a few. Remember that anxiety isn’t a disorder, an anxiety disorder is a disorder. It comes in a range of shapes and sizes and anxiety is involved in a lot of other problems too. I’m over simplifying here but anxiety disorders can be defined to some extent as a fear of something and this fear is out of proportion. Here’s a few: social anxiety – fear of social situations and performances, generalised anxiety – fear of uncertainty leading to excessive worry about lots of things, panic disorder – fear of panic, post traumatic stress disorder – fear of a reexperiencing a terrible traumatic memory, specific phobia – fear of specific object or specific situation, and health anxiety – fear of getting ill or fear that that a physical symptom is a sign you’re really ill. Finally, there is Obsessive compulsive disorder, where there is a little more to it. OCD is fear of something horrible going wrong that’s your responsibility, but this is out of proportion. Sufferers will get intrusive thoughts and are compelled to do something to cope. For example, excessive germ related thoughts/images and compulsion to hand wash in a certain way to the nth degree. Again, these are massively over simplified and each disorder sits on a spectrum of severity, often overlapping with other disorders and problems.
When should I get help? There is no exact threshold where on one side is ‘I can deal with this myself’ and on the other ‘I need help’. Remember Mr A Joe who for all intents and purposes does not suffer from an anxiety disorder. First recognise that they are human and will experience anxiety. How would Mr A Joe deal with things that make them anxious? Would they need to proofread every email dozens of times? Would they worry about heading to the shops because of a hypothetical danger? Will they retch and be physically ill in anticipation of a social event? Probably not. They will be anxious often, but it will not necessarily have an impact on their day to day life. If you find yourself thinking, ‘jeez that’s a bit extreme of me…hypothetical A Joe would definitely not do this’, maybe anxiety is playing a bigger part than you think. Some other Q’s to ask yourself; ‘if I continue as is for 6 months, a year, 3 years, what will this look like?’ Maybe this Q conjures dread, worry, a sense of hopelessness. If it does, maybe learning more and getting help is worth doing. Another Q is to ask yourself, ‘what impact is anxiety having on my life?’ Do you avoid things, cancel plans, carry out behaviours or cope with day to day tasks by carrying out safety behaviours? A safety behaviour is something you do in order to help you cope when doing something anxiety provoking. For example, I’ve known people in the past to always have water on them just in case they need to talk to someone and want to prevent having a dry mouth and sounding anxious. I’ve known people to have hoods up when out to avoid being seen when in a shop. Safety behaviours come in a range of shapes and sizes. They can be helpful in the short term but in the long term gradually erode self confidence and increase anxiety.
What does help look like? Most approaches to helping people get over anxiety is all about giving you a gentle push out of your comfort zone. One reason you may be anxious is that you’ve tried to operate inside your comfort zone for a bit too long. Comfort zone feels nice. When you step inside it it feels like a relief. It’s this relief that is often the problem. Feel a little anxious, avoid and get relief. Along the way you probably have learned that you cannot cope, have lost a bit of confidence, resilience and have gradually lost what you had before. Help will be there to get you to the point you learn you can cope despite a little anxiety. When you are outside your comfort zone, the circle widens, then a little more and a little more. What the help is will vary depending on where you live and your local services, but this could be a course, some short term 1:1 work, self help options, or a range of Cognitive Behavioral Therapy informed interventions for specific anxiety disorders. As always speak to your Dr, mental health worker at your surgery or visit local MIND who offer help or make suggestions about the next steps.
In Wales you can use a free online CBT platform called Silvercloud (read the small print). You can also access more information on SilverCloud through your relevant health board website. This might also be available elsewhere across the UK, so check with your local health services. Silvercloud is a great gentle approach if your difficulties are not too challenging and you’re able to engage in a bit of self help. As always, I rabbit on about the Overcoming book series, check out Overcoming anxiety by Helen Kennerly (she’s a bit of a don when it comes to CBT!). There is also an Overcoming book on lots of specific anxiety disorders too, however, I wouldn’t recommend self help for a specific anxiety disorder without having a chat with someone first, just in order to make sure you’re addressing the right problem for you.
Remember, to be human is to experience all emotions. This includes being anxious from time to time. This anxiety shouldn’t stop you from doing what Mr A Joe would be able to do. If it does, there is a lot of help out there and you’re not alone in asking for it.
About the author
Paul Regan
I have been working as a mental health nurse since 2016 and have been around the block working in a lot of different areas. At present I work in a service where I assess people and provide interventions. I love my job, I love learning and talking to people about mental health and wellbeing. This article represents my personal opinion and is certainly not medical advice. If you have concerns about your mental health please speak with a GP or health professional.
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