Being a therapist has taught me to avoid making assumptions about people’s experiences. This is actually the opposite of what some believe we do- if I had a penny for every time someone asked me “Oh you’re a therapist? Well, what am I thinking right now?”- I would be writing this from a beach somewhere. Contrary to popular belief, therapists do not read minds, although sometimes I wish I could!
However, it is easy to assume that everyone has a similar understanding of mental health expressions. In reality, there are as many experiences of mental health as there are people. So naturally, we cannot assume a single shared understanding. When we replace assumptions with curiosity, something remarkable happens: we open doors to a wealth of learning opportunities about ourselves and others. And yes - this is not easy to do!
Introducing the Anxiety Blog Series
This is why we are going back to basics, starting with one of, if not the most commonly reported mental health concern - ANXIETY.
In this series, we will take a step back and explore anxiety in its simplest form and answer several of the most frequently asked questions. Many of us have a basic understanding of what anxiety is. We can describe how it feels in our minds and bodies, and that knowledge is invaluable.
This series will increase your awareness in 3 ways:
1. Discussing what anxiety is and how it operates in our bodies
2. Answering commonly asked questions about anxiety
3. Exploring techniques on how to manage anxiety
In this first post of the series, we will cover 4 areas:
➼ What is anxiety?
➼ How it manifests, either physically and/or in our thoughts and behaviours
➼ The anxiety alarm: fight-flight-freeze response
➼ Frequently asked questions about anxiety
So, what are we waiting for? Let’s crash this course!
What is anxiety?
Anxiety is described as a feeling of apprehension, uncertainty, or fear about what is to come. We feel anxious about something that we believe is threatening, new, or important.
Experiencing anxiety is normal and healthy. We may feel it before heading into a job interview, giving a presentation at school, or asking someone out on a date for the first time. These feelings are generally mild, brief, and go away when the anxiety-inducing event is over. Do you think if you never felt anxious, you would prep for the interview or study before an exam? Generally speaking - none of us would.
However, someone with an anxiety disorder feels anxiety that is intense and more frequent, lasting sometimes hours or even days. It can get in the way of doing daily tasks and things that they enjoy. In severe cases, anxiety can prevent people from being in crowds, driving on highways, leaving the house, and even can impede them when it comes to maintaining their personal hygiene.
To break it down even further, there are 3 parts to an anxiety response:
1. Cognitive (in the mind): attention shifts to the source of the threat, causing feelings of worry
2. Physical (in the body): increased heart rate, tense muscles, shallow breathing, nausea, dizziness
3. Behavioural: engaging in behaviours that protect against anxiety (i.e. avoiding certain tasks, places, people and situations)
These parts of an anxiety response often work together. Let me help you understand this better.
A Common Example
I was extremely nervous before the interview at my current place of work - University of Toronto. I had done a ton of interviews at my previous employer (Center for Addiction and Mental Health). Given that it was going to be a drastic change in scenery (hospital to academic setting) after several years.
Finally, the day of my interview came and I felt nauseous. To help settle the nausea I filled my bottle with water and planned to sip on it throughout the interview. On my way to the interview, of course, I left my bottle on the TTC. At this time, my anxiety was a 15/10. I went to the bathroom, washed my face with ice-cold water and then gulped some down. Following that, I rehearsed my questions and responses in the bathroom. It went better than I anticipated, and they offered me the gig.
If we break it down into the 3 components of the anxiety response:
➻ Me worrying a lot about a job interview (cognitive)
➻ Led to me to feel nauseous (physical)
➻ Me rehearsing potential interview responses in the bathroom (behavioural)
Types of Anxiety
While anxiety is often used as an umbrella term, there are several types of anxiety.
Here are the 6 main categories of anxiety disorders and their brief descriptions, based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5):
Generalized Anxiety Disorder: persistent and excessive worry that is out of proportion to the circumstance
Phobias: excessive fear of a particular object, place, or activity
Panic Disorder: reoccurring episodes of intense fear and anxiety that peaks within minutes
Obsessive-Compulsive Disorder (OCD): performing specific, repeated actions to ease irrational thoughts
Post Traumatic Stress Disorder (PTSD): anxiety following a traumatic life event
Acute Stress Disorder: severe anxiety that occurs within one month of a traumatic event and creates a sense of re-living the event
While, these disorders all have specific qualities that make them different from one another, they share these features:
⤅ Irrational and excessive fear or worry
⤅ Feelings of apprehension and tension
⤅ Difficulty managing daily tasks or feeling distressed about these tasks
What does anxiety look like in our bodies?
In other words, how do you know that what you are experiencing could be anxiety? Anxiety looks different for each person. For example, some people may feel nervous and sweat a lot. Others can have intrusive thoughts, nightmares, or fear of a specific thing or place. The following information lays out what anxiety can feel like in general terms.
Anxiety can feel like this in our bodies:
Urgency to use the bathroom
Anxiety can lead to these thoughts and mental states:
Excessive or uncontrollable worrying
Thinking something bad is going to happen
Negative thoughts about the future
Anxiety can motivate these behaviours:
Avoiding things that evoke apprehensive feelings
(people, places, memories, feelings)
(double-checking locks, make sure the stove is turned off multiple times)
Alcohol and drug use
Irritation and anger
Now, if you are wondering what is happening in our bodies to evoke this complex set of sensations, thoughts, and behaviours, I've got you. The answer is actually quite simple and elegant.
The Anxiety Alarm: Fight-Flight-Freeze Response
What if I told you that our body’s anxiety response is adaptive and helpful? Yes, that's right, there is a method to this madness!
Anxiety activates the flight-flight-freeze (FFF) response in our bodies. This response occurs outside of our conscious control. It is designed for one simple purpose: to keep us out of danger.
Nerd alert: here is a summary of the sequence of events that happens to give us the experience of anxiety:
The racing heart, tense muscles, tingly fingers and upset stomach all have an explanation once you know about the FFF response.
➼ Racing Heart: your body is making sure blood and oxygen is pumped to major muscles, giving you the energy to act fast
➼ Tense Muscles: tensing up your muscles puts them in a ready position, so you can spring into action
➼ Tingly Fingers and Toes: blood is being re-routed to bigger muscles, leaving your fingers and toes feeling cold or tingly as blood moves away from them
➼ Upset Stomach: your body slows down non-essential functions like digestion, so it can put all its resources into dealing with the threat
This response happens instantaneously. It’s what makes us move out of the way of a moving car, protecting us before we even realize what has happened. How incredible is that? Our bodies deserve some credit!
So, anxiety is normal, adaptive, and even necessary. A little anxiety can be motivating and help us perform better. As a student, my anxiety was a constant companion during exams and helped me get off Netflix and open my books!
When does Anxiety become a problem?
If the symptoms of anxiety are persistent and cause levels of distress that affect your ability to study, work, socialize, and carry out every day tasks, it may be more than a healthy level of anxiety.
Here are 3 ways health professionals may identify if your anxiety has become an anxiety disorder, such as Generalized Anxiety Disorder (GAD):
For at least 6 months, you are spending most days feeling excessively worrying about things that are out of proportion to the actual threat or risk
It is difficult to control the worrying and manage the distress
The anxiety or worry is accompanied by 3 or more of these additional symptoms for the past 6 months:
⤅ Feeling tired all the time
⤅ Difficulty Concentrating
⤅ Body pain (back pain, headaches)
⤅ Sleep issues (difficulty falling asleep or sleeping too much and not feeling rested)
What is a panic attack?
A panic attack is your fight or flight system active in its strongest form. It feels like a rush of anxiety symptoms, all at once, and can be quite debilitating. During a panic attack, you may experience:
➻ Trouble breathing
➻ Chills or hot flashes
➻ Dry mouth
➻ Distress and fear
While some may experience panic attacks, others may have chronic worry over a long period of time. Your unique experience of anxiety matters, and you are certainly not alone. In 2013, approximately 3 million Canadians above the age of 18 reported having an anxiety or mood disorder.
Frequently Asked Questions About Anxiety
You know those questions that you've always wanted to ask but didn't want to do it in front of others? I pulled up a few of the most commonly asked questions from google on anxiety and thought it would be a good idea to list them here. If most people are searching for it on google, chances are these questions might have crossed your mind as well.
Question: Can my anxiety be cured?
A permanent cure for anxiety sounds like a tempting idea. However, its not as simple as yes or no. Anxiety can be managed with psychotherapy, medication, and lifestyle changes in diet, exercise, and stress levels. It is a work in progress for most of us. By consistently practicing anxiety management strategies, some of us may be able to reduce anxiety symptoms and lead a very healthy lifestyle. Or, you may do all of the above and just get to a point where you can manage on most days. Dealing with mental health issues is a highly personalized experience because every one of us has unique upbringings, coping styles, and exposure to adversity. Therefore, a one-size-fits-all formula simply will not do.
Here is something else to consider: anxiety is more than a list of symptoms. Its reoccurring nature tells us that the symptoms are red flags for underlying issues. Sometimes these take the form of natural changes over the course of the life span. Therefore, as we move through life, our anxiety levels may dip and rise accordingly.
Eliminating anxiety entirely may not be beneficial for us- it's adaptive and helpful, sometimes even life-saving. Perhaps a 'cure' isn't what we should be aiming for. Managing your anxiety in a way that works for you is a healthier and more compassionate mindset to adopt in your mental health journey.
Question: Can my anxiety cause depression?
Anxiety and depression can commonly occur together. They have also have similar treatment approaches and are both responsive to psychotherapy, medications, and lifestyle changes. Research tells us that co-occurring anxiety and depression may require closer management because it is associated with slower recovery and more frequent recurrence.
There is no conclusive evidence in the research that one causes the other, however. This concern makes sense because many of the symptoms of depression overlap with anxiety! We encourage you to talk to a health professional to discuss your specific symptoms.
Question: Can my anxiety affect my baby?
Our friends and family members often tell us to relax during pregnancy, because stress is not good for the baby. There is some degree of truth to this. Research has shown that high levels of anxiety in pregnancy can have adverse effects on the mother and baby. Earlier in pregnancy, very high levels of anxiety can increase the chances of fetus loss. In the 2nd and 3rd trimesters, the baby can experience a decrease in birth weight. Researchers say that it can also affect maternal-bonding when the baby is born.
Keep in mind that pregnancy is a time of remarkable physical and emotional changes. Some of these changes can be welcome, while others may be quite stressful and overwhelming. It is natural to have some worries during pregnancy. However, if these worries start to interfere with your ability to go about your day, there may be concerns with managing your anxiety. Once again, we encourage you to talk to a health professional if you are concerned about you and your baby's wellbeing.
Question: Can my anxiety cause heart attacks?
The heart palpitations that go along with feeling anxious can feel overwhelming and scary. Panic attacks, which may occur in people who have panic disorder, are often mistaken for heart attacks. A panic attack can mimic a heart attack, with both causing dizziness, sweating, and shortness of breath.
Harvard Health Publishing provides a short guide on determining if what you are experiencing is a panic attack or a heart attack. However, always consult your doctor if you are concerned about your health.
If you are experiencing the following symptoms, it is more likely a panic attack:
The pain is stabbing and "needlelike"
The pain and discomfort tend to occur in the centre of the chest
Chest pain and other symptoms decrease quickly
The reassuring news is there's a lot that you can do to help manage your anxiety! We are here to help. The first step in solving any problem is developing a better understanding of what the problem is in the first place along with identifying possible underlying causes. Hopefully, this first part of our series on anxiety helped in that regard. Stay tuned for the rest of the series.
Next up: we tackle common questions and myths about anxiety
If you have a question or would like to hear more about a topic, leave a comment below or flip me an email.