Understanding Anxiety Management 1

by Stuart Sorensen – RMN

There are many types of anxiety disorder ranging from mild feelings of ‘worry’ at one end of the scale to complete panic attacks at the other. Although these extremes are very different in severity the basic ‘process’ of anxiety is the same for both. It is the awareness of this process which forms the basis of anxiety management techniques.

Let’s begin by understanding what anxiety is not. ANXIETY IS NOT OUR ENEMY. In fact, we all need a certain amount of anxiety in our daily lives just to keep us going. It’s the little ‘worries’ and trivial concerns of everyday life that motivate us to get out of the bed in the morning.

APPROPRIATE AND INAPPROPRIATE ANXIETY

The first person to meaningfully classify anxiety was the Austrian psycho-analyst Sigmund Freud. He divided it into two broad areas which are still accepted today. These are the areas of appropriate and inappropriate. Let’s look at what this means.

When we are faced with threatening situations we need to be aware of the dangers they represent. The way we recognize them as dangerous is by our feelings of anxiety. It can be thought of as a call to action warning us that something is wrong and prompting us to act. This is called appropriate anxiety because it helps us to stay safe.

Sometimes however people become anxious inappropriately. They perceive or imagine a threat which isn’t actually there. This is called inappropriate anxiety because it prompts us to act inappropriately, running away or losing control of ourselves for example.

The way to decide whether or not anxiety is appropriate is to carefully weigh up all the information logically. Also see if other people think the situation is actually threatening or dangerous. If not it’s likely that your anxiety is inappropriate. Later we’ll look at ways of combating anxiety but for now it’s enough just to learn how to recognize it. Below are some questions you can ask yourself about your anxiety.

What’s the worst that can happen?

What can I do to cope if the worst were to happen?

How likely is it that the worst will happen?

What’s most likely to happen?

Am I worrying about a problem (which can be solved) or a fact which can’t be altered?

If it can’t be altered (something in the past perhaps) is it appropriate to worry about it or should I just move on?

If the situation can be altered isn’t it better to act instead of just worrying?

Let’s look at how anxiety works – the fight or flight mechanism.

FIGHT OR FLIGHT

Anxiety is part of our natural defense system. If we didn’t get anxious about dangerous situations we probably wouldn’t live very long. The process of anxiety triggers the ‘fight or flight’ response – a vital defense system which is common to all mammals and most other animals as well. Let’s look at how the fight or flight system works.

Imagine you’re walking along a dark street at night. Suddenly from out of the shadows a large man appears with a knife and tries to stab you. You have two choices – to run away or to fight. Fight or flight.

Whatever you decide to do it’s important that your body works as well as it can if you are to survive. You need to be able to rely on your muscles to run or to fight back and you must stay alert to other possible dangers – the man may have an accomplice for example. Whether you choose fight or flight you need to be at your best in order to survive.

The body’s way of preparing us for peak performance is what we call anxiety. It involves a lot of physical changes which can seem frightening and confusing until we learn to understand their meaning. Let’s look at some of the more usual symptoms of anxiety. These can be divided into two categories – physical and psychological.

PHYSICAL SYMPTOMS OF ANXIETY

Muscle tension is one of the most common physical symptoms. It is the body’s way of storing up energy in the muscles in readiness for action. The more energy is stored the greater the tension we feel. Sometimes people experience aching muscles or a trembling sensation. This can result in uncontrollable shaking as the muscles store up more and more energy. Imagine the tension in a heavy spring as it gets pressed down. In many ways the tension in our muscles is just like that.

Of course all that energy uses fuel and the more tense we become the more fuel we need. The body’s fuel supply is controlled by breathing and blood flow or circulation. Blood is pumped around the body by the heart to provide nutrients and oxygen to the muscles and tissues. At times of anxiety more fuel is needed so the heart rate speeds up and often it feels as though the heart will ‘explode’ as it fights to keep the muscles properly fuelled. Also breathing speeds up and becomes more shallow so people begin to ‘gasp’ for breath. All this extra physical exertion provides heat and so the body begins to sweat – our natural cooling mechanism.

In order to get enough energy to the large muscles of the body such as legs, arms and the abdominal muscles blood supply to the less important areas is reduced. That’s why some people experience a tingling sensation (pins and needles) in their hands or feet. It also explains the churning stomach or butterflies sensation. That simply means that the system is working efficiently in order to keep us safe. Incidentally the need to use the lavatory is just another part of the same process. It is no more than a sign that things are working as they should.

Remember the attacker in the street we talked about earlier. You’d have a much better chance of escaping or defeating him and his cronies with all that energy stored up in preparation for fight or flight.

PSYCHOLOGICAL SYMPTOMS OF ANXIETY

 

Of course the man with the knife may not be the only problem you have. It may be that there’s another assailant or some other danger lurking just around the corner. It’s important that you stay alert and keep a constant check on your surroundings. That’s why your mind begins to hop from one topic to another. It’s checking for danger so you can have as much warning as possible if something else crops up. Sometimes we experience this constant checking as paranoia but it’s actually an important part of the fight or flight mechanism. This constant searching for things which may become a threat to us is what we call worrying. It’s also why some people seem unable to concentrate on any one thing when they’re anxious. They have to keep reviewing a large number of things in order to make sure they’re still safe. This is what we call racing thoughts.

 

SYMPATHETIC AND PARASYMPATHETIC NERVOUS SYSTEMS

Now for the scientific bit!!

The fight or flight mechanism is rather like an electric circuit. It can only be ‘on’ or ‘off’. When we get anxious and our body changes in the ways described above the system is ‘on’. That’s because of the action of the SYMPATHETIC NERVOUS SYSTEM. It’s just like flicking a switch which sets the whole system in motion.

The other side of the coin is the PARASYMPATHETIC NERVOUS SYSTEM. That’s the part which calms us down again. It’s the off switch. Once the danger is passed the parasympathetic nervous system is triggered to restore normal function to our minds and bodies.

Remember we compared the system to an electrical circuit. That’s because it can only be either ‘on’ or ‘off’. The trick is to learn how to switch the system off. That’s what we’ll look at next.

MANAGING ANXIETY

Because the system can only be on or off we don’t need to control all the symptoms of anxiety at once. In fact we can’t – that would be impossible. Fortunately for us all we need to do is control one or two key symptoms and the rest will fall into line. Remember – we can’t be half anxious any more than an electric light can be half on.

The easiest thing to control is breathing. When we are anxious we breathe rapidly and shallowly. Combat this by making a special effort to breathe slowly and deeply. This will slow your heart rate at the same time, reduce the flow of blood and nutrients to your muscles and begin to reduce the anxiety. At the same time concentrate on counting as you breathe. Slowly breathe in as you count four – slowly. Then slowly breathe out as you count four. Every time you exhale let the muscles in your shoulders drop and relax your arms as much as possible. You should find that your arms, neck and shoulders will become a little more relaxed with each breath. Do this as many times as you need to until you feel the anxiety disappear.

This technique is called quick relaxation and with a little practice you’ll find it can be done anywhere at any time without anyone else noticing. It’s also helpful to lie down for twenty minutes or so each day and either listen to a taped relaxation exercise or relaxing music. Music which has sixty beats per minute in 4:4 time such as baroque is most effective as it mimics the rhythm of a relaxed heartbeat.

Other excellent techniques which may take a little longer to learn include progressive muscular relaxation which is also known as Jacobson’s relaxation and the more advanced transcendental meditation. Your occupational therapist will be able to help you learn Jacobson’s although you may need to look further a field if you want to try TM.

In the next handout we’ll look at more of the psychological or cognitive techniques for managing anxiety.

RECOMMENDED READING

 

Lyttle J. (1986)

Mental disorder

Balliere Tindall

London

Chapter 16

Compliments of Stuart Sorensen – RMN