You can experience more than one type of anxiety. Here are tips to cope

Anxiety can be overwhelming and all-consuming. One patient with severe anxiety told me, “Nothing feels safe, and I feel there are no grown-ups left in the world.”

Another patient would feel terribly anxious whenever she thought anyone said something critical about her. She compared it to someone “poisoning” her mind, as she would replay the words over and over, making it impossible to do or think about anything else. This led to her isolating and calling out from work until her mind would settle.

During anxiety the “emotional brain” is overactivated, overriding the “thinking brain”.Credit: Getty Images

If certain cues set off a cascade of worry and stress, we may fixate on them and magnify their meaning, keeping our mind and body on overdrive. This can make it hard to think our way through situations. Our thoughts can be emotion-driven, negative, repetitive and hard to change (what has been termed “perseverative cognition”).

Neurobiologically, during anxiety, the “emotional brain” (including areas such as the amygdala, which determines the quality and strength of our emotional reactions) is over-activated, overriding the “thinking brain” (which includes areas within the prefrontal cortex or PFC, responsible for limiting amygdala activity).

As anxiety increases, we have less access to the prefrontal cortical areas that would allow for flexible thinking. In such instances, the amygdala takes over, stimulating other areas to release stress hormones such as cortisol and noradrenaline, preparing the body and mind for the perceived threat.

This state of alertness and rigid thinking can dominate our lives, making it hard to feel settled and keeping us in a constant state of worry.

Anxiety can also disrupt sleep since it is hard to shake off these troubling thoughts at night. When sleep is limited or fragmented, the brain may prioritise consolidating negative experiences and fear memories during the sleep we do achieve. This can strengthen pessimistic outlooks.

Many patients report their anxiety peaks upon awakening, feeling dread about the day ahead.

There are many ways in which anxiety can manifest, and oftentimes people’s experiences don’t fit neatly into a certain category. Here are some common ways in which anxiety can be felt.

Social anxiety

In social anxiety we might be concerned about being judged, imagining others are scrutinising us. Such beliefs can be fuelled by a “negativity bias”, which impairs recognition of people’s actual intentions and mind-set, reinforcing skewed beliefs.

As a result, we may behave in ways that limit our exposure to others, minimising social interactions and situations that would direct too much attention onto us. When the fear of shame or embarrassment is great, we may go to extremes to avoid any social engagements. Several patients struggling with social anxiety have shared their relief at being afforded opportunities to work remotely.

Generalised anxiety

In generalised anxiety, there may be several recurring situations or stressors constantly driving anxiety (such as work and home obligations, deadlines and bills), leading to a persistent state of worry. Generalised anxiety is also marked by body-related symptoms such as muscle tension, fatigue and restlessness.

While other forms of anxiety are often attributed to specific stressors, generalised anxiety can feel more diffuse, with an ongoing feeling of unease that may not be attached as readily to any one thing. Patients who have generalised anxiety often report that “everything, anything” is cause for worry, making it hard to find satisfying coping strategies.

Panic attacks

One of the most distressing forms of anxiety is a panic attack, marked by a surge of intense fear or discomfort that can peak within minutes, as well as strong effects on body and mind – for instance, a fear of dying or losing control, chest and abdominal pains, shaking, increased breathing, heart pounding, sweating and feeling lightheaded.

Panic is so overpowering that brain activation can go into “survival mode,” stimulating areas such as the periaqueductal grey, which drives behavioural responses along the fight-flight-freeze spectrum, such as paralysis or freezing, or escape strategies.

Some panic attacks are linked to situations or circumstances. However, if someone has had one before, there may be significant concern about having another, given how distressing they are. The person may have a panic attack driven by worry about having a future panic attack.

Phobias

The idea of engaging with objects or environments that cause us fear or worry can lead to life choices that are dictated by “negative reinforcement” strategies (behaviours aimed at removing or avoiding unpleasant feelings).

For instance, someone with a phobia of needles or seeing blood may refuse to seek medical care, given the possibility of lab work. Or, someone with a fear of busy roads may turn down a promising job because the commute would require driving on a highway. These behaviours may limit anxiety, but there can be significant trade-offs.

Helpful coping strategies

When anxiety takes over, try these methods:

Give yourself a break. There is no way to fully control our reactions to our environments. We all have limitations and individual responses to situations. Respecting how our minds operate, as opposed to trying to change them at all costs, can help us nurture self-acceptance.

Lean in, as you can. As self-acceptance grows, we may find small, sustainable ways of “inviting” anxiety and sitting with it, as opposed to avoiding or getting rid of it. Creating an “exposure hierarchy” can help map the pattern of our anxious responses and find acceptable ways to engage with distressing cues. For instance, someone with a fear of elevators may have “standing outside a building with an elevator” first on the list and “entering a packed elevator” last, with several intermediate steps.

Find a middle space. Anxiety-driven thinking is hard to redirect, keeping us stuck in unchanging thought loops. Finding ways to view thoughts as just that (“thoughts”) instead of absolute reality can create distance from our troubling mind-set. We can write down our “automatic thought records” – responses to stressors (including anxiety-driven cognitions) – and alternative ways of thinking about the situation (for instance, what we would tell a friend who was having anxiety and negative thoughts in similar circumstances). That perspective can serve as an “inner compass” we can access when we are anxious, helping reframe rigid cognitions amid difficult circumstances.

Washington Post

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