Mar 2, 20237 min read

Anxiety

By: Troy Weeldryer, LMSW

You may have noticed at your last primary care physician (PCP) appointment that you were asked questions related to depression during a routine office visit. These might include questions such as, “Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things.” This is known as a depression screener, which helps your PCP determine if someone might be experiencing depression. Recently, a non-governmental independent panel of experts (US Preventive Services Task Force) published a draft recommendation for regular screening of anxiety disorders for all adults aged 64 and younger. The UPSTF has made this recommendation due to the high rates of anxiety reported by Americans and because anxiety disorders are often missed by PCPs.

Clearly, the medical field is becoming more aware of anxiety disorders and their impact on people’s health. But what does it mean to have an anxiety disorder? In this blog post, I will talk about what anxiety is, what it isn’t, and what distinguishes normal anxiety from an anxiety disorder. I will also touch on both evidence-based and non-evidence based treatments for the disorder as well as common but ineffective ways people often try to treat severe anxiety.

What Anxiety Is and Isn’t Anxiety is often associated with the emotion of fear. However, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, “(f)ear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.” In other words, fear is a reaction to something threatening that is immediately happening while anxiety is worry about something that might happen in the future. To keep things simple, I am going to just use the word “anxiety” going forward to describe both fear and anxiety responses.

Anxiety shows up in both our bodies and our minds. The physical sensations of anxiety might include sweating, pounding heart, shallow breathing, stomach pain, muscle tension, chills or heat sensations, choking feelings, chest pain, shaking, numbness, restlessness, feelings of shortness of breath, feeling faint, and/or dizziness. The psychological or thought-based symptoms might include persistent worry, racing thoughts, fear of losing control, fear of dying, difficulty concentrating, and/or feeling irritable.

In recent decades, research using technology like functional magnetic resonance imaging (fMRI) has shed light on the parts of the brain that are involved in a number of mental health conditions. From this research, we now know quite a bit about what causes the sensations we associate with anxiety. The amygdalae, two small structures deep in the center of our brains, seem to be involved in sending signals to the rest of the body to produce the physical aspects of anxiety. You can think of the amygdalae as your body’s fire alarm system. When it detects “smoke” (something it perceives as threatening), the alarm goes off and your body’s nervous system automatically responds by mobilizing all its resources to either fight the threat or run away from the threat (the fight-or-flight response).

Think about this scenario: imagine one of your ancestors walking in the woods and suddenly seeing a mountain lion cross their path. Their brain wasn’t going to stop and think, “I wonder where this kitty came from? I wonder if it’s tame?” In fact, their brains weren’t going to think much at all, except maybe a thought of, “Let’s get out of here!” Their body would then react by stopping less important body functions like digestion, pumping blood harder, and quickening their breath to help them move faster and get to safety. Once they were able to escape, your ancestor might have been less likely to take that path again, or might have developed some kind of plan to keep them safer like bringing weapons or friends with them next time to protect themselves. This is an example of how worrying

about what could happen in the future (the psychological aspect of anxiety) also kept our ancestors safe and prevented further harm.

It’s pretty clear this alarm system is necessary to keep us safe. Anxiety is thus a normal part of the human experience and is “hard-wired” into our biology. We could not get rid of anxiety even if we wanted to. Having anxiety doesn’t mean you are broken, wrong, or “crazy.” Experiencing anxiety from time-to-time means that your body is working normally.

What is the difference between normal anxiety and disordered anxiety? Having anxiety regularly does not necessarily mean that someone has a disorder. Having an anxiety disorder means that a person’s anxiety must have been occurring for more days than not for the past 6 months or longer and is severe enough to impair their day-to-day living and cause significant distress. The anxiety must also not be caused by another illness or due to substance use or medications.

Anxiety disorders can appear as generalized or non-specific anxiety disorders, anxiety about specific fears like phobias, separation, or social interactions, and obsessive-compulsive disorders. These will not be explored in depth here, but there are many good informational resources available online, such as the National Institute of Mental Health , The Anxiety and Depression Association of America, and the National Alliance on Mental Illness that discuss the differences between these disorders. Please also contact us at Nizhoni Counseling to get set up with a professional counselor or therapist who can properly diagnose the type of anxiety disorder.

1 Some people are born without amygdalae or have other neurological conditions that impact their ability to feel fear and anxiety. These people cannot live “normal” lives and must be monitored constantly due to their increased risk of getting into accidents or dying. See https://www.wired.com/2010/12/fear-brain-amygdala/.

Treatments for Anxiety Disorders Regardless of the type of anxiety disorder, there are many effective, evidence-based psychological and medical treatments available. Psychological treatments for anxiety include psychotherapy, where you work with a licensed psychotherapist to learn and practice relaxation techniques, breathing retraining, mindfulness exercises, and safe exposures to feared situations. Psychotherapy may be done in individual and group settings. Evidence-based psychotherapies for anxiety include Cognitive-Behavioral Therapy, Exposure and Response Prevention, Acceptance and Commitment Therapy, and Mindfulness-Based Cognitive Therapy. Your psychotherapist will let you know which therapy they primarily practice, but all of the therapies above have been shown in research to be effective in treating disordered anxiety.

Medical treatments for anxiety include medications like benzodiazepines and antihistamines. These medications work by “numbing” the receptors in your brain that respond to the alarm signals sent by the amygdalae. You might think of these medications as hitting the snooze button on the alarm. Overuse of these medications prevents your brain from learning that experiencing anxiety does not necessarily mean that there is a threat. They do not “cure” disordered anxiety and frequent use of benzodiazepines can result in dependence. This means that stopping these medications suddenly can result in withdrawal symptoms, which often means experiencing more intense and prolonged anxiety (this effect is known as “rebound anxiety”). Please be sure to consult with a medical professional before starting or ending any anti-anxiety medications.

Other therapies that may be helpful for anxiety disorders include acupuncture, yoga, energy work/Reiki, cranial-sacral therapy, chiropractic, and massage therapy. These are not evidence-based therapies2 but may be helpful as complementary or add-on services to evidence-based therapies. Consulting with trusted religious leaders or doing personal spiritual work can be healing for people living with disordered anxiety.

What Does Not Work Anxiety is an unpleasant emotional state to be in, which understandably leads people to try to escape or avoid their anxiety. Unfortunately, constantly avoiding anxiety often results in people making large changes to their lives to accommodate the anxiety, impacting their health and happiness. It also tends to lead to more anxiety, as the nervous system does not get a chance to learn that things that we associate with anxiety (like thoughts and worries) are not necessarily dangerous. Avoiding anxiety can also lead people to misuse anti-anxiety medications or other substances like alcohol or opioids that numb the nervous system, leading to substance dependence and even more unmanageable anxiety.

Mindfulness: The Right Tool for the Job

When we try to avoid anxiety, it is like using a shovel when you need a ladder. A shovel can be a very useful tool, but if we are already in a hole, it doesn’t make sense to keep digging. Regularly practicing mindfulness is like climbing the ladder back into our lives. Earlier, I mentioned mindfulness as one of the skills taught and practiced in psychotherapy. Here is a brief mindfulness exercise you can try right now:

Begin by sitting upright in a chair with your feet on the floor, breathing normally and easily. Bring your attention to any areas of your body that feel tense or strained and gently let go of the tension. Imagine yourself sitting beside a calm stream in a forest. It’s fall, and the leaves are falling into the stream to be carried away by the gentle current. Imagine placing each of your thoughts on the leaves as they float by. Notice when your mind starts to wander, and then return to placing your thoughts on the leaves as they float away. Practice noticing and allowing your thoughts to happen for the next few minutes.

Mindfulness is a practice and a skill that all people can cultivate. There are many ways to practice mindfulness and it can be done at any time or place (it’s also free!). If you are used to using the shovel, it may take some time to learn how to use the ladder effectively. A trained psychotherapist can help you learn a variety of techniques and support your practice. Keep climbing!

Conclusion Anxiety is a normal human emotion that keeps us safe. Avoiding anxiety keeps us from living our lives and prevents happiness. The good news is that disordered anxiety is treatable. If you are concerned that normal anxiety has become unmanageable and is impacting your health and happiness, please contact Nizhoni Counseling today to set up a consultation and assessment.

Works Cited American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Sanders, L. (2010, December 16). Rare brain disorder prevents all fear. Wired. https://www.wired.com/2010/12/fear-brain-amygdala/