Living with anxiety
A psychologist’s perspective
We live in a day and age where we are inundated with anxiety-fuelled messages — whether this is from our family and friends, media outlets, educators, heads of state, policy makers, community leaders or from our nearest and dearest. It is, therefore, not surprising that anxiety disorders have become one of the most widely diagnosed mental health conditions of the 21st century. According to the most recent Diagnostic and Statistical Manual for Mental Disorders V (DSM-V) published in 2013, ‘anxiety’ is defined as ‘anticipation of future threat’.
In other words, we have been socialised from infancy onwards to be finely attuned to threats from our environment, and this can transform into an array of different colours and gradients on our anxiety pallet. As social animals we need one another for our survival as a species and, therefore, fear isolation, alienation and abandonment. Another threat to our sense of identity and ego is the fear of being criticised and what that might entail in terms of our fear of not belonging, not being accepted and not being loved. Our need for belonging and connectedness reinforces our sense of safety and comfort and that is why stepping outside of what is known to us as our frame of reference and comfort zone can feel very threatening, anxiety-provoking and unsettling for some of us.
For example, going alone to a social event with a room full of strangers can feel unbearable to some due to a heightened state of anxiety and threat to their sense of safety. The fear of appraisal and rejection from others is very potent and can be paralysing, self-constricting and self-sabotaging, and it can negatively impact on someone’s quality of life. For others anxiety might be provoked by the fear of illness, identity and loss; speaking in front of a crowd; eating in front of others; taking transportation; being intimate, vulnerable, physically and emotionally seen or simply being themselves. The list can go on and can transpire in all the domains of our lives. What is crucial to remember is that anxiety is a universal part of our common humanity.
Psychological therapy for anxiety
I often see people in my consulting room who speak about feeling ‘abnormal’, wishing to ‘rid their anxiety’ and carrying a lot of shame and stigma associated to their anxiety as if it were their dirty little secret. The first step I take is to normalise their experience by providing education around anxiety from evidence-based therapeutic interventions. In my practice as a psychologist I conceptualise anxiety under a biopsychosocial lens, meaning that it is important to look at the role of our biological, psychological and socio-cultural drivers. The psychological drivers are our thoughts, beliefs and assumptions about anxiety and how we construe their meaning. Examples of these might be that anxiety is ‘bad’; ‘ a sign that something is wrong’; ‘a catastrophe about to happen’; ‘a physical indicator of illness and fear of death; ‘a sign of weakness’; ‘a failure’; ‘a lack of aptitude and ability’; ‘not being resilient’; ‘not being enough’; etc.
Biological drivers that are experienced as a response to our sympathetic nervous system or ‘fight, flight or freeze’ bodily response alert us and protect us against danger and threat from our immediate environment. Some of these physiological symptoms can be experienced as shortness of breath, heart palpitations, sweaty palms, tremors, dizziness, restlessness, difficulty sleeping, concentrating, muscle tensing, stomach churning, etc.
It is important to demystify anxiety and examine its multi-layered meaning and purpose in context. What is the function and role anxiety is serving? Why do you choose to address your anxiety at this stage of in your life? What is anxiety coming in the way of? What is your struggle point and what do you aspire to achieve? What are the positive and negative facets of living with anxiety? Can you foster a better relationship with your anxiety?
If instead of striving to rid ourselves from our anxiety, we strive to examine and live with it differently. A key behavioural tenet of anxiety is avoidance and trying to attenuate any sense of threat by seeking reassurance that we and/or others are safe. In therapy, learning to let go of some of these unhelpful coping strategies and challenging our behavioural avoidance is a central part of the therapeutic work. Taking a cognitive-behavioural approach, can help you cognitively restructure some of your thoughts, beliefs and assumptions surrounding anxiety.
We are our own worst self-critics and, evolutionary, are more prone to negative cues from our environment. Therefore, learning how to notice our negative thoughts and/or mental imagery and sit with them is also be a component of the therapeutic process. This is drawn from mindfulness principles, which is the practice of being grounded and alert in the present moment in a non-judgemental way. A useful metaphor I often use that stems from acceptance commitment therapy is to imagine that we are constantly listening to ‘Anxiety News Radio’ that is always broadcasting in the background. Our aim is to lower the volume and intensity of the radio station so that it does not come in the way of our intrapersonal and interpersonal relationships. It might still be there, but the sounds will be fainter, quieter, and less all encompassing.