Imagine that you’re on your way to meet a friend at a party. As you walk toward the house, she texts that she’s running five minutes late. You stop and wait. You don’t know anyone else at the party, only your friend, so it feels awkward to go inside alone. You check your phone well after five minutes have past–she still hasn’t shown up or texted you back. Your heart starts beating faster. Your hands begin to sweat. You’re not sure what to do. You check your phone again. You can hear people talking and laughing nearby. Your hands feel clammy. Thoughts start racing through your mind:
“I can’t believe she’s late.
What am I supposed to do now?
Maybe I should walk back down the block and wait for her.
Am I going to have to go over there by myself?
It’s going to be so awkward.
What am I supposed to say?
No one knows me. They’re going to think I’m some weirdo crashing the party.
I should leave.
What if they see me walk away and then come back… they’ll think I’m weird.
They’ll know I’m nervous and they’ll think I’m weird.”
While you go back and forth in your mind, trying to figure out what to do, you notice that you are feeling lightheaded. You start to worry that you’re going to pass out. Your heart is beating even faster and you feel like you’re about to lose control. You’re feeling nervous and scared as your thoughts shift to what’s happening in your body.
“My heart feels like it’s about to explode, what’s wrong with me?
This isn’t normal, something must be wrong.
What if I’m having a heart attack?
Am I just panicking? What if I’m not?
What if I pass out in front of all these people?
They’re going to think I’m so weird.
Oh no, I think I really am going to have a heart attack.
I need to get out of here NOW.”
Anxiety can be triggered by common situations like the one described in this narrative. It can also escalate quickly to high levels of distress, resulting in a panic attack. The word “anxiety” is used in everyday conversation and it means different things to different people. It’s true meaning can get lost because of its casual use. What is anxiety, really, and how does it affect us?
Anxiety, also known as first fear, is a your body’s response to a perceived threat. When the brain perceives something as threatening, several interrelated structures in the brain respond immediately to set in motion our “Fight or Flight” response. When your body is in Fight or Flight mode, it is preparing itself to either attack the threat or run away to safety.
The Fight or Flight response occurs within milliseconds of your brain sensing a threat. Your brain releases adrenaline and cortisol to prepare you to react. This brings on any number of physiological symptoms: increased heart rate, changes in your breathing, light-headedness, dizziness, muscle tension, dry mouth, sweating, and even stomach issues. Because the Fight or Flight response occurs so quickly, you already feel these symptoms by the time the frontal lobe of your brain — which is responsible for thinking, judgment, and decision making — can catch up and assess the situation.
Here’s an example of how that might look in real life:
You’re out for a hike in the woods with friends, walking along and enjoying the scenery. Suddenly you spot a huge brown and beige object a few feet in front of you. You jump back and yell out: “snaaaaake!!!” Before your feet even hit the ground, your heart rate is through the roof, you’re sweating, tingling, and your whole body is tense. You do a double take and realize that the snake is actually just a large stick. You and your friends laugh, relieved. Although your brain has assessed the situation and determined the threat isn’t real, it takes a few minutes for the physiological symptoms to subside. You also pay more attention to your surroundings as you continue on your hike, even though the threat is gone.
This is how anxiety keeps us safe. It’s generally adaptive, but it is by no means a perfect system. The Fight or Flight response is sensitive and conservative; it errs on the side of keeping us alive. Anxiety is our friend, but it is sometimes an annoying and impulsive friend that ignores the new information we are trying to give it (“Don’t worry brain, that’s just a stick!”) and continues to operate on its first impression (snaaaaaaaake!!!). This is why you may continue to feel physiological arousal even after the trigger is gone.
When your anxiety is frequently triggered by situations that are not actually dangerous, such as attending a party alone, you can develop a second fear of experiencing the physiological symptoms of anxiety. Anxiety becomes an anxiety disorder when you avoid doing the things you care about in an effort to prevent these symptoms from happening. You call in sick to work, stay home while your friends are out, skip going for a run, or cancel your concert plans. When you avoid things that you normally enjoy, your world gets smaller and smaller. Before you know it, your anxiety seems to be triggered by everything and you’re not sure how to manage it.
Cognitive Behavioral Therapy can be a helpful way to understand and manage your anxiety. In therapy, you and your therapist work together to identify WHY certain situations trigger your anxiety. Together you uncover HOW you typically respond to those triggers and WHAT you are doing that helps maintain the cycle of anxiety. In my practice, I often teach cognitive interventions to help clients respond more effectively to anxious thoughts. We may also use behavioral interventions such as exposure therapy to gradually reduce avoidance of anxiety triggers. If you are willing to be open and curious about your experiences with anxiety, therapy can help you break the cycle of anxiety so that you can live a life you value.