What is anxiety?

​

Anxiety is a physiological response to not feeling save caused by a real threat or a projected fear, quite often catastrophising an outcome of an event. Anxiety can be triggered by a real event and a fear of recurrence of this event can cause (severe) anxiety.  However, more often anxiety is caused by a perceived threat and this is often an unrealistic view of the reality, creating a belief system that leads to low self-esteem and lack of confidence. These physiological symptoms can be faster/pounding heartbeat, shallow and fast breathing, sweating, trembling, feeling weak/tired, wanting to escape, having a sense of impending danger/doom/panic, not able to think right or do things, wanting to punch the wall. Anxiety or having anxious thoughts may feel that they are taking over everything, taking away any pleasure or joy. There is a distinction between state anxiety and trait anxiety, as state anxiety relates to a specific perceived threat while trait anxiety is associated with a anxious personality. 

​

According to the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) (American Psychiatric Association, 2013) anxiety disorders share similar symptoms such as sleep disturbances, concentration problems, distress and compromised social functioning. The DSM-5 also lists the classification of anxiety spectrum disorders (spectrum as they can vary in severity) and these are: separation anxiety, selective mutism, specific phobia, social phobia, panic disorder (PD), agoraphobia and generalized anxiety disorder (GAD). Quite often anxiety is formed in childhood and it is a coping mechanism to navigate and deal with tricky situations by preparing us for tough outcomes. Anxiety is a nervous system that is on high alert for possible dangers.

 

How does our nervous system work? 

The primary function of our nervous system network is the survival of the physical body. The Central Nervous System includes the brain, spine cord and all the nerves in our body which sends information to and from the brain. The Peripheral Nervous System contains all the nerves in our body which sends information to and from the brain, and is divided into 2 further branches - the Somatic nervous system (includes muscles and motor & sensory nerves) and the Autonomic Nervous System (ANS). The ANS controls the heart rate, digestion, respiration and many other functions and uses feedback loops to detect changes in its system. So, the ANS is constantly monitoring and responding to changes in the body. The ANS has two branches, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) are always active and antagonistic, meaning one of them is dominant. SNS acts 'to fire up' the nervous system and mobilize the system/us, while the PNS  counterbalance the SNS and is dominance when we rest and digest and helps to restore the body's resources. 

The SNS is best known  for the flight/fight response, which I will explain later. 

​

How does anxiety manifest in the brain and body? 

When we think of a threat or perceive a real threat, the amygdala (alarm system of the brain) flags the incoming information and reassess it against previous experience, with the help of the hippocampus (memory center) and act as an alarm system triggering the body into action if it ‘reads’ the body is under threat. It will set in motion some actions in the brain to release hormones to get the body ready for action to deal with the stress. This is technically called the amygdala activates the HPA axis in the brain. HPA is “a term used to represent the interaction between the hypothalamus, pituitary gland, and adrenal glands; it plays an important role the body's response to stress. The hypothalamus relays the signal through the hormone system in the body, but also through the brain's neurons. Symptoms  of this activation are (some of them you will notice) a rise in blood pressure, increase in breath rate, certain areas in the brain start to become active. Other areas become less active or inactive (i.e. the prefrontal cortex (high functioning part of the brain), which will 'reason' the threat and even dampen the degree of the threat/distress). This will cause you to be in a state of high alert and vigilance. Due to these neurons in the brain and the release of  hormones the body starts to produce cortisol. 

Cortisol is needed to activate the SNS for the body to fight or flight (fight the threat such as originally a threat from an animal when we lived in the wild, or flight running away from this animal). There’s also a 3rd mechanism – freeze, which comes into play if the nervous system (NS) has no other alternative (pretending to be dead as you may sometimes see with animals such as mouse threatened by a cat). Cortisol is used by the body or will be released afterwards when it shakes it off  coming out of 'freeze' state and the NS is back in a PNS state for rest and digest. 

​

So, as anxiety takes over the brain and body, we will struggle to even think clearly, or it affects what we are doing. We are feeling in a state of panic and that there is no way out. Sometimes it may make us physically incapable of doing simple tasks or exercises which causes more stress and pressure leading to feeling anxious. This becomes a vicious circle. 

When a person suffers from a lot of anxiety, the condition can become chronic which means that the individual are vulnerable to overreaction to external and internal stressors and may find it hard to calm themselves down. This is caused by a heightened SNS activation, over-reactive amygdala and a reduced activation in the PNS. The individual is constant on high alert, vigilant, and bodily functions such as heart rate, breathing rate are constantly increased. This can cause stress-related conditions such as cardiovascular disease, irritable bowel syndrome and skin-conditions. 

As we learned that the hippocampus is important in interpreting all incoming information and uses its memory system to assess how to best handle the situation, in chronic anxiety, the hippocampus is enlarged meaning that it gets extra sensitive for incoming 'threat. Therefore you may feel constantly hyper-vigilant and feeling stressed, as the body is not 'finishing' the stress response through using up the extra cortisol released. That’s why when you are feeling stress or anxious, you may notice your legs shaking, trembling, or your breath going faster or your heart pounding, . These symptoms  may worry you and adding to the stress, making this a vicious circle. You may feel that you are not able to cope and a sense of overwhelm. 

 

“Anxiety is the result of a nervous system that is on high alert. The solution is not to ‘turn off your anxiety, but to learn how to regulate your nervous system”.  

​

What can I do? 

Firstly starting to understand what anxiety is and how it affects your body; what are your stressors and what can you do to feel safe. Often writing it down, in a journal for example, may be a good way to start to understand your anxiety. In order to regulate our nervous system, we need to feel safe. When I learned about creating safety in my system, and how anxiety ‘works’, I started to feel less anxious.  

​

For example, we can think that a particular task, i.e. an exam, is going to be stressful and the result will be failure of this exam. So, our brain perceives this as it is stressful and we have failed the exam with all the consequences that entail. The brain will activate the stress response and we will notice all the symptoms and starting to sweat, shake etc. Our PFC is not able to override this and we start to forget what we have learned, resulting in a low mark or failure. And all because of our thought!

​

We use our senses (sight, hearing, touch, smell, taste) to detect danger when we were living in the wild. So, equally, we can use our senses to create safety. By noticing our environment through the senses we bring ourselves in the present, and we see really what is there and not what we perceive into our mind.

• So, asking yourself what can I see? Or how can I describe to myself what I can see. If you are very anxious this may be difficult to start with but keep practicing it. Imagine describing what you can see to someone who can't see that object/image. 

• Secondly, what can I hear and describe this to yourself. If you are outside, you may hear many noises, but when inside you can do this exercise in steps - what can I hear outside this room, - what can I hear inside the room etc. 

• Sometimes you can use smell as well.

• The next step is to ground yourself. This is nothing more than feeling the ground underneath you. In our feet we have many neuron receptors that send information back to the brain constantly about the ground underneath us (no threats). If we feel solid ground underneath us, it creates a sense of safety and supports the nervous system. Again, this may be difficult to start with to send your mind's eye to your feet and really feel. You can wiggle your toes, play with the weight load (moving your upper body so that the weight changes on the feet) can help to start feeling the feet. You can also tune into your buttocks if seated on a chair. 

• Now you have grounded yourself, you can start noticing the breath, through noticing the location of your breath, the breath rate. How we breathe has a great impact on your anxiety. Shallow chest breathing activates the sympathetic state, while deeper slower breathing activates the parasympathetic state and induce relaxation. It may be helpful to put a hand onto your tummy and work towards breathing towards your hand. Once your breath is deeper, it will also elongate the exhale (as more air will need to come out), which also send signals back to the brain to activate the parasympathetic drive. 

 

In a following article, I will write about the breath and give different breathing techniques.

 

If we ignore our anxiety, our nervous system feels ignored. Remember treating your anxiety with kindness, your body is only trying to keep you safe.

​

References: Heather Mason, Kelly Birch, Yoga for Mental Health, (chapter 2 Mason & Gerbag),  Handspring Publishing, London 2018

​

​