What is anxiety?
Anxiety is a normal human emotion which serves a protective function, which basically means it
keeps us alive! Anxiety is also described as the “fight or flight” response, and is designed to alert us
to potential danger and prepare us to respond to that danger.
Anxiety is both a physical and psychological experience, characterised by physical feelings such as a
racing heart, dry mouth, sweaty hands, racing mind, increased body temperature, tense muscles,
quickened breathing and butterflies in our stomachs, and emotions such as fear, nervousness,
apprehension, again, all helpful and necessary in threatening situations. All of these responses are
designed to prepare our bodies to fight or run. If you think about it, if you needed to fight or run, it
makes total sense to get more blood and oxygen to your muscles, and to do so, your breathing and
heart both need to quicken. It also makes sense that blood rushes from your digestive system to
your muscles, and that your skin tries to cool you down by producing sweat. And that your mind
focuses on scanning for danger, and so it feels as though it is racing.
However, a problem arises when anxiety is excessive, chronic, or triggered by non-threatening
situations. You can think of your fight or flight response as an alarm system, similar to a fire alarm.
These are really helpful to keep you safe in case of an actual threat e.g. fire. However, not so helpful
if it goes off every time you put bread in the toaster, or pop to the shops, for example. When this
happens, it can negatively impact our day to day lives and lead to difficulties such as irritability, lack
of concentration, muscle tension, avoidance and withdrawal from events or activities and
depression.
What causes anxiety?
The answer to this isn’t a simple one. As with any psychological problem, the causes are often a
combination of biological, psychological and environmental factors. Some people are more
susceptible to difficulties with anxiety due to their biological or psychological make-up, however it
often takes an environmental trigger for the anxiety to manifest. For example, someone with a
predisposition to anxiety might experience bullying as a child, or a parent being unwell, and this
triggers problems with anxiety. Or they may experience a trauma at any time in their life, for
example a car crash or traumatic birth, that then triggers difficulties with anxiety.
How do I know if I have anxiety?
It’s important to recognise that everyone experiences anxiety. It is a normal and adaptive emotion.
Without it, we wouldn’t be able to respond to threat and as a species we wouldn’t have survived.
However, if you are noticing that symptoms such as those below are chronic (lasting a long time),
excessive (happening too much) or are happening in non-threatening situations AND this is causing
you distress and negatively impacting upon your life, then you may have a problem with anxiety that
can be treated.
What are the symptoms of anxiety? (taken from the GAD-7, see reference list)
– Feeling anxious, nervous or on edge
– Not being able to stop or control worrying
– Worrying too much about different things
– Trouble relaxing
– Being so restless that it is hard to sit still
– Becoming easily annoyed or irritable
– Feeling afraid as if something awful might happen
What are anxiety disorders?
Anxiety disorders are symptoms of anxiety, which are causing a person distress and impacting
negatively upon their day to day lives, grouped into different “disorders” based upon their
symptoms.
What are the common anxiety disorders and how do they present? (All taken from DSM IV, see reference list)
Generalised Anxiety Disorder or GAD
An individual with GAD will engage in excessive worry that is experienced as difficult to control and is
about multiple different areas of life. Someone with GAD often exhibits physical symptoms such as
muscle tension, sleep disturbances, fatigue, restlessness and difficulty concentrating. These
symptoms cause significant distress or impairment in social, occupational or other values areas of
life.
Panic Disorder (with or without agoraphobia)
Someone with Panic Disorder will experience panic attacks which involve a range of physical
symptoms such as shortness of breath, racing heart, dizziness, chest pain, nausea, sweating, shaking
and cognitive symptoms such as thoughts of dying or losing control or feelings of unreality. People
with panic disorder, after experiencing a panic attack, have a persistent fear that they will experience
another panic attack. Accompanied with this are often significant behavioural changes, where
someone may avoid situations in which they have previously experienced a panic attack or where
they cannot easily escape.
Social Anxiety Disorder
Somone with Social Anxiety Disorder will experience a persistent fear of social situations where there
is the potential of negative evaluation by others. People with Social Anxiety Disorder often believe
that they will be judged, humiliated or embarrassed in social situations. This often leads the
individual to avoid social situations altogether, or to endure social situations whilst experienciencing
significant levels of distress.
Obsessive Compulsive Disorder or OCD
OCD is a commonly misunderstood disorder, with many people believing that it is about cleanliness
and order, an idea that is perpetuated by the media. However, although these behaviours may be
seen in someone with OCD, they do not do justice to the significant difficulties experienced by
someone with OCD. OCD is a disorder characterised by the presence of obsessions and/or
compulsions.
Obsessions are recurrent and persistent unwanted intrusive thoughts, urges or images
that cause significant anxiety or distress. The individual with OCD tries to supress or neutralise these
thoughts, images or urges with another thought or action (the compulsion).
Compulsions are
behaviours or metal acts that someone feels compelled to do in response to the obsession. The
individual performs these behaviours with the aim of avoiding a feared situation or preventing or
reducing their distress. However, compulsions are often not connected in a realistic way to the
feared event, for example someone may experience an intrusion of an image of a loved one dying,
and then engage in a compulsion of tapping. In someone with OCD, obsessions and compulsions
take up a significant amount of time and/or interfere with day-to-day functioning. The individual also
realises that their obsessions or compulsions are unreasonable or excessive.
Post-traumatic Stress Disorder or PTSD
Someone with PTSD will have been exposed to a traumatic event, either by experiencing it
themselves, witnessing an event, learning that a loved one has been exposed to trauma, or by
repeatedly being exposed to aversive details of a traumatic event. This then leads the individual to
experiencing intrusive symptoms, including one of more of the following: distressing dreams of the
event, recurrent, intrusive and involuntary thoughts and images of the event or flashbacks or
dissociation where they feel as though the event is happening again. This causes the individual to
engage in significant avoidance of anything associated with the trauma, including avoiding
conversations, thoughts and feelings about the trauma, as well as places, activities and people
associated with the trauma.
Individuals with PTSD experience alterations in their mood and cognition, including difficulty remembering important parts of the trauma, negative beliefs about themselves and others, distorted self-blame for the trauma, persistent negative emotional state (e.g.
fear, shame, horror, anger, guilt), significant lack of interest in in activities and detachment from
other people. The individual may also experience feelings of anger and irritability, be hypervigilant,
have disturbed sleep, an increased startle response or engage in reckless or self-destructive
behaviour.
Health Anxiety
Someone with health anxiety will have a significant preoccupation with their health and be
excessively worried about having or acquiring a serious illness. This preoccupation will remain
despite reassurance and medical tests and will impact upon their day-to-day functioning.
Phobias
An individual with a phobia will experience marked fear or anxiety in response to a specific object or
situation (e.g. flying, animals, heights, injections). This fear will be immediate and occur almost
always in response to the phobic object or situation. The individual will actively avoid the object or
situation or endure it with significant fear and distress.
Body Dysmorphic Disorder or BDD
Someone experiencing BDD will have a preoccupation with one or more perceived ‘defects’ in their
appearance that are not observable or appear slight to other people. They will engage in repetitive
behaviours such as checking in the mirror, excessive grooming, or mental acts such as comparing
their area(s) of concern to others. This will cause significant distress and impact upon the individuals
functioning and may result in avoidance of social situations.
What can be done about anxiety?
There is lots that can be done about anxiety, including:
– Medication
– Therapy, including CBT
– Social support
– Self-help
– Lifestyle changes, including getting enough sleep, eating well and exercising.
– Mindfulness and relaxation techniques
How is anxiety treated in CBT?
The treatment plan will vary, depending on the individual and their unique goals and symptoms.
However, in general CBT treats anxiety by looking at 2 things: thoughts and behaviour.
We know that the way that we think affects how we feel. And so, if you struggle with anxiety, your
thinking will be part of the problem. This doesn’t mean to say that the way you think doesn’t make
sense. In fact, the way that we think comes from our experiences and beliefs and in this context,
makes total sense. For example, someone who was bullied at school for the way they looked, may
have developed a belief “other people will judge me negatively”, and so in social situations, worry
that other people are thinking badly of them.
Once you understand how your experiences and
beliefs have shaped the way that you think, you often come to realise that your thoughts are
completely understandable, and are actually often trying to protect you from perceived ‘danger’.
However, what we also know is that our thinking, or perception, isn’t always accurate or helpful.
Often, when problematic anxiety is present, the thoughts that go alongside that are unhelpful,
biased and not grounded in facts (more on this to come in another blog!).
The same applies to behaviours. Our behaviours are often shaped by either positive reinforcement (a
behaviour that elicits a positive stimulus or rewards) or negative reinforcement (removal of a
negative stimulus). So, for example, if we feel anxious about something, and then avoid it and feel
relief, this is negative reinforcement (removal of anxiety). When we experience this reward, we are
more likely to repeat the behaviour (the behaviour is reinforced). The problem with negative
reinforcement is that the relief is only temporary, and the next time the person is faced with the
same situation, they don’t feel any more able to cope with it and they avoid it again. This can lead to
difficulties with day-to-day life, where an individual may have to go to great lengths to avoid their
triggers. It can also really diminish confidence, and leave us feeling as though we cannot cope.
How does CBT help with these difficult thoughts and behaviours?
CBT helps us to identify these unhelpful patterns of thinking and behaving and replace them with
more helpful ones by:
Challenging, reevaluating and changing our thoughts.
Noticing, reducing and eliminating avoidance behaviours.
And creating new, more helpful ways of thinking and behaving that bring you closer to your goals and
allow you to live life the way you want to.
Oh, and also (really importantly!), allow you to overcome problematic feelings of anxiety.
So, what next?
If by reading the information in this blog, you have identified that you have problematic symptoms of
anxiety that are negatively affecting your life, and you’d like to make positive changes, you can book
in for CBT (or a free 15-minute exploratory call) with me via our “Book Now” button.
I’d love to help you overcome these symptoms and live a more fulfilling life.
Emily 
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). Arlington, VA: American Psychiatric Publishing.
Spitzer, R.L., Kroenke, K., Williams, J.B. & Lowe, B. (2006). A brief measure for assessing generalized
anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-7.