Anxiety is universal and commonplace. We have all experienced anxiety at some point of time in our lives, and most of us don’t even think it is something to be taken seriously. Perhaps we assume that it’s natural to be worrying, anxious and high-strung in today’s world and so, we don’t see how anxiety wreaks havoc on our lives.
Sometimes we confuse an anxious mind with an active mind or as being concerned, which gives us the justification and incentive to remain anxious. A mother who’s constantly thinking about her child’s future may find not worrying as a sign of being a bad mother. If a student is not crumbling under pressure before an exam, we might be quick to judge them as ‘not serious’ about studies. A person who usually takes things in their stride calmly may not be perceived as driven or productive enough. It will not be an exaggeration to say that through many of our apparently normal thoughts, ideas and lifestyle choices, we are constantly priming ourselves to be anxious in many ways. And many of us are paying a price for it.
Anxiety falls under the umbrella term ‘neurosis’, which is defined as maladaptive psychological symptoms usually precipitated by stress. Basically, we are said to have neurosis when our mind cannot cope with the perceived or real challenges, threats or stressful situations, and we start worrying excessively, feeling apprehensive about the small things. This causes a lot of distress and dysfunctionality.
Anxiety can manifest as a sudden episode of acute panic attack (Panic Disorder), worry of being embarrassed in public (Social Phobia), worry of being contaminated and developing a repetitive compulsive behaviour (Obsessive Compulsive Disorder), of being away from close ones (Separation Anxiety Disorder), fear of having a serious illness (Hypochondriasis) and being overweight (Anorexia Nervosa) to a more defused but constant lurking of fear and tension (Generalised Anxiety Disorder).
Generalised anxiety disorder (GAD)
It’s when there is more or less constant worrying even when things look okay. One feels an uncontrollable, persistent, free-floating anxiety most of the time of the day, and one is also always apprehensive about everyday events or problems.
It gets accompanied by other symptoms like restlessness, tiredness, difficulty in concentration, irritability, muscle tightness and sleep disturbance. According to the DSM V (Diagnostic and Statistical Manual for mental disorder) criteria for diagnosis, if one has at least three of the above symptoms along with pervasive and persistent worry for most days for at least six months, one can be diagnosed of having GAD.
It is important to note that various medical conditions like hyperthyroidism or even substance abuse may mimic the symptoms of GAD. According to ICD-10 (International Statistical Classification of Diseases and Related Health Problems), GAD is recognised by:
• ‘Autonomic arousal’ including palpitation, increased heart rate, increased respiratory rate, trembling or shaking and dry mouth.
• Physical symptoms like breathing difficulty, choking sensation, chest pain or discomfort, nausea, abdominal discomfort or pain.
• Psychological symptoms like feeling unsteady, dizzy, light-headedness, ‘derealisation’ (which is an acute sense or suspicion of being in an unreal, unfamiliar world or/and a sense of detachment from one’s own thoughts and feelings or sense of self), fear of losing control, fear of going crazy or dying or passing out, difficulty in concentration or ‘mind going blank’ from stress, persistent irritability, sleep disturbance.
• General symptoms like hot flushes, cold chills, numbness, tingling.
• Symptoms of tension including muscle tension/aches and pains, restlessness or inability to relax, feeling on the edge or tense, feeling a lump in the throat or having difficulty in swallowing.
A more dramatic and acute presentation of anxiety is a panic attack — a short period of intense fear accompanied by some of the symptoms mentioned above, including a few others. Sometimes the fear or anxiety can be so distressing and painful that suicidal thoughts can arise. In panic attack, symptoms develop rapidly, peaking in about 10 minutes and usually don’t last for more than 30 minutes. It may happen out of the blue or when there’s a specific recognisable trigger. Having to perform in front of others, meeting unknown people, facing a crowd, being in public places or in emotionally charged moments can be some of them.
Ironically, the fear of having a panic attack itself can trigger one; and so can the fear of getting sick or lost. Sometimes attacks may happen in sleep and in rare cases, physiological symptoms of anxiety may occur without the recognisable psychological component, which is known as non-fearful panic attack.
A chronic and recurring panic disorder may present itself with only physical symptoms like chest pain, Irritable Bowel Syndrome and certain types of headaches, that is, without an actual panic attack. Another common form of anxiety is ‘Specific Phobia’ where there is an irrational fear of a particular trigger, like phobia of closed spaces, public speaking or injections.
Learning to disengage
Whatever be the symptoms, there are psychological patterns behind most cases of anxiety. We love and value a person who is constantly anticipating, recognising, getting engaged with a problem and thinking of ways to handle them or at least trying to prevent them in advance. We also love a perfectionist who is in charge and delivers perfectly every time. These same traits can also give rise to dysfunctional anxiety or panic attacks because they programme us to constantly think of the worst-case scenarios and create an urgency to micro-manage our environment according to our ideals.
Learning to disengage from anxiety-creating thoughts, beliefs and ideas is an important skill to develop. We need to be self-vigilant so that we can recognise these troublemakers and challenge them when they are causing more distress than benefit. It requires long-term commitment to change and to keep disputing the beliefs and thoughts that may be triggers.
Daily practice of breath control techniques like the ones taught in the Vipassana meditation courses, mindfulness-based stress reduction programmes, Zazen or Zen meditation are quite useful in dealing with anxiety.
Nowadays excellent medications are available for anxiety. Don’t shy away from consulting a psychiatrist and getting a proper evaluation and prescription. A therapist might also be able to help recognise early symptoms and teach effective tools.
In an acute condition, one needs to affirm to oneself that, “it’s a passing phase, it will go away in half-an-hour”. Practise focusing on your breath, and try breathing slowly and deeply during an acute attack. You can listen to calming music or nature sounds, or do a quick guided anxiety-relieving meditation on one of the various apps available. Carry your medicines if you are prone to panic attacks. Educate yourself and know what works for you.
FIVE PSYCHOLOGICAL POTHOLES TO AVOID
‘Should be’ fixation: When one is too fixated on how things should be rather than being aligned with how things are, it creates a psychological environment of anxiety. It is great to try to better things but we also need to understand that not everything can be how we think it should be. We are imperfect creatures who live in an imperfect world and ‘should be’ can be aspirations and preferences but not compulsions and demands.
‘Comfort zone’ adherence: If we only stick to things and environments that we are comfortable in, our tolerance threshold for things that we don’t know how to deal with is bound to be low. This does not help one to grow. The more we are exposed and forced to negotiate things that are outside our comfort zone, the more skilful we become to handle ourselves during stressful times. Slowly trying to get out of our comfort zone might make us less anxious.
Need to be in control: If one constantly nurtures a need to be in control and micro-manage one’s surrounding, then there will be anxiousness. There are things that we can be in control of — these are related to us, our behaviour, and our ideas. There will always be things that will be out of our control. Unless we are okay with that, we will always be stressed.
Resistance to ‘unpredictables’: Life surprises us. If we have a strong need to have a predictable outcome, we will often find ourselves distressed. Be ready and willing to negotiate surprises, both positive and negative, and you’ll will find it easy to deal with ups and downs.
Fixer syndrome: It is good to be a problem solver, but if you think you need to fix everyone’s problems around you, you are in for trouble. There is a difference between the problems you can solve, problems which you want to solve and problems which need to be solved, so choose and prioritise carefully; you cannot fight every battle without getting torn apart within.
Dr Sangbarta Chattopadhyay and Dr Namita Bhuta are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions