Understanding Anxiety and Panic
Approximately 40 million adults in the United States suffer from one or more types of anxiety disorders. Medication is effective in managing the symptoms, however medication does not provide an understanding of what anxiety and panic are nor does it teach us how to help ourselves. Additionally, the most common and effective anxiety medications, benzodiazepines, bring the risk of psychological and physical dependence with extended use. In acute cases of anxiety, medication may be needed as a support in the beginning stage of psychotherapy.
The first step in reducing anxiety is having an operational definition of what anxiety is. Traditionally, anxiety has been described as worry, nervousness, apprehension or dread around a specific or vague threat, or an adrenalized “fight or flight” state. It is often used in combination with the natural emotion of fear. Symptoms of anxiety can include heart palpitations, shortness of breath, chest constriction, dry mouth, cold or hot spells, muscle tension, gastrointestinal disturbance, impaired concentration, and sleep disturbance. Chronic anxiety often results in fatigue, compromised judgment, impaired self-esteem and impaired social functioning.
Over the course of my years as a clinician, I have come to define anxiety not as a true feeling such as fear, sadness, anger, or shame, but as a sensory experience. This sensory experience occurs because we have consciously suppressed or unconsciously repressed a natural feeling. Anxiety, therefore may also be seen as a physiological warning signal that a feeling(s) has been activated within us that we are either unaware of, we believe might overwhelm us, or ones that have been prohibited by parents (or caregivers).
We suppress or repress painful or prohibited feelings in the present because during our development, our parents did not have the capacity or skills to help us identify, tolerate, express, and finally integrate these feelings and thus teach us to calm and soothe ourselves. Feelings that have not been integrated also run the risk of going rogue into emotional reactivity and increased anxiety. The skill of soothing ourselves called is emotional self-regulation. We are not born with the ability for emotional self-regulation; we must learn this from our parents, such as learning to tie shoes or developing basic morals and ethics such as not grabbing another child’s toy and learning to share. If parents were not sensitive or attuned enough to meet our emotional and psychological needs or caused direct emotional injury, they were correspondingly not equipped with the awareness or capacity to soothe their children and teach them emotional self-regulation. In the absence of this necessary developmental assistance, our feelings will have to be suppressed or repressed as unwanted, bad, and potentially dangerous (feelings not permitted by our parents, i.e., joy or anger). The suppression or repression of true feelings will leave us vulnerable to bouts of anxiety whenever these underlying feelings are activated. A central focus in psychotherapy, in general and in particular for anxiety problems, is to teach individuals the skill of emotional self-regulation.
Panic attacks are an acute escalation of anxiety that occur in two circumstances. In the first, we do not understand or recognize anxiety for what it is, and reasonably, but falsely, believe that what we are experiencing is a medical/psychiatric emergency such as a heart attack or stroke, or that we are “going crazy.” We believe we are in a life or death situation and this drives our anxiety into panic. The second type of panic attack stems from social anxiety. In this form of panic we believe our anxiety, even at imperceptible levels, is being broadcast to and judged by others. This belief will in turn make us more anxious resulting in a rapid spiral into panic. People who experience this type of panic episode avoid crowded places such as long supermarket lines, the middle section of a row in a movie theater, or freeways with regular traffic jams where there is no easy or quick escape. These individuals are diagnosed with the anxiety disorder called agoraphobia. People with acute states of anxiety will often refer to this experience as a panic attack.
Cognitive Therapy is a popular form of treatment for anxiety disorders. This modality of treatment identifies, challenges, and modifies anxiety provoking thought patterns in order to reduce or eliminate anxiety. I have found, however, that addressing thinking alone is not enough. Emotions pre-exist the capacity for thought in brain development. Feelings are at the center of human existence and they are the axis of family, primary relationships, and friendships. What makes a movie, piece of music, or hiking in Yosemite memorable and great are the emotions these experiences evoke. This is also true with negative life experiences. Therefore, if the clinician is focused only on thinking, he or she is not connecting with anxiety that stems from sometimes powerful, unintegrated emotional experience, particularly that which occurred before we had the capacity to think abstractly. What is needed is a therapy that is integrative and focuses not only on our thoughts, but on our emotions and physiological functioning as well. Despite our highly developed cerebral cortex, emotional self-regulation continues to be necessary, not only for the reduction or elimination of anxiety, but for mental health and optimal functioning throughout our life.
Copyright © 2020 Bruce A. Howard, Ph.D. All rights reserved.