Worry. Stress. Fear. These are all different ways in which we experience anxiety. And though these feelings are unpleasant, anxiety is inherently a good thing. It’s a useful thing. It’s a healthy thing. For example, worrying about being late can cause us to be more organized with our time. Feeling stressed before an important meeting will cause us to prepare adequately and give us a perspective on priorities. Fear will cause us to go out of our way to avoid danger.

Anxiety is triggered by a perception of potential harm, and the level of anxiety we experience varies, usually in proportion to how dangerous or harmful we believe the trigger to be. Interestingly, the anxiety we experience is tied to our perception of what can hurt us, not necessarily the actual dangerousness of the situation. For example, a child may experience high levels of fear around an unfamiliar dog, regardless of whether or not the dog is well trained or aggressive. Or, a world-class mixed martial artist may feel relatively calm and unperturbed if threatened with a knife, if they happen to feel confident in their abilities to disarm and subdue their assailant. Another way to understand this dynamic is to see the relationship between our levels of anxiety and the level of our perceived helplessness or competency. High levels of helplessness equate to high levels of anxiety. High levels of competency lead to low levels of anxiety.

There are two primary functions of anxiety, the first is that of an alarm. Let’s use a smoke alarm as an example. If the alarm goes off, it’s to alert us that there may be a fire in our home. It’s important to have a functioning smoke alarm because if part of our house was on fire, the alarm could alert us as early as possible of the potential danger, so that we can act accordingly. We could either put the fire out, or get out of the building as soon as possible. So anxiety works similarly to alert us of potential problems, giving us early warning should we need to act quickly to get out of harm’s way.

Once our anxiety is triggered, the next step is that we make an appraisal – is the threat real or is it a false alarm? If our appraisal tells us that in fact there is a real threat, then we are already primed to act based on the changes in our minds and bodies due to the “fight or flight” response. At this point, the second function of anxiety becomes apparent, in that it prepares us and equips us to protect ourselves. We become more aware of our environment. We create a mental hierarchy of priorities. We start analyzing our options. Our bodies prepare to act through increased muscle tension, increased heart rate, and increased respiration – a potential warm up for a fight or for a sprint towards safety. If we channel these emotional energies back towards the resolution of the problem, then we’ve used our anxiety appropriately, minimizing our exposure to harm. “Fight” is when we choose to stay and solve the problem, “flight” is when we choose that the best option is to get to a safe place. If either option works, then we feel relief, and anxiety goes away because we’re no longer in harm’s way. This is an example of how a healthy and appropriate emotional response creates a closed loop – a resolution of the initial trigger.

Alternatively, if our appraisal tells us that it’s a false alarm, then our anxiety levels start to regulate immediately and we return to our normal baseline mood states. A friend sneaks up behind you and yells “boo” in your ear. The anxiety response is instantaneously triggered – we feel alert, our muscles tense, our heart rate goes up. But when our mind registers the familiar face of our smiling friend, acknowledging that there’s no real danger, our anxiety is quickly diffused. Sort of like when we reset the smoke alarm after we’ve made the assessment that the smoke alarm went off not because the house was on fire, but because we left a piece of bread in the toaster oven too long.

Everything up until this point is a description of the normal, healthy, and useful mechanism of anxiety. Understanding how this works “normally” can also help us to understand why sometimes our anxiety can work against us.

The first example is when the intensity of our anxiety is too high, and rather than creating a situation where we are prepared to act, instead we are overwhelmed and “frozen.” So instead of fight or flight, it’s freeze. There’s actually two versions of this – frozen by feelings and frozen by thoughts. Both are a reflection of the thinking and feeling components of emotion being out of balance and disconnected. When we are frozen with anxiety, sometimes our feelings become overwhelming, with so much muscle tension that it feels like we can’t move, our hearts pounding in our chest, our blood vessels overconstricting to the point that we feel numbness in our extremities and a light-headedness. Our awareness diminishes, our thoughts go blank. This is the “deer in headlights” version of becoming frozen with anxiety, where the feelings are too big, and the thinking part is too small, and the two parts of our mind seem disconnected. The other version is when our feelings are overshadowed by having too many thoughts, and we can’t act because we are overthinking things. What if this, and what if that? This is the “paralysis by analysis” version of being frozen. Sound familiar? The problem here is not that our anxiety is out of context, but rather the appropriate emotion is dysregulated. Therefore the goal wouldn’t be to try and shut down our anxiety, but rather to create more balance and connection between our thoughts and feelings. If we are frozen by feelings, we should try to be more analytical and think our way to a more balanced state. If we are frozen by thoughts, we should try and take a small step and do something, reconnecting with the feeling and experiential side of our self.

Having examined the different aspects of the typical anxiety experience, we can also understand why certain vulnerabilities can lead to long term challenges in managing anxiety.

Traumatic experiences affect our anxiety response in a couple of ways. One is that the duration and intensity of the negative experience causes us to stay in a persistent state of anxiety that is hard for our minds to re-regulate. We see this in an Acute Stress Reaction where because of a traumatic experience, all the “normal” changes in our thinking and feeling during a typical anxiety reaction become amplified and persist for a period of days or weeks. In most situations for most people, gradually these unnatural changes slowly return back to normal, especially as the positively reinforcing experiences of everyday life provide the grounded reminders that the trauma was the exception, and that the rest of life still thankfully remains the same. If this correction in perception does not occur, then the symptoms remain amplified and become chronic, which is the nature of Post-Traumatic Stress Disorder or PTSD. This chronic state of anxiety also affects our appraisal of danger, causing many people suffering from PTSD to overinterpret the potential harm of less than traumatic but still negative experiences.

Errors in appraisal can also cause chronic situational anxiety. In these specific situations, the anxiety response is not necessarily excessive relative to the person’s belief. It is proportional to what they believe is a real threat. As I mentioned previously, the level of anxiety we experience is based on the perception of danger or harm. This is the mechanism for Phobias, such as a fear of heights, of snakes, of flying, or of crowds or public speaking. These triggers are not in fact dangerous, but a person has a belief that they are, and their high levels of anxiety are a response to that belief. Because the incorrect appraisal is the trigger, the person’s assessment of the level of harm is unreliable as well, usually erring on the side of excessive caution. People with phobias tend to choose “flight” therefore avoidance as their primary coping mechanism, and are frequently “frozen” when confronted by their triggers.

An error in the underlying functions of the parts of the brain that trigger or regulate anxiety can also cause chronic anxiety problems. If a person’s limbic system is unusually active, a person can feel a chronic persistent state of anxiety. This is the biological mechanism of Generalized Anxiety Disorder. If coupled with a coping strategy that emphasizes control (rather than competency), Obsessive Compulsive behaviors can also arise from this predisposition for chronic anxiety. If a person’s brain occasionally has a “glitch” that triggers a maximum anxiety response without an actual real world trigger, this is what causes a panic attack. If a person’s appraisal about a panic attack incorrectly judges a panic attack as being dangerous (and given that a panic attack typically comes with a feeling of impending doom, this is understandable) they can develop a phobia of having future panic attacks, and develop Panic Disorder.

The specific strategies we use in mental health treatment to help people with anxiety problems are aimed at our understanding of what is causing the particular anxiety issue. With PTSD, we help people correct their perspective from being past-negative to being present and future oriented. With phobias, we help people experience their triggers as they are in the real world – non-threatening and safe. For Generalized Anxiety, OCD, Panic Disorder, and PTSD we help people to be more accurate in their appraisal, to minimize anxiety reinforcing habits, and work on correcting the underlying biological triggers.

When grouped together, Anxiety Disorders can affect up to 18% of all adult aged Americans in any given year (roughly 40 million adults). What does this statistic mean in the real world? It’s likely that you or someone that you know well is dealing with an anxiety issue right now. The good news is that most people can make meaningful improvements, get better, and get well with help and support. Hopefully talking about anxiety in both its healthiest context as well as understanding why things can go wrong has given some clarity as to why we are all vulnerable to problems with anxiety, but also provides a clear path as to how positive changes back towards healthiness can be made.

Written by Joseph Lee, M.D.

I'm a Psychiatrist in private practice in Redondo Beach, CA. I completed both medical school and residency training at UCLA. My practice is psychotherapy based with a health-oriented focus on personal growth and wellbeing. I also teach about mental healthiness and advocate for social emotional learning (SEL) in all contexts.

1 comment

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s