We’ve all encountered dangerous or stressful situations which provoke in us feelings of panic, anxiety and fear. These feelings are completely natural and usually don’t occur too often. However, for people with anxiety issues these feelings can occur regularly and can strike at any time. These attacks, when they happen, cause distress and leaving the individual feeling both powerless and out of control.
For the people who suffer these attacks, anxiety can come in varying degrees. At times it is a low-frequency, background noise; there but not too troublesome. It can range from this low level, through to milder bouts, and go all the way up to severe. For people with severe anxiety it as if the volume has been turned up to eleven. This degree of anxiety overwhelms all the other senses and excludes any other form of mental activity. This can affect the individual’s work life and shut down their capacity to derive any pleasure from life.
If this sounds like your experience, then know that you are not alone; anxiety is one of the most common reasons that people seek therapy.
Types of Anxiety
There are many different types of anxiety including social anxiety, PTSD, phobias and panic attacks, categories which I look at below. It’s important to remember that while they designated separate categories, they’re can (for individual sufferers) be some overlap between them.
For example, the symptoms of anxiety are similar across the different categories. There are mild symptoms such as feelings of unsteadiness, dizziness, light-headedness or faintness, sweating or shortness of breath. Mid-range symptoms such as hot or cold flushes, nausea, shortness of breath, trembling or shaking. And more severe symptoms such as chest pain, palpitations, or feelings of choking. Other symptoms might include feelings of being dissociated from own body, fear of not being in control, and fear of dying.
These symptoms can fall under any one of the types of anxiety.
Another common factor is the activation of the fight-flight response. We humans, like all other animals, evolved the fight-flight response as a protective mechanism. The response involves, among other things, the secretion of extra adrenaline, and an increase in the heart rate, along with a sense of urgency or terror. When we’re really facing a dramatic event that we need to flee from, this response keeps us safe. But when we suffer the symptoms of fight-flight even when there’s no immediate threat, we may be suffering from an anxiety disorder.
Again, the fight-flight mechanism is a commonality that underlies the different types of anxiety.
Now. Having touched on some of the ways in which they are the same, let’s look at some of the ways in which they are different.
Social Anxiety, sometimes known as social phobia, is a common anxiety disorder that can have a significant impact on quality of life of an individual. Almost everyone has at some point experienced social anxiety (e.g. during public speaking), making it a normal experience. It becomes problematic, however, when someone’s ability to enjoy life and/or their ability to function is impaired. This is because sufferers tend to get overwhelmingly anxious, excessively self-conscious and even in a state of panic in everyday social situations. Social anxiety can bring on feelings of being negatively judged and evaluated, thereby leading to avoidance of social situations where interaction with others is inevitable.
Meeting new people, or feeling you’re being ‘inspected’ by others (like in an interview situation), can be enormously stressful. The individual may panic about not making a good impression, or feel uncomfortable becoming the centre of attention, with ‘all eyes on them’. They may run from social situations that, deep down, they’d rather be able to enjoy.
Perhaps they worry that they’ll will flush, blush or stammer, thereby drawing negative attention to themselves. If any of these do occur, the individual can experience emotions like shame and embarrassment. The anxiety around these situations then makes it difficult for them to express their opinion to a group of friends or colleagues, or even eat and socialise with friends.
This can make life very restrictive.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) usually develops after a severe physical or emotional trauma such as a car crash, being the victim of a crime or assault (sexual or otherwise), or being involved in war or violence. Symptoms often include flashbacks of the trauma, or frightening thoughts that interfere with a person’s everyday routine. These can take place months or years after the traumatic event. When people with PSTD experience a flashback they experience much of the original trauma, with similar levels of stress, but without any resolution.
People with PTSD often avoid thinking about the triggering event and may have difficulty recalling it. PTSD also implies some distance from the activating event. While a ‘stress reaction’ to an event that is still ongoing is normal and healthy, experiencing symptoms long after the event is a problem.
In addition to PTSD’s psychological repercussions, and it can also impacts an individual’s physical health. It leads to people experiencing all the symptoms of severe stress – secretion of high levels of adrenaline, elevated heart rate, etc. This stress puts the body under strain and can aggravate any underlying physical condition that the individual may have.
People with untreated PTSD can also be vulnerable to substance abuse, often in an attempt treat their symptoms by ‘self-medicating’.
The overall effect of PTSD is to have a negative impact on most aspects of an individual’s quality of life.
For anyone who has suffered them, panic attacks are a terrifying experience. Such attacks often happen suddenly and without warning. They include symptoms such as sweating, trembling, shortness of breath or a feeling of choking, and a pounding heart or rapid heart rate.
One shocking thing about a panic attack is the rapidity with which they occur. They can come out of the blue, leaving an individual feeling very vulnerable. In addition, the individual in the grip of a panic attack often feels as if they are dying. This fear in turn creates more anxiety and the sufferer is caught in a vicious cycle, fearful as to when the next attack might occur.
Panic attacks can be triggered by a range of stimuli. For one person the sensation of being in a crowded space – making them feel as though they can’t breathe – can trigger a full scale panic attack. For someone else, the trigger could be finding themselves alone in a large, empty space. For a third individual, the trigger might be being faced with the need to make some important decision.
Although the symptoms are real; the increased blood pressure, elevated heart rate, and rapid breathing, the good news, at least, is that panic attacks won’t kill you. The bad news though, is that long term the symptoms can negatively affect your health.
A phobia is a persistent fear of an object or situation. Individuals who suffer from a particular phobia will try to avoid the object of their fear, even though it might not pose any actual danger. These fears are often said to be irrational, and are sometimes divided into two different types; simple and complex.
Simple phobias might include a fear of dogs, mice, snakes, spiders, enclosed spaces or even dentists. Reactions to simple phobias range from mild to severe and, in certain cases, might result in a severe panic attack.
Complex phobias tend to be a more deep-seated fear of a particular situation. Examples might be agoraphobia or social phobia. Agoraphobia is an intense, debilitating anxiety – regarding open or public spaces – that leaves the sufferer unable to leave the house. It usually occurs as a result of the individual having suffered from recurring panic attacks in the past, leaving them to fear going outside in case they suffer a panic attack with nobody around to help.
Simple phobias start earlier in life and usually disappear on their own. Most complex phobias start later in life and can be more troublesome. If the source of the phobia cannot be avoided, the severe distress can have a marked effect on daily activities.
Avoidance as a Natural Response
A natural response to anxiety can be avoidance. Avoidance is a common behaviour for anxiety sufferers as they attempt to control any given situation. For example, they avoid certain places or people or they only feel they can do things if certain restrictions have been put in place. The social anxiety sufferer may avoid or delay responding to invites so that they can ‘play for time’ while they think of a way to avoid the social event in question. The sufferer of PTSD might avoid anything that reminds of them of the source of their anxiety. The panic attack sufferer may avoid going out into public at all.
In short, people suffering from anxiety often try to cope with negative reactions by avoiding the very situations or experiences that make them anxious.
Unfortunately, avoidance can backfire and actually end up feeding the anxiety. Although the anxiety may feel alleviated temporarily, it has been avoided rather than dealt with. Using avoidance as a tactic, the sufferer never gets to learn that the ‘bad thing’ it is not really as bad as they imagined. The avoidance usually results in an intensification of the anxiety; meaning their reaction to the ‘trigger’ becomes more acute, rather than fades away. In avoiding these situations, an anxiety sufferer finds their world grows ever smaller.
Some anxiety sufferers turn to alcohol, or dependence on medication to avoid their negative feelings. These behaviours also have a dramatic impact upon their life.
Ultimately avoidance leads to the feeling that their anxiety is controlling them.
In the short term, medication can provide some relief, but for lasting change, psychotherapy can make a big difference. In therapy the individual gets to explore the possible causes and triggers of your anxiety and work on developing effective coping strategies. They also get to explore techniques and tools that will help them manage stressful situations in the future.
Within the therapeutic space the individual learns how to cope with and manage the physical symptoms of anxiety and panic, helping them realise that them can control it rather than anxiety controlling them.
It also important to remember that anxiety is the symptom. It shows up as the result of something else and therapy can help to explore and discover what that is. Psychotherapy can also break an individual out of the closed system of their own interpretations, and when they see the anxiety for what it really is they may find that it loses most of its power over their lives.