- Do you worry that terrible things will happen even if they are unlikely?
- Do you often feel worried, 'on edge' or nervous?
- Do you criticize yourself harshly?
- Do you often assume that things will turn out badly?
- Do you need to think things through for a long time before you act?
- Do you procrastinate or avoid doing things altogether because of anxiety?
If you answered yes to any of these, chances are that you're dealing with some degree of anxiety. That's not necessarily bad; anxiety is a basic human emotion. But it can become uncomfortable and even debilitating. And that’s when it makes sense to do something about it. In this beginner's guide, we cover everything you need to know.
What is anxiety in the first place?
The obvious starting point is to understand what anxiety is in the first place. Psychologists and researchers mostly define it as
an emotional state characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.
It's the human body's physical response to danger. And it's made up of three components: thoughts, feelings and behaviors.
Without uncomfortable feelings, negative and repetitive thoughts and dysfunctional behaviors (like avoidance) there’s no anxiety. It can go different ways but it’s always some combination of those three ingredients that make life uncomfortable.
When psychologists talk about anxiety, they often refer to anxiety disorders. And about 40 million people in the US alone suffer from some form of those. But even more are simply prone to anxiety. That means that they simply have a general tendency to feel anxious, nervous or uneasy.
In whatever category you fall, there are a couple of problems that anxiety causes. The good news is that there's something we can do about this. The bad news is that many people don't know what. But that's why you're here.
The reason you experience anxiety
Anxiety is caused by an over-reaction of the human fight-or-flight response. This innate reaction has developed over more than hundred thousand years of evolution in order to protect us from danger. It's a biological process that kicks in whenever the brain detects something dangerous.
Imagine you live in a world full of dangerous animals. That's the life many of our early human ancestors had. When you were walking through the woods and a wild tiger crossed your path, you had to react quickly. Your entire body and your brain had to switch into survival mode. And that's what the fight-or-flight reaction is designed to do. The heart beat increases, you breathe faster and you can't think of anything but the danger in front of you. Without the fight-or-flight response, our ancestors wouldn't have survived so successfully.
The same reaction, however, also causes anxiety. And that's when it's not helpful anymore. People with social anxiety, for example, feel the same intense physiological response when they interact with other people. Their brains trigger a response that developed to help them in life-threatening situations - but they do this when there is no real danger in sight. The same happens during panic attacks. The fight-or-flight reaction gets completely out of hand - often without an apparent reason.
What's important to understand is that even though this isn't rational we all know it one way or another. Imagine you're young and alone at home at night. You hear a noise that you wouldn't even pay attention to during the day. But hearing it alone at night, this noise becomes scary. That's what anxiety is. It makes your heart beat faster and you start to look out for other things that could be scary. Your mind becomes hyper-focused on figuring out if you're in danger and you get extra sensitive to anything that could be scary. Regular anxiety feels the same way.
The many kinds of anxiety
Anxiety can come in all kinds of different shapes and forms. It causes various symptoms but all of them fall into one of the three categories. Thoughts, feelings and behaviors.
1. Worrying and rumination
It's quite common for anxious people to worry a lot. There's an urge to think things through to prevent bad things from happening. Or to replay events in your mind to find out how other people might have perceived you. The problem is that most of the time people end up going over negative thoughts without actually solving the problem.
Anxious feelings and worrisome thoughts then form a feedback loop. Negative thoughts cause unpleasant feelings which in turn lead to more worries.
There’s a whole range of options but the most effective ones involve dealing with those thoughts directly.
In cognitive-behavioral therapy (CBT), people gradually learn that their anxiety is caused by so-called thinking errors. Those are irrational thought patterns that we can learn to identify and then restructure systematically.
In acceptance and commitment therapy, people learn to see their thoughts as mere events in their mind. Or put differently, ACT teaches how to distance oneself from one’s thoughts. The key here is to see which thoughts are helpful and which are not.
Mindfulness-based approaches then use a uniquely human ability. There's a space between whatever happens to us (the stimulus) and how we respond to it (the response. The ability to widen and use this space is trained by regular mindfulness practice. As a result, thoughts and external events lose their power over us as we learn to respond to them differently.
2. Negative Self-Talk
We talk to ourselves all the time. In fact, everybody does. But when anxiety interferes, this self-talk can easily turn negative. Whether it's self-doubt or relentless self-criticism, anxiety can turn almost any situation into something bad.
This self-talk is often so habitual and salient that we don't even notice it. It's as normal to us as water is to a fish. We are surrounded by it. And even though it's irrational it always sounds like the truth.
The dilemma is this: Self-talk doesn't only affect what's in your head. It has real-world consequences. The critical inner voices become louder every time you even think about trying something new or meaningful. And every time you give in, that's another blow to your self-image.
The goal of acceptance and commitment therapy is to help people understand that it's possible to not to believe every thought. That's how people learn to let go of thoughts that are unhelpful and only focus on the ones that help live a happy and meaningful life. Acceptance – you learn – is a powerful strategy when it comes to self-doubt.
Another way to counter this anxiety-fueled self-talk is by offering self-compassion. This strategy has been researched only recently but with very promising results. It works by shifting the relationship we have with ourselves. Instead of treating ourselves like an adversary or a hyper-ambitious parent, we become our own best friend. For many people that's not easy at first but can bring transformative changes.
Anxiety and procrastination are often not put together - yet they are closely linked. Because chronic procrastination is an emotional strategy for dealing with stress and situations that make you feel anxious.
Scientists define procrastination as the voluntary delay of an action despite foreseeable negative future consequences. In other words, it's choosing short-term relief at the cost of long-term benefits. The essence of procrastination is we’re giving in to feeling good.
The way we think influences the way we feel and behave. And the underlying reason for procrastination are hidden beliefs like fear of failure or fear of getting out of one’s comfort zone. As long as we (unconsciously) believe that procrastinating is the best option, we will keep putting things off. That’s why the CBT solution to procrastination is to identify those false beliefs and – over time – reframe them.
The other helpful way of dealing with procrastination involves dealing with the feelings of procrastination. The key insight is that we not just avoid a particular task but we avoid the feelings that somehow come with that task. The key skill is learning to experience uncomfortable feelings without giving in to them.
4. Avoiding anything that may cause anxiety
Anxiety often causes us to avoid certain situations. It can be avoiding working out for the fear of causing a panic attack. It can be not taking an exam for the fear of failing it. Or it can be cancelling a date with friends for the stress of meeting them and fearing we might say something embarrassing.
The root cause of this avoidance is so-called thinking errors. We imagine catastrophes, jump to conclusions about what other people think or filter out positive information and focus only on the negative.
Ultimately, avoiding can only be solved by the most obvious strategy there is. Exposure. That means gradually facing whatever we avoid. But that's not done blindly or without preparation. Just do it may sound great but for many anxious people it's an unworkable strategy. In order to face anxious-provoking situations, it helps to use CBT and mindfulness strategies. And then gradually increase the challenge and we will notice that things aren't as bad as they seem after all.
5. Fear of Criticism
It's common knowledge that feedback is important to become better. People who are anxious, though, tend to avoid it because it feels uncomfortable and even threatening.
We fear negative feedback because we habitually misinterpret it. We take it personally, think it’s permanent and that it applies to all areas of our lives. As a result, we end up feeling like a failure. If we look at it from this angle, it's only logical to be afraid of criticism. And to try to avoid it at all cost.
In order to reduce this fear of criticism, we need to reframe those underlying beliefs. Change happens when we - over and over again - make ourselves aware that criticism isn't as bad as we make it out to be. Systematically and step by step, cognitive behavioral therapy helps identify the reasons for our fear of criticism. And then helps establish alternative, more realistic thinking patterns.
Anxiety-related perfectionism can get in the way of both feeling happy and being successful. It causes all kinds of problems such as prioritizing the wrong tasks, becoming frustrated with ourselves and putting those things off that really matter.
Perfectionism is the result of a toxic combination of thinking patterns: Exceptionally high standards and a fear of failure. Many of us are afraid of failing, at least some of the time. But fear of failure is when we allow that fear to stop us doing the things that can move us forward to achieve our goals.
After about fifteen years of research, it's now clear that self-compassion is a much more effective strategy if you're striving to learn, get better and achieve good results. There's a simple reason for this: Perfectionists focus much of their energy on avoiding mistakes. People who are self-compassionate on the other hand can move past mistakes more quickly and are much better at learning from mistakes. That's because they don't see mistakes as threats but as learning opportunities.
Closely related to that solution is shifting from a so-called fixed mindset to a growth mindset. Through cognitive reframing it's possible to create new and more constructive beliefs about failure, progress and change. That's what psychologists call a growth mindset.
7. Panic attacks
A panic attack is a rush of intense anxiety which triggers strong physical sensations – often without an obvious reason. The changes in body and mind take place so rapidly that you experience them as an "attack".
The key problem with panic attacks is that we experience them as truly dangerous. In reality, they are not dangerous at all. They simply are an uncomfortable overreaction of one’s nervous system.
Panic attacks happen because we start to associate certain changes in the body (increased heart beat or sweating for example). And we develop a fear of those feelings because we believe they are the signs of a coming panic attack.
Effective interventions often focus on a combination of things. On the one hand it’s helpful to learn to relax deliberately. Being able to turn down one’s own nervous reaction is a key skill for any anxious person but it’s especially important if you struggle with panic.
Mindfulness skills also come in handy as they help take away the frightening power of uncomfortable sensations. In treatment for panic attacks, it’s used to teach people to experience uncomfortable sensations without reacting negatively to them. And that helps them short-circuit the vicious cycle of panic.
The third and most important strategy to manage panic attacks is confront anxiety-provoking situations on purpose. The key is to face what we’d normally avoid – but doing this step by step and with the help of mindfulness and relaxation techniques.
In this section, we're covering the most frequent questions that arise. If there are things you'd like to know that we do not cover, feel free to reach out.
Should I use medication to treat anxiety?
The short answer here is that medication can be a useful form of help for some people. It is used to reduce symptoms and that's why it's usually most effective when you combine it with professional therapy. If you consider taking anti-anxiety medication, it's strongly advised to consult a doctor.
Are they different kinds of anxiety?
Yes, indeed anxiety is not the same for everyone. Firstly, it can come in different degrees. Some people experience mild forms of anxiety while others really cannot live a normal life because their symptoms are too strong. Then there are also different types of anxiety disorders:
Generalized Anxiety Disorder (GAD): This anxiety disorder comes with a lot of worrying and rumination. People who struggle with GAD usually worry about all kinds of things and this often interferes with living a normal social life and functioning effectively at work or school.
Panic Disorder: People who routinely experience panic attacks typically fall in this category. Those attacks are sudden bouts of intense fear. They build up quickly and can feel live-threatening.
Phobias: Phobia is the intense fear of an object or a particular situation which is out of proportion to the actual danger. For example: spiders, heights, flying or public speaking. Phobias are often not as debilitating as other anxiety disorders because they only affect one area of life.
Social Anxiety Disorder: This is the most common form of anxiety disorder. It's root cause is the intense fear of social situations. People who struggle with social anxiety typically avoid being the center of attention and being criticized and they often worry about doing something wrong or embarrassing.
Does anxiety usually go away by itself?
General anxiety is temporary. It goes away after a while. Chronic conditions like generalized anxiety disorder, on the other hand, usually do not stop without some effort. The interventions and treatments described above, though, are well-validated methods that help many people who suffer.
What are some simple things I can do right away?
- Cut down on coffee, black tea and energy drinks. They activate the sympathetic nervous system and this can increase anxiety.
- Physical exercise like running or swimming can be an effective anxiety treatment.
- Sleep deprivation is not only a symptom of anxiety but also a cause. If you're experiencing anxiety, it's advisable to get a regular sleep routine.
What about people who've always had a tendency to feel nervous and anxious?
Some people are more prone to anxiety than others. This tendency is the result of our genetic make-up and our upbringing. If you believe that you fall in this category, it doesn't necessarily mean that you're having an anxiety disorder. However, you can still benefit from the therapies and interventions outlined in this guide.
This post is not intended to give medical advice and does not substitute professional help.
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