After the outbreak of novel coronavirus, there has been a tremendous increase in mental health issues worldwide. Rates of Anxiety following uncertainty in employment, health concerns, the economic crisis, to name a few, has increased manifolds. But even before the coronavirus outbreak, the prevalence of anxiety disorders worldwide has been approximately 3.8%, i.e. 284 million people suffer from one of the different types of anxiety disorders. The numbers have surely increased after the pandemic.
Let us first understand and clear our myths around anxiety. Anxiety, by definition, is our body’s natural response to stress. The moment we perceive a threat, either in our surroundings or in our imagination, our body is prepared to work in “fight or flight mode”. While fear is a response to a threat in the present, anxiety is our body’s response to anticipation of future problems. It is excessive and persistent worry. We experience symptoms like racing of heartbeats, muscle tension, trembling, sweating, breathing rapidly, experiencing gastrointestinal problems, and avoiding triggers to name a few. Although our nervous system helps regain our body homeostasis by returning to normal after we feel anxious, due to prolonged stressor and perceived threat, we might constantly and disproportionately have symptoms of anxiety. Anxiety disorder occurs when these symptoms continue to persist for longer periods of time, even in the absence of a stressor and interfere with one’s daily functioning. Anxiety disorders are categorized into 6 types and are more or less treatable.
Now that we know the rising stats of one of the most common anxiety disorders, let us look at the probable causes of it. We can broadly categorize it into 3 types of vulnerabilities.
- Genetics– Genes play a major role in the etiology of any type of anxiety disorder. Research suggests that there are 30-40% chances of a child inheriting anxiety disorder if it is present in the parents.
- Childhood trauma– A person is more prone to develop an anxiety disorder if he has been exposed to early childhood trauma. Trauma can be very subjective and can be perceived when a person either faces or witnesses a traumatic experience. The trauma perceived during childhood can manifest in many forms, one of them being severe anxiety. Neglectful or abusive parenting, loss of a parent, being bullied, meeting with, or witnessing an accident to name a few, may all come under trauma.
- Particular Stressful events– Anxiety disorder may also manifest when a person is facing a stressful event. A person who is genetically predisposed may find such events as a triggering factor and may fall prey to anxiety disorders quicker than the rest of the low-risk population.
What Happens in the thought process?
Although there is a large part of the neural and biological basis for anxiety disorder, and a few percentages can be attributed to external, uncontrollable events like natural calamities, there’s a percentage share of how we perceive a situation, our thoughts and our beliefs that can be modulated to work upon anxiety.
Consider an example: You have an interview in some time and you also have to go to the hospital to collect your father’s medical reports. A person who has severe anxiety might have a train of thoughts, might feel he’s unable to control any situation, what if the interview goes wrong, what if the medical reports are positive, what if he messes up all the interviews and he never finds a job again, etc. He’ll suddenly start sweating, might feel his heart pumping, become restless, might feel shortness of breath, and might have a sense of losing control. With continued thoughts, his symptoms might aggravate and it will take longer than usual for him to calm down. What starts as a worry ends up in anxiety. For people with severe anxiety or generalized anxiety disorder, they may continue feeling this way even when there’s no particular trigger.
So what exactly happens in the thought process? We’ve observed that most people with anxiety have a thinking pattern known as catastrophization. In this, a person sees the problem for not what it is but greater. He magnifies the problem he thinks of, ruminates about it, forms negative, worst possible outcomes in his head, and considers it to be the reality. Now the brain doesn’t differentiate between an actual present threat or an imagined threat. All the worst possible negative outcomes now become a threat for your brain, to which it responds in a manner like it would to an actual threat. You’ll hence start noticing all the symptoms of anxiety the moment you start seeing the magnified version of your problem.What happens when you face an actual threat though, like seeing a snake in front of you? After the fear response, your body comes back to its natural state when the threat goes away. But in cases where the threat is heightened by your thoughts, your body will continue remaining in that arousal state. This is where your functionality starts affecting.
We can categorize the triggers for catastrophizing thoughts into 4 broad categories. An awareness of where your thoughts fall is always a good start to deal with anxiety. These are:
- Ambiguity- If something is unclear or there is no sense of direction.
- The highly valuable things at stake- for example your job, the health of a family member, etc.
- Fearful situation- If a person is already afraid of flying and is about to board a flight.
- Being run down- When you are already tired or depleted, you tend to catastrophize more.
Challenging these thoughts
There are two main treatments for anxiety disorders- pharmacological treatment and psychotherapy. There are a few ways that surely helps a person to reduce anxiety. A few of them are:
- Yoga and relaxation
- Mandala and Art therapy
- Deep Breathing
- Grounding Techniques
- Dance Movement Techniques
Along with the above-mentioned techniques, constant work on rewiring your thoughts is also required for a person to see long term changes. Here are a few strategies to challenge these thoughts as well. A word of caution: These thought challenging tools may not be efficient while you are in the middle of facing all the symptoms. Without proper guidance, it might even aggravate your anxiety. But you can surely try these out the moment you become aware of the negative self-talk or after you’ve calmed down and are in a state to reflect on the event.
For people with mild levels of social anxiety, or when you are run down or depleted, you can try to search for evidence or solid proof to make yourself understand why your thought is not true. You might want to find evidence from your past experiences that were against your current belief and challenge your thoughts with it. You can start your sentences by using the phrase “This is not true because..”.
When you feel you have highly valuable things at stake, you can use this simple reframing technique where you can take a look at the same thing from a more optimistic perspective. A simple sentence starter for help could be “A better way to look at it is…”.
Sense of Control
In cases where the direction is unclear or there’s a feeling of helplessness, a sense of losing control, you can make a list of things in that situation that is under your control, things that are not and things which are a bit more challenging but you can exert some control over it. In this manner, you may regain your composure and might start feeling more empowered over the situation.
A four-step technique
Once you’ve thought of all the worst possible outcomes in your head (which is the first step that we naturally do), make a list of all the best possible outcomes that may happen. Go bigger in the thought till you feel a little relieved. After that, try recognizing the possibility of either of the two actually happening. And finally, based on what’s probably going to happen, make an action plan. For example: what can you do if you feel nervous in the interview. This is known as a contingency plan. “If x happens, then I will y”.
Ask the right question
This one is my personal favorite. It is important that we be mindful of the questions we’re asking ourselves. If we can turn the question of “What if this happens” to “ What can I do to avoid this thing from happening” or “How can manage better even if this happens”. It’ll give you more action-oriented answers. You’ll feel more in control of the situation and hence more empowered.
All the above-mentioned strategies are surely no substitute for therapy. If at all you feel your anxiety is coming in your way of normal functioning, please do not hesitate from seeking professional help!