Dr. Angela Hanford
Anxiety is prevalent in today’s society and you or someone you know has probably been affected by anxiety at some point. The researchers in the National Comorbidity Study (NCS) found that 19.1% of adult participants in the United States have struggled with an anxiety disorder during the year, with 31.1% experiencing an anxiety disorder during his or her lifetime (Harvard Medical School, 2007).The level of impairment that these participants experienced ranged from mild to serious, with 22.8% reporting serious impairment, 33.7% at moderate impairment, and 43.5% at mild impairment.
The NCS Adolescent Supplement (NCS-A) reported 31.9% for adolescents with anxiety disorder and 8.3% with severe impairment (Merikangas et. al, 2010). In my own practice as a psychologist, I have seen more and more people from all age groups seeking treatment of anxiety disorders.
What is Anxiety?
You might be wondering “what constitutes anxiety?” We all have worries and stressors in life. When does anxiety become a problem or a “disorder”? Part of the answer depends on whether the feelings of worry or anxiety affect someone’s ability to function in life or are particularly distressing.
Anxiety is defined by Merriam-Webster as “apprehensive uneasiness or nervousness usually over an impending or anticipated ill”. Everyone has experienced these feelings at some point. Furthermore, many of us would not go to work or finish a homework assignment if there was not some level of uneasiness about failing to do so! Some level of anxiety is actually motivating. Therefore, anxiety can sometimes be healthy and adaptive.
Physiological Components of Anxiety
Another way that apprehension or fear can be healthy and needed is in a life-threatening situation. For example, if you are caught in the middle of a fire, you need to react quickly and escape. During life-threatening situations, certain parts of the brain (i.e., brainstem and limbic areas) take over and we go into the fight, flight, freeze, or faint response (aka, fight or flight response). Our body mobilizes to quickly deal with the fear-inducing situation in a way that will allow survival, rather than thinking through the steps needed before acting.
When this fight or flight response is activated by the brain we experience bodily changes, such as (Wilson & Lyons, 2013):
- Dilation of pupils
- Increased perspiration
- Increased heart rate
- Muscle tension
- Increased blood sugar
- Blood flow increases to certain parts of the body (e.g., head, trunk) and decreases to others (e.g., hands, feed)
Daniel Siegel’s concept of the Upstairs and Downstairs brain helps illustrate the mechanisms involved in the fight or flight response (Siegel & Bryson, 2014). The Upstairs Brain is the cerebral cortex, especially the region right behind forehead (e.g., prefrontal cortex), which is involved in such things as language, problem-solving, alertness, flexibility, and calming.
The Downstairs Brain consists of the limbic regions and the brainstem. The brainstem regulates our body, such as heart rate, breathing, and alertness. It receives information from the limbic regions. The limbic region consists of several different structures, one of which is the amygdala, which is highly associated with emotions.
This part of the brain quickly processes and expresses emotions, especially anger and fear. The amygdala alerts us to threatening situations and senses danger. However, an overactive amygdala has been associated with anxiety.
When the amygdala senses danger and starts the chain reaction leading to the fight or flight response, the downstairs brain takes over and breaks off communication with the more logical upstairs brain. As you can imagine, reactions are not always in the realm of logic but are coming from a place of emotion.
Again, this is adaptive in dangerous situations, such as when you scream “stop” and run toward your child that just darted into the street full of cars. You do not have time to have a conversation in your head about what is happening or what you should do. Instead, you react.
However, sometimes the amygdala becomes activated in non-emergency situations and creates what Siegel calls “flipping our lid” (Siegel & Bryson, 2014). For example, a child may not be able to find a homework assignment and, feeling overwhelmed, starts to panic and go into meltdown mode. Rather than having the logical part of the brain instruct the child to look for the homework, the downstairs brain has taken over.
This is also an example where frequent meltdowns and tantrums can actually be a sign of anxiety rather than simply “bad” behavior. Adults flip our lids too. Think of a time that you lost your keys or cell phone and did not necessarily respond in the most logical manner!
Another factor to consider is that a child or teenage brain is still developing. Although the amygdala is online at birth, the cortex continues to develop into at least the mid-20s! Therefore, children and teens are even more prone to flipping their lids, especially when under significant stress.
When someone experiences chronic anxiety, the signals go a bit haywire in the brain and the brain becomes mobilized for a crisis without there being a crisis (Wilson & Lyons, 2013).
When anxiety reaches a certain level of distress or impairment, an anxiety disorder may develop. Specific anxiety disorders are included in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) (American Psychiatric Association, 2013). The anxiety disorders from the DSM-5 include:
1. Separation Anxiety Disorder: Extreme difficulty separating from an attachment figure.
2. Selective Mutism: Consistently not speaking in social situations where speaking is expected.
3. Specific Phobia: Fear about a specific situation or object.
4. Social Anxiety Disorder: Anxiety regarding social situations.
5. Panic Disorder: Experiencing frequent panic attacks.
6. Agoraphobia: Fear of certain public places.
7. Generalized Anxiety Disorder: excessive worry that occurs on most days.
8. Substance/Medication-Induced Anxiety Disorder: Anxiety symptoms that are induced by a substance/medication.
9. Anxiety disorder Due to Anther Medical Condition: Anxiety that is a result of a certain medical condition.
10/11. Other Specified Anxiety Disorder and Unspecified Anxiety Disorder: Other instances of significant anxiety.
Each anxiety disorder has a list of criteria that must be met in order for a diagnosis to be given.
Do I Have Anxiety? Questions To Ask Yourself
During the last couple of weeks to six months, on most days have I…
- Felt anxious, worried, or nervous?
- Attempted to control worry but had had little success?
- Experienced worry about many different things often?
- Had feelings of restlessness?
- Been more easily irritated?
- Feared that something bad will happen?
- Had difficulty relaxing?
- Frequent and distressing anxiety or fear in social situations?
- Experienced physical symptoms such as shortness of breath, difficulty concentrating, muscle tension, insomnia, fatigue?
- Has anxiety negatively affected your functioning or other areas of life?
- Experienced frequent panic attacks?
Although this list of questions is not sufficient to diagnose anxiety disorders, answering “yes” to these questions can point toward anxiety. If you are concerned that you may be suffering from an anxiety disorder, seek out a mental health professional for an evaluation.
Strategies for Combatting Anxiety
1. Learn what anxiety looks like and when it becomes problematic.
2. Stop consuming caffeine and see if that lessens anxiety. If you consistently consume caffeine, remember that there can be significant withdrawal symptoms. In this case, you may ask your medical doctor the easiest and safest way to taper off from caffeine.
3. Have a medical evaluation to rule out any physiological causes for anxiety.
4. Healthy living, such as getting enough sleep and healthy eating.
5. Exercise, as long as you are cleared by your medical doctor for exercise.
6. Mindfulness: A practice that helps people learn to be fully present in the moment.
7. Relaxation exercises
8. Study and meditation on passages in the Bible that can counteract anxiety. For example:
But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own. – Matthew 6:33-34
Whoever dwells in the shelter of the Most High will rest in the shadow of the Almighty. I will say of the Lord, “He is my refuge and my fortress, my God, in whom I trust.” Surely he will save you from the fowler’s snare and from the deadly pestilence. He will cover you with his feathers, and under his wings you will find refuge. – Psalm 91:1-4
9. Maintaining consistent boundaries: For children, this means having consistent rules and containment in order to create safety (Siegel & Bryson, 2014). This does not mean rigidity, but consistent limits. As Daniel Siegel states, “living without living without clear boundaries is as anxiety-provoking as driving over that bridge without guardrails” (Siegel & Bryson, 2014). Boundaries are also important for adults. This could include saying “no” to too many responsibilities or setting limits with friends and families.
10. Connect and Redirect: Daniel Siegel and Tina Payne Bryson (2013) write about how to work with children who become emotionally dysregulated. The first step is to connect with the child at an emotional level (i.e., empathy) to soothe the emotions before trying to be logical. An emotionally dysregulated child (or adult for that matter) cannot hear the logic when his or her amygdala is in charge.
11. Combat Avoidance: Avoidance does not allow someone to master whatever is causing the anxiety. Backing away from that which creates anxiety is only a temporary relief. That being said, when the feared object or situation is actually dangerous (e.g., a bully, abuser), other strategies should be utilized.
12. Cope with Uncertainty: Wilson and Lyons (2013) assert that anxiety is an attempt to seek “certainty and comfort” in the immediate present. However, this is not always possible in a world that is filled with uncertainties and difficult experiences. A child may constantly ask questions such as, ”Am I ok?”, “Am I sick?”, “Do I have _____”, “Is ____ safe”, “what if _____”.
What the child is doing is looking for the reassurance and comfort that all is well or will be alright. However, always answering these questions and providing that “certainty”, it does not allow the child to combat the anxious thoughts or learn how to self-soothe. In fact, it can perpetuate the cycle.
13. Avoid Rescuing: It can sometimes be easier and quicker for a parent to take charge of a situation; however, it does not teach the child or teen to learn how to assert themselves or take responsibility. For example, if a teenager is anxious about grades you could have the student talk with the teacher about solutions rather than talking to the teacher on your own. This teaches the teenager to be active in life rather than avoiding difficulties.
Anxiety TreatmentWhen anxiety starts to interfere with functioning or becomes overwhelming or you have tried all avenues available, it is time to seek professional help. Seek out a caring counselor who has experience treating anxiety disorders.
Methods that can be used to treat anxiety include, but are not limited to: cognitive behavioral therapy, dialectical behavioral therapy, relaxation training, mindfulness, psychodynamic approaches, exposure therapies, eye movement desensitization and reprocessing (EMDR), and play therapy (for children).
Along with psychotherapy, you may need a complete medical evaluation to rule out physical contributors to anxiety. A medical evaluation may also be recommended in order to determine if medication can be of help.
Remember, anxiety is treatable and you do not need to live with the daily dread and overwhelming feelings that come with anxiety. We are here and to help come alongside you on your journey toward health and wholeness!
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Harvard Medical School (2007). National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort. Retrieved on 5/26/18.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, & Swendsen J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child Adolescent Psychiatry. 49(10):980-9.
Siegel, D. J., & Bryson, T. P. (2014). No-drama discipline: The whole-brain way to calm the chaos and nurture your child’s developing mind (First edition.). New York: Bantam.
Wilson, R. & Lyons, L. (2013). Anxious Kids, Anxious Parents: 7 ways to stop the worry cycle and raise courageous and independent children. Deerfield Beach, FL: Health Communications, Inc
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