Friday, April 2, 2010

The Anatomy of Anxiety

The Anatomy of Anxiety

In my capacity as an outpatient psychologist, I have seen
clients with anxiety for twenty-five years. That and
depression seem to be the number one and number two presenting
Anxiety accompanies major depression seventy-five percent
of the time, not because it is a separate syndrome in this case,
but because it appears to be part of the depression problem.
So, treating the depression, with psychotherapy, medications,
or both, usually resolves a significant part of the anxiety.
This is diagnostic, because if the anxiety lifts in rough
proportion to the depression, then it probably is really about
depression, not anxiety, proper.
However, we all know there are anxiety "experiences" that
do not correlate with depression. Panic attacks and phobias
are two. OCD and PTSD can occur separately, too, but often
are accompanied by depression.
Or, there can be what psychologists call "co-morbid"
conditions. This is when anxiety and depression co-exist as
separate entities, not necessarily one causing the other.
It is a little confusing, but necessary to distinguish,
because in this article I'm going to talk just about anxiety
of the panic and phobia kinds, even though OCD sufferers will
be able to "relate."
What is the role of anxiety? Anxiety is the harbinger
of feeling out of control. It is a "red flag" from the back
of your mind (think subconscious) to the front of your mind
(think conscious). It's telling you that if you keep doing
what your are doing, or thinking what you are thinking, something
bad is going to happen and you are not going to be in control.
What is the response to anxiety? Most of us stop doing what
we were doing or thinking what we were thinking, and then our
anxiety diminishes. Presto! Instant reward for avoiding!
We no longer have to deal with those pesky "background" thoughts
or feelings because we removed ourselves from the triggers
(think "cues") that elicited our anxiety. In other words,
something in our environment reminded us of something we don't
like (memory, feeling, situation, etc.), but we didn't really
want to consciously pay attention to it. So, when our
subconscious mind perceived that this was going to be stimulated
(memories, feelings, thoughts, etc.), it directed us to steer
clear and "disconnect."
This is a neat trick and an almost automatic defense
mechanism. We all do this every day. The subconscious is very,
very good at picking up potential threats, way before the
conscious mind catches on. Panic and phobia sufferers have
perfected this escape trick, and at the same time have buried
lots of feelings, memories and other associations
(to the trigger). They have very high internal "pressure"
due to such a load of background feelings, memories, etc.
Precisely to the extent they have an overload of repressed
material and precisely to the extent they strive to avoid it
dictates the strength of the panic or phobia.


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