Good and bad anxiety
Everyone feels anxious at times – that’s normal, and healthy. Our emotions exist for a reason; anxiety is a signal that we feel threatened in some way. If you’re in danger, you don’t want to feel at ease. But anxiety is a problem when the worry isn’t rational, especially when avoidance is used to deal with the perceived threat. If you feel extreme panic when someone points a gun at you – normal and healthy. But if you feel that same sort of panic at the thought of being at a party, catching a train, or when you remember a traumatic event, that’s no good (that’s a technical term).
Why me? Why have I got an anxiety problem?
There are a few different theories around to explain why some people develop anxiety conditions, but by far the most accepted model is that anxiety conditions are learned responses – our experiences have taught us to respond in that way. That might sound simple, mainly because it is – though it took us humans a surprisingly long time to realise it (or at least for psychologists and psychiatrists to realise it). Some other explanations argue that it’s just the way some people are born; or that brain chemicals are responsible; or that there are unconscious forces at work. If you go back a few centuries, severe anxiety was sometimes seen as evidence of being possessed. Most people don’t care what the explanation is, they just want to get rid of their anxiety problem. And that’s where a learned response explanation really matters, because that just happens to be the most effective way to treat most types of anxiety. The vast majority of clinical psychologists will treat anxiety by using a form of cognitive behavioural therapy; that’s a good thing, because there is a large body of research showing it to be the most effective approach. While different types of anxiety have common features (such as – well, anxiety) the way treatment is designed will depend on the type of anxiety, and on your particular circumstances. Clinical psychologists can adapt their approach to suit each person.
Panic is a feature of several anxiety conditions; that in itself isn’t enough to be called “Panic Disorder”. For example, someone very scared about giving a speech can have a bout of panic (“panic attack”) because they’re worried about looking stupid – that’s not Panic Disorder. In Panic Disorder, the bouts of panic seem to occur for no reason, and are seen by the person as a sign that something terrible is happening – that they’re having a heart attack, going crazy, about to faint – you get the picture. Remember what anxiety is? A fear that something bad is going to happen. So in Panic Disorder, a wave of panic is triggered, which is then interpreted as a sign of something catastrophic happening, which causes even more panic. What’s really happening is that the panic is about panic. Treatment for Panic Disorder takes a few approaches, but they’re all aiming to change the way you think about the triggers of panic, how you interpret the panicky feelings, and eliminating avoidance – sometimes it’s not easy to see how avoidance is being used, but where there’s an anxiety problem, there’s almost always avoidance. Where avoidance has become extensive, the additional label of agoraphobia might be warranted; an example would be someone who is too scared to catch trains or go to the movies, and will only go to one “safe” supermarket. See Challenging Negative Thoughts for some questions that help to see things in a more balanced way.
Also called Social Phobia, the focus of this anxiety is what other people think of you. Common worries are that people don’t or won’t like you, that you’ll be criticised, or make a fool of yourself. People usually have some safe people and places where they feel comfortable, but other situations are quite upsetting. Psychological treatment starts by getting you to clearly understand the thoughts you’re having when you feel anxious. Then those thoughts are challenged and defeated. It’s not about pretending to yourself, or repeating to yourself sentences that just aren’t true. You can’t control what everyone thinks or how every situation will turn out, but fortunately you don’t need to. Treatment doesn’t stop at thoughts – it’s also important to look for avoidance and deal with it too. It’s also useful to look at underlying assumptions that you hold about yourself and the world, since these can make you vulnerable to having negative thoughts in the first place.
Some people seem to worry about everything. Often Generalised Anxiety Disorder (formal label) has been a problem for a long time, people thinking it’s just the way they are, so they don’t get help. But treatment for generalised anxiety is effective, and is based on the same principles described above. The idea is that excessive worry is the way you’ve learned to make sense of the world, with difficult situations avoided since they make you feel worse – seems sensible. But avoidance teaches you that you can’t cope, which makes you more vulnerable the next time. Psychological therapy teaches you to identify the distorted ways that you’re thinking, and you’re taught techniques to be more accurate with your thoughts (cognitions). Sometimes relaxation techniques are used to help you keep physical and emotional symptoms in check, which in turn can help you to think straight. And that avoidance – it has to be dealt with too.
Even though Obsessive-Compulsive Disorder (OCD) is classed as a type of anxiety – and has anxiety as a central feature – it’s probably the most different of the Anxiety Disorders. Obsessions are thoughts or images that are experienced repeatedly, and that cause distress, the person trying to suppress them. Compulsions are behaviours that are performed in response to obsessions, with the belief that the compulsions will prevent something bad from happening. In its own way, a compulsive behaviour is a way of avoiding whatever would happen if the behaviour wasn’t performed. Psychological treatment mainly focuses on getting rid of the obsessive thoughts by teaching you to stop the compulsive behaviours that normally provide short term relief. When these behaviours stop, you learn that the feared situations don’t occur, and the obsessions lose their power. Many people with OCD will also need to take medication, which should be managed by your GP or psychiatrist. There is strong evidence to show that psychological treatment for OCD usually provides significant benefit.