Anxiety
COUNSELLING FOR ANXIETY
It is normal and even helpful to feel anxious some of the time, for instance before a job interview, a stage performance or an exam. However, with an anxiety disorder, these feelings can occur at any time and are a disproportionate response to most of life’s everyday events.
Some of the issues that might cause anxiety to develop
• Having a personality that is more prone to anxiety
• A single or multiple traumatic event/s
• Stress caused by illness or difficult life events
• Alcohol or drugs (although many people begin to use alcohol or drugs to try and deal with anxiety, they also have the effect of creating more anxiety)
• Abusive relationships
• Anxiety can run in families (however it is important to stress that this doesn’t mean that it cannot be treated)
Some of the symptoms you may be experiencing with your anxiety:
In your body:
Racing heart; rapid breathing; sweating, shaking; tiredness; sleep difficulties; stomach problems
In your mind:
Feeling a sense of dread; constant worry; avoiding anything that worries you; avoiding social interaction; shame that this is happening to you
Is your anxiety panic or anxiety based?
Your anxiety may be more panic based in which case you may be prone to the sudden onset of panic attacks, for which there may or may not be a trigger. Alternatively, it may be more anxiety based so that you are trapped in endless cycles or catastrophising about future events or criticising yourself for past events. You can read more on Very Well Mind
They stress that it is possible to experience both panic and anxiety-based disorders at the same time.
Distinguish between panic and anxiety-based symptoms with this useful table:
Panic Attack
• Sudden
• Lasts for minutes
• Shaking or trembling
• Chest pain
• Hot flashes
• Sense of detachment
Anxiety
• Gradually builds
• Can last for months
• Restlessness
• Fatigue
• Muscle tension
• Irritability
Post-Traumatic Stress Disorder
If you are experiencing PTSD, this will have been triggered by a terrifying event and may have developed a few weeks after the event, but may not develop until years later.
Symptoms include:
- being easily startled
- flashbacks
- suicidal thoughts
- feeling disconnected
- dissociation
- guilt and shame
- self-destructive behaviour
- being quick to anger and many more
This is debilitating and requires treatment. Counselling can help to disentangle the feelings that are causing these symptoms to persist. Often, identifying the feelings of guilt and shame can be a turning point in treatment.
How will I work with your anxiety?
I have found since starting work as a counsellor that no two people describe anxiety in exactly the same way. As such, I have always worked with the person to find out the kind of being their anxiety is. Although physiological responses and feelings of dread seem to be shared by all with anxiety, the feelings people have about themselves are unique and tailored to their perception of their life experience.
It is often a ghastly cocktail of the worst of the hurts from childhood with some unpleasant adult experiences thrown in. These beliefs determine how the person reacts in day-to-day events. If I tell myself I am unlovable or a failure, I will have memories of feeling that as a child and perhaps the disdain on a parent’s face and I will probably reprimand myself in the tone of that adult.
If I go into a social situation, I will be monitoring myself for failures. If I am unable to complete a task about which I am phobic, I will bully myself after. When I get home, I will rewind and play back those perceived failures and berate myself in the tone of the critical parent (and anyone else who I perceive as having negative feelings for me).
This will go on until the next perceived failure happens to me and I start to ruminate on that. As such, the thought of putting myself through a social situation or trying to make myself do something fear inducing becomes unbearable.
It is often a ghastly cocktail of the worst of the hurts from childhood with some unpleasant adult experiences thrown in. These beliefs determine how the person reacts in day-to-day events. If I tell myself I am unlovable or a failure, I will have memories of feeling that as a child and perhaps the disdain on a parent’s face and I will probably reprimand myself in the tone of that adult.
If I go into a social situation, I will be monitoring myself for failures. If I am unable to complete a task about which I am phobic, I will bully myself after. When I get home, I will rewind and play back those perceived failures and berate myself in the tone of the critical parent (and anyone else who I perceive as having negative feelings for me).
This will go on until the next perceived failure happens to me and I start to ruminate on that. As such, the thought of putting myself through a social situation or trying to make myself do something fear inducing becomes unbearable.
What can we do about this in counselling?
When we meet for a consultation, we can talk about the kind of anxiety you have. It doesn’t matter if you have a diagnosis, whether you have been anxious for your whole life or if it is a recent adaptation. If you decide to work with me, we will begin the process of investigating why it has been necessary for anxiety to develop for you. We will discover how you are talking to yourself and challenge that approach.
We will work at improving your relationship with yourself so that you begin to accept yourself and like yourself more, which will lessen the anxiety that you are experiencing.
Read on if you are interested in theories of the brain and anxiety, but don’t worry if you don’t want to – it really isn’t necessary to the work we will do.
You may be familiar with the popular understanding of anxiety based on Maclean’s Triune Brain Theory developed in the 1960s https://thebrain.mcgill.ca/flash. You will probably have heard the term ‘lizard brain’ and be familiar with it as it is taught in schools, by coaches, therapists of all kinds, psychology text-books and self-help books. The idea is that human brains developed in three stages/layers, in line with our evolutionary history. The lizard brain was said to develop first, being responsible for breathing, other bodily functions and movement. Next, the mammalian brain or limbic system was said to have formed around the lizard brain and this part is crucial to learning, memory and emotion. This was followed by the development of the neocortex, essential to language, abstract thought and imagination.
Using this model, the understanding of anxiety has been that our hunter-gatherer ancestors, in common with all animals, relied on the fight/flight freeze response to evade predators. The part of the brain seen as responsible for sensing danger, the amygdala, prompted cortisol and adrenaline to be pumped around the body, leading to increased heart rate, blood pressure and breathing rate. This could be sustained for up to 30 minutes and increased the ability to run away from threat, fight it or freeze if necessary.
Fast forward to the 21st century and our sedentary office-based lifestyles when this kind of response is usually disproportionate to the kind of threats we face. If the amygdala kick-starts the same level of response when the boss comes into the room as it would have when faced with a lion, the effects are bound to be debilitating. With the triune brain theory, the understanding is that if the prefrontal cortex is working optimally, it is able to restore calm by reasoning that it is only the boss and not a huge threat (unless of course, the boss is an actual threat!). However, for those with anxiety, the amygdala is said to be firing indiscriminately and the prefrontal cortex unable to intervene.
This theory is also used to explain addiction, impulsivity, predatory sexual behaviours, anger outbursts, selfishness and other anti-social or maladaptive behaviours. The understanding is that the ‘lizard brain’ has run amok and out-manoeuvred the cerebral cortex carrying out all of the self-destructive behaviours that it loves.
When I was writing up this page, I thought I would be using the triune brain theory as it is so widely accepted as accurate. However, I fell at the first post because as I searched various psychology, therapy and science sites, I could not even find any general consensus as to which of the three brain parts housed the amygdala. Some say the amygdala is part of the lizard brain while others locate it within the mammalian brain. If the amygdala is considered in the triune brain theory to be essential in the recognition of danger, how can it not be located in the lizard brain and if it isn’t, how do reptiles detect danger?
Following further searching, the reasons for these anomalies in the triune brain theory became clearer.
- Mammals did not evolve from reptiles, but rather both evolved from a shared fish-type ancestor https://drsarahmckay.com/rethinking-the-reptilian-brain/ https://allyouneedisbiology.wordpress.com/2016/01/10/amniota-evolution/
- Numerous studies have found that reptiles do in fact have an amygdala (or at least regions of the brain that operate in the same way as the amygdala) and that they are capable of emotional learninghttps://www.intechopen.com/chapters/41591. Damage in these areas, leads to changes in aggression, avoidance, reproductive behaviour and parental care. This undermines the understanding that it is the lizard part of the human brain, devoid of emotion, that is responsible for behaviour thought to be unreasonable. Furthermore, a number of studies have found that reptiles do feel emotions.
- Neuroscientist Dr Lisa Feldman Barrett, conducted a meta-analysis, analysing data from all published neuroimaging studies on emotions over a 20-year period, to establish whether any particular area of the brain consistently demonstrated activity in relation to a particular emotion. When participants were experiencing fear, only 25% showed amygdala activity and in studies regarding perceived fear, only 40%.
- Furthermore, Barrett’s meta-analysis showed that the amygdala was activated by a variety of situations, such as when learning new information, perceiving pain and meeting new people.
We feel either pleasant or unpleasant feelings according to a continuous process within our bodies called interoception (Barrett, 2017). This is our brain’s interpretation of sensations derived from hormones, organs, our immune system and blood. According to how my brain interprets these signals, it will determine whether I have a pleasant or unpleasant feeling. These affects or feelings are the ground upon which emotions are then constructed.
The brain uses this information in tandem with data from past experiences to predict what is likely to happen next and create a relevant simulation. This combination will become your experience unless the simulation doesn’t match what happens next, in which case energy will be expended to adjust as needed. If you are anxious, you will be continually predicting threats from the outside world that are incorrect so that physiological processes are geared up for action unnecessarily, leading to your feeling exhausted. Simultaneously, your anxiety will be leading you to misinterpret information derived via interoception, so that any changes in heartbeat or how hot or cool you feel, for example, will also lead to predictions of threat. As you become increasingly worn down by these prediction errors, it becomes more difficult to distinguish what is actually going on in your world from that which you fear to be occurring.
Barrett describes the way out of this as being by increasing emotional granularity or the ability to distinguish between multiple feeling states. Rather than emotions being universal and lying innate within us, she describes them as being constructed in the moment according to the emotion concepts we have stored. If I have few concepts for feeling bad, but just say to myself, I feel rubbish, my brain won’t know what to predict to get me out of this. If, however, I say to myself I feel frustrated because I missed my favourite tv programme, I can act on this in some way. The more I can develop my emotional granularity, the more I am able to deal appropriately with what is occurring as opposed to feeling a blanket feeling of dis-ease about what I fear could be happening.
This is in line with the way in which I work. Any negative feelings will have been leapfrogging into an anxious state because of your unpleasant perception of yourself as not being able to cope in the world. As you develop more of a descriptive language for these feelings, you will begin to trust that you don’t need to do that and instead acknowledge the feelings as they come up.
