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Is There Something Wrong With Me? (Part 2 – Anxiety)

Image by Liza Summer via Pixels.

Disclaimer: This blog post is not intended as medical or psychological advice, but rather as personal opinion and educational information.

Blog Image by Liza Summer via Pexels.

In part two of the series entitled “Is There Something Wrong With Me?”, explore the emotion of anxiety and how to know when the developmentally normative emotion of anxiety becomes pathological and requires clinical treatment. I’ve titled this series “Is There Something Wrong With Me?” simply because when we are struggling, or feeling our emotions deeply, we tend to think we are flawed or there is something wrong with us.

We all feel anxious at times. Anxiety is a normal emotional response to uncertainty. However, sometimes we may wonder whether what we are experiencing is normal, or if we need to seek professional help from a medical provider. My hope is through this series you will gain a greater appreciation for the complex nature of our emotions, how thoughts and feelings influence our mental health, and a better understanding of when a normal emotion, like anxiety, crosses into something more serious, like anxiety disorder.

Coaching and Counseling: differing approaches to engaging with anxiety

In part one of this series, I clearly defined the distinct roles of coaching and counseling in mental health and wellness*. Coaching and counseling address some of the same topics, like anxiety, from different angles.

  • In coaching, the focus is on the normal experience of occasional anxiety that can be uncomfortable but manageable. We all get anxious from time to time, it’s part of being human. How our brain processes the encounter of anxiety is directly connected to the tools we have at our disposal to navigate and manage the encounter of anxiety. Specifically, how we are able to calm our body and mind after we encounter an environmental cue that causes the anxiety indicates whether we are handling anxiety in a normal and healthy way. When we are able to identify the cues that trigger our occasional feelings of anxiety, and develop healthy coping strategies to manage the mild experience of anxiety, we build resilience to navigate short term and temporary experiences of anxiety from a position of strength. 
  • In counseling, the focus is on the pathological experience of chronic anxiety that can be debilitating and impacts daily functioning. When anxiety consumes your thoughts more days than not, is persistently intrusive resulting in the inability to quiet the spinning thoughts in your mind, and you are unable to effectively use coping strategies to navigate the anxiety, then it is time to seek professional help from a medical provider. Counselors center their attention on appropriately diagnosing the client’s specific anxiety disorder, understanding how a client’s temperament, environment, and genetics contribute to the manifestation of the disorder, and creating a focused treatment plan to reduce symptoms and increase functioning around the anxiety disorder. For some clients, a referral to a psychologist for testing or a psychiatrist for medication may be necessary to manage the chronic and debilitating symptoms of anxiety most effectively.

What is Anxiety?

A diagnosis of anxiety is not subjective (“you seem anxious”) but rather assigned to a client by a counselor, psychologist, or psychiatrist based on observable symptoms over a specific time frame that corresponds to The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-TR) used by clinicians. The DSM is published by the American Psychiatric Association and is considered the definitive handbook used by healthcare professionals as the authoritative guide to the diagnosis of mental, behavioral, and psychological disorders worldwide. 

It is worth noting that fear, anxiety, and panic are often used interchangeably, but in the world of psychology they are distinctly different from each other.

Fear, Anxiety and Panic Briefly Defined

Fear: Dr. Judson Brewer, MD and PhD, explains that “…fear is an adaptive learning mechanism that helps us survive.” Fear is the emotional response to a real or perceived imminent threat. When an individual encounters a fearful situation, they instinctually react via their autonomic nervous system in one of five escape behaviors: fight, flight, freeze, appease (fawn) or dissociate. 

Anxiety: Psychiatrist Dr. Judson Brewer explains that “…anxiety is maladaptive when our thinking brain spins out of control because it doesn’t have enough information.” Anxiety occurs in the mind and is a rumination on a past event, or an anticipation of a future threat, persisting beyond developmentally appropriate periods. It is marked by vigilance in preparation of a future threat or avoidant behaviors of the perceived danger. 

Panic: Dr. Judson Brewer explains that “…panic is born from fear.” A panic attack is an abrupt surge of intense fear that reaches a peak within minutes, during which a combination of several of 13 specific somatic (physical) or cognitive (mental) symptoms occur simultaneously causing intense discomfort.

The Five Responses To Fear In Detail

It’s worth noting there is much more detail on these instinctual aspects of survival when we perceive danger. We do not choose our response conciously. Our nervous system automatically chooses our response based on a lifetime of encountering, and surviving, perceived threats and danger.

Fight: When your brain perceives imminent danger and believes it can overpower the threat, it will respond by engaging with the source of danger. The body will release various hormones and chemicals to prepare it for the physical demands of fighting.

Flight: When your brain perceives imminent danger and believes it cannot overcome the threat, it will respond by releasing various hormones and chemicals to prepare it for the endurance of running away from the threat.

Freeze: When your brain perceives imminent danger and believes neither engaging or fleeing is the best course of action, it will respond by immobilizing physically and temporarily shutting down mentally.

Appease: Appease is also known as the fawn response. This is a secondary response after an unsuccessful fight, flight, or freeze attempt and occurs primarily in people who have experienced chronic abuse in childhood, experienced frequent racism, or frequent gender inequality, etc. Fawning includes overt efforts of appeasement towards the source of the threat. Examples of fawning behavior include over-agreement despite personal views to the contrary, trying to be overly helpful despite the imminent threat from another individual, and a primary concern with making the source of the threat happy.

Dissociate: This is an extreme secondary response, often caused by trauma, after an unsuccessful fight, flight, or freeze attempt. When the self is so overwhelmed by a threat they can no longer cope, the brain is capable of dissociating to protect the mind. American Psychological Association (APA) defines dissociation as “a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche.” Dissociation is a form of a “mental escape” when physical escape is not possible leading to a process of disconnecting from one’s thoughts, feelings, memories or sense of identity. Examples of dissociation include amnesia, depersonalization, derealization, and dissociative identity disorder.

Types Anxiety Disorders

The DSM manual states that “anxiety disorders differ from developmentally normative fear or anxiety by being excessive and persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety (which is often stress-induced) by being persistent and typically lasting longer than 6 months (in adults). A child’s diagnosis is marked by a lesser threshold of intensity, duration and/or frequency.

The determination of an anxiety disorder “being excessive and persisting beyond developmentally appropriate periods” is somewhat individualized and must take into account “cultural and contextual factors” of the client when a diagnosis is being made by the clinician.

Types of anxiety disorders are listed below by the typical age of onset from childhood through adulthood. They are directly connected to an individual’s temperament, genetics, and sometimes traumatic experiences (often in childhood).

  1. Separation anxiety disorder is an anxiety disorder that often develops in childhood. It is a “fearful or anxious separation from attachment figures to a degree that is developmentally inappropriate. There is persistent fear or anxiety about harm coming to attachment figures and events that could lead to the loss of or separation from attachment figures, and a reluctance to go away from attachment figures, as well as nightmares and physical symptoms of distress.”
  2. Selective mutism disorder is an anxiety disorder that often develops in childhood. It is “characterized by a consistent failure to speak in social situation in which there is an expectation to speak (school) even though the individual speaks in other situations.”
  3. Phobia disorders are a specific anxiety disorder that often develops in childhood. These are anxiety disorders that are grounded in “fearful or anxious avoidance of specific objects or situations that is persistent and out of proportion to the actual risk posed.” Types of phobias include animals (dogs, insects, etc), natural environment (ocean, weather, etc) medical or injury (dentist, injection, sight of blood etc), situational (enclosed spaces, washing hands, etc) or other (flying on a plane, loud sounds, etc.)
  4. Social anxiety disorder is noted by an individual’s excessive anxiety about or avoidance of “social interactions and situations that involved the possibility of being scrutinized, negatively evaluated by others, being embarrassed, humiliated, rejected, or offending others. These include social interactions such as meeting unfamiliar people, situations in which an individiual may be observed eating or drinking, or situations where an individual performs in front of others.”
  5. Panic disorder is an “unexpected panic attack that is an abrupt surge of intense fear that reaches a peak within minutes, during which a combination of specific somatic (physical) or cognitive (mental) symptoms occur simultaneously causing intense discomfort”. These symptoms include accelerated heart rate, sweating, trembling or shaking, shortness of breath, feelings of choking, chest pain, nausea or abdominal distress, dizzy or lightheaded, chills or heat sensations, numbness or tingling sensations, derealization (feelings of unreality) or depersonalization (feeling detached from oneself), fear of losing control or thoughts of “going crazy”, fear of dying.
  6. Agoraphobia involves “fearing and avoiding places or situations because they might have a panic attack and would unable to escape”. This leads to feelings of being trapped, helpless or embarrassed. Diagnosis includes fearing two or more of the following: public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside the home alone without the presence of a companion. 
  7. Generalized anxiety disorder is defined as “excessive anxiety and worry occurring more days than not for at least 6 months, about a number of everyday events (job performance, finances, health, family members well being or safety, household chores, being late to appointments, etc). The intensity, duration or frequency of the anxiety is out of proportion to the actual impact of the anticipated event and the client finds it difficult to control the worry”. A person will exhibit a combination of the following symptoms (restlessness, feeling keyed up, fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, sleep disturbances), where the anxiety or symptoms cause significant distress or impairment in social and/or occupational functioning. The disturbances are not attributed to physiological effects of medication, a medical condition, substance abuse, or another mental disorder. The criteria for GAD in children is significantly less comprehensive and tends to focus on excessive worry in relations to their their competence or performance in school, performance in sporting event, punctuality, and catastrophic events. Children diagnosed with GAD may be overly conforming, perfectionistic, unsure of themselves, dissatisfied with less than perfect achievement and want to redo tasks over and over, frequently seeing reassurance and approval from authority figures or caregivers.
  8. Unspecified anxiety disorder is a diagnosis given when symptoms characteristic of anxiety disorder are present and cause social or occupational distress but do not meet the full criteria for any of the specific diagnosis.

NOTE: While Obsessive Compulsive Disorder is a diagnosis that exhibits elements of anxiety, it is considered its own classification in the Diagnostic and Statistical Manual of Mental Disorders and does not fall under the anxiety disorders.

Summary

Anxiety is a normal emotion that can feel overwhelming when our brain and nervous system are not equipped to navigate and manage the uncertainty, or fear, of a situation. Just as an athlete must build endurance to be resilient during, and recover after, their athletic performance… so must we humans build endurance to be resilient during, and recover after, stressful events that trigger anxiety or fear. There are many tools that individuals with a normal experience of anxiety can use to manage anxiety. Many can be learned in coaching sessions and customized to a person’s unique situation. 

For those individuals whose experience of anxiety, fear and panic is debilitating, therapy may be the right next step. In counseling an individual will receive a diagnosis and focused treatment to improve their experience with anxiety. If this resonates with you, and you are uncertain where to start, speak with your primary care physician who can recommend a reputable counselor, psychologist, or psychiatrist depending on the uniqueness of your situation and severity of your symptoms.

Final Thoughts

If you want to learn more about the topic of anxiety and the mind, I highly recommend on the book Unwinding Anxietyby Dr. Judson Brewer. It is extraordinarily clear and insightful, written with humor and compassion, and absolutely understandable to anyone not trained in psychology or neuroscience. Dr. Brewer has personally experienced anxiety and panic attacks in his own life, so he is writing from a perspective of an empathetic patient as well as a dedicated psychiatrist.

Additionally, I recommend Breath as Prayer by Jennifer Tucker as a helpful resource. Jennifer writes “Breath prayers combine two powerful tools that can help calm anxiety: the science of deep breathing and prays of meditation on God’s Word.” I love this book, incorporate it into my life almost daily,and have given it away at least a dozen times. Each of the 80+ breath prayers are organized by one of 12 themes so it is easy to locate a breath prayer to provide comfort in almost any situation.

(RECOMMENDATION NOTE: I only recommend books I have actually read and I do not include affiliate links. Why? Affiliate links give an influencer, blogger, or creator a financial payback for recommending an item, which I believe creates bias. If I personally recommend a book to you, my trusted blog readers and clients, it’s because I think the book is valuable and not because I will be financially rewarded for recommending the item.) 

In part 3 of this series, I will explore the experience of depression and how to know when the developmentally normative emotion of sadness becomes pathological and requires clinical treatment. 

I’M GRATEFUL YOU TOOK THE TIME TO READ THIS POST. DID YOU FIND IT HELPFUL? IF SO,I WOULD BE HONORED IF YOU SHARED IT WITH A FRIEND.
Bethany Grace

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Disclaimer: This blog post is not intended as medical or psychological advice, but rather as personal opinion and educational information. Though Well Soul Studio, LLC was founded by a clinician with a master’s degree in counseling, the scope of this practice is limited to certified embodied coaching, somatic therapy, and enneagram discovery. If it is determined a client’s needs would better be served by a licensed mental health professional such as a counselor, psychologist, or psychiatrist, Well Soul Studio, LLC will always make that recommendation. A client’s mental health and well-being are always a priority at Well Soul Studio, LLC. 

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