Know the Anxiety, Panic Attack and Stress
The experience of anxiety is common and universal. It is not an emotion restricted to the economically deprived nor to the politically oppressed. Anxiety is an inescapable part of the human condition, for life on all its levels, from the international and governmental to the domestic and personal, is marked with uncertainty, perplexity, and stress. Many may deny their personal anxiety, or at least the intensity of it (even to themselves) for a variety of reasons, such as, the desire to avoid embarrassment, the sense of pride, the fear of rejection, the threat and unease of vulnerability, etc; notwithstanding, nearly everyone experiences anxiety to some degree. Its occurrence is disturbing and debilitating. Its persistence is crippling. As long as daily living is characterized by struggle, strife, and suffering, the anxiety-experience is an inevitability.
The Nature of Anxiety
Anxiety is a mental tension which expresses itself in worry, irritability, apprehension, or uneasiness. The mental tension results either from a sense of uncertainty about future or impending events, or from a sense of inability to control one’s environment or state of affairs. Anxiety is a natural emotional response of human beings endeavoring to survive and live comfortably. Anxiety is a constant reminder of humankind’s appalling frailty and its utter impotence to master its own destiny.
Anxiety and fear, though closely interrelated, are not synonymous concepts. Fear, sharply defined, is both the psychological and emotional response to a sense of being in danger. Fear is basically a survival mechanism in that it promotes self-preservation. Anxiety, however, is the warning signal of one’s increasing impotence to survive. It has been said that anxiety is “fear spread out thin.”
Not all anxiety is pernicious, but rather only certain forms of it. Psychologists, both secular and spiritual, generally believe that periodic mild anxiety assists in productivity and performance. Alertness is enhanced, motivation is stimulated, and concentration is heightened. One’s potential and ability are thus more efficiently harnessed. In fact, serious educational and socializing repercussions may result when anxiety is absent (such as typifies hardened criminal behaviour); or when anxiety is excessive (such as typifies sensitive children in a disruptive home).
The relationship between amiable and pernicious anxiety is similar to that of stress and distress. A moderate amount of stress is indispensable to peak performance and success. This fact is particularly evident with the athlete prepared to run a race or compete in a field event. However, the threat to health occurs when the increase of stress is transmuted into distress. This situation may arise with the business executive who has demanding daily quotas to fill and unrelenting deadlines to meet. Inefficiency and atrophy are the natural by-products. The outcome is the onset of serious emotional disturbances. Pernicious anxiety is particular focus of this article.
A further classification of anxiety may be helpful. Debilitating anxiety is basically of two types, namely, simple and neurotic. Simple anxiety is the temporary emotional tension which most people experience towards life’s pressures and struggles. Neurotic anxiety is emotional tension which has become an ingrained behavioural trait of one’s personality. A neurosis is a fixed emotional disturbance pervading the whole personality. Some neuroses, for instance, are obsessive-compulsive reaction, hysteria, phobia, hostility, neurasthenia, chronic depression, etc. An untreated neurosis may possibly develop into a psychosis, though this development is usually dependent upon hereditary and predispositional factors. Simple anxiety is primarily discussed in this article, though much of what is considered has equal relevance to neurotic anxiety. The intrinsic nature of anxiety remains constant, only its degree and intensity differ. The treatment of neurotic anxiety entails a specialized approach because the anxiety has become behaviourally entrenched. Personality maladjustment may also have to be addressed. The causative factors and the psycho-dynamics underlying the anxiety need to be discovered and investigated, which may require detailed discussion and analysis of childhood experiences and domestic training. People who suffer from neurotic anxiety typically need professional counselling.
The Effects of Anxiety
The costs of anxiety are exceedingly high. The effects are profound and far-reaching. These effects fall into three basic categories: the physical, the psycho-emotional, and the social. Let us first consider the physical effects of anxiety. Anxiety results in a whole array of physiological discomforts. One particular manifestation of anxiety can be labeled under psychosomatic symptoms, such as, the common upset stomach, heart palpitations, headaches, muscle cramps, and various bodily aches and pains. Sustained or chronic anxiety results in deteriorating physical health. Organic and functional illnesses, ranging from dyspepsia to heart disease, are the long term effects.
Anxiety may also occasion serious psycho-emotional disorders. Initially, anxiety decreases performance by curtailing reasoning abilities, dulling imaginative thinking, and causing general discouragement. Feelings of disorientation and depression may then ensue. Personality maladjustments are the eventuality.
Anxiety may also result in strained social relationships and retarded interpersonal development. Extremely anxious people may tend to avoid social contact, even with familiar friends, in order to reduce the anxiety level. Social contact tends to generate feelings of uncertainty, suspicion, and uneasiness, with the natural reaction being social withdrawal and alienation. Security and peace are construed as the fruit of separation and solitude. Accordingly, the development of communicative skills and social etiquette may be hampered. Extremely anxious people learn to live by themselves.
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The Causes of Anxiety
The psycho-dynamics underlying anxiety are complex. Some psychologists generally describe anxiety as a vague and indirect feeling, having no particular source or fundamental cause. This claim can certainly be challenged. With anxiety there is typically a cause-effect relationship, though the cause may be hidden or misunderstood.
I suggest that the actual causes of anxiety are usually associated with specific tenuous mental states. There are basically three major tenuous mental states from which derive emotional disturbances. The first of these is guilt. Guilt by its very nature creates psychic tension. Guilt is the sense of personal wrongdoing and being liable for punishment. The guilt may be false or true (imaginary or real, psychological or moral). In either case, the psychic experience and tension are similar. True or real guilt results from the transgression or rejection either of some authoritative or societally-established law. When a person steals another’s possession, he or she may sense guilt. False or imaginary guilt, on the other hand, results from the failure to conform to the expectations or judgements of others. For instance, a child’s peers may ridicule him because he has played poorly on the sport’s team, though he has performed to his full potential. He may then feel that he has failed his friends. Consequently, he feels guilty. This guilt is ‘unjustified’, for the supposed offense does not involve moral culpability. Some of the secondary mental states attributable to guilt are depression, discouragement, loneliness, insecurity, despair, etc.
Many neuroses have guilt as their central component. Usually the impetus underlying false guilt is the need to please, to win the approval of, or to be accepted by, others. The person who feels guilty should thus ask himself or herself a series of questions: What kind of guilt am I experiencing? Is it a justified guilt? What is the cause or reason for the guilt? What is the proper way to view the situation? If the guilt is morally justified, then moral action should be pursued in order to address and resolve it. If the guilt is (morally) unjustified, then it should be acknowledged as such, assessed as harmful, and even wrong, and disowned.
The second major tenuous mental state which may generate anxiety is egoism. The individual suffering from egoism has a preoccupation with himself and with his personal needs. It should be noted that a common trait of the egoistic state of mind is anger. Egoism has two fundamental dimensions, namely, superiority (arrogance) and inferiority (inadequacy). A superior disposition compels a person to obsessively strive for personal attention and to secure the applause and praise of others. His conceit, exaggerated self-love, and his need for recognition often foster an insensitive, judgmental, and even merciless attitude. His behaviour is also potentially volatile. Various examples from the worlds of show biz and professional sports could easily be cited by way of illustration. Some secondary mental states of a superior disposition are hostility, jealousy, hatred, bitterness, resentment, and envy.
An inferior disposition appears to be the more prevalent of the two dimensions in those who suffer from anxiety. An inferior disposition compels a person to socially withdraw and to feel intimidated around people. This person feels unworthy of personal recognition, and even love. He or she even lacks in self-respect. This person feels that anything he or she does is either not right or not good enough. This person views himself or herself as a failure. The child who is continually criticized by his authoritarian mother (for instance, because of an inability to intellectually grasp certain concepts in a particular discipline) may tend to view himself as stupid. Consequently, he may lose interest in academics altogether. He eventually may lose all confidence even in his ability to think.
The person with an inferior disposition learns to dislike himself, and consequently believes that others do not like him either. He or she often becomes a perfectionist, which is the path to a very unsatisfying, frustrating, and unhappy life. The person predictably never quite makes the grade, regardless of how hard he or she may try. The secondary mental states of an inferior disposition are depression, discouragement, emptiness, loneliness, insecurity, jealousy, hatred, envy, etc.
The third major tenuous mental state is fear. Not all fear is malignant. Instinctive fear is required for physical survival. Morbid fear is pernicious and is characterized by a slavish preoccupation with personal safety and well-being. An immoderate concern over securing (or maintaining) an admirable public image, a respected reputation, a high social status, good health, family welfare, material possessions, etc., may effectuate morbid fear. Morbid fear often arises when an exaggerated value or importance is assigned to these particular objects. The motivational belief is that the procurement of these objects will provide security. The person’s perception, however, has become distorted. Consequently, the threat of loss or damage of these objects may be paralyzing, and even incapacitating. The secondary mental states of fear are depression, insecurity, suspicion, panic, etc. Fear is also the essential component of various neuroses, such as, hysteria, phobia, and paranoia.
These three major tenuous mental states–guilt, egoism, fear–may may be situational or chronic. If they are situational, then their duration is temporary, if handled appropriately. If they are chronic, then professional counselling may be required in order to discover and examine the causative factors. In treating anxiety (we shall say more about this shortly), the determinative mental state should be confronted and fully explored. The psychic tension is mitigated through the exposure of its underlying cause(s). In exploring the underlying cause(s) of anxiety, the antecedent perception(s) of any given mental state should be examined. One’s mental perception determines the particular mental state which is responsible for ensuing anxiety. The personal interpretation of a situation/set of circumstances effects a corresponding mental state. For instance, a person may notice after a business meeting that a colleague is looking askance at him. The colleague’s facial expression may be totally innocent and unself-conscious. However, this person, especially if he is generally suspicious and naturally sensitive, may interpret this facial expression as antagonistic. As a result of that faulty mental perception, the person may then feel guilty and rejected. He may then begin to scrutinize himself minutely, reflecting upon his present relationships and questioning his past deeds and actions. If this fallacious thinking persists, this person may eventually become depressed and anxious.
Hence, generally speaking, anxiety must be managed indirectly. For example, a person may suffer from a rejection syndrome. As a result of the psychic conflict, he may find himself continuously anxious, completely unaware that the anxiety is the result of this particular psychic conflict. The sufferer must come to realize the relationship between the psychic conflict and the anxiety. Further, an adjustment of perception or a reframing of interpretation is also critical in correcting emotional disturbances. Adjusting personal perceptions, or reframing personal interpretations, does not result in a masking or denial of the truth of the given situation, nor does it result in a subtle form of self-delusion. Mental adjustment or psychic reframing simply allows for the achievement of a right perspective in order that there may be proper understanding. The ultimate goal is to learn to think clearly and correctly.
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The Management of Anxiety
In the management of anxiety, as with other emotional disturbances, there are different schools of thought. Various therapists advocate some form of behaviour modification, such as, relaxation training, thought-stopping, modeling, and behaviour rehearsal. These techniques may prove partially helpful, but an obvious deficiency with behaviour modification is that the perception(s) and mental state that engender the anxiety may not comprise the fundamental focus or consideration in the treatment. Treatment must be primarily cognitive, not behavioural. The behavioural is usually secondary and concomitant.
Some direction for the management of anxiety has already been furnished above. Further elaboration and suggestions are now offered. As already argued, anxiety is dependent upon one’s mental state. Therefore, management for anxiety must begin with a confrontation and analysis of the mental state responsible for the anxiety. This approach, of course, will include a consideration of one’s perception and interpretation of the situation(s) occasioning the mental state.
First, confrontation involves self-consciously addressing one’s thinking. It consists of self-consciously turning inward on one’s thoughts and observing them in as objective a manner as possible. It is seeking to identify the commensurate thoughts of the experienced anxiety. For example, an aspiring young minister may become extremely anxious days before he is to preach. This anxiety may be more than simple “stage fright”. His mental state, though unconsciously recognized (which is often the case), may be one of fear. He may be fearful of not being impressive; fearful of rejection; fearful of appearing inadequate. Confrontation is the mental act of being honest and courageous with oneself.
Analysis is a more complex process than confrontation. It involves the critical examination of one’s mental state with a view to the understanding of its origin, justification, and validity. For example, in feeling anxiety, one may recognize that he is harbouring guilt. He should ask himself why he is experiencing guilt or what has occasioned this guilt. It may be that he didn’t shake a fellow church member’s hand on Sunday or that he asked a rather simple question in the economic’s class. He then should ask himself whether it is right to feel this guilt, whether he really committed a wrong. In the first case, he may not have had a real opportunity to shake the member’s hand and thus should not feel guilty. In any event, he is not obligated to shake the person’s hand every Sunday.
Hand-shaking is an expression of spiritual fellowship and not one of mere religious duty. In the second case above, he may have asked a question to which he didn’t know the answer in order to clarify a point or enhance comprehension, and thus he should not be concerned about other peoples’ personal evaluations. He apparently is seeking to learn and grow. In the two cases cited, the person probably shouldn’t feel guilty. Next, he should ask himself what would have been the proper way to perceive and interpret the situation (i.e., the reasonable, objective way). In these two cases, the guilt is false and thus should be rejected. His thinking is faulty. His mental state is morally unjustified. So, analysis involves a close and intense investigation of the dynamics underlying and shaping one’s mental state in order to evaluate the propriety of such a state. The origin of such a state may find its roots in some childhood experience, rendering analysis complicated, and professional help may be needed at this point.
Analysis allows one to assume a particular mental position (an objective one) in order to correct a tenuous mental state which has arisen. Often when one confronts his or her thoughts and recognizes the commensurate thoughts of the experienced anxiety, he or she simultaneously recognizes the origin of the mental state (if the anxiety is situational). Hence, in this two-fold process of confrontation and analysis, it would be beneficial for the sufferer to discuss his or her anxieties with a close friend or with a competent associate. Honest, transparent communication is very therapeutic.
This exercise of ‘confrontation and analysis’ should be viewed as a special kind of cognitive procedure, namely, self-examination. This procedure allows for an object-subject relationship to be established between the sufferer and the anxiety (with its causative factors). The sufferer, rather than remaining indistinguishably one with the anxiety, being “caught up” by it as it were, is able to stand over and against it. This psycho-positioning in itself diffuses some of the force of the anxiety, but more importantly, it initiates a dissipating mechanism. The sufferer should become ‘the watcher’ or ‘the observer’. The sufferer is now able to become somewhat emotionally removed from the experience itself, establishing a quasi-objective situation in order to evaluate the validity and origin of the anxiety itself, as well as the justification for the occasioning situation giving rise to such anxiety.
This “objectivizing”–moving from a subjective relationship with respect to the anxiety (and its occasioning situation) to a quasi-objective relationship–is critical for the effective treatment of anxiety. Ignorance simply perpetuates the condition, and may even intensify it. Self-understanding is at the core of mental health. Only on the basis of self-understanding can the edifice of self-adjustment solidly stand. The emotive is secondary; the cognitive is primary. The emotions merely reflect or express thoughts and perceptions. Emotions are not isolated and independent entities. They are necessarily dependent upon how and what one thinks. Treatment, therefore, must be primarily cognitive. Emotional disturbances must be treated indirectly, by directly treating one’s cognitive state.
Accordingly, with the stages of ‘confrontation’ and ‘analysis’ achieved, the stage for ‘transformation’ is set. In order to overcome anxiety, one needs a change in his or her thinking patterns and attitudes. The ancient New Testament counsel of St. Paul underscores the validity and benefit of this point. He writes, “Finally, brethren, whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things. The things you have learned and received and heard and seen in me, practice these things, and the God of peace will be with you” (Phil 4:8,9).
This mind transformation, particularly in reference to anxiety, also entails cultivating a proper mind-set. This mind-set is characterized by two perspectives. First, there must be a present perspective on issues. Many anxieties stem from the assumption of a future perspective which is conducive to uncertainty and doubt. One should focus on the issues and challenges of any current day, and try not to overly focus on, and worry about, future days (which does not discount the need for proper planning). One must discipline himself to train his mind to be currently-focused, though future-aware.
Second, one should try to cultivate a more universal perspective. One should examine, analyze, and assess matters and events within the larger scope of the ‘global village’ and the ‘collective consciousness’. Narrow-mindedness and an unreasonable preoccupation with personal details typically provoke anxiety. Excessive attention given to life’s details, failing to evaluate them within the larger setting, results in a misconception of what constitutes real value and true significance.
In addition to the preceding remarks for the management of anxiety, there are some practical steps which may be adopted in order to maintain control over anxiety. First, changes should be made concerning the anxiety-provoking situation(s). For instance, if one is anxious about arriving at work on time, then the clock should be possibly set 30 minutes earlier. Second, a list of daily duties and responsibilities should be made, preferably with the more exacting and demanding duties listed first. One should list only what he or she believes may be accomplished that day. Third, there should be a schedule of periodic breaks and recreation times for each day. Even walking briefly outdoors can be invigorating. Fourth, sufficient sleep each night is required. A healthy body contributes to a healthy mind. Fifth, a program of regular exercise should be adopted. Physical exercise is paramount. Exercise advances stamina and stability. Sixth, one should learn to “talk through” his or her frustrations and problems with a close friend. Again, honest, transparent communication can be quite therapeutic. Seventh, vacations should be taken regularly, and they should be a complete change from daily routine. Eighth, regular medical check-ups should be scheduled. Anxiety can have a biological or chemical basis. Ninth, one should adopt the practice of listening to melodious music. The right kind of music has a soothing and beneficial effect. Tenth, one should develop a good circle of friends. Learning to socialize has psychological benefits and rewards. One acquires a sense of belonging. Also, a good support system is indispensable for emotional well-being. Eleventh, a hobby should be undertaken. Interest and enthusiasm release positive and well-directed energy. Twelfth, eating nutritiously and healthily may help mitigate anxiety. Along with organic foods, one should consider such supplements as vitamins B and D, omega 3 fatty acids, and such minerals as calcium and magnesium. Herb teas, like chamomile, may also prove supportive.