Hi, and welcome to today’s session. My name is Gilles Brideau. I’m a psychotherapist, coach, and hypnotist that works and lives in Sudbury, Ontario, Canada.
I thought I’d do a quick presentation today that’s very content-rich. You’re going to see there’s a lot of words on the page about understanding anxiety disorders. I’m going to do a general overview about anxiety disorders, and then in coming weeks, we’re going to talk a little bit more about treatment.
Now I also produced another video on I think five easy steps to reduce your anxiety. That may be helpful if you find today’s content beneficial in identifying a sign or a symptom specific to anxiety. That video gives you some tips and tricks on how to do something when you’re actually in an anxiety-provoking moment. Today we’re going to just, like I said, do an overview about anxiety as a whole, so I hope that you find it beneficial. Strap in and let’s get to it.
The first thing is really what distinguishes anxiety from fear. Fear is a state of immediate alarm in response to a serious known threat. It’s oriented in the present. It’s something that’s happening right now. If you see a bee or a snake or something like that, it’s normal to respond feeling anxious, shortness of breath, or anything like that because that’s a normal response to something that’s happening now and in the moment.
Anxiety on the other hand is a state of alarm in response to a vague sense of threat. It’s usually oriented towards the future. What that means is it’s really based on the what ifs. What if I give this presentation and I don’t remember what I’m going to say? What if I go there and everybody judges me? It’s really oriented in the future, not what’s happening right in the moment. What if I pass out as soon as I see the needle? There’s a lot of things that are anxiety-provoking. I give you a couple of examples of maybe phobias and social anxiety and all that kind of stuff. That’s really what we’ll cover a little bit more in detail today.
Now, when does it become more like a disorder? What’s the difference really between just adaptive fear and maladaptive anxiety? Fear, again, it’s realistic in a given circumstance. If you jump at the sight of a snake or something, it’s happening right now, it’s a realistic event. Or if you’re getting ready to parachute out of a plane, then that fear is realistic. Maladaptive anxiety is unrealistic. It occurs when a person is not in danger.
Anxiety is really the emotional response to perceived danger. Now, the thing that’s important in that definition is it’s perceived, so if a person is going to do a presentation in front of their colleagues, the perceived danger and why they feel anxious could be about judgment, could be a lot of things, but it’s not always about being in danger.
With fear, it’s in proportion to reality, so it could be something that’s actually physically happening. If you were being chased by a bear, it’s normal to feel some fear there. Now, maladaptive anxiety is out of proportion. Let’s say you’re meeting a new group of people, it’s normal to feel slightly uncomfortable. That’s our normal kind of cautionary thing when we meet somebody new. It keeps us humble and that’s normal, so if you go to a new situation on a scale of one to twenty, it’s probably normal to feel at a five or something.
When it’s so intense that it prevents you from doing the things that you really want to do or even leaving your house, that’s really out of proportion. I know some people even coming to their first appointment, when I measure where their anxiety is at on a scale of one to twenty, it’s at seventeen or eighteen, and it’s just by being here. That’s out of proportion intense. That’s what I mean by that.
In adaptive fear, the fear ends when the threat ends. In that example, being chased by the bear, as soon as the bear goes in a different direction, everything returns to normal in a relatively quick sequence. However, with anxiety, it could be long-lasting. I’ve had students when I was a campus counselor at our local college that their thoughts about giving a presentation or anything like that would last for days before and after. It was really long-lasting. On the same example, if they had a presentation on Thursday, they could be worried about it from last week, even two weeks prior, because they know it’s coming. Again, it’s that what if mindset, what if kind of thinking.
Obviously it interferes with a person’s ability to function. Now what we find in anxiety a lot is just avoidant behavior. If doing a presentation makes you nervous, people have a tendency to avoid them. If that’s a big component of you passing or failing a class, then you could see how it could be very destructive to the person’s ability to function.
The first of the anxiety conditions is general anxiety disorder, which is often called GAD. This is overwhelming anxiety and difficulty in controlling worry. It’s more than just a slight worry, it’s constantly worried about the what ifs. It’s characterized by excessive anxiety under most circumstances and worry about practically anything. It’s kind of free-floating. It’s not anything specific. It’s that they worry about everything. They worry about traffic, they worry about their family, they just worry about everything and it becomes more and more debilitating where they can’t sleep and can’t really function.
A little bit more of the warning signs. Continuous worry about major and minor events without cause. They’re always hyper-vigilant. They’re very threat-sensitive. Obviously with all this tension constantly going up, there’s often headaches and other aches and pains from cortisol continuously being released in the system. They often have body tension, so they present with a lot of neck, shoulder, upper back kind of tension, fatigue.
They have a great amount of difficulty relaxing and being in a calm state. They have a hard time focusing on one task at a time. It seems like everything is really, really overwhelming. They get crabby, grouchy. They’re much more irritable because it’s like they are constantly under tension, so that hyper-vigilance makes you always on guard, so they’re much more likely to be touchy.
Of course, with that, the thoughts go even more intense when you’re trying to relax or fall asleep. It’s like you keep replaying event after event after event in the mind. They have great difficulty either falling asleep or staying asleep. For some of my clients, as soon as their head hits the pillow, they’re out, but they’re up a couple hours after with the inability to go back to sleep. They get hot flashes or they’re sweaty in hands or body. They have a feeling like there’s always a frog in their throat or the feeling that they’re going to throw up, especially when worried.
The next one is a phobia. Now that is much more specific. Feelings of panic, dread, horror, terror in response to thoughts, images, or exposure to a specific object or a situation. The most common one that I see actually is a fear of flying, so fear of being in a plane. It’s a very phobic response. They’ll avoid it at all costs. Now with some of the people that I worked with that didn’t have any choice, they were getting married or being a part of a wedding party or stuff like that, but it’s this real eminent threat that something’s going to happen.
It’s a recognition also that the fear goes beyond normal boundaries. Yes, there are some dangers to flying, but it’s to the point where there’s this real inability to do it. It’s overwhelming to the person. It’s to know that those reactions are automatic and uncontrollable. It usually takes over a person’s thoughts. What I get with the people that talk about a fear of flying for instance, they say that their significant others try to give them glib advice like, “You know, flying’s the second safest mode of transportation,” and it’s like, logically I understand that. Logically I know that, but I can’t control the fact that my physiology is changing and my breath is getting short. I feel like I’m going to pass out. All that kind of stuff. That’s the automatic reaction that takes over. We just talked about that. Shortness of breath, rapid heartbeat.
Oftentimes, extreme measures are taken, so sometimes that’s chemicals. I had one client that said, “I had to take a couple Ativans and a couple shots of alcohol in order to fly.” Of course, that is pretty dangerous behavior, but it was like, “That was the only way I was able to fly.” Or just avoid it altogether.
Now with social phobias, here are the differences with this warning sign is they are really uncomfortable. Now I said before that people can be generally shy when meeting new people, but people that have a social phobia, they are extremely uncomfortable in new surroundings. They have great difficulty being in situations where people are involved. They have an intense, not just a shyness, but intense fear of embarrassment. They have a constant fear of making a mistake and being watched and judged by others like they’re not good enough. Fear of embarrassments results in avoidance of important activities. Sometimes if something really important that they know and want to attend, it could be a family function, it could be a wedding, baptism, or something like that, and they do not have the ability to go through with it.
Excessive worry about upcoming social situations. Frequent blushing and sweating, trembling, even nausea before a big social event. Sometimes just a total avoidance of social situations. Again, with the anxiety more than anything is it isolates a person suffering with this from the world, even to the point where they become so closed in that they have a hard time leaving their home. Oftentimes they will self-medicate using alcohol or other types of sedatives so that they can function in those social circumstances.
Next is panic disorders. Here it’s frequent unexpected panic attacks. Sometimes it’s a displacement of the fear. You have a fear of getting a panic attack. Obviously some possible restrictions of behaviors for the prevention of such attacks. People will just avoid so that they make sure they don’t get any panic attack. Here it’s a repeated experience of sudden bursts of fear for no apparent reason. Clients often talk about the fact that they did not see it coming and it just affected them suddenly. Loss of breath. We’re going to talk a little bit about the physical symptomology here. Chest pains, heart racing, feeling dizzy, stomach problems, wanting to vomit, shaking, trembling. Really the big thing is the feeling of being out of control and that they’re going to die, that clients have often experienced this and compared it to having a heart attack. It feels like you’re going to die. The fear of dying or that they’re losing it, they’re going crazy.
The next category is obsessive compulsive disorder. One or more obsessions which may occur together with certain compulsions. It’s a recognition that these obsessive thoughts arise in their own minds, but it’s the inability to control or suppress the thoughts. It’s kind of like a loop, and we’re going to cover that in just a little minute here. It’s a feeling of being trapped in a pattern of unwanted or upsetting thoughts. When they get the upsetting thoughts, then they have to do the behavior in order to feel calm again.
They know that they’re doing this for no good reason. Again, it’s not a logical thought. It’s not like, would you just stop washing your hands? They’re clean. It’s like, they know that in a logical way, but it’s this sense of anxiety that comes on until they do the compulsion and then it can get them back to a more calm state of mind.
Oftentimes it’s a real feeling that I can’t stop thinking that my hands are contaminated or this surface is contaminated or that I must arrange the cups in a certain way or the spices in a certain way. They have a real hard time stopping themselves from doing the thing again and again and again and again. They have excessive worry that if they don’t do the behavior, that something horrible will happen.
For example, there’s washing, checking, symmetry, order. Washing, like hand-washing, all that kind of stuff. A checker could be a door checker, so they go back and check if the door is locked again and again and again and again. We talked a little bit about symmetry and order, is that things need to be placed in a certain way and they can really tell if a thing is out of place. Some people count, so they have to count and do certain things based in numbers before they get comfortable. The last one, and it has been popularized on TV, which is hoarding.
This is the loop that I talked about before. You could see it starts with an obsession, which leads to anxiety, which leads to doing the behavior. The compulsion is really the doing of the behavior, which finally leads into relief, but the relief is really short-lived because it’s so loop that it starts back.
Stay Tuned for Part 2…