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There are many ways in which anxiety can manifest, and oftentimes people’s experiences don’t fit neatly into a certain category. Here are some common ways in which anxiety can be felt.
Social anxiety
In social anxiety we might be concerned about being judged, imagining others are scrutinising us. Such beliefs can be fuelled by a “negativity bias”, which impairs recognition of people’s actual intentions and mind-set, reinforcing skewed beliefs.
As a result, we may behave in ways that limit our exposure to others, minimising social interactions and situations that would direct too much attention onto us. When the fear of shame or embarrassment is great, we may go to extremes to avoid any social engagements. Several patients struggling with social anxiety have shared their relief at being afforded opportunities to work remotely.
Generalised anxiety
In generalised anxiety, there may be several recurring situations or stressors constantly driving anxiety (such as work and home obligations, deadlines and bills), leading to a persistent state of worry. Generalised anxiety is also marked by body-related symptoms such as muscle tension, fatigue and restlessness.
While other forms of anxiety are often attributed to specific stressors, generalised anxiety can feel more diffuse, with an ongoing feeling of unease that may not be attached as readily to any one thing. Patients who have generalised anxiety often report that “everything, anything” is cause for worry, making it hard to find satisfying coping strategies.
Panic attacks
One of the most distressing forms of anxiety is a panic attack, marked by a surge of intense fear or discomfort that can peak within minutes, as well as strong effects on body and mind – for instance, a fear of dying or losing control, chest and abdominal pains, shaking, increased breathing, heart pounding, sweating and feeling lightheaded.
Panic is so overpowering that brain activation can go into “survival mode,” stimulating areas such as the periaqueductal grey, which drives behavioural responses along the fight-flight-freeze spectrum, such as paralysis or freezing, or escape strategies.
Some panic attacks are linked to situations or circumstances. However, if someone has had one before, there may be significant concern about having another, given how distressing they are. The person may have a panic attack driven by worry about having a future panic attack.
Phobias
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The idea of engaging with objects or environments that cause us fear or worry can lead to life choices that are dictated by “negative reinforcement” strategies (behaviours aimed at removing or avoiding unpleasant feelings).
For instance, someone with a phobia of needles or seeing blood may refuse to seek medical care, given the possibility of lab work. Or, someone with a fear of busy roads may turn down a promising job because the commute would require driving on a highway. These behaviours may limit anxiety, but there can be significant trade-offs.
Helpful coping strategies
When anxiety takes over, try these methods:
Give yourself a break. There is no way to fully control our reactions to our environments. We all have limitations and individual responses to situations. Respecting how our minds operate, as opposed to trying to change them at all costs, can help us nurture self-acceptance.
Lean in, as you can. As self-acceptance grows, we may find small, sustainable ways of “inviting” anxiety and sitting with it, as opposed to avoiding or getting rid of it. Creating an “exposure hierarchy” can help map the pattern of our anxious responses and find acceptable ways to engage with distressing cues. For instance, someone with a fear of elevators may have “standing outside a building with an elevator” first on the list and “entering a packed elevator” last, with several intermediate steps.
Find a middle space. Anxiety-driven thinking is hard to redirect, keeping us stuck in unchanging thought loops. Finding ways to view thoughts as just that (“thoughts”) instead of absolute reality can create distance from our troubling mind-set. We can write down our “automatic thought records” – responses to stressors (including anxiety-driven cognitions) – and alternative ways of thinking about the situation (for instance, what we would tell a friend who was having anxiety and negative thoughts in similar circumstances). That perspective can serve as an “inner compass” we can access when we are anxious, helping reframe rigid cognitions amid difficult circumstances.
Washington Post
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