Everything You Need to Know About Anxiety: How Does Anxiety Work?

Welcome to Part 2 of Everything You Need to Know About Anxiety: How Does Anxiety Work? In this series Robin Back, MSW, RSW addresses the important issues surrounding anxiety and anxiety treatment.

• Part 1: What is Anxiety?

• Part 2: How Does Anxiety Work?

• Part 3: How CBT Can Help

Most people do not recognize their anxiety for what it is, and instead think there is something “wrong” with them. Some may think they are weird, weak, or even going crazy! Unfortunately, these thoughts only make people feel even more anxious and down on themselves. Because of this, the first step to successfully managing anxiety is to learn to understand and recognize it.

In Part 1, we learned more about what anxiety is, when it’s a good thing, and when it becomes a problem.

Today, we will discuss how exactly anxiety works, using the Cognitive Behavioural Model of Anxiety as our framework, because understanding the mechanisms behind anxiety is the key to overcoming it!

The Three Parts of Anxiety

According to the Cognitive Behavioural Model of Anxiety, there are three main components:

1. Physical symptoms (sensations we experience in our bodies, such as dizziness, nausea, sweating, heart palpitations)

2. Cognitive (our thoughts; what we say to ourselves, such as “something is wrong”)

3. Behavioural (our actions; what we do when we’re anxious, such as pacing or avoidance)

These three systems all interact with one another:

For example, if you’re anxious about giving a presentation at work you might have some thoughts like, “What if I mess up?”, experience some physical sensations like increased heart rate, upset stomach, and take some sort of action, like rehearsing your presentation.

If your rehearsal isn’t going well you may start having more anxious thoughts like, “What if I freeze and forget what to say?”, that might lead to more physical sensations (sweating and lightheaded-ness), which might lead to a new action, like calling in sick to work and missing the presentation.

Let’s take a look at each system more closely. And remember, anxiety is your body’s way of protecting you from danger. Each part of the system plays a role in preparing you for immediate action, and ultimately in keeping you safe!

Physical System

What happens to our body when we are anxious?

As we’ve been discussing, anxiety can cause many sensations in our bodies as it prepares for danger. These sensations occur when the body's natural alarm system (Fight or Flight Response) is activated and the body is getting ready to help us defend ourselves.

A number of automatic (and harmless) physiological changes occur and we experience:

• Increased heart-beat to help get enough blood to large muscles and essential organs so that you can run away or fight off danger - we feel heart palpitations and sometimes have pale, cold skin and numb/tingly fingers and toes, as the blood moves away to places where it’s needed

• Increased breathing helps us to get more oxygen as we prepare for action - can produce feelings of dizziness, breathlessness, numbness, tingling, choking, and even pains or tightness in the chest

• Digestion slows - systems/processes that aren’t needed for survival shut down so that the body can direct energy to more critical systems - experienced as nausea/upset stomach

• Sweating increases to help cool the body - experienced as a cold sweat

• Muscle tension increases to helps prepare the body for danger - experienced as shaking, trembling, heavy legs, and even a tight/painful chest

• Pupils dilate to let in more light and help us see more clearly - things can look ‘unreal’, which can be disorienting, or we can experience spots in front of the eyes

If you think back to a time when you were anxious, you can probably recall experiencing a few of these physical sensations. And although uncomfortable to experience, these sensations are not harmful in any way and they do not last forever.

There are mechanisms in place in the body to help turn down the Fight or Flight Response and return the body back to a relaxed state. If that’s the case, though, you might be wondering, why do I still feel so anxious?

Adrenalin and noradrenalin are two chemicals that are released during the Fight or Flight Response and they take some time to be destroyed. So, even after the Fight or Flight Response has been turned off, you are likely to feel keyed up or apprehensive because the chemicals are still in your system. Again, this is perfectly natural and harmless.

Cognitive System

What happens in our mind when we are anxious?

Anxiety also affects how we think. Anxious thoughts typically involve:

1. Overestimation of danger or threat; for example, when we’re anxious we tend to see the world in ways that make it seem more dangerous and threatening than it really and we may overestimate the possibility that things will turn out badly or jump immediately to worst-case scenarios (e.g. “What if I get in an accident?”)

2. Underestimation of our ability to cope; we discredit our own ability to handle life’s problems, assuming we will fall apart at the first sign of trouble.

But as we know, the problem with thinking as if there is danger when there is no real danger is that you feel unnecessarily anxious.

Therefore, one effective strategy to manage your anxiety is to replace anxious, negative thinking with more balanced and helpful thoughts, by looking at all aspects of a situation (the positive, the negative and the neutral) before drawing conclusions.

Stayed tuned for Part 3 for more information on managing anxious thoughts!

Behavioural System

What do we do when we’re anxious?

When we’re experiencing a range of physical symptoms and our mind is flooded with anxious and worrisome thoughts, it becomes very tempting to engage in avoidance (this is Flight aspect of ‘Fight or Flight’). We engage in avoidant behaviours in an effort to avoid anxiety. Examples include:

• Calling in sick to work

• Eating at home instead of in a restaurant

• Taking public transportation rather than driving in heavy traffic

• Cancelling a date

We can also engage in safety behaviours in an effort to feel safer and avoid anxiety. These are things we do too much of. For example:

• Only going places with a trusted companion

• Not leaving the house without your cell phone

• Seeking lots of reassurance from others

• Engaging in excessive reassurance before taking a trip to try and ensure nothing will go wrong

At first glance, avoidance and safety behaviours make good sense for someone feeling anxious. After all, anxiety feels unpleasant, so why not prevent it?

Although effective in reducing anxiety in the short-term, the problem with avoidance and safety behaviours is that they make anxiety worse in the long-term. After a while, the things we are avoiding seem harder to approach. And the safety behaviours we engage start to seem ‘necessary’ to our being able to do things.

In other words, safety and avoidance behaviours are problematic because:

1. They prevent you from learning that a lot of your fears might not come true, or might not be as catastrophic as you imagine.

2. They lead you to believe that you wouldn’t be able to cope if something bad did happen.

3. They prevent you from learning that, although unpleasant, symptoms are normal and very rarely harmful.

As you might have already guessed, another target of CBT for anxiety is challenging and eliminating safety and avoidance behaviours. More on this to come!

Now that we are able to understand and recognize the components pf anxiety, we are better prepared to manage it effectively. Stayed tuned for Part 3 of this series to learn more about how Cognitive Behavioural Therapy (CBT) can help you manage your anxiety!