Anxiety and Panic

Digital Art by Robert Ek

Do you feel tense, restless, and on edge most of the time? Are you doubting your abilities, second guessing everything you do and anticipating the worst? Does it feel an imposter hijacked your normal self and is lashing out with an endless stream of negativity? You might find yourself spiraling down in self-criticism while feeling paralyzed to take action. All you might wish for is to turn off that harsh, loud, and stubborn voice inside of your head to finally get some rest. Anxiety can be messy and unpredictable, overpowering and insidious, physical and mental, and at times so unexpectedly debilitating that it feels impossible to break out of it. Some describe anxiety as a brain fog that clouds their mind, others experience it as a brain explosion that scatters their thoughts in all different directions - leaving a void, a crater of emptiness.

You are not going crazy and you are not alone! Over 40 million adults in the U.S. (18.1%) struggle with feelings of intense and overwhelming fear and distress.

Even though anxiety often leaves us with a sense of impending doom and hopelessness, it is treatable and healing starts with awareness, understanding, and compassion. Together with you, I want to explore, piece together, understand and address the sources of your unique experience of anxiety and develop an internal sense of safety and security.

Stress versus Anxiety

Life often takes us on a rollercoaster ride, demanding us to navigate the unpredictable ups and downs along the way. We have to juggle the demands of work/school, family, health, finances, and relationships. It seems that there is always something we stress about or worry over.

Generally, stress is a response to an external cause, such as a tight deadline at work or having an argument with a friend, and subsides once the situation has been resolved. While the feeling of being stressed may be unpleasant, there are some short-term benefits to it. Stress comes with physiological changes that can help us overcome challenges and meet our goals — such as increased concentration and enhanced reaction time.

Digital Art by Keith Negley

Stress is typically caused by an external trigger. The trigger can be short-term, such as a work deadline or a fight with a loved one or long-term, such as being unable to work, discrimination, or chronic illness. People under stress experience mental and physical symptoms, such as irritability, anger, fatigue, muscle pain, digestive troubles, and difficulty sleeping.

Anxiety is a person’s specific reaction to stress; its origin is internal. Anxiety is typically characterized by persistent, excessive worries in situations that are not actually threatening. Unlike stress, anxiety persists even after a concern has passed or without even knowing the origin of it. Feeling a certain level of anxiety before big decisions or transitions in life is totally normal. However, if you find that your fear or worry does not go away and, in fact, gets worse over time, it might be helpful to address your anxiety with a therapist.

People tend to reach out to me when their anxiety becomes so excessive or so persistent that it negatively impacts their overall quality of life, their physical health (e.g. headaches/migraines, insomnia, fatigue, nausea) and/or their ability to:

feel like themselves
cope with daily stressors
look after themselves
keep a job
form, maintain, or enjoy relationships
try new things
simply enjoy their leisure time.

What exactly does anxiety feel like?

Ultimately, there are a variety of ways that anxiety can feel as it affects individuals differently. While the symptoms listed above represent some of the most common things that people feel with anxiety, it is not a comprehensive list.

Feeling tense, nervous or unable to relax
Having a sense of dread or fearing the worst
Feeling like the world is speeding up or slowing down
Feeling like other people can see you're anxious and are looking at you
Feeling like you can't stop worrying or that bad things will happen if you stop worrying
Worrying about anxiety itself, for example worrying about when panic attacks might happen
Wanting lots of reassurance from other people or worrying that people are angry or upset with you
Worrying that you're losing touch with reality
Wanting to avoid certain situations
Rumination (obsessive and/or intrusive thoughts) – thinking a lot about bad experiences, or thinking over a situation again and again
Depersonalisation – a type of dissociation where you feel disconnected from your mind or body, or like you are a character that you are watching in a film
Derealisation – another type of dissociation where you feel disconnected from the world around you, or like the world isn't real
Worrying a lot about things that might happen in the future
Low mood and depression

Anxiety and depression commonly appear together. This means that you may alternate between periods of anxiety and depression. This can feel like being extremely worried and uneasy for a certain amount of time, followed by feeling extremely hopeless or disconnected until the cycle repeats.

Physical symptoms of anxiety can include:

A pounding heartbeat
Breathing faster
Palpitations (an irregular heartbeat)
Difficulty breathing
Chest pains
Headaches
Muscle tension or twitching
Inability to sit still
Sweating when it’s not hot
Trembling when it’s not cold
Stomach aches
Feeling sick
Loss of appetite
Feeling faint
Visceral sense that you’re in danger
Needing the toilet more frequently
Difficulty sleeping at night

Panic Attacks

Some individuals with high anxiety can experience panic attacks. A panic attack comes on suddenly and with intense symptoms that can often be mistaken for symptoms of a heart attack. Therefore if you went from being calm to feeling extremely distressed in a matter of minutes, you may be having a panic attack. Additionally, panic attacks are classified as exhibiting at least four of the following:

Choking sensation
Racing heartbeat
Feeling hot or cold
Shortness of breath
Chest pain
Numbness or tingling
Shaking or trembling
Sweating
Heart palpitations
Nausea or stomach problems
Feelings of detachment
Tightness in the chest
Feeling a loss of control
Fear of dying

Both anxiety and chest pain can be a sign of something more serious and your doctor will need to confirm that your symptoms aren't caused by an underlying medical condition.

Will anxiety go away on its own?

Anxiety and its symptoms resolve only when the underlying cause of the anxiety is addressed.
The causes of anxiety disorders aren't fully understood but likely involve a combination of factors including genetic, environmental, psychological and developmental.
Growing up in an unpredictable environment is one of the most influential factors in the development of anxiety disorders, including Generalized Anxiety Disorder. Highly stressful and overwhelming experiences, especially early on in life, can lead to changes in brain structure and function and can impact how one perceives physical sensations.

For example, a child who grew up with an angry or violent parent or was faced with bullies at school may have had to learn to read their parent’s or their bullie’s mood in order to know when to avoid them or try to calm them down. These children grow into adults who constantly evaluate their environment and other people’s responses for danger. They might be worried if someone doesn’t respond quickly enough or might anticipate the worst case outcome of every situation.

People who had painful relational experiences in childhood have been documented to have changes in the brain and nervous system that can be long-lasting. One of these changes is a larger or overactive amygdala. Deep in the center of the brain, the amygdala is involved in detecting and responding to threats, among other functions. An enlarged or overactive amygdala is associated with an increase in reaction to danger. People who have this symptom might detect danger or threats where there are none, thus becoming afraid or worrying over even minor occurrences. The worry and anxiety these people experience can feel very real and distressing, even when there is nothing to worry about, and can be difficult to calm down.

Sculpture by Alexander Milov
Picture by Alec Kondush

Painful and unprocessed early experiences in life can also impair one’s ability to successfully experience and regulate emotions throughout life. According to Accelerated Experiential Dynamic Psychotherapy, the inability to fully and safely experience our core emotions (joy, anger, sadness, fear, and excitement) in the body can lead to inhibitory emotions such as anxiety, guilt, and shame. For example, if a child “learns” by experience that their sadness leads to mother’s withdrawal or impatience, the child will learn to suppress sadness. As a result, the child may feel anxiety instead of sadness. Similarly, if a teenager grew up playing competitive sports as a High School athlete, he or she might have learnt to suppress any feelings of anger or fear and instead experience anxiety or shame.

Accordingly, when working through anxiety, it can be helpful to first find ways and tools to calm the overactive Sympathetic Nervous System and then to be curious about potential origins of the stress response and to explore potential core emotions that might be underlying the anxiety (“Do I feel angry? Do I feel sadness? Do I feel afraid? Do I feel disgusted? Do I feel excited? Do I feel joy?”).

Having had painful or overwhelming childhood experiences does not guarantee that a person will develop anxiety or panic and the route is not entirely clear. Other factors in the environment and personal differences can moderate the effects of trauma.