Does Everyone Have Anxiety Lately?

Anxiety is everywhere. You may notice your friends, family members or even yourself talking about experiencing anxiety. We are both living in a society in which there are higher rates of anxiety and it is more common to speak openly about mental health. Anxiety, however, can mean different things to different people. So that we're all on the same page, let me explain how I like to conceptualize anxiety, through a cognitive behavioral therapy (CBT) framework.

What is Anxiety?

Anxiety is a primal emotion. Everyone experiences anxiety from time to time. Anxiety can be conceptualized in terms of thoughts, feelings and behaviors. Many people notice physical sensations first when they feel anxious. This is due to the biological fight or flight response, which causes our pupils to dilate and make sights around us appear blurry or for blood to rush to our extremities, leaving us feeling tingly and shaky. We may notice our hearts race and chest tightness as well. There are also automatic thoughts that pop up when we're worrying, whether or not we are aware! For instance, you may have worried thoughts about your future being uncertain, concerns about if your presentation will go well at work or thoughts that other people are judging you. Lastly, there are behaviors we engage in when we feel anxious, and things we knowingly or unknowingly avoid. This could look like fidgeting or avoiding doing something that feels scary or uncomfortable.

Anxiety is an important emotion to experience. We feel anxious if something scary is approaching, as we want to try to keep ourselves safe. We also feel anxious when we are preparing for something we care about. Some degree of anxiety is helpful, as it motivates us. Imagine if you never felt any anxiety before a big exam or presentation. You would not have the energy or care to prepare as much. However, when anxiety gets too high or is out of proportion to the situation, it can be detrimental. I like to think of anxiety on an inverted U-curve (also known as the Yerkes-Dodson Law), where we can envision anxiety as helpful up until a certain point, when it then starts to become unhelpful.

Anxiety Prevalence 

As discussed, we all experience varying degrees of anxiety throughout our lives. However, anxiety can be classified as a disorder when it interferes in a person's life and/or bothers the person to a significant degree. Anxiety disorders are the most common of all mental health disorders. It is estimated that approximately 4% of the global population is currently experiencing an anxiety disorder (1). As of 2019, 301 million people across the world were experiencing an anxiety disorder. However, only about 1 in 4 people in need of treatment receive it (2). Effective treatments exist, such as psychotherapy (cognitive behavioral therapy approaches being the most effective), stress reduction (yoga, exercise, meditation) and psychopharmacology (medications, such as SSRIs), however barriers exist. Common barriers include lack of awareness of effective treatments, lack of access (financial, accessibility) and stigma. 

How Treatment Works

I will spend more time in future blog posts discussing various effective treatment approaches. However let me explain briefly how treatment can help. In line with how anxiety manifests physically, cognitively and behaviorally, treatment can address each of these domains as well. For example, we can start to learn approaches to relate differently to our thoughts. Many people accept thoughts as absolute truths. Instead, what if we could begin to distance ourselves from our thoughts, and become curious observers of our thoughts? As humans, we have the unique ability to observe our thoughts, challenge them, and choose to accept or distance ourselves from them. 

We can also learn to relate differently to our physical experiences. Whether through breathing meditations or exercise, we can calm our sympathetic nervous system, which can induce relaxation. We can also practice strategies to become more accepting of then discomfort we may feel inside our bodies, rather than reacting to uncomfortable physical sensations (through biofeedback or something called interoceptive exposures. Lastly, anxiety often urges us to avoid situations we find frightening. Through exposure therapy, we can learn to slowly approach our fears. By doing so, we learn that our fears usually do not unfold, and even if they do, we can handle the feelings of discomfort better than we may think.

Anxiety tells us two lies:

1. The worst case scenario will unfold (it usually does not)

2. If something bad does happen, we won't be able to handle it (we usually can- even if we don't like it)

Anxiety likes to have control and certainty. And, unfortunately, lack of control and uncertainty are fundamental qualities of life. Most people come to therapy stating they no longer want to feel anxious, and hope that I can help them learn to have more control and more certainty over their lives. People often don't like to learn the hard truth that in order to ultimately reduce anxiety, we will need to learn in therapy to lean into the uncertainty of life and to relinquish control. This is a hard, painful truth of life, and takes a lot of work and willingness to sit in this discomfort. This is why treatment for anxiety is HARD. There is not immediate relief, rather treatment compliance involves relinquishing short term relief for long term gains.

As an anxiety therapist, there is so much we can learn about and discuss in relation to better understanding anxiety and its treatment. I welcome any questions and comments and look forward to diving deeper into treatment components in future blog posts.

References

1. GBD Results Tool. In: Global Health Data Exchange [website]. Seattle: Institute for Health Metrics and Evaluation; 2019 (https://vizhub.healthdata.org/gbd-results?params=gbd-api-2019-permalink/716f37e05d94046d6a06c1194a8eb0c9, accessed 5 September 2023).

2. Alonso J, Liu Z, Evans-Lacko S, et al. Treatment gap for anxiety disorders is global: results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195–208. doi:10.1002/da.22711.