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Anxiety, what it is and what to do about it

This blogpost about anxiety includes a summary of a training by Michelle Vickers, a UK-based psychotherapist and coach, given on the Counselling CPD website. Her experience rings true with mine as a counsellor and how she accompanies people with their struggles with anxiety. 

Anxiety is a learned reaction to an emotion, it’s something that’s created, which then begins a habitual cycle of behaviours that keeps it alive. It is helpful and protective and it’s normal and healthy to have anxiety within somebody’s daily function. However, that can become a problem if there’s so much anxiety that it affects situations that are not supposed to be fearful, for instance, having a coffee with a friend, when anxiety can become debilitating and can affect the normal function of an individual. 

The reaction turns the attack into a disorder, so it’s important to know where the reaction comes from. Distinguishing a true phobia from anxiety attack is very important, and the panic attack can determine what we avoid. For example, if we were in a traffic jam and we had an anxiety attack, we may assume that the traffic jam was something that we needed to avoid in the future, because that’s where we felt the feeling of fear, but actually this reaction just causes further avoidance and deeper integration in the cycle of anxiety. It’s not the traffic jam that’s the problem, but what’s going on inside us. 

Anxiety is associated with physiological, cognitive, affective and behavioural symptoms. Physiological symptoms can be palpitations, tachycardia, chest pain, rapid breathing or gasping, a dry mouth, nausea or other gastrointestinal discomfort, dizziness and sweating, amongst others. Cognitive symptoms can be worry, feeling insecure, difficulty in making decisions, negative thoughts about ourselves, others and our environment, frightening thoughts or images, hypervigilance and ruminating on negative or worrying ideas, amongst others. Affective symptoms are fear, but also nervousness, stress, panic, worry and impatience, amongst others. Behavioural symptoms are avoidance behaviours to avoid the sense of fear, for instance, by isolating, freezing, stuttering, crying, repetitive movements, or consuming excessive alcohol, tobacco or food.

Anxiety is a necessary reaction as it helps us to a basic function: it warns us about threats, dangers or risks so that we can adapt to the situation. So, feeling anxiety is normal and even healthy on some occasions. It’s helpful as long as it’s in proportion to the threat we encounter, as long as it’s temporary and so disappears when the situation is over, and as long as we have the resources or tools to deal with it. However, it becomes a problem when it’s disproportionate to the threat we encounter, when it persists (either continuously or intermittently), even when the threat has gone, and when a person is incapacitated and unable to use resources or tools with deal with it, to such an extent that it affects their daily life.

Some people can be more predisposed to developing problems with anxiety. An anxious upbringing, or anxious parents can cause us to develop problems with anxiety as adults. It’s learned behaviour, which can be an unconscious, multi-generational pattern, which we can pick up as children. It can be the result of something traumatic, a stressful event or life experience, such as a bereavement. It could also be a result of a lot of small experiences, like water slowly dripping into a cup, the drips are these small life experiences which subconsciously build and build as small, stressful events. Eventually, the cup fills up and the water overflows, which is similar to the fear response. Also, there can be no obvious trigger or the trigger can be very difficult to identify. Sometimes searching for a reason why somebody is anxious doesn’t help them and it’s better to work with their here and now and how they’d like to move forward.

All anxiety disorders stem from anxious feelings at the root, but they manifest in different people in different ways. It’s not unusual to have an umbrella of anxiety disorders rather than just one. Some of the most common and different types:

  • generalised anxiety disorder (worry about worry). It might not manifest in a panic attack or a lot of panic attacks, but it’s a constant worry that’s beyond what would be classed as acceptable worry. It doesn’t seem to stop and can have a massive effect on a person’s ability to function. 
  • panic disorder (fear of fear). It manifests much more in full blown panic attacks. This person might have upwards of 10 to 15 full scale panic attacks in a day while they’re in the really acute stages of this anxiety disorder, which is debilitating. 
  • obsessive compulsive disorder (‘doubting’ disease). The person says, ‘What if that happens to me?’. It’s a thought that they then obsess about and then they implement a behaviour to counteract the thought. If we worry about cleanliness, for example, we may spend a lot of time disinfecting everywhere. As soon as we think, ‘Oh no, there are germs’, we implement a cleaning behaviour in order to counteract what we fear might happen if the germs have contact with us. 
  • social anxiety disorder (worry of what others might think of us). It’s more than shyness and can be debilitating. It can be fear of interacting with others, calling somebody, feeling that people are looking at us and judging us when they’re not. It severely impacts our ability to connect, communicate and work. 
  • post traumatic stress disorder, or PTSD (often caused by a traumatic event). It brings feelings of anxiety and pictures in the mind’s eye will almost make a person relive the event, and it can be terrifying and debilitating. People can experience nightmares or hallucinations. 
  • body dysmorphia (being anxious about the way that we look). The person may obsessively look in the mirror, or check their skin. Most often it centres around the face, for instance, if something’s not symmetrical or a wrinkle appears, it becomes an obsession. They may invest a lot of money in plastic surgery and constantly change themselves. It’s not vanity, but rather being fearful that ‘I can’t bear the way that I look’. 
  • agoraphobia (fear of the feeling of fear). It is commonly thought that the person fears going outside, however, it is the fear that a panic attack or a fearful feeling might come. For instance, I feel that if I go to a supermarket, I may get a panic attack, so I’ll  avoid the supermarket. The things we avoid build up and become a lot of things until we don’t go out or we don’t do anything at all. It is often a secondary anxiety disorder to panic disorder. When somebody experiences panic attacks in a lot of places that are very intense as they do with panic disorder, the experience is debilitating, so they tend to avoid that feeling of fear. The person develops behaviours to protect themselves from this fear. It’s important to become aware of and learn how to reverse them. 
  • phobias (an overwhelming fear of an object, place, situation, animal or feeling). 

Extreme anxiety severely affects an individual’s ability to function, feeling very agitated, unable to concentrate, or to think about anything. This affects other aspects of an individual’s life and the people that they have around them. It becomes very difficult to hold down a job or have any ability to work. Suffering from anxiety disorder has a huge impact on entering into or maintaining relationships. The largest impact is on the family. The person looks the same, but doesn’t act the same, because they’re not the same. It’s not like seeing a broken leg and thinking ‘OK, well, that person needs help’. Quite often there’s animosity towards the person because of the impact their anxiety is having on other people’s lives. There’s a lot of shame connected to this. It’s hard to stay connected to others as it’s very isolating to feel this way. The person may feel judged, as being seen as anxious could be embarrassing. As a result it’s very easy to isolate yourself from other people. The ability to relax or feel calm is often not there, for example, to take a bath or read a book, because they feel agitation all the time. All this severely drains their ability to enjoy life and to be able to live in the moment. It’s also very difficult to see how the future might look if they believe that they’re going to feel like this all the time. When you’re in that moment, it’s very difficult to see outside of that. Relating to the connection between mind and body, there’s also often an impact on physical wellness, such as gastric problems or fatigue. 

Anxiety disorders are very common and formal diagnoses of anxiety disorders are increasing. One explanation could be the stress of social expectation in modern life. During 2013, there were 8.2 million cases of anxiety in the U.K. By 2023 one in 10 people in the UK were likely to suffer from an anxiety disorder during their lifetime, and one in three is suffering at any one time. 90 percent of disability worldwide is directly due to anxiety and depression. In Spain, in January 2022 57% of people said they had felt anxiety at some time in their lives,  and 92% of people who visited their GP with anxiety symptoms were diagnosed with anxiety and/or depression. 10.4% of people have symptoms or a diagnosis of anxiety. So, the problem is growing, which means it’s more normal now to suffer from anxiety. Any statistics are those that can be recorded from individuals who visit a GP or seek help for their anxiety symptoms. However, many more people will suffer from these symptoms in silence, so, the prevalence of anxiety disorders could be much higher.

Anxiety is often something that is centred around a worry about the future. It makes sense that trigger events can affect how that future might look and consequently turn that future from being something we’re happy with into something we’re really frightened of, which is where an anxiety problem can develop. Life events that may trigger an anxiety disorder would be events such as:

– bereavement

– divorce

– redundancy

– financial pressures

– ill health or becoming ill

– moving house

– a childhood trauma (one that we’re consciously unaware of to some extent in the subconscious)

There could be a lot of little things that we are not aware of, which are festering in the subconscious and causing us to react to situations in our daily life. 

When there is a danger, the senses send a message to the amygdala (a small part of the brain which is responsible for emotional processing). Emotional processing involves the amygdala attaching emotion to memory, as if it were filming or scanning a film of a person’s life (happy, sad, distressing moments) and each time it attaches an emotion to an event. When it’s very excited and fearful, it sends a distress message to the hypothalamus, the command centre in the brain, which is responsible for the activation of  the synthetic nervous system, the fight, flight or freeze response. This happens very quickly. If you imagine a car coming towards you, you jump out of the way before you are consciously aware of it, and after you jump out the way you think, ‘Oh, that car nearly hit me.’ and feelings such as adrenaline pump through your body in reaction to how you felt about the car coming towards you. 

First of all, we have thoughts, fearful thoughts, usually ‘what if’ type thoughts, which produce a feeling of fear. After the thoughts come the unpleasant feelings. For instance, if we were worried about getting seriously ill, our feelings would be a reflection of our thoughts. These thoughts and feelings work together as a link in order for a person to remain anxious. Then come our behaviours in reaction to our thoughts and feelings, which is what can turn this into an anxiety disorder or a longer term problem. I have a thought that I might get ill, my heart rate rises, my legs and arms turn to jelly. I struggle to breathe. I feel that I need to check online or go to the doctor’s and reassure myself that I’m not getting ill. Anxiety almost happens falsely because we have thoughts, then feelings, then we perform a behaviour, which is something that a person creates, not a natural fight or flight response. They have thoughts that may not be real and they may not be correct. They generate feelings and then they implement a behaviour which keeps them stuck, because they’re reinforcing the cycle. We could add rumination (a cycle of negative thinking that doesn’t have a solution) to this cycle. The brain is a very logical organ so if we have a ‘problem’, the brain will work hard to solve it and it often does that by thinking about it. In most cases, rumination is very useful, but with anxiety, it works against us, because we keep the negative cycle of thoughts going, generating feelings, then causing us to react with a behaviour. It’s a reaction which turns this into a habitual cycle and a chronic problem or an anxiety disorder. 

Negative, repetitive thoughts are a really key symptom of somebody who is suffering from an anxiety disorder. The average individual will have 50 to 70 thousand thoughts per day. We remember around 10 or 20 of those and we don’t pay attention to the other thoughts. Someone who’s struggling with an anxiety disorder, focuses on the anxiety-provoking thoughts, but not on everything else. For individuals not suffering from an anxiety disorder, over 90 percent of their 50 to 70 thousand thoughts a day would be negative. So, it’s interesting they can have so many negative thoughts and not pay any attention to them. It’s also interesting that if we try not to think thoughts or have them, we make them stronger. A way to help someone who feels, ‘I need to stop having these thoughts. I need to try not to think them.’ is to help them to get to a point where this process becomes insignificant so they can learn to accept that a thought is just a thought, it’s not harmful and having a thought does not mean that it will be acted on. A person may have some very distressing thoughts which seem very unusual or frightening, something that really impacts the person, as that’s where the anxiety will centre, so it may help them reflect on that. 

Anxiety is a very individual process so there may be very personalised symptoms. Here are some common ones:

  • lack of emotion. It feels as if this process is so intense and exhaustive that a person might say, ‘I’m unable to cry. I’m unable to have any emotion. I feel like I don’t love my family’. This is really normal as we close down and shut off to emotion, because we’ve almost got too much emotion inside of us. 
  • loss of interest or motivation in anything. It’s not that a person doesn’t want to feel motivated or interested in anything, it’s just that they are unable to step out of their head. 
  • feelings of hopelessness. 
  • a feeling that you may go crazy or lose all control of yourself. When this is going on inside of you, it’s easy to think this is not ‘normal’, but actually you’re already experiencing the worst thing that’s going to happen, that feeling of constant fear. 
  • becoming very self-conscious and worrying what others may think of us if we’re suffering. It’s important to treat that person with unconditional positive regard by allowing them to feel anxious and do what they need to do with the tools they have available to them at that time. 
  • constant tiredness and fatigue is really common because it’s exhausting to have that level of fear with the nervous system so excited all the time. There can be a lot of difficulty in falling asleep or staying asleep because a person might feel too alert. It’s common for someone to wake in the night suddenly feeling panicky. If we have a panicky feeling during the day, we might feel like we can vacuum or do something else to distract us, but at night, it’s very difficult to do that.
  • depressive moods and thoughts. 
  • difficulty breathing. The tendency is to shallow-breathe or to hyperventilate, with small laboured breaths rather than large, slower breaths. Breathing exercises and mindfulness can be useful to learn; how to take deep breaths from the diaphragm. 
  • dry mouth. 
  • rumination. 
  • avoidance. A person needs to change the feeling of  ‘If I feel worried, I’m not going to go. I need to avoid and isolate.’ because unless they feel a feeling of fear, they’re not going to get over it. 
  • feeling a sensation of choking or difficulty swallowing. 
  • chest pain, tightness or heaviness. 
  • headaches or an intense feeling of pressure in your head. Pressure is a common symptom. 
  • dizziness or feeling like you may faint. 
  • a racing heart. 
  • disturbing or strange thoughts or visions in the mind’s eye. They are very common. The person needs to normalise that this is not them, but what is happening. It’s a normal part of this process, so they need to work through it. 
  • blurred vision or seeing spots in front of the eyes. 
  • pins and needles in the hands and feet. 
  • feeling irritable because it’s agitating. 
  • hot and cold flushes.  
  • an upset stomach is very common.
  • an urgent need to urinate or to empty your bowels in fight or flight.
  • yawning is to do with hyperventilation and so a person with an anxiety disorder may yawn quite a lot. 

Our behaviours are our responses to the fearful feelings that we’re having. We act in a way in which we believe keeps ourselves safe. Whereas we are actually trying to keep ourselves safe from something that isn’t dangerous, which has a negative impact. They’re helpful until they negatively impact on our lives and then they begin to affect our emotional health. One aspect can’t stay in this cycle if the others don’t, so we’ve got to break that chain somehow. A person’s responsibilities lie in their behaviour, which they need to change in order to break the cycle. So, understanding that they have control over their behaviours is vital, to act against their natural instinct and not to protect it. 

Anxiety and the habitual part of the cycle, or the behaviours, the feelings, the thoughts, the reactions come from what’s really going on deep within an individual. Therapy helps because it’s about exploring and getting to know the person, understanding their reactions, their core feelings and where everything comes from. Unfortunately, if this isn’t unblocked, panic attacks become an anxiety disorder.  A person can feel that something is wrong and that something awful is going to happen, very isolated, fearful, agitated, terrified of being alone, unable to stand anyone being close, shame, guilt, unable to feel their feelings, unable to relax, very tired in moments of calm, that the days are interminable, unable to do simple tasks, loss of hope that things will improve, and fear for the future.

Medication suppresses the feelings we have and it may get someone to a point where they can actually work with what’s underneath and what’s going on for them. So, it is a valid treatment option, and different things work best for different people. However, the question arises as to whether we should work with the feeling itself instead. Regarding therapy, the core conditions of the person-centered approach are effective for anxiety. That means empathy, an unconditional positive regard and congruence, without judgment, in order to get into a person’s head and understand and see the world from their frame of reference. If a therapist has a wider knowledge of what an anxiety disorder is, that helps them to be able to connect. There’s a lot of shame centred around anxiety, making it very difficult to even contemplate starting therapy. So, it’s important to not feel judged if you want to walk around in a session instead of sit down because you feel panicky. Congruence means being really transparent, open and honest with a person, and creates a sense of trust. Cognitive behavioural therapy (CBT) is measurable, looking at someone’s behaviour and giving someone homework to look at their behaviour in a cognitive way and so change it. It can be very effective for working with anxiety as long as the person is engaged by putting this into action and works towards their own recovery. A person needs to find the right approach for them and their anxiety and often an integrated approach works, using different methodologies which are really tailored around a person and their own process. Exposure therapy can help with phobias, where a person is gradually exposed to something they fear. It’s more useful to say to a person with obsessive compulsive disorder (OCD), to not do their compulsive behaviour right now, and delay it for a while, rather than to simply stop doing it. We can ask them to stand back and think about it for a minute. Self-help helps us to reflect so it can be useful and give comfort. Positive self-help platforms can help direct people to websites and resources which may help them to facilitate their own recovery together with their therapy. However, we need to be mindful of the negative forums which can be harmful. Mindfulness is a great way to train us to accept thoughts, as it doesn’t stop thoughts, but rather allows us to observe them and then accept them. This can help a person to learn to sit with what’s going on in their head. Mindfulness has to be practised, and a good way to do this is to commit a couple of minutes in the morning and at night to it so that we develop the habit of keeping ourselves relaxed throughout the day. Meditation, like mindfulness, is something that has to be practised and is very effective. Learning to breathe deeply from the diaphragm can slow down chronic symptoms. A lot of these options may not seem to help in the short term on a conscious level, but subconsciously, things will change in us if we keep them up. 

There are some measures that can be used to prevent anxiety and to manage it when it arises: 

1. Try to maintain a healthy and balanced lifestyle: quality sleep, eating well, exercising moderately and regularly, etc. 

2. Having a good social network: looking for people to share hobbies and activities with, but also to turn to in case of need. 

3. Do activities that you find pleasurable, which are good for your well-being, and that you like: dancing, theatre, photography, hiking… 

4. Try to learn some relaxation techniques (diaphragmatic breathing, meditation techniques, mindfulness, yoga or pilates) and put it into practice when you feel agitated or anxious. 

5. Learn to identify your anxiety reactions and symptoms, as well as the situations that trigger them. 

6. Learn to manage your emotions: once you identify them, put them in context and understand them. 

7. Get support from your loved ones, friends, family or partner. 

8. When you find yourself in an anxiety-provoking situation, think about what the worst thing that could happen to you is. You will see that fear often puts us in extreme and terrible, but unlikely scenarios, and that its true consequences are most likely not so bad.

9. When situations are not under our control, when anticipating anxiety-inducing situations or their consequences, try to differentiate between what is really possible and what is just probable, so that you can decide how to act because you do have control over that.

10. Seek help from a professional (GP, counsellor, psychotherapist etc.) if you feel you can’t cope on your own.

Michelle Vickers, UK psychotherapist and coach, sees anxiety as having two arms. The first looks around the exploration of the self, which is done in therapy. It’s the root of who we are and how it may impact our thoughts, feelings and behaviours. We have reactions to our panic but need to work out where these reactions come from. Once we have brought what’s in our subconscious into our conscious awareness, then we can work towards facilitating change. We all live in our ‘normal’ reality, but what is normal? We all have our own frame of reference and so see the world differently. So our reality may not be correct. We need to bring it into conscious awareness. The second is dealing with the habitual behaviour relating to the anxiety cycle, which develops as a result of the root of who we are. 

Working with anxiety is about giving someone a new perspective. The goal is not to be anxiety free or to erase large parts of your own life story, as the adverse events that happen in our lives are what shape us. This is an opportunity to change what’s not working for us and to move forward. It’s not helpful to believe that before this happened, we were happy all the time and that we can go back to that. It’s impossible to go back to that even if we didn’t have anxiety. We really probably weren’t happy all the time and we can’t erase our life story. We’ll always change and evolve whether we’ve got anxiety or not. It’s necessary to understand the self as an individual, and what makes up these feelings and subsequent habitual behaviours. We need to develop the courage to stand back, break our habits and create a new reality and perspective with our own criteria. There are two rules that Michelle Vickers believes are key to anxiety. Number one, it feeds off itself and number two, it takes up a lot of time. 

It’s important to offer a person the core conditions of empathy, unconditional positive regard and congruence. We need to have a wider picture on what might be going on underneath the anxiety. This is the narrative and this is the story that the person’s giving which we need to accept on face value. We need to look at this person and think about what is causing them to react to those types of situations in that way. It’s vital to normalise their symptoms as all anxiety symptoms have a logical explanation. The body works to protect you, but it ends up overprotecting you. This logical explanation through psychoeducation using a more directive approach can help people. It’s not about fixing it or searching for a solution. There may be difficult underlying beliefs, such as, ‘I’m wrong. I’m the one that cannot get better. Something’s wrong with me. Everyone else is ‘normal’ but I’m not’. People can suffer relapses when things get tough in the future, as if their behaviours are a kind of comfort blanket. The idea that ‘I’m wrong’ isn’t true, but rather a learned reaction to an emotion and that can be undone. Delaying the reaction is useful by, for instance, giving yourself a couple of minutes, to have time to regain rational thought and decide how to proceed rather than be governed by my anxiety. The person needs to remember that it all starts with a symptom and then there is a reaction to a symptom, which starts the cycle. In therapy, we can look at the person’s upbringing and explore how the person sees themselves and which unconscious patterns are relevant. A holistic approach (emotional, hormonal, nervous) with unity of mind and body is important as chronic anxiety affects a person’s physiology. Emotional patterns don’t reflect individual choice, but often multi-generational patterns within the family structure. It’s not somebody’s choice to be how they are, so they are not to blame. They do feel shame, unconsciously, however. The person really is doing their best and needs to learn about making unconscious patterns conscious. If we’re consciously aware, we can take responsibility for our behaviour and we can change it to better suit our emotional and physical state. If you want to have a different impact on your physiology, you must become consciously aware. 

If we think about anxiety as a disorder, it’s known as an avoidance disorder and anxiety is often the result of suppressed feelings. Think about the anxiety cycle and how the avoidance of feeling fear can negatively impact recovery. A fear of feelings drives avoidance. We’ve got a conscious side and a subconscious side. Consciously, you are reading this text now. Subconsciously, you’re breathing and are probably not aware of that. If we see a feeling as a full circle, it must be processed within the subconscious and for the subconscious to accept it, it has to do a full circle. The subconscious cannot accept a negative feeling, it has to do this full circle, and in order to do that, a feeling has to be felt. Relating this back to anxiety, we’re trying not to feel fear, but for this to process into our subconscious, it must be felt by doing the full circle. If something’s very traumatic, very sad, or very overwhelming, what our brain does is protect us by storing it in the back of the brain, in the subconscious to an extent or on the surface of it, until such a time when we’re able to feel this feeling, then it will bring it back for us. What actually happens is that it does a half circle and then we take all our half circles down to the subconscious, but the subconscious says, ‘Stop, unfortunately, I can’t take half circles, they must be full circles.’ so it gives them back to you. 

Looking back at the self, if we think of a baby, if the parents put it in a Gucci dress, does it know that and what that might mean to everybody around it. No, it’s just itself. We have social expectations, culture, different beliefs and we learn our family’s culture and beliefs. We can add to that possible attachment issues, regarding whether our needs were met, and what our parents’ emotional states were. We can also look at how a child copes, for example, with parents arguing downstairs by going upstairs and pulling out their hair. This is a maladaptive coping strategy and might help that child to get through that difficult period of their life. Going forward all this might make up a possible future anxiety disorder. If we look at how trauma works, if there’s been a childhood trauma, we revisit the event in our heads, but then we add to it. Each time we think about it, we add to the story. Then to complicate things, there will be triggers to trauma. If, for example, we’ve been attacked in an alley, we might have triggers where there’s darkness, small spaces, alleys, or when somebody’s around us. We need to explore with a person what the gap is between the external persona and an internal sense of self to determine their reactions and their ability to cope with the feelings that they’re feeling. What we’re doing when we implement a behaviour to help with our anxiety is controlling an internal state with an external source, but what we need to do is look into all this and make some sense of it. This is what causes addiction. In fact, anxiety has been considered an addiction by some, because we’re chasing the better feeling and the behaviour which avoids the fear. Anxiety can be seen as a comfort zone. Imagine a person who was in a domestic violence situation. Family and friends would tell the person to leave because the situation is out of control. The person may have panic attacks, low mood, feel uncertain about everything, or be living on the edge. If you take that person out of that relationship, quite often they find another partner who is exactly the same, which seems almost unbelievable to everybody around them. What’s really happening is they’re acting in a way that they know how to be, even though it’s difficult and anxious and depressing. It’s become their comfort zone, so stepping out of that into a loving, nurturing relationship is like coming out of the comfort zone into a new zone. In between that is intense fear. The person that is then in a loving, nurturing relationship may need long term therapy because they don’t know how to cope outside of their previous relationship. Relating this back to anxiety, it becomes obsessive, takes up a lot of time and feeds off itself, it becomes completely consuming and it almost becomes our ‘normal’. The person needs to go towards that fear to be able to go into the life that they’d like to have going forward. 

The person is in some respects driving the habit, and that can be quite a hard thing to accept. In order to talk about them learning to take responsibility for their habits, it’s essential to have a solid therapeutic relationship in the therapy process. When a person works on their reflection points it helps them to bring their subconscious patterns into the conscious moment, so that they can be changed. They work with experiences and reactions at the root, which will ultimately give them a different perspective on their anxiety and the difficult feelings from their early life. In terms of responsibilities it’s not enough for a person to know everything there is to know about anxiety and panic. It’s about no longer driving and reinforcing that habit and taking action to move forward towards this fear. What helps is delaying the reaction, and not carrying the anxiety around with them. There is a saying, ‘life change in the initial times causes great stress’, which means understanding that consciously it might not feel better, but subconsciously there will be changes going on, and becoming aware of the urges to perform the behaviours which protect them and how to resist them. Understanding that this is a process and where the person is within that process is exactly where they need to be as this is a learning experience. It’s about building strength and resilience and that it’s OK to be where they are. Once they’re locked in the cycle, a person may feel out of control, but it’s very important for them to understand that there are aspects of this cycle they can control. It’s important to reflect on their responsibilities and have awareness of a choice as there is always a choice. A person drives their own car and their process is about taking small steps forward and pushing onwards, taking as many little steps as they feel they can. 

A wider definition of addiction is a ‘habitual behaviour that self soothes’. Somebody who compulsively shops, gains a nice feeling from purchasing. Avoiding fear in the short term, the fear lessens and they feel better so they repeat that behaviour and that’s where the addiction comes in, which only increases the chance of a negative longer term outcome and becomes difficult to give up, with an increase of fear in the long term. The behaviour soothes pain and then distracts from it and it’s about exploring not why they have the behaviour, but why they have the underlying pain. The behaviours are an attempt to regulate what is an unbearable internal state. In therapy we connect with a person in a therapeutic alliance or trust that helps them to explore that unbearable internal state. When that part is solved, the anxiety tends to melt away. This is what’s really important. A person needs to understand that they have to sit with that feeling in order for the longer term fear to be resolved. Doing further reading around addiction can be really useful to us. 

The amygdala has a way of protecting against danger and we can train it. A person needs to know that they need to speak to the amygdala in a way in which it understands. In the same way that we can’t tell a dog to not get on the sofa, but rather train it not to, we have to do the same with the amygdala. 

Michelle Vickers created the  ‘Fear Monster’, which she believes helps to visualise how to train the amygdala. In a person’s journey, it is helpful in helping them to stand back from the habitual side of anxiety. We all have a monster. If you’re not aware of it, maybe it’s in a corner that you’ve not yet become aware of. It’s usually very well contained and we don’t realise it’s there, but if it surfaces properly during a panic attack or when we have a very anxious feeling and we focus on the way that we feel, then we focus on the fear monster and it becomes a menace. Its primary ability to function comes from fear, inner pain, self-doubt and trauma, amongst other things. Something triggers us to make us notice it, either subconsciously or through an event and then it grows and becomes enormous as we implement behaviours which keep us safe, keeping it big. It gives us an acute feeling of fear. It stands there next to us, so our focus is on it. It needs to keep us stuck because our fear is its oxygen. It whispers in our ear the whole time, because it needs to keep us stuck. To defeat it we need the right knowledge, together with conscious awareness of how it’s created and how it works. It can be a really useful visual tool to refer to to help people to understand the habit of anxiety which we need to work with. 

If we divide the brain into three parts, there’s the rational part, then there’s the fear monster which works on using our feelings to make assumptions about situations, and finally, the amygdala scans all this and records it. 

How the monster grows is not a conscious awareness, but rather about how we see our fears. We can use it to bring fear into conscious awareness. People may not realise that they have control over it and how much choice and power they actually have. It can seem a huge task to regain control over it. However, going back to the two rules, that it feeds off itself and takes up a lot of time is key in it keeping its oxygen. It needs to keep a person in the cycle. We can make it big, so we can also make it small. To make it smaller we need to understand that we have the responsibility to do so through taking action. 

We need to understand the wider picture and not just the feeling of anxiety. In addition to concentrating on the fear monster when there are a lot of things going on inside a person or when large trigger events happen, we need to know the self and understand the impact of life experiences and our reactions to them. Normalising our feelings is very important, when we know what triggers fear and then have a maintenance plan in place. When a person has reached a point where they feel they have a better quality of life, they need to know how to keep that. It could be through an exercise program, or understanding when they’re taking on too much. It’s not about suppressing valid emotions because we need to express our emotions. We can use the fear monster when we feel anxiety being triggered. For instance, if I feel overwhelmed by the idea of visiting a friend, then I can tell myself that it is possible to move the monster from blocking the door. Acceptance is not accepting feelings that enable us to feel so horrible, but rather maybe considering accepting where we are in the process and that we are doing the best we can in the situation that we’re in. It’s about accepting that and not the anxiety itself. 

We can develop maladaptive coping strategies to help us deal with the feelings of fear in the short term, but which actually in the longer term don’t help. It’s unhelpful to do endless searching to find the source of anxiety. There’s even research to say that anxiety can begin in the womb and if that is the case, then a person will never identify it. It just keeps the cycle alive, so it’s worth supporting a person to understand that it may be about working with where they are right now and how they’d like to move forward. Avoiding where the person had a panicky feeling is also unhelpful, as it’s not about where we have the feeling and linking that, it’s about what’s going on inside us. Labelling people or people labelling themselves is unhelpful, for instance, agoraphobia. Trying to get rid of it or trying to erase the anxious part of our life is also unhelpful as it is still focusing on it and in that respect, it will stay. 

There are new studies, advances, and new ways of dealing with anxiety all the time. I hope all of the wise words from Michelle Vickers can help you to understand a bit more about what is happening to you if you suffer from anxiety and even encourage you to make some changes in your life or seek help. 

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