Angst
All emotions serve a purpose, and fear is no exception. Fear is meant to help us assess risks and keep ourselves safe. In the evolutionary environment where humans originate, there were various dangers such as dangerous animals, people with malicious intent, heights, etc. Fear was and still is essential for our survival. Anxiety is also a form of fear, but unlike fear, anxiety is activated by something that isn't actually dangerous. Most often, it's something within ourselves that triggers anxiety, such as emotions, thoughts, imaginings, or physical sensations. For 'phobias,' anxiety is triggered by a combination of external conditions, like heights or tunnels, and our assumptions or thoughts about them. When anxiety is activated too frequently, it becomes troublesome, and we say that someone is struggling with anxiety.Unconscious and automatic response
Unconscious and automatic response
For humans to reach safety when in danger, the brain evolved so that the fear response became incredibly fast and entirely automatic. When a lion approaches your group, it's not beneficial to scrutinize it carefully to make sure it's a lion. If you think too long, you risk being eaten. Instead, it's best to jump straight into the trees and then double-check whether it was a lion or not. Therefore, the moment the brain perceives a stimulus that even remotely resembles a threat, fear is activated. This occurs despite the fact that it often turns out not to be a lion but perhaps just the wind rustling in the bushes. Because it's much more favorable to be wrong when there isn't actually a threat than to be wrong when there is one, we've developed a somewhat oversensitive radar that searches for possible threats. Even though there are no lions in Norway, our brains remain largely unchanged since the time we lived in hunter and gatherer tribes in Africa. Therefore, it doesn't take much to activate the fear response in us. It's simply our natural defense system trying to keep us safe. For fear to be activated as quickly as possible, it is initially entirely unconscious, meaning we become anxious without our will or awareness. Afterwards we can consciously engage with it. This conscious anxiety is the one we can think about, for example, when we notice nervousness before a presentation.
Fight, flight, and freeze
When the fear response is activated, a series of physiological changes occur designed to protect us. There are essentially three functions of these changes: to prepare our body to escape from the threat, fight against the threat, or play dead. These are entirely essential physiological reactions that organisms have had for millions of years. In the short term, such reactions have a function. In threatening situations, it's useful for the body not to expend energy on 'unimportant' processes like digesting food but rather redirect the energy to muscles and the heart. However, when the fear response is constantly activated almost all the time, it has many side effects. Physiologically, we can distinguish between three different types of 'unconscious' anxiety with various side effects.
Anxiety in striated musculature
Striated musculature consists of muscles that we can move voluntarily, such as arms, legs, and fingers. When anxiety activates these muscles, we become tense, starting in the hands and then the shoulders and neck, chest, stomach, legs, and feet. When we have striated anxiety, we appear and feel tense, and may feel short of breath and shaky. Over time, persistent anxiety in these muscles can lead to symptoms such as tension headaches, a feeling of tightness in the throat, neck pain, fibromyalgia, back pain, chest pain, abdominal pain, cramps, tremors, and more.Anxiety in smooth musculature
Smooth musculature includes muscles that are not under voluntary control, such as blood vessels, the heart, airways, bladder, and intestines, among others. When anxiety affects smooth musculature, we might blush, feel our stomach rumble, or feel tired, etc. If anxiety frequently affects smooth musculature, one may experience symptoms that prompt a visit to the doctor, such as high blood pressure, heart spasms, asthma, coughing, a feeling of suffocation, irritable bowel syndrome, gastroesophageal reflux disease (GERD), bladder issues, migraines, and more.Cognitive and perceptual disturbances
Cognitive and perceptual disturbances occur when one's unconscious anxiety disrupts the senses and the ability to think clearly. Signs of this include disrupted hearing and vision, blurry vision, tunnel vision, tinnitus, or feeling like ears are plugged. Cognitively, it may feel like one is disconnecting or becoming confused, making it challenging to keep up in a conversation. Some patients dissociate, meaning they experience reactions where it feels as if the connection with their own body or the surrounding reality is disturbed.
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Anxiety disorders
Most people who come to me have some degree of anxiety, regardless of whether it is the main issue or not, and that's normal. In some of them, anxiety takes up so much space that we can classify it as an anxiety disorder. The most common anxiety disorders are social anxiety, panic disorder, generalized anxiety disorder, and health anxiety (hypochondria). Additionally, there are anxiety disorders related to trauma, often classified as PTSD, as well as obsessive-compulsive disorder (OCD) and phobias, among others.
Treatment
All effective anxiety treatment involves some form of exposure, gradually challenging oneself to face the fears, allowing our somewhat oversensitive nervous system to acclimate to what triggers the fear response in us. Sometimes, even being vulnerable and open with a therapist can be very anxiety-provoking, making the therapist-client interaction a good starting point for exposure. Many people have what we call 'affect phobias,' meaning that certain emotions evoke anxiety reactions. For such clients, we try to expose them to the emotions that trigger anxiety. Sometimes, we may need to talk about things that happened in the past or that one is afraid might happen. Occasionally, I might even suggest leaving the therapy office to expose ourselves to something that only exists outside. However, it's important to remember that exposure should happen gradually, so the client doesn't become overwhelmed by anxiety. If one becomes overwhelmed, exposure doesn't work. At the same time, it's unavoidable to acknowledge that one must be brave and push oneself to challenge anxiety.