What Is Anxiety?
Anxiety is what you experience following your appraisal of an incoming external or internal threat. An external threat could be literal, like encountering a large stray dog on your neighborhood walk, or something like an eviction notice or a big argument with a loved one that leaves you unsure about the relationship. An internal threat could be a feeling that you have but are not okay with, like anger, guilt, certain sexual feelings, etc. Your appraisal of this feeling as "bad" can lead to anxiety, and this is pretty normal.
Severity ranges from mild up to panic attacks or completely frozen and dissociated. The term 'anxiety' has a common problem in psychology: it is used both clinically and colloquially in different ways. There are anxiety disorders, and then there is your run-of-the-mill anxiety that is part of normal human life. Lots of gray in between (spectrums everywhere). For example: anxiety disorders have duration criteria; they're chronic. But you could experience a single panic attack in your life, which is not a disorder and not everyday anxiety. I'd like to talk here about the "normal" kind.
You're giving a presentation in front of peers. You walk into a gathering where you don't know anyone. You're about to talk to your doctor about test results. We can all relate. It is often unconscious (re: out of your awareness at the moment) at both low and high levels. One very common way that people experience anxiety is a slight tightening in the chest or abdominal muscles. We often discharge this kind of anxiety into our voluntary muscle groups, also called 'striated muscles'. There is an inability to feel physically calm and relaxed.
Symptoms of Anxiety
Fidgeting with hands
Bouncing your leg
Clenching your jaw
Tightening a specific muscle group that could cause or worsen pain
Tension in shoulders, neck, face, or hands
Sighing (a reaction to tension in intercostal muscles)
At higher levels, we may feel also anxiety in involuntary muscle groups. These are called 'smooth muscles', found in the airways, bowel, and blood vessels. Presentations include:
Stomach and GI issues
Blood pressure changes
Unexplained abdominal pain
Mental fog, mind going blank, tunnel vision, concentration issues
[Note: This does not mean that IBS, migraines, and high blood pressure are always caused by stress and anxiety. You would have much better luck reviewing your diet, drinking a glass of water, and checking with a doctor. However, you can also ask any doctor how many people they see with medically unexplained chronic pain or gut issues, and you might be surprised at what they say. Often, these doctors are sympathetic to the idea that their patient is actually suffering from anxiety and stress. But telling someone suffering from very real, chronic pain that they may benefit more from psychotherapy than a medical intervention is a difficult conversation.]
Where Does Anxiety Come From?
Importantly, we don't only feel these symptoms of anxiety in response to external stimuli. Our interpretations of events can make us anxious. This is what Cognitive Behavioral Therapy (CBT) is built around, and it can help significantly to take a good look at how you talk to yourself. Interestingly, our own internal feelings can make us anxious. This logic sounds strange: isn't anxiety also a feeling? I'd like to focus here for the rest of the post. Language is often imprecise in psychology, but consider:
You're replaying the argument from earlier today with someone who was speaking cruelly. A wave of heat and anger wells up, but you learned early in life that being angry is bad and even dangerous. So, instead: anxiety. Being openly angry with another person makes you nervous, so it automatically gets covered up before you're aware of what's happening. Instead of just feeling very natural anger that wants to rise up in you, you sigh and feel tight, or shut down. Maybe this anger even gets turned onto yourself, where it feels safer and more familiar. "Why didn't I just stand up for myself...?!"
You remember the last time you saw a loved one's face, and you feel a pressure. Tears want to come. The grief feels huge and scary, bottomless, like you will lose yourself inside of it. It's threatening. Within a second, instead of crying and allowing sadness to wash over you, you pace and feel nauseous. This pushes aside the grief for a bit longer.
You say "I love you" to your partner but you're not sure that you really mean it or feel it. You feel a little twinge when you say it because it seems fake. Sex is similar: you think you 'should' want it, but when trying to be intimate and close you instead feel a little anxious or awkward. This anxiety might tighten you up and create sexual dysfunction and/or barriers to real emotional closeness in your relationships. Maybe you were taught that sex is bad or dangerous. Maybe your parents were uncomfortable saying "I love you" or hugging, unable to openly show you affection. This is huge to a child and gets encoded deeply.
This is a pattern found frequently with "normal" anxiety. Look carefully:
A feeling builds. You may be able to intellectualize about it but it's not freely felt, though it pushes up for expression. Sadness, anger, guilt, even positive feelings of closeness with another person. It gets blocked somehow, and you aren't quite feel it through (by crying/asserting yourself/expressing heartfelt remorse/or showing love). In childhood, where emotions run freely and we are implicitly taught how to manage them through repeated experiences with attachment figures, certain feelings can get tagged as unacceptable.
The feeling is threatening for some reason, so the smoke alarm kicks on and immediately it is replaced or muddled by anxiety, which may also be out of your awareness.
Now that you are feeling anxious you have some habitual and automatic (i.e. unconscious) ways of responding to lessen it, similar to how we automatically self-soothe when in pain. Examples include: Nervous laughter when nothing is funny; people pleasing; obsessively ruminating; frantic activity to distract; self-attack; drinking, etc. These are Defenses against anxiety, also known as 'defense mechanisms' or 'defenses' for short.
So: [unconscious feeling > unconscious anxiety > unconscious defense].
We all do this. We have unconscious feelings constantly in our bodies (See: acclaimed neuroscientist and Head of the Department of Neurology at the University of Iowa College of Medicine, Dr. Antonio Damasio), some of which make us anxious due to implicit learning. Defenses can be helpful and healthy by affording us some control with overwhelming experiences. They are usually adaptive when first established in childhood. Carried into adulthood, defenses can leave you unfulfilled or even destroy your life.
How Does Therapy Help Anxiety? What Is The Best Kind of Therapy for Anxiety?
If we find that your anxiety follows this kind of pattern, there are established ways of addressing it. Sometimes it's helpful to strengthen your defenses against anxiety (e.g. coping skills). Often, the most beneficial move is to help you identify and bypass certain defenses which prolong your symptoms and keep you from feeling what it is that you need to feel in order to move forward. This could happen quickly, or we may need to take a much slower and more gentle approach. Other times, we'll just build your awareness of this whole structure and work on allowing yourself to fully accept that this is you, and that is perfectly normal. Paradoxically, acceptance can be a path toward radical change.
Learn more about getting help with anxiety therapy in San Antonio, Texas.