The ultimate anxiety guide: The 6 biggest questions about worrying, answered by a psychologist

Here are the simple, science-backed ways of reframing your inner-demons.

By Christian Jarrett

Published: Friday, 07 July 2023 at 12:00 am

Anxiety is a complex and common mental health condition impacting millions worldwide. It affects people in different ways, with some individuals finding anxiety overwhelming and interfering in their everyday lives.

How can you spot when it becomes a problem? And what causes anxiety in the first place? Here’s all you need to know.

What is anxiety?

Essentially, anxiety is an emotional state of nervous apprehension that often involves negative and worrisome thoughts and physical jitters. Although anxiety is often focused on a specific upcoming event or challenge, it can sometimes be more diffuse – experienced as a general unease about the future.

To analyse it more deeply, anxiety can be broken down into thoughts, feelings and behaviours. For instance, you think you might make a fool of yourself in a meeting; that makes you feel nauseous; and this affects your behaviour, so you decide to miss the meeting.

In the short term, dodging the meeting makes your thoughts and feelings subside but this strategy is likely to feed your anxiety in the long term. This is a key feature of anxiety: it can provoke avoidance, which perpetuates the anxiety.

What causes anxiety?

A bout of anxiety will often start with negative thoughts about an upcoming situation. For instance, worry that an exam will be too difficult and end in failure; or that something will go wrong on a flight. These expectations can lead the brain to trigger a fear response, which releases hormones, especially adrenaline, that activate your sympathetic nervous system. This primes your body to survive a threat – to fight, flee or freeze.

If you’re confronted with a truly dangerous situation, it could save your life. But you can think of unhealthy anxiety as a false alarm, one that primes your body in a way that’s out of proportion to the situation.

A pounding heart and adrenaline-pumped muscles aren’t too useful during an exam or on a flight. Other causes of anxiety include past traumatic experiences that leave you in a permanently fearful state; certain drugs that trigger fearful thoughts or your fight-or-flight response; and medical conditions, such as hyperthyroidism, which can play havoc with fear-related hormones.

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What does it feel like?

Depending on the intensity of your anxiety, it usually feels unpleasant and uncomfortable, in large part due to the physical symptoms. These can include a racing heart, sweaty palms, dizziness, shakiness, stomach churn, nausea and more.

Some people with chronic anxiety problems find the physical sensations associated with anxiety especially troubling and, of course, this can then feed their anxiety (imagine someone who is anxious about public speaking who gets freaked out by their shaky hands and tummy butterflies).

On the mental side, anxiety can also trigger a flood of fear-related thoughts and out-of-control worries. Combine the physical symptoms with the runaway thoughts and a common end result is a strong urge to get out of – or avoid – the anxiety-inducing situation as quickly as possible. This is what makes avoidance as a strategy so tempting, even though it’s counterproductive in the long run.

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People suffering from anxiety may have a tendency to catastrophise. Photo: Joe Waldron

When does anxiety become a problem?

It’s completely normal to experience anxiety from time to time. In fact, in moderation in appropriate situations, anxiety can be helpful (as the boxing coach Cus D’Amato put it, anxiety is like fire: it can kill you but, under control, it’s an invaluable resource for warmth and cooking).

For instance, if moderate anxiety about a job interview compels you to do some preparation, that’s better than just showing up and winging it. And if your mild anxiety gave you a shot of adrenaline during the interview, it might help you to think fast.

Anxiety becomes problematic when it gets out of control (you’re so anxious during an exam that you can’t concentrate, for example) and/or it becomes chronic and overwhelming.

A specific red flag is when anxiety starts to lead to a cycle of avoidance. For example, you might be so tied up in knots about flying that you never travel abroad. If your anxiety is so intense that you begin avoiding situations, not only is there a risk of your life becoming narrower, which might make you unhappy, but it also means you never get a chance to discover that you can cope better than you think with the situations you’re worried about.

Avoidance can also take the form of using unhelpful coping strategies to mask your anxious feelings – such as getting drunk to calm your nerves. The same unhelpful process applies to this masking form of avoidance. While it might bring short-term relief, it risks fuelling your anxiety. In contrast, confronting your anxieties can be challenging in the short term, but is often the best route to easing them.

Is anxiety a psychiatric disorder?

If a person experiences significant anxiety on more days than not over a period of more than six months, about a range of different things, then they could be diagnosed with ‘generalised anxiety disorder’.

There are also types of anxiety disorder with a more specific focus. For instance, if a person has a lot of anxiety that’s specifically tied to social situations, they might be diagnosed with ‘social anxiety disorder’; and if a person is frequently anxious that they will have a panic attack, this is diagnosed as ‘panic disorder’.

The various phobias, such as agoraphobia (a fear of places where escape is difficult), are also considered forms of anxiety disorder. Other psychiatric conditions, such as post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD), used to be considered forms of anxiety disorder, but psychiatrists now treat them as their own categories even though they do involve anxiety.

In PTSD, the traumatised person is often left in a super-vigilant state, as if perpetually on the cusp of a fight or flight response. In the case of OCD, a person gets stuck performing checks or compulsive behaviours as an ultimately counterproductive way to reduce their feelings of anxiety.

Are some people more prone to anxiety than others?

The genes we inherit and our experiences in life combine to shape our personality traits, and, in turn, these traits can affect our vulnerability to anxiety. Most of all, people who score highly on the personality trait of neuroticism tend to experience frequent ups and downs in mood, negative emotions such as shame and guilt, and they worry a lot – they’re especially prone to severe anxiety.

But there are other traits that are also relevant. For instance, people who are more trusting (a facet of the broader trait known as ‘agreeableness’, which is associated with less stress and fewer relationship problems) are often less prone to anxiety. There’s also some evidence to suggest that extroverted people tend to be less anxiety-prone, especially in a social context.

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