Is Anxiety a Mental Illness?

All of us experience anxiety at times, although it can be unpleasant and we may wish we never experienced it at all, anxiety is our brain and bodies' way of letting us know that something needs our attention. 

Anxiety is like an inner alarm that alerts us to real danger and motivates us to take the steps needed to avoid harm. 

For example, if we did not experience anxiety when confronted by a bear when hiking somewhere in North America or crossing the road when a speeding car is approaching, we may not respond in a way that would protect us. 

Anxiety motivates us to perform at our best. It will prompt a university student to study diligently for an upcoming exam or perhaps being a best man at a friend’s wedding will ensure we practice our speech so it's endearing and funny. 

But how do you know that anxiety has become a problem for us if it designed to help us take precautions? If you're experiencing anxiety that is inappropriate more often than is reasonable, alongside a decline in quality of life, your anxiety has probably become problematic. Untreated, unmanageable anxiety can become debilitating and stop us from living a full and productive life. A person living in this condition may be diagnosed with what is known as an anxiety disorder.                                                  

So, what is an Anxiety Disorder?

An example of inappropriate anxiety that has become pervasive would be Generalised Anxiety Disorder or GAD. 

I was diagnosed with this disorder myself some years ago, and so can write this article from lived experience complemented with working as a Registered Nurse in Mental Health services for some time. What is encouraging is that with personal belief and application unmanaged anxiety can be overcome. 

GAD is characterised by chronic and exaggerated worry and tension that is mostly non-specific. By non-specific, I mean an experience of anxiety and worry about a variety of things a lot of the time without being able to identify the exact cause. Just the thought of getting through the day can provoke anxiety. A person with GAD may have difficulty relaxing and will feel tension most of the time. Finances, work, relationships, health, past and future can all seem to be a cause of concern for the individual. Although the person with GAD will acknowledge their anxiety and worry is unreasonable, they will continue to feel this way. 

Another example of an Anxiety Disorder is Social Phobia or Social Anxiety Disorder in which a person will feel anxious in social situations or when having to perform in front of others. Unfortunately, people with this type of anxiety will tend to avoid social events or perhaps avoid taking jobs or positions where they will be the centre of attention. Post-Traumatic Stress Disorder, Panic Disorder, OCD are other types that we all have heard of and there are others, but the common theme among all the Anxiety Disorders is that the experience of anxiety is inappropriate to what appears to be the cause and occurs regularly.

Why do I feel this way?

Anxiety is an emotion, the best way to think of an emotion is that it is a sensation we experience in our body. We hear the terms feelings and emotions used interchangeably but feelings are the way we think about an emotion or a way we assign meaning to that emotion after we experience it.  

It works the other way around too, just the thought of thinking about something threatening such as the prospect of a World War can trigger an emotional fear response. The emotion or sensation of anxiety we experience when faced with some perceived threat is sometimes referred to as the “adrenaline response”. A racing heartbeat, sweating, feeling jittery, nervousness, shortness of breath and so forth, we have all experienced these sensations when under pressure or “stressed”.  

The part of the brain that initiates the sensation we associate with anxiety is called the amygdala. The amygdala is a small almond-shaped structure in the limbic area of the brain that works as the brains alarm system, when it receives input from our senses of a potential threat it works at great speed to initiate a chemical response via the sympathetic nervous system to prepare us for the perceived danger. Adrenaline is released which rapidly increases heart rate and rushes blood into our muscles. Our breathing increases and the airways expand to allow more oxygen into our lungs which sends it to our brains for increased alertness; blood sugar levels also increase from being supplied by the liver to allow for more glucose to be available to the brain and body. Norepinephrine causes blood vessels to narrow which results in higher blood pressure. This physical response is our brain and bodies attempt at preparing us to be in battle ready condition or what is commonly known as “fight or flight. This is a survival mechanism that assists us in taking the necessary steps to protect ourselves from real danger. In the Western-World predominantly we are fortunate not to be in imminent danger most of the time, but we will sometimes respond to common daily stress as if we were, leaving us in a state of continual tension which is unhealthy. One of the other difficulties that can arise is that the amygdala can be become unregulated such as in the case of an anxiety disorder and will sound its alarm bell without having any sensory input to tell it to do so. 

The good news is that anxiety can be managed via managing our thoughts, learning that anxiety itself is not dangerous and gradually exposing ourselves to those things we have avoided in the past that are not actually harmful to us. 

Why do I think this way?

We have discussed emotions and feelings, or what our body experiences and the way we think about that experience. We also know that fearful thinking can lead to the experience of anxiety in our body. Remember, evaluation of or how we think about something is subjective, meaning it is an interpretation. If that is true than it is also true that our interpretation can be wrong with regards to what is happening or what may happen. 

Unfortunately, we can inappropriately evaluate some of our current experiences and future possibilities as dangerous partly because of false assumptions. These false assumptions may be influenced by past experiences leading to the evaluation that all similar situations should be avoided.  Our false assumptions remain simply because we don’t take the time to investigate the reality of what we fear, especially when those thoughts are coupled with anxious emotions. The behaviour that greatly reinforces our belief that a certain situation is to be feared is to avoid that situation. When we forget to challenge our thoughts and emotions while avoiding all that we are worried about, then we will remain tense. Constant stress can lead to depression. In fact, anxiety and depression are commonly experienced together along a continuum because rumination or “overthinking” is a form of thought common to both. Over time, anxiety with associated worry can become ingrained as an automatic type of behaviour. It is in this case that an anxiety disorder develops.                                            

Let's change the way we respond to anxiety

We have discussed what anxiety is and why we experience it, we know that regulated anxiety is not harmful and is designed to alert us of potential danger. We've identified that inappropriate anxiety that happens frequently is a problem. The way our body experiences anxiety is because of chemical exchanges within our brain and body, and I have expanded on this idea in a relatively straightforward way to help gain a little more insight. 

After a discussion about physiology, it's important to recognise that how we think is closely connected to our emotional experience. Once you understand what anxiety is and all its contributing factors you can do something about it. 

What is encouraging is that when we become more self-aware and mindful - we better understand our emotional experience while placing it into the right context, we become more confident about separating our self from the anxiety while taking a reality-based stance.

Your child wandering onto the road when they have left your side is appropriate anxiety - of course you will run and gather that child back to yourself. What is important is to reconsider the things we consistently dread (public speaking, meeting new people) or consider threatening (flying, walking the streets alone) when past-experience has proven that this should not be the case. Past- experience also confirms that future challenges can more than likely be overcome.

Another part of the brain called the prefrontal cortex can be thought of as the brain’s CEO, it is our ally in overcoming anxiety. The prefrontal cortex is located at front of the brain, a section called the frontal lobe. It is the part of the brain responsible for executive functioning and It is involved in planning, problem-solving, impulse control, redirecting attention and calming intense emotions. The prefrontal cortex also helps us adapt to new and uncertain situations. It can gather information from the amygdala and the hippocampus, which store conscious memories in an organised way. From gathering information from past-experience and the ability to problem solve alongside its other attributes mentioned, the prefrontal cortex can calm down the amygdala’s response to stress by providing it with more constructive and reality-based information than previously available. 

That is why facing our fears is so important: when we realise that we can indeed complete a task that we thought was overwhelming, over time our brain begins to acknowledge that there is no danger. This, of course, is an active process that we are involved in - being self-aware and alert to our emotional experience while being able to recognise the reality of what is happening rather than attributing an idea that is not accurate is paramount. When we separate appropriate anxiety (a normal part of life) from inappropriate anxiety, we begin to teach ourselves to regulate our emotions better. With practice, our brain and mind becomes more resilient and flexible while our experience of anxiety will become less intense or bothersome. What is encouraging is that over time there is a correlation between changing our thinking and long-term changes in brain structure.

Measurable changes in brain structure that support more rational thinking and deliver better anxiety management is not just a hypothesis - it is backed by many encouraging studies performed over the last decade using MRI. The good news is that the way we are is not hardwired from birth and we can improve the way our brain functions because it is in fact malleable. 

The most encouraging changes in brain structure include the reduction in size of the amygdala accompanied by an increase in thickness of the prefrontal cortex. These studies have mainly been focused on those who practice mindfulness - a practice that is all about being focused or present in the moment with non-judgemental awareness, cultivated by paying attention. The idea is to fully participate on the task at hand while noticing when our thoughts start to wander and then refocusing back to the present moment. This helps us to simply notice various thoughts and emotions without getting caught up in them. 

 Another important skill learnt from mindfulness is the ability to observe and describe, which is simply going back to the idea of evaluating things in an accurate and rational manner. The idea that “I feel like something is wrong, therefore something must be wrong” is a common cognitive distortion; we must first investigate to ascertain if something is indeed wrong.

What help is available

For many of us, a combination of medication with talking and behavioural type therapies are helpful. 

Others have found therapy alone to be successful and have enlisted the help of a psychologist, psychiatrist, therapist and other professionals who have proven knowledge to help sufferers of anxiety. Common therapies include CBT, DBT and exposure therapy. 

Mindfulness has proven to be very beneficial for those suffering from anxiety and has been embraced by Mental Health practitioners around the world. Talk to your GP if you believe anxiety has become a problem for you, remembering that anxiety disorders affect 15 per cent of the New Zealand population. 

Other practices that have helped many people include yoga, meditation, spiritual belief and remembering to simply take time to relax and take a few weeks out from your normal environment to recharge and learn skills that will help you manage anxiety for the rest of your life (I recommend the Capri Sanctuary programme!). Remember to get adequate sleep as sleep deprivation can be detrimental towards managing both anxiety and depression. Eating a balanced regular diet alongside regular exercise is also central to management of anxiety.

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