Anxiety is the most commonly reported ailment that our Registered Clinical Counsellors see at Nightingale Counselling. It has a major impact on the health and well being of our clients. Although the prevalence rate for diagnosed anxiety disorders is roughly 1-2% of people, nearly all of us will feel and occasionally suffer from and with anxiety. The truth is that anxiety is a normal part of ordinary life—as normal as happiness, sadness, or excitement—but it can become highly distressing. For most people, anxiety takes on a variety of forms including physical, emotional, and cognitive symptoms, all of which can be uncomfortable and distracting to say the least. To make it worse, most people find it very difficult to understand why they feel these symptoms, how to manage their onset, and how to prevent them from returning. For people with severe and debilitating anxiety, these symptoms can escalate into panic, insomnia, and digestion problems. All too often these additional symptoms cause their own amplification of anxiety.
What are the symptoms of anxiety?
The symptoms of anxiety are often felt in three different “domains:” the physical, the emotional, and the cognitive. Importantly, people can experience anxiety differently. Everyone has his/her own “anxiety profile;” that is, symptoms in the three domains listed above will be more noticeable or distressing and some others may not exist. The following lists include common symptoms in these different domains. It’s important to note that severity matters: the experience of anxiety can range from mild stress to a major disorder, from minimal sensations to full on panic.
Physical Symptoms of Anxiety
The word anxiety comes from a Latin word meaning “to choke,” and these physical or “somatic” symptoms have always been associated with the experience of anxiety.
Hot, sweaty or flushed
Wide eyes, pupils dilated
Hands are cold or hot, shaky or trembling
The feeling of pins and needles in the hands or feet
A feeling of constriction or choking in the throat
A heaviness or pressure in the chest
Bowel/belly discomfort of a wide variety
Emotional Symptoms of Anxiety
Feeling very vigilant or watchful
A sense of impending doom
Cognitive Symptoms of Anxiety
Circular and perseverant thinking
Catastrophizing, imagining grim scenarios
Most of us have and will feel various symptoms of anxiety as part of everyday living. However, for those who can be said to suffer from anxiety, there will often be distressing levels of symptomatology that occur with regularity and often include a lack of distinct cause and completion.
So… what IS anxiety?
First, what let’s say what anxiety in and of itself is not: a disorder, a pathology, or a disease. Anxiety is a normal part of human functioning, which can become distressing when it goes into overdrive. Consider allergies: when a bee stings a person with an allergy, it’s not the sting that is so deadly, but an overproduction of natural “histamines” in the body of the person who was stung—hence the use of antihistamine medicines. Anxiety, just like histamines, is there to help us.
Anxiety is our natural defense mechanism when we are under threat. It is a state of mind and body that we shift into when the alarm bells ring and tell us that something is wrong. When we shift from a state of calmness to anxiousness, we are putting ourselves in a position to be maximally alert and responsive.
So, all of those physical symptoms can be understood as our body positioning itself to see, hear, think, and act QUICKLY AND WITH PURPOSE. Our pupils dilate and eyes widen to take in as much of the visual field as possible. We say we “lose focus” with reference to whatever task we are trying to do, but actually what’s happening is that we are broadening our focus to whatever might be causing our alarm bells to be going off. We get hot and agitated as adrenaline fills our system, preparing us for action. Our stomach feels uncomfortable, because we have stopped the digestive process to save energy for dealing with the threat. Our mind searches for possible problems and solutions. And our emotions respond with a sense of vulnerability, exposure, and fearfulness. Taken together, anxiety PRIMES US FOR ACTION.
Anxiety is a natural and evolutionarily important product of our nervous systems. When these symptoms happen for a very obvious reason—we are in the middle of a sporting event or riding a roller coaster—we aren’t worried. But when it is chronic, without beginning and end and disruptive to our daily living, it can feel as if we don’t understand ourselves, that we are being hijacked by this feeling and are powerless to stop it. At this point, counselling can become a useful option.
Help with Anxiety
Getting help with anxiety is immensely productive for most people, and Registered Clinical Counselling is a primary pathway for creating change. For people with very severe anxiety, medication may help. If problems in daily living such as work, relationships, and family are severe, then even a medication that has side effects may still reduce the overall impact. As well, if strategies for coping with anxiety, such as drug and alcohol use, promiscuity, etc., become dangerous in their own right, then the side effects of medication becomes increasingly justifiable as we consider an overall harm reduction approach. And for many people, medication is an easy and effective aid in helping manage anxiety.
But medicine is not the only tool, and for most people only addresses the symptoms rather than the causes of anxiety. Counselling can help with anxiety by addressing BOTH the symptoms and the root causes.
Symptom management is an important part of what Clinical Counsellors begin with. Before getting into deeper questions about where these challenging experiences arise from, professional therapists recognize the importance of “stabilization.” Moving too quickly to the treatment of root causes can be ineffective if the day-to-day challenges of anxious feelings are not brought under control in early sessions, particularly if panic is involved. Often, learning so-called “tools” is a crucial step in the therapy.
Often, these tools for managing anxiety include some of the following:
Self care strategies
Thought/feeling noticing activities
Differing approaches to the inner voice that can accompany anxiousness
For most therapists, including us at Nightingale Counselling, managing the surface symptoms of anxiety is only the first step. The deeper goal with therapy is to explore the root causes. For some people, there are general situations in which their anxiety is more predictable.
Anxiety disorders, or triggers, or types can include:
Test or performance anxiety
Specific phobias or fears
Trauma/PTSD-type triggers of association
But for just as many people, the source of anxious thinking feels impossible to pin down. This is where some of the deeper work of therapy can become invaluable. One of the reasons that anxiety is so difficult to understand on one’s own is emphasized by the following idea: “Although mathematical thinking is used to solve math problems, anxious-thinking can’t solve anxiety problems.” Indeed, the more we think about our anxiety, the more we try to “figure it out,” we most often find that we merely “feed” the anxiety rather than actually create clarity and understanding.
No Shortcuts to Treatment
As with most mental health issues, there are no short and quick internet articles that can isolate the root cause of anxiety for you. What’s needed is careful conversation, FOLLOWING the physical, emotional, and cognitive experiences while NOT allowing the conversation to derail into typical thought patterns. This requires a second person, and a Registered Clinical Counsellor is adept at navigating these conversations, gathering information from the thoughts and symptoms without succumbing to their conclusions. In addition, we learn about what seems to trigger or cause anxious feelings, what helps to alleviate them and what seems to amplify them. Through this process we learn more and more about the natural, healthy, and productive ways you ALREADY COPE with anxiety, and use that information to ADD to that capacity. By making these processes more conscious and intentional, you can execute them on command rather than waiting for them to naturally appear. High quality counselling services should provide both depth therapy and here-and-now strategies, which work hand in hand.
But what about the different types of anxiety?
When we apply a typical mental health approach to anxious experiences, the readings will show that there are certain specific typologies of anxiety, which we then presume require very different treatments.
Some of the specific “disorders” which are outlines in the DSM-5 include:
separation anxiety disorder
social anxiety disorder
generalized anxiety disorder
substance/medication-induced anxiety disorder
But why didn’t this article start with mental health categories?
For some people, especially those requiring psychiatric or psychopharmacological care for very severe anxiety, these categories can be very useful. However, for most people who are researching their anxiousness and consider counselling services, these categories can be misleading. They emphasize small differences rather than help explain anxiety as a whole. For the vast majority of people who experience ordinary (if distressing) anxiety, there is no need to seek out a very specific medical diagnosis. A majority of Nightingale Counsellors’ caseloads include clients who are experiencing some form or degree of anxiety, worry, fearfulness, and/or vigilance. Counselling therapy is an effective treatment for anyone experiencing stress, distressing thoughts, relationship or social issues, and any of the symptoms of anxiety related to emotions, thoughts, or the body.