When we are traumatized at an early age (and most of us are in one form or another), one of the most obvious and prevalent defensive structures we use to survive is disconnection from our bodies. This is the mind walling itself off from the experience of trauma to prevent being overwhelmed. When the mind is overwhelmed, it stops functioning.If you are reading and understanding this, whatever you have suffered, it means your defensive and family or social support structures were sufficient to allow you to become emotionally formed. This disconnection from our bodies becomes important when we start to wonder about anxiety, because the first place we notice anxiety is in our bodies.
Symptoms of Anxiety
The American Heritage Medical Dictionary defines anxiety as “a state of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation, often to a degree that normal physical and psychological functioning is disrupted.”
Symptoms may include but are not limited to:
- muscle tension
- heart palpitations
- syncope (fainting)
- tingling in the hands
- shortness of breath
The body and mind store trauma as a defense mechanism. When something is damaging, the brain takes automatic steps to remember and avoid the damage in the future, in essence wiring the trauma into the brain. This is the essence of PTSD; a soldier experiences the trauma of combat, and now when he (or she) hears a car backfire, he breaks out in a cold sweat and his breath comes short.
The body is trying to protect itself, but the soldier is cursed to relive the trauma of combat over and over until he gets treatment. Another example might be someone who, as a child, was angrily silenced anytime they tried to share something personal and so they feel tightness in their throat when someone treats them with disregard. The person feels they have no voice and it manifests as tension in the throat muscles. This is only one example of hundreds, because each person stores trauma differently.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes a number of different anxiety disorders, including but not limited to:
- phobias (fears associated with specific animal, environmental or situational conditions)
- social anxiety (fears involving social situations)
- panic (incapacitating anxiety)
- substance related (anxiety caused by using substances)
- general anxiety (anything not caused by something else)
If you are using substances (drugs, alcohol, etc.) and experiencing anxiety, you will have to stop using to determine if the substance escalates the anxiety. Most of the anxiety disorders in the DSM have a phrase, “if not better explained by” use of substances. Getting a clear diagnosis will require you to stop using long enough to make a good assessment.
Identifying Symptoms of Anxiety
Usually, when anxiety finally becomes a problem, it is only after years or decades of trying to ignore, avoid, or otherwise stuff it so we don’t have to deal with it. We do this by disconnecting from our body, distracting ourselves, browbeating or in some other way trying to hammer ourselves into a more useful (non-anxious) state.The first task when you are trying to begin to truly manage your anxiety and identify the triggers that set it off is to learn to pause yourself and be curious. Say it with me: pause and be curious.
Imagine you have an argument with a coworker. In response to your idea, he says, “Well, that would just be stupid.” Now, imagine between the ages of 5 and 12 your dad called you stupid countless times. Your defenses have driven the memory of the abuse from your conscious mind, but when the coworker uses the word “stupid,” you feel frightened, angry, and find it hard to stay in the conversation without screaming.
This is where you pause and be curious, “Wow, he called me stupid, and… no, wait. He didn’t call ME stupid, he called my idea stupid, and instead of being irritated with a normal amount of defensiveness, my anxiety is way up and I want to (run, cry, rip his head off). I wonder what that’s about.” That last part is the most important: “I wonder what that’s about.”
Your anxiety or anger is good data, which can tell you a lot about what is happening inside you. Pause and be curious about it. Where are you feeling it? When you heard the word “stupid,” was your stomach in a knot? Was your chest tight? Were the muscles in your throat constricted? The awareness of these responses is the beginning of unraveling the mystery of our trauma-based defenses. As is usually the case, this emotional work is best handled with a therapist.
Managing Symptoms of Anxiety
Once you realize you have anxiety, the question becomes one of first managing symptoms, and second understanding the psychodynamic triggers that are causing anxiety to escalate and make life unmanageable. If the anxiety we are experiencing is pretty high and has been more or less steady for 6 months, we may need to seek a pharmacological solution with our doctor or psychiatrist.
Long-term anxiety means we have conditioned (or wired) our brains to prefer this mode of operation, hence the need often for medicine to begin to work against it. Anxiety frequently occurs alongside depression. In essence, being depressed can contribute to our anxiety, and being anxious can contribute to our depression.
Below is a list of some of the medications your doctor or psychiatrist might prescribe for you if you are anxious, depressed, or both. This is not a complete list:
- alprazolam (Xanax) for panic, generalized anxiety, phobias, social anxiety, OCD
- clonazepam (Klonopin) for panic, generalized anxiety, phobias, social anxiety
- diazepam (Valium) for generalized anxiety, panic, phobias
- lorazepam (Ativan) for generalized anxiety, panic, phobias
- oxazepam (Serax) for generalized anxiety, phobias
- chlordiazepoxide (Librium) for generalized anxiety, phobias
- propranolol (Inderal) for social anxiety
- atenolol (Tenormin) for social anxiety
- imipramine (Tofranil) for panic, depression, generalized anxiety, PTSD
- desipramine (Norpramin, Pertofrane and others) for panic, generalized anxiety, depression, PTSD
- nortriptyline (Aventyl or Pamelor) for panic, generalized anxiety, depression, PTSD
- amitriptyline (Elavil) for panic, generalized anxiety, depression, PTSD
- doxepin (Sinequan or Adapin) for panic, depression
- clomipramine (Anafranil) for panic, OCD, depression
- trazodone (Desyrel) for depression, generalized anxiety
Monoamine Oxidase Inibitors (MAOIs)
- phenelzine (Nardil) for panic, OCD, social anxiety, depression, generalized anxiety, PTSD
- tranylcypromine (Parnate) for panic, OCD, depression, generalized anxiety, PTSD
Selective Serotonin Reuptake Inhibitors (SSRIs)
- fluoxetine (Prozac) for OCD, depression, panic, social anxiety, PTSD, generalized anxiety
- fluvoxamine (Luvox) for OCD, depression, panic, social anxiety, PTSD, generalized anxiety
- sertraline (Zoloft) for OCD, depression, panic, social anxiety, PTSD, generalized anxiety
- paroxetine (Paxil) for OCD, depression, panic, social anxiety, PTSD, generalized anxiety
- escitalopram oxalate (Lexapro) for OCD, panic,depression, generalized anxiety, social anxiety, PTSD, generalized anxiety
- citalopram (Celexa) for depression, OCD, panic, PTSD, generalized anxiety
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIS)
- venlafaxine (Effexor) for panic, OCD, depression, social anxiety, generalized anxiety
- venlafaxine XR (Effexor XR) for panic, OCD, depression, social anxiety, generalized anxiety
- duloxetine (Cymbalta) for generalized anxiety, social anxiety, panic, OCD
- buspirone (BuSpar) for generalized anxiety, OCD, panic
- Valproate (Depakote) for panic
- Pregabalin (Lyrica) for generalized anxiety disorder
- Gabapentin (Neurontin) for generalized anxiety, social anxiety
I should note here that doctors are moving away from prescribing opiates and benzodiazepines because there has a been an alarming increase in the number of deaths related to abuse of these substances.
If the anxiety is lower level or not as long term, it may more easily respond to non-pharmacological methods, like deep breathing and mindfulness, or exercise. In actual practice, engaging your parasympathetic nervous system should reduce anxiety (or anger).
We do this with diaphragmatic deep breathing; breathing in through the nose and out through the mouth with our diaphragm (pushing the stomach out on our in breath). Imagine for a moment that you walked into a room in your basement and saw an animal coiled to spring. In an instant, your sympathetic nervous system kicks into action, cortisol floods your body, along with adrenalin and other chemicals, all geared to giving you the necessary reflex and energy to run away (flight) or defend yourself (fight).
Now, suppose in the next moment you realize the coiled animal is that old stuffed badger your weird uncle Morty keeps forgetting to pick up. What’s the first thing you do? Crisis averted, you take deep breath and blow it out through your mouth. This literally signals your parasympathetic nervous system that it’s okay to stand down. No flight or fight necessary. This is why deep breathing works, if we work at it long enough and persistently enough.
Entrenched anxiety will not usually respond quickly to deep breathing. If we are sitting there fidgeting, trying to slow our breathing, and thinking with ever greater anxiety, “It isn’t working!”, it’s time to try something else. You have to let yourself off the hook for “doing it right.” If deep breathing helps you calm down, then do it. If it only contributes to your anxiety, let it go for now.
Another useful tool for managing anxiety, and a good one to do along with your breathing, is mindfulness, which is essentially locating yourself in your body in the present. Notice where you are feeling tight or tense and see if you can relax it. Remind yourself you are HERE, NOW. The past is the past, it’s not happening now. The future is unwritten, it’s not happening now. All we have is now. For right now, in this moment, we don’t have anywhere else to be, we don’t have anything else to do, we don’t have anyone we’re responsible for.Our worries, responsibilities, even our anxieties will all be waiting for us when we are finished with our relaxation. We don’t have to take them up now. Sometimes it can be helpful to pick up a smooth stone to hold in your hand. Notice the cool smoothness of it. Wonder what it’s made of, or what it looks like inside. Your brain can only think of one thing at a time. If you can focus on something like a stone or a centering word (like “rest” or “Jesus”), your anxious thoughts will have to take a back seat.
One other helpful tool I want to mention is positive affirmations, which can function as nice additions to the previous two methods. These are just simple phrases we repeat to ourselves as we breathe. For example, say you have a breathing pattern of 4 seconds on your in breath, hold for 2, and then 6 seconds on your out breath.
Now, choose a saying or Scripture that has meaning for you. A simple saying is “Lord Jesus Christ, have mercy on me.” So, on your in breath, you think, “Lord Jesus Christ…” and on your out breath, “… have mercy on me.” The desert fathers used to pray this prayer a thousand times a day. Don’t beat yourself up if you can’t make that particular goal, but it will change you if you are persistent.
If you prefer Scripture, then pick one you like and split it up. So, for example, “The Lord is good…” on your in breath, “… and His steadfast love endures forever” on your out breath. If you struggle with self-worth, this can also be addressed in your positive affirmations. We are, after all, the image of God in the world. An affirmation might look like this: “I am an amazing, unique expression…” on your in breath, and “… of the image of God upon the Earth” on your out breath.
If our emotional structure is wired to make us feel one down, or worthless, or like we have no value, this may sound like nonsense at first. But if we can actually grasp, even a little, how astonishingly precious and valuable we are, it will begin to change us.
Anxiety can be a nasty companion, cutting desire off at the knees, crippling our will to work, to enjoy, to love. We get to ask for help, and be creative, and try new things, and get medication, if we think that might help. Be curious and kind with yourself and believe that change can happen, and you can gradually move forward toward emotional growth and health.
“Alejandra thinking,” courtesy of Luis Alejandro Bernal Romeo, Flickr CreativeCommons (CC BY-SA 2.0); “Bench,” courtesy of Elvert Barnes, FCC (CC BY 2.0); “Sad,” courtesy of Mihai Surdu, unsplash.com, CC0 License; “Down,” courtesy of Max Sandelin, unsplash.com, CC0 License