Anxiety is a mental disorder with overwhelming and unpleasant bodily sensations. Anxiety is experienced in various ways, but you will typically experience several of the following symptoms: heart palpitations, difficulty breathing, diffuse inner turmoil, chest pain, upset stomach, tingling in the arms and legs, sweating, chills, tremors, tension, and perhaps fear of death. They are bodily reactions that are controlled by the autonomic nervous system beyond your will and you may feel you have lost control. It is common to interpret the bodily sensations as signs of a physical illness, and many do not realize it is anxiety.
The loss of control over bodily reactions means that with an anxiety disorder you may develop a great need to have control over your life, to compensate for the uncontrollable anxiety. It can therefore be extra difficult to handle uncertain situations, such as the current COVID-19 pandemic, relocations, a new education, or other transitions.
Avoidance behavior
Avoidance behavior is a common reaction to all anxiety disorders. You avoid the places or situations that you have experienced can provoke your anxiety. Though such reactions are understandable, avoidance behavior allows anxiety to control and restrict your life. If you avoid the places or situations you are afraid of, you will never have the opposite experience – that it is not dangerous or (life-) threatening to take the bus, stand in line, be in a social context, eat something specific, etc. Anxiety can spread in your life like little rings in water; more and more situations are perceived as dangerous.
Much treatment of anxiety is therefore about ‘exposure’, ie. that in small doses and in a safe environment you expose yourself to what you are afraid of and slowly get an experience that nothing bad is happening to you. The treatment will also typically work with your negative expectations, catastrophic thoughts, and self-criticism. This cognitive-behavioral therapy approach is often very effective against the anxiety itself. In my treatment of anxiety, in parallel with exposure and the work with catastrophic thoughts, I will have a greater focus on what lies behind the anxiety, behind the symptoms.
My treatment of anxiety
Possible consequences of anxiety – avoidance behavior, self-medication, depression, etc. – can be severe and disabling. But anxiety is not dangerous in itself. Anxiety is a sign or symptom that there is something behind it you need to take care of. Very often, anxiety is a sign that there are some underlying ‘unwelcome’ and rejected feelings that are too painful or too ‘dangerous’ for you to embrace. Maybe you have bottled-up painful experiences from your upbringing or later in life. Perhaps there were emotions that could not be embraced in your childhood home, e.g. anger, jealousy, sadness, and weakness. Maybe you feel fundamentally wrong, failed, and inadequate. Anxiety acts as a defense against pain by attracting all the attention. Chief psychologist Lars J. Sørensen puts it this way:
“It is as if the ‘intention’ of the feeling of anxiety is to give the person something else – namely the anxiety – to be aware of and worry about because what has happened is just too painful for the mind to deal with it. ” (Lars J. Sørensen, Skam – medfødt og tillært, p. 48-49, my translation).
It can be difficult to see this connection between your anxiety and your painful emotions on your own, as the emotions are often repressed and unconscious. If you come to me for therapy, I will help you to gently open up to the unconscious emotions that have felt so violent and dangerous for you that you had to repress them. It is very important that you feel safe and confident that I as a therapist can embrace and acknowledge your feelings and thoughts. Among other things, we will work with the difference between then and now – at the time you experienced the emotions, they were too painful for you, but today you are somewhere else in your life. By opening up to and embracing these repressed feelings, the root behind your anxiety will diminish and hopefully disappear. You can read more about my treatment approach under My therapeutic approach and Individual therapy.
Types of anxiety
One distinguishes between different forms of anxiety, i.a. generalized anxiety, anxiety attack, social anxiety, OCD, eating disorder, disease anxiety, and agoraphobia. It is common to have multiple anxiety disorders at the same time. In the following, I will elaborate on generalized anxiety, anxiety attack, and social anxiety. In a separate tab, you can read about eating disorders. I treat all kinds of anxiety.
Generalized anxiety
Generalized anxiety was formerly called worry anxiety. If you suffer from generalized anxiety disorder, you feel restlessness in your body and have severe, persistent worry that is excessive for the situation. It can be hard for you to let go of the worries, relax and be present in the moment. The worries of today and of the future can take over and shadow over everything else, which is extremely stressful for you. The anxiety and worry often cannot be attached to anything concrete, which makes it intangible and difficult to get a grip on. Many people with generalized anxiety disorder have experienced the same pattern in a parent, and you may know the tendency to worry from when you were a child or at a very young age.
If you have severe, persistent worries and feel restlessness in your body, you may be able to divert your thoughts and restlessness when you are busy with work and other chores. For some, packing the calendar tightly can be a (survival) strategy. The restlessness and worries are most strongly felt when you relax and have peace around you, typically at bedtime. Many people, therefore, experience sleep problems.
Anxiety attack
Anxiety attacks are sudden and very intense surges of overwhelming panic that last for a short time, most often no more than 30 minutes. They are not dangerous and they will pass. But it is a very shocking experience as you have a feeling of totally losing control. You feel your heart pounding, you have difficulty breathing, you may have chest pains, shaking, sweating, or freezing. You can become seriously afraid of what is happening to you. The unpredictability, the loss of control, and the feeling of powerlessness is such a frightening experience that you just can’t ‘shake it off’. The experience settles in your body and it is hard not to fear that it will happen again. The fear of a new anxiety attack, so-called ‘expectation anxiety’, can become a self-fulfilling prophecy – if you are anxious and afraid that it will happen, your anxiety level is so high that it does not take much to trigger a new anxiety attack.
It can feel as if anxiety attacks are coming out of the blue, as there is often no obvious connection between the anxiety attack and the situation. Anxiety attacks do not come without a reason. Anxiety attacks are a signal that there is something inside of you that you need to take care of. It may be that something in the situation evokes some previously unconscious and repressed emotions which you have difficulty embracing. It could be that you have been under too much mental pressure for too long, and now it is becoming too much for your organism.
Since an anxiety attack is a symptom of underlying mental complications, anxiety attacks can in most cases be treated with therapy alone.
Social anxiety disorder
Social anxiety disorder is more than ordinary shyness and performance pressure. Your thoughts and bodily reactions can be so unpleasant that it significantly burdens your everyday life.
Social anxiety disorder often manifests itself both before, during, and after a social context. Before heading to a social setting, you will typically experience reluctance, bodily restlessness, and negative expectations. Maybe you have thoughts of standing alone, falling outside, saying something stupid or blushing, sweating or shaking so that the others feel your nervousness and see how insecure you are. You fear or expect others to dislike you. During the social context, you may experience unpleasant bodily symptoms, such as palpitations, redness, trembling voice, sweating, shaking hands, dizziness, and nausea. You are likely to keep a low profile as you fear the attention and critical judgment of others. You have many thoughts about what others think of you and have a hard time relaxing. After the social event, you can replay the situation several times and assess your behavior in a self-critical light.
Understandably, many respond by making themselves as invisible as possible or avoiding social contexts. But it will typically result in a downward spiral where you confirm to yourself that the more invisible you are the better. That way, you will never experience the fact that others may not be critical, but want to meet you with kindness and interest. Avoidance behavior can severely inhibit and invalidate you in both your education/work life and in your private life. It is therefore important that you seek help from a therapist where you feel safe and confident – as early as possible so that your social anxiety does not increase.