Anxiety

Charles Darwin observed that fear reactions are fairly universal across species: all mammals, including humans, exhibit readily observable fear responses.Stossel, Scott, My Age of Anxiety p. 42 In 1915, Walter Cannon, the chair of the physiology department at Harvard Medical School, coined the term “fight or flight” to describe Darwin's idea of an “alarm reaction”.Stossel, Scott, My Age of Anxiety p. 43

Negativity

Individuals who suffer from anxiety disorders generally have a hyper-awareness of their environment. They are always scanning for possible threats which can be either external threats or internal threats.

Anxious people are very smart at plotting out possible bad outcomes.Stossel, Scott, My Age of Anxiety p. 324 Elements of modern research lend support to Northfield's warning: anxious people have a pathological tendency to focus their attention inward, on themselves, in a way that suggests a book-length dwelling on one's own anxiety is hardly the best way to escape it.Stossel, Scott, My Age of Anxiety p. 24 David Barlow, one of the preeminent researchers in the field, notes that pathological, negative self-focus “seems to be an integral part of the cognitive-affective structure of anxiety...”Stossel, Scott, My Age of Anxiety p. 24

If the variables in the external environment become too uncontrollable to possibly safeguard against, attention can then switch to the internal environment of the patient where they at least feel they have some control.

Anxiety disorder patients tend both to feel like they don't have much control over their lives and to be afraid of losing control of their bodies or their minds.Stossel, Scott, My Age of Anxiety p. 87

Sleep

Sleep deprivation appears closely associated with anxiety. Many people who have anxiety also report problems sleeping. It is no wonder then that sleep deprivation adversely affects the brain and cognitive functions. Stress and sleep deprivation can feed off of each other to produce a monster that holds the mind in captivity.

I'd imagine that the lack of sleep and the extreme amounts of mental stress had done a physical number on my body. Not only was I not sleeping, I was so stressed that I wasn't even getting hungry.Ryckert, Dan, Anxiety as an Ally p. 14 Nights were always the worst, as I'd lay in bed with a racing mind that would inevitably start fixating on my condition.Ryckert, Dan, Anxiety as an Ally p. 34 Minutes seemed like hours as I tried to quiet my mind long enough to fall asleep.Ryckert, Dan, Anxiety as an Ally p. 80

Physiology

The notion of the mind and body being separate from one another has existed a long time. It was even once thought that all our mind's thoughts emanated from one a great celestial mind. Modern science and biology has dispelled these ancient philosophies and we now know that the organ in our body called the brain is responsible for our thinking; and that when the brain is damaged so are our abilities to think.

Physical states create psychic ones and not vice-versa.Stossel, Scott, My Age of Anxiety p. 54 My anxiety is a reminder that I am governed by my physiology - that what happens in the body may do more to determine what happens in the mind than the other way around. Though thinkers from Aristole to William James to the researchers who publish today in the journal Psychosomatic Medicine have recognized this fact, it runs counter to the one of the basic Platonic-Cartesian tenets of Western thought - the idea that who we are, the way we think and perceive, is a product of our disembodied souls or intellects.Stossel, Scott, My Age of Anxiety p. 30 The bases of mental illness are chemical changes in the brain... There's no longer any justification for the distinction... between mind and body or mental and physical illness. Mental illnesses are physical illnesses.Satcher, David, U.S. Surgeon General 1999

The part of the brain that is associated with anxiety is the area that is activated during an emotional fear response called the amygdala.

For instance, acute anxiety generally appears on fMRI scans as hyperactivity in the amygdala, that tiny almond-shaped structure located deep in the medial temporal lobes near the base of the skull. Reductions in anxiety are associated with diminished activity in the amygdala and with heightened activity in the frontal cortex.Stossel, Scott, My Age of Anxiety p. 41

Treatment

To reduce anxiety, the autonomic “fight-or-flight” response must be reprogrammed. Modern treatment generally involves a combination of methods, both pharmacological and behavioral.

One was accepting that this would be a long fight with no magic solution. The other was discovering the importance of opening up about what I was going through.Ryckert, Dan, Anxiety as an Ally p. 49

Exposure Therapy

In the 1693 the philosopher John Locke described what is now known as exposure therapy in his book on education.

Your child shrieks, and runs away at the sight of a frog; let another catch it and lay it down a good distance from him; at first accustom him to look upon it, and see it leap without emotion; then to touch it lightly when it is held fast in another's hand; and so on till he can come to handle it as confidently as a butterfly, or a sparrow. By the same way any other vain terror may be removed if care be taken, that you go not too fast, and push not the child on to a new degree of assurance, till he be thoroughly confirm'd in the former. And thus the young soldier is to be trained on to the warfare of life.Locke, John, Some thoughts on education p. 176 The logic of this approach - which has lately been undergirded by neuroscience research - is that extended exposure to the object of fear, under the guidence of a therapist, makes the object less frightening.Stossel, Scott, My Age of Anxiety p. 68

Meditation

The Law of Noncontradiction states that “contradictory statements cannot both be true in the same sense at the same time”. It is the logical basis for the the rationale behind Joseph Wolpe's work on behavioral modification.

Wolpe’s rationale was that you cannot be both relaxed and anxious at the same time.Wikipedia, Joseph Wolpe

Techniques which involve deep, slow and controlled breathing (diaphragmatic breathing 1) are often used to help calm the body and change it from a state of anxiousness to one of relaxation. In the same manner, meditation can help the mind refocus its thoughts off of its object of fear and on to an object of security.

The biomedical view, for its part, increasingly recognizes the power of things like meditation and traditional talk therapy to render concrete structural changes in brain physiology that are every bit as “real” as the changes wrought by pills or electroshock therapy.Stossel, Scott, My Age of Anxiety p. 53 Meditation led to decreased density of the amygdala, a physical change that was correlated with subjects' self-reported stress levels - as their amygdalae got less dense, the subjects felt less stressed.Stossel, Scott, My Age of Anxiety p. 54

References

1. Wikipedia. Diaphramatic breathing

Additional Quotes

This was the very definition of panic disorder, he explained - the fear of more panic attacks. They're so traumatic that the sufferer is terrified of experiencing more of them, and begins to avoid situations that may produce them.Ryckert, Dan, Anxiety as an Ally p. 22 Panic attacks and generalized anxiety are very difficult to explain to the portion of the population that has never struggled with these conditions.Ryckert, Dan, Anxiety as an Ally p. 29 The brain starts coming up with every worst case scenario that it can, but then there inevitably comes a point where it just... ends. It seems like the brain reaches some kind of threshold for anxiety that it can't support for long periods of time, and every panic attack reaches an end. Years later, I'd adopt “It always ends” as a kind of mantra.Ryckert, Dan, Anxiety as an Ally p. 31 Only in 1980 - after new drugs designed to treat anxiety had been developed and brought to market - were the anxiety disorders finally introduced into the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, displacing Freudian neurosis. In an important sense, the treatment predated the diagnosis - that is, the discovery of antianxiety drugs drove the creation of anxiety as a diagnostic category.Stossel, Scott, My Age of Anxiety p. 10 For instance, generalized worry about future events... tends to appear as hyperactivity in the front lobes of the cerebral cortex... most fearful emotions and behaviors are in one way or another produced by, or at least processed through, the amygdala...Stossel, Scott, My Age of Anxiety p. 11 If we can't control something, there's no value in fearing it, since the fear accomplishes nothing.Stossel, Scott, My Age of Anxiety p. 12 The Stoic philosopher Epictetus anticipated the same idea about faulty cognitions. “People are not disturbed by things but by the view they take of them,” he wrote in the first century; for Epictetus, the roots of anxiety lay not in our biology but in how we apprehend reality. Alleviating anxiety is a matter of “correcting erroneous perceptions”.Stossel, Scott, My Age of Anxiety pp. 12-13 Why do drug treatments for anxiety that work so well on Americans and the French seem not to work effectively on the Chinese.Stossel, Scott, My Age of Anxiety p. 21 All of which lends the appearance of scientific validity to the diagnosing of an anxiety disorder. But the reality is that there is a large quotient of subjectivity here (both on the part of patients, in describing their symptoms, and of clinicians, in interpreting them). Studies in the 1950s found that when two psychiatrists consulted the same patient, they gave the same DSM diagnosis only about 40 percent of the time.Stossel, Scott, My Age of Anxiety p. 39 Some geneticists say they can find no distinction between major depression and generalized anxiety disorder.Stossel, Scott, My Age of Anxiety p. 39 The result of a physiological fear response that has no legitimate object, or that is disproportionate to the size of the threat, can be pathological anxiety - an evolutionary impulse gone awry. William James, the psychologist and philosopher, surmised that the cause of severe anxiety, and of what we would today call panic attacks, might be modernity itself - specifically, the fact that our primitive fight-or-flight responses are not suited to modern civilization. “The progress from brute to man is characterized by nothing so much as by the decrease in frequency of proper occasions for fear,” James observed in 1884. “In civilized life, in particular, it has at last become possible for large numbers of people to pass from the cradle to the grave without ever having a pang of genuine fear.”Stossel, Scott, My Age of Anxiety pp. 44-45 Many studies are now finding that cognitive-behavioral therapy, or CBT, is the safest most effective treatment for many forms of depression and anxiety disorders.Stossel, Scott, My Age of Anxiety p. 52 Which means that anxiety, for all the philosophizing and psychologizing we've attached to it, may be an irreducibly biological phenomenon that is not so different in humans than in animals.Stossel, Scott, My Age of Anxiety p. 55 David Barlow, the former head of the Center for Anxiety and Related Disorders, says the goal of exposure therapy is to “scare the hell out of the patient” in order to teach him that he can handle the fear.Stossel, Scott, My Age of Anxiety p. 69 Writing an emotionally neutral account is a commonly prescribed way of trying to forestall post-traumatic stress disorder after a traumatic experience.Stossel, Scott, My Age of Anxiety pp. 71-72 This is consistent with a trait called anxiety sensitivity, which research has shown to be strongly correlated with panic disorder. Individuals who rate high on the so-called Anxiety Sensitivity Index, or ASI, have a high degree of what's known as interoceptive awareness, to the beepings and bleatings, the blips and burps, of their physiologies; they are more conscious of their heart rate, blood pressure, body temperature, breathing rates, digestive burblings, and so forth than other people are. This hyperawareness of physiological activity makes such people more prone to “internally cued panic attacks”: the individual with a high ASI rating picks up on a subtle increase in heart rate or a slight sensation of dizziness or a vague, unidentifiable fluttering in the chest; this perception, in turn, produces a frisson of conscious anxiety, which causes those physical sensations to intensify.Stossel, Scott, My Age of Anxiety p. 76 Social phobics worry that their interpersonal awkardness or the physical manifestations of anxiety - their blushing and shaking and sweating - will somehow reveal them to be weak or incompetent.Stossel, Scott, My Age of Anxiety p. 102 The social phobic (timide) fears other people, lacks self-confidence, and eschews social interactions.Stossel, Scott, My Age of Anxiety p. 104 A cross-cultural comparison conducted in 1994 suggested that the relative prevalence of social phobia symptoms in Japan could be related to “the socially promoted show of shame among Japanese people.” Japanese society itself, the lead researcher of the survey argued, could be considered “pseudo-sociophobic” because feelings and behaviors that in the West would be considered psychiatric symptoms - excessive shame, avoidance of eye contact, elaborate displays of deference - are cultural norms in Japan. If nothing else, this demonstrates the complex ways in which culture and medicine interact: what's normal, even valorized, in one culture is considered pathological in another.Stossel, Scott, My Age of Anxiety p. 104 Besides, some quotient of nervousness about social interactions is normal. How many of us don't feel some discomfort at the prospect of having to make small talk with strangers at a party? Who doesn't feel some measure of anxiety at having to perform in public or to be judged by an audience? Such anxiety is healthy, even adaptive.Stossel, Scott, My Age of Anxiety p. 106 Many studies have demonstrated that the amygdalae of those diagnosed with social anxiety disorder tend to be consistently more reactive to the human gaze than those of healthy control subjects.Stossel, Scott, My Age of Anxiety p. 108 Two influential twentieth-century psychotherapists, Albert Ellis and Aaron Beck, the founders of rational emotive behavioral therapy (REBT) and cognitive-behavioral therapy (CBT) respectively, each argued that the treatment of social anxiety boils down to overcoming fear of disapproval. To overcome social anxiety, they say, you need to inure yourself to needless shame.Stossel, Scott, My Age of Anxiety p. 111 That is, social phobics are better at picking up on subtle social cues than other people are - but they tend to over-interpret anything that could be construed as a negative reaction. Since they are predisposed to believe that people won't like them or will react badly to them (they tend to have obessive thoughts like I'm boring or I'm going to make a fool of myself by saying something stupid), they're always seeking confirmation of this belief by interpreting...Stossel, Scott, My Age of Anxiety p. 113 This finding aligns with the many studies showing that social phobics demonstrate a more hyperreactive amygdala response to negative facial expressions.Stossel, Scott, My Age of Anxiety p. 115 Like low-ranking animals, people with the general subtype of social anxiety disorder tend to look downward, avoid eye contact, blush, and engage in behaviors that advertise their submissiveness, eagerly seeking to please their peers and superiors and actively deferring to others to avoid conflict.Stossel, Scott, My Age of Anxiety p. 119 Low-status monkeys and socially phobic humans also tend to have notable irregularities in the processing of certain neurotransmitters. Studies have found that monkeys with enhanced serotonergic function (in essence, higher levels of serotonin in their brain synapses) tend to be more dominant, more friendly, and more likely than those with normal serotonin levels to bond with their peers. In contrast, monkeys with unusually low serotonin levels are more likely to display avoidant behavior: they keep to themselves and avoid social interactions.Stossel, Scott, My Age of Anxiety p. 119 The association of dopamine and serotonin with social phobia doesn't prove that neurotransmitter deficits cause social anxiety - those irregularities could be the effects of social anxiety, the neurochemical “scars” that develop when the brain becomes overstressed from having to be so vigilant all the time, constantly scanning the environment for social threats.Stossel, Scott, My Age of Anxiety p. 120 Thinking too much about what you are doing actually impairs performance.Stossel, Scott, My Age of Anxiety p. 131 Anxiety can spread by contagion, so armies seek aggressively to contain it.Stossel, Scott, My Age of Anxiety p. 134 Everyone of the most commerical significant classes of antianxiety and antidepressant drugs of the last sixty years was discovered by accident or was originally developed for something completely unrelated to anxiety or depression: to treat tuberculosis, surgical shock, allergies; to use as an insecticide, a penicillin preservative, an industrial dye, a disinfectant, rocket fuel.Stossel, Scott, My Age of Anxiety p. 155 But a hundred years from now, medical historians may once again be marveling at the addictive, toxic, or useless substances we consume in such great quantities.Stossel, Scott, My Age of Anxiety p. 157 This was the moment the pharmaceutical industry awoke to the idea that it could sell psychiatric drugs by marketing them as correcting “chemical imbalances,” or deficiencies of certain neurotransmitters.Stossel, Scott, My Age of Anxiety p. 175 The Greeks also credited Pan with their victory at the Battle of Marathon in 490 B.C., where he was said to have put anxiety in the hearts of the enemy Persians. The experience of sudden terror - especially in crowded places - became known as panic (from the Greek panikos, literally “of Pan”)Stossel, Scott, My Age of Anxiety p. 182 Panic disorder was the first psychiartic disease for which the determining factor in its creation was a drug reaction: imipramine cures panic; ipso facto panic disorder must exist. But this phenomenon - in which a drug effectively defined the syndrome for which it was described - would soon recur.Stossel, Scott, My Age of Anxiety p. 187 For starters, some of its [the DSM's] new category distinctions appear awfully arbitrary. (Why does panic disorder require the presence of four symptoms, rather than three or five, from the list of thirteen? Why do symptoms have to persist for six months, and not five or seven, for an official diagnosis of social anxiety disorder. The head of the DSM-III task force, Robert Spitzer, would concede years later that many of its decisions were made haphazardly.Stossel, Scott, My Age of Anxiety p. 191 Studies have shown that people who score high on scales of anxiety sensitivity tend to suffer drug side effects more severely.Stossel, Scott, My Age of Anxiety p. 206 We may look back 150 years from now and see antidepressants as a dangerous and sinister experiment.Glenmullen, Joseph, Prozac Blacklash The serotonin theory of depression is comparable to the masturbatory theory of insanity.Healy, David One early study of a group of depressed patients, reported in Science in 1976, found that only half had atypical levels of serotonin - and only half of those had serotonin levels that were lower than average, meaning that only a quarter of the depressed patients could be considered serotonin deficient. In fact, an equally large number had serotonin levels that were higher than average. Many subsequent studies have produced results that complicate the notion of a consistent relationship between serotonin deficiency and mental illness.Stossel, Scott, My Age of Anxiety pp. 217-218 Edward Drummond, a psychiatrist in New England, used to regularly prescribe benzodiazepine tranquilizers o his patients in order to reduce their anxiety. Today, he strongly believes tranquilizers are a significant cause of chronic anxiety. Taking Xanax or Ativan can temporarily alleviate acute anxiety, Drummond says, but at the cost of allowing us to avoid dealing with whatever issues are causing that anxiety.Stossel, Scott, My Age of Anxiety p. 222 According to the stress-diathesis model of mental illness, clinical disorders like anxiety and depression often erupt when a genetic susceptibility to psychiatric disease combines with life stressors that overwhelm the individual's ability to cope.Stossel, Scott, My Age of Anxiety p. 286 “There is no greater cause of melancholy than idleness, 'no better cure than business,'” he wrote, citing the Arbian physician Rhasis.Stossel, Scott, My Age of Anxiety p. 309 The experience of trauma or abuse, he explained, gets stored in the body, “woven into the bodily tissue.”Stossel, Scott, My Age of Anxiety p. 319 Anxiety is productive mainly when it is not so excessive as to be debilitating.Stossel, Scott, My Age of Anxiety p. 325 Anxious people, because they are vigilantly scanning the environment for threats, tend to be more attuned than adrenaline junkies to other people's emotions and social signals.Stossel, Scott, My Age of Anxiety p. 325 Albert Bandura believed that repeatedly proving to oneself one's competence and ability to master situations, and doing so in spite of feelings of anxiety, depression, or vulnerability, builds up self-confidence and psychological strength that can provide a bulwark against anxiety and depression.Stossel, Scott, My Age of Anxiety p. 336 I have come to believe that anxiety accompanies intellectual activity as its shadow and that the more we know of the nature of anxiety, the more we will know of intellect.Liddel, Howard, The role of vigilance in the development of animal neurosis

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