40 million Americans have an anxiety disorder and cost American society at least 45 billion dollars a year in direct and indirect health care. The female to male ratio is three to two. Most anxiety disorders begin in childhood, adolescence and adulthood.
Anxiety represents a vague sense of worry toward an unknown object, while fear is a strong emotion directed at a specific known entity. Specific phobias indicate that the two are closely related to each other.
The Biology of Anxiety
The amygdala is a small, almond-shaped structure located deep in the temporal lobes of the brain. It is constantly on the alert for changes in the environment that might signal danger. It receives input from the olfactory lobe and via the thalamus from the other senses. Smelling, hearing. Seeing, touching or tasting even before it is experienced by our higher brain centers is signaled by the amygdala. Once the amygdala rings the danger alarm, it activates the hypothalamus-pituitary-adrenal (HPA) axis that initiates the flight-or-fight response. Our heart beats faster, we breath harder and tense our body to meet the threat. This circuitry obviously evolved to help us survive very real dangers out there in the wield.
The amygdala also has secondary inputs from the prefrontal cortex and higher brain structures that think rationally about whether a threat actually exists, and if not to signal the amygdala to shut is alarm off.
The system breaks down in people with anxiety disorders. Either the fear threshold of their amygdala is set too low, or their higher brain centres feed the wrong information to it, informing it that there is danger when in fact there is none. When split-second images of fearful faces are shown to anxious subjects, their amygdalas light up to a greater extant than those with a less anxious temperament. They are very sensitive to subliminal threats and are picking up stimuli that the rest of us do not perceive. There is a biological basis for that unconscious emotional vigilance.
Part of that vigilance may be genetic. Subjects who inherit one or two copies of the short variant of the human serotonin transporter gene experienced greater activation of the amygdala when shown fearful images than those with two copies of the long variant of the gene.
Environmental causes (childhood physical or sexual abuse, trauma from war) can reset the amygdala-HPA pathways at a more sensitive level, making it more likely that future stimuli will trigger anxiety. Chronic stress can deplete the supply of neurotransmitters that keep the brain functioning in balance. SSRIs used to treat depression help with anxiety and are not addictive like many tranquilizers. There is a high level of comorbidity between two mood disorders and anxiety. A person with one has a 25-50% chance of developing the other.
The Virtues of Anxiety
A certain amount of anxiety helps us perform well on a test at school or out in the business world. It is okay to have butterflies – just make sure they are all flying in the same direction. In the business world a certain amount of anxiety seems to provide motivation that gives individuals the edge they need to compete. Built in anxiousness, excitement, motivation means that you are thinking about your goals, objectives and plans, and the risks and opportunities. It can be very useful and enabling. If you’re free and open to deal with the uncertainty of it all, then you have to be able to say you’re anxious. Generalized anxiety can be concentrated into a manageable tool that can help you get things done in the workplace.
Anxiety is also important in the creative process. It is an essential condition or intellectual and artistic creation. When an artist faces an empty canvas or a writer confronts a blank piece of paper, there is the anxiety of “what now?” How does one create something out of nothing? Most artists channel their anxieties into the creative process, which makes a virtue out of anxiety. When anxious, many are sharp, alert, observant and sometimes even witty. Fear energizes them. When artists create, they tap into the collective fears of humanity and help make them sensible and bearable. The more conflict, the more rage, the more anxiety there is, the more the inner necessity to create. Gifted individuals feel the inner necessity even more intensely, and in some respects experience and give voice not only to their own demons but the collective demonic as well. They sense the dangers, the conflicts, the cultural shadows and try to give it some meaningful expression. The self develops essentially by facing anxiety-producing situations. To venture causes anxiety, but not to venture is to lose oneself.
At the same time, anxiety may violate the time-honoured social value: tranquility.
The Evolutionary Advantages of Anxiety Disorders
There are six major forms of anxiety disorders.
Each of these appears in the gene pool because it served some important function in evolution. This may explain why anxiety disorders are so common in today’s society, affecting almost 20% of the population, far more than any other psychiatric disorder. In prehistoric times, life was poor, brutish, and short. Dangers lurked around every corner: beasts of prey, poisonous plants, drought, fires, floods, intertribal warfare, and more. Anxious people have fewer fatal accidents in young adulthood but not with the number of non-accidental (e.g. illness-related) deaths before age 25. After 25, this was counterbalanced by a greater likelihood that older anxious people would die of medical related problems than non-anxious people. Evolution was more concerned with the fate of young people to avoid accidents long enough to pass their genes along.
1. Generalized anxiety disorder is an ongoing sense of worry that lasts at least six months without their being present a specific object of fear. Generalized anxiety disorder probably evolved s a way of dealing with threats nature could not be identified very distinctly.
2. Panic disorder causes repeated, unexpected attacks of intense fear lasting from a few minutes to hours. Symptoms include palpitations, sweating, trembling, and intense sensations of choking or smothering. Panic disorder may have evolved as a way of quickly activating the “flight-or-fight mechanisms releasing large amounts of adrenaline to get away from danger immediately.
3. Post-traumatic stress disorder can occur in the wake of a traumatic event such as physical or sexual abuse or combat duty in the military and can include nightmares, flashbacks, and hypervigilance. The excessive watchfulness and avoidance behaviors of PSTD involves the memory in avoiding previously dangerous situations. The hippocampus is actually smaller in PSTD because of stess-induced degeneration of dendrites. After the person returns to a safe environment, nature doesn’t know this and continues to activate these responses, resulting in serious debilitating illness, often lasting years.
4. Social anxiety disorder is the fear of being seen negatively by others or humiliated in public, resulting in an avoidance of social situations. Symptoms can include blushing, shaking, fear of vomiting or urgency or fear of bladder or bowel movements. There may have been an advantage of knowing one’s place in the social hierarchy in ancient times, avoiding confrontation with powerful figures in one’s own tribe by averting one’s gaze, and withdrawing from the social scene to forestall potential conflict with others. Threats by more dominant members of the group put them in a state of braced readiness.
5. Phobias. The largest category includes those with specific phobias. Agoraphobia (the fear of leaving home) may have evolved from the dangers that existed in areas that did not have protection from outside threats. About 70,000 years ago, Homo sapiens expanded beyond its heavily forested East African indigenous niche into sparsely wooded habitats where there was much greater vulnerability to attack from predators.
Achluophobia (fear of darkness) would be appropriate where nighttime was filled with fear of roaming predators. Phonophobia (fear of loud sounds) would make sense where lightning or ferocious animals threatened.
6. Obsessive-compulsive disorder is characterized by unwanted thoughts or behaviors that seem impossible to stop or control – “If forgot to lock the door”, “I’m contaminated by germs”, I have a terminal disease”. In an attempt to quell the anxiety, the person engages in compulsive actions. The behavior temporarily reduces the anxiety, but then the obsession returns, resulting in a resumption of the compulsive disorder. In severe cases of OCD, a person may spend hours a day checking locks, washing hands, visiting doctors, or engaging in groundless activities to such an extent that they interfere with their work, family, and social roles. The OCD individual realizes that the obsession and behaviors are irrational but can’t stop experiencing or doing them.
In a sense, there is a continuum of such behaviors in most of us. We all have little quirks or annoyances that we consciously or unconsciously go through during the day, such as knocking on wood, or crossing our fingers. Baseball players are famous for having superstitions. The important distinction is that these rituals don’t interfere in our daily lives in the way that they do in people with OCD.
OCD may have a unique connection to a wide range of religious rituals and cultural ceremonies. It may have represented a certain advantage in cultures where rigid rituals were important. In ancient times (and even today), priests perform elaborate rituals to propriate the gods. Such rituals had to be performed in a precise way. Any omission required that the entire ritual had to be performed all over again. Priests with OCD characteristics may have been just what was required. As they were often the individuals with the greatest prestige and wealth, then having OCD-like behaviors may have been the surest way routes to success in those cultures.
Niche Construction and Anxiety
In many ways, an anxiety disorder can interfere with one’s career. Certain features when kept under control are potentially congruous with certain occupations. Creative professions can take their minds off their worries, or into which they can channel their anxieties. Woody Allen makes films to prevent anything from distracting him. The performing arts as a whole attracts many people with anxiety disorders including Aretha Franklin, Cher, Sheryl Crow, Donny Osmond, Barbara Streisand, Johnny Depp, Eric Clapton, Ray Charles, David Bowe, and Roseanne Barr.
There are many assistive technologies. Biofeedback devices measure heart rate, muscle relaxation, body temperature, or electrical waves in the brain. Neurofeedback monitors brain-wave technology to reduce anxiety with calmness, relaxation, or a meditative state. Specific phobias or PTSD can be helped with virtual-reality computer hardware to desensitize users to their fears by providing them with a gradual exposure to the feared object.
Mindfulness meditation uses breath and awareness can be powerful. Sitting in a comfortable position and back straight, train attention on the breath by focusing on the rising and falling of the belly, or on the air moving through your nostrils. If the mind should wander, simply notice what you are experiencing and then turn your attention back to the breath. Using this can gain some distance from their experience. The breath serves as an anchor for awareness, and pure awareness is ultimately free of anxiety. It is not necessary to suppress anxiety, or try to turn it into something else. Rather, one simply notices the anxiety, acknowledges it, labels it, and then turns the focus elsewhere. This means that we are accepting anxiety into our world, not turning it away.
The key is to allow ourselves to experience a certain amount of anxiety without it becoming debilitating.
