The Anxiety Loop and How to Escape It
Rates of anxiety are on the up, as are rates of prescription medication to help people cope
Psychotherapist Laurie Castelli-Gair offers some tips to help you find relief from anxious feelings
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The British Journal of General Practice recently published a report highlighting the soaring rates of prescribing for anxiety in the UK between 2003 and 2018. Looking at data from 2.6 million adults, the report shows that the levels of prescription of a number of medications, including anti-depressants, beta-blockers and benzodiazepines, nearly doubled over that period, propelled to an alarming extent by prescriptions to women and young people (under 25s). And, bear in mind, this study does not include the well-documented negative impact of the pandemic on our mental health.
The report speculates that this sharp rise may be due to a greater willingness to seek help for anxiety, or the emergence of previously undiagnosed problems, or indeed that it might be the result of symptoms having become more severe.
We know that prescription medicines, particularly combined with other therapies, can help alleviate the symptoms of anxiety and other psychological disorders, but the sheer scale of the increase in psychiatric medication should give us pause. In fact, the report itself contains a stark warning:
‘…some of this prescribing is not based on robust evidence of effectiveness, some may contradict guidelines, and there is limited evidence on the effect of taking anti-depressants long-term, and therefore, there may be unintended harm.’
Who can blame GPs overwhelmed by cases of emotional distress arriving at their already busy surgeries, and without adequate access to talking therapies? However, from the point of view of a psychotherapist, it is difficult not to view this trend toward increasing prescription as a further medicalisation of mental health, without thinking through the implications of the long-term effects of pharmacological intervention. Or indeed at a more profound level, asking ourselves what is making us (and particularly our young), so anxious and distressed, and what might we do about it.
From generalised anxiety disorder to phobias and panic attacks, anxiety has many flavours, some of which can be debilitating and suck the joy out of life. So, how might we empower ourselves to deal with our anxiety better without resorting to medication as a first response?
Anxiety is natural
We all get anxious; it is important to recognise that anxiety is a natural adaptive response in our nervous system that ultimately is designed to keep us safe.
In the face of a perceived threat, fear circuits in our brain and adrenal system are activated. Neuromodulators like epinephrine (adrenaline) and cortisol prepare our fight or flight response by increasing our breathing rate, heart rate and blood pressure. This is all very useful when you are facing life-threatening situations, like needing to jump out of the way of an oncoming car. However, your body can also trigger this fight-or-flight response as a result of emotional stress or worrying thoughts.
The anxiety loop: anxious about being anxious
Our imagination is a brilliant resource – when put to good use it can solve problems, fuel invention to create a better world. But when misdirected, it is so powerful that it can create mental scenarios that cause us to worry excessively. This activates our fight or flight response at a physical level, which in turn signals to the mind that there must be an imminent threat.
As a result, our mind goes on high alert for danger, looking for somewhere to pin the sense of discomfort that the body is feeling. This in turn makes otherwise normal events seem threatening, which further arouses our overall fear and threat response. And so, the anxiety loop escalates – feeding on itself like a faulty feedback mechanism.
It’s not surprising that we can end up jumpy, on edge, and with a creeping sense of dread about the world around us – exhausted by a state of induced hyper-vigilance.
The mind-body connection: using the breath to break the anxiety loop
Signals are constantly going back and forth between our brain and body. It’s a feedback system designed to manage our energy systems and adapt to whatever circumstances we encounter. This is called homeostasis.
Anxiety puts the mind-body system into a high state of emotional arousal in which our cognitive faculties are naturally impaired. That’s why it’s so hard to think our way out of anxiety (or any other emotionally charged psychological difficulty). Consciously adjusting our breathing is one of the most effective ways of taking back control of our emotional regulation.
7/11 breathing (inhaling deeply through the nose for a count of 7 and exhaling for a count of 11) is particularly helpful. (See my demo here: https://www.lauriecastelli.net/resources/the-711-breathing).
By extending our out-breath so that it is longer than the in-breath we reduce our autonomic arousal, and signal to our brain that we are safe. This borrows from the natural sigh response that all mammals seem to have – a quick intake of breath followed by a long out-breath that often follows from a stressful event. It’s like a natural remote control or reset button for the nervous system.
Getting distance from our thoughts
Once mastered, this simple technique is something that can be practiced any time we find ourselves in a stressful situation, or when we sense the presence of anxiety triggers. In effect, by reducing the physical sensations of anxiety we can begin to cultivate a more detached observation of our habitual thoughts that may be trying to terrorise us. Only now that we have stepped out of our anxiety loop, we can re-engage our thinking brain, and start to adopt some cognitive self-therapy. For example:
1. Name your anxiety
We can start by naming our anxiety. Ideally, we take a moment every day (see point 3 below) to write down our worries. It seems that the more words we can find to describe them, the more relief we can gain. This appears to work by engaging our pre-frontal cortex (part of our centre of rational thought and control in the brain) in the act of labelling – which reduces the activity in the fear related centres such as the amygdala and wider limbic system.
2. Grade your anxiety
A refinement of this cognitive approach is to grade our anxiety. Give it a number from 1 to 10, where 10 is totally unbearable and 1 is totally un-aroused. Find effective ways to relax the body from the inside, lean into our worries, name them and grade their severity. Numbering is another form of labelling, which helps us reframe our emotions into a rational object that is easier to get a handle on.
3. Allocate some dedicated ‘worry time’
When we feel triggered, and sense our mind entering a worry spiral, leading to anxiety, firstly we can engage in our breathing exercise, then we can tell ourselves to park our concerns until our designated worry time. Once again having first relaxed the nervous system we can set aside 20 minutes to actively focus on our anxiety. We may well find that by doing this we free up some emotional capacity, and get a fresh perspective that begins to diminish the ‘emotional charge’ of our intrusive thinking.
No one should seek to minimise the misery caused by uncontrolled anxiety, and the techniques mentioned here are just a few of the many approaches that can be learned and practiced to help us all self-regulate our nervous systems. Given the rampant increase in cases of acute anxiety, particularly among the youngest members of our society, it seems self-evident that these and many other self-management skills should be taught in schools as a matter of course.
This is also not to deny that prescription medication has its place under controlled conditions. However, let’s start by acknowledging that anxiety is a natural response of our mind-body system trying to keep us safe from harm. Rather like a smoke alarm in our home that can save our life, but is set to be a little too sensitive, and sometimes goes off when we burn the toast. So, our own internal self-defence mechanism can sometimes become conditioned to be overly sensitive to perceived threats, and this in turn can lead to a self-perpetuating worry cascade, and the anxiety loop.
Good therapy tries to look behind the symptoms at precisely this conditioning that may have led our clients to have developed an over-active fear response, in an effort to help them recalibrate their own internal smoke alarm.
But in the meantime, let’s all help each other to befriend our nervous system, and learn ways to escape the anxiety loop, before we rush to turn a natural human response mechanism into a psychiatric disorder.