Has your anxiety increased in the last year? If so, you’re not alone. Over the past year, the social, personal, and environmental stressors of the pandemic have caused a dramatic increase in the prevalence of mental disorders—most commonly anxiety and depression. We discussed depression last week, so we know that environmental triggers can worsen or even cause episodes of depression. Perhaps even more than mood disorders, anxiety disorders are strongly impacted by social and psychological context. Anxiety disorders—which include phobias, panic disorders, and trauma disorders—are innately tied to our sense of self-preservation. Evolutionarily speaking, an attuned sense of fear and avoidance can be essential to keeping you safe. But when these instincts spiral out of proportion, they can become crippling.
You’re probably familiar with the feeling of anxiety—the sweating palms, racing heartbeat, and feeling of unease that hangs over you before a big presentation or a job interview. Anxiety is an innately physiological response to a perceived threat. Thousands of years ago, those threats were mostly external, life-or-death situations—hungry predators, dangerous weather, or other hostile humans. In these uncertain environments, evolution favored people with a healthy sense of anxiety whose bodies would prepare them to run or defend themselves as soon as a threat appeared. But today, for many of us, our main sources of anxiety are much less dire. Giving a presentation in front of a hundred people isn’t going to kill us, but our bodies seem determined to gear up for a fight that will never come (unless someone in the crowd happens to hold a particularly strong grudge). Our lives have become divorced from the wild and dangerous world of our ancestors, but even all these centuries later, we’ve managed to hold onto the same primal fear that kept them alive.
Biologically, anxiety is driven by activation of the sympathetic nervous system and the release of hormones like adrenaline and cortisol into the blood. These factors trigger systems all around the body. Breathing and heart rate increase to improve the circulation of oxygen, blood pressure and blood sugar increase to help carry more nutrients to the muscles around the body, the digestive system shuts down to conserve energy, the skin produces more sweat to cool down the body, and our senses become more attuned to surrounding threats. These are all excellent responses to being surrounded by a pack of wolves, but they are probably overkill in response to being surrounded by a group of (mostly) well-meaning people. In a world that is objectively less black and white than primitive society, how do our brains decide what is and isn’t a threat?
While anxiety is a ubiquitous experience, anxiety disorders affect just about a fifth of the population. The difference between the two has to do with the severity and persistence of the anxiety or fear. Anxiety disorders are characterized by persistent fear or anxiety that is out of proportion to the size of the threat and often causes severe distress or disturbances to a person’s ability to function. There are many different types of anxiety disorders, each characterized by different triggers and responses. The most common form of anxiety disorder is Generalized Anxiety Disorder (GAD). GAD is characterized by persistent anxiety that is often triggered by internal or imagined threats. People with GAD tend to fall into thought cycles of worry and anxiety that can cause them to avoid activities that they might otherwise enjoy. Avoidance and hyper-planning are common coping mechanisms for people with GAD because they create a sense of control.
The physical symptoms of GAD can vary from person to person and can change over time. Many people with GAD experience increased heart rate, rapid breathing, or even intense nausea associate with anxiety. But plenty of people experience intense anxiety that isn’t linked to any physical symptoms at all. This form of GAD can be just as debilitating because it can disrupt a person’s thinking patterns and behaviors. Some people experience the severe episodes of physical anxiety symptoms known as panic attacks. Panic attacks are sudden, isolated episodes of intense fear that can last for minutes or longer. Panic attacks can be triggered by certain events or environments, or they can occur without a trigger. Panic attacks are usually accompanied by any number of the physical fear responses we mentioned above. People suffering from a panic attack can also feel detached from their own bodies or the environment around them. The physical symptoms can be so severe that some people mistake them for symptoms of a heart attack, which can be an additional source of anxiety. Anyone can have a panic attack if they feel stressed or overwhelmed, but roughly 3% of Americans have what is known as a panic disorder, where they experience repeated panic attacks that can be sudden and unpredictable. For people with a panic disorder, there may be additional anxiety surrounding the anticipation of having another attack.
GAD and panic disorder can often manifest without any environmental triggers, but some people have specific phobias—targeted fears of particular objects or experiences. These phobias can cause a person to experience fear, anxiety, or even a panic attack when exposed to that trigger. There are phobias for all sorts of objects and experiences, including heights (acrophobia), spiders (arachnophobia), dogs (cynophobia), being buried alive (taphophobia), and more. People with phobias often go to great lengths to avoid exposure to a known trigger, and this can become a major disruption in their day-to-day life depending on the nature of the trigger. A common phobic anxiety disorder affecting around 7% of Americans is social anxiety disorder, a severe anxiety or fear triggered by social situations. A person with social anxiety can be intensely self-conscious in front of others to the point that the anticipation of meeting new people or socializing can cause them to spiral into anxiety or even a panic attack. Instead, they will often try to avoid social situations whenever they can, creating a sense of isolation.
Anxiety disorders do have strong roots in biology and evolution, and several genes have been linked to anxiety risk. But cognitive and social factors tend to be instrumental in the development of these disorders, especially for phobias. We can learn fears the same way we learn anything else. In our blog post on cognition a few weeks ago, we talked about a fictional scenario where someone who was afraid of dogs was approached by a dog in a park. In general, no one is born with a phobia of dogs. As young children, we may be wary or even afraid of them, which is fair when you’re small enough to be trampled by most average-sized dogs. Many of us lose that fear as we get older because most dogs aren’t a real threat. But a few traumatic experiences with dogs growing up can condition your brain to see dogs as a threat. And because your brain likes simplifying ideas, it’s likely to generalize that phobia to apply to all dogs. We can even learn phobias indirectly, using observational learning. If your parent has a phobia of dogs, you’re more likely to develop one yourself through observation of their fear—even if you never have a traumatic experience with a dog yourself.
Because of their strong connection to cognitive and social triggers, anxiety disorders tend to be best treated by talk therapies, particularly cognitive-behavioral therapy (CBT). CBT helps people overcome anxiety by retraining how the brain responds to triggering situations. Some people with specific phobias also benefit from exposure therapy where they are exposed to a particular trigger in a controlled, safe environment. Exposure therapy can help to slowly rewrite the fear associated with the trigger. There are also medications that can be effective at managing the symptoms of anxiety, including anti-anxiety medications (like benzodiazepines) and antidepressants (particularly for people who also experience depression). Most of the time, the best solution for treating an anxiety disorder is some combination of short-term medication and longer-term talk therapy.
Next week, we’ll continue our discussion of mental health. For now, check out last month’s series on the psychology of perception and cognition. Comment on this post or email me at contact@anyonecanscience.com to let me know what you think about this week’s blog post and tell me what sorts of topics you want me to cover in the future. And subscribe below for weekly science posts sent straight to your email!
National Suicide Prevention Lifeline:
- 800-273-8255 (24/7)
- Online chat: https://suicidepreventionlifeline.org/chat/ (24/7)
- https://suicidepreventionlifeline.org/
For International Suicide Resources: https://www.opencounseling.com/suicide-hotlines
