Local Missoula High Schooler Amelia Chinikaylo has some questions about anxiety for her Senior Project.
What is the most common type of anxiety you have dealt with?
Where does anxiety commonly come from?
What is the most common form of "treatment" or remedy for anxiety?
How do you know the difference between mild and severe anxiety?
The most common anxiety I see is anxiety caused from an underlying trauma history/response. One way of thinking about that kind of anxiety is seeing it as a low-grade, prolonged fight/flight response (activation of your sympathetic nervous system) that is trying to warn you or alert you to a potential perceived threat or lack of safety in your environment. This often happens below our "conscious" awareness and is sometimes referred to as “neuroception”, which in part explains why a lot of people with anxiety are not really sure "why" they are anxious, they just feel that they are. When we cannot move out of the flight/fight response into social engagement (connections and care from people around us) our nervous systems tend to hover in the flight/fight zone or, when that gets really taxing, our bodies go into a conservation mode, sometimes referred to as immobilization, which is another way of categorizing what we typically refer to as depression (not having the energy or the will to do anything).
Oftentimes we do not fully understand that we are having anxiety due to an experience of trauma and so we treat the "symptom" of anxiety rather than treating the underlying trauma. Historically, a lot of therapy for the treatment of anxiety includes things like progressive muscle relaxation (PMR), breathing techniques, and grounding techniques. This is historically paired with classic Cognitive Behavioral Therapy (CBT) interventions where you would help someone look at the thoughts/beliefs about the anxiety, their correlating behaviors, and then you offer them different ways of looking at the beliefs or behaviors in an attempt to "retrain" the mind/behavior of a person. Obviously medication is used to treat the symptoms of anxiety as well, but does not address the underlying issues.
(Side note: a lot of trauma goes under/un-diagnosed because there are no medications that effectively treat it, so a lot of people are given anxiety or depression diagnoses instead in order to justify medication medically. Then the medications fail over the long run because they haven't treated the root cause of the anxiety and depression and in the meantime have altered your nervous system (and the systems around it like your hormones) making it even harder to get it regulated again when someone comes off medications. People have the right to choose medications if they feel that that is in their best interest, but in my experience they are rarely given fully informed consent about the potential long term impacts of these medications on their bodies and their bodies' natural regulatory systems, and when I can, and it's safe to do so, I try and educate people about this and help them to step off of their medications.)
Excluding certain kinds of anxiety, like Obsessive Compulsive Disorder or Phobias for example, most kinds of "generalized anxiety" can be better treated with trauma-focused interventions. Trauma focused interventions are designed to move the traumatic experiences through our bodies (or in other words, through our sympathetic nervous system) while also identifying areas of social engagement and connection for someone, so that they are no longer "stuck" in fight/flight and can get the help and care they need. Trauma, and subsequently anxiety, can be seen as a failure of our social engagement system, rather than simply a "chemical imbalance", "genetic", or otherwise exclusively person-centered cause. Consequently, treating anxiety from a trauma-informed perspective means that we help people feel the feelings and sensations associated with the trauma in their bodies until that energetic experience moves through our nervous systems. Trauma focused interventions like EMDR and somatically based (body-centered) interactions help to do that. Teaching people the necessary social skills to appropriately ask for help when they are experiencing anxiety are also helpful. Teaching them about how our bodies respond to trauma is good too.
Most of us have some anxiety (activation of fight/flight responses) because most of us have trauma. Those with more trauma, especially from childhood, which is also called Developmental Trauma or Complex-Post Traumatic Stress Disorder, have more pronounced fight/flight responses because more things trigger our sense of safety and early childhood trauma conditions us to believe that we are not safe, even when we are. Early childhood trauma also conditions us to believe that we are not good enough or lovable enough to be cared for, which interrupts our natural ability to seek out our social engagement system. That becomes very problematic for people because when we are exposed to childhood trauma we discover that the very thing that is supposed to help us move through fight/flight (which would be our social engagement system) is the same thing that is causing us to be in fight/flight in the first place. We then end up in physiological feedback loops, below our conscious awareness, within our nervous systems, in which we avoid vulnerable connections with others because we fear that we will not be safe, loved, or worthy enough. Then we do not seek others out appropriately, our fight/flight system is maintained, and we stay stuck in our anxiety and our anxiety builds over time.
Another issue that contributes to the degree in which people experience anxiety is our ability to "be in our bodies". If you are really good at feeling things in your body (feelings and sensations) in the first place, and you feel supported by those around you, it is nearly impossible to experience trauma and consequently nearly impossible to experience anxiety. Unfortunately, one thing that trauma contributes to is a sense that it is not safe to actually BE in our bodies. We spend a lot of time stuck in our heads, thinking things over and over again (also called Rehearsal), and forget that the path through the experience is to stop thinking and simply have, name, and allow for our feelings and sensations to energetically move through us. People who do not fully know how to allow that process to naturally unfold tend to have much higher levels of anxiety. One of the reasons that deep breathing and Progressive Muscle Relaxation have worked historically is because they interrupt our tendency towards Rehearsal and get us back in our bodies. They are still impactful overall in treating trauma and anxiety, but a targeted approach that guides people towards feeling and experiencing the underlying feelings and sensations (often times fear, sadness, grief and the sensation of "holding" or "constriction"--also known as the freeze response) associated with the trauma can be more impactful for many people. .
When looking at any differences in severity, say mild anxiety to significant anxiety, we are looking at spheres of a person's life that are impacted by their anxiety. First I would look at their connections to others (again back to the social engagement piece). Is anxiety impacting their peer relationships, family relationships, romantic relationships? Is it impacting school or work? Is it leading to secondary mental health issues like addiction and is that secondary issue impacting their connections to others? To what degree is it impacting their daily living activities--does it get in the way of showering, cleaning, eating, sleeping, leaving their house? Does it get in the way of them enjoying themselves alone or with others? Is it starting to impact their physical health (under/over eating, weight issues, sex life, alcohol use, etc.)? Has the anxiety built up to the degree that they are now experiencing periods of conservation/immobilization/depression?
One of those most profound impacts from the pandemic and subsequent policies around how to handle it has been the isolation of people from their friends, family, and communities. We introduced a trauma (covid-19) and then we stripped people of their ability to impactfully access their social engagement systems. Anytime you have an overwhelming or threatening experience and you limit access to social connections, you are going to produce a group of traumatized people that now have anxiety. Pandemic policies are such a great, relevant example of why we have now doubled the rates of depression and anxiety in High Schoolers. These policies really impacted High Schoolers in particular because developmentally, High School is the time that you begin deepening and widening your social engagement systems so that age demographic really truly DID get hit with the biggest impact.