For quite some time, and likely still, the “common cold” of mental health seemed to be depression. Statistics are hovering around the 1 in 10 mark for experiencing a depressive episode in one’s lifetime, with men being the more likely gender to suffer it. Keeping in mind, of course, that these are only reported cases in which a diagnosis was given. If we acknowledge that in a lot of cases a depressive episode will go unreported and undiagnosed, that number goes up a significant amount. I would guess that it doubles at least.
But this is not a post about depression.
I recently decided to go through the list of people that I’ve seen in the last 8 months and tally up the “presenting concerns.” The issue at the top of the list, unsurprisingly, was our common cold – depression (incidentally, only a small fraction of these people had a diagnosed ‘disorder’ such major depressive disorder – though many met the criteria). But coming up at a close second was another issue that has been, in my view, becoming more and more prevalent: anxiety.
It’s not always easy to separate the two. In fact, in the DSM-V, they are flirting with creating a new diagnostic category called mixed anxiety depression because the two so often play together.
In any case, if I were to count the number of issues of my clients without limiting it to one issue per client, I’m confident that anxiety would be at the top of the list. It’s just something that accompanies other problems. And there’s good reason for that, which I’ll get into shortly.
Now, I’m not too big a fan of the manualization of therapy. I like to think that each individual person that I sit with has a unique life situation and that there are many equally valid ways of resolving whatever distress they are going through, and that we have to work to find out which way is going to be the most productive. I have a problem with pretending to know exactly what is required to do to ‘fix’ a person before I even know anything about them.
However, when it comes to anxiety (and perhaps more specifically, panic), there’s come to be one thing that I ALWAYS do, and it couldn’t be simpler. It takes 5 minutes. It’s so simple that I’m going to do it with you, right now, because I know that you’ve experienced anxiety before and that this might be new information for you. But that’s all it is: information. So, without further ado, I present to you…
A Brief Discussion on the Physiological/Evolutionary Nature of Anxiety
At some point in our evolutionary history, the fact that some folks had something that we now call the ‘autonomic nervous system’ became somewhat of a survival advantage. You see, this nifty gifty had two sub-systems: one called the sympathetic and one called the parasympathetic nervous system. The former had this neat function where it got us really pumped up in response to some kind of threat in our environment. Maybe a poisonous snake crossed your path, maybe some pre-historic douche-canoe was making moves on a certain female member of the species that you wouldn’t mind impregnating. In any case, a threat is detected. This is where the sympathetic nervous system decides to step in and do its thing. Suddenly, more blood starts pumping out to your arm and leg muscles, your heart rate doubles, breathing becomes fast and shallow, and your pupils dilate, and all sorts of chemical changes start happening. In a split second, you are literally stronger, faster, and more alert. Now, you have much more capacity with which to either flee the threat or engage it physically. This is what is more popularly known as the fight/flight response.
This is all well and good. Obviously this all developed over generations and the process of evolution refined it to be what it is today. But as with so many traits that allowed us to survive in an ancestral environment, it doesn’t always function with the same level of effectiveness in our lives today. The simple fact of the matter is that, for the more fortunate of us, we don’t live life surrounded by the possibility of constant threats to our survival.
So, for those of us who don’t have problems with anxiety or panic, this system tends to be well-regulated most of the time. Every now and then a legitimate threat is perceived and you’ll get that response happening, but most of the time, when faced with normal everyday stimuli, nothing happens.
When we start talking about anxiety, and particularly with panic attacks, what effectively has happened is that the sympathetic nervous system’s threshold has been lowered way down. It’s been over-sensitized for some reason (which obviously varies depending on one’s history – in the case of trauma there is very good reason for this). But the point is that there is a natural, physiological process that is happening – one that was well-developed back when our ancestors didn’t have the cognitive abilities that we now possess in order to make logical sense of the the world around us.
So, when someone with social anxiety begins to have a panic attack when forced to interact in a group, we (and they) can easily come to the conclusion that it just doesn’t make any sense for that to happen – nothing bad is going to come out of it and there is no logical reason to become anxious. But on a deeper level, this system that’s basically been told to go into red alert status starts going off the rails.
So what about this other subsystem of the autonomic nervous system – the parasympathetic one? This one is actually responsible for the exact opposite function of its sister – it calms us down when a threat is no longer present. Our blood begins to flow back to our core, heart rate slows, pupils return to normal size, breathing slows, and all sorts of chemical changes happen. It’s no longer adaptive to be hyper-vigilant and ready to spring at the drop of a pin. And this is also the system that has to start kicking in when maladaptive anxiety is starting to cause panic.
It’s just not possible for both of these systems to be fired up at the same time. You can’t be anxious and relaxed simultaneously. And this is the bottom line of what I say to anxious people. The beauty of it is that there is an incredibly simple way to kick-start the parasympathetic nervous system’s calming effects – it’s as simple as taking control of your breath. Slow down your breathing, you slow down your heart rate, and just maybe, that gets some of the other processes going.
I find it to be a hopeful message. It’s just a starting point, and it’s by no means the ideal, ultimate solution to anxiety, but it is simple enough that it’s worth saying every time.