Anxiety as a functional aspect
Anxiety, along with depression, the disorder is probably currently the most widespread in the population of the Western world. But it is always legitimate to speak of disorder? Actually what we call anxiety is that set of physiological reactions, emotional, cognitive and behavioral component is a powerful adaptive body to the external environment.
When we perceive a threat (cognitive component: we evaluate the presence of an imminent threat), we feel fear (emotional component), the sympathetic system is activated (physiological component) and prepares the body to fight-flight mode, a defensive mechanism developed in each animal species, thus increasing the blood supply to the muscles, the heart starts to beat faster and faster, the veins contract and increases blood pressure, dilate the bronchial tubes and also increases oxygenation, it is simultaneously slowed digestion, the sphincters contract (physiological component or somatic), the body is now ready to hit or miss (behavioral component).
graphic nervous system
Multiple studies have also revealed how anxiety is closely connected to the quality of performance, as a good level of anxiety allows you to stay focused, active, alert, and then, in many circumstances, to do my best in what we are doing. In the description just made, you will notice, there is nothing unusual, no disease, no disturbance, but the simple description of a phenomenon that everyone has experienced it many times.
Anxiety as dysfunctional aspect
But those who suffer from anxiety disorders (in which category they enter: generalized anxiety, panic disorder, post-traumatic stress disorder, phobias, obsessive-compulsive disorder) says in a completely different transformations of the body and the sensations experienced. All the characteristics of sympathetic become bothersome symptoms that prevent a run "normal" of life: rapid breathing, palpitations, dizziness, nausea, headache, sweating, dry mouth, throat, muscle aches, chest tightness and gastric, feelings of confusion, confusion, hot flashes or chills, shortness of breath. The anxiety disorder is therefore the activation of the fight-flight mode in the face of danger or greatly overvalued or that is not actually located in the present, but it may have existed in the past (such as a major trauma in PTSD ) or you think might be in the future (the so-called anticipatory anxiety). Anxiety often originates in the present, it is very difficult, if not impossible, to recognize what causes this nagging feeling in the situation we are facing.
Returning to the relationship between anxiety and performance, too much anxiety deteriorates dramatically their results, so those who suffer from anxiety "over range" is often found to live below their capacity because in the most important was the fact autosabotato. The anxiety must be considered as an emotion like any other, in itself neither good nor bad. The difference between functional and a dysfunctional anxiety is the amount and matching with the context in which it occurs: to have a little 'anxiety before an exam is normal and profitable, have so much to be decided not to go and do It becomes paralyzing and self-defeating.
Relationship between anxiety, depression, panic attacks
Fear is similar to anxiety, but while the former has an object (I'm afraid to X), the second is no object (I feel in danger, but I do not know what I have to defend myself). Often people suffering from anxiety also experience panic attacks, which are the peak expression of symptoms which we have already spoken. The panic attack is unpleasant and terrifying experience where we experience a complete loss of control of one's emotions: you are afraid, you think of going crazy or star for having a heart attack. Many people go to the emergency room in prey or following a panic attack, but unfortunately, sometimes doctors are not trained to recognize psychosomatic manifestations and collude with the request of the same patients for more physical exams, fragmenting and breaking down the framework Symptomatic in a series of distinct elements. So tachycardia becomes a heart problem, breathing hard a lung problem, sweating problem endocrinological, digestion difficult problem gastrointerinale, headache a neurological problem etc. A lot of money, both public and private, and long, are then spent in search of some evil to explain their discomfort, and while, the anxiety of having something that you can not find increases, worsening the general status and removing the solution. In reality, though very unpleasant, there are physical consequences of panic attacks even when protracted. The worst damage appears to be rather the psychological, because the feeling of helplessness and lack of self-control that this event leaves, can seriously change not only the mood, but the style of the conduct of their lives. Indeed, there is a correlation between anxiety and depression. Often the two disorders occur together and independently, but in some cases people who for a long time suffering from anxiety and panic attacks to develop a sense of anxiety to their lives that can spill over into a real depression. At the same time long-depressed people, develop a perception of danger to their lives and to their destructive thoughts that can lead to anxiety and panic attacks. Many psychiatrists, in the case of depression, anxiety and panic attacks, suggests that drug treatments are a combination of anti-anxiety drugs and antidepressants. The drugs act on symptoms and tend to reduce their impact on the quality of life of patients, so their use is often be very important, especially in severe cases. On a psychological level, however, it is essential to distinguish the cases in which a disturbance is the consequence of the other and orient the therapy accordingly. In other words, focusing a therapeutic work of a depressed person who has developed symptoms of anxiety on management of the latter, it will have a benefit, but not solve the problems at the basis of the disorder, as well as, on the contrary, focus on feeling of abandonment / anger / sadness of an anxious person showing signs of depression, such as low mood or thoughts of death, without affecting its avoidant behaviors and its internal conflicts, improve your mood, but it will a real impact in improving the quality of life.
Theories on anxiety
I have so far limited to describing the phenomenological aspects of anxiety, that such events involve and what are the most frequent consequences, but now I would like to give some information in regard to the etiopathogenesis, ie what are the causes that make an adaptive mechanism that is born, dysfunctional. The purpose of this article is not to compare every possible theory in a systematic way, so I'll just mention the main theories of biological, cognitive and psychodynamic.
Many studies link anxiety to biological mechanisms, and of course is not surprising considering that a part of what we call anxiety consists of a physiological process. Gabbard (Gabbard, 2000), reports some research which suggests that alterations in the biological functioning brain are responsible for specific anxiety disorders or that behind them there is a shorter version of the gene involved in the transport of serotonin. It seems that almost 70% of individuals with the shorter version of this gene are more anxious than those who possess the longer version of the same gene. There is also evidence of a family history of anxiety disorder. In fact, the percentage of agreement for certain anxiety disorders are higher in monozygotic twins than in dizygotic twins. Note well that if genetics was the only mechanism responsible for pathological anxiety, the correlation between the identical twins and between the owners of the short gene should be 100%, but it is not so. Also it could be argued that households where the reference figures are particularly anxious can, by their example, teach a way "eager" to deal with life, or with their continuing concerns to the children give him the idea that not only the the world is dangerous, but they are not able to face it alone. Reduce the complexity of variables related to anxiety to only biological element also it tends not to distinguish more than it is an adaptive process (the ability to anticipate problems, is often creative solutions emerge) from what is a pathological aspect (paralysis faced with the thought of an action).
Another explanation comes from the theories developed by members of the cognitive-behavioral psychology. Anxiety is the body's reaction that is felt when we feel threatened, so every time we think of a dangerous situation, not only our minds, but our whole body prepares for action. However, prey to 'anxiety, I begin to think of the dangers that can occur and that I was not able to cope with so my reactions of fear and anxiety are congruent (imagine situations that terrify me and rightly feel fear), but thinking associated with the situation often is not, because I imagine scenarios that occur rarely. Imagine, for example, wanted to put at the head and start thinking "driving causes many accidents, often fatal, and I'm not good enough / to you can avoid them. I once crashed a car. If I take the car something bad will happen to me, but I'm forced to go to work, how do I? If you do not arrive on time will I fired and I can not afford it, so I will go bankrupt. ", The result is often that this kind of reasoning leads actually to an excessive increase in anxiety and a short attention span that is the actual cause many road accidents. This is a phenomenon known as self-fulfilling prophecy (Merton, 1971). The situation gets worse when they are aware of being anxious and I do not care anymore, reusing the example above, you have a car accident, but to have a panic attack while driving, and of course, the fear of having He lives in fear will lead to a spiral emotional increasingly enveloping greatly increasing the chance of panic. But in the reasoning of the first, there are at least four errors of thought
1. Exaggeration: the idea that every auto accident is fatal or that it happens so frequently is a clear exaggeration of the available data on the cases of accidents
2. Catastrophism: things can go wrong, but anxious people often do not think simply to a negative result, but the worst result obtained. If you arrive late to work maybe I will come recalled to punctuality, hardly will come fired.
3. Excessive generalization: a negative experience does not generate a universal law applicable at all times and in every circumstance. If I crashed a car it does not mean that I am not able to drive or who have a "serial tamponatore".
4. Ignore the positive: Often the anxiety makes us blind to the positive results and abilities. If in 15 years of driving I had a single incident, it means that in the vast majority of the time that I started driving I was up to the task.
In conclusion, the cognitive theory sees an error in the anxiety of thought, a short circuit between what you think and what you feel, so the cognitive-behavioral therapy focuses in examining and undermine these ideas of reference and teaching dysfunctional behaviors that can block the circuit of anxiety: for this therapeutic approach is the 'experience of being able to deal with situations that make us fear that diminishes the impact and defuse the vicious circle between thought and emotion.
Psychodynamic theories identify anxiety instead the signal of an internal conflict between the conscious and unconscious. Wishes or thoughts censored and removed from consciousness because they are considered incompatible with their own sense of morality and ethics, lose their object (no longer channeled towards a goal, and are no longer recognized by the conscience), but not their energy charge that find a new channel of leakage through the anxiety symptoms. Freud in 1925 he spoke in terms of a conflict of the ego (the organizing function of consciousness) which disguises and removes sexual desires or aggressive coming from 'Es (the most instinctual unconscious), for fear of punishment by the superego (its internal jury that judges and censorship). Moreover, according to Freud, every developmental period produces a fear characteristic of that stage, and based on his insights and those of later psychoanalysts, were unable to process a "evolutionary hierarchy of anxiety" (Gabbard, 2000: 244). Within more mature level in the most primitive there are:
· Anxiety superego (resulting from the superego, is the perception that something in your behavior does not comply with an internal standard of moral adequacy)
· Castration anxiety (in the oedipal phase, the fear of receiving an injury to the genitals, and by extension any other form of physical injury at the hands of a parent figure vindictive. This fear must not only be taken literally, but symbolically such as fear of incurring disapproval when you put on the same level, or higher, their caregivers)
· Fear of losing the love (in the pre-Oedipal, fear of losing the love and affection of significant figures)
· Separation anxiety (in the pre-Oedipal, the fear of losing not just affection, but physically the love object because it disappears or dies)
· Persecutory anxiety (is a very primitive form in which it is feared that dangerous and harmful elements will invade his consciousness from outside or inside)
· Disintegration anxiety (fear of losing their internal borders and their own sense of self, and because it merged with another object, either because not recognized by others)
In conclusion, for the exponents of the psychodynamic theories of mold, anxiety is a sign / symptom of an internal conflict, it appears when a desire, an emotion, or a feeling, is censored and removed from consciousness; psychic energy and biological linked to that impulse is not destroyed, but it manifests itself in the form of anxious symptom in which, however, it has lost the connection between emotion and the object to which it is addressed, making it completely unconscious, sufferers d ' anxiety, the underlying reason for which the experiments.
Concluding remarks on anxiety and panic attacks
We call forward to a series of physiological and emotional signals that produce and at the same time are powered by thoughts and behaviors specific. Anxiety is an adaptive process to the dangers of the environment, the ability to predict them and be able to plan in advance how to deal gave an evolutionary advantage to the species, therefore it plays a crucial role in the survival and should not be considered just a nuisance or a pathology. It is not the mechanism of the anxiety to be pathological, but becomes so when anxiety exceeds a level, different for each person and individual, which makes it dysfunctional and counterproductive. Anxiety is associated with panic attacks and depression, but also with low self-esteem, relationship difficulties, phobias, some sexual disorders, some intestinal disorders etc, should therefore not be underestimated the impact it creates on the psychological well-being general. It has no correlation with intelligence, but it has the performance: severe anxiety can make it unable to perform simple tasks, making us feel stupid that never was. The main theories on anxiety caused by seeing the pathological aspects of genetic or physiological changes (biological model), from errors of thought (cognitive model) or by internal conflicts unresolved (psychodynamic). Frankly I do not see why these models should be excluded from them, I think that there is indeed, in every model individually considered, the risk of over-simplification of a very complex psychosomatic phenomenon. I am inclined to think, for example, that individuals who have a genetic predisposition and who live in a particular social context, family and the environment, may be unable to respond adequately to its internal conflicts, thereby developing the symptoms of anxiety, and later, in an attempt to manage, produce ideas and unfounded theories about themselves and the world around them, by implementing avoidant behaviors that feed more disorder.
In clinical practice I have often seen people particularly aware of a plan of their cognitive processes anxious and their errors of thought, with which a purely cognitive approach would be fruitless, but not at all aware of their own emotional conflict, or otherwise capable people of great depth introspective and emotional honesty, with which every psychodynamic interpretation seemed superfluous, but stuck in a spiral cognitive and behavioral could not see from their perspective. Moreover, in some cases, a pharmacological help to ease the symptoms too intrusive was crucial to start a work in finding the causes of the problem, in others, the erroneous attribution of any improvement to the drug has fueled greater insecurity and sense of impotence, and are therefore completely counterproductive on a psychological level. In the health and mental well-being, is, in my opinion, simplistic and reductionist not take care of the whole person, but only the single symptom or disorder. "Treat surgically" anxiety, or focus only on the reduced symptom psychotherapy, is an operation that can succeed, but that does not take into account the problems sottacenti disorder and conflicts that have generated. Nevertheless, I understand the reasons of those who for lack of time, introspective abilities and / or cognitive, motivation, money etc. He decides he wants to be helped only a short path focused on the management of anxiety, without wanting to put into play other aspects of the self; I understand, but I prefer a choice that leads to a partial solution and not to personal growth.
I believe that all theories of reference have a common element: the control. That anxiety is due to an exponential increase in the supervisory function that warns us of impending danger (environmental control and physiological), or that it is due to a cognitive attempt to predict every possible consequence of their actions (control cognitive and behavioral) or, finally, that it is due to our unconscious attempt to avoid certain feelings and emotions (emotional control), the actual result is that excessive effort to control results in the loss of control (including panic attacks are an obvious retaliation) . A first step to lower the anxiety level is therefore to accept the idea of not being omnipotent, that the things most of the time are not under our control and that flexibility, not rigidity, is our best weapon defense and resolution.
