Anxiety disorders: what they are and how to deal with them
The anxiety disorders are medical conditions worthy of attention, among the most common and more particularly in this period of global health emergency.
There are various clinical manifestations that share a state of fear and excessive anxiety, as well as the implementation of dysfunctional behaviors for psychological well-being .
Anxiety and fear are not mutually exclusive, but integrate by remaining distinct from each other: anxiety refers to muscle tension, being alert and preparing to face the adverse situation, while fear is associated with thoughts concerning danger and avoidance behaviors (APA, 2013).
In other words, the former responds to a physiological aspect, the latter reveals cognitive elements, including images and ” mental films “, and behavioral reactions to a perceived threat.
What distinguishes an anxiety disorder from an adaptive reaction to stress is the persistence of symptoms that continue to last over time, as well as the excessive reaction that often implies a difficulty in regulating certain emotions, both by default and by excess.
Contrary to stereotypes, anxiety does not only capture subjects commonly defined as “emotional” or “hot” , who often get scared, amplify the nature of the various dangers (diseases, driving, going around the street, being judged negatively or staying alone, for example), but also people who appear controlled, “cold” , able to manage emergencies and the most difficult situations, the “loners” who often rely on their own strength, rather than relying on others.
A panic attack , for example, can be the same for various people, but hide different ways of dealing with difficulties, various episodes before and after the manifested problem: for this reason, managing anxiety means first of all exploring your own way to react to one or more changes in relationships and circumstances, changes that are relevant for psychological functioning.
Avoid rather than face
In an anxiety disorder it is common to avoid the feared situation or object. Those who experience an agoraphobia, for example, are afraid of leaving home for fear of passing out, of collapsing on the ground and hurting themselves, of losing control, of making a bad impression in front of passersby, or of meeting some acquaintances, friends , relative who can mock them and go to blurt out what happened, or even take them back on their cell phone and publish everything on social media.
Consequently, he will set aside crowded places for fear of being trapped in an unpleasant situation and being suddenly seized by a panic attack, which would make escape impossible or difficult (Guidano, Liotti, 1983; APA, 2013).
The child with a separation anxiety disorder will feel anxiety before going to school, while staying in the classroom, will often avoid lessons to stay at home.
Or even a teenager with social anxiety disorder (or social phobia) will avoid hearing or talking to certain people for fear of being judged. The more the feared situation is avoided (for example, avoiding going to the supermarket, at work, taking a walk) the more you lose the ability to manage a difficult situation effectively, learning to find illusory solutions that do not solve the problem and risk solidifying it.
The salient contents
Under an anxiety disorder there may be the fear of contracting a disease (hypochondria), of being infected and infected, of being abandoned by a partner who lives in another home and of being alone, of losing your job and feeling useless, to be rejected or to end the year with lower marks than expected with consequent feelings of shame and inadequacy.
There are also fears of ” falling behind ” with sports, artistic training that at home has not been possible to perform correctly, with the feeling of having violated one’s own standards or those of the discipline. There may be a finding that we are different from others, that we cannot be of help to those who are ill or loved ones far away, or that we are not sufficiently correct.
Anxiety disorder can occur in conjunction with conjugal or family problems, with significant changes in one’s existence that lead to revolutionizing everyday life and adapting to a heavy, tiring, unsustainable circumstance. Everyone experiences the disorder differently depending on how he perceives himself, others and reality.
Everyone, therefore, reacts to the difficulties with certain strategies that at some point do not have the same effects, the psychic structure has undergone too many disturbances to be restored with the usual ways of managing a critical situation. For this reason, psychotherapy helps to broaden the various ways of dealing with anxiety, the points of view on the problem that allow you to treat it in its real dimensions, with a more balanced emotional regulation.
How to deal with anxiety disorder
The first intervention in an anxiety disorder is to skim the moments in which it occurs, the places, what happens before, during and after, what is avoided and why.
The episodes, the dynamics of the disorder are explored, the therapy objectives are agreed together, involving the patient in what he will do and how he will work. The therapist is therefore comparable to a trainer who helps to observe what happens in the inner world step by step, without putting pressure or haste.
The patient brings his experience, what has changed and led him to ask for help, to develop a symptom and the therapist the method, his expertise that has the purpose of rearranging the pieces and having a clearer and more complete situation . He does not trim invasive and imaginative interpretations, he explores together with his interlocutor, with the due times.
Working on anxiety means identifying the situations that trigger the disturbance, the personal emotional and cognitive reactions, or the images and thoughts that arise , the emotions that are tolerated less and influence mental states, behaviors.
You learn to discriminate thoughts from emotions, persistent and dysfunctional thoughts from adequate ones, how to use images and sensations, relaxation techniques. You learn to monitor emotions and thoughts and to manage the problem with targeted techniques.
Anxiety disorders: clinical cases
Giulia ( invented name) is 16 years old, cannot go to school, cannot meet friends and boyfriend due to restrictions on the Covid19 health emergency.
One day her mother asks her to go shopping at the supermarket and as she goes down the stairs Giulia feels a strong hot flash, her legs are trembling, she can’t breathe and she is afraid of collapsing on the ground. She can’t stand the mask, but she doesn’t feel confident about taking it off.
Giulia manages to do the shopping, but with extreme effort, she also feels dizzy and is forced to stop several times on the way to remove the mask and breathe, even for a few moments. When she returns home she tells the story, but her parents reassure her that the situation is difficult for everyone and she will soon pass it.
Panic attacks, however, repeat themselves, occur at different times of the day and on different occasions. One of them is while waiting for a response from the boyfriend, when he does not receive any response to his calls or messages. It also happens when her father silences her to watch television, just when she confides in him the discomfort of not going to school and not going out with friends.
With therapy Giulia begins to focus on the episodes, writes them down, notes the thoughts and images, what she gets to do, the reactions of others. He discovers that under panic attacks there is a sense of loneliness, a pervasive sadness that he cannot focus on.
Carlo (invented name) is 25 years old and often feels restless, tired without knowing why. He lives only during the quarantine and cannot go to his parents and brother residing in another region due to restrictions. Carlo does not want to go to the supermarket, he has difficulty concentrating, the main concern is centered on the possibility of contracting Covid19.
Scenarios of hospitalization in intensive care, of excessive weight loss, which trigger a feeling of suffocation and nausea, are activated. So he often starts calling his family, some friends, he contacts the ex who hasn’t heard for months, writing and calling them several times a day, he often connects on social networks.
He feels a great need to talk about his concerns, about the work he cannot do from home, about the improprieties of people, about any problem, even the slightest, he gives a lot of space to his monologues rather than dialogues. At some point the fiancée makes it clear that she no longer has any intention of continuing this resumption of contacts, because she has the impression of feeling used, noting the little interest in her problems. He adds that showing up after four months of silence, in a situation like this, is no accident and should reflect on it.
He denies it, but the girl does not retrace her steps. During a video call the father, after listening to him with impatience, gets nervous and asks him with harsh tones to stop with these complaints because they already have enough problems as they are older and more exposed. The brother does not answer calls, he contacts him when he is free. He seems to devote little time to him because of work and his family.
In therapy Carlo begins to identify the symptoms and the moments in which they emerge. He understands what happens especially when he realizes that he is alone in facing this big problem and that he feels the need to talk to his family and ex to reassure himself. He acknowledges that he does not feel self-sufficient right now, that he has a great need for comfort, basking in the fear of getting sick. Failing to control such a situation terrifies him and clings to others in an illusory attempt to feel protected.