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Introduction
Anxiety is adaptive. It drives the athlete, motivating them to compete, to train, to perform and to win. It drives the student to attend lectures, to read boring textbooks, to study and to pass. They may be anxious about failure, about humiliation, about losing self-esteem, losing confidence, losing momentum, about letting others down, or merely anxious to chase success. There are numerous fears that might trigger anxiety that is adaptive as it helps to drive some behaviour that is deemed adaptive for the individual. Anxiety
may also be triggered by danger, by the fear of death, fear of injury, fear
of annihilation. It is also,
obviously, adaptive as the individual must survive into early adulthood to
reproduce and into adulthood to raise their children and contribute to their
family’s (genetic) propagation. The
patient is walking cautiously through a jungle when a lion jumps out from
behind a bush. The
‘fight or flight’ survival program is automatically activated, triggered
by the sudden danger. Anything
perceived as threatening the integrity of the body or mind is a danger.
The organism is not supposed to ‘think’, just react in a
stereotyped physiological manner: The
adrenal glands pump out adrenalin, which acts on various organs.
The respiratory rate increases so that more oxygen can be pumped into
the blood. The heart rate rises so that more oxygenated blood is pumped:
perceived as palpitations. The
muscles prepare for action and blood flow is maximised to the muscles:
perceived as muscle tension. The
blood flow to the brain and gut is minimised: perceived as the mind freezing
and butterflies and nausea. The
aim is to maximise the patient’s strength and agility to enable a rapid
and automatic retreat. The
terror of the attack might provoke a punch in the beast’s nose to stun
it and give time for escape, if the individual has been cornered by the
beast. Although the patient may not realise it at the time, s/he may
be capable of accomplishing extraordinary feats of courage or strength
during that moment when they are physiologically at a peak of their
endurance. This
is what is supposed to happen, the way Nature (Natural Selection) intended the program to play
out. We evolved in an
environment where the dangers were consistent: large hungry carnivores,
smaller creatures inflicting poisonous bites, heights, strangers, extreme
sensory phenomena (dark, bright light, loud noise, rapid movement) and
unfamiliar water or land. These
are the atavistic fears -- the inbuilt, hardwired danger triggers that are
meant to activate the ‘flight or fight’ response. In
a hunter-gatherer, tribal, rural lifestyle, these dangers were diffuse.
When encountered, the survival program would save the individual’s
life. Those who did not have programs that were activated rapidly
would die out.
Thus there would have been a natural selection pressure on being
reasonably neurotic i.e. having a sensitive, trigger-happy nervous system. Those
who got anxious somewhat too easily (the neurotics) would have had more
uncomfortable, less relaxed lives, but they had a survival advantage over
those very calm, unconcerned people who didn’t worry about anything.
(Perhaps the latter compensated for their reduced neuroticism by being
more selfish and antisocial.) Neurotics
are also usually more anxious about how others perceive them and are thus
more empathic and giving. Certainly cooperating with others is a good survival scheme,
as organising into specialised roles is likely to improve subsistence
efficiency and permit rotation of roles.
There would be an opportunity to enjoy less stressful assignments
alternating with the more dangerous tasks (e.g. hunting), and this might
compensate for anyone with higher stress levels. Individuals
living in a tribal community would have been unlikely to encounter dangers
alone. Dependency behaviour is
adaptive as it improves survival prospects.
But it also makes you more dependent on others, which may make you
more anxious when not living in closely-knit groups.
Modern Western ideology worships the materially successful individual
working altruistically in a large anonymous society.
A bit of a paradox? Our
current environment is extremely different to the one we lived in for tens
of millions of years, in other words, the environment we had evolved to
‘fit in’ to. In the last
few thousand years, we began to congregate increasingly into villages and
cities. This progressed further
in the past few hundred years, such that it is now the case that we live in
densely packed cities. The
skyscrapers and swarms of strangers living in the metropolis of Manhattan,
New York, is a very alien environment to the rural savannah plains that we
had been living in for millennia, as small hunter-gather tribes of kinsmen. We
now live in an environment that our nervous systems find confusing.
There is an endless array of triggers that mimic the atavistic fears:
heights from buildings, planes, stairways, windows; strangers everywhere;
vast stretches of unknown terrain due to the large distances that can now be
easily travelled in short periods; unfamiliar sensations and phenomena
abound. These are interpreted,
incorrectly, as dangerous by the hardy ancestral nervous system within us. A
panic attack usually does not remit quickly, as it has been triggered by a
non-serious threat or threat that is not evident to the individual. Without any
serious danger present for the individual to escape from or destroy, which
signals an end to the danger and activates an end to the panic state, s/he is left continuing to pump out adrenalin, with its end-organ effects, for
longer than Nature intended. The
ongoing hyperventilation leads to an increased ratio of O2:CO2, which leads to
light-headedness, dizziness, headache, myoclonus (muscle jerks), carpo-pedal
spasm (muscle spasm) and parasthesiae (pins & needles). Because
the symptoms are prolonged (usually 10-30 min), the sufferer is confused and
afraid and begins to imagine the worst ...that they are about to have a
heart attack or stroke or faint or die from suffocation or heart
strain. Why
would panic attacks consistently occur in response to triggers that are not
particularly dangerous (such as a lion attack) or even in anticipation of
triggers or situations? People
appear to have a peak performance where anxiety is optimal at driving their
performance but beyond which it becomes counterproductive and leads to
reduced performance due to the severity of the end-organ symptoms and/or the
duration of symptoms. Some people seem to overshoot beyond the peak in
certain circumstances. Perhaps they have developed a hypersensitivity
to particular stimuli due to past experience telling their brains that they
did not cope effectively with that encounter with danger. Everyone
appears to have a different peak height beyond which the anxiety
becomes counterproductive. In other words, the same amount of anxiety
can be adaptive in one person and undermining in another. The
anxiety-performance peak is determined by an
individual's genetics interacting with their lifetime experiences. Most
psychiatric disorders' onsets, courses and symptoms are determined in this
way. See genes in the
Introduction. The
threshold appears to be modifiable. Repeated traumatic stimuli
occurring during relevant developmental stages appears to be able to
recalibrate the level of arousal that the individual ends up with, for their
particular environment. Even
a single traumatic stimulus is capable of permanently re-setting the
threshold, bringing it much lower and leading to an individual being in a
persistently hyperaroused and anxious state. See Post-Traumatic Anxiety
Disorder. Anxiety
of certain quantities and qualities can trigger another computer program
called dissociation. This can be defensive, helping the individual
deal with an intensely traumatic scenario by changing their levels of
consciousness, awareness, pain sensation and responsiveness. It may a
program equivalent to a non-human animal ‘playing dead’ to survive an
encounter with danger. In this case, the intensity of anxiety may be
helpful to the individual in determining when to initiate such a behavioural
repertoire. Unfortunately, if remaining for too long in this
dissociated state, there will arise distortions and misrepresentations of
the world around. These confusing perceptions and sensations may confound
the individual and stress them further, setting up a vicious cycle. We
still don’t know much about how different quantities and qualities of
anxiety work to influence the individual. Some forms of anxiety seem to lead
to increases of arousal and others to reductions. An example of the
latter is ‘learned helplessness’ when animals have been exposed to
situations where they lose control no matter how hard they try to flee or
fight. Almost
any external or internal stressor can trigger the onset of a hyperanxiety
state where the threshold to having panic attacks is lowered. Drugs,
medications, depressed states and other anxious states, such as OCD, social
phobia, separation from a loved one and psychosis, included. Even the
anticipatory fear of having another panic attack can trigger panic attacks. When
the individual tried to avoid the triggers this is called agoraphobia.
Unfortunately, the more one avoids the triggers and becomes convinced that
this is the way to avoid further panic attacks, the more anxious they become
and by pushing themselves further along the anxiety curve, they worsen their
condition. A
usually highly effective method of undermining panic attacks is to conduct breathing
exercises. This technique involves counting in a 6-second cycle in
one's head (1-and-2-and-3, 4-and-5-and-6, 1-and-2-and.... etc), whilst breathing
in through the nose during those first 3 seconds, then breathing out through the
mouth during the latter 3 seconds (4-6), repeatedly for about 5 minutes. Because
it is difficult to think straight during a panic attack, it is wise to practice
this breathing exercise for 5 minutes two-to-three times per day for about a
week or more. The sufferer may
develop all sorts of elaborate and detailed rituals as a futile attempt to
reduce the anxiety that the thoughts are creating. The thoughts need
to be identified as obsessions (abnormal ideas that are the result of the
disorder, not realistic ideas to be acted upon, not even with compulsions, which
only make the anxiety worse because the obsessions continue or become more
elaborate). They need to be seen as the tentacles of the octopus, which
must be fought continuously to win control back over the sufferer's
mind. Tools and weapons
to use against the OCD octopus are anti-obsessional medications (selective
serotonin reuptake blockers like Prozac), cognitive behavioural strategies and
behavioural tricks to undermine or ward off the anxiety symptoms, such as
breathing and relaxation exercised. Above all, the obsessions and
compulsions must be resisted at all times. Never give in to the obsessions
or compulsions. Ward the tentacles off with your mental
shields and swords. Cut them short by ignoring them ...they will always
eventually abate if they see they are not getting a reaction. This is called
exposing your brain to not performing the compulsions, which leads to
confidence and increased emotional strength to remain in control. It might be
helpful for the sufferer to imagine the octopus as 'the enemy' who they must
'fight', using tricks, tools and weapons such as active resistance, ignoring,
distraction, special behavioural strategies and medication to weaken the
octopus, shrink its tentacles and reduce its control over their brain and
behaviour. A PET
scan of a sufferer's brain shows a circumscribed area of overactivity.
This represents the source of generation of the obsessions, which then lead to
compulsions being performed. Anxiety can fuel the circuit. Therefore, anti-anxiety measures
greatly assist. Selective
serotonin reuptake blockers work here to shrink the degree of overactivity in
these neural circuits. The
circumscribed area may also be considered the body of the octopus (combining
with the previous metaphor), sending obsessions through tentacles into the
surrounding brain tissue. The
genes can be switched off with medications, which also dilute the hot
spot. Behavioural strategies can be used to fight and compensate for the
symptoms that the hot spot fuels. However,
genetics presumably play a large part in the development of the neural circuitry
(perhaps a 70% say in it) suggesting that perhaps some people may be more
vulnerable to developing PTSD if their circuitry is more vulnerable to getting
overheated ...in the same way that certain types of plastic coating electrical
wires may be more likely to allow heavy currents to lead to heat leakage and a
fire than others (due to different insulation levels). The
overheated circuit is overactive and the images and emotions that have been
imprinted by the colossal stressor keep intruding into the sufferer's
consciousness in the form of flashbacks, dreams and re-experiencing, especially
when triggers occur that re-activate that circuit. The sufferer
recognises which triggers do this and they may begin to avoid any situations
where those triggers occur. Taken to extreme, they often become
agoraphobic and housebound. It
may well be beneficial to spend some amount of time 'resting' the overactive
circuit by avoiding triggers. Once it has cooled down, then it might be
reasonable to begin to re-expose the jumpy circuit to the triggers, gently,
gradually increasing the amount of time in contact with triggers and exposing
the circuit to increasingly specific and stronger triggers in a step-wise
progression. It is important that this is done slowly and cautiously,
allowing the circuit to cool down sufficiently after each re-exposure so that it
can learn to be less jumpy and sensitive. It is
important to give the sensitive circuit adequate time to rest between exposures,
and to activate other circuits during these periods that are as disconnected and
as far from the sensitive circuits as possible. Thus, relaxing,
pleasurable and restful experiences (which do not activate the sensitised
circuits) must be undertaken regularly. In other words, activation and
strengthening of diametrically opposed circuits may be necessary. This
will lead to relative weakening and decreased sensitivity of the overheated
circuits that give rise to the PTSD symptoms. A
water drop causes ripples that progressively decrease in intensity and frequency A
weight lifer must gradually increase the weight of barbells when training
to improve muscle strength because if he progresses too quickly by overworking
he will cause a muscle strain or injury that will undermine his course of
training. Similarly, if he uses steroids he may cause unwanted side
effects. Being
in a state of high anxiety is like being a soldier on guard. PTSD
is like being haunted by a ghost living in your mind's library of memories, such
that the autobiographical books come flying off the shelves. PTSD
is like . |
This
assists the brain to learn how to conduct the exercise, without needing
to consciously "think" about how to do it, which is particularly hard
to do during a panic attack. This learning process is akin to learning how
to ride a bike, which requires wilful concentration until the coordinated activity
becomes learnt, and then can be conducted subconsciously. Theoretically,
the sufferer will eventually automatically conduct the breathing exercise
whenever anxiety climbs and the risk of a panic attack being inappropriately
triggered occurs. 
Obsessions are
like octopus tentacles putting the ideas into the sufferer's mind. Of
course, the octopus is a chemical creature (the chemical imbalance in the brain)
and the thoughts are experienced as originating from within, but as being silly,
purposeless and disturbing, but not foreign. Certainly the sufferer does
not want the thoughts and would like them to desist. 
In
OCD, genetics appears to play a large part in the development of regional
overactivity in the circuits that evolved to assist people in avoiding contact
with or ingestion of harmful agents. 
A
massive emotional stressor can lead to local, regional overactivity in certain
neural circuits in the brain. This is the classical disorder where
an environmental stressor is considered necessary for the psychiatric disorder
to occur. In other words, the environmental stressor is seen to be more
important than genetic vulnerability in the causation of the disorder.
Whereas in other psychiatric disorders, the interaction of genes and
environmental experience is seen as the route leading to onset, here the environmental
experience itself directly causes the onset. 
Trauma-Induced
pruning of cortical brain circuits in childhood may predispose to there
occurring an over-activation of limbic circuits in response to a serious
life-threatening threat later in life. This occurs due to reason circuits
inadequately compensating for the excessive fear response, or perhaps
over-excitability of the passion circuitry. It is normal for
post-traumatic symptoms to occur following a serious life-threatening threat,
but the over-activation of limbic circuits usually gradually dissipates as
reason circuitry becomes activated and gradually neutralises this limbic
over-activation. If the reason circuitry is less likely to fully activate,
an imbalance results between it and the passion circuitry, with a resultant
ongoing activation of the fear circuitry. 
The
False Alarm Metaphor