Reflections From A Chair

[anxiety psychotherapy panic]

This is my first effort at a blog. So, it may take a while to get it right. I appreciate your patience and any comments or suggestions you may have are welcome. My hope is to get one installment on to the blog per week.

I will start by providing some educational material about some of the common problems that bring people into my office. Given the nature of blogs, I can neither answer questions about specific cases nor provide an exhaustive coverage of the topic. It is, after all, a blog and not a book. None of the information presented in this blog is a replacement or substitute for psychotherapy, diagnosis, or treatment by any professional. (Please refer to the privacy policies of my website for a fuller discussion of this matter.)

What’s In a Word?

Anxiety in one form or another is perhaps the most common problem for people in my practice.

One of the best starting points for the treatment of anxiety comes from the definition of anxiety. For such a common emotion, the Wikipedia definition is technical and stuffy. However, it still helps to make a clear distinction between anxiety and fear. They write: “Anxiety occurs unconnected to a specific identifiable external stimulus; as such it is distinguished from fear, which occurs in the presence of an identifiable threat.”

Now, let’s look at the history of those two words, anxiety and fear.

The Online Etymology Dictionary traces the original meanings of anxious and anxiety to “uneasy, troubled in mind” and “choke, cause distress,” “tightness, narrowness.”

Their history of the meaning of fear includes “danger, peril…harm…risk…”

All right, we have the definitions and their history. Now let’s see how they apply in practice.

Anxiety is a state of vigilance, being on alert, worrying that there is a looming problem. There is no clearly identified threat. We are troubled or worried about something hard to define or to put our hands on. For example, “I’m anxious because I heard a noise in the dark.” However, a noise in the night does not clearly identify any harm or risk.

Fear, as we found out above, is an emotion we have when confronted with a real, external danger. For example, “I am afraid of the growling, drooling dog that is coming toward me.” The danger and peril are clear-the rabid dog wants to bite me.

In day-to-day life, both anxiety and fear play important and necessary roles. Anxiety alerts us to the possibility of danger. Fear informs us about a clear and present threat.

When we are anxious, a host of biological processes kicks into gear. (In a later blog entry, I will deal more with the biological side of anxiety.) At the same time, our thoughts turn towards identifying potential threats. This is as it should be. Our internal warning systems engage when there is a vague but still potentially real risk to our welfare.

In anxiety, it is difficult if not impossible to plan a course of action. That holds true because we are still uncertain about what the real threat is. Without knowing the source and nature of the threat, we cannot make reliable plans for our protection and defense.

Actions based on anxiety are often regrettable. Perhaps you can recall reading about one of those instances where a parent hears a noise in the middle of the night. He or she grabs the bedside pistol and anxiously goes down to investigate. Hearing the noise again, the levels of anxiety rise and they pull the trigger. Thinking that they have defended the home against an intruder, they are shocked to learn they have shot one of the children.

In these cases, anxiety warns the parent of the possibility of danger. However, before fully determining if there really is any threat, they act blindly. It is important to see that anxiety itself can be the foe. It is crucial to hold back until verifying if there is anything to fear.

These tragic scenarios show us the real value in fear. Fear occurs when we can identify the threat. When we are fearful, we have a lot of energy and our thoughts focus solely on the threat. Now we can make plan to deal with the threat. When in fear, the who, what, when and where are known. The rabid dog is right now ten feet in front of me. Our job is to use fear to figure out how to deal with the dangerous situation.

Using the intruder in the night scenario, the anxious parent goes down the hallway and yells down the stairs “Who’s there; is that you Johnny?” The parent then turns on the light. If he or she sees little Johnny getting a glass of water, the anxiety vanishes with a sense of relief.

However, if it is a thief, anxiety turns to fear. The parent can now make and evaluate plans. Is it best to yell and order the thief out of the house? Is it better to use a cell phone to call the police? How would it work out to run back into the bedroom and lock the door? Is there no other option but to shoot?

Closely related to anxiety and fear is panic. Panic, according to the NIMH, is “characterized by a fear of certain disaster or a fear of losing control.” Someone panics when they judge that there is no escape from an overwhelming external threat. Alternatively, panic comes when someone no longer has a feeling of control over oneself. Panic abandons the attempt to reason or plan one’s way out of danger. The instinct to run or to freeze in place takes over. Like the old joke: When all else fails, Panic!

Panic has a valid role in survival. It is logical to run from an oncoming disaster. “Run, the house is on fire.” It can be just as logical to become immobile and play ‘possum. “Shh! Don’t move and he won’t see us hiding here.”

Anxiety, fear and panic in the right context are healthy and adaptive responses. They become reasons to enter into psychotherapy when they occur without apparent reason or in situations where they don’t belong.