My guest for the interview today is somebody I know very well. This is my cousin Luigi Formisano, psychologist, psychotherapist and Wellbeing Practitioner. He is currently working between Italy and the UK.
Can you give us a definition of anxiety?
Anxiety is a feeling of fear we all experience when we are confronted with possible sources of threat and with difficult situations.
Do you mean that anxiety is a defensive reaction?
Anxiety helps us to be alerted when it comes to facing dangerous situations or to carrying out tasks that might involve some stress (e.g. an exam or something that we may find it hard to do or to say…). When things get out of hand they can become difficult for us to manage. Stress complicates things because our modern life has become too hectic.
What are the symptoms of anxiety?
Anxiety can be experienced as a constant worry about a person or about something. We can constantly feel anxious regarding a specific situation (like the mother always worried about her child’s health conditions); but it can also be experienced as mental state without a specific object but rather as a general condition that we call generalized anxiety. Symptoms may include: fatigue, irritability, insomnia, poor concentration, increased heart rate, sweating, muscle tension and aches, trembling, shortness of breath, dizziness, and irritable bowel symptoms such as difficulty with digestion or diarrhea (symptom also typical of colitis).
If the patient’s anxiety worsens, what may be encountered?
A sudden and unexpected increase in anxiety levels can lead to panic, resulting in uncontrollable urgency to remove oneself from a situation or a place. The panic can be related to a specific situation such as a crowded place, a waiting room at the dentist, a workplace and so on. It can also occur “out of the blue”, that is, without any specific trigger and this can create even more distress because we can’t really predict when a panic attack is likely to occur. About the stress, then, when we are tired and exhausted we feel even more anxious and this leads to feeling more stressed as a consequence. This is what we call a vicious circle.
And what do you say about phobias?
Phobias are irrational fears of situations/objects in themselves not necessarily dangerous; some people perceive these situations as very anxiety provoking and so quite impossible for them to face. When anxiety levels go up as in panic and phobias, we feel bound to avoid feared situations and sometimes also to stop doing things we would like to do (like with flight phobia). Over time, what was only avoidance of something becomes a habit, or rather something that we learn not to do in order to get on with life. Often at the onset of the problem the patient rationalizes by saying that they do not like to do a particular thing or to expose them to a particular experience; the trouble is that by keeping on avoiding situations that person will eventually experience a phobia.
What is the mechanism through which anxiety is getting worse?
According to cognitive behavioral therapy, we can organize our experience of anxiety in three different areas: 1) physical symptoms/ physical feelings 2) behaviors and 3) thoughts. These three areas interact with each other and a change in one of the areas generates a change in the other two. When we are feeling anxious this is because we read a particular situation in a given way (e.g., see a dog apparently aggressive), we feel physical symptoms (e.g. accelerated heartbeat), we have some thoughts like “I think the dog is going to bite me” and we adopt a certain behavior (running away). Dear Luigi, you will teach me, physical symptoms are due to the releasing of adrenaline into our bloodstream; this activates in the autonomic nervous system the fight-flight response, so called because our ancestors had to roll up their sleeves and do one thing or the other when meeting a lion. Today we are more likely to meet lions at the zoo but we perceive a danger for instance when we have to speak in public. The problems begin when we do something to relieve anxiety instead of staying in the situation and just getting on with things. If we give up doing those things we perceive as risky and we avoid situations, we feel some relief but this lasts only for a short time. In fact, after a while, thinking about what happened we tend to see things in a negative way for us and we have thoughts like these: “I could not do it! I did not make it!”. This will affect our confidence and contribute to making us feel more anxious as a consequence, and, thus, creating a vicious circle. The good news is that the adrenaline is produced in response and luckily we only have a limited amount of it so if we remain in the situation rather than avoiding it, the adrenaline will eventually wear off and this will help with familiarizing with the anxiety provoking situations through a process called habituations. In this way we learn to swim as kids and it is through this process that the tamers feel comfortable (sometimes too much) when they are in the cage with the lions. To sum up, when we avoid facing the feared situation we make things worse for us next time because we will be more likely to automatically avoid the problem without overcoming it. In this way anxiety takes control of our lives. The secret when it comes to anxiety is to face our fears and the right strategy is taking baby steps.
What about emotional eating?
You know very well sometime we indulge in comfort food when we are stressed and anxious. This helps in the short term, but just like avoidance mentioned earlier, this strategy becomes a trap in the long run!
Beware if we do deal with the source of anxiety at the grassroots (e.g., health problems, economic, family) the risk then is to use comfort food (and alcohol) improperly, and by this I mean not only to satisfy physiological hunger but as also a coping strategy for one’s anxiety. This helps with temporarily relieving anxiety but increases stress in the long run, affecting our health and our self esteem; this will have also an impact on our finances and more importantly on our wellbeing.