CHAPTER
3

Why Me?

In This Chapter

• Who gets anxiety disorders?
• The biology of fear
• Ways we learn to be afraid
• How thoughts influence anxiety
• What triggers your anxiety?

Monica’s parents describe her as a happy, sensitive, and eager-to-please child. Sure, in fifth grade, she went through a brief period of what she calls “nervous stuttering” and nail biting, but these subsided as she adjusted to a new school and her parents’ separation. High school was fine, even though Monica always felt anxious at parties and was terrified in her speech class. However, she had many good friends. And although she suffered for hours before a speech, she always managed to get through it. In fact, she was valedictorian of her high school class and received an academic scholarship to an Ivy League college hundreds of miles from home.

The first semester away was rough. For the first time, Monica felt dumb; academic competition among her peers was fierce, and Monica found herself doubting her ability to succeed. She also worried that she would lose her academic scholarship and let her parents down. Then in November of her freshman year, she learned her father had prostate cancer. On December 1, walking to class on a sunny but cold fall day, Monica had her first panic attack.

All of us experience stress and pressure. Many of us have lost someone close to us or faced the possibility. Yet not all of us develop an anxiety disorder. In this chapter, we look at why anxiety disorders develop and what clues their origins provide to help us regain control over our lives.

Who Gets Anxiety Disorders?

Although anyone can get an anxiety disorder, they are twice as common in women as they are in men. Anxiety disorders also show up more often in certain age groups; they can appear at any age, but most people experience their first symptoms in childhood, adolescence, or young adulthood.

Anxiety disorders also run in families. If someone in your family has an anxiety disorder, you are several times more likely to develop one yourself; in general, the closer the genetic link between you and your anxious family member, the more your risk increases. But even if your identical twin has an anxiety disorder, it doesn’t mean you will.

Certain life experiences also put us at risk for an anxiety disorder. A childhood history of abuse can increase our odds of adult anxiety, as can childhood parental loss or separation. In addition, children with highly reactive temperaments may be innately more sensitive to their environments and, as a result, more reactive to environmental stressors and the physical cues they generate.

So where do these disorders come from? Are they psychological or physical? The most commonly accepted model of mental illness is the diathesis-stress model. This theory proposes that some people are born with a predisposition for a given illness such as generalized anxiety disorder or panic disorder that may or may not develop, depending on what life throws at them. For instance, a natural worrywart may get along just fine until she is diagnosed with breast cancer. A shy teenager may develop full-blown social anxiety only in response to a humiliating school event or a bully’s constant teasing.

The answer, then, is that anxiety disorders often develop for biological and psychological reasons. When they do develop, what we put in our bodies and how we use our minds can make them better or worse.

ON THE CUTTING EDGE

Recent research suggests that anxiety and depressive disorders run together in families and share a genetic basis.

Psychology and Anxiety

Many years ago, psychiatrists and psychologists believed that anxiety was usually explainable in terms of unconscious conflicts, and psychodynamic theories still often focus on anxiety symptoms in this way. For example, the rituals associated with obsessive-compulsive disorder (OCD) are viewed as a way to ward off unacceptable impulses or internal conflicts. Phobias are sometimes interpreted as a use of displacement, a psychic defense mechanism whereby a person redirects thoughts, feelings, and impulses from a source that causes anxiety to a safer, more acceptable one. From a psychoanalytic point of view, a boy who develops a fear of horses may really have an unrecognized fear of his father.

Even today, from the psychodynamic perspective, anxiety is sometimes interpreted as reflecting basic, unresolved conflicts in intimate relationships or hidden anger. Treatment often centers on uncovering these hidden conflicts, impulses, and feelings. Unfortunately, there’s not much evidence that this treatment works as well as other treatments, at least for some anxiety and related disorders, particularly OCD and phobias (see Chapter 19).

STRESS RELIEF

There is some evidence that women may ruminate more about distressing life events than men, suggesting that learning to monitor and acknowledge thoughts and worries may be especially useful tools.

Behavior

The behavioral model focuses on how we learn to be afraid. According to behaviorists, we learn in three different ways: classical conditioning, operant conditioning, and modeling. All of these have implications when it comes to anxiety.

Classical conditioning is when you learn by automatically associating two different things or stimuli. In particular, the emphasis is on how we learn to pair a normal reflex action with a “neutral” stimulus nearby. If you feed your dog canned food, you can witness classical conditioning firsthand. Watch her drool when she hears the electric can opener running—even if you’re opening a can of pineapple! She associates the sound of a can opener (a neutral stimulus) with being fed and, as a result, is drooling in the absence of dog food.

How can this relate to anxiety? In a famous experiment, social scientist John Watson (1878–1958) intentionally induced a phobia in an 11-month-old boy by pairing a loud noise with a little white rat. (Please note that ethical standards have changed; no university would allow such an experiment now.) Every time little Albert reached for the rat, Watson clanged away. Not only did Albert begin to associate the white rat and the noise, becoming anxious around the rat, he also began to generalize. He became anxious around other white, furry objects, including a rabbit, a fur coat, and a Santa Claus beard.

But this doesn’t have to happen in a laboratory. For example, let’s say that when you were young you ate a chocolate-mint Girl Scout cookie, and shortly afterward you were violently ill with a virus affecting your gut. You might feel sick and avoid eating (or even thinking about) that kind of cookie, or Girl Scout cookies in general, for years afterward–even though the original cookie had nothing to do with your nausea and vomiting! This is classical conditioning at work, and it’s not hard to imagine how this could be useful in some circumstances; that is, it is not good to eat food that makes us sick. However, we don’t always know what makes us sick. Sometimes we have strong aversions without a reasonable basis, and we don’t even realize where these aversions come from.

Next, any parent understands operant conditioning; it simply means we learn to do things we’re rewarded for, and we stop doing things that lead to painful or negative consequences. Although this risk/reward strategy works well most of the time, it can backfire when our avoidance interferes with doing what we love or when short-term rewards lead to long-term problems.

For instance, most of us tend to stay away from things we fear. According to operant conditioning, this avoidance behavior tends to be reinforced because when we avoid (or escape) unpleasant situations, we feel better. An unfortunate side effect, though, is that this strategy reduces opportunities for us to overcome our fears. An attempt to avoid unpleasant feelings can have life-altering—even life-threatening—consequences. For the right person, a bad encounter with an inexperienced nurse and a needle could lead to avoidance of much-needed medical care for years. Fears of driving after a car accident could adversely impact our careers and our relationships.

Note that avoidance is not the only behavior reinforced in anxiety disorders; compulsions are also highly reinforcing! Unfortunately, though compulsions temporarily decrease anxiety, they don’t cure it—anxiety almost always comes back if the cycle below is not interrupted.

Finally, modeling is another way we may pick up fears. If Mom is terrified of snakes, we may decide all snakes are dangerous without ever coming near one. If everyone in the family is anxious about the same thing, we’re even more likely to jump on the bandwagon.

So is all anxiety learned? It appears that some anxiety disorders are more so than others. For instance, one study found that more than three quarters of people with a needle phobia had had a bad experience with an injection or blood draw. That may reflect learning at work, at least to some extent. On the other hand, a study of children who were terrified of water showed that more than half of them exhibited the fear at their very first aquatic encounter! Obviously, not all anxiety can be associated directly with learning.

MYTH BUSTER

“Stress causes mental illness.” In reality, stress may trigger an episode or cause worsening symptoms (e.g., of anxiety or depression), but this is just one part of a complex picture. There are probably many things that can contribute to mental illness—the causes are not yet fully understood.

When Twisted Thinking Leads to Anxiety

Cognitive theories of anxiety focus on the way our thoughts influence us. Here’s an example: picture yourself about to give a big speech at school or work. Imagine that you’re thinking to yourself, “Okay, I can handle this. I’m well prepared. Everyone here wants me to do well. Even if I make a few mistakes, it won’t matter.”

Now imagine that you’re in the same situation, but instead you’re thinking, “I can’t do this. I’m going to throw up. I’m going to pass out. The speech I prepared is pure garbage. Everyone is just waiting for me to screw up. One mistake and I’ll get an F [or get fired].”

It’s the same speech! But there’s no question about which situation would make you, me, or anyone else more anxious. It’s not just reality that matters—it’s what we think about what happens or what might happen that influences how we feel about the situation.

Cognitive distortions occur when our thoughts become unreasonable, irrational, or even ridiculous. Psychologists have a whole list of ways we distort our thinking when we become anxious. Some of these may ring true with you (note that these can overlap).

Catastrophizing happens when we turn a molehill into a mountain. “Oh my Lord, it’s the end of the world—I have to give a talk and I have a run in my pantyhose!” The reality? Most people won’t notice—or care.

Dichotomous reasoning means seeing everything as black or white. You’re either a success or a failure (and one mistake can make it seem like you’re a failure). In reality, none of us are perfect, and none of us are completely flawed.

Disqualifying the positive happens when you ignore the good feedback you get. Ten people say you look great today, but you find reasons to discount what they say.

Emotional reasoning happens when you decide that what you feel must really reflect reality. For example, you feel incompetent, so you must really be incompetent. Remember that our feelings can mislead us.

Fortune telling happens when you act as if your worst fears will certainly come true. You’re not worried the worst might happen; you’re sure it will.

Labeling occurs when we give a global label to ourselves (e.g., “I’m a failure”) rather than seeing something as a single event (e.g., “Well, I blew that one, but I’ll do better next time”).

Mind reading is when we assume others are reacting negatively to us, even when we have no evidence.

Minimization is when you don’t give yourself credit for your good qualities or accomplishments. You might be able to tell someone all your faults but nothing good about yourself.

Overgeneralization means taking one event and basing reality on that. For example, he says he loves you at the end of 99 phone calls, but if he forgets to just once, it must mean he doesn’t really love you.

Personalization means taking everything personally and ignoring other factors. “She didn’t smile; she must hate me!” (In reality, her cat just died, or she doesn’t feel well today.)

Selective abstraction happens when you focus on one part rather than the whole; you get five A’s on your report card and one B minus—and all you can think about is the B minus.

“Should” and “have to” statements can mess up your mind if you go overboard with them. Some 12-step programs refer to overdoing this as “should-ing all over yourself.”

STRESS RELIEF

One way anxiety can influence thinking is described in a metaphor of a lake. We don’t actually perceive things as they really are—we perceive them as they are reflected by our emotions, as in the surface of a lake. If we are emotionally unsettled, angry, afraid, depressed, or anxious, the reflection is distorted, and we cannot see things clearly.

Biology

What about biology? We discuss this later in the book in more depth, but we’ll take a brief look here. You may remember from high school biology that your nervous system transmits information throughout your whole body.

Your nervous system is divided into two parts: your central nervous system (the brain and spinal cord) and your peripheral nervous system, which transmits information back and forth to your central nervous system.

Next let’s get more specific. The peripheral nervous system is also divided into two parts: the somatic nervous system, which controls our voluntary actions, and the autonomic nervous system, which controls our internal organs.

The autonomic nervous system divides down yet again into two parts: the parasympathetic system, which helps us relax, and the sympathetic system. The sympathetic system activates our survival responses to perceived threats.

In extreme instances, this survival response is known as fight or flight. Your body is preparing you to either run away or do battle. This was probably great for our caveman ancestors. You see that mammoth approaching, and it’s time to run like heck or get ready to try to put it on the dinner table.

But this survival response is often no help with modern stressors. When we’re at the dentist’s office, it’s not appropriate to jump out of the chair and run or to challenge the dentist to a duel. It’s time to open our mouths and let the dentist do her job of taking care of our teeth.

STRESS RELIEF

Learning through rewards and punishments still works, no matter how old we get. But we can reward ourselves, too. Got a stressful event coming up? Depending on how stressful the event (and how much money you’ve got), a reward might range from a chocolate milkshake to a new dress to that getaway vacation you’ve been dreaming about.

The Fear Pathway

So what happens in the brain during fight or flight? The startling noise of a mammoth—and every other piece of worrying sensory information—takes two pathways. One pathway is to the frontal cortex, the reasoning part of the brain, where every perception is analyzed and interpreted with powerful processing tools.

But this processing takes precious time, so there is another, shorter route. On this route, the perception is rapidly matched by the amygdala against possible threats. The amygdala is an almond-shaped structure in the limbic system whose job is to trigger responses to danger. If there is a close enough match, the amygdala will hit the emergency button, raising the heartbeat, changing breathing, and revving up the engines for action. However, because the amygdala’s focus is on survival, it tends to err on the side of caution; accuracy takes a backseat to speed, and innocuous situations can be misperceived as dangerous. Right or wrong, the amygdala takes a stand long before the rational mind has processed the incoming data.

Of course, sometimes the amygdala serves us well in getting us out of real danger quickly. But many times this life-saving system activates our panic mechanisms needlessly. Even when the rational mind catches up and concludes there is no threat, it takes a while to calm down the systems that have been alerted.

All the physical symptoms of fear—the shortness of breath, the nausea, the need to use the bathroom, the speeding pulse, the restlessness—are caused by the amygdala’s response to a perceived threat. In the case of an anxiety disorder, this pathway becomes well trodden, a default pattern of response that becomes all too familiar—and difficult to maneuver around.

MYTH BUSTER

“It’s all in your mind.” Wrong! Anxiety, like all emotions, produces physical reactions in our bodies, too. Sometimes, particularly when the anxiety is extreme, the physical reactions can cause other changes, such as a reduced immune system from chronic stress.

Life Experience and Anxiety

We know that biology affects psychology: if your body is pumping adrenaline into your bloodstream, you’re unlikely to stay in a calm, peaceful frame of mind. But psychology can also affect biology.

Think about the last vivid dream you had. Was it scary, thrilling, funny, or just plain weird? Dreams are perhaps the most dramatic and challenging type of thought we have—and despite the frankly bizarre imagery, we usually completely believe dreams while we’re having them. This is because the analytical, fact-checking higher cortex of the brain is largely shut down while we dream. So when we wake up, we are often charged with all the emotions of the dream; the body is responding as if the dream is real. If the dream is frightening, the sympathetic nervous system accordingly opens up all the channels needed to deal with the apparent reality. In other words, your body is responding to nothing but your mind.

In a sense, our brain chemistry changes with every thought. Each time a brain cell makes a connection with another brain cell, a chemical called a neurotransmitter is released to jump the gap. And different neurotransmitters are produced for different types of thought. So our state of mind can clearly affect the biology of our brains.

What’s the Cause—Genes or Environment?

The simple answer is that it’s probably a mix of both. There’s no doubt that the genetic makeup we inherit from our parents sets a precedent for how we behave—we are all set at different emotional levels, and these levels are largely determined by our genes. However, this does not mean we are genetically doomed. Even if we are more inclined to respond with fear or anxiety to a given situation, learning how to manage emotions and irrational thinking is a powerful way to manage what nature and nurture have given us.

Take a look at the following table to compare the anxiety risk factors we face from both our biological makeup and what daily life can throw at us.

It’s clear that biology and the environment can both influence our susceptibility to anxiety disorders.

What Triggers Your Anxiety?

Film actress Scarlett Johansson recently divulged her anxiety trigger: work. She suffered severe panic attacks on the set of one of her movies. “I usually feel nervous before every film, but this time it was a lot worse. I was so nervous that, by the time we were ready for the first scene, I was nearly dead from anxiety.”

STRESS RELIEF

Daily hassles are minor irritants—misplacing or losing things, an unreliable car, continuous interruptions by a co-worker—that can create wear and tear on an anxious psyche. Dealing directly with these and building a strong support system can significantly cut down on chronic stress.

Understanding the causes of your own anxiety provides a basis for coping with and managing it. Studies have shown that there are some common causes for anxiety and anxiety disorders, but each person will have his or her own experience and triggers. What are yours? Rate your anxiety level for each of these known triggers.

In addition to these common stress inducers, you may also need to think about whether any of the following are already affecting your physical state:

• Are you taking medication that can cause excitement, nervousness, or irritability?
• Is your caffeine intake too high?
• Are you taking illicit drugs such as cocaine or cannabis?

Anxious feelings can spread easily. When we feel anxious, our perspective can be altered, and it can be hard to pinpoint the source of stress. So it’s important to analyze your physical state and anxiety level with respect to triggers when you are at your calmest.

You can also discover your own anxiety triggers by completing a stress diary, explained later in the book. Make a note of the situations in which you feel most anxious. Notice when your anxiety levels decrease. This is invaluable information in learning to manage your own type of anxiety.

Now that we’ve talked about the types of anxiety disorders, and the causes and triggers of your own anxious feelings, what can we do about them? Is it possible to change, or should we accept what we have and live with the consequences? And if we are to change, how do we keep up the motivation when the going gets tough? In the next chapter on what to expect on the road to recovery, we talk about these issues and more.

The Least You Need to Know

• You are not alone; anxiety is a very common phenomenon.
• Anxiety has biological and environmental roots.
• Biology can affect your thinking, and thinking can affect your biology.
• Understanding your own anxiety triggers helps to form the basis of recovery.