Anxiety and stress are closely linked
To understand anxiety, we need to understand about stress, because anxiety and stress are closely connected, though in two different ways. The first, perhaps most obvious, connection, is that very many anxiety problems arise because of chronic levels of stress. The second we will look at shortly.
What is stress?
Stress is any pressure or accumulation of pressures - physical or psychological - that is too much for a person to cope with comfortably. Therefore, what is perceived as a stress will vary from individual to individual. A marathon runner, for example, will have no difficulty running three miles, yet that might well tax most of the rest of us beyond our endurance. A stand-up comic may thrive on the 'rush' of performing live in front of an audience of hecklers, whereas just giving a short presentation to supportive colleagues will induce extreme panic in someone else.
Throughout our lives we may well have to cope with many highly stressful events, ranging from the death of a loved one, relationship breakdown, divorce, job loss, financial difficulties, sex problems and chronic illness to even much longed-for events such as pregnancy, a new child in the family and retirement. And less marked changes in our circumstances, such as a change of job/college/school, a deteriorating relationship with a partner or friend, grown-up child leaving home, more or less responsibility at work or difficulties with a new boss, can all take their toll.
When several events like these happen at the same time or within a short time span, we can be pushed completely beyond our normal coping capabilities. But even lots of small stressful events (or 'hassles') that mount up over the day can have a strong negative effect on us. It is often said that stress can be good as well as bad -getting married, for instance, or setting off on holiday are eagerly anticipated activities, yet they can also be highly stressful.
There is an important distinction, however, between being stretched and being stressed. When we are undertaking new challenges, whether planning a big event or learning a new skill, we are initially stretched beyond our comfort zone but, if we can rise to the challenge, it feels good. We feel excited. Whereas when we are stressed, we can't rise to the challenge: we feel defeated and negative and that the effort is too much. It feels bad, and we feel anxious. The physiological effects are initially the same (as we will show in a moment) but the outcome very different. In the first scenario, energy is discharged and something is achieved; in the second, there is nothing to show for it.
This is an important difference that needs to be more widely understood. In human terms, which we will be explaining fully later, all forms of stress arise because, in one way or another (for whatever reason), one or more essential physical or emotional needs are not being met in a person's life.
It may be something that happens gradually - starting, perhaps, with loneliness due to the loss of a loved partner or the inability, because of overwhelming shyness, to make new friends -and then builds and builds in an insidious way, taking the light and enjoyment out of life.
Or it may be something that happens suddenly, as on those tragic occasions when people, whose lives were working well, are caught up in a natural disaster or become the victims of violence - everything is changed in a flash, and their lives become ruled by fear, making it harder and harder for them to get their essential needs met.
When all of our needs are being met in balance and we are confident about our place in the world and about how we go about in it, we don't suffer from seriously disabling anxiety and stress.
How do we know if we are under stress?
If we are struggling to cope with day-to-day living, this can manifest itself in a variety of ways, such as:
- Disturbed sleep
- Physical complaints - certain conditions, such as asthma, angina, heart disease, migraine, skin complaints, high blood pressure, irritable bowel, peptic ulcer, rheumatoid arthritis and some cancers, can be triggered or exacerbated by stress
- Excessive alcohol consumption or the taking of drugs
- Burnout - this particularly affects dedicated professionals such as doctors, teachers and social workers who become overly involved in their work, and so don't keep their lives in balance
- Anxiety disorders
We all have different ways of expressing the excess demands on our body systems that we experience when we are under extreme pressure, and anxiety disorders are just one of them.
Suffering extreme anxiety is not a sign of weakness or lack of moral fibre: it is purely a response to stress.
Ongoing stress causes serious wear and tear on the body, whereas, if something stressful suddenly happens during the day and we take action to deal with it, the stress dissipates. In fact, we can even feel a sense of achievement when we've dealt with it. This is because' dealing with it' is exactly what our bodies were designed to do.
Way back in our evolutionary past, when predators were a daily source of danger, anything that could be perceived as a threat to our safety had to be responded to at once, in order to ensure our survival. We still have that survival mechanism now: it is known as the 'fight-or-flight response'. And it is the other reason that anxiety and stress are so interlinked.
For, physiologically, anger, fear and anxiety are very close cousins, and they are all natural reactions to stress-inducing threats.
The fight-or-flight response
Imagine for a moment that we are our long-ago ancestors, still living in the wild. Our very survival depends on our being ready to react instantly, if a wild boar thunders out of the undergrowth or members of a hostile tribe come over the hill towards us. As soon as we sense a threat, a cascade of bodily events is triggered to help us cope.
Almost instantly, the following happens: Our muscles tense ready for action. Our blood pressure goes up, to increase the circulation to our muscles and heart, which beats faster, to cope with the expected increased demands on it. We breathe faster, to speed up the time oxygen takes to get into our blood, and that makes our chests hurt and our bodies tremble. To divert as much blood as possible to our limbs to aid action, our digestion is interrupted, making our saliva dry up, and our kidney, intestine and bladder functions stop, causing the muscles at the opening of the anus and bladder to start to relax. We sweat, to try to cool ourselves.
Our bodies are flooded with 'stress' hormones that enable all these responses to happen and, as a result, we immediately flee the wild boar or fight the unwelcome tribesmen.
Once the threat is over, if we are still alive to tell the tale that is, our hearts slowly pound less, the shaking gradually stops and the sick feeling passes, as our blood circulation returns to normal and digestion and the other regulatory functions start up again. The stress hormones that were swarming through our body have been burned up during the action we took or else are neutralised as our body maintenance gets back to usual business.
This excellent system has served us well for millions of years. But it was designed to deal with circumstances in which we could take action. The stresses we face today are less often of the life-threatening kind.
More usually, we find ourselves in circumstances where we feel psychologically threatened (the boss is critical of our work; someone else is getting our promotion; we're being bullied at college; a neighbour is continually picking arguments).
Or we feel unsafe (we may fear walking the streets at night or meeting gangs of teenagers; the news is full of gloomy predictions about wars and global warming and deadly diseases).
Or we feel 'cornered' - but not by a wild beast that we can flee -we are stuck in a traffic jam; work deadlines are unrealistic; the phone keeps ringing.
The very primitive, early-developed part of our brain (which gives the directions that set our fight-or-flight response in motion) is not able to distinguish between events like those above which it perceives as threatening and those that actually are life threatening.
Even worse, it cannot distinguish between real or imagined life-threatening events either. ("I'll die if I have to get up on that stage and speak!")
Indeed, when the fight-or-flight mechanism first evolved, we didn't have a 'thinking' brain and there was no such thing as imagination. So now, if we imagine ourselves experiencing disaster vividly enough, we can still easily trigger off the fight-or-flight response.
But, when we are being criticised by the boss, sitting stewing in a traffic jam or imagining being trapped in a lift, there is nowhere to run to and no one to fight. And, although the physiological arousal that is switched on when we get stressed in such ways is mopped up quite quickly, an expectation that something - will or should happen - also gets switched on in the brain, and stays switched on, taking up our attention and energy.
This is a cumulative process and, with each additional stress, not only does more and more arousal occur but more and more expectation patterns stay switched on in our brains. Eventually this puts too much stress on us physically and it is at this point that one person might start to develop headaches or angina; another will turn to drink; and you may develop an anxiety disorder.
Whatever the reaction, it is the body's message that it has been pushed too far. Of course, stressful events will always happen. Some will drop out of the blue to scupper our plans, however well we may think we have prepared for every eventuality. At some point, someone we love will die. Companies go bust. Fires, floods and other natural disasters are all out of our control.
But what is within our control is learning how to deal with stress when it arises. By taking appropriate action of some kind, we can dissipate the stress hormones - this both relieves the stress and helps us to avoid developing anxiety. (We will look in detail at how to do this in Part 2.) So, while we can't prevent a lot of the stressful events we face in life, we can develop psychological robustness.
Continued in this article: Anxiety is usually what you make it
The widespread rise of stress
In our busy, modem lives, stress is hugely on the increase. Recent government statistics, for example, revealed that work-related stress accounts for over a third of all new episodes of ill health. And each case of stress-related ill health leads to an average of 30.9 working days lost; in 2004/5, a total of 12.8 million working days were lost to stress, depression and anxiety.
Indeed, sickness absence surveys have consistently shown that 30-35 per cent of employee sick leave in the UK is related to these same three factors. The insurance company UnumProvident has calculated that, between 1995 and 2001, changes in work patterns in the UK resulted in a 50 per cent increase in claims for compensation arising from mental and psychological problems.
Another insurance company, Norwich Union, reports on their website that one in every three claims is for mental illness, including stress, and this number has risen steadily over the last ten years.
In short, severe anxiety and fear-related disorders are a major and widespread problem that, surveys show, affect up to 18 per cent of the UK population.
Department of Health (1995), ABC of Health Promotion in the Workplace: A Resource Pack for Employees. London: Department of Health.
CBI (1995), Managing Absence. CBIj Centre File Survey. London: CBI.