1) What is normal?
2) What is "human"?
One mission of my blog posts is to reduce stigma towards mental health conditions. I seek to broaden the concept of normality. Freud promoted a conceptualization of anxiety as neurosis. I want to disabuse that notion. Every human being is faced with fears: "am I good enough? am I safe? will this work out? did I leave the oven on? will I lose what I have? will I not get what I want? does [insert name here] respect me?" The line crossed from management of these anxieties to impaired daily functioning can be infinitesimally thin. The "normal" reaction to anxious thoughts can be so blurred that one week it is fine and one week, it is not fine.
I now recognize I've been thinking too small in my push for broadening the concept of normality. I was focused on human beings. How incredible it is that anxiety even extends into the crawdad and other animals. Findings reported on Thursday in Science indicate that crayfish that had not been shocked were more adventurous. Similarly for humans, when we receive confirmation of our fears (e.g., [insert name here] describes disliking us), we may shut down and be more cautious so as to not get hurt again. I believe courage doesn't occur simply when one accomplishes a feat such as climbing to the top of a 14,000 foot peak. Courage occurs in the context of accomplishing what one fears: climbing the peak takes courage if you fear heights, initiating social contact with someone new takes courage if you fear rejection.
For the crawdad, medication that was a precursor to Valium, alleviated the anxiety even after being shocked for the crawdad to again be adventurous.This brings me to my third reflection: treatment. There are multiple medication options. Some work with the GABA receptor, such as benzodiazepines, and have a sedative effect. Beta blockers, a medication that reduces blood pressure, can help manage acute anxiety situations such as public speaking.
While the crawdad may not have the cognitive capacity to engage in talk therapy, cognitive behavioral treatment is very effective for reducing anxiety in humans. The cognitive component explores two common errors that underlie anxious thought:
1) increasing the likelihood of the negative event
2) increasing the negativity of the consequences of the negative event
For example, panic disorder with agoraphobia is maintained by the fear of having a panic attack in a public place and being judged by others. Driven by increasing the likelihood of a panic attach as well as over-catastrophizing the impact, people have difficulty leaving their home environment. Exploring these thoughts, really getting to the meat of them, is helped with professional therapeutic guidance.
The behavioral component of CBT for anxiety looks at avoidance. When we avoid the social event due to social anxiety, the immediate relief from this decision sends evidence that we would have been unsafe. It is necessary to approach that which we fear to see that the world does not fall apart even when the negative event occurs. With obsessive-compulsive disorder, the behavioral component is termed exposure response prevention. Specifically, the obsession is triggered and the person is not allowed to engage in the compulsion to provide evidence that nothing catastrophic in fact happens.
If your heart is racing as you read the previous paragraph, please know that the behavioral process is gradual. You construct a fear hierarchy and therapy begins with items that generate less fear first. It is key that you don't embark on a stage until you know can sit in the fear until it eases: termed habituation. If you stop in the middle of an exercise, at a point of high anxiety, the reasons to fear are reinforced.
Please remember that very little separates people impaired by anxiety from people with manageable anxieties. In fact, the avoidance that occurs due to fear is mirrored in crawdads! In a gentle, compassionate way, consider what it would look like to approach that which you fear. List what you would do if the worst outcome occurs to reintroduce a sense of agency. You know what it is like when a song is stuck in your head and you have to play the song in its entirety for that to stop? Anxiety thoughts work similarly. By clearly determining solutions to even the worst outcome can stop that song.