Anxiety treatment

Anxiety is a completely natural feeling, just like joy, anger, sadness, surprise, grief and disgust. Everyone needs to be able to feel anxiety, otherwise it would be life-threatening. It is a survival mechanism that makes us react quickly and instinctively, defend ourselves or flee, when there is real danger.

But for many different reasons we can come to interpret situations, things, people, animals or thoughts as dangerous even though they are not. Then the natural anxiety becomes unhelpful anxiety, and it can develop into an actual mental disorder that paralyses normal life. We distinguish between normal anxiety, that is, fear and terror in situations that are actually dangerous, and clinical anxiety, where you have become afraid of something that in reality is not dangerous.

Both fear and anxiety are controlled from a small area of the brain, the amygdala. The amygdala cannot tell whether the danger is real or an interpretation, and it sets off the alarm in both cases. That is why anxiety treatment is about teaching the amygdala that there is no danger. It is an interpretation, an idea.

Anxiety is a continuum from mild nervousness to severe, disabling anxiety, where you may believe you are going mad or will die of it. So you can be nervous or apprehensive without having an anxiety diagnosis, and you can be so anxious that it takes help to bring it back to a normal level. According to the Danish Mental Health Fund (Psykiatrifonden), anxiety is one of the most widespread mental disorders in Denmark. Precise figures do not exist, partly because many people live with anxiety without getting help, but it is estimated that around 350,000-400,000 adult Danes suffer from anxiety. According to the Danish Health Authority, anxiety is the second most common reason for contacting a psychiatric emergency department and the third most common diagnosis in general practice. In other words, you are far from alone.

In principle anyone can develop anxiety, because we all have the feeling of fear in us. We need it to survive. But some are more vulnerable than others to fear developing into anxiety. Some are born more anxious than average. It is simply genetic. Innate anxiousness does not have to lead to an anxiety disorder, however. What matters is how those around you respond to it, and what resources you yourself have to handle it. Anxiety develops in an interplay between psychological, social and biological factors.

Many of those I treat for anxiety discover along the way that they have probably always been a little anxious. Perhaps there was some anxiety in childhood that they grew out of, but a certain anxiousness lingered without affecting everyday life, and so they did not notice it. Then something happens in life, such as stress, children, divorce or an unpleasant experience, and the anxiousness flares up and becomes actual anxiety.

You can also develop anxiety entirely without innate anxiousness, for example after violent or traumatic experiences, divorce, bullying, life-threatening illness, unemployment, bereavement or stress.

There are several different anxiety disorders. Perhaps you recognise yourself in one of them, perhaps in several. The most common are:

Anxiety is a physiological reaction to some areas of the brain interpreting a situation, a thing, an animal, a person, a thought or an action as dangerous. Then the amygdala is told to raise the alarm, and it sets off an anxiety reaction to make the body defend itself, flee or freeze.

The reaction is not only set off by things outside yourself. It is just as often set off by thoughts inside you, that is, the interpretations you make of what is outside. The amygdala reacts exactly the same in both cases. When you suffer from anxiety, it is your interpretations that create it, and that is why we work with your thoughts. When the alarm sounds, you react in all three of the other corners of the cognitive diamond:

The avoidance and the safety behaviour bring calm in the moment, but they prevent you from discovering that you could have managed the situation without them. New or worrying physical symptoms should always be assessed by a doctor.

Racing thoughts are exactly what the words say: a swarm of thoughts running around in your head. Some people have them almost all the time, others especially when they lie down and try to settle to sleep. Some have them in periods, others struggle with them almost every day.

Racing thoughts are a faithful companion of generalised anxiety, but they also occur in social anxiety and self-esteem problems, and in depression in the form of rumination, that is, brooding. Especially in social anxiety and low self-esteem the thoughts have an inward focus full of self-criticism and sometimes even self-hatred.

Most people experience racing thoughts as a dust cloud or a tornado of thoughts in the head that grows, because one thought leads to the next. If you engage with one of the thoughts, it always leads to even more. Whether you can pin the thoughts down or they flit around out of reach, they affect your feelings, your actions and your body.

There are several ways to stop racing thoughts, and here are some of the ones we work with, depending on how intense your racing thoughts are.

1. Distinguish between productive and unproductive thoughts. You can deal with the productive ones by acting: "What if I am late for the meeting tomorrow?" You set the alarm and go to bed early. The unproductive ones you cannot act on: "What if I get ill next week and we have to cancel the holiday?" In principle you do not know what will happen in ten minutes, let alone next week. You have to learn to set that thought aside, blow it away or send it off on a little leaf down a rippling stream, whatever suits you.
2. Do not engage with the thoughts. You do have one kind of control over your thoughts: whether you engage with them or not. We do not decide which thoughts turn up, or when. But we decide what we do with them. You can choose not to engage with the unproductive ones and perhaps engage with the productive ones.
3. Move your attention outward. Direct your focus to what is happening around you, instead of inward towards yourself and your thoughts. Count cars, look at the sky and the birds, look at the pictures on the wall, count the books on the shelf, put on good music and dance.
4. Use your breathing. Your parasympathetic nervous system has to be activated to calm the sympathetic one. Calm breathing right down into the belly, which fills with air, signals calm to both your body and your brain.

In the sessions we find out which approaches suit your racing thoughts. You can read more about working with worry on the metacognitive therapy page.

No two lives with anxiety are the same. What yours is like depends on which type of anxiety you have, how strong it is, and how much it troubles you in everyday life. But some things recur in all forms of anxiety, whatever the level.

The anxiety restricts your life, to a greater or lesser degree. Perhaps you isolate yourself and no longer spend so much time with family and friends. There are situations you avoid, and people you avoid. And anxiety has a tendency to spread from one area to several. If you are afraid of taking the bus, you may also become afraid of trains and the metro. If you have avoided parties, you may also start withdrawing from smaller things: concerts, the cinema, a cup of coffee in town. It is unpleasant, it can damage your self-esteem, and it can make you feel very lonely.

Some never get rid of their anxiety completely, and then it turns up in periods of prolonged pressure. But you can learn to handle it, so that you control the anxiety instead of the anxiety controlling your life. Others become completely free of their anxiety, and it never returns. I have seen both many times.

It varies from person to person, but often there is an anxiousness or actual anxiety right from childhood. It may come from being born a little more anxious than average, and from those around you not handling it well. It may also be that you yourself have experienced something violent or frightening, have heard about something you interpreted as frightening, or know someone who has experienced something violent. All of that can settle in you and at some point develop into anxiety.

When there is something we are afraid of, we try to protect ourselves against it. Either by avoiding it, avoidance behaviour, or by guarding ourselves against it, safety behaviour. But if we guard ourselves against, or avoid, something that is not actually dangerous, we never show ourselves and our brain that there is nothing to be afraid of. That is how we keep the anxiety going, and in many cases we reinforce it.

If the anxiety is not treated, but is allowed to live on through avoidance and safety behaviour, it spreads to more and more parts of your life and restricts it more and more. That is why it is so important to do something about it now, and it is also why it works when we do.

If there is something you are afraid of that has started to take control of your life, that is, it decides what you do and do not do in everyday life, then you are developing anxiety, or you have already developed it. Then it is important that you seek help, because otherwise the anxiety spreads and becomes more and more disabling. Besides contacting someone who can help you, there are things you can do yourself:

• Get to know your anxiety. Think about what exactly it is you are afraid of, and especially why. What thoughts lie behind the anxiety?
• Use your breathing. In the situations where the anxiety comes, calm breathing can soothe your nervous system and tell your brain that there is nothing to be afraid of.
• Look at your life. Is something weighing on you, are you under too much pressure on some front? Anxiety tends to flare up when we are out of balance.
• Get enough sleep. Lack of sleep affects energy and resilience, and then things become more overwhelming and "dangerous".

You do not need to be able to explain all the connections yourself before you get in touch. We do that together.

The best thing you can do as a relative or friend is to help the person you care about get help. You can also read up on supporting someone with anxiety, online or in a book from the library, so you are guided towards what is best to do.

When you have anxiety, you want to protect yourself against what you are afraid of, or avoid it completely, and so you use safety behaviour and avoidance behaviour, as described above. As someone close to them, you want so badly to help, so that the person you care about does not have to feel bad. So you often end up going along with the safety behaviour and the avoidance: you help to make things safe, or you agree to the person with anxiety avoiding what he or she is afraid of. But when we do that, we actually maintain the anxiety. The person with anxiety never gets to confirm or disprove whether what he or she is afraid of really happens. The more we go along with it, the more we maintain and reinforce the anxiety. The best support is therefore to help the person with anxiety not to use safety and avoidance behaviour.

Remember at the same time that you are not a therapist, and that you are not responsible for fixing anything. You can support. And look after yourself. Be aware of how much of your time and energy goes to the anxiety, because you need your own life too. Otherwise you burn out, and then you cannot be there for the person you want to help.