Anxiety—a physiologic and emotional response to a threat that the brain perceives— is one of the most common reasons why people seek psychological or psychiatric treatment. For example, a memory of a frightening experience from childhood or adolescence may produce feelings of anxiety in your day-to-day adult world. Although you may or may not consciously remember the frightening event, something triggers the feeling of fear, your brain senses danger, and your body responds accordingly.
Anxiety can also be experienced vicariously in response to a real or imagined event. In the movie Alien, each character tries to avoid being eaten by the monster (as they should). It’s easy to feel tense when you watch someone die in the film. Even though you know this is only a made-up plotline, the anxiety you may experience from the suspense of such a film can seem as real as if it were your own life. For that to be possible, each person’s imagination must create and accept the threat as real. Similarly, when studying for an important exam, weeks of preparation may be filled with feelings of nervousness and a sense of doom. Most of the time, underlying fantasies of what the test means to you are fueling the anxiety. You may imagine that a poor grade on this test will affect your chances for admission into college or graduate school, which would determine your career path, your future financial stability, and, ultimately, your ability to survive.
Nightmares are other unreal experiences that may trigger anxiety. When you wake up, you may feel a lingering sense of terror, and then you realize it was only a dream. Thus, anxiety may occur as a result of a signal from a perceived threat that is unconscious, known to be unreal, or exaggerated by the individual’s imagination.
Fear, on the other hand, is a response to real danger. As you walk down the street, you are suddenly threatened by a man holding a gun. Your brain immediately signals danger by alerting you with fear and the need to seek safety.
What is Your Fear Response?
The human brain responds identically to both real and unreal danger. This is called the “fight or flight” response, and it causes a surge of adrenaline to assist with either fighting or fleeing. Your heart rate and blood pressure increase, and your senses become hyper-alert. But it is also up to your brain to determine whether (a) the trigger is real, the feeling is fear, and the need to fight or flee is also real; or (b) the trigger is unreal, like a movie, fantasy, or dream, and the feeling is anxiety, requiring no action.
In other words, anxiety and fear produce virtually identical physiologic responses. The difficulty is that your mind must make sense of the data. Over time, the mind learns how to distinguish between reality and unreality. However, it is never able to do this perfectly, because frightening experiences, whether real or imagined, automatically trigger the flight or fight response.
An anxiety disorder results when the flight or fight response becomes triggered too easily and too frequently. Usually, this occurs after many events of any kind that are perceived as threatening from early childhood to the present or fewer extremely intense events that have left a strong impression of danger on the individual. As a result, the brain has learned to perceive the world as more dangerous than it actually is. In the most serious anxiety disorder, panic disorder, the individual’s physiologic response is genuine terror.
A Quick Note on Treating Anxiety: What is Psychotherapy?
Modern mental health treatment focuses on both the psychological and physiologic aspects of anxiety. Yet too often this results in the overuse of medication to provide only immediate symptom relief via a “quick fix.” On a daily basis, we are bombarded by pharmaceutical ads that imply that feeling better is as simple as taking medication. However, medication does not afford you the opportunity to understand and make meaning about what may have triggered the anxiety in the first place. Psychotherapy, however, offers an opportunity to work through, understand, and change the effect of the lifelong experiences that have been over-triggering anxiety.
There are different kinds of psychotherapy. Short-term, limited goal psychotherapy, such as Cognitive Behavior Therapy, can help you manage the immediate symptoms. However, more intensive forms of treatment such as psychodynamic psychotherapy and psychoanalysis are designed to fully explore the psychological roots of anxiety, reduce anxiety to a manageable level, and offer insight into the extent to which perceived (instead of real) threats are getting in the way of enjoying life. The goal is not only to alleviate symptoms but also to make lasting changes in your life. In some cases, medication may still be necessary for symptom relief, especially in the treatment of panic disorder.
Psychodynamic psychotherapy can help you begin to understand how early life experiences have shaped your view of the world—especially when it comes to perceived threats. By getting a fuller grasp on this, you can better comprehend not only your fear and anxiety, but also the way you approach relationships, stress and challenges.
Angela Retano is a Board Certified Psychiatric Nurse Practitioner with prescription privileges, holding degrees from New York University School of Nursing and Slippery Rock University. She specializes in psychodynamic psychotherapy and pharmacotherapy, with experience in various treatment settings. Angela is a third-year candidate in adult psychoanalysis at the Institute for Psychoanalytic Education affiliated with New York University. She is a registered expert witness with the Technical Advisory Service for Attorneys and an active member of professional associations including the American Psychiatric Nurses' Association, New York State Nurse Practitioner Association, and American Psychoanalytic Association.