Understanding the mechanisms of anxiety

We all worry about new situations.

Anxiety is an instinctive reaction that protects us, enabling us to anticipate and cope with dangers. It comes into its own in the context of occasional stress or real threat, helping us to cope better. But sometimes it has nothing to do with reality, becoming autonomous and taking on disproportionate proportions, leading to irrational fear. Anxiety, an emotion so typical of human beings, then becomes pathological. The red line is crossed when the threat seems to be everywhere, when anxious thoughts spiral out of control and reason fails to put them into perspective. A reproach at work and we fear losing our job. A headache and we're already thinking about a serious illness. For others, it's the thought of getting on an elevator or standing in a crowd that triggers a cold sweat.

Sick anxiety is based on catastrophic beliefs. It's a tendency to imagine the worst, overestimate danger and underestimate one's ability to cope.

On a biological level, anxiety is explained by a disturbance in the brain's alarm system, particularly in the amygdala, the seat of fear. Just as the immune system of an allergy sufferer goes into overdrive at the drop of a hat (pollen, cat's hair...), the fear system of anxious people is out of whack and is clearly overdoing it. Their tolerance threshold is low, due to a hypersensitive amygdala that overreacts to an object or situation.

Anxiety is recognized as a psychic disorder, listed in diagnostic classifications. Anxiety disorders are characterized by a triad of physical, psychological and behavioral symptoms.

On a physical level, anxiety can manifest itself as a lump in the stomach, headaches, chronic pain or difficulty breathing. It can take many forms, giving rise to different diagnoses. It can be diffuse, dull and permanent in generalized anxiety disorder (GAD), or focused on a specific object in phobias or obsessive-compulsive disorder (OCD) (fear of germs, for example). But it can also be sudden and abrupt, as in a panic attack. An anxiety-provoking situation can trigger a series of somatic reactions (palpitations, tachycardia, spikes in blood pressure, dizziness, blurred vision, tingling, cramps, digestive problems), felt so intensely that the person finds themselves in acute distress. This is when awareness of the psychic origin of these symptoms begins to emerge.

Psychologically, anxiety, especially when generalized, is "intolerance of uncertainty". It expresses itself through constant hyper-vigilance, and leads to avoidance behavior. For fear of not being up to the task, or of being crushed by their own fear, anxiety sufferers resort to all kinds of strategies: delegating a public presentation, refusing to leave the house unless accompanied, or developing rituals to reassure themselves, for example. Even if they're aware of it, it's hard for them to get out of their own way. They know they're exaggerating, but they can't help it. They become prisoners of their anxiety.

While in the short term, avoidance strategies calm anxiety, in the long term they restrict freedom. As for anxious ruminations, which are a vain attempt to maintain control over events, they are, in the long run, a source of exhaustion. Little by little, a whole life is conditioned by the disorder. Those around them are often not spared. When a person prevents the whole family from going on vacation for fear of flying, or embroils their loved ones in a system of rituals and checks, they take others hostage and become a tyrant in spite of themselves. But by avoiding situations we dread, we risk distancing ourselves from ourselves and from what's important to us, as for example, people with social phobia avoid social contacts when they actually attach great importance to them.

At the root of anxiety disorders lie a set of factors linking certain personality traits that predispose the individual to acute sensitivity to negative emotions and conflictual relationships, and a number of unconscious factors linked to childhood development, life experience and adaptive defense mechanisms.

In some cases, patients suffering from anxiety disorders can benefit from short-term pharmacological treatment (anxiolytics) prescribed by a doctor, but it is above all psychotherapy with a psychologist or psychoanalyst that will effectively treat the anxiety phenomenon over the long term.

The therapeutic palette is broad, and the chances of recovery are real. Anxiety disorders can be treated effectively today, but they are not always completely cured. The cognitive-behavioral approach focuses on alleviating symptoms and helping people to live with them. It's about putting anxiety in its place, in the background. The analytical approach focuses more on becoming aware of the origin of the disorder and the strategy for dealing with it constructively.