Something is going to happen, coming from somewhere, at any given time….. I only know it will be terrible, and that it will happen to me

By Claudia Carrara, Ph.D., M.Sc.

You have been looking forward to meeting your best friend for lunch. As you think that you should soon leave the house to walk the short distance to the place where you have agreed to meet, your heart starts racing, your breathing gets faster, your hands become sweaty, your head spins and everything around you seems to get fuzzy. Fear takes hold of you, and the only thing you can manage is to reach the couch and curl up breathless, hoping that whatever is happening to you will soon stop. This is how a panic attack can feel like. A sudden fear that something terrible and unavoidable is going to happen. In fact, although you felt that your heart was going to explode in your chest, nothing happened. You did not suffer any heart attack and, despite how likely it felt to you, you have not passed out.

It is the deep sensation of being vulnerable to any impending and unavoidable catastrophe that triggers our fear and anxiety. However, fear and anxiety are two very distinct emotions. We fear a known object or event, such as fearing to fail an exam because we are not well prepared, or fearing to break a leg while skiing. Once the threat is gone, our fear disappears. Fear is an emotion we share with most mammals because a potential danger can indeed affect our chances of survival and/or wellbeing. On the other hand, anxiety is an emotion seemingly linked to the human ability to shape abstract scenarios, and therefore enabled by our more evolved nervous system. However, the main difference that distinguishes fear from anxiety is that the latter is not triggered by a real danger, but by a perceived and undefined threat.

Some of us may now be wondering why indeed a more evolved nervous system like ours would trigger “false alarms”, engaging our body is acute stress-responses to merely perceived threats. In fact, our capacity to prepare for potentially dangerous situation (i.e. abstract scenarios) is probably one of the main reasons that has kept our species alive! If we had been unable to predict the harsh conditions of the winter season, we would not have been able to store the necessary food, to prepare the necessary shelters nor to tan animal skins to protect our body from the low temperatures. Without anticipatory anxiety (i.e., anxiety for events that might be occurring in the future), we would have simply frozen and starved to death. However, sometimes our brain misjudges the circumstances: A generally low trust in ourselves and the perception of not being “good enough” can translate into the false alarm that there is a danger looming outside our door.

We can identify 4 main triggers of anxiety:

Health – You believe to be affected by an undiagnosed illness. You have undergone multiple screenings and consulted different specialists but, despite the reassurance of your doctor that there is absolutely nothing wrong with your health, you are convinced that your days are counted. Everything becomes a symptom: An almost imperceptible temperature increase, a slightly faster heartbeat …. The more your attention is focused on trying to discover your elusive sickness, the greater will your anxiety grow and, in an evil circle, greater will become your obsession to find a diagnosis.

Imminent danger – To step out of your house means to expose yourself to a fatal risk. A car accident, an object falling from a balcony, a vicious assailant, perhaps even a terrorist attack: You are vigilant and ready to run! As catastrophes are most likely not actually looming outside your door, your state of alert will only serve the purpose of further increasing your anxiety and, with it, your certainty that something is going to happen.

Poverty – You have a good income and, after all expenses are payed, you can easily put aside a hefty amount of money every month. And yet, this is never enough. You calculate your monthly budget to the tiniest detail, and reduce any unavoidable expense to the bare minimum. After all, everyone can be fired at any time, companies can suddenly file bankruptcy and international markets collapse! Your anxiety of losing economic stability shapes visions of extreme poverty and even homelessness and this, obviously, only increases your fear of becoming poor.

Social inadequacy and Loss of Control – Nobody likes me. No matter what I say, people will judge me and think I am stupid. More so….. what if I lose my mind, pass out, or suffer a full-blown panic attack in public?! I am an expert in finding “good reasons” not to attend social gatherings and to refuse invitations. However, should the social event be truly compulsive (e.g. my best friend’s wedding or the company party I just cannot elude without jeopardizing my job), I will be the quiet observer floating at the margins of conversations.

Independently from which the roots of your fears might be, the outcome is the same: Your belief in their unavoidable occurrence will feed your anxiety, which in turn will feed your fears. Ultimately, your fear of becoming anxious, will make you more and more anxious.

How to stop the cycle

In sum, anxious thoughts will increase your anxiety and, on the contrary, positive thinking will lower your anxiety and increase your well-being. But how about when the things we fear are solely connected with negative thoughts? Then we must build new connections! Here is a technique that might help you to achieve this goal.

Make a list of the things that trigger your anxiety (e.g. you find it challenging to sit at the table with all your colleagues during the lunch break, or to take the elevator to the top floor.) Once you made your list, then rate your fears from the one that scares you the least to the one that terrifies you the most. Finally, for each of them, try to identify simple actions that feel less taunting, like joining only one of your colleagues when you see him or her approaching the coffee machine, or riding the elevator only to the first floor together with someone else. Starting then from the event you fear the least, pick the simple action in your list that you find most manageable, and agree with yourself on a day when you are going to try it. After every successful accomplishment, pick the next-in-line among your simple actions: For example, one day you could ask your colleague to join you for a coffee break, or you might decide to ride to the first floor alone.

Every little success can help paving the road that will encourage you to tackle a slightly more difficult task, and it will strengthen a cycle of positive thoughts around your perceived threat until you will no longer perceive it as such.

Nevertheless, sometimes the path out of the tunnel of our negative thoughts might be less straight forward. It can then be useful to work together with a therapist who can help you to break out of the suffocating grasp of anxiety.