Navigating the Landscape of Unease: Nervousness, Worry, Anxiety, and Panic

Nervousness, worry, anxiety, and panic are related experiences, often existing on a continuum, with each having unique characteristics while sharing common threads.

Nervousness is a common human experience, often a response to a specific situation.

Worry is characterized by apprehensive thoughts about potential future events. It’s often a verbal manifestation of anxiety, involving fearful thinking and imagining worst-case scenarios. Worry can also be a way of avoiding stress associated with anxiety.

Anxiety, unlike worry, is an encompassing experience affecting thoughts, feelings, behaviours, and physical health. It’s often marked by “what-if” worries and can include physical symptoms such as muscle tension, heart palpitations, sweating, and shortness of breath. Emotional symptoms can include restlessness, a sense of impending doom, and fear of embarrassment. Anxious individuals may be overly sensitive to perceived threats. The experience of anxiety is often described as being super focused on the ways that life could go wrong. It can be energizing, spurring a person to attempt to change and control their experience, but when this becomes exhausting, resignation can set in, resembling depression.

Panic is a sudden onset of intense physical symptoms of anxiety. It can include overwhelming physical sensations and catastrophic thoughts that indicate a need for escape. Panic attacks can occur in the context of various anxiety disorders and are often associated with a fear of future attacks. It is worth noting that panic is a vital and life-saving emotion. The terms anxiety attack and panic attack are often used interchangeably, though technically a panic attack is a facet of panic disorder, while an anxiety attack is a response triggered by anxiety-provoking situations. Sometimes panic is referred to as ‘panxiety’ to denote that the anxiety is not the main issue.

Common Factors

• Physiological Response: All of these experiences can trigger the body’s stress response, involving increased heart rate, sweating, and other physical changes.
• Cognitive Processes: They involve specific thought patterns, like overestimating threats, catastrophizing, and biased thinking. These patterns can contribute to a cycle of increasing anxiety.
• Avoidance: A common reaction to anxiety is avoidance of feared situations, which can worsen the problem by preventing the individual from learning to cope. It is often an attempt to regulate emotions and is a key factor in the development and maintenance of anxiety disorders.
• Emotional Regulation: All these experiences are connected with how people manage their emotions. The struggle to control unwanted thoughts and feelings is a core issue in anxiety.
• Overlapping Conditions: Anxiety can be connected to, or overlap with other conditions such as depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Common Treatment Approaches:

• Solution Focused Brief Therapy (SFBT): This approach focuses on identifying exceptions to anxiety and building upon existing coping mechanisms. It is future-oriented, focusing on what clients want instead of the problem itself. This therapy uses questions to help clients make positive changes by asking about how they managed to do something, or what they might do differently. Therapists normalize concerns and use neutral language to avoid negative connotations.
• Acceptance and Commitment Therapy (ACT): ACT focuses on acceptance of difficult thoughts and feelings, rather than trying to control them. It emphasises being present with one’s experience, instead of avoiding it, and uses mindfulness practices to observe thoughts and feelings without judgement. ACT seeks to clarify values and encourage action in valued directions, even in the presence of anxiety. This approach aims to reduce the impact of difficult internal experiences on behaviour.
  • This approach sees avoidance and control efforts as key issues to address in anxiety treatment.
  • It encourages a willingness to experience a full range of emotions while still pursuing a meaningful life.
• Mindfulness: This approach focuses on observing thoughts and feelings without evaluating them. This process is not used as a control strategy but rather to help make contact with experience as it is. It is a form of defusion and helps create a non-evaluative approach to internal experience, allowing people to notice their process of thinking, evaluating, and feeling.
• Neuro-Linguistic Programming (NLP): This approach uses techniques to change the way people perceive and respond to situations that trigger anxiety. It helps people to view associations and memories, and rewrite them in a more positive light. It focuses on recognising and changing maladaptive habits of behaviour.
• Exposure Therapy: This method involves gradually exposing oneself to feared situations to reduce anxiety. Exposure is re-cast within an acceptance framework rather than a framework of mastery and control.
• Deep Breathing: Deep breathing exercises can help to calm the body and burn off adrenaline released during anxiety.
• Questioning Thoughts: Instead of challenging the content of thoughts, this approach involves examining their origin, assumptions, and impact. It also involves questioning one’s ability to handle a situation and recognising potential false alarms.
• Focusing skills: Learning to focus productively on the present moment, rather than on internal sensations and thoughts, can be a helpful way of managing anxiety.
• Physical Activity: Exercise can assist with the management of stress and anxiety.

Summary

Nervousness, worry, anxiety, and panic exist on a continuum of unease, each with unique characteristics while sharing common threads. These experiences are linked by physiological responses, patterns of thinking, emotional regulation issues, and avoidance behaviours. While traditional approaches emphasize reducing negative affect, SFBT and ACT approaches seek to increase positive affect and acceptance. Approaches such as mindfulness and deep breathing can help to calm physical symptoms of anxiety. Questioning thoughts can assist with perspective taking, and exposure therapy can help people with avoidance behaviours.

Tags: Anxiety, Worry, Panic, Nervousness, SFBT, ACT, Mindfulness, Emotional Regulation, Exposure Therapy, NLP, Deep Breathing