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Exploring anxiety
Exploring anxiety

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3.2 Key issues in understanding anxiety

The activity below will explore key issues to help you gain a broader understanding of anxiety and anxiety-related disorders.

Activity 4 Understanding anxiety – key issues

Timing: Allow 60 minutes

Listen to the podcast below and consider the questions that follow. You might wish to listen to the entire recording first and review this again thinking specifically about the questions the second time around. Alternatively, you can consider the questions as you listen to the recording the first time around. Choose whichever approach suits you best.

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BBC World Service Health Check “Anxiety” Extract 1

Claudia Hammond from the BBC talks about anxiety, speaking to Claire and Scott about their experiences of anxiety and the effect it has on them, and to Nick Grey, a clinical psychologist from the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital in London, in this recording broadcast in 2014.

  1. How many people worldwide would meet the criteria for an anxiety disorder at any given moment?

  2. How does Nick Grey define ‘anxiety’ in lay terms?

  3. Scott Stossel, interviewed in the extract, describes a ‘milder form of anxiety’ and what he refers to as acute forms: acute-onset ‘panic attacks’ and the response to a ‘phobic stimulus’. How does he describe the symptoms associated with these forms of anxiety?

  4. Can anxiety and phobias be viewed as ‘normal’ behavioural responses; do they serve a purpose?

  5. Is anxiety simply a reflection of the ‘stresses and strains of modern life’ and how much harder it all is living in today’s world?

  6. Is anxiety a ‘Western’ construct? Is diagnosis on the increase in the Western world?

  7. Can anxiety be ‘transmitted’ between generations? How much is down to environment and how much to genetic factors?

  8. How does Nick Grey describe social anxiety disorder?

  9. Claire suffers from social anxiety disorder which she thinks was brought on by her job. How does she believe the situation arose, and has she had a similar experience in the past?

  10. Is there a possible upside to having an anxiety disorder?

Discussion

  1. Around one in 14 people around the world are thought be affected by an anxiety disorder at any time.

  2. Nick Grey describes it as 'a kind of feeling of worry, fear, nervousness that people would have about something that has got an uncertain outcome'.

  3. For him (i.e. from his perspective and subjective experience), that generalised feeling of worry at the back of his mind, worrying about negative outcomes, pessimistically anticipating the worst, is in some ways the milder form of anxiety, whereas acute-onset panic attack and phobias (he has a fear of flying) are more debilitating. He describes his experience of the symptoms of phobia (his fear of flying) to be similar to a panic attack – terrifying and uncomfortable. He describes the symptoms as losing the ability to think straight, starting to sweat, to hyperventilate, feeling 'like you can’t get enough breath', 'as though your chest is constricting' and suffering from gastric distress.

  4. Nick Grey explains that anxiety is a survival mechanism that can help to keep us and those we care about safe. This is a short-lived response that helps us adapt to a situation, quite different from the disabling and chronic anxiety problems that Claire and Scott describe. Similarly, phobias serve a basis through evolution, to help us to prepare against things that could potentially cause us harm (dangerous animals, snakes, spiders, germs, etc.). While we have evolved to feel a degree of anxiety that can be considered beneficial, phobias can also develop following traumatic events and an 'anxiety response' can be associated with traumatic experiences. Scott refers to Darwin’s theory that fear enhances the chances of survival of a species, and if we had not developed the ‘fight or flight’ response through evolution, we as a species would probably have gone extinct long ago, so some quotient of anxiety is highly adaptive (note that this is also referred to as 'state anxiety').

  5. Scott explains, based on the research for his book, that going back to Greece in the 4th century BC, Rome in the 2nd century AD or the Renaissance, Victorian or Georgian eras, there are accounts of ‘anxious, miserable, melancholic people’ and that ‘every age presumes it is the most anxious age ever’, so there is some quotient of anxiety that is relatively fixed throughout the human population and is enduring (i.e. a percentage of the population will tend to be more ‘anxious’ than others). But there is an argument that certain eras (including the Industrial Revolution which saw rapid technological change; where the economy is uncertain; where there is rapid social transformation; and changing ideas of gender), are more ‘productive’ of anxiety and feelings of uncertainty.

  6. This is a difficult question to answer given that there is so little evidence to go by outside of the Western hemisphere, as Nick Grey says in the extract. There is very little research outside of America, Western Europe and Australia to be able to address this question. A lot of the work has focused on community studies.

  7. Scott explains that his mother had emetophobia (phobia of vomiting) and he thought he had acquired his own phobia from seeing her worries, but that his own seven-year old daughter developed the phobia, which as far as he is aware was independent of having seen him express his own worries. Although this is certainly not conclusive, he does allude to the fact that there may be a genetic influence or predisposition. Nick Grey explains that there is a genetic propensity to have an anxious temperament (this is also referred to as 'trait anxiety'), and life experiences and traumatic events add to this.

  8. Nick Grey describes this as being where a person’s ‘worst fears are about showing signs of anxiety or saying or doing something that would be embarrassing or humiliating. And then other people thinking badly of them’.

  9. Claire says she worked with very strong characters who were a lot louder and more expressive than her, and she felt under social pressure to ‘compete’. It felt as though she was back at school (in classrooms), and just couldn’t be herself. She was worried about speaking to certain people in the office, and showed physical symptoms of anxiety (not sleeping, developing a tremor, heart palpitations, difficulty breathing) which made her progressively more ill. The fact that this was a recurrent experience which she had first had as a child is significant.

  10. Given the chronic disabling symptoms and negative experiences, you would perhaps think not. Nick Grey does point out, however, that people may develop personal growth from their experiences, overcome adversity, and develop greater levels of empathy and compassion for others who are also experiencing similar difficulties.