Hot, trapped, and a garda at the car window ... the worst experience I had of anxiety was when I was driving to my then job several years ago and got stuck in a huge traffic jam on the quays in Dublin. It was a warm summer's day, and I began to feel like I couldn't breathe. Sweating and claustrophobic, I rapidly started to feel very sick and very dizzy, my mind racing off into disastrous scenarios of me passing out, crashing into the car in front.
At one point, I was experiencing visual disturbances – such that it seemed the car was moving when it wasn't. Heart racing, gripping the steering wheel until my knuckles were white, I was in my own personal piece of hell.
There was nowhere to pull over and, in desperation, I moved into the bus lane. A garda pulled me in a minute later, only adding to my panic and embarrassment; but I managed to explain that I felt ill and was just looking for a place to park and he let me go. I stopped shortly afterwards, was able to calm down a little and then somehow I made it to work, feeling utterly traumatised. But I told no one.
The person you're sitting next to on the bus, at work, in the pub could easily be experiencing some of the above symptoms and you'll likely never know. Many sufferers tend to struggle in silence.
It has been great to see all the media coverage in recent months in relation to depression and suicide, which is doing much to ease the stigma over these issues. But I believe we now need to start talking just as much about anxiety.
Both depression and anxiety can be described as responses to overwhelming situations or events in our lives – but while people who are depressed tend to withdraw and shut down their emotions; in anxiety, they over-mobilise and become constantly on the lookout for 'threats''.
Like depression, chronic anxiety is potentially serious because it can lead to self-harming and even suicide; its symptoms and effect on daily life being, at times, almost intolerably distressing.
But perhaps one of the more important reasons to talk more about anxiety is that many people aren't aware that this is what their actual problem is. They may have various physical symptoms – such as stomach problems, periods of dizziness or nausea, extreme fatigue, feelings of unreality – but not realise that their root cause is, in fact, anxiety. Sometimes sufferers even think they must be going mad.
To appreciate why anxiety causes health issues and feels so physical to sufferers, you need to understand the fight or flight response – that's what kicks in when anxiety is triggered. The body prepares you to either fight or flee a threat by releasing hormones like adrenaline and noradrenaline, which speed up your heart and breathing rate and raise blood pressure. With anxiety, the fight or flight response tends to stay turned on, keeping you on edge, and your body operating at a much higher than normal level.
The origins of anxiety can be broadly explained as either existential (concerning the big themes of death, freedom, responsibility and willing, grappling with what it means to be alive) or related to past (including recent past) situations or events.
Right now the recession is an obvious cause of worry. But regardless of the state of the economy, existentialist Irvin Yalom says "life cannot be lived nor death faced without anxiety". Because no matter how good our relationships might be, we still all have to face our life – and our death – alone. Responsibility for how satisfying our lives are is in our own hands, and it's a responsibility that weighs heavy – French philosopher Jean-Paul Sartre wrote of the 'anguish' involved when we realise our freedom to choose who we want to be.
Yalom goes as far as to say that death anxiety is at the heart of what brings many people to therapy, but there is such a 'primitive dread' around dying that our minds tend to protect us from it. So rather than being consciously scared of death, you might latch on to a specific situation instead about which to be anxious.
For example, someone might come to therapy saying they have a fear of driving – they see this as the symptom to be fixed; but actually the real problem is fear of their own mortality.
Anxiety may stem from some kind of relational trauma – including how you were brought up and taught to think about yourself; sexual abuse; neglect; violence; separation from parents or bullying. Such trauma can leave you with an insecure sense of self; a fear you will be unable to cope or protect yourself; a dread of being hurt, abandoned or rejected.
It is also possible to see anxiety in a more positive light – Danish philosopher Soren Kierkegaard argued that it has something to teach us – perhaps that something is not working in our lives; that we're not who we are meant to be.
Unfortunately there is no quick-fix for anxiety, there just isn't. I do believe, however, that it is vital that psychotherapists and counsellors, regardless of theoretical orientation, are able to offer clients immediate help in managing their anxiety. Too many times, I have heard clients say they had seen therapists who "only wanted to talk about the past" and had no guidance to offer in helping them right now. Sufferers first need to feel they have a "toolbox'' of coping options they can draw from, and there are many such options.
For example, to go back to my experience in the traffic jam, knowing what I know now I would have tried to accept how I was feeling instead of fighting it. I would have said to myself, "It's okay, it's just the anxiety" or "It's just the adrenaline". I would have gone on to actively encourage the anxiety symptoms: literally asking my body to make me more dizzy, more agitated, etc – with an attitude of "bring it on, anxiety, you don't scare me''. I always use the bully in the playground analogy to explain why this works. Think of anxiety as the bully: bullies feed on their victims' fear. But if the bully sees you are not bothered by him, he loses interest. Same with anxiety.
While doing the above, I would have smiled, despite how bad I felt, which would have helped calm me. It's been found that your facial expression and your mood are linked – try it: make a sad face and then notice how you feel.
A coping strategy with longer term effects is mindfulness – which is all about staying in the present instead of ruminating on the past or worrying about the future, and also promotes acceptance of feelings. It has been scientifically proven to change the structure of our brains.
Notably, research has shown it impacts on the emotional system of the brain – the limbic system – reducing activity in the amygdala region. This is important because people with very active amygdalae have been found to suffer more depression and anxiety.
Don't be intimidated by mindfulness – it isn't at all complicated, it just takes a bit of discipline. The easiest way to be mindful is simply to notice your breathing – it will help you stay focused if you count each in and out breath. Psychotherapist Padraig O'Morain's book Light Mind is a great, easy-to-read guide if you want to find out more.
But ultimately it is likely that talking about the past or just talking about what has happened to you in your life is indeed what you need to do, preferably to a trained professional. I think the main reason this works is that it increases self-awareness and understanding, reconnects you to parts of yourself that you have had to hide, making you feel more grounded and sure of yourself.
As I heard someone on the radio say recently, it is in the unspoken that trauma lies, not the spoken.
Gayle Williamson is an IACP-accredited psychotherapist with a private practice in Dublin. www.ferneytherapy.ie