Why we need to broaden the mental health discussion.
About seven years ago, I found myself in the emergency ward of my local hospital waiting to see the on call psychiatry team. My GP had sent me there directly from her office as she was concerned that I may be having suicidal thoughts.
Thankfully the Generalised Anxiety Disorder I’d developed over a period of about 9 months hadn’t taken me down that path - but it certainly was making life close to unbearable.
My insomnia was debilitating; the constant stream of loud and intrusive thoughts were exhausting; the depersonalisation made it impossible to participate in things I’d once enjoyed; and I felt so incapable of functioning ‘normally’ that I’d had to leave my job.
Thankfully, I’ve now fully recovered, but the path to recovery wasn’t an easy one to find.
It required a basic level understanding of both the physiology AND psychology of my anxiety illness, so that the link between psychological treatment options and positive change in my brain physiology was clear.
Unfortunately for anxiety sufferers, these two things are generally not provided together when we seek professional help, and as a result many people stay stuck in the anxiety cycle.
Given that one quarter of Australians will experience an anxiety condition in their lifetime, there’s definitely good reason to take a fresh look at the way recovery related information is provided.
Outside of prescription medication, the advice we receive when we seek professional help for an anxiety illness generally consists of one or a combination of the following:
Learn and practice Cognitive Behavioral Therapy (CBT)
Learn and practice Acceptance and Commitment Therapy (ACT)
Learn and practice mindfulness mediation
This is good advice, and incorporating one of these techniques into your life can definitely assist in recovery from an anxiety illness.
The problem however is that this advice is often given without an explanation of how it helps – so the advice doesn’t stick. We leave the office of our treating professional knowing what to do, but not necessarily why we should do it.
Sure, we know it should ease our anxiety symptoms, but how it does that – from a physiological point of view – remains a mystery.
When we are dealing with a physical illness, understanding the how of our recovery is perhaps not so important. We don't need to understand how our bones heal to enable us to follow the medical advice for recovery.
But when it comes to recovery from mental illness, understanding the how - in terms of how our mind heals - is crucial.
And to understand how our brain heals from its anxiety illness, we need to understand how it became unwell in the first place.
Anxiety in the brain.
Physiologically, the amygdala is the part of the brain that’s responsible for all of our anxiety woes because it initiates our fight-or-flight response. So it’s helpful to know a bit about it.
Yet, in her work on this subject, clinical psychologist and author Catherine M. Pittman PhD writes that,
'Therapists often don’t discuss the amygdala when treating anxiety disorders, which is surprising, given that most experiences of fear, anxiety, or panic arise due to involvement of the amygdala.’
Entire books have been written about our small almond shaped amygdala (we have two of them), so it’s possible to get incredibly deep on detail. But for an anxiety sufferer there’s a few key things we need to understand.
The amygdala triggers our fight or flight response, and that response eventually causes our adrenal glands to release our stress hormones – including cortisol and adrenaline.
Prolonged or chronic exposure to these stress hormones can cause the amygdala to get bigger (and therefore better at doing its job) through a feedback loop.
When the amygdala gets better at doing its job – it does it more often and more easily – which means we get anxious more often and more easily.
This feedback loop eventually leads us into the anxiety cycle because our hyperactive amygdala keeps us flooded with stress hormones like cortisol all day - and therefore constantly anxious.
Eventually, if we stay stuck in the cycle long enough, we start to fear the myriad of anxiety related symptoms we experience, and how these make us feel – rather than actually being afraid of a particular event or situation.
This fear of how we feel can eventually lead to the development of an anxiety illness such as Generalised Anxiety Disorder, Social Anxiety or Panic Disorder.
Physician, and Psychiatrist Dr. Henry Vyner says,
'when your fight or flight response remains switched on when there is no danger, or if it gets switched on too easily, again when there is no danger, then the flight or fight response will morph into - and become - prolonged anxiety and anxiety disorders.'
How does this information help?
1.The first thing this information enables an anxiety sufferer to do, is understand what has happened in our brain that has led to the development of our illness.
Understanding this can be a powerful tool because knowing how we got where we are makes it easier to believe that there is a way out.
When our anxiety is telling us that we are losing our mind or going crazy; when we feel like we can’t get out of bed because our symptoms are so bad; or when we convince ourselves that some other sinister illness other than anxiety must be causing us to feel so bad – going back to the physiology of our anxiety and reminding ourselves what’s actually occurring in our brain can provide the hope we need to keep going.
2. The second thing this information enables an anxiety sufferer to do, is understand why we stay stuck in the anxiety cycle of worry and fear.
Our fear of our anxiety – or more specifically the myriad of symptoms anxiety causes – ensures that we keep receiving an onslaught of stress hormones triggered by the amygdala, and so remain in anxieties grips indefinitely. This is important because when we understand what keeps us stuck, we start to get some clarity on how to get unstuck.
3. The final thing an anxiety sufferer can do with this knowledge is apply it to our life in a practical way that helps break the cycle and lead to recovery.
To begin the recovery process we need to re-educate our amygdala and let it know that it no longer needs to keep us safe day and night. When we begin to remove the fear from the way we feel – the amygdala slowly starts to get the message.
Incorporating one of the most common psychological treatment options into our life – whether it be CBT, ACT or mindfulness mediation – is one of the best ways to begin removing the fear from our symptoms and re-wiring the brain. And when we understand how practicing these techniques helps us physiologically, the practice is more likely to stick and lead to recovery.
Full recovery from anxiety illness is possible. Ensuring that those suffering understand the physiological and psychological connections is an important part of the process that requires more attention.
David McLaughlin is an author and mental health advocate who writes frequently on the subject of anxiety and recovery. His book, I Am Anxiety, was recently a finalist in the Readers Favorite 2019 Book Awards, in the category of Non-Fiction: Health/Medical, and is rated 5 stars by readers on most book review platforms.
He has also been published in the Australian Sunday Telegraph; The Art of Healing magazine and Living Now magazine.