Am I Anxious? (Part II)
Do you know when you are anxious?
How does Anxiousness feel?
Can you measure it?
If I’m not anxious, then I must be calm. Will I ever be Anxiety free?
It’s Christmas Day. Falling snow, the fire burning low, logs crackling, the smell of bread rolls cooking. The family near, readying Christmas dinner. Here you sit, alone, in the living room, looking at the fire and feeling ANXIOUS. Why? What on earth do I have to be anxious about? Why won’t this anxiety stop! I want some relief. After all, it is Christmas. That’s my Christmas wish. One minute without anxiousness! (Sound familiar, maybe, maybe not. This is how a client described Christmas to me.)
Is the absence of anxiousness contentment, happiness, fulfillment?
These are questions I’m asked by clients.
TRUISM: Everyone feels mildly anxious from time to time. I’ve summarized what normal anxiety is like in (Part I).
Anxiety is unforgettable and uncomfortable. I’ve yet to hear anyone say, I’m anxious and I feel great! Even if anxiousness is because of a wonderfully positive event, the feeling (sweating, fidgeting, rapid heart rate, need to escape) is not comfortable.
In my office, I witness individuals pace back and forth, grip and un-grip hands, trapped in intolerable anxiousness. “Dr. I’m so anxious today, I can’t sit!” In one instance, during a PTSD interview, a Veteran, in tremendous unalterable anxiousness, got up, ran out the door and never returned.
Anxiety is as much a symptom as it is a condition. People feel anxious when they are not physically well (“I had the Chicken Pox and at first I thought I was having a “Panic Attack”), through drug withdrawal (“I started feeling anxious all the time when I stopped my sleeping medication.”) (“I stopped drinking alcohol and I now feel anxious all the time.”). During big life changes (“when I moved to the new house, I could NOT stop having these feelings of unease and anxiety.”).
It makes sense, given the dysphoria surrounding anxiousness, that doctors would want to medicate it away as a symptom.
What or Who gives anxiety such power? To feel anxious is different than feeling depressed, but then again, people who feel depressed frequently describe feeling anxious at the same time.
This is curious because, diagnostically, anxiety and depression are supposedly “mutually exclusive” - the occurrence of one precludes the occurrence of another. (but, believe me, they’re not!)
How Much Anxiety Am I Experiencing?
Psychology is right on top of this question with surveys, checklists, questionnaires galore. Tale the items from the (Generalized Anxiety Questionnaire (GAD-7). Score your own level of anxiety below: (This Test is in the Public Domain)
Over the last two weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
Not being able to stop or control worrying
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
Worrying too much about different things
0=Not at all
1=Several days
2=More than half the days
3=Nearly Ever day
Trouble relaxing
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
Being so restless that it is hard to sit still
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
Becoming easily annoyed or irritable
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
Feeling afraid, as if something awful might happen
0=Not at all
1=Several days
2=More than half the days
3=Nearly ever day
GAD-7 total score for the seven items ranges from 0 to 21. 0–4: minimal anxiety 5–9: mild anxiety 10–14: moderate anxiety 15–21: severe anxiety
Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu.
If your score is between 15 and 21, then the Christmas Story I described probably fits with your personal experience.
I found this note below in the public domain. The note appears to be from a highly anxious individual who wrote it as part of an “anxiety-awareness” week. Can you see anxiousness in the note? Not just in what it says, but in the way it is written, the intensity of intent. There is disappointment in life, but a resignation, and then a hope. Chronic anxiety eventually generates disappointment, particularly self-disappointment in the realization that self control in the long-run, can be self-destructive. (Source: https://dev.theocdandanxietytreatmentcenter.com/2021-ocd-awareness-week/)
Anxiety is within us. It might be triggered by something outside or external to the inner self, but it operates within the individual. To be sure, anxiety operates on physiology and this process has been studied and documented. Although the process is nuanced depending on the kind of anxiety (panic attack, generalized anxiety, OCD), there are specific manifestations of anxiety in: 1. Behaviors, 2. External features of the person, 3. Emotions transmitted to others. How emotions are transmitted to others is a topic for another entry. See below, the figure of the same face changing in subtle ways through various emotional states:
ANXIETY (middle row, #4). Contrast this to WORRY (top row #3). What are similarities in the eyes, nose, mouth, facial position that you notice between “worry” and “anxiety”?
ANXIETY (middle row, #1). Contrast this to WORRY (top row #1). What are similarities in the eyes, nose, mouth, facial position that you notice between “worry” and “anxiety”?
I don’t have the space to describe the study in detail, but it was conducted in Argentina, involved showing standardized faces to individuals in three groupings (1. elementary school, 2. high school, and 3. University students). Findings: Women were better at identifiers of emotion than men; more education improved recognition. There are more questions raised than answered. Note: It is hard to distinguish anxiety from worry versus from happiness or sadness or even fear or contempt. Given how close anxiety is to fear, I find recognition between: fear (60+%) versus anxiety (40+%) intriguing.
Source: Comparison of emotion recognition from facial expression and music. T. Gašpar, M. Labor, I. Juric, D. Dumančić, V. Ilakovac, M. Heffer Psychology Collegium antropologicum 2011
I’ve now (Part I) Described Anxiety, and (Part II) explored what it looks like and how it feels. My next entry and perhaps the one people are waiting for is, How to be anxiety-free (Part III). I do have a strategy I will share for achieving real relief from chronic anxiety.