Sherry Stewart - Overcoming the Fear of Fear: How to Reduce Anxiety Sensitivity

Part I

What Is Anxiety Sensitivity?

chapter 1

Learning to know anxiety is an adventure which every man has to affront if he would not go to perdition either by not having known anxiety or by sinking under it. He therefore who has learned rightly to be in anxiety has learned the most important thing.

Sren Kierkegaard

Kierkegaards quote suggests that, to avoid being overwhelmed by anxiety, we must learn to be in anxiety. This book is designed to do just that, to help people, in particular those who have a high level of anxiety sensitivity, learn to feel anxiety and not sink under it. This chapter introduces the concept of anxiety sensitivity and explains the relationship among fear, anxiety, panic, and anxiety sensitivity. Youll learn how our bodies normally respond to stress (our natural emergency response system) and how some people are hypersensitive to the sensations produced by this response system. Youll be introduced to the types of concerns that bother people with high anxiety sensitivity.

Case Vignette: Isabel

Isabel is a twenty-three-year-old woman, who, for as long as she can remember, has been prone to bouts of anxiety. As a child, she remembers being particularly frightened by the sensations associated with anxiety, such as stomachaches. As a teenager, she dreaded gym classes because the sensations evoked by the physical activityincreased respiration, perspiration, and heart ratefrightened her. Whenever her heart started racing and she started to sweat, she was filled with a sense of dread that something terrible would happen to her. Isabel feared that she might have a heart attack or something worselike completely losing control of herself. Moreover, she feared that if the other students noticed her anxiety, theyd tease her and make fun of her. Whenever her mother had asked Isabel to help her carrygroceriesup the stairs to their apartment, Isabel had made excuses to avoid the risk of having the feared sensations. In her teenage years, Isabel started to experience panic attacks, acute episodes of sudden and intense anxiety that seemingly came on completely out of the blue. These attacks occurred two or three times a month; sometimes shed wake up in the middle of the night in the throes of a panic attack. When she wasnt having a panic attack, she worried about having one. She started to avoid situations or events that she thought might lead to a panic attack. By her second year in college, her panic attacks were so bad that she sought help at the campus health and counseling center.

Isabel has panic disorder. Panic disorder is one type of anxiety disorder that is characterized by unexpected and repeated episodes of intense fear. This fear is accompanied by a number of physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation. Heredity, other biological factors, and stressful life events are all believed to play a role in the onset of panic disorder. Another factor known to play a role in causing panic disorder is a high level of anxiety sensitivity.

Anxiety sensitivity (AS) refers to the fear of sensations associated with being in an aroused state, such as being anxious or distressed. Fear of these sensations arises from the belief that these sensations signify that harmful consequences will follow. Isabel, for example, was frightened by the sensation of her hearts racing; she feared that something terrible would happen, like a heart attack. Having high AS means that Isabel is predisposed to misinterpreting and catastrophizing about body sensations associated with being anxious. Having high AS increases Isabels risk of developing panic disorder. Isabel is not alone. Studies tend to show that 10 to 20 percent of people in the general population have elevated levels of anxiety sensitivity (Bernstein et al. 2006; Watt, Stewart, and Cox 1998). These individuals may fear breathing difficulties, thinking that they signify an asthma attack; fear that feelings of detachment and being spacey indicate that theyre going crazy; or fear that blushing while anxious will draw unwanted attention and ridicule from others. In other words, these people fear their own fears. This additional fear puts them at risk for a lot of problems, which well discuss shortly. First, lets review some related concepts to thoroughly explain what anxiety sensitivity is (and what it is not) and why we need to understand it better.

Fear sharpens the senses; anxiety paralyzes them.

German psychiatrist Kurt Goldstein

Everyone has experienced fear and anxiety. Seeing a scary movie, barely avoiding a car accident, walking down a dark alleyway, meeting a bear in the woodsall can elicit feelings of fear and anxiety, resulting in weak knees, pounding heart, shortness of breath, and racing mind. We often use the words fear and anxiety interchangeably, but theyre not simply different labels for the same emotion. On one hand, fear is defined as an emotional state in the presence of a dangerous or unpleasant stimulus. Typically fear is accompanied by an internal, subjective experience of extreme agitation, a desire to flee or attack, as were a variety of arousal sensations (The Penguin Dictionary of Psychology, 3rd ed., s.v. fear). Whereas fear is a response to a current threat, anxiety is oriented toward the future. In short, fear is a reaction to a somewhat clear and present danger; anxiety is a reaction to an anticipated situation or event in the future.

Its good that we experience fear and anxiety; otherwise, wed be at risk for harm. Fear is our reaction to an identified threat (we meet the bear); anxiety is our bodys response to perceived threat (we anticipate meeting the bear in the near future). Anxiety is the bodys way of telling us to prepare for fight or flight, a response controlled by our autonomic nervous system (ANS). The ANS regulates many of the major muscles and organs of the body, such as the heart, stomach, and intestines. Most of the time, were unaware of the ANS, because it operates involuntarily and reflexively. We do, however, notice the operation of the ANS in an emergency because we breathe faster, our heart rate rises, and we start to sweat. For our ancestors, this response was vital for survival; for us, it remains a reaction to stressful situations when we feel threatened. For example, most of us would react with alarm if we encountered a bear while walking in the woods. Our sense of alarm might include an increased heart rate, increased sweating and respiration, dizziness, nausea, and difficulty concentrating. This response prepares the body to act quickly, depending on how we appraise the degree of risk and the action to take.

Of course, we also react with alarm to things that do not necessarily involve a physical threat. Taking a test, making a speech, or performing in front of others also can evoke the same sensations as seeing a bear. All of these situations produce physical sensations, such as nausea, dizziness, shortness of breath, and racing heart. Some people become anxious about the physical sensations themselves. These people (about 19 percent of women and 10 percent of men; Bernstein et al. 2007; Stewart, Taylor, and Baker 1997) are said to have high AS. When highly anxiety-sensitive people experience bodily sensations associated with anxiety, they tend to amplify, or turn up the volume on, these sensations; they focus on the sensations, misinterpret their meaning, and begin to catastrophize about what they mean. In contrast, less-anxiety-sensitive individuals tend to reduce the volume, recognizing these sensations to be normal, temporary, and unpleasant but otherwise harmless consequences of being in an anxious state (Reiss 1991).