"I've been through some terrible things in my life, some of which actually happened." In Mark Twain's biography, as in that of each one of us, there is a part written through thoughts and emotions. How we interpret experiences, our internal discourse, what we believe, hope or fear conditions our reality and if this impact is often negative, it can overshadow it. The pandemic has left a trail of gloom in that inner world. The feeling of loss of control, vulnerability and uncertainty is even greater and anxiety has skyrocketed, especially among young people. How can we help someone deal with such deep psychological discomfort? With this report we begin a series in which experts, those affected and relatives of various pathologies will offer some guidelines to accompany a person in our environment who is suffering in the most appropriate way.
Feeling stress when we face situations of alarm or uncertain outcome (taking an exam, attending a social gathering...) is an adaptive reaction. Our body prepares to act in the face of a possible negative outcome and arms us with physiological tools to successfully overcome it thanks to the activation of adrenaline, noradrenaline and cortisol: the heart beats faster, we breathe faster, the muscles tense. .. This state of alert sharpens the senses and we think faster and more carefully, which makes the response more agile. Once the risk is overcome, the body 'deactivates' and returns to its usual 'resting' state.
The problem arises when this is not the case. The restlessness persists for no apparent reason and our body remains prepared for attack or flight and with maladjusted symptoms: palpitations, lack of concentration, loss of appetite, irritability, insomnia, anticipatory ideas of danger and threat... The one who suffers from them becomes a victim of those "terrible things" that Twain spoke of. He lives besieged by tension, fear and a growing sense of exhaustion. And in a society like the current one, subjected to continuous stress for multiple reasons and overloaded with personal obligations and pressures, this state is not too foreign to anyone.
High anxiety symptoms
Spanish for the Study of Anxiety and Stress- Cardiovascular system: palpitations, rapid pulse, high blood pressure
- Respiratory system: rapid and shallow breathing, choking
- Gastrointestinal system: discomfort, nausea, diarrhea, vomiting, aerophagia
- Motor system: muscle tension, tremors, tingling, tension headache
- Autonomic nervous system: dry mouth, swallowing difficulties, excessive sweating, fainting
- Worry, fear
- Ideas of inferiority or incapacity
- Difficult to focus
- Feeling of disorganization and loss of control
-Unsafety
- Anticipatory ideas of danger and threat
- Difficulty making decisions
- Repetitive movements
-Motor restlessness
-Hyperactivity
- Motor paralysis
-Avoidances
-Stuttering
- clumsy movements
- Consumption of food, alcohol or tobacco
When anxiety occurs at inappropriate times or is so intense and long-lasting that it interferes with a person's normal activities, then it is considered a disorder. The latest European Health Survey confirms that this is one of the most frequent mental health problems in Spain. 5.84% of the population over 15 years of age declared having been diagnosed with chronic anxiety and 10.86% having used tranquilizers to sleep. It is the most common psychiatric illness and affects more women. It cannot be attributed to a single cause but responds to multiple factors, from psychological to biological or sociocultural.
Hiding emotions increases anxiety
This feeling of internal lack of control is often experienced as a weakness and tends to be silenced. Not talking about it can aggravate the situation. "Trying to hide emotions increases anxiety," warns Antonio Cano Vindel, president of the Spanish for the Study of Anxiety and Stress. We must try to encourage that person who we see badly, nervous, tired or despondent to express what is happening to him and, if necessary, to seek professional help to channel the problem [click on this link if you want to know if you suffer from anxiety] . In his long experience offering tools to do so, Cano has observed that those who suffer from it do not always find understanding in an environment that usually asks: "If you have a good job, your salary and a family... why do you suffer?"
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Finding that answer supposes a deep personal work. One of the first steps is learning to detect and manage thoughts. "Cognitive behavioral techniques [learning to interpret threats in a way that is not so catastrophic, training in problem solving or social skills, not paying so much attention to symptoms, not avoiding...] have been shown to be very effective," he explains. Spout. A study applied to 1,000 primary care patients showed that those who had received "psychological training" in only seven sessions improved in 70% of cases, while those who were only treated with drugs saw progress in 15%. Changing the way of interpreting reality is a process of personal transformation in which family and friends have little room for action, but they can serve as a point of support.
Paula welcomes us with a smile that fills the video call with warmth. She speaks in a slow tone and with the clarity of someone who has spent much of her time trying to understand herself. She does it with special depth since anxiety broke into her life 20 years ago and disarmed her reality. She was then a Sociology student who shared a flat with other university students in Alicante. She traveled independently, went out with her friends, led a "normal" life, with the routines and activities of a young woman her age. From one day to the next all that changed and she began to have panic attacks.
"I would get really bad, I thought I was going to die and then it would go away. I had never experienced a set of sensations that invalidated me so much," she recalls. Just thinking about going out on the street made her "sick" and those activities that were previously part of her daily life such as going to class, shopping or going to the movies became threats. "My brain identified situations as dangerous even if they weren't and my body went into survival mode. That's an anxiety attack. Our pupils dilate to see where the danger is coming from, the blood goes to the extremities so we can run away , your heart is pounding really hard, you start hyperventilating to get more oxygen to defend yourself. It puts your body into superpower mode but you don't need it because you're standing in line at a supermarket." Paula describes in detail the symptoms that she still perceives today, at 42 years old, in each relapse. "Each attack confirms to that brain that it is right, that actually being on the street, in a shopping center or in a classroom is a danger." Hence the importance, she emphasizes, of receiving specialized psychological care without delay to prevent the disorder from worsening and becoming chronic. In her case, like that of many others, she was not like that and she had to go to private healthcare. She was diagnosed with panic disorder with agoraphobia. She also later drifted into depression.
Types of anxiety disorders
Spanish Internal Medicine (SEMI)Generalized anxiety disorder is chronic tension even when nothing seems to cause it. This worry or excessive nervousness is almost daily and is diagnosed as such when it lasts for at least six months.
In panic disorder (or panic attack): The patient experiences recurrent panic attacks that arise spontaneously. It is an acute and extreme anxiety in which the person suffering from it often believes that they are going to die. These sudden attacks of intense fear have no direct cause. Sometimes, patients suffering from this disorder develop anxiety to experience the next attack, whose occurrence they cannot foresee, it is called anticipatory anxiety.
The essential feature of phobic disorder is the presence of an irrational and persistent fear of a specific object, activity or situation with the consequent avoidance of the feared object. For example, the fear of flying, birds or open spaces.
Obsessive-compulsive disorder includes involuntary thoughts or actions that the patient cannot stop thinking or doing so as not to generate anxiety. In any case, the subject recognizes the absurdity of her thoughts or actions. For example: wash your hands every few minutes.
Post-traumatic stress disorder occurs in those cases in which unpleasant psychological sequelae occur after the impact of emotional trauma, war, rape, etc. It is characterized by persistent memories of the traumatic event, an emotional state of heightened vigilance, and a general reduction in interest in everyday events.
"Your life already changes from the moment an anxiety attack with that intensity hits you, you stop being the person you were. You have to face therapy and help that comes from a very uncomfortable pharmacological treatment," he explains with the strength of a person who accepts their limitations and struggles to overcome them. She had to leave Alicante, put her studies on hold for months, return to Valencia to her parents' house and begin a hard psychological journey that would help her regain a sense of control. She didn't go through it alone. The support of the environment is key in the recovery process. What does a person suffering from anxiety attacks require?
-- CREDIBILITY . You need to perceive that your suffering is perceived as real. "It is not an invention, it is a mental health problem. Although it is invisible to medical tests, it is a reality." People who suffer from severe anxiety often have to hear phrases such as "it's just nerves, calm down and that's it". They are not 'nerves' but feel like the protagonist of a horror movie 24 hours a day. The imprint of the disease is reflected in his behavior, in how he has changed since he suffered from it. In Paula, she notes avoidance and isolation.
Anxiety is a red light that is activated in our body and for it to disappear, we must first understand what is wrong. Self-knowledge is essential. "You have to know what tools you have and what you need, such as assertiveness, self-esteem, emotional management, perseverance, the ability to overcome and make an effort," she explains. A common trait among patients with anxiety, especially among women, is self-demand and perfectionism.
--- INFORMATION AND UNDERSTANDING . It is not easy to understand what happens and why these "so strange" things happen to someone, not even for those who suffer from it. "How do you explain to someone that you can't stand in line, that you can't go out unaccompanied but that the company of just anyone isn't worth it...?" asks Paula, still without too many answers because "people don't understand the dimension of the problem". Faced with this ignorance and the social stigma that he still perceives towards the mentally ill, he defends the importance of associationism and mutual aid groups that, like those of AMTAES (The Spanish Association for Mutual Aid against Social Phobia and Anxiety Disorders) have offered for six years an "oasis of peace and understanding".
To help a person suffering from anxiety disorders, it is crucial to have "information, training and understanding", Paula sums up. Her mother bought books on anxiety, phobia, agoraphobia and depression to try to better understand her daughter and later explained it to her husband. The fluid and constant communication with the specialists was also essential to know the symptoms and how to act. To know, for example, why it was so necessary for me to go with her to the exams so that she would perceive some security even if it was looking at her shoe while she waited or to accompany her when she had to expose herself to situations that generated anxiety as part of the therapy (desensitization) until she could face them alone. It is essential in the process "to have a person by your side, someone to hold on to," she says.
-- THAT THE SYMPTOM DOES NOT DOMINATE THE FAMILY LIFE . Ana María Ruiz Sancho is a psychiatrist. Numerous people with anxiety problems and relatives worried about her condition have passed through her consultation. "What can I do for him?" they often ask. The first thing is to "recognize it as a problem", but to be clear that "the person is not the disorder, the person is much more than his disorder". Focus on accompanying him, be patient and understanding, listen to the suffering "without dramatizing it", but do not try to become therapists and make sure that she has the specialized care she needs. This expert usually observes how everything in the family nucleus ends up wrongly revolving around the disease. She therefore advises not to forget that life is "much more than problems and symptoms" so it is convenient to maintain the rhythm and usual routines of the family as well as not to lose contact with family, friends and leisure and free time activities .
Help him develop an action plan to eliminate these potentially stressful situations in his environment and encourage him to make changes in his life that can relieve anxiety, such as relaxation practices or physical exercise, reducing the consumption of stimulant substances such as coffee or alcohol and to rest and follow a diet that is as healthy and balanced as possible.
-- KNOW HOW TO HELP IN CASE OF CRISIS . Paula has suffered "hundreds" of panic attacks, especially at night, and despite this she feels in each of them that she "is not going to get out of this." It is very difficult "to learn to think with fear", she explains without losing her smile. That anxiety crisis will pass on its own, with or without help, but if there is someone nearby who knows what to say and do, it will be shorter. He explains the correct way to react: "Keep calm and patient, try to rationalize the situation with a calm tone of voice and say 'it's okay', 'I'm here', 'you're not alone'. Hug him if needs Some people can feel depersonalized, as if they are outside their body, which causes immense distress Help the patient to breathe [see here for different techniques], to remember to relax the muscles and put into practice everything you already know Do not overwhelm or ask for answers Do not overwhelm Do not make him feel guilty because he already feels shattered inside.
-- DIVERT THE FOCUS . Reaching out to someone who is trapped by harmful thoughts means listening to them without giving advice, helping them to relativize without downplaying and reinterpreting threats in less catastrophic terms. It is of little use to tell someone to be "calm" and "don't think" about what worries them so much. Let's do a test. Imagine right now on a pink elephant. If I tell him, stop thinking about him. Can do it? Possibly not right away. "How did we forget about that elephant? Talking about something else," says Cano Vindel.
An anxious person what he does is 'ruminate' (turn his thoughts over and over). What for other people are normal situations, for her it supposes a threat (interpretive bias) and she spends a lot of time on them. In a conversation, for example, he cannot enjoy himself because he is not fully present but instead feels judged and evaluated with very negative self-talk: "He must be thinking that I am not saying anything...and now what do I say...and if nothing comes to mind ...and if I mess up...) Trying to focus on what you're doing (talking and listening) is helpful in breaking out of that loop. Remember this metaphor when intrusive thoughts hit you: "A driver (you) is on a bus and the passengers (your thoughts) start to arrive. Some are really annoying, they insult you, they tell you that you're driving terrible, that you're going to crash... You can do two things: give them importance, believe them and surely you'll have an accident because you're distracted, or you can continue, although they won't go down and you will continue to listen to it, and arrive at the destination and fulfill your work for the day. Despite the anxiety, despite the disturbing thoughts, some really cruel and painful, the goal is to keep going and make small conquests every day. Little by little, there will be less and less uncomfortable passengers and the road may be easier. If you don't feed your fear, fear cannot survive.
One of the great concerns of the person suffering from anxiety is that he is perceived from the outside. "It's a cognitive distortion," Cano explains because "the other doesn't realize my sensations" and in the event that he sweats or trembles, something that can be detected, fear of rejection may appear. A person with anxiety often becomes his worst enemy because he talks to himself with a harshness that he would never treat anyone with. It is convenient then to encourage that person to ask himself. Would you turn your back on someone who was trembling or sweating? No. Would you think it's "asshole"? No. Then why would they think that of you?
-- DO NOT AVOID . Imagine that you have to read in public before a packed auditorium. We are nervous before our public, believing ourselves evaluated and boycotting ourselves with thoughts and that perpetual fear of remaining 'blank'. The more anxious we are, the less attention we pay to reading. We have entered that loop of panic and we are blocked. We get out of the trance as best we can and possibly with great discouragement. "After this experience an apprenticeship is developed" and in similar situations "you will have a bad time". We are afraid that this feeling of paralysis will be repeated and we "magnify the interpretations of others" so we tend to avoid exposing ourselves again. Not trying again is not a solution. "Just as you learned to develop abnormal anxiety reactions, you can learn well again," Antonio Cano comforts those people who suffer from anxiety disorders.
"A common psychological reaction when something causes anxiety is to want to avoid it, but most disorders are treated with coping. When you live with someone who is afraid of something, you try to avoid it," says Ana María Ruiz. It's a mistake. Exposure is essential to embark on the road to recovery, always keeping in mind that in cases of severe anxiety it must be done with therapeutic support because otherwise it can be highly damaging.
-- HOW TO PROTECT CHILDREN
Anxiety is not just an adult thing. That child who frequently suffers from stomach pain, who is excessively restless or sad, who feels an intense fear of something or that adolescent who isolates himself, gets angry or worries more than usual because something could happen to you may be suffering a true internal torment that must be treated in time so that it does not end up affecting its development.
The behavior of parents is decisive in preventing and mitigating anxiety in their children. In the first place, by their own response to stressful situations. If it is thoughtful and not disproportionate, minors will learn to better regulate their emotions, which is a safeguard for their mental health. An upbringing without overprotection or authoritarianism and clear and respectful limits will also help the child grow up with greater self-confidence. That the parents free themselves from their own inner restlessness with a balanced and healthy life will also drive away that ghost.
Anxiety disorder does not have a single cause and responds to psychological, biological or sociocultural factors. It is the most common psychiatric problem among minors and can mark both their present and their future, which is why it is crucial that the family does not look the other way.
Parents cannot diagnose but they can perceive when their child suffers. And in case of doubt or suspicion always consult with the pediatrician. Ana María Ruiz Sancho stresses that a clear factor in avoiding concerns and "pathologizing" behaviors that are normal is knowing the "fears of childhood". Find out about the fears that can arise at this stage of development and any "deviation from what can be expected in a healthy child" address it with a specialist.
When treating minors with anxiety, it is tried to resort to medication only in the most serious cases. The therapeutic intervention is aimed at working with the child, helping him to detect and manage his thoughts and emotions and training him in coping strategies but also with the people who are in his care so that they know how to communicate with him, giving him empathy, security and constructive formulas and realistic to deal with the problem. [MORE INFORMATION ABOUT ANXIETY IN MINORS]
At 42 years old, Paula is now "building" her life again because she has decided to move on. The acceptance of the patient and her environment is crucial in the process. Her day-to-day life and that of her peers in her support groups show her that people with anxiety disorders "continually achieve feats." "We don't live, we survive," she admits. Her ability to overcome drives her to continue and with her, her family. She tells them fully convinced, "I'm not my illness, I've been diagnosed with depression but I smile and I'm happy." And it is this same disease that has led her to strengthen emotional management skills that can open up an exciting future for her, such as training as a coach and that her experience serves to guide other people with difficulties. And that those "terrible things" that Twain spoke of are more and more blank pages in her biographies.
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