Healthy living Coping with anxiety

Fear warns people of danger and can be an extremely unpleasant, threatening feeling. But without fear, people would not have survived over time, because a person who feels no fear does not recognize danger.

When we experience fear, processes are set in motion in the body that quickly provide the energy needed to respond to danger: either to fight or to flee. Stress hormones such as adrenaline are released for this purpose. They cause the heart to beat faster in order to supply the muscles with oxygen-rich blood. Sweating and discomfort are also part of this reaction. Organs not needed for an escape or attack response receive less blood flow. This includes, for example, the digestive system.

Fear is felt when concrete dangers, such as fire, the smell of gas, or a dangerous animal, are present. However, people can also experience fear even when there is no actual danger. This type of fear includes, for example, a heightened fear of negative judgment by other people or ongoing fear of having a severe illness even when test results come back negative.

This article deals with this type of heightened fear and panic. Panic is a very intense form of fear in response to a perceived or actual threat.

Some people often experience “false alarms”. They have distressing feelings of anxiety even though there is no acute danger. Anxiety can range from mild restlessness to complete panic.

Panic usually occurs suddenly and lasts for a limited amount of time. During a panic attack, a person is usually afraid of dying or of losing control of their mind and body. After an initial panic attack, many sufferers fear that the panic will occur again. They become afraid of the fear.

When worry, nervousness, or panic interferes with everyday life for an extended period of time, generalized anxiety disorder or panic disorder may be present.

Some people are more susceptible to anxiety disorders than others. As a rule, a combination of different factors is needed in order for a person to develop an anxiety disorder. For example, stressful events in the past can make you more likely to experience strong anxiety and panic. 

If you are susceptible in this way and then experience difficult life events such as the death of a loved one, a separation or a major period of transition involving taking on additional responsibility, you may develop an anxiety disorder. Dealing with the same stressors (stress triggers) would not necessarily be sufficient to cause another person to develop the same disorder. 

Sometimes bodily sensations, thoughts, feelings and physical reactions mutually reinforce one another within a short period of time, with the result that anxiety increases and creates a kind of vicious circle.

For example, a person goes shopping in a department store that becomes increasingly crowded. They start to feel warmer and warmer, and realize that they are starting to sweat. This triggers the thought, “I’m suddenly sweating so much. There must be something wrong with me,” and the person becomes anxious.

The fear sets off changes in the body, for example, the release of stress hormones. As a result, the pulse increases. The person now notices a rapid pulse and pressure in the chest and thinks, “I’m going to have a heart attack!”

The anxiety then increases rapidly and hormones are released faster. The pulse seems to be racing. The chest becomes tighter and tighter. Panic sets in.

As a rule, people tend to avoid unpleasant things. Someone who has experienced panic in a certain place or situation may avoid that situation or place in the future. Someone else may have a fear of certain things or creatures, for example, syringes or spiders, and avoid these completely.

If they try to approach the situation or object, they may flee at the first sign of anxiety. They are afraid that strong feelings of anxiety or panic will return. In other words, they perceive a threat even if the location, object or situation does not present a danger to them.

In the short term, escape brings relief and anxiety decreases. Several factors determine whether avoiding the feared places, things, and situations can be a viable long-term solution. One factor is how dependent the person is on the places or objects they avoid out of fear. For example, many people in Germany can cope well with a fear of snakes because they are rare in this country. On the other hand, it is more difficult for people who have a fear of syringes, supermarkets, or taking the train.

Fear can also spread from one situation to others, for example, from department stores to supermarkets. These situations can be avoided, but life also becomes increasingly restricted.

It is important to take action in the face of heightened anxiety because anxiety rarely disappears on its own.

Assess the danger

In the long run, avoidance often leads to limitations and reinforces anxious thoughts. Therefore, an important goal is to face the fear. An important question in this context is whether the situations that are being avoided really do present a threat.

If a panic attack is triggered by concerns about a serious illness, medical tests can help determine whether there is really an increased risk.

Accept minimal risk

There is no such thing as 100 percent certainty in life: in theory, bad things can happen at any time. Because of this, some people want to withdraw completely from life for safety’s sake. But withdrawing to a significant degree only increases the risk of developing an anxiety disorder, for example, through lack of exercise and social isolation. It is healthy and reasonable to accept that a small amount of risk is part of life, rather than allowing small risks to limit you.

Facing fears

In most cases, there is no reason not to expose yourself to situations that are anxiety-provoking but not dangerous to you. This approach is also called confrontation or exposure. It is useful to seek professional support when taking this approach. It may be sufficient in some cases to imagine or look at a picture of the feared object or situation. But why would someone intentionally put themselves in a situation that causes them great fear?

In answering this question, five assumptions play an important role, which at the same time describe how to confront fear:

• The fear-based belief of being in acute danger does not reflect reality.
• The situation can be endured without causing long-term physical or psychological harm.
• By enduring the situation and feeling the fear, people can experience how the fear subsides on its own. This usually happens after 5 to 30 minutes. 
• The situation, place, object, and even the fear itself lose their power to provoke anxiety.
• People can put themselves in previously avoided situations or face these things again with little or no fear.

In summary, by confronting their fears, people learn that neither the situation, place or object nor the fear itself is dangerous. Fears continue to diminish the more often they are confronted. The fears gradually subside on their own, and eventually people no longer associate the situations, objects, or places with fear. In this way, confrontation can help people to overcome fears and live with more freedom again.

Important: For most people with severe anxiety or panic disorder, facing fears sounds very scary. Confronting your fears can be a step-by-step process. This process should be undertaken with the support of a psychotherapist.

High levels of stress and pressure can make people more susceptible to anxiety and panic attacks. Almost everyone has a personal anxiety threshold. Their physical fear response only kicks in once this threshold has been reached. This is also how the vicious cycle of anxiety begins. 

When overall tension is low, everyday stressors do not cause the anxiety threshold to be crossed. However, the general level of stress can increase to high levels, for example, due to unemployment or social isolation. When this happens, everyday stressors, such as an argument or small mishaps, can lead to the anxiety threshold being exceeded. Under these conditions, severe anxiety or panic can occur more frequently in everyday life.

A simple analogy can illustrate this well. If you stand in the sea up to your ankles (low stress), a big wave (stressor) must come in for your knees (anxiety threshold) to get wet. But if you are already standing in water up to your calves (high stress), then your knees will get wet even when small waves (stressors) come in. In other words, panic occurs more frequently.

Reducing tension and stress in everyday life

Reducing tension and stress in everyday life can help decrease the likelihood of experiencing anxiety and panic. There are several ways to do this.

• Relaxation techniques can be effective for reducing anxiety and stress. One well-known form of relaxation is the Jacobson progressive muscle relaxation (PMR) technique. This involves first tensing and then relaxing different muscle groups in succession.
• Sports and exercise also help to reduce stress and tension.
• Yoga, meditation, and mindfulness exercises involve movement, breathing techniques, and focusing on the present moment. These practices can also help reduce stress. An important element of the practice is acceptance: accepting things that cannot be changed.
• In addition, it is important to maintain a healthy lifestyle. This includes eating a balanced diet, getting enough sleep, limiting alcohol and caffeine intake, and abstaining from tobacco and other drugs.
• It is also helpful to complete tasks according to importance and to create weekly plans with realistic goals.
• In addition, it helps many people to actively address conflicts with others and resolve them.
• Finally, stress can be reduced by knowing your own limits and setting boundaries.

The following thoughts may help people who are experiencing anxiety for various reasons:

• My physical sensations are not absolute proof of impending disaster.
• I allow for the possibility that I have misinterpreted my physical sensations as danger.
• It is possible that fear is the reason for my physical reaction.
• The fear itself is harmless and will pass.

If one or more of the following statements apply, seek professional help from a psychotherapist or psychiatrist.

• I think about my anxiety more than half the day.
• My fears considerably restrict my quality of life and freedom of movement.
• Because of my anxiety, I am becoming more and more depressed.
• I have had suicidal thoughts because of my fears.
• I often cope with my fears by using alcohol, drugs, or tranquilizers.
• My fears are putting my relationship or my job at serious risk.

For more information about various anxiety disorders and treatment options, see the patient guidelines published by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V, AWMF).

Local psychotherapists and psychiatrists can be found through the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung). Call 116 117 or use the online doctor search.

For more information about finding a psychotherapist and understanding emotional distress, visit the website Wege zur Psychotherapie (“Pathways to Psychotherapy”) operated by the Chamber of Psychotherapists (in German).