Anxiety is a primary reason people seek therapy. Anti-anxiety medication is the number one selling psychotropic medication in the U.S. There are many anxious people out there. While it’s true that we live in a more complicated world and are under more stress than ever, the kind of anxiety that causes people to seek therapy and/or medication is rarely caused primarily by societal conditions. Psychologically caused anxiety is what does that; societal conditions can only exacerbate pre-existing anxiety.
By psychological causes I mean early childhood experiences, that occur either within or outside the family, which then interact with later developmental transitions. (e.g., adolescence, adulthood, becoming a parent, empty nest, retirement, etc.) These childhood experiences remain with us throughout our lives, for better or worse. In this regard, anxiety is not different from any other psychological problem: it results from family relationships beginning at birth: parent-child, sibling-sibling, adult-adult (parents' relationship) and the interactive combinations of all of them. If these interactions in some way produce a sense of fear or danger in the child he or she will react with anxiety. Anxiety is an alarm that tells us there is danger nearby. A child or adult can avoid the perceived danger altogether (phobia) or remain anxiously inhibited by it throughout life. The severity of anxiety and the degree to which it interferes with the enjoyment of life is what determines whether or not someone needs help.
Like most behavior, anxiety is an adaptation to something that was originally beyond the individual’s (child's) control. While a person may want relief from his/her anxiety, it is important to discuss the purpose it has served in the past and what triggers it now. The anxiety is not there by accident or the result of genetics. If a child is bitten by a dog, for example, he may spend his adulthood crossing the street whenever he sees a scary one. That is an understandable and reasonable reaction to a frightening, past experience. But what if a person has not had such an experience yet is so terrified of dogs that he avoids going anywhere they might be? The overwhelming fear is debilitating itself, but it also places severe limitations on the person’s life. In this case, the object of anxiety may not actually be the dog. The dog could be a “stand in” for something else that the child or adult fears. That something else could be upsetting thoughts, feelings, or desires that the person thinks are unacceptable. So he "distracts" himself from those thoughts by transferring them to dogs and/or becoming preoccupied with them.
The first example is a very specific fear and there are many of them: fear of any number of animals, doctors, medical procedures, flying, elevators, driving, test taking, etc. These are phobic-type anxieties and can be treated systematically with behavioral approaches that help the individual become less fearful of the animal or object with gradually repeated exposures to it.
A lot of anxiety is not so specific. Many people experience more vague, “free floating” anxiety. People who experience this kind of anxiety may be completely unaware of its source and be left with just the physical symptoms: butterflies, sweats, feelings of dread, palpitations, etc. If these symptoms become intense enough they can lead to a panic attack. Generalized anxiety like this is symptomatic of deeper fears and experiences.
Another common form of anxiety is separation anxiety and while it can occur at any age, it usually begins early in life and results from not having a secure base from which to take on the world. By secure base, I mean a sense of being valued, loved and cared for which then produces confidence and well developed self-esteem. An insecure base can result from any number of family dynamics, and the frequency and intensity of those dynamics usually determine how an individual copes with anxiety as an adult. For example, when parents are anxious themselves because of their own histories; if they regularly react anxiously to their child’s behaviors because of their own insecurities; it increases the likelihood that the child will be anxious as well. In this situation, the child “adopts” or internalizes his or her parents’ anxiety. Parents communicate their own anxieties to their children in many unobservable, unconscious ways. Other potential causes of early insecurity leading to debilitating anxiety are parental marital conflict, unmodulated anger or aggression, and frequent criticism.
As with depression, sometimes anxiety is an adaptation for anger or aggression that cannot be expressed appropriately for fear of parental retaliation. This initially starts with being afraid of parental disapproval and/or withdrawal whenever the child gets angry or expresses anger, particularly towards parents. The child is fearful about expressing negative and/or angry feelings and becomes anxious instead to protect him or herself, as well as the parents, since anxiety is often less threatening than anger is. The focal point becomes the child, not the parent. Fear of parental disapproval can transfer to other authority figures like teachers or eventually employers. As an adult, he or she can become anxious anytime a confrontation occurs or anytime the expression of his or her anger is involved, or even just feeling angry. For some people, this situation can become quite inhibiting if not paralyzing in terms of achievement or promotions.
With all forms of anxiety, it is important to first determine what the original source was. One way of doing that is to take a detailed history as to initial occurrence, duration, frequency, and under what circumstances it occurs. It is also important to know the thought processes associated with anxiety to determine whether there is a durable theme. Does it involve loss, physical threat, fear of retaliation, etc? What is most essential to remediating the symptom of anxiety, regardless of the therapeutic modality a therapist employs to treat it, is the quality of the relationship between therapist and patient. A good therapist creates an environment of safety and trust. A therapist can also provide a certain amount of didactic information regarding anxiety in general and thus engage the individual in a collaborative way. Just being able to talk about one’s anxiety with another person is itself a way of desensitizing the individual. Equally important is that in therapy, the anxious person is no longer alone with his or her fears and worries.