By Simone Sobel, LCSW
Do we need to know what causes our anxiety to get rid of it? Clients will sometimes ask me at our first therapy session: “are we going to have to go way back into my childhood for me to be free of my anxiety?” They are generally to hear that, no, we will not be spending hours of sessions talking about their mother in therapy in order for them to find relief from their anxiety symptoms. It is not always necessary to pin down specific causes to benefit from anxiety treatment. It’s true is that anxiety is a multidimensional problem that functions on many levels (including biological, family history, upbringing, thinking patterns, coping skills, stressors, and your support system among other factors). It’s also true that both nature and nurture or biology and psychology come into play when talking about what’s causing anxiety. In all likelihood, no one factor on its own has caused a person’s anxiety, but rather some combination of biology, heredity, childhood circumstances, cumulative stress, life difficulties or other vulnerabilities that have triggered it in some way. Anxiety can be activated by a variety of elements operating in both your present and your past. But according to psychologist Edmund Bourne (whose view of anxiety is one that greatly informs my own on anxiety causes and treatment) it is the different ways we think, feel and cope that keep anxiety going in the day-to-day. These “maintaining causes,” as Bourne terms them, are the easiest and most obvious places to begin treating anxiety, and often the ones where clients can begin to realize the most benefit early on in treatment.
In this post I’ll describe some long-term, biological, short-term, and especially some of the maintaining causes of anxiety. I’ll spend the most time on the latter in subsequent posts. Why? Because while we may not have had any control over traumatic or painful experiences in our past that can underlie anxiety, and nor are we necessarily able to alter major life stressors, such as a health crisis, that may also be provoking the problem, we can absolutely work on changing thought patterns, altering anxiety-provoking beliefs and working on self-talk or the way we manage stress, how we communicate and express our feelings and other methods for reducing versus perpetuating anxiety.
Long-Term Anxiety Causes
Personality Type – very often a more reactive, excitable or easily distressed personality is inherited from family members, either biologically or environmentally, by being raised by someone with a similar personality type.
Childhood Experience – when parents are excessively fearful or anxious, they can convey a sense that the world is a dangerous place. Children subsequently have a greater likelihood of becoming worriers as adults, and to be overly cautious or vigilant or excessively concerned with safety.
Children who experience excessive criticism or unrealistically high expectations from caregivers in childhood can become overly self-critical or perfectionistic as adults. They may also engage in people-pleasing or approval seeking or avoid taking risks for fear of failure or looking bad, all of which can precipitate anxiety.
Individuals whose parents were punitive or became angry when their children expressed strong feelings or opinions may have learned early on to suppress their feelings and to avoid asserting themselves. Long term suppression of feelings creates an ideal environment for anxiety to fester.
Cumulative Stress – stress can build up over months or years due to life changes (such as illness or marital difficulties) or unresolved conflicts. Sometimes a lot of change at the same time and that lasts over a long period of time can lead to chronic stress and exhaustion, which in turn affects our physiological systems (neurological, endocrine) that can activate anxiety disorders. An example might be getting married, moving cities and beginning a new job all within the same year or two.
Biological Anxiety Causes
Biological causes of anxiety relate to a physiological imbalance in the brain or the body and are most easily addressed through lifestyle changes, such as exercise, increasing social support, self-nurturing and relaxing activities, such as massage or yoga, good nutrition, or looking at medications that may be contributing to anxiety. Some examples of the way biology can play into anxiety are the way the parasympathetic nervous system is set off in the midst of a panic attack, or a lack of the neurotransmitter serotonin that has been linked to the occurrence of OCD (more on this in posts on panic and OCD.) Again, though, while biology may be the most obvious cause, it has likely combined with others such as cumulative stress or a difficult life event to produce a panic attack or other type of anxiety presentation.
Medical conditions that can lead to anxiety include hyperthyroidism, hypoglycemia, deficiencies in calcium, magnesium or iron, food additive allergies, inner ear disturbances, emphysema, congestive heart failure, hypertension, acute reaction to stimulants like caffeine, aspartame, cocaine or amphetamines, withdrawal from alcohol, sedatives or tranquilizers or exposure to environmental toxins like mercury or pesticides.
Short-Term Anxiety Causes
Specific stressors – such as significant personal loss, including death, divorce or separation or loss of employment or financial reversal, health crisis through illness or injury, significant life change that requires a major adjustment such as getting married, having a baby, going away to college, moving cities, or changing jobs.
Trauma – which can lead to generalized anxiety, phobias by avoiding anything associated with the trauma or PTSD
Maintaining Anxiety Causes
As mentioned above, these are the ones that allow anxiety to operate in the present. As you read through these, see if you can pinpoint the ones most responsible for your own anxiety, and ask yourself which ones you’d be most willing to begin working on right now.
Avoidance – this is a type of learned behavior; it is much more comfortable to avoid what distresses us or causes us anxiety than to allow ourselves to experience it. Unfortunately, while more comfortable, avoidance serves to maintain and feed our fear and anxiety. The best way to address avoidance is to work on facing and staying within a particular anxiety-provoking situation in small, manageable doses, until we are desensitized and better able to tolerate it.
Self Talk – self talk is our inner monologue or conversation that we have with ourselves, the way we talk to ourselves internally. We all engage in self talk throughout our day. Self talk can be positive or negative and can become habitual in either direction. Anxious self talk, such as “I will never be good enough,” “I can’t do this” or “what if something bad happens to me?” contributes to worry, panic and anxiety. You can learn to recognize, control and replace anxious self talk with calmer, more nurturing and self-affirming messages to yourself.
Mistaken Beliefs – these are distorted beliefs about ourselves or the world that can underlie a lot of our anxiety. Examples of beliefs that maintain anxiety are “the world is a dangerous place,” “I can’t trust anyone” or “I have to be perfect.” Such beliefs may be rooted in actual negative experiences or in messages we received during our upbringing. But they may not be true of our present reality and they can serve to keep us stuck in our past and in anxiety.
Withheld Feelings – denying or suppressing feelings such as anger, sadness, or frustration is also a learned behavior. Often, it’s caused by caregivers who shut down strong feelings, opinions or assertiveness in their children, due to their own inability to cope with them. Just as you may have learned to suppress feelings, you can also learn how to begin recognizing and expressing them more easily and more often.
Lack of Assertiveness – Assertiveness is one of the ways we express our feelings, by communicating in a way that is direct, open and clear. When we lack assertiveness skills to get our needs met, we can end up feeling frustrated, resentful and stuck. We may also focus excessively on people pleasing or become overly dependent on others. Learning to ask for what we want in a direct, open manner and other assertiveness skills, can be learned.
Lack of Self-Nurturing Skills – if we lacked consistent nurturing, attention or security in childhood, we may not have had the opportunity to learn adequate self-nurturing skills. As we become adults and the demands of life increase, we may become overwhelmed and not have a clear sense of how to love and nurture ourselves in healthy ways. According to Bourne, the solution for a lack of self-nurturing skills is to become a “good parent” to yourself through gaining an awareness of your needs and working to nurture them in yourself.”
Stressful Lifestyle – you can address a high-stress lifestyle through time management, avoiding perfectionism or “type A” thinking, and working on communication, among other stress management skills I’ll address as we delve more deeply into specific ways of targeting anxiety.
Lack of Meaning or Purpose – lack of meaning or purpose in life can create a sense of boredom or claustrophobia, or “existential vacuum” as Viktor Frankl defines it in Man’s Search for Meaning. Dealing with your anxiety may mean taking a closer look at this area of your life.