Can Anxiety Harm Me?

In my years working with clients with anxiety disorders, including OCD, one thing I’ve noticed is that a key feature of anxiety disorders is the fear of anxiety itself.

Sometimes this is called ‘secondary anxiety’ because not only is there the anxiety about the initial thing (eg. The heart check-up or the job interview or the exam), but there’s also the secondary anxiety which is anxiety about anxiety.

No one likes anxiety.  It feels yucky. But some people really hate anxiety and they think they simply can’t tolerate it.  This is often what leads to anxiety disorders such as panic disorder and OCD  – an inability or unwillingness to tolerate or sit with anxiety.  Sometimes this is because people fear the effects of anxiety. They fear that the anxiety might make them go crazy or give them a heart attack or give them a panic attack or cause them to faint. 

So what I want to do in this blog post is look at anxiety and reassure you that anxiety, in almost all cases, will not harm you!

Why Do We have Anxiety?

A really helpful place to start when thinking about anxiety is to appreciate that anxiety, like all our emotions, evolved to help us. Anxiety keeps us alive and it certainly kept our ancestors alive.  If two cavemen were walking along and heard a rustling in the bushes, the caveman with more anxiety would run away more quickly and readily than the other caveman. Sometimes the rustling in the bushes wouldn’t have been anything dangerous, perhaps just a bird or something.  On those occasions the non-anxious caveman might have scoffed and laughed at his cave-buddy, ‘relax man, it’s just a bird.’  But one day it wasn’t just a bird, it was a snake or a tiger (or whatever) and the chill cave man got eaten his chill genes lost forever. Now all 8 billion of us on planet earth are descendants of the anxious caveman (and cavewoman).

But why do we seem to get anxious so often when we don’t need to? Has evolution made a mistake with our anxiety response? Psychiatrist Randolph Nesse, one of the founders of evolutionary medicine, explains why natural selection did not rid our species of onerous psychiatric disorders. He uses the metaphor of the ‘smoke detector principle’ which is that our anxiety response is like a smoke detector in your house: it’s very sensitive and will go off very often even when the house is not on fire (usually because the toast is burning or there’s a candle nearby or something). These false alarms are annoying (they make a load noise and you need to climb up and turn the smoke alarm off), but they’re calibrated the way they are because the cost or the annoyance of many false alarms doesn’t outweigh the cost of dying in a fire.  So even though the smoke alarm might ‘get it right’ just 1 in 100 times, it’s still functioning properly and doing its job well. It’s the same with our anxiety response.  Most of the time, we’re anxious for no really good reason.  But our anxiety alarm goes off anyway, just in case.  In other words, an overactive fight-or-flight response that causes false alarms—and potentially an anxiety disorder—is better than an underactive system that fails to alert you to danger and could result in death. This is annoying for us, but our genes don’t terribly mind if we’re happy or not, they just care that we survive.

This is why someone can be put an anti-anxiety medication, even something very strong like a benzodiazepine (eg. Valium, Xanax, Ativan) and usually, nothing bad happens to them. Meaning, they don’t usually die.  They don’t suddenly forget to worry about cliffs and walk off them or forget to worry about speeding cars and walk in front of them. In other words, people can have very low levels of anxiety, and still make sensible decisions and avoid danger. (NB. I think if there was a way to take anxiety down to absolute zero this would cause problems. One would likely end up dead or in jail within a few weeks. Imagine not worry at all about anything, even keeping yourself alive!?)

How does this help? Well, for one thing its reassuring that if you struggle with anxiety, it’s not because there’s something wrong with you. It’s perfectly normal, even if it’s very distressing.  A lot of my patients find this fact alone very therapeutic. It’s one thing to have anxiety, it’s another thing to think it also means you have something ‘wrong’ with you’, some sort of ‘condition’. No! The only condition you need for anxiety is the human condition!  Take away this false idea that something is ‘wrong’, and a lot of people start to feel less anxious already.

Can It harm me?

But isn’t anxiety and stress bad for my health? This is another area where people unnecessarily exacerbate their anxiety.

It is true that chronic stress can cause health problems. The long-term activation of the stress response system and too much exposure to cortisol and other stress hormones can disrupt almost all the body's processes. This puts you at higher risk of certain health problems, including digestive problems, headaches, and heart disease.  But short-term anxiety – or acute stress - can’t hurt you or cause any of these things. In fact, we are all encouraged to acutely stress our bodies for 30 minutes a day, five times a week – this stress is called moderate physical exercise!

Most of the problems attributed to chronic stress are actually caused by the unhelpful behaviours that people do in response to feeling stressed. Things like drinking too much, smoking, eating poorly, staying up late scrolling on their phone, neglecting pleasant activities and positive social interaction, becoming aggressive or demanding, and so on.

Short Note: Stress vs Anxiety

There’s a fine line between stress and anxiety. Both are emotional responses, but stress is typically caused by an external trigger. The trigger can be short-term, such as a work deadline or a fight with a loved one or long-term, such as being unable to work, discrimination, or chronic illness. People under stress experience mental and physical symptoms, such as irritability, anger, fatigue, muscle pain, digestive troubles, and difficulty sleeping. Anxiety, on the other hand, is defined by persistent, excessive worries that don’t go away even in the absence of a stressor. Anxiety leads to a nearly identical set of symptoms as stress: insomnia, difficulty concentrating, fatigue, muscle tension, and irritability.

Now let’s walk through some of the main physical symptoms of stress/anxiety, and explain what anxiety will and won’t do…

What Anxiety Will Do

The worst thing anxiety does to us is make us feel afraid. That’s it. Anxiety doesn’t actually do anything to us. It doesn’t harm us. It feels to many of us – especially those of us with anxiety disorders – that it really is terrible and harmful, but it isn’t. 

If we walk thought the most common physical features of anxiety we can see that it is harmless. If we start with heart rate: Most people experiencing anxiety experience increase in strength and speed of heart rate. Maybe it speeds up from 70BPM to 120BPM or even higher. This is to pump more blood with its oxygen and other nutrients around your body to fuel the muscles and other tissues. But this is completely normal and safe. This is the range it would reach if going for a fast walk. If you go for a run, it will probably go up to 160BPM or higher (depending on your age and fitness). And as I’ve said, this is not only not harmful to you, it is beneficial to you, as it builds your cardio fitness.

Anxiety can sometimes be accompanied by heavy breathing and this also can feel to some people like it’s dangerous. You might feel like you’re suffocating or chocking. You might get faintness or dizziness, blurred vision, confusion, feelings of unreality (like you’re in a dream), and hot flashes. But although these sensations are uncomfortable, they’re temporary and completely benign.

Another symptom of anxiety is trouble sleeping. This again, makes complete sense. If your brains feels you are under threat, it doesn’t make evolutionary/adaptive sense to sleep! Your brains wants to scan your environment and/or analyse the situation to look for signs of danger and/or think of ways to avoid the danger. This is useful when there’s an actual threat to prepare for. But when it’s false alarm – as is the case with OCD and a lot of other times – it leads to obsessional preoccupation, trouble focussing, remembering, or concentrating on things.  Lack of sleep certainly isn’t ideal, but it’s not as bad as many people think and it certainly isn’t helped by worrying about not being able to sleep, which obviously just compounds the worry and makes sleep less even likely to happen.

What Anxiety Won’t Do

Anxiety will not cause you to break down, lose control, become paralysed or act in strange ways.  Remember that the fight or flight response is designed to help when threat is perceived. So although you may feel overwhelmed or confused, you are actually able to think faster and react more quickly than normal when anxious.

Some people worry they might have psychotic break or develop schizophrenia, but psychosis and schizophrenia begin gradually not suddenly, usually run in families, and are easy for mental health professionals to recognise.  While people suffering from schizophrenia do often experience anxiety, there is no evidence that schizophrenia on bought on by anxiety.

Others worry that anxiety might weaken their body, ‘wear out’ your nerves or cause medical conditions such as a stroke or heart condition.  None of this is true. Dizziness and pain can occur during intense anxiety but they result from intense breathing patterns and muscle tension associated with the fight-flight response. There’s no actual threat to any vital organs. While chronic-stress over many decades can increase the risk of heart disease and stroke, this is different from the fight-flight response, which involves short burst of adrenaline, similar to physical exercise.

In conclusion, its usually people’s response to anxiety that causes the problems in their lives, not the anxiety itself.  This is what Acceptance and Commitment Therapy (ACT) tries to address. ACT helps you to keep living your life in a values-driven and constructive manner, even when uncomfortable feelings and sensations might be present. 

To read more about ACT see here or watch the video below.