As the leaves change from lush green to a mosaic of red and gold, and the cool breeze carries the harbingers of winter, nature begins to pause. The cold season slowly wraps its dark cloak around the world and with it come the long nights of shadow and silence. In this time of introspective silence, the ancients believed that the gates between the worlds open at the equinox, allowing us a glimpse of the unknown.
This mystical belief can be understood metaphorically as an invitation to explore our inner landscapes, especially the dark corners of our psyche where fears lurk. Fears are like icy winds that sweep through the cracks of our mental defences. They can be bitingly cold, yet they have the power to awaken us and lead us to deeper self-knowledge.
Phobias, those inexplicable and often irrational fears of certain situations, objects or experiences, are like dark forests that we are reluctant to enter. They are parts of our inner world that we avoid because they remind us of our vulnerability and human limitations. But just as the ancients believed that the gates between worlds were open, facing our fears and phobias offers the possibility of connection and healing.
In the depths of the soul lies the opportunity to explore the roots of these fears, to unravel the complex web of their origins, and to work to bring light into the darkness. For in confronting what makes us fearful lies the hope of liberation and growth. The journey through the darkness may seem daunting at first, but with trust and support it can become a journey of self-discovery and healing. Just as nature changes with the seasons, we too can experience transformation by facing our inner shadows and stepping out stronger into the light of new knowledge.
Some statistics
Anxiety disorders are not uncommon in Germany: more than 15 out of 100 people are affected every year. Women are more often affected than men. In figures, this means that 21 out of 100 women, but only 9 out of 100 men, suffer from an anxiety disorder in the course of a year. Over a lifetime, it seems that about one in four people will experience an anxiety disorder at some point in their lives. This is a significant number, especially when you consider that anxiety disorders are very common compared to other mental illnesses. These figures highlight the importance of providing information about anxiety disorders and ensuring that support and help is available for those who need it.
Realistic or pathological anxiety?
Anxiety is our body's normal response to threats or stressful situations. Sometimes, however, anxiety gets out of hand and has a negative impact on our daily lives. It is helpful to distinguish between realistic anxiety and pathological anxiety. Genuine anxiety is a healthy response to real threats, such as when we are in a dangerous situation. It makes us alert and careful, and disappears as soon as the danger has passed. Pathological anxiety, on the other hand, is an excessive or persistent fear that can occur even in the absence of a clear threat. The intensity of this fear is often disproportionate to the actual situation and can be so strong that it interferes with our daily lives.
Imagine walking down a poorly lit street in the evening and suddenly hearing footsteps behind you. The fear you feel at that moment - realistic anxiety - is a natural response that makes you alert. In contrast, pathological anxiety can be characterised by constantly avoiding poorly lit streets or checking locks in even the safest neighbourhoods for fear of being burglarised or robbed.
Unlike realistic anxiety, which can be motivating and helpful, or even essential for survival in certain situations, pathological anxiety significantly impairs our quality of life. For example, it can prevent us from leaving the house or cause physical symptoms such as heart palpitations and tremors. When anxiety interferes with daily life, occurs for no apparent reason, or is disproportionately focused on normally innocuous things or situations, it may be pathological anxiety. In such cases, it is advisable to seek professional help to better understand the anxiety and learn effective coping strategies.
Common anxiety disorders
The most common anxiety disorders include generalised anxiety disorder (GAD), in which people worry chronically about a variety of issues, often without a specific cause. Panic disorder involves repeated, sudden panic attacks accompanied by severe anxiety and physical discomfort. Social anxiety disorder, or social phobia, is an exaggerated fear of social situations, mainly due to fear of rejection or embarrassment. Agoraphobia is a fear of situations that are difficult to escape from or where help is not available in the event of a panic attack. People with specific phobias have an intense fear of certain objects or situations, such as heights, flying, spiders or cats. In addition to these anxiety disorders, there are other mental health conditions, such as obsessive-compulsive disorder and post-traumatic stress disorder, which are disorders in their own right, but are often accompanied by anxiety symptoms.
Generalised Anxiety Disorder (GAD)
Panic disorder
Social anxiety disorder/Social phobia
Agoraphobia
Specific phobias (some examples):
Arachnophobia - fear of spiders
Acrophobia - fear of heights
Aviophobia - fear of flying
Kynophobia - fear of dogs
Ophidiophobia - fear of snakes
Trypanophobia - fear of injections or needles
Claustrophobia - fear of small spaces
Hemophobia - fear of blood
Dentophobia - fear of dentists or dental treatment
Nyctophobia - fear of the dark
The fight or flight response
Fear is our body's natural response to threat, and the characteristics of fear can be illuminated through the prism of the body's survival mechanisms - the fight or flight response and the death feigning reflex. When we feel threatened or anxious, our bodies go into fight-flight mode to prepare for a response. In this state, we often experience heart palpitations, rapid breathing, trembling and sweating as our body releases adrenaline and prepares for either fight or flight. These physical changes are designed to enable us to respond quickly to threats and are an integral part of the experience of anxiety.
In extremely stressful or traumatic situations, the tonic immobility can also occur, a kind of temporary paralysis in which the body 'freezes'. This is another survival strategy in situations where neither fight nor flight is possible. Linking these ingrained survival mechanisms to the characteristics of anxiety helps us to better understand the physical and emotional responses that people with anxiety disorders experience. Although these responses are not as useful in the modern world as they were for our ancestors, they are an essential part of how our bodies respond to perceived threats.
Symptoms of anxiety
Severe anxiety can cause a variety of physical symptoms that are often experienced as uncomfortable and distressing. These symptoms reflect the body's increased arousal in response to the perceived threat. The most common physical symptoms include palpitations, where the heartbeat feels faster and more intense, and muscle tension, which often manifests as stiffness or pain in different parts of the body. Shaking, often accompanied by a feeling of shock or alarm, is also a common symptom.
Dryness and a feeling of 'tightness' in the mouth and throat may make it difficult to speak or swallow, while a tightness in the chest or a feeling of the stomach contracting is often accompanied by nausea. Despair and the need to urinate or defecate may also occur, as well as irritability and sometimes increased aggressiveness.
There may also be a strong need to cry, run away or hide, underlining the emotional toll of anxiety. Shortness of breath and tingling in the hands and feet are other physical symptoms that can be very uncomfortable. Anxiety can also create a sense of unreality or distance, and in extreme cases people may feel faint or fear falling.
If anxiety persists for a long time, it can cause exhaustion even in otherwise healthy people. Prolonged anxiety can cause depressed mood, slowness of movement, restlessness and loss of appetite. Insomnia or nightmares may also occur. Overall, a tendency to avoid anxiety-provoking situations may develop.
Anxiety in a panic attack
The symptoms of anxiety can be particularly severe and distressing during a panic attack. A panic attack is a sudden episode of intense fear or anxiety that often occurs for no apparent reason and peaks within a few minutes. The most common symptoms of an anxiety attack are:
palpitations or an accelerated heartbeat
sweating
trembling or shaking
shortness of breath or feeling of suffocation
choking
chest pain or tightness
nausea or stomach pain
feeling light-headed, faint or dizzy
cold or hot flushes
numbness or tingling
feeling detached from yourself or from reality
fear of losing control or going mad
fear of death
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), at least four of the above symptoms must be present for an episode to be classified as a panic attack. However, it is possible for a person to experience all 13 symptoms during a particularly intense panic attack.
The symptoms of a panic attack can be very intense and are often experienced as overwhelming or frightening. The individual symptoms can vary in severity and the experience of a panic attack can vary greatly from person to person. Panic attacks can have a very negative impact on daily life, especially if they occur repeatedly and in unpredictable patterns.
The first time a panic attack is particularly severe, the intense physical sensations and emotions can cause a person to experience a strong fear of death, so they seek medical help as soon as possible and undergo a thorough examination. Usually, no physical cause is found for the symptoms and psychotherapeutic help is recommended.
"I felt like my heart was going to jump out of my chest. I couldn't breathe and thought I was going to die. The world around me seemed unreal and I wished it would all stop." This personal account allows us to empathise with the terror and helplessness that a panic attack can bring.
The fear of fear
Fear of fear, often referred to as anticipatory anxiety, is a common problem for people with anxiety disorders, particularly panic disorder. This occurs when the fear experienced or feared is perceived as overly threatening or unpleasant. The person fears a possible recurrence of these anxiety episodes and therefore develops a kind of "anticipatory anxiety" about future episodes. This anticipation can become so stressful that it triggers additional anxiety, resulting in a cyclical pattern of anxiety amplification. Avoiding situations that might trigger anxiety often becomes a coping strategy that can significantly reduce quality of life.
Anxiety can have a major impact on a person's daily life, creating a state of constant vigilance and worry that makes it difficult to live a relaxed and carefree life. It can lead to monitoring one's physical state and emotional responses, with the fear that the slightest sign of discomfort or stress could signal the onset of a new anxiety or panic attack. Overcoming the fear of anxiety often requires professional support and therapeutic interventions to promote understanding and management of anxiety in order to break the vicious cycle of anticipatory anxiety.
Practical coping strategies such as breathing exercises, meditation or cognitive restructuring can be helpful in the early stages to reduce anxiety. These strategies can encourage people to face their fears rather than avoid them.
Specific phobias or anxiety disorders
Specific phobias are a unique category within anxiety disorders because they are characterised by clear and well-defined fear triggers. While other anxiety disorders are often characterised by a more general or diffuse fear, specific phobias focus on an intense fear of a particular object or situation. This focus often allows people to clearly identify the source of their fear, even if they cannot control the overwhelming reaction. Another characteristic is the often very specific and consistent avoidance behaviour that is used to avoid any contact with the feared trigger.
The following example illustrates the phobic experience:
"I'm terrified of spiders, it's called arachnophobia. Once I found a spider in my room and the fear was so overwhelming that I had to spend the night in the living room for fear it would touch me while I slept. Although I am aware of the disproportionate nature of my fear, I can't control it and avoid going to places where spiders are common."
Compared to other anxiety disorders, specific phobias may also begin earlier in childhood and be directly related to negative or traumatic experiences. Treatment for specific phobias, often using exposure therapy, differs from other therapeutic approaches to anxiety disorders because it works directly on the specific anxiety trigger. People with specific phobias are often aware of the disproportionality of their fear, which brings a degree of self-awareness, even if the fear response itself is perceived as uncontrollable. The specific nature of these phobias often allows for targeted and effective treatment, enabling individuals to confront and overcome their fears to achieve a better quality of life.
Common causes of anxiety disorders
Anxiety disorders often result from a complex interaction of genetic, biological, environmental and psychological factors. One of the facilitating factors may be genetics, as anxiety disorders often run in clusters in families, suggesting a possible hereditary predisposition. Brain chemistry also plays a crucial role: imbalances in neurotransmitters, which regulate signaling between neurons, can lead to anxiety symptoms. Personality traits such as anxiousness or perfectionism also increase the risk of anxiety disorders.
Traumatic experiences, especially in childhood, and prolonged or severe stress in adulthood are common causes of anxiety disorders. Psychological trauma can have long-lasting effects on the psyche and increase the risk of anxiety disorders. Chronic stress puts the brain and body in a constant state of alert, which can lower the threshold for anxiety reactions. Medical factors, substance abuse and negative environmental conditions can also promote the development of anxiety disorders. The exact causes vary from person to person, and identifying the underlying factors is an important step in developing an effective treatment plan.
Preventive measures such as stress management, mindfulness, regular exercise and a balanced diet can reduce the risk of developing an anxiety disorder. It is also important to seek professional help after traumatic events to prevent the development of post-traumatic stress reaction.
Before the journey to healing: what comes next?
In the stillness of the coming winter nights, when the world is shrouded in a silent darkness, there is an invitation to explore the darkness of one's fears. Just as nature changes with the seasons, so too can each individual experience change by confronting their inner shadows. In the next part of this series, we will look at different approaches to treating anxiety disorders, with a particular focus on the transformative power of hypnosis. The journey through the darkness may seem frightening, but it holds the possibility of emerging strengthened into the light of new insights. Join me on this journey of self-discovery and healing and learn how you can regain control of your anxiety to live a more fulfilling and free life.
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