Fear and anxiety are negative reactions to something that might happen in the future.

Fear is a reaction triggered by the presence of a dangerous situation or stimuli, real or perceived whereas anxiety is triggered by uncertainty about the future with no real threat at the present.

Fear can trigger a reaction to fight or flee to preserve our life in dangerous life threatening situation and it could be healthy and useful.  A strong fear can sometimes makes a person freezes and unable to react or think coherently to solve the problem and becomes completely helpless.

There are many different kinds of specific fear or phobia: fear of heights, fear of spiders, fear of closed spaces, fear of open spaces, fear of strangers, fear of failure, fear of changes, fear of illness, fear of public speech, fear of communicating with others or social phobia…

Anxiety is a mental process that tries to predict the future and often about something wrong that might happen and is therefore based on our imagination or fantasy rather than facts. This could be a projection of an adverse life event experienced in the past into the future. A past failure will make us most anxious about future failure and the anxiety can be disabling and prevent us to perform at our full potential and failure will then ensue.

Symptoms of anxiety can be shortness of breath, nausea, dry mouth, palpitations, poor sleep, early morning awakening, repetitive thoughts, shaky hands… Some people may present with various somatic symptoms especially after hearing someone they know had a serious illness.

Anxiety can affect our ability to concentrate or perform ordinary tasks at home, at work or at school.

People with anxiety may be unable to stop worrying about unimportant things and they can perceive situations as much worse than they actually are.

In some extreme cases, by avoiding stressful situations, they sometimes avoid going out altogether.

 

Causes of anxiety:

The main cause of anxiety is the fear of an adverse event happening and causing harm to “me” or what belongs to me including my family, my loved ones, my possessions…  This is simply a form of attachment everyone has to a certain degree.

Most of the time, our self-absorbed attitude is the cause of the anxiety. We focus and imagine many different bad scenarios that could happen to us or to our loved one and we could not put our problem in a broader perspective and to see other people who are worse than us.

Some people, by thinking themselves to be perfectionists, are so fearful of making mistakes, of facing failure, of being a fool in front of others.., and at the end they could not do anything. In that situation, how can they be perfect?

 

Self- help treatment:

1-   Accept and understand the problem.

In many years of medical practice I notice that many people are not aware that they are anxious and they tried to see the doctor for numerous medical complaints that are unrealistic. It is a costly exercise as many investigations had to be done to exclude a serious illness to allay their anxiety.

I had one case of a patient who saw many different doctors and specialists and still came to see me for further opinion. I sat down and asked her what she is afraid of and she eventually told me that someone in the past told her that she has a serious hidden medical condition that doctors could not find. She said that this person was not practising as a fortune teller but he did tell her some predictions in the past that turned out to be true.

Another case of a patient who presented to Emergency Department with chest pain and shortness of breath twice in the last 4 weeks and she was completely healthy prior to that. On further questioning, it was found that the person recently worked as an interpreter in the hospital system and was in contact with terminally ill patients.

Worry, upset, anger may often cause a tight sensation in the chest and trigger you to take deep breaths to have enough air. But the more deep breaths taken, the more you will feel short of breath and may feel like “impending death” from choking. You may experience pins and needles sensation around the mouth and extremities such as fingertips and toes and sometimes muscle twitching or cramps (tetany). This is a panic attack caused by rapid or deep breathing resulting in a loss of CO2 (carbon dioxide) and a pH imbalance in the body (metabolic alkalosis).  This can be treated by a conscious effort to slow breathing or to re-breath your own breath by breathing into a paper (not a plastic) bag. It may help raise the carbon dioxide level in the blood as you breathe carbon dioxide back after breathing it out.  Practising slow breathing technique daily may help you to be able to use the technique in time of crisis: breathe in and hold for 2 seconds and breathe out and hold for 2 seconds before breathing in again. You need to count IN, 2, 3 and OUT, 2, 3.

 

2-   Find the cause of the anxiety:

The anxiety may come from anything negative in the past such as a traumatic or a painful event that was experienced or witnessed in the past and you chose to carry it forward to the future.

It can be from a feeling of high insecurity, a need for acceptance, for validation by others giving rise to low self-esteem and an inability to accept who or how you are. Your reaction may be anxious to please everyone and find fault with yourself or on the contrary it may cause you to hate other people and over react to any form of perceived criticism and may withdraw socially or become antisocial.

The other cause may be from your high and unrealistic expectation, a perfectionist approach to life. You are afraid and do not accept failure and therefore you are always anxious before performing anything in case you could not do as well as you expected it to be. Such a fear may freeze you to a point that you could not attempt anything new.

The main cause of the anxiety can be seen as too much concentration on your self -importance or the importance of your loved ones’ welfare.

Many of my patients told me that they are fearful of illness because they worry that they might die early and no one is going to look after their children. But they forget that when they spend so much energy to find any insignificant changes in their body and lost sleep due to their worry, they have no energy to look after their own health (such as exercise and healthy diet) and their own children now.

 

3-   Believing that you can overcome Anxiety:

Anxiety can be disabling and take over your own life and you sometimes believe it was the way you were born and it is impossible that you can change so there is no point of trying as you had so many unsuccessful attempts in the past with treatment such as taking medicine and seeing psychologists.

If you never believe that you could do something, you never will. If your mind does not give you a permission to change and to succeed you will certainly be doomed to failure again and again.

It is a long process to change your way of thinking, your way of reacting to life events, your way of seeing yourself and your priorities and any change needs a lot of determination and time.

No one can change completely overnight, so a small progress in the right direction is a good indication of the possibility of future success so try not to be impatient.

 

4-   Practical ways of overcoming Anxiety:

a- Reducing the importance of your own SELF and what belongs to YOU (your family, friends, possessions…). If adverse events happen to someone else, you may feel a little compassionate but as long as nothing happen to you or what belongs to you, it is alright.

Therefore, you have to reduce your attachments to your own life, your own comfort, your success, your social status, your family’s welfare… This is not to say that you should not work hard to achieve your own goal, to protect and nurture your family but you are not to sit there and worry and imagine that something bad may happen in the future, realistic or not. It is a contradiction in itself that when you worry, you have an uncomfortable feeling and it is a hindrance for you to act or solve a problem successfully when something untoward happens to you or your family.

b- See yourself as an simple individual as everyone else in this world.

You have to see that everyone is equal and can suffer as you do and a lot of people are even worse than you. Try to cultivate compassion to every living sentient being and thus you are able to see your problems objectively and you do not put so much importance on what might happen to you.

See yourself small comparing to the whole humanity.

c- Everything in this life is impermanent that is it is changing all the time.

Life is possible because it is impermanent. A child can grow into adulthood because of constant changes in the body, old cells die and new cells are multiplying at each second. Nothing is static. Accept the life changes with equanimity that is with calmness and composure especially in a difficult situation. Remember that every living being has to adapt to the environment for survival and not the reverse- that is asking for the environment to be as you want it to be.

d- Practice to have humour and be able to laugh at yourself:

Nothing is more important than your own peacefulness so let go of every worrying thought. If something meant to go wrong in the future, it will any way and you cannot do anything about it, so relax. You have to accept it as such and you need to have the courage to face the problem when it arises with a clear mind.

Practice smiling in front of the mirror every day when you wake up and clean your teeth. Think about it as an exercise of your mouth muscles if you do not feel like to smile.  This simple movement may make yourself laugh at your funny face and gives you a minute of releasing tension.

e- Practice Mindfulness:

Anxiety arises from a mental process that tries to predict the future, something that has not happened yet and is then a fantasy of your mind rather than facts.

Mindfulness is to keep the mind to be aware of the present moment, of the task in front of you.

-         Practice to concentrate fully on every activity that you do no matter how big or small.

If your mind is straying and thinking about what will happen in the past or future, refocus your mind to the activity on hand. You can then conserve all your energy to perform well at whatever thing you do and not to worry about the future result as if you do your best at the present time, the future will be certainly better.

If you worried about your health now, you are better to adopt a healthy lifestyle such as stop smoking, alcohol in moderation, no drugs of dependency, exercises regularly and healthy diet with less fat, less carbohydrate and less chemicals..

Anxiety will cause the heart to beat faster, blood vessels to constrict, blood pressure to increase and these factors can cause deleterious harm to your body.

-         Practice walking meditation:  that is walking and being aware of your body movements such as your footsteps and ignore any other thoughts that arise in the mind.

This is a very easy practice to do especially when you are in your most worry state, you can pace the floor of your room and keep your mind away from unwanted thoughts by following your footsteps in your mind.

It is best to have a regular practice daily as practice will make it perfect and then you can resort to use it when you most need it at stressful moments.

-         Breathing meditation:

Everyone breathe but most people are not aware of the breath.

You can do  a formal meditation daily (which is recommended ) but you can do it at anytime that you have a moment to sit down or lying down and your mind is kept wandering.

Remember to return to your breath every time you find your mind starts to wander and think about the past or the future.

You just try to be aware of the air moving in and out through your nostrils or your abdomen inflates or deflates when you breathe. You are simply becoming an observer and the task is to follow the breath and not to follow any other thoughts that come to the mind.

In my opinion Meditation has the following aims in overcoming Anxiety.

Firstly, meditation will help to clear the mind of unwanted, stressful thoughts by focussing the mind to observing the breath. It helps to clear the deck and have a clear mind. Too many thoughts will cause headache, stress and increasing anxiety. The mind can have florid imagination that leads to unstoppable scenery of bad things that could happen and it is like a faulty disc that keeps rewinding itself again and again.

Secondly when the mind is relatively clear, you can objectively observe each thought that arises without following it and elaborates on it. This will give you an insight into your own problem. A lot of time the source of anxiety may be from a past experience of something painful that may be denied or suppressed by your own mind.

Thirdly when the mind is clear and you can objectively observe each thought, you can find ways of changing your reaction to this thought that is, instead of the thought eliciting anger, worry, or other negative feelings, you come to feel acceptance or conflict resolution. You can use your understanding about the nature of life, of impermanence to accept what happened or to use your compassion towards others and compassion to yourself to accept you as you are.

 

Always remember that life is hard enough for you to cope and do not add more anxiety by imagining the worse could happen. Believing in yourself and you can overcome the anxiety that prevent you to live a full and meaningful life.

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