Neuroscience and anxiety

My heart pounded in my chest; I felt the familiar sense of dread in my belly; my face felt on fire. I watched in horror as the light went green; I was live on camera. I fixed a smile on my face but thoughts were spiralling: ‘You haven’t prepared enough. What if you mess up?’ Soon it would be my turn to speak yet I felt frozen in my chair. A rabbit in the headlights.

This was a typical occurrence before any presentation I gave during my 20-year legal career. Although I enjoyed presenting, each time I encountered fear and dread that would lead me to doubt myself. I retrained as a psychotherapist in 2016 and have spent many years learning about the nature of anxiety and fear and how it affects our mind and body. Discoveries in neuroscience and the function of our nervous system have given me the insights and strategies that I am sharing with you today.

What do we mean by anxiety? Anxiety is an expectation of what we fear may happen. It can present as worry, panic, dread, fear, or terror. We can feel restless, irritable, dizzy, impatient. It can be prompted by our thoughts or an outside situation or person that triggers an internal fear association.

Why anxiety is not the enemy. The neuroscientist Antonio Damasio writes that all emotions, including fear, have evolutionary functions geared towards our survival. Since our hunter-gatherer days we developed an automatic system of engaging our body in fight, flight or freeze responses that protected us in the presence of predators. Many of the perceived threats we encounter these days are not physical but we can react as if they are.

Anxiety starts in the brain and affects the body. This automatic response begins in the amygdala, the fear centre in the limbic (emotional) system in our brain. It releases a flood of chemicals and hormones, notably adrenaline, into our body which mobilises us and prepares us to respond appropriately to an intense situation. This fight-or-flight response leads to raised heart rate and blood pressure, fast and shallow breathing and digestive issues. Usually, once the perceived threat is over, the fight-or-flight response switches off and the rest-and-digest response is switched on. This assists our body’s attempts to calm down, slows our heart rate and we can return to a sense of safety.

When we can’t turn off the fight-or-flight response. Anxiety can linger and be disproportionate to the challenge faced. When this happens our amygdala remains on high alert. The body signals an anxious state back to the brain which triggers yet more anxiety. The resting state happens less and less. We can become so used to negative thinking, shallow breathing and muscle tension that we aren’t even aware of them. Headaches, neck and back ache, high blood pressure and a host of other physical health issues can follow.

What can we do about this? One of the most useful things I have learnt is that this amygdala hijack bypasses our emotional control centre; the frontal lobes of our pre-frontal cortex, located just behind our forehead, which give us reason and context. This means that we cannot respond to the anxiety-provoking situation with logic alone. Instead we need to find different ways to activate those frontal lobes and re-regulate our nervous system. There is no one-size-fits-all solution. It’s about experimenting and finding the strategies that work for you.

Relate to your anxiety with compassion rather than self-criticism. Our brain circuity is set, in part, by early life experiences. If we were exposed to highly stressful or anxious experiences in our life we may be prone to feel more anxiety as adults. Understanding this means we can start to have more compassion for our anxiety rather than blame and self-criticism, which keeps us fearful and perpetuating negative thoughts.

Build up your self-awareness muscle. We can try in vain to control anxiety by disconnecting from our feelings and body by distraction, keeping busy or rumination. However, when we can get curious and notice what’s happening in our body, naming the sensations and thinking about them, this activates and strengthens our emotional control centre. This calms down the amygdala’s fearful reactions.

Breathing. When we are anxious our breathing can be fast and shallow. When we breathe more deeply, making the exhale longer than the inhale, it activates the rest-and-digest response, sending a signal to our brain to tell the amygdala that we are safe. We can do this any time. At our desk or in the middle of a sleepless night.

Grounding. Bring the focus back to the present moment. Focus attention internally by noticing and feeling your feet on the ground and posture as you sit in your chair. Or focus externally by paying attention to specific aspects of the environment, describing the room, or imagining a pleasant or safe situation. The aim is to activate the rest-and-digest response just enough to start thinking clearly again.

Social connection. We pick up signals from others from body language, facial expression and tone of voice. If those signals are friendly then they help us feel safe. Having a supportive conversation with a friend, family member or colleague in which we name our fears and feel understood can help us feel less alone. This is why a psychologically safe workplace that promotes openness, support and kindness to each other has such a positive impact on our wellbeing. Safety is a shared endeavour.

So back to that presentation. I had let my colleague know that I get stage fright, so he introduced me with supportive words, smiling warmly. I was not alone. I moved my feet up and down on the ground and started breathing more deeply again, focusing on my exhale. Reason returned as my heart rate slowed. I remembered it was a presentation that I knew well. My stage fright was a legacy of a childhood experience (playing piano in school assembly to hundreds of people and one time I really did mess up). But that was over. Now there was no real threat. I knew I was going to be ok.

Claire Jacques is a LawCare champion and a director at Lawsight Ltd, which provides counselling and mental health support to lawyers. (See lawsight.co.uk and lawcare.org.uk)