by Michael D. Anestis, M.S.
A pounding heart, a feeling of faintness, numbness in your extremities, shortness of breath, nausea, trembling, difficulty concentrating. When we feel anxious, our body sends us a lot of signals, most of which are not particularly comfortable. These sensations, the work of our sympathetic nervous system, represent our body preparing us to fight or to flee our immediate environment. All of these sensations maintain important goals that, evolutionarily speaking, make a lot of sense. By speeding up our heart rate, for example, blood flow increases, allowing our muscles to perform their needed functions. Additionally, in these situations, blood flow is increased particularly in muscles needed for fighting or fleeing such as biceps and quadriceps, and prioritized less in areas that are required more for fine motor skills (e.g., finger tips). The resulting sensation - numbness in our extremities - if often disconcerting; however, it simply represents our body preparing to respond to a threat. Similarly, when the sympathetic nervous system is activated, digestion slows down, as it is less of a priority when we are in danger. The resulting sensation, nausea, is an aversive experience; however, in emergencies, our body allocates its energy to processes likely to be more pivotal for our survival. Even sweating in times of stress is theorized by many to serve an evolutionary purpose, perhaps rendering us more slippery and thereby increasing our chances of escape from a predator.
The utility of the sympathetic nervous system and our fight or flight response is clear. Particularly in the early days of human beings, prior to the development of language and before our cognitive processes had advanced, such visceral signals in times of danger served to motivate us towards actions necessary for our survival and to ensure that all of our resources were being used effectively. Being a modern human, however, makes this process a bit more complicated. Aaron Beck - the developer of cognitive theory - was the first to point out that many of the symptoms of mental illness and, in fact, many of our day-to-day discomforts are the result of simple misinterpretations of the world around us. When we are depressed and, in fact, prior to the onset of depression, we interpret simple errors as weaknesses of character. When we are socially anxious, we interpret others' looks (or lack of looks) as negative evaluations and we overestimate the likelihood that others notice our fears and the consequences of such observations. Cognitive theory helps explain our response to our sympathetic nervous system as well. Some individuals demonstrate a tendency to misinterpret normative physiological sensations, particularly those associated with anxiety, as catastrophic events. This tendency, referred to as anxiety sensitivity, leaves individuals constantly monitoring their bodies for hints of danger and frequently evaluating their body's responses to the environment as a sign of impending danger that could result in problematic psychological, physical, or social consequences (Reiss, Peterson, Gursky, & McNally, 1986).
Anxiety sensitivity is, in fact, a perfect example of the ways in which cognitive theorists argue that people become vulnerable to mental illness. Take my dog, for example. When a noise startles him, he jumps and positions himself to safely determine what - if any - threat is looming in the area. Presumably, his heart races, his digestion slows, and his muscles are prepared to either protect our back yard or run away. Never, however, do I see him stop in his tracks, put his paw to his brow, and declare "I think I'm having a stroke." Non-human animals simply respond to their body's messages with the corresponding action. Humans, on the other hand, have the power to interpret and, while this is immensely useful more often than not, it also get us in trouble from time to time.
For individuals with high levels of anxiety sensitivity, trouble comes when their bodies send them harmless signals that become grossly misinterpreted. A racing heart, whether prompted by exercise or fear, is interpreted as an impending heart attack. Feelings of faintness prompted by a rush of blood to the brain due to an increased heart rate is interpreted as an impending stroke. Hyperventilation is interpreted as suffocation. Even worse, these misinterpretations cause increased anxiety, which prompts the physiological sensations themselves to increase in intensity, which prompts further catastrophic misinterpretations. This cycle, in turn, can lead to a panic attack.
Research has linked anxiety sensitivity to a variety of problematic mental health outcomes. Anxiety sensitivity is trait-like, meaning that it is fairly stable across time and thereby could serve as a risk factor for mental illness long before the onset of a disorder (Taylor, 1999). Panic disorder, in particular, is characterized by high levels of anxiety sensitivity, as individuals suffering from this disorder are preoccupied by the fear of having a panic attack and are hypervigilant to physiological cues that might signal an impending attack (Schmidt, Lerew, & Jackson, 1997). Mood disorders (e.g., depression, bipolar disorder) and substance use disorders have also been linked to anxiety sensitivity (Taylor, 1997; Stewart, Karp, Pihl, Peterson, 1997; Zvolensky et al., 2009).
Several researchers have tested the theory that individuals with chronically high levels of anxiety sensitivity attempt to overcome this trait by regulating their emotions through behaviors capable of dampening feared physiological sensations. For instance, Zvolensky and colleagues (2005) demonstrated that individuals with high levels of anxiety sensitivity smoke cigarettes in an effort to reduce anxiety. In addition, Cooper, Russell, Skinner, and Windel (1992) demonstrated that, when individuals with high levels of anxiety sensitivity consume alcohol, they do so primarily in an effort to reduce negative affective sensations such as anxiety.
Quite clearly, anxiety sensitivity can lead to devastating outcomes. Individuals likely view themselves as simply sensitive to their body's responses and are reluctant to seek help and unlikely to be encouraged by family and peers who view the individual as simply hypersensitive. This leaves the individual responsible for managing his or her own symptoms. Some turn to substances capable of slowing down the sympathetic nervous system (e.g., alcohol, benzodiazepines), thereby becoming dependent upon them. Others simply grin and bear it, but over time develop symptoms of a mood or anxiety disorder.
Fortunately, a recent meta-analysis has indicated that cognitive-behavioral therapy (CBT) is efficacious in reducing anxiety sensitivity (Smits, Berry, Tart, & Powers, 2008). In other words, although left untreated anxiety sensitivity tends to be stable and trait-like, it remains a strong target for therapy and can be addressed effectively. As such, if you are reading this article and get the sense that anxiety sensitivity is highly relevant for you or a loved one, there is reason for hope and no reason for panic. Consult our EST clinics page for local resources that provide CBT. If none are listed for your area, consult the nearest university to determine a clinic or clinician in your area that provides CBT.
If you would like to learn more about anxiety sensitivity, we recommend several resources. The work of authors such as Michael Zvolensky, Brad Schmidt, and Carl Lejuez, offers incredible insight and is available through any university or library with subscriptions for academic journals. We will cover many of their studies in future PBB articles. Additionally, the following resources are available through our online store:
- Overcoming the Fear of Fear: How to Reduce Anxiety Sensitivity
- Anxiety in Health Behaviors and Physical Illness (Series in Anxiety and Related Disorders)
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University
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