Living on a knife-edge

Anxiety, stress, panic disorder, trauma.

Sometimes you might feel like your living your life on a knife-edge – caught between the extremes of volatile emotions and hair-trigger reactions to stress.

This is usually a result of anxiety-related conditions, but most people who have lived with stress or anxiety for years may not even be aware of it. They may bottle it up. Try to keep calm and carry-on. Or bury their anxieties in the hope they will eventually disappear. They might normalise the highs-and-lows of living on a knife-edge, as a necessary evil. They may even learn to manage their symptoms with alcohol, drugs, letting off steam in the gym, sensation-seeking, extreme-compulsive behaviours, avoidance or outbursts of anger.

At critical moments some people may show signs of a startle response and become frozen with fear or suffer from an impending sense of dread. They can feel absolutely breathless and become overwhelmed with panic attacks. Or get caught up in a combustible mix of tension and spiralling stress that leads to intolerable feelings of helplessness.

Once the stress response has been activated certain hormones and neurochemicals are produced (such as adrenalin and cortisol) by an interaction between the emotional centres in the brain’s limbic region and the body’s visceral organs. This is known as the ‘fight-and-flight response’, setting off a train reaction which may include – breathlessness, headaches, muscle tension, sweating, heart palpitations, leg-tapping, trembling, sudden weakness, agitation and so on. It may also be followed by angry outbursts at home, periods of exhaustion, depressive states and alcohol dependency just to manage the symptoms.

You might notice the steady build-up of adrenaline or feel entirely numb from the neck down. You may even become detached and dissociate from yourself – activating an almost out of body experience. Or suffer from vicious cycles of chronic stress that seem to spike and trough all-day, every day.

People often tell me “but I’ve been like this all my life… it’s part of my personality” as if it were normal “So why am I only aware of it now?” But this idea hides the underlying truth and probably means they’re ignoring the warning signals until it’s too late. The analogy is that of a shaken cola bottle whose restricted potential energy is inert until the bottle cap is removed as it explodes into life.

For example, you may have become accustomed to stress and not even notice the physical symptoms of anxiety because they have been suppressed for years. Or dismissed your sense of unease and apprehension, while everyone around you is walking on eggshells. Perhaps you try to justify stress and anxiety as a necessary part of your lifestyle, because it helps you operate on a high, motivated by adrenaline, predicting and solving problems or meeting tight deadlines. It’s part of the game.

All of this may be true, but without realising how much underlying damage it can actually do to your health and well-being. Long-term levels of chronic stress and anxiety are often related to problems such as acid reflux, respiratory conditions, heart disease, headaches, IBS, back pain, obesity and lower life expectancy to name some.

Anxiety, stress and dissociation can cause swing states – where highly charged emotions create swings between hyperarousal and hypo-arousal (oscillating between being overwhelmed to shutting down).

Anxiety is also often bound up in our relationships with others – fear of intimacy, fear of abandonment, rejection and loneliness. Social anxiety is a fearful response to not knowing how to act or what to say in a social situation. Such people may feel humiliated in groups, afraid of making their opinion known or standing up for themselves in a situation they believe to be unfair. They may be afraid of not living up to other peoples’ expectations or feel it’s necessary to win their approval and favour by people-pleasing. Many people simply put social anxiety down to nervousness, being overtly shy, sensitive or suffering from periods of excessive worry about life’s trivia.

The main responses to stress and anxiety are outlined below:

Fight response:

Sensations – tension, agitated, acid reflux, trembling, jaw clenching, aggressive posture.

Emotions – irritability, frustration, anger, rage, fear, aggressive facial expressions.

Thoughts – anticipating conflict, expecting the worst of people, excessive worrying, predicting outcomes, problem-solving, plotting revenge.

Behaviour – aggression, excessive arguing, frequent angry outbursts, twitching and edginess, shouting, physical violence.

Flight response:

Sensations – tension, butterflies, trembling, pronounced startle response, defensive postures.

Emotions – anxiety, fear, distress, upset, hypersensitive, fearful facial expression.

Thoughts – victimisation, anticipating conflict, worst case scenario, excessive worrying, evading thoughts, planning an exit.

Behaviour – avoidance, escaping, fleeing from loved ones, dodging responsibility, placating (pleasing) others, excessive apologising.

Freeze response:

Sensations – stillness and muscle tension in back, neck and spine; rigid posture, stiffness, closed body language and defensive postures.

Emotions – flat, numb, confused, ambivalent, simmering anxiety, dread, expressionless face.

Thoughts – blank, distracted, detached, out-of-body, daydreaming, drifting off to another world.

Behaviour – staring into the middle-distance, paralysed, phases of dissociation, passive behaviours, procrastination, freezing when frightened, feeling spent, exhausted.

So what is the way out?

In counselling as well as understanding your story and exploring the multiple causes behind your anxiety, stress, panic and/or trauma; together with your therapist, you will look at you as a whole person and understand the relationship between your body and mind. That means taking all of who you are into consideration – including your psychology, mindset, personality, body, personal relationships, lifestyle, history, emotions and physical sensations etc. This is a vital part of the process as there is not usually one single identifiable factor which causes anxiety. It is important to help you learn how to help yourself by developing self-awareness, how to observe your unconscious processes and understand your own emotional states. This puts you slowly back in charge of your own process of change.

Understanding – for example gaining insight into how your childhood experiences with attachment figures, family and friends may have led to anxieties about what other people think of you, unrealistic expectations of yourself, fears of rejection and poor self-image and confidence.

Self-awareness – for example building up a deeper awareness of your underlying physical sensations and emotional responses to anxiety. Using them to identify the triggers and early warning signals of stress. Such as whether anxiety is related to the symptoms of trauma and learning how to process or reduce these symptoms.

Mindfulness – for example practising a number of mindfulness techniques – such as mindfulness of breathing and grounding techniques – to help you self-regulate your emotion states; be more present in the moment while observing your feelings; developing a level of self-acceptance.

Neuroscience – for example developing a more accurate knowledge of how your brain functions – looking at how anxiety can be triggered by an interaction between your neuronal networks; your cerebral cortex; the sensory-motor cortex and the emotional centres of your limbic region. And how to change your emotional resilience, tolerance and ability to process heightened states of emotion in a crisis.

Conscious/unconscious conflicts – understanding that under stressful environmental conditions the brain and body may experience an internal conflict between the conscious decision-making powers of the mind and the survival instincts of the unconscious mind.