Almost Anxious: Is My (or My Loved One's) Worry or Distress a Problem? (The Almost Effect) - Softcover

It’s only human to worry about problems in our lives—but for some of us, obsessing for weeks and months, or avoiding social situations due to feelings of panic, can become regular habits. If any of these describe you or a loved one, it could be “almost anxiety.”

Those of us who are “almost anxious” may never address the issue because we don’t fully meet the diagnostic criteria for an anxiety disorder. In Almost Anxious, Luana Marques, PhD, describes the spectrum of these symptoms, from normal situational anxiety on one end to a full-blown diagnosable anxiety disorder on the other. Drawing on case studies and the latest research, she gives you the tools to

assess whether your or a loved one’s worry is a problem

gain insight on how to intervene with a loved one

discover proven strategies to change unhealthy feelings of distress

gauge the physical, psychological, and social impact of your anxiety symptoms

determine when and how to get professional help if needed

Chapter 1: What is "Almost Anxious"?

One hot afternoon in the middle of July, I learned a lesson on how to keep a healthy perspective on anxiety. I was near the end of the Half-Dome trail in Yosemite National Park in California. Since 4 a.m. I'd been hiking uphill through forest. So far the hike had been extraneously uphill, but the terrain was covered by beautiful trees.

Suddenly, the landscape shifted and I found myself clambering up open rock, surrounded by empty space. My body immediately responded to the perceived threat of falling. My heart pounded, my sweat increased, my body tensed up, and I slowed down my pace. All I could think about was "What if I slip and fall?" The more I focused on that thought, the more my body reacted. I began scanning around for rocks with edges that I could hold on to in case I stumbled. My sense of apprehension increased. My friend, who was hiking with me, asked if I was okay. I answered, "I'm not sure; I might have a height phobia." "And you choose now to tell me?" he responded. We both laughed. It was an unfortunate time to discover that I might be afraid of heights, given that in a few more minutes our hike would culminate at the steep, 4,800-foot climb arriving at to Half Dome.

Does this mean I have a diagnosable phobia of heights? Am I "almost anxious" about heights? Or was I just exhausted from hiking several hours and had normal protective physical sensations? Examples like my hike at Yosemite and the fears, anxiety, and worries that many of my patients face can help you better understand natural responses to anxiety compared to a diagnostic disorder, and the almost anxious space in between.

Maggie's Story
As I mentioned in the introduction, anxiety is helpful, up to a point, but most of my patients' anxiety is a signal of something being wrong. However, anxiety is not necessarily the problem, but rather how my patients manage their anxiety level that gets them into trouble. Take the example of Maggie, who came to see me after having a severe panic attack during her freshman year of college.

Maggie was 19 years old, originally from South America, and was studying abroad for the first time. You might not have known that Maggie was a foreigner had she not told you, since her spoken English was remarkable and she was very knowledgeable of American culture. Maggie experienced her first panic attack while walking to class mid-semester in her freshman year. She could not pinpoint anything that led to the attack, which had truly come out of the blue.

"I was walking to class when suddenly I noticed my heart started to pound, I started to feel nauseous, and had some difficulty breathing. My mind started to race and I had trouble focusing. I started to sweat and it felt like someone was sitting on my chest. I really believed I was having a heart attack. I nearly went to the emergency room but I thankfully was able to reach my mom on the phone. She distracted me from my anxiety and helped me calm down enough that I was able to go to class," she told me.

Overall, Maggie described herself as happy, with many friends, and very lucky to have gotten a scholarship to study in America. At our first meeting, however, she was still scared. Maggie decided to seek help right away because she noticed that she was changing her behavior in response to her fear of panic attacks and at the recommendation of her mom, who had battled panic disorder for most of her life. For example, she decreased her coffee intake to morning only because she noticed that coffee would make her heart speed up and remind her of her panic attack. Similarly, she had been an avid runner but was now only running short distances with friends just in case she would have another panic attack.

Maggie is a great example of someone who is "Almost Anxious." Although her anxiety is interfering in some aspects of her life, mostly daily life style things, she is still engaging in life. In fact, Maggie's avoidance, at the time I first met her, were very limited to a few things, and she was still managing to engage in classes, see friends, and enjoy most aspects of her life. Yet, if Maggie did not seek help, it is probable that she might go on to develop panic disorder.

Is my "anxiety attack" severe enough to be considered a "panic attack"?
What do people mean when they say they had an "anxiety attack"? Often my patients are referring to what psychologist call a panic attack. A panic attack is defined as having an intense surge of anxiety and fear, combined with the experience ofat least 4 of the following symptoms:

To find out if your anxiety attack is in fact a panic attack, think back the last time you had a lot of panic and anxiety and check the following boxes if the symptoms happened at the same time and bothered you significantly.

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or warm sensations
• Numbness or tingling sensations
• Feelings of unreality, like things are happening in slow motion or not in real time
• Feeling detached from your body, as if you were having an "out of body experience
• Fear of losing control or going crazy
• Fear of dying

Evolutionary Benefits of Anxiety
Walking through a forest hundreds of years ago, our ancestors had to be alert, sharp, watchful, and ready to attack a prey for dinner or to fight off an enemy to stay alive. People learned that adrenaline--or the anxiety that resulted--was essential to their survival. But centuries later, modern humans have come to interpret anxiety and its emotional consequences (like a sense of dread, doom, and fearfulness) as well as its physical symptoms (like pounding pulse, sweatiness, dizziness, difficulty concentrating) as the enemy.

If Maggie were facing a lion in the jungle, her body's first response would be to go into a fight or flight. As a result, several of the symptoms Maggie was experiencing as a "panic attack" would have actually increased her chances of survival:

• Her heart would speed up, as she would need more blood moving through her body to get ready to either fight the lion or flee. A stronger heartbeat leads to more blood circulation, which in turn would raise Maggie's body temperature.
• She'd get sweaty, which has two primary functions: to decrease her body temperature (this is important to keep her brain cool!) and to make her body more slippery, which would in turn make it harder for an enemy to grab her in a fight.
• Her muscle tension would increase--much like it would have done if she had been on one of her normal jogs. But during an encounter with a lion, her muscles would be ready to help her flee
• If Maggie had just eaten prior to seeing the lion, she likely would start to feel nauseated. In an extreme circumstance, she might even feel the pangs of diarrhea, since her body would stop digestion to ensure blood was instead utilized for running.

These symptoms were familiar to what Maggie experienced during her panic attack late that fall. Physical sensations like these can be scary when you're having them. But if you keep in mind that they're simply tools that evolution has hard-wired into our bodies for a good reason--much like a fire alarm in a home--you can change the way you think about them so they're not so bothersome.

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