Distinguishing Between Different Types Of Anxiety

As often happens, it is reading or hearing about other people's experiences that clarifies my own thinking, so once again the credit for this post lies elsewhere. It's several years now since I retired from therapy and my memory needs jogging from time to time. I have been writing about anxiety here as if it is a single, unitary thing and it's not. Just as there are different types of arthritis, diabetes, dementia and autism for example, so there are different types of anxiety. When I was working with clients on a daily basis I was aware of this even if not consciously, and I adjusted my approach according to the apparent source of their anxiety; I had forgotten that, so it's good to be reminded. On reflection I would say that there are three main types of anxiety, which I shall refer to as situational anxiety, existential anxiety and separation anxiety. My posts here have been entirely concerned with situational anxiety and how to deal with it. In the early days of psychology the belief was commonly held that anxiety was the manifestation of a subconscious, unresolved conflict; Freud and his followers developed the psychoanalytic technique of using free association and stream of consciousness to encourage the patient to uncover the trauma that was at the root of their condition. In its own terms it was highly successful; it made an awful lot of psychoanalysts very rich, especially in America. Unfortunately, by the time the money ran out the patient was no better. Then in the 1960s when I was training, along came Behaviourism. In a nutshell this argued that deep seated trauma didn't exist. Anxiety was caused by faulty learning; something unpleasant happened and you associated your reaction with the situation in which it happened and subsequently felt anxious if confronted by a similar situation. What you had learned, you could unlearn. From developmental psychology we learned that a baby or young child will become anxious if separated even briefly from those it looks to for nurture. An example of this is my youngest granddaughter. From time to time her mother has to travel on business and may be away from home for as long as ten days. At nine years old, N finds this hard to cope with. The solution she has found to make life easier is to take an article of Mummy's clothing out of the laundry basket and have it in bed with her; it smells of Mummy and provides some comfort. What I concluded in my own work with clients was that these three types of anxiety were each quite different in origin and required a different approach in treatment. Situational anxiety arises out of wrongly attaching threat to a particular situation or activity and then having to avoid that situation or activity. Or your imagination paints a scary picture for you of a situation you haven't experienced - flying to Florida on holiday, for instance, and you develop a phobia about flying. This type of anxiety fits the Behaviourist model and is best dealt with by learning to react differently towards the focus of your anxiety. I've already written quite a lot about this, so I won't labour the point here. Separation anxiety, which usually has its origin in early experience, can persist in some cases up to and throughout adulthood. A lady in her sixties consulted me because she felt constantly vaguely anxious 'for no reason'. This free floating anxiety was something that went back as far as she could remember; she had somehow never felt quite comfortable in the world. This type of anxiety has a root cause, which is more than faulty learning. Something happened to cause an anxiousness that never went away. I saw her in the 1970s, so we are talking of someone born in the early part of the last century. We used hypnotherapy as an aid to finding the trigger. It went all the way back to birth. Jane was born prematurely and was taken straight from her mother to an incubator where she spent the next several weeks under nursing care which met her physical needs but left her floundering emotionally. There was no skin to skin contact with someone who smelled right, when she moved her limbs they never came into contact with anything, above her only emptiness to look at. We did make some progress, but really it should have been dealt with years before to be successfully resolved. And so that leaves existential anxiety. What is it? It is a terror that has no external object, and is probably the closest to what Freud had in mind. Past experiences generate emotions too dangerous to be expressed - or so it seems. For people with existential anxiety the threat is that something may burst the lock on the door behind which they had put the emotions of those experiences, and their escape threatens that person's continued existence, literally. The floodgates once opened will let everything out and overwhelm them. I'm becoming increasingly convinced that when I see a blog post with a TW flagged up, I am reading the story of someone in the grip of existential anxiety. This is not an area for amateurs; this needs the sustained support of a team of professionals, and it will need a great deal of time to find safe ways of dealing with what has been suppressed. In conclusion, it's probably the case that existential anxiety will be accompanied by situational anxiety where the upsurge of anxious feelings is wrongly associated with the external situation rather than the internal pressure, so whilst professional help, guidance and care are needed to deal with the existential anxiety, the sufferer can safely tackle any problems with situational anxiety, using the kind of things I've written about previously. I apologise for the length of this post, but I felt that it was better to treat the subject in some detail rather than cut corners to keep it brief.