Is fear a learned behavior

Anxiety disorders and panic attacks

Anxiety disorder

Anxiety disorders are among the most common mental disorders. Ten to 15 percent of all people are affected (1). Around 61.5 million patients (2) suffer in Europe - two out of three are women. The first symptoms often appear in early adolescents up to around 40 years of age. Psychotherapists differentiate between generalized anxiety disorder, panic attacks and phobias - whereby the transitions are often fluid. It is not uncommon for patients to stress several anxiety states at the same time. The anxiety disorders have a decisive impact on the quality of life.

It is insidious that untreated fears often no longer go away, but other psychological complaints arise. It is not uncommon for there to be a purely organic condition at the beginning, such as an overactive thyroid gland with nervousness and irritability, a palpitations or neurological disorders.

What is an anxiety disorder?

Fear is actually a good feeling. Feeling is part of being human. Fear warns and protects us from real dangers. It causes the hormones adrenaline, noradrenaline and dopamine to be released - and the body is prepared for a fight-or-flight response in a matter of seconds. In healthy people, fear works like the lubricating oil for the engine. It spurs on top performance, stimulates the nervous system, promotes a career. But millions of people in Germany suffer from fears that turn into torture.

Fear is the same as with other mental illnesses: First of all, it is normal to be disgusted with spiders, to feel uncomfortable in crowds, to have a fast heart and a shaky voice in the interview. Everyone is in a bad mood at times - and then stays away from other people or certain situations. However, if this attack has a permanent place in everyday life, restricts work and private life and occurs without real threats, an anxiety disorder is likely. Physical symptoms such as palpitations, dizziness, nausea, pain or shortness of breath occur in those affected with a supposedly extreme strength.

Anxiety Disorder Symptoms - From Acute Symptoms and Chronic Suffering

The first signs of an anxiety disorder usually show up in adolescents.

Typical acute symptoms include:

  • Sudden anxiety attacks, extreme feelings such as fear of death or "panic attacks" for a few minutes.
  • Fear of tight spaces, crowds, wide spaces.
  • ongoing worries.
  • Fear of critical judgment from other people.
  • Fear of individual objects or situations such as spinning, splashing, flying, elevators, height.

Anxiety is often accompanied by physical symptoms. This includes:

  • Racing heart
  • Tension
  • inner unrest
  • nervousness
  • accelerated pulse
  • sweat
  • Tremble
  • Shortness of breath
  • dizziness
  • nausea

If the disorder remains undetected and untreated, it often takes a chronic course. Studies show that around every third anxiety disorder persists. Early anxiety disorders also increase the risk that patients will develop further mental illnesses such as depression or substance-related disorders such as alcohol, drug or drug addiction over the years. (3) Studies have also shown that fears increase the risk of cardiovascular disease and cancer.

What are the causes of an anxiety disorder?

Anxiety disorders have various causes, they are one of the complex genetic diseases. There are several environmental factors such as negative life events that, combined with various genetic factors, lead to anxiety. The negative life events include besides

  • chronic diseases
  • Abuse,
  • Violence,
  • Breakups.

Many patients learn fear in their families. Prepare the basis:

  • overprotective parents,
  • an exaggerated perfectionism,
  • a principally insecure feeling about life.

If parents sense danger on every corner, the children often take on the overly cautious behavior. If children do not learn to deal with their fears independently, this can trigger a so-called generalized anxiety disorder, for example. From family studies we know: First-degree relatives of patients with panic disorder also have a three to five times higher risk of panic attacks. In addition, social circumstances such as financial worries, unemployment or the fear of social decline favor anxiety disorders.

Fears are learned behavior

Learning plays an important role in the development and maintenance of fears. Because in the course of the illness, the body first learns to react to situations or objects that are perceived as threatening with even greater fear. The brain's learning process is then that it feels relieving if one avoids the fear-inducing situation.

Experts speak of what is known as operant conditioning. The anxious patient no longer leaves the house when he is afraid of people. He no longer gets into the car because he is afraid of an accident. The operant conditioning prevents the person affected from finding out that there is actually no threat to him if he confronts the fear-inducing situation.

In the long term, a vicious circle arises:

  • Due to the pronounced avoidance behavior, he maintains the already excessive fear.
  • Over time, other situations arise that the anxious patient experiences as excessively dangerous - and subsequently avoids. So he isolates himself more and more.
  • He avoids all busy places.
  • At some point he is afraid of the fear.

He also often exaggerates accompanying physical complaints. For example, a patient with panic attacks often interprets palpitations as a sign of a heart attack. In his perception, dizziness becomes a harbinger of impotence.

What are the most common anxiety disorders?

Experts differentiate between different anxiety disorders. Sometimes it happens that they appear together or merge into one another.

The most common are

  • Panic disorder,
  • the social phobia,
  • generalized anxiety disorder.

In many patients, anxiety is accompanied by depression; experts speak of the so-called comorbid anxiety disorder. "Because of the fear, many of these patients feel inferior, less productive, and have a negative self-assessment overall," says Dr. Sabine Hoffmann, head psychologist at Theodor-Wenzel-Werk Berlin.

"In addition to the fear, they are depressed and hopeless and have other depressive symptoms."
Dr. Sabine Hoffmann

Panic attacks

Panic disorder is accompanied by repeated panic attacks - seemingly out of nowhere. Step alongside

  • Palpitations,
  • Chest pain,
  • Feelings of suffocation,
  • Nausea, sweating,
  • Trembling and dizziness too.

Those affected experience themselves or the environment as strange and unreal and are afraid of fainting, dying or going crazy. The panic can last up to half an hour. Those affected often interpret their pronounced physical reactions as an organic condition such as heart disease.

The panic attack often occurs together with what is known as agoraphobia. This is a fear of being in public places, going into department stores or shops, being in crowds, cinemas or narrow, enclosed spaces.

Generalized anxiety disorder

People with a generalized fear

  • live in exaggerated concern, for example for their children and their relatives.
  • They fear for their existence if the washing machine breaks.
  • You fear losing your job if the boss doesn't say hello.
  • When there is pain, the thought of a life-threatening illness immediately arises.

Women get sick significantly more often than men. Feelings of fear take up a large part in everyday life - typically the diffuse concern leads to even more fear.

In addition, those affected sleep poorly, are restless, irritable, tired and cannot concentrate. Physical reactions are:

  • Sweat,
  • Tremble,
  • Palpitations,
  • Dizziness,
  • Drowsiness,
  • Dry mouth,
  • Gastrointestinal complaints.

The patients interpret the permanent physical tension as threatening: They are caught in a vicious circle that they can usually no longer escape on their own.

Social phobia

A social phobia describes a fear of the situation - those affected feel that they are being critically observed and assessed everywhere. A social phobia can trigger a fear of being the center of attention, being embarrassed, speaking in front of other people, or participating in larger social gatherings.

Affected people refuse to have social contact and become more and more insecure and fearful - until finally their own apartment is the only safe place left. Unlike most other anxiety disorders, men are just as likely to experience social phobia as women. In addition to social phobias, there are also specific phobias, with symptoms such as panic of spiders or height.

How is an anxiety disorder diagnosed?

Patients often go through a long ordeal before being diagnosed with an anxiety disorder. Anxiety patients often visit doctors with their physical symptoms and initially withhold the strength of their fear. Since fears can actually be the cause and consequence of physical symptoms, only experts such as specialists in psychiatry and psychotherapy as well as medical or psychological psychotherapists should make the diagnosis.

"We hold in-depth discussions and use situation and behavioral analyzes and questionnaires to determine whether anxiety is the main problem or whether it occurs as part of another mental illness such as depression," says Hoffmann.

The diagnosis of anxiety requires two different criteria:
1.) The patient experiences the thought of the fear as inappropriate or clearly exaggerated compared to the actual threat.
2.) The person concerned is under considerable psychological and physical stress due to the fear.

Physical causes can also be based on examinations

  • of the blood,
  • the cardiac excitation (EKG),
  • a lung function test,
  • MRI and CT
  • the function of the brain can be excluded by means of the EEG.

What is therapy for an anxiety disorder?

There is an effective treatment for anxiety disorders: these include
1.) cognitive behavioral therapy,
2.) Self-help measures
3.) a combination of psychotherapy and medication.

Drug treatment, for example with antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs), is usually carried out alongside psychotherapy. The sooner the anxiety disorder is treated, the better the prognosis.

Treatment increases self-confidence

Cognitive behavioral therapy is about the patient facing fear-related situations or stimuli and thus experiencing that the fear subsides over time and the feared negative events do not occur.

The therapy strengthens self-confidence in one's own abilities, the patient learns targeted behavioral strategies. A specific strength of behavior therapy is also the confrontation with fear-inducing situations.

At Theodor-Wenzel-Werk e.V., patients with anxiety disorders are initially treated in individual therapy. In addition to treatment, there is also a so-called anxiety management group that inpatients can visit twice a week. "This is where anxious patients exchange ideas with one another and receive background information on how they can burden the symptoms, which seem uncontrollable, and how they can influence them positively," says Hoffmann. The Theodor-Wenzel-Werk also offers group offers for outpatient therapy.

Together and professionally

"We do not necessarily treat most anxiety and panic disorders as an inpatient, because that too encourages avoidance behavior," says Hoffmann. At Theodor-Wenzel-Werk e.V. we work in a multi-professional team

  • Doctors,
  • Psychologists,
  • Nursing experts,
  • Ergo-,
  • Music therapists and
  • Social workers together.

There is also good cooperation with resident therapists.

What does self-help look like?

Relaxation methods and exercise also help to cope better with anxiety attacks. Relaxation methods can reduce physical tension - restlessness, racing heart or pressure on the chest become better.

The TWW offers different things:

  • Relaxation procedures such as occupational therapy, music therapy, dance and movement therapy,
  • Creative therapy,
  • a running group,
  • yoga
  • Jacobson's progressive muscle relaxation.