Anxiety

Self-Awareness: Does It Increase Or Decrease Anxiety

What we are aware of can cause anxiety. How well does limiting awareness work?

Posted Jan 26, 2016

Thoughts can trigger the release of stress hormones. We all know that. Those of us fortunate enough to be securely attached probably developed an ability early in life to automatically self-regulate arousal when stress hormones are released. Those of us who didn’t develop such regulation have to work at it. One way to limit stress is to limit inner awareness where troubling thoughts often reside. But, this strategy can lead to trouble.

Limiting awareness is not something we can do with surgical precision. Why? Because to keep something specific out of mind, we have to do it deliberately, which of course, makes us aware of what we are trying to keep out of mind. To keep something specific out of mind, and to do so without awareness of it, requires a shotgun approach. We avoid awareness of all that is inside by focusing only on what is outside.

I’ve recently explained how lack of looking inside - “reflective function” - sets a person up for phobia. If you missed that blog, read it now. It’s at https://www.psychologytoday.com/blog/conquer-fear-flying/201512/fear-can-make-you-believe-the-worst-will-happen-how

New research shows that avoiding awareness causes trouble. When the shotgun approach is used to avoid inner awareness, body-awareness is lost. When body-awareness is lost, we don’t notice stress building up in the body. Finally, the stress builds up to the point that it intrudes into awareness. When it does, it is at such a high level that its appearance startles us.

My father was a coach. Athletic competition involves physical discomfort and pain. He taught those he coached to avoid awareness of discomfort and pain by focusing on the game. That works. But only up to a point. It works only so long as the discomfort does not break through the person’s ability to block awareness of it. When the pain suddenly breaks through, it causes more distress than the person is prepared to deal with.

During flight layovers in Tokyo, I usually began the day by jogging around a park near the hotel. One morning, as I began jogging, I felt a slight pain in my ankle. On a scale of zero to ten, it was a one. After a few more strides, it went to a “two,” and then to a “three.” As I continued running, the pain continued to rise. Gradually, it became quite intense, a “seven” out of ten. Nevertheless, since I maintained awareness of the pain, and since its increase was gradual, I simply adjusted to it. Shortly after it reached a “seven,” it reversed, and began to lessen. Within a few minutes, it had disappeared, and I was able to continue my run as planned.

On the other hand, if I had used my father’s strategy, there would have been a problem. Let’s say I had a “level five” ability to block pain from my awareness by focusing outside. As I began jogging, I would have blocked the pain when it was at one, two, three, and four. Even when it reached five, I would have been unaware of it. 

But when the pain reached a “six,” it would have broken through my ability to block it from awareness. What would then happen? Would I simply feel the difference between a “five” and a “six?” That would be merely a “one.” That is not what happens when pain breaks through. We feel the full measure of the pain, in this case a “six,” 

My experience would have been this: after several minutes of jogging with no discomfort at all, I suddenly and unexpectedly was hit with intense pain. That would be shocking. My amygdala would react to the unexpected; it would also react to the idea of being injured. With a double release of stress hormones, I might go into psychic equivalence, the state in which what a person imagines to be true is experienced as true. The idea of having sustained a serious injury would be accepted as fact. I would have stopped jogging. I might have even sat down and waited for someone to call for medical help.

In new research at the University of California San Diego, Dr. Lori Haase and her team found that people who maintain body-awareness are more able to adapt positively to stress. Their research, titled “When the brain does not adequately feel the body: Links between low resilience and interception,” was published this month in Biological Psychology. 

In this study, researchers first examined elite athletes and special-operations soldiers, people who face extreme physical and emotional demands. Each person was placed in a brain scanner where, by wearing a face mask, they could be exposed briefly to being unable to breathe. Being unable to breathe was selected as the stressor because it universally - and non-cognitively - triggers a sense of alarm. In the brain scanner, as the person waited, expecting their ability to breathe to be restricted, their brain activity showed constant body-awareness, constant heart rate awareness and constant breathing rate awareness. In spite of heightened body-awareness, they experienced only slight anticipatory anxiety. They remained aware that they would momentarily be unable to breathe, then remained aware while unable to breathe, and returned quickly to normal when the test was completed. At no point did they overreact.

Next, the researchers repeated the experiment with 48 adults with ordinary jobs, not exceptional athletes or soldiers. They first completed a questionnaire to determine their level or resilience, high, average or low.

Next, they were given the same breath restriction test in the brain scanner. Those who the questionnaire identified as having high resilience showed the same brain activity as the elite athletes and soldiers; they maintained awareness during anticipation, during breathing restriction, and during return to normal. 

But those the questionnaires showed to have low resilience were different in the experiment. As they anticipated the restricted breathing, the brain scan showed they lacked body-awareness. They were not aware of their heart rate or their breathing rate. Then, when breathing was made difficult, suddenly aware of their heart rate and breathing rate, they overreacted with a panic-like response.

This research suggests that avoidance of inner awareness can lead to trouble, just as it would have had I blocked awareness when jogging in Tokyo.

The same principle applies to flying. It is a mistake to try to keep one’s mind off the flight. 
When an anxious flier relies on blocking, selective focus, or distraction, they are fine until the flight runs into turbulence. When turbulence develops - as in the restricted breathing research - they are shocked by it. Thereafter, they worry that their flight may be turbulent. Though keeping the flight off the mind may work for a novice, once the person has discovered blocking is unreliable, they worry not only during the flight but prior to the flight.

While flying, if there is a movie, watch it. If there is a magazine to read, read it. But while being aware of the movie or the magazine, be aware also of the plane that is transporting you. Notice what is really going on with the plane. If it is smooth, it’s smooth. If it is rough, it’s rough. To the plane, it doesn’t matter. To you, if you know it doesn’t matter to the plane, we could say it shouldn’t matter to you. Experience the flight as it is. Do not depend on blocking. Do not depend on selective focus.

Unfortunately, if you have been traumatized by turbulence, turbulence does matter. Though you now know turbulence is not a problem for the plane, back when you didn’t know that, your amygdala learned to react to turbulence as though it were life-threatening. As you approach a flight now, what you know intellectually collides what what your amygdala learned when you believed your plane was falling from the sky. When you fly - or even think of flying - it does a job on you. It reacts as if to say, “What’s wrong with you? Don’t you know? If you fly you will die!”

One type of memory cell in the amygdala learns fast; it can relearn - canceling out what it first learned - very quickly. The other type of memory cell learns slowly. Once these cells learn, the learning is essentially fixed. When exposed to an extended period of in-flight turbulence, if you felt hyperaroused and feared the plane would plunge, the amygdala's “storage” cells mistakenly learned that flying means turbulence and turbulence means falling out of the sky.

Even if a long series of smooth flights allowed these cells to partly relax the association between dropping, arousal, fear and turbulence, one turbulent flight would eliminate all improvement in your ability to deal with turbulence. More at this blog.

Therapy that seeks to reduce amygdala response to turbulence through exposure (virtual or actual) is doomed to failure. Courses that help fearful fliers get through a flight via group support and a pilot's constant reassurance do not emotionally prepare them for encounters with turbulence. Courses that tell clients to rely on relaxation and breathing exercises to control arousal and fear set clients up for failure, for research shows these exercises to be ineffective.

Clients are not helped by therapy that asks them to regard how they react to turbulence to be irrational. Once traumatized by turbulence, the amygdala is as fixed in how it reacts to turbulence as a smoke alarm is to particles in the air. A smoke alarm cannot change how it reacts to a toaster burning toast. Nor can a therapist change a fearful flier's reaction to turbulence by labeling it irrational.

What can help? Though its programming is fixed, noise from a smoke alarm can be stopped by temporarily shutting down the smoke alarm by removing its battery. Similarly, feelings caused when turbulence triggers stress hormones can be stopped by inhibiting the amygdala by establishing links between turbulence and an oxytocin-producing memory.

These same amygdala inhibiting links can, in some cases, keep stress hormones from leading to psychic equivalence.