Verified by 
Anxiety is one of our modern plagues. Its effects are visible everywhere, interfering with our happiness and our abilitiy to live productively. Anxiety limits our connections with other people, saps our energy, reduces our focus and our skillfulness and undermines our health. Most of us experience significant anxiety at one point or another, some of us more often than others. Recently several people have asked me questions about the ongoing anxiety that they experience post injury. Although anxiety arises from the same major causes regardless of the particulars of our circumstances, looking at the anxiety that develops in response to illness and injury can make these causes of anxiety easier to see for all of us.
The first and most obvious cause of anxiety is uncertainty. We understand our world by the way we move in it, by the way people respond to us and how we can affect things around us. Any significant change that shakes the way we know our world and our place within it, like a natural disaster, the loss of a job, a death or a major change in our physical wellbeing, disrupts our sense of what is real. "This (whatever it is) is not happening to me!"
When our view of our world suddenly changes, our sense of who we are and how to make things work no longer fits with what is happening. One minute we are active people engaged in building our lives in a particular direction. We are parents, spouses, people with jobs, neighbors who help other neighbors, athletes, you-name-it. Suddenly those roles are either substantially altered or they no longer function in a way that we can make sense of. Yesterday we played catch with our children or grandchildren. Today we have lost the use of one of our hands and no longer know how to play. When our sense of what is real is disrupted, we can become very uncertain and consequently deeply anxious.
So much is different and we don't know how we are going to reestablish ourselves in the midst of that difference. We don't know how to relate to the world around us. We struggle to find our way, to make sense of what we now can do. We are often told that as we sort things out and come to terms with our injury or illness we will develop a new way to respond to our lives and reduce our anxiety. Over time, this new response may happen and may help us to reduce our anxiety, but this readjustment may not happen as easily and take longer than we hope it will.
Our friends and families and our medical professionals tend to see this first cause of anxiety, the disruption of our worldview and its resolution, as part of the healing journey. We are likely to encounter some understanding, patience and support for our dealing with this, at least for a while. The second and third sources of anxiety may be less obvious to others and ones for which we find less understanding — both from those around us and in ourselves.
The second source of anxiety is over-stimulation. While anyone can become over-stimulated without being ill or injured, brain injury in particular highlights this anxiety response clearly. Our brains filter stimuli, focusing our awareness. When a person experiences a brain injury he may feel as if his ability to filter stimuli has gone haywire — as if he is in unmanageable contact with every source of stimulation, no matter how ordinary. Noise, music, conversation, touch, odors, sights can all feel overwhelming, and be experienced as too intense, uncontrollable and painful.
Stimulation winds us up and continuous stimulation keeps us wound up. The wind-up is physical as well as psychological. Muscles tighten into knots. Shoulders hunch. Our brains begin to hard wire patterns of response. Anxiety grows. We cope by becoming more and more alert. There is a pervasive but undefined sense that something is wrong and about to get much more wrong unless we "do something". We don't know what to do exactly and alertness increases as we try to figure out what we must do. We respond with alertness because we believe that if only we pay more attention and anticipate what will go wrong, the unknown threat will be averted. The problem with this approach, of course, is that the more alert we become, the more susceptible to over stimulation we become, and thus the our resulting anxiety becomes. Not the other way around. It's not preventing the undefined threat that will help us. What helps us is reducing the stimulation that initiated the wind-up in the first place.
We live in a culture that is constantly stimulating. These sources of stimulation and the resulting wind-up can be addictive. Our bodies learn to make a habit of staying alert and being anxious. Because the wind-up has become a habit, reducing stimulation may, at first, feel uncomfortable. For those of us who have experienced a major illness or injury, the increased sensitivity to stimulation may subside as we recover but not entirely go away. The deliberate management of this heightened sensitivity can be an essential part of our self-care.
The third cause of anxiety is the disconnection between the expectations of other people and our actual capacity. As we heal, we may look far more able than we actually are. Our disability may be hidden. The expectations of the people around us may be that we will respond the same way a person who has not experienced an illness or injury would respond, either mentally or physically.
Doing what we used to do, or what other people can do, may be either not possible or significantly harder for us now. We may not understand or accept our exhaustion when we try to keep up. Perhaps we believe we should be the same as we were before the illness or injury because other people think we should and ask more of ourselves than we can manage. When we cannot perform to our own expectations we experience frustration and confusion, judging ourselves harshly in an attempt to meet a standard that is unrealistic. This gap between what we can do and what we feel we must do produces anxiety. Being honest with ourselves, accepting our capacities and limitations throughout the healing process, and clearly communicating to the people around us are skills we may need to learn.
What can we do about the anxiety that we experience from these three or any other sources? The first step in dealing with any source of anxiety is quieting the mind and body. Anxiety revs up our nervous systems. The more revved up we get, the harder it is to stop. Regular physical exercise, deep, soft breathing and daily meditation practices are very beneficial for slowing down and becoming quieter. I use them regularly.
And when we get really wound up we may not be able to quiet our minds and bodies on our own. We may need help to intervene in the wind up. One of the best people I have found to help quiet the mind and body is Dr. Marty Rossman http://www.thehealingmind.org/ Dr. Rossman's audio recordings for relaxation and anxiety reduction are wonderful and he has recently released an excellent new book called The Worry Solution: Using Breakthrough Brain Science to Turn Stress and Anxiety into Confidence and Happiness.
As we quiet our minds and bodies, the next step is finding emotional support from a group of peers and/or a counselor who specializes in dealing with our particular challenges. Being with people who have "walked a mile in our shoes" teaches us compassion for ourselves, just as we are, and helps us see ways we can grow our abilities and find creative solutions to our challenges. Working with both our uncertainty and our coming to terms with our changed abilities can be much easier with support. As we do this, we begin to reduce these causes of our anxiety. To find resources for counselors and peer groups in our geographical area, we can ask our friends, our medical professionals or contact the various umbrella organizations, like the American Heart Association.
Anxiety gets in the way of living our lives fully. Understanding causes of anxiety and working together to address them can benefit all of us.
