Anxiety: when the body sounds the alarm

What Walter Cannon saw

In the late nineteenth century, while still a student at Harvard, Walter Cannon began to watch the digestion of laboratory animals using a newly discovered technique: X-rays. And he noticed something else. When an animal became upset, the movements of its stomach stopped, and returned as soon as it calmed down.

That led him to spend years studying what the body does when it faces a threat. In 1915 he described it in a book and gave it the name we still use today: the fight or flight response. The nervous system and adrenaline get the body ready to defend itself or to run:

• The heart beats faster and harder.
• Breathing speeds up.
• The muscles tense.
• Digestion slows down, which is why you feel a knot in your stomach.

That is why anxiety is felt so strongly in the body. It isn’t imagination: a real alarm has gone off.

Why it goes off when there is no danger

The American Psychiatric Association’s diagnostic manual (DSM-5) tells fear and anxiety apart. Fear is a response to a threat that is right in front of you, real or perceived. Anxiety is the anticipation of a future threat: what sets it off is a possibility, a “what if…?”.

In 2001 the psychiatrist Randolph Nesse explained why this alarm so often goes off for no good reason, and he called it the smoke detector principle. A detector that beeps when you burn the toast is annoying; one that stays silent during a fire is a disaster. The body’s defence systems work in the same way: because reacting costs little, and failing to react to a real danger can cost everything, they are set to give plenty of false alarms.

Your heart may keep racing for a while, but you can now read it differently: the fact that your body reacts strongly doesn’t prove that the danger is great.

When it is normal and when it isn’t

Feeling anxious before an exam, an operation or while waiting for news is only to be expected. The World Health Organization (WHO) points out that everyone feels it at some point. What marks an anxiety disorder is that the fear and worry are intense, excessive and hard to control, last a long time and get into daily life: work, family, studies.

It isn’t unusual. According to the WHO, in 2023 around 470 million people in the world had an anxiety disorder, the most common of all mental disorders. In Spain, a report from the Ministry of Health using primary care data from 2017 also put it in first place among the mental health problems on record: it appeared in the records of 6.7% of the population, 8.8% of women and 4.5% of men.

Signs that it is time to book an appointment with your doctor

• Worry fills almost every day for weeks and you can’t stop it.
• You sleep badly, find it hard to concentrate or are irritable almost all the time.
• You have started to avoid places or things because you fear feeling unwell.
• You turn to alcohol to calm down.
• You notice physical symptoms that worry you, such as palpitations or chest pain. A doctor can rule out other causes.

The WHO stresses that there are very effective treatments for anxiety and yet only one in four people who have it receive treatment. Your GP is a good first step. And if the distress becomes unbearable, find someone to talk to. In Spain you can talk to a person at the Teléfono de la Esperanza, 717 003 717, at any time. If you are thinking of ending your life, call 024: it is free and answered 24 hours a day. If you are in another country, call your local emergency number or a helpline there.

What helps, according to research

According to the WHO, the best-supported option is psychological therapy, above all the cognitive behavioural kind, which teaches you to approach what frightens you little by little. Alongside that, there are things within your own reach:

• Moving. A review from the University of South Australia, published in 2023, gathered 97 reviews covering more than a thousand trials and concluded that physical activity noticeably reduces symptoms of anxiety. The authors themselves warn that many of those reviews were of low methodological quality.
• Breathing slowly and relaxing the muscles. The WHO lists these among the things people can do for themselves, along with mindfulness.
• Looking after your sleep and your food and keeping regular hours.
• Avoiding alcohol and other drugs, as the WHO also recommends.
• Putting it into words. Naming what you feel helps turn the alarm down, as you can read in naming what you feel.

If the unease is worst when you switch the light off, you may find it helpful to read about night-time worries.

The avoidance trap

When something makes you anxious, the natural thing is to step away: not to go, not to call, not to go out. In the moment it brings relief. The trouble is that the mind is left with the idea that you got away thanks to not going, and next time the alarm rings sooner and louder.

Therapies for anxiety work on exactly this: going back towards what you fear, little by little and at your own pace, until you find that you can. The UK’s National Health Service (NHS) sums it up in simple advice: instead of avoiding the situations that distress you, slowly build up the time you spend in them.

When the alarm won’t switch off

Anxiety is harder to carry in silence. If it helps, write what troubles you on a star in A shared universe, with “What weighs on me”, without saying who you are; someone will leave you a touch or some comfort. It isn’t a treatment, but it can be a little company on a difficult day.