Hello everyone and welcome to ‘Managing anxiety’, Week 1, Session 1. We’re so glad you’re with us and reading this course! 

The goals for this session are:

• Introduce the concept of anxiety
• Explore how the body produces a fear response

We do grounding exercises at the start of every session! Grounding exercises are a set of strategies that help us when pain or difficult memories become overwhelming - our first “trick” to wellness! They’re designed as techniques to stay “present” when we feel ourselves “dissociating” or as though we’re outside our own bodies. If, at any point, you feel uncomfortable while reading this session (or anywhere), you can use one of our grounding exercises to bring yourself back and away from hard emotions or physical sensations.

 **Today’s grounding exercise is…
**Take a breath in and take a moment to look around the room you are in. As you do that, pick one interesting object in your field of vision. This can be anything from a windowsill, to a chair, to the shoes you are wearing. It doesn’t matter what it is, just something you can see. Slowly, trace its outline with your eyes, as if you were drawing its lines. If you can, remember to keep breathing while you draw it’s outline. Great job!
Remember: every one of us is different. A grounding exercise that works for someone may not work for you. That’s totally fine. We’ll be going through a different exercise each week, so we can find the ones that work best for us. If you don’t feel able to do one, feel free to step back and just do some breathing. 

Fun question: We also like to start out our sessions with a fun question. As is appropriate for our programme’s name: What’s your favourite flower or plant? 

We are so glad you are here. We know it takes a lot of energy and effort to confront difficult emotions and by reading this content you are taking a massive step towards understanding anxiety a little bit better and finding ways to improve your relationship with it.

Now, to start, we want to make sure you know that as much as we are going to try and give you helpful information here, we are of the belief that you are the expert of your life and your own mental health. You already have a lot of the knowledge and tools that you will need within yourself, we just want to help you gain clarity on your needs and what works better in your personal case. But we need you here, with your ideas and understanding of anxiety, as you are the lead person in your learning process. 

Let’s start to think about anxiety.

Our psychologist Paula, who wrote this course, is a big fan of etymology. Do you know what that is? Etymology is the study of words, their origin, their transition between languages & cultures and evolution in meaning. The way she sees it, it reveals the story behind the concept, almost as if you were getting to know a person: it allows us to learn where they come from, what their upbringing was like, any important changes they went through all the way to understanding where they are now. 

In the case of Anxiety, we can probably all agree that it has become a very prevalent word in our time. But, is anxiety a “new” word? Nuh-uh. There are records of the word being used at least from the 1600s. Interestingly enough, the word anxiety (anxius) in Latin means “to choke, squeeze” and in Serbo-Croatian it literally translates as “tightness, narrowness”. Another definition we really like from the 17th century describes it as: “Greatly troubled by uncertainties”.

We already have some interesting starting points. We have: choking, tightness, narrowness and uncertainty as key words. Oof. Just the words themselves are a bit anxiety-inducing, aren't they?

Which probably means whoever thought of this kind of nailed it. Anxiety does involve all those concepts and feelings. It’s a generalized feeling of unease that can appear when we feel threatened or concerned. It’s also our natural response to stress, which means we have all felt anxiety at some point in our lives as it’s part of our condition of being human. We usually experience anxiety when we are worried, tense or afraid about something that is about to happen - which is why uncertainty is such a big factor when thinking about anxiety. If we cannot anticipate what is coming, we are likely to feel anxious not knowing what we need to prepare for. This is one of the reasons the COVID-19 pandemic has been such a difficult time for many of us. We will look at ways that uncertainty and “chronic threats” affect the way we experience anxiety later in the course.

Now, the word might be from the 1600s but the FEELING of anxiety is much, much older. It dates to the time of cave people.

Let’s try to imagine how people lived then.

During the day people were living their lives outside their caves, hunting, collecting fruit, swimming, exploring, discussing very important things too possibly, and then at night - as we, humans, are not very good with night vision - we would retire to our caves. That’s where we would prepare and eat the food, relax, digest and rest. So basically, some of the time we would be relaxed and safe and the rest of the time, when we were out in the wild, we were a little bit more exposed to threats such as predators but also opportunities to hunt prey. 

These 2 “modes” are expressions of our parasympathetic and sympathetic systems. The parasympathetic is the system that kicks in when we are relaxed and able to concentrate on rest and digestion - so our “cave” mode. The sympathetic system, on the contrary, takes over whenever we feel we are under threat and need to respond immediately, so our “out in the wild” mode. This system helps us focus our energy and strength on the organs we will need to use to attack or run - also known as the fight/flight response.

Now, one thing to remember is: when the fight/flight response is activated, it kicks in with an IMPERATIVE. It will change our entire body’s functioning to be able to protect us from danger and give us the most chances to keep us safe. It will pump oxygen into our muscles so we are prepared to run or fight and it will inhibit our digestive function - because that, we can do later. This is a short-term survival system. When we are living in this state long-term, we start experiencing problems. We will look at this along the course.

This is all happening at our body level. Now bear with us for a little bit longer so we can give you the full picture of how this all works at our brain level. This fight or flight response depends on the possibility of identifying something as a threat, are you with us? If we can’t identify something as dangerous then we won’t activate the fight/flight response. And what is responsible for that? The one and only: the amygdala. The amygdala is our early warning system, it is there looking out for potential threats as our own personal guardian. 

Imagine you have a fortress around your house: the amygdala is the person sitting in one of the towers looking out to the sea making sure no enemy ships are approaching the fortress. The amygdala is the center for emotions like anxiety, fear, and anger, and these emotions occur before we are conscious of them. So, let’s say the amygdala sees a ship approaching that does not look friendly. She then immediately sends an urgent message to the hippocampus - which is helper N1 sitting in another tower - saying “threat is present”. This then allows the hippocampus to create an emotional response and provide some context: from recalling previous memories it can help give a fuller picture of the situation. A message was also sent to the prefrontal cortex, but because this one sits on the other side of the wall, it takes a little longer to get there (in reality, both amygdala and hippocampus are located in the limbic system and they have a stronger link between them). The prefrontal cortex kicks in to put on the brakes. It is responsible for our judgement, decision making and emotional regulation. It allows us to connect to our sense of self and not act instinctively all the time. It can basically control and stop the action the amygdala has started. In neuroscientific terms, we would say the pre-frontal cortex ‘modulates’ activity in the amygdala in response to threat.

But as you might have been able to anticipate, over the long term with chronic anxiety, the relationship between our amygdala and pre-frontal cortex, as well as other brain structures involved in informing the way we respond to threat, like the hippocampus, can become imbalanced. Research has shown that anxiety is associated with an increased risk of hyper-activation of the amygdala, and irregular modulation of that activity by the pre-frontal cortex. 

Whew! That’s enough neuroscience for today. Of course we must say the neuroscience of the anxiety response is a bit more complicated than we’ve just explained, and the relationship between different brain structures and their function, as well as the involvement of these structures in cognitive processes like decision-making, is complicated. But these irregularities in brain activity have been validated by research. 

And we think that it can be helpful to understand how our brains and bodies produce the fear response, including the sympathetic and parasympathetic nervous systems, in order to understand what our minds and bodies are doing under anxiety. Because guess what - we can consciously initiate and learn ways to take control of these cycles of stress and relaxation, as part of our tools for managing anxiety. More on that in the weeks to come.

The homework for this week is… before next session, we want you to start a journal! And your first task for the journal: think about what anxiety feels like for you. Write it down if you can. And you can interpret this task how you want: if you want to write down situations that make you anxious, go for it. 

Maybe you want to draw it, sketch it, record a video, maybe you want to describe how it feels in your body, which kind of thoughts you have when you are anxious, or maybe just writing isolated words works better for you. It’s your choice. Some people benefit from completing the following sentence: “When I am anxious, it feels like…”

Remember, this is an investment in your own journey to recovery. Give yourself the best chance to build resilience. You can do this.