Something I have been asked a lot in therapy sessions late is this - "I feel unstoppable physical sensations when I am anxious & this has gotten worse during the pandemic. Why does this happen?"

Here is a primer for comprehension—

Anxiety & fear are both part of our emotional landscape. Neither constitutes a pathology. Anxiety has its own uses in survival. The chief difference is that fear is when you are grasping with a known or certain threat & anxiety is usually an unknown or certain threat.

Therefore, confronting a fear can, in most cases, be a more direct, tangible process whereas anxiety-inducing stressors can be more shadowy or repressed leading to ongoing aftershocks from time to time. Over a period in time, anxiety can turn into a generalised response to fear.

While there are some (debatable?) biological/neuroschemical markers for anxiety, a lot of it is due to psychosocial causation. If you grew up in a family where attachment & trust were patterned on insecurity & self-doubt, it is likely that you feel anxious about relationships.

Repeated anxiety --> worrying. It shows up as physical signs including palpitations, sweating, the feeling of a knot tightening in your stomach, your ears getting warmer among a host of other bodily discomforts. It is cyclical. Worrying, ironically, becomes a coping mechanism.

How can worrying be perceived as a coping mechanism? Because it is the only control one might have in a situation. It involves repetitive thinking and in a way, it makes the person experiencing said anxiety feel like if they keep thinking, maybe a 'solution' will surface.

One of the reasons this happens is due to a somewhat mysterious part of our brains called the 'adaptive unconscious' (Daniel Wegner, 2002) which is composed of a a set of unconscious mental processes that exert influence on our perception & on-the-go decision-making.

The Adaptive Unconscious is efficient but rarely unchangeable and inelastic. Once a belief is coded, it gets hardwired. It is separate from a more conscious form of processing events+experiences because it happens rather quickly. It is kinda unreachable in our conscious moments.

For e.g. if you grow up with a fear of dark+abandoned places, you automatically stay away from an abandoned or dark house or feel anxious when near one. This happens due to repetition of a belief that something can cause us harm leading to a behaviour which is avoidance.

This is linked to "Interoception", a lesser know sense that helps us understand whats going on within our bodies. When our interoception is distorted or has become less available to us consciously, it can induce specific and severe anxious physical sensations.

Gaining better awareness of how your body is feeling and what it is trying to convey helps reduce anxious sensations. When we soothe our bodies' anxious sensations, we send a signal to our brain to calm down. We create a sense of physical awareness and anchoring.

This is also why rationalising or "talking" your way through an anxious event is usually not sufficient or even fails miserably. Language is not coded in the adaptive unconscious, it is a part of the conscious neural circuit which shuts down during an anxiety/panic attack.

The Interoceptive system gives us the ability to feel what is happening within our bodies. Special nerve receptors all over our bodies including internal organs, bones, muscles and skin. On the side, your heart, for example, sends more signals to your brain than vice versa.

So there are usually more body to brain (afferent) signals than brain to body (efferent). This is good news coz it means if we learn to soothe the body during an anxious situation, we can send the necessary signals that allow the brain to calm itself down.

This is harder to do when there are disabilities/a history of trauma/abuse or a generally disturbed relationship with our bodies. However, this also means that slowly engaging with somatic/bodily calming techniques as an ongoing ritual will improve response to anxiety triggers.

Improving the functioning of the interoceptive system can help with processing of anxiety-inducing triggers. This is secondary because primarily, we need to address the complex socio-cultural challenges that embed these stressors in us: poverty, racism, casteism, violence.

Emotions aren't invoked. They are always present. We have different emotional reactions to different situations depending on how the ecological (external environment: home, society, country & so forth) combine or thwart with our internal/innate emotional landscape.

So yes, it is possible that someone takes flights a hundred times during the year and yet feels severe flight related anxiety/panic. Someone can make presentations at work for years and still feel an anxiety attack from time to time.

Ad hoc methods to "avoid"/ "fix" anxiety can worsen it. Leaning in and making the unconscious, conscious is possibly what is going to help in the long term. That & a better sense of recognition+connection+soothing of physical sensations linked to anxiety.

Here is an Interoception activity guide - http://web.seru.sa.edu.au/wp-content/uploads/2019/04/Interoception-101_March-2019.pdf