Everyone, at some point in our lives, has felt anxiety . For example, before taking a test where we have a lot at stake or when we have had to make an important decision. This psychological reaction is, in many cases, something normal, which appears when faced with situations of stress or uncertainty.

Interview with Andrés Quinteros

Anxiety disorders are spoken of with some frequency today. But what is the difference between normal anxiety and pathological anxiety? In today’s article we interview Andres Quinteros, founder and director of the Center of Psychology Cepsim in Madrid, to help us understand what anxiety disorders are and what we can do to prevent them.

Jonathan García-Allen: Good morning, Andrés. Anxiety and stress are often seen as similar states that sometimes get confused. But what is anxiety? Is it the same anxiety as stress?

Andrés Quinteros: Well, to answer these questions I will begin by briefly describing what anxiety is and what stress is.

Anxiety is a normal emotional state that serves a very important function, since it warns us that there may be a danger or threat and it functions as an internal alarm system. Therefore, it is useful and adaptive. I emphasize this because sometimes you have the perception that anxiety is in itself something negative. This only happens when it is inappropriate, that is to say, when the alarm goes off when there is no danger, or when it is excessive, too intense, or also, when it is prolonged too much in time.

Stress can be defined as a psycho-physiological process that begins to manifest itself the moment we begin to perceive that a new or challenging situation can overwhelm us or that we find difficult to resolve, so we activate ourselves to seek an answer to that situation. The new situation can be something positive, like the preparation of a wedding, it can be a challenge, a new work project or it can be something unexpected, like facing the process of an illness.

In the face of any and all of these situations, our stress will be activated, tensing our organism to the maximum in order to optimize its performance and prepare us for what lies ahead.

That is why stress is also adaptive and necessary, as it enables us to take action to provide answers to life’s problems and situations. It becomes negative, when this tension to the maximum does not cease and it is prolonged indefinitely in the time producing all the weariness and own discomforts, such as upheavals of the dream, the irritability and the low tolerance to the frustration.

However, sometimes it can be difficult to differentiate between anxiety and stress, since anxiety can be a symptom of stress, that is, anxiety can arise in a stressful situation, in addition to other emotions, such as frustration, sadness, and anger.

Another difference is that in stress, the stressor object is in the present, triggered by a stimulus that appears: a task that I have to do or a problem that I have to solve. While in anxiety it can arise in anticipation of an event that may happen in the future in this case, it is anticipatory anxiety or even feeling the anxiety without knowing very well why it is there, without being able to identify something external that triggers it.

In this sense, stress has to do with the demands that the environment presents us with, while anxiety can come from something more internal, it can be anticipatory as I already pointed out and if it appears from the demands of the environment, then it is a symptom of stress. Following this thread we can say that stress is produced by external factors that demand something from us, while anxiety can be produced by this, but also and mainly by internal factors – psychological and emotional – that can anticipate a threat and can even appear without apparent specific cause or real threat.

J.G.A: Is anxiety a disorder? When does it go from being a minor problem to generating a real problem that affects the normality of a person’s life?

A.Q: Anxiety as an emotional state is not a disorder, I think it’s important to differentiate them, all emotions are useful and necessary. I don’t like to differentiate between positive and negative emotions, but rather between those that produce feelings of well-being or discomfort, pleasure or displeasure. All the emotions felt in an appropriate way are positive and all of them can become negative.

It is inevitable in certain situations to feel fear, anxiety, grief and many times and on the contrary, to feel joy or pleasure in some situations is negative. For example, for a person addicted to gambling for example, at the moment of being in the game room, they express being well, with sensations that they identify as pleasant and if they win those pleasant sensations increase. To feel the same way again, they look to repeat it, they play again. In this sense these emotions that produce well-being are dysfunctional in this situation because they are a support for addictive behaviour.

However, like all emotions, it becomes a problem when its intensity is very high or when it appears in certain situations generating an unnecessary alarm, altering itself without reason. For example, as I indicated above, we can feel anxiety, although nothing in our lives explains or justifies it. There are even people who say they are fine with their lives, but do not know why anxiety does not leave them alone. In these two situations anxiety becomes a problem. It is also a problem when small things that can cause us low anxiety, this is disproportionate and overflows us.

J.G.A: Anxiety disorders are the most talked about mental illness, even ahead of depression. Are they disorders that only appear in developed countries?

A.Q: If that’s the case, there’s a lot of talk, because it happens frequently, along with depression are the problems that people consult us about the most and there is also a very generalized knowledge of their symptoms, so people now identify more if they are anxious or depressed and they present themselves in the consultation like this “I come because I have anxiety”.

The studies indicate that in the last decade and in the present one, the consumption of anxiolytics has grown almost 60%, in 2016 data were indicated that Spain was leading figures in the consumption of certain anxiolytics.
Therefore, there is a lot of talk about it. Furthermore, I believe that today’s society and its cultural, material and social demands cause an increase in anxiety and stress.

With regard to the second question, I can indicate that anxiety problems do not only occur in developed countries. I have lived and worked as a psychologist in 4 countries and in all of them anxiety disorders were present, even though people’s life situations change. But what I would dare to say is that nowadays and especially in developed countries, there is a very strong hedonistic tendency, which leads to deny the emotions that produce displeasure and to want to get rid of them quickly.

The great demand is that we always have to feel good, and that this paradoxically exerts a pressure that generates stress and anxiety. This causes, and I see this a lot in consultation, what I would call a kind of phobia of negative emotions, as if it were forbidden to feel bad and as I pointed out before, all emotions are useful and we cannot do without fear, anxiety, anger, frustration, etc. And we already know that when we try to deny an emotion, it grows stronger and anxiety is no exception.

If we refuse to feel it, the anxiety is triggered, I think we have to re-educate ourselves about the importance of being able to cope better with these emotions as they are sometimes signs of what is not going well for us. When we try to remove them, we lose a kind of compass that serves to orient us.

J.G.A: Anxiety disorders is a general term that covers different pathologies. What types exist?

A.Q.: Yes. The pathologies of anxiety are varied we have panic attacks, generalized anxiety, phobias are also included, such as agoraphobia, social phobia or simple phobias, as well as obsessive-compulsive disorder and post-traumatic stress.

J.G.A: What are the main symptoms of a panic attack and how do we know if we are suffering from it? On the other hand, what kind of situations can cause it?

A.Q: A panic attack is a very intense and overwhelming anxiety response, where the person has the feeling of losing total control of the situation.

One of its main characteristics is the feeling of terror that the person feels because he or she thinks he or she is going to die or because he or she has the idea of suffering a catastrophe, of dying or going crazy. This feeling is accompanied by other physical symptoms, such as tremors and choking sensations, dizziness, nausea, palpitations, sweating, agitation and also chest pain, which makes people think they may be having a heart attack. These would be their main symptoms.

We cannot say that one situation or another can cause a panic attack, I think it is a combination of 2 factors, on the one hand, the internal processes in which we include the configuration of the personality that in some cases can be prone to feel anxiety, the locus of internal control of emotions, the style of attachment, etc. and on the other hand, the external situation that the person is going through.

If we only consider the external, we cannot answer the question of why people can react in very different ways to the same situation. This is due to their personal characteristics.

What could be a sign is that people are more likely to have panic attacks, when they are prone to anxiety and do not seek help to deal with it.
Another important point to understand this problem is that after a panic attack, the person is often left with a lot of fear that another attack will occur and this is usually the cause of the second and subsequent panic attacks: fear of fear.

Andrés Quinteros has been working for years on the management of problems related to anxiety. | Image for the occasion.

J.G.A: Are the cases of anxiety disorders increasing because of the crisis and the socioeconomic situation we are living?

A.Q: Yes, of course, and not just anxiety, but many more psychological problems such as depression, difficulties in coping with change, overcoming situations of loss of work, status, social condition. Crisis situations provoke uncertainty, feelings of danger and fear increase and are a breeding ground for increased anxiety, despair and the burden of not being able to resolve.

J.G.A: What causes anxiety disorders?

A.Q: It is a question that is difficult to answer today and it will depend on what psychological theory we are inserted in. There are currents of thought that point to organic causes and others that indicate their cause in the problems of attachment, bonding, and experiences in development. I personally believe that although we come with a biological base that determines us, the attachment, the affective bond, and the experiences that we live in our development will mark us to be more vulnerable or more resilient in the face of anxiety.

**J.G.A.: What do we do in an anxiety crisis? **

A.Q: The psychoeducational part in the treatment of anxiety and panic attacks is very important, as it will help prevent and/or minimize the magnitude of the attack. First of all, it is important to make the person lose the fear of feeling anxiety, that he or she is not going to die or suffer a heart attack. It is only anxiety that his mind creates and that it is the mind itself that can regulate it, this at first surprises the person, but then it is a thought that helps in the moments when the anxiety increases.

It is also important to indicate that anxiety is not an enemy, in fact it is an emotion that warns us that something is not right and that maybe there is some situation that you have to overcome, accept or leave behind.

In addition to the above, it is important to teach some body regulators of anxiety, such as breathing control, mindfulness is now widely used and it is also useful to teach thought control techniques.
Of course also if necessary, having the possibility to go to medication for anxiety, but always controlled by a medical psychiatrist specialist.
And of course if you want to regulate your anxiety properly, a psychological treatment is the most appropriate.

J.G.A: What treatment exists for anxiety disorders? Is it good to use only drugs?

A.Q: Well there are many procedures that are good and effective, I can tell you how I work it, I think it’s been more effective for me to do an integrative treatment, because I believe that each person has their own particularities, so each treatment has to be specific. Even if 3 people with the same problem come to me for consultation, for example panic attacks, I will surely carry out 3 different treatments, since the personality, history, and ways of coping with each one are different.

Therefore with some I will apply for example EMDR, sensorimotor therapy, Gestalt, hypnosis, cognitive, internal family, etc or a combination of them. What is done in the sessions will depend on each case. I believe that this way you can be more effective.

Well, now to the question of whether it is good to use only medication, as I said before, it depends on each case. I think that in a group of people, for example, therapy without medication works very well and there are cases in which it is necessary to do a combination of work with psychotropic drugs. It also depends on what problem we are talking about, it is not the same as an obsessive compulsive disorder or a phobia, in the first case it is likely that you need a combination of therapy and medication, in the second case it is likely that with therapy alone it will be solved.

J.G.A: Is there really a cure for pathological anxiety or is it a problem that accompanies the whole life of the person who suffers from it?

A.Q: Well, I think that in psychology we can’t talk about curing everything or forever, in our profession we use more the dependence. Again, I must say that it depends, for example, on the disorder you suffer from; phobias, panic attacks, generalized anxiety, usually have a good prognosis and in obsessive disorders, treatments are more prolonged and complex.

If we say that anxiety and stress are adaptive mechanisms, they will not disappear, they will become more functional and it will be possible to regulate them better. What I would dare to say is that a good psychotherapy will help them to be better, being able to make the disorder disappear or diminish the effects that it produces and that the person has a better quality of life.

J.G.A: Can anxiety disorders be avoided? What can we do to prevent them?

A.Q: As in everything, there are always many things that can be done to avoid and prevent psychological discomfort. As a psychologist, I recommend a psychotherapy to help strengthen our personality and self-esteem, which is the best defense against these problems. You always think about going to the psychologist when there is a disorder already present, I recommend it as mental hygiene, you also have to go, to grow and develop personal resources.

Then, there are many other things that will help prevent anxiety, I would leave a small catalog:

  • Learning to become familiar with and listen to our emotions, because something is telling us, in this case anxiety signals that something is not right, if we learn to listen to it, we can solve what causes it and thus improve our life
  • Sharing time with people who enrich us internally
  • Taking advantage of our free time, doing pleasant things
  • Develop sports activities, since not only is it good for the body, but exercise is also a good emotional regulator
  • A healthy diet is also important
  • Accumulate positive experiences. It is also important to understand that we will feel better if we accumulate positive experiences rather than objects. The well-being of having something is momentary and less lasting than having lived a good experience that will last in our memory.

Of course there are many more things that help, but I would leave these 6 as important.