Tokyo Mental Health is here to support you and provide you with the help you need.
Author: Udeni Appuhamilage, Ph.D, TMH Psychologist 
Table of Contents
A string of bear sighting has been reported in Sapporo since late April, but traces of the animals actually wandering in the city -- such as footprints and droppings -- have not been confirmed at many of the sites, suggesting that heightened fear among residents, partly fueled by multiple bear attacks in 2021, may be making them see brown bears that aren't actually there. . . This suggests a cycle in which a sense of anxiety is leading to "bear" sightings and the increased number of reports is further fueling people's fear. [1]
In a survey of 362 school counselors nationwide by The New York Times in April, the counselors — licensed educators who teach these skills — described many students as frozen, socially and emotionally, at the age they were when the pandemic started. . . Nearly all the counselors, 94 percent, said their students were showing more signs of anxiety and depression than before the pandemic. [2]
Amid the feelings of overwhelming love and joy that having a baby gives, more than 100,000 Australian mums each year also find themselves experiencing anxiety and depression. Some even think their baby or partner would be better off if they were not around. [3]
What Is Anxiety?
According to the World Economic Forum, the number one mental health concern of the people in today’s world is not depression but anxiety; a total of 275 million people (i.e., 4% of the global population) suffer from anxiety disorders worldwide.[4] Global prevalence of anxiety (and depression) has increased by 25% during the first year of the COVID-19 pandemic; the youth, women, and people with pre-existing health-related problems-both mental and physical, are among the more vulnerable.[5] As a disorder, anxiety recognizes situations where one’s anxiety symptoms interfere with and severely debilitate the person’s daily work such as school work, job performances and relationships. These disorders are categorised into different types, including generalised anxiety disorder, social anxiety disorder, panic disorder and many phobia-related disorders such as agoraphobia (i.e., fear of situations from which it would be difficult to escape), claustrophobia (i.e., fear of feeling trapped in closed spaces) and acrophobia (i.e., fear of height).
Beyond psychopathology, anxiety is also a buzzword, a dynamic emotion and a common everyday experience. It is pervasive and consistent, even when it is low in its intensity. It is our body’s natural response to stress; it is quite normal for us to feel anxious about a job interview, moving houses, an exam or a date. While such anxiety can be unpleasant, it also helps us by making us vigilant, mindful and driven to prepare for the task ahead. Anxiety, for the most part, is future-oriented (i.e., anticipatory anxiety), even though its roots can also be about the past, especially about difficult past experiences and their possible, feared consequences. Anxiety closely resembles fear; the two emotions differ from each other too since anxiety does not originate from a specific object. This also means that anxiety is not something from which one can escape momentarily by removing an external threat as is the case with fear which is linked to a specific danger.
Cultural dispositions and orientations shape anxiety experiences by socialising us to express anxiety in certain ways or to even repress/suppress it in order to meet certain cultural traditions (Harding and Pribram, 2002).[6] In Soren Kierkegaard’s famous essay ‘The Concept of Anxiety’ (1844), anxiety is discussed both as a feeling typical of the Protestant culture and also as a medium or mediating force between freedom and fear. He connects mediation with the necessity/ possibility /privilege of the free, modern individual to make choices. The importance of Kierkegaard’s work is not only about its referential value for the following scholarly reflections on this topic; its importance is also about how it links anxiety with our ability to make decisions in an autonomous way-an ability that we value, promote and embrace, but also an ability that exposes us to overwhelming risks and vulnerabilities. Anxiety is also considered as a collective emotional state rooted in Western modernity. For instance, Giddens (1991)[7] explains how future-oriented anxiety in the contemporary world is closely connected with the openness and implied close proximity of the future that is typical of modernity. While modernity recognizes the future as unknowable, it also implies future as an area of possibility, thereby subjecting future to risk calculation and self-monitoring (Giddens 1991).
The autonomy of the free, modern individual, their sensitivity to risk and the resulting anxiety that is discussed in the scholarly works referred to above are also connected to ‘self-governance’ (Beck, 2005).[8] Self-governance, in Foucault’s (1977)[9] explanation, is a psychological attitude that implies the individual as accountable to solve problems and make decisions, even in areas that are external to their control or understanding. Such an attitude is believed to foster autonomy and is promoted socially, culturally and politically by educational systems, employment sector, political authorities, policies, media and even guidebooks. Despite the many arguments on the importance of self-governance as conducive and even necessary for the development of the ‘autonomous’ individual, the same emphasis on self-governance is also responsible for taxing the singularized individual with new tasks of self-management, self-protection and self-care in a world that is uncertain and unpredictable; the inevitable emotional consequence of such expectation is anxiety (Rebughini 2021).[10]
The COVID-19 pandemic offers a classic case study for an analysis of anxiety that recognizes this complexity. COVID-19 is a situation that clearly evidences uncertainty, insecurity and the precariousness of our lives. It is a pervasive source of anxiety in social relations, economic and health care needs and services as well as in its power to reveal the reality of serious scientific, political and economic ignorance and historical errors. Thus, the spread of anxiety across populations within the context of the pandemic is not only about the loss of a job, closing down of the city’s school or death of loved ones; it is also about people questioning scientific knowledge, the capacity of economic, political and governance structures/authorities to react and regulate crisis situations and the forced necessity for individuals to reorganise their everyday lives on the basis of uncertainty.
Living with Anxiety
Anxiety has a direct impact on our daily lives; when the worry of the tasks ahead debilitates you to an extent that you cannot get out of bed in the morning to start your day, when you struggle to focus and concentrate on even routine errands like washing dishes or going to the market, or experience excessive fears about travelling in a crowded train or attending a function at your child’s school, life becomes unnecessarily stressful and hard.
Anxiety feels different to different people. Some of my clients emphasize the physical symptoms of anxiety, including increased heartbeat, hyper-ventilation, insomnia, nausea, sweating and headaches. The physical symptoms can be debilitating, especially when anxiety triggers panic attacks. Beyond the bodily symptoms, panic attacks also trigger severe psychological discomfort. One of my clients described a panic attack as an intense worry that she would not be able to catch the next breath; the fear makes her not want to let go of the breath that she already took. Some other clients focus more on psychological symptoms; persistent worry, agitation, difficulty with concentrating and repetition of thoughts, specifically disturbing ones. They describe anxiety as a constant worry about something, but not knowing what that something is; hence not only do they suffer from anxiety but also feel confused and angry about it.
One of the most prevalent experiences that my clients with anxiety report, disregard of their gender, age or nationality, is loneliness. Children and teenagers complaining about friendships or the lack of it, the youth worrying about their failed romance and married partners struggling with intimacy are all connected to loneliness. Loneliness, defined simply, is the feeling we experience when our need for rewarding and meaningful connections is not met. This is why we can feel lonely even when we have many people living with us. Despite the fact that we live in a world flooded with technologies that are built to aid socializing and have so many policy documents and laws to protect human rights, eliminate prejudice and discrimination, we feel so apart from each other and increasingly become so. Studies show that loneliness is becoming increasingly prevalent and social media has been found not to be a cure but to increase anxiety and loneliness.[11] Another common experience among those with anxiety is fear of judgement. Maggie (whom I have anonymised) is in her late twenties, and reports severe symptoms of social anxiety. She speaks several languages fluently, has a well-paid job and thus, can afford weekly outings with a group of work-related friends. She has her own apartment in the middle of Tokyo, and even savings in the bank. Despite the security that her job and social group provide her with, she is constantly worried about how others perceive and judge her. In fact, she notes how she feels the pressure to maintain a kind of a social life – in the real world and in the virtual world- because she does not want society to think that she lacks friends. This is a classic feature of anxiety, where one makes choices not necessarily driven by what one wants but by what one does not want; choices led by avoidance.
What Can We Do?
As is discussed above, anxiety is not a condition that neatly fits to a narrowly defined psychopathology; instead, it is also a natural response to risks, a day-to-day experience of avoidance and denials, a culturally-framed response to discomfort and a psychological experience that is triggered by the challenges of modernity. Recognizing and understanding the external threat, whether it is about loneliness, modernity and its implications for self-management and autonomy, or unpredictability and uncertainty due to man-made (e.g., pandemics) or natural (e.g., Tsunami) disasters, helps us to establish clearer and pragmatic boundaries about our responsibilities and expectations for our wellbeing. For instance, while autonomy is valuable and helps us with making healthier decisions, some of the challenges such as the pandemic, are beyond our individual control. Recognizing these limits of our autonomy and inherent vulnerabilities, hence, is not about being weak but about radically accepting our complex reality and seeking external help as needed. I will briefly discuss some techniques of such radical acceptance in the latter part of this paper.
Understanding our own attitude towards anxiety is fundamental to effectively work with it. For the most part, we problematize it, fight against it, try not to feel it or hide it. While excessive anxiety is difficult to work with, anxiety is not the enemy. On the contrary, it is a mediating emotional state that guides us in navigating our psychological and bodily responses to the unknown and prepares us to face and fight against the risks that threaten our safety and wellbeing; it does so by making us more vigilant, self-conscious and attentive. Moreover, the external threat itself is not what makes us anxious; it is the way we narrativize the threat that triggers feelings of anxiety. Understanding and accepting this reality, and building a healthier connection with anxiety is one of the first and most constructive steps to better regulate anxiety in the long run.
If a clinical assessment shows your anxiety to be severe, it is time to seek professional help. Several types of medications are used to treat anxiety; for the most part antidepressants (both SSRI and SNRI classes) are the first line of medications prescribed; Buspirone and Benzodiazepines are also used, if prescribed by a medical practitioner. Psychotherapy is recommended with or without medications and is a highly effective treatment for anxiety. Cognitive Behavioural therapy (i.e., CBT), for example, is generally a short-term treatment that helps you to understand underlying, dysfunctional thinking patterns that precipitate and perpetuate your anxious thoughts and behaviours; following such insight building, the CBT therapist will guide you in building specific skills that will gradually help you to return to the kind of activities and lifestyle that you have avoided because of anxiety. As a part of CBT, some therapists may also work with you on radical acceptance (i.e., RA). Some of the key steps of RA are:
- Detached observance (i.e., observe the disturbing thoughts as they come and go, without attaching yourself to them)
- Reality checking (i.e., recognize and remind yourself that you are questioning the ‘reality’)
- Make causal attributions (i.e., question and understand that there are reasons that can explain your understanding of reality)
- Practice acceptance (i.e., practice accepting your observations and understandings about reality with your whole self; you can use self-talk, mindfulness, relaxation techniques to help you accept reality)
- Imagine and confirm (i.e., imagine your life once you’ve accepted reality, list out all the different behaviours you would engage in once you radically accept reality and rehearse those conversations and behaviours in your mind)
- Attend and validate (i.e., attend to all your bodily sensations as you think about the difficult reality and validate all the negative feelings such as disappointments, frustrations and sadness related to the experience)
- Acknowledge (i.e., acknowledge that life is still worthwhile and meaningful even when there is pain)
- Analysis (i.e., do pros and cons if you find yourself resisting RA).
Humanistic therapy is another example of a psychotherapeutic approach to treat anxiety. It is an umbrella term used for a group of therapeutic approaches (e.g., person-centered therapy, existential therapy, logotherapy, gestalt therapy, narrative therapy, transactional analysis, focusing therapy, etc.) that are rooted in the principles of humanism. The humanistic therapist is not focused on the problem but upon the individual; thus, they do not diagnose or problem-solve, but aim to take a journey of meaningful growth with the client as an equal partner. The strength of humanistic therapies is this focus on the individual which enables the approach to adapt to the unique needs of each person. Humanistic therapists will understand your anxiety as an inevitable part of life which nevertheless restricts your potential. They will not seek a total alleviation of anxiety; instead, they will work with you to help you connect with your potential so that you can build courage to accept the paradoxes of life and choose to live your life meaningfully, despite anxiety.
In Conclusion
Anxiety is a mediating emotion, a bodily tension, a reaction to the various challenges of our lives in the contemporary world, and a cultural representation of discomfort. It is an inevitable part of our human condition, and an inherited capacity against risks. While excessive anxiety can lead to negative consequences and needs to be addressed with proper diagnosis and care, we have the capacity-which is both bio-psychological and socio-political, to endure everyday anxiety and thrive despite it. Understanding and accepting this complexity of anxiety is a healthier approach to work with it than hiding and avoiding it. In fact, as Salecl (2004)[12] argues, what produces the dysfunctionality of anxiety can very well be our discomfort with it and attempts to get rid of it, and not the emotion of anxiety itself.
References
[1] https://mainichi.jp/english/articles/20220527/p2a/00m/0na/032000c
[2] https://www.nytimes.com/interactive/2022/05/29/upshot/pandemic-school-counselors.html
[3] https://www.abc.net.au/news/2022-05-29/post-natal-depression-world-first-screening-tool-victoria-mums/101102152
[4] https://www.weforum.org/agenda/2019/01/this-is-the-worlds-biggest-mental-health-problem/
[5] https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
[6] Harding, J. & D. Pribram. 2002. The power of feelings: Locating emotions in culture. European Journal of Cultural Studies 5:4 (407-426).
[7] Giddens, A. 1991. Modernity and Self-Identity. Cambridge: Polity Press. For further information, please read Giddens, A. 1990. The Consequences of Modernity. Cambridge: Polity Press, and Beck, U. 1992. Risk Society: Towards a New Modernity. London:Sage,
[8] Beck, U. 2005. Power in the Global Age: A New Global Political Economy. Cambridge: Polity Press.
[9] Foucault, M. 1977. Discipline and Punish: The Birth of the Prison. London: Allen lane
[10] Rebughini, p. 2021. A sociology of anxiety: Western modern legacy and the COVID-19 outbreak. International Sociology 36(4): 554-568
[11] Ballard J. Millennials are the loneliest generation. YouGov. https://today.yougov.com/topics/lifestyle/articles-reports/2019/07/30/loneliness-friendship-new-friends-poll-survey
[12] Salecl, R. 2004. On Anxiety. London: Routledge.
