Almost everyone experiences some form of anxiety in their lives and much of it will be manageable, such as being anxious about meeting new people, going to a job interview, or taking an exam. Some more stressful experiences like taking a driving test or getting on a plane if you’re nervous about flying, can cause stronger physical reactions but they normally reduce soon after the event is over.
Anxiety that is linked to trauma is much more severe and can be both physically and mentally debilitating for the trauma survivor.
Understanding trauma related anxiety
Anxiety that arises out of the trauma experienced by a survivor of sexual violence, sexual abuse, or sexual exploitation is not just stress, but is linked to the body’s response to the traumatic event when it was happening. A really well made and informative video by NHS Lanarkshire and Gender-Based Violence Services shows how the brain responds at the point of trauma, and how memories are recorded. This film is available on YouTube and can be viewed at Trauma and the Brain – YouTube.
This film shows how the brain changes when the attack is happening. Normal thinking processes are too slow to cope with the threat so the limbic system, the part of the brain that focuses on survival, takes over and begins to ready the survivor to respond to the threat.
After the danger is over, though, the brain’s ‘fire alarm’ in the limbic system sometimes gets jammed on ‘red alert’ so that the survivor experiences floods of cortisol into the body keeping it hyperalert, hypervigilant, with a high-level startle response, in effect jumpy much of the time. This is more common in cases where the survivor has experienced multiple traumas such as childhood sexual abuse, or domestic abuse. Being constantly in this ‘fight or flight’ state means that any frontal lobe thinking is affected, often making the survivor feel confused, forgetful, unable to think straight. It also means that what may be seen by others as ‘small stresses’ are hugely magnified by the trauma survivor in this state of hypervigilance.
Understanding an anxiety attack
Most people who experience anxiety attacks describe changes in their bodies. These happen because the anxiety has triggered the brain’s ‘fire alarm’ and is getting ready to respond to danger if it needs to. Anxiety attacks mirror trauma response in that survivors talk about:
Rapid breathing: This is the body taking more oxygen into the lungs to send this oxygen enriched blood to the muscles. This is the ‘fight or flight’ response that is often described.
Heart pounding or palpitations: The heart is working hard to ensure that oxygen rich blood is circulating well.
Cold sweat: Adrenaline rushing through the body can create the ‘cold sweat’ feeling, a mixture of sweating and chilling. This also causes hair follicles to contract which is why we see ‘goosebumps’ or ‘goosepimples’ on our body.
Shaking: The muscles are becoming tense, ready to fight or flee, sometimes so tense that trembling or shaking begins.
Nausea, butterflies, ‘stomach churning’: When the fear response is happening, the digestive system often closes down and that’s why it’s common for someone to talk say, “my stomach was churning” or “I thought I was going to be sick”.
For most people, when something happens that causes a sudden fright, these responses happen, but they return to their normal physical state soon afterwards. There might be a longer-term memory that sticks with them (for example, a large snarling dog is dangerous, which results in someone feeling afraid of large dogs) but day to day, they manage pretty well.
For the trauma survivor, a stressor like this can have a major impact and add to the heightened levels of anxiety and fear that she already has. Not only will the memory of the large dog (for example) loom large in her mind, but the sight of large dogs may trigger a more serious panic attack.
Panic attacks are bouts of intense heightened anxiety that are sometimes described by survivors as ‘sheer terror’ or ‘feeling like I’m going to die’. Panic attacks can happen suddenly, and survivors may feel them building through physical changes in their body, such as feelings of intense fear or terror, shortness of breath, nausea/feeling sick, trembling, or a cold sweat. The survivor may recognise the trigger for the panic attack and if so, may be able to develop coping strategies to help ease the intensity of her fear, or halt the panic attack completely.
Although panic attacks can be frightening, they are normally not dangerous. Some things that might be useful to a survivor when she experiences a panic attack:
- Try to remind yourself that it’s a panic attack and although it feels overwhelming and frightening, you are safe, and it will pass.
- If you are outside when the panic attack starts, you may feel safer if you are in place such as a women’s toilet in a store or a café. Toilets that are accessible for disabled people are generally individual rooms when you can lock the door and spend a few minutes getting your breathing back in order and getting grounded again.
- Doing something like washing your hands or face, if you are sweating, can help with the feelings of grounding
- Take some time to focus on breathing. Breathe slowly and deeply, counting each breath. This can focus your attention on your body and away from your thoughts.
- Think about carrying a small item that may help with your grounding. This can be a small stone or crystal, or another small object that means something to you. If you feel overwhelmed, touching the object, feeling its smoothness or rough texture, can help take the focus of your thoughts to the physical feelings of the stone, rather than the panic you are feeling.
When the panic attack is over, be gentle with yourself and take some time to relax and think about how well you have coped with an often overwhelming situation. Panic attacks can be exhausting so a bit of rest time can also be useful.
Avoidance is part of the ‘fight or flight’ response. The diagram below shows how our short term and long term reaction to trauma can manifest.
Anxiety sometimes leads to avoidance of people, places, events, going out, talking about certain issues that might trigger a trauma response, not watching certain programmes or films. In some cases, this can be protective; for example, avoiding films where women are abused or hurt can protect survivors from images that are distressing, but avoidance can also be isolating. Using safe support spaces may be a good first step in tackling that avoidance and reducing the isolation that can come with it.
The British Red Cross have a really useful section on their website that offers guidance on grounding and managing anxiety. This can be accessed on https://www.redcross.org.uk/get-help/get-help-with-loneliness/wellbeing-support/understanding-dealing-anxiety