Anxiety Disorder: How Much Anxiety Is Normal?

Fear is her profession. Dr. Babette Renneberg is professor for clinical psychology and psychotherapy at the Free University of Berlin. Her research focus: anxiety disorders. They were among the most common mental disorders in Germany even before the Corona virus, but have become more topical since the pandemic.

BRIGITTE WOMAN: How do you experience this time as a psychotherapist?

Dr. Babette Renneberg: The subject of Corona keeps us all very busy – also due to the sometimes still intensive reporting. This type of crisis communication is absolutely necessary on a social level. On a personal level, however, it often fuels strong fears in many. We humans naturally tend to focus on threatening information; this applies to both fear of the disease itself and its possible consequences such as unemployment or economic decline. It can be said very clearly that the risk of developing Covid-19 is still very low.

Significantly lower than the probability of a fatal road accident.

Right. This is the problem when the rather calming statistics are pushed into the background by dramatic reporting. Then there is a greater risk that justified caution will turn into disproportionate panic. Therefore, people may be on a kind of alert for a longer period of time and ultimately even argue about toilet paper. In most cases, the symptoms of an infection are mild. It was the same for me, by the way.

When do you need therapeutic help with anxiety?

We differentiate between anxiety and anxiety disorders. Fear is not only normal, it is vital. It protects us from falling on steep slopes or other dangers and, yes, also from contamination. Fear only becomes medically and psychotherapeutically relevant when the person concerned experiences severe suffering and everyday life is clearly restricted by the fear.

Do you have an example of this?

Many people have a certain disgust or fear of spiders. It's not uncommon. However, if you are afraid of leaving the apartment, I would recommend that you seek professional help and, as a first step, talk to your family doctor or a psychotherapist about it. The rule here is: the faster, the better, so that the anxiety disorder does not spread. It is interesting, by the way, that spider-phobics actually immediately discover a spider when they enter a room – in contrast to people who have no problems with the animals. This could be proven in experiments. Our perception changes with our fears, we focus more on objects that are uncanny and uncontrollable for us – and unfortunately this is precisely why we find them more often. This in turn permanently increases the feeling of threat and fear.

And then?

Often followed by a strong physical reaction in fearful situations. Our brain ensures the release of stress hormones such as adrenaline, the knees become weak, or every muscle tenses in order to be able to escape. This can lead to a panic attack – and with it symptoms such as shortness of breath, rapid heartbeat, sweating, tremors, nausea and strong thoughts of fear such as: Now I'm dying! A relatively small impulse can turn into a big problem, and very quickly. It can go so far that you call the emergency doctor just because the heartbeat changes for a very banal reason.

What do you mean?

When I lie down, the heartbeat changes automatically, which we normally don't even realize. But if you have ever had problems with your heart, such as a heart attack, you may perceive this change differently. We speak of attribution, i.e. what we attribute to an object or a situation: one person associates a pounding heart with being in love, while the other may have a serious health problem. And the fearful reaction to it – there is definitely something with my heart again! – can cause such strong physical reactions.

So head cinema.

The interesting thing is that this cascade could theoretically be changed again via thoughts. Because that's exactly what set the reaction in motion.

They say, in theory …

Yes, because in practice it is difficult to regulate yourself in such a stressful situation. It is true that the thoughts led to this burden. Conversely, however, it is understandably difficult to realize that calming thoughts could lead to relief. Anyone who has already survived a serious illness or a stroke of fate may tend to activate the fear response more quickly than others in a crisis situation like Corona. Nevertheless, it cannot be generalized, because there are also people who become even more crisis-proof and less anxious as a result of such situations – according to the motto: I can do it now.

What helps against fear?

Empirical studies show that anxiety disorders respond particularly well to cognitive behavioral therapies, carried out by trained and licensed psychotherapists. Put simply, it is about becoming clear about your thoughts, attitudes and expectations and changing stressful thought patterns. Exposure, also known as exposure therapy, plays a major role. You work together with the person concerned to consciously expose yourself to the fearful situations – with the aim of overcoming the fear. To climb a tower if you are afraid of heights. The prerequisite for this is a good preparation of the treatment steps. The patient must understand very well how and why the treatment is carried out in this way.

But you can't get infected or go bankrupt under therapeutic supervision.

No. But it can be helpful to think through your worries. Step by step. What is your fear? That I get sick with the virus? The probability is there. Are you worried about dying from the virus? Nobody can rule that out 100 percent either. What then? Be calm and conscious of your fears and ask yourself at the end: is this fear helpful right now? Does it change something in the current situation? What is she doing to me Playing through this scenario can be calming, even without therapy. It's also about accepting that one hundred percent control is not possible.

When we face our fears, they become less, they wear out – right?

In fact, that's exactly what many experience. Fear is an exertion on the body. Our attention is raised, stress hormones are released, the level of tension is very high. Our organism cannot do this indefinitely. The willingness is exhausted, there is a kind of feedback. Then even panic attacks stop, for example. You can tell now that we've been living with the virus for a few months. The fear of becoming seriously ill or dying is reduced overall. I once experienced the most severe turbulence on an airplane. For many minutes I thought I was just being afraid. Then suddenly everything in me relaxed. This is a classic example. We refer to this moment as radical acceptance. When we understand: "No matter what I do, I can't change the situation", this feeling sets in and a certain relaxation.

What reactions do you experience from anxious patients after successful therapy?

Often there is great relief – and at the same time there is often deep regret about the restrictions they have accepted for a long time and what they have missed through their fear. Just think of people who rarely leave the house, avoid social contacts or have never traveled far because of their fear of flying. They often feel a great gain in freedom through regaining control over their lives.

Can fears that have been reduced flare up again?

Yes. We cannot fundamentally ban fears from our lives, precisely because they also have important functions. Those who were previously affected by severe fears are more susceptible.

Where does fear come from anyway?

Our level of tension varies greatly from person to person. We are brought into the world with biological equipment. Already recognizable in newborns: some scream a lot, others sleep. Our handling of fear is partly based on this temperament. At the same time, our experiences and the respective environment in which we live also play important roles – and our upbringing.

Do you mean helicopter parents?

Yes. Parents want to protect their children from danger, that's normal. Very anxious, overprotective parents could, however, deprive their offspring of learning important skills and independence. Children have to fall down or make mistakes, even if it hurts their parents too. But from this the children learn to deal with real dangers and with fear.

What can help us all better deal with fear?

We should keep in mind that our environment has become safer – instead of focusing on making everything even safer. Evaluating every little thing as really bad makes a realistic classification more and more difficult. Our social development is also paradoxical. We want our own security to be guaranteed more and more – without understanding that we have long been more secure than ever before. The crime rate is demonstrably falling. At the same time, people in Germany are arming themselves with alarm systems and a small gun license. In 1980 there were more than 13,000 road deaths in Germany, today around 3,000. That begs the question of why I need a tank-like SUV in Berlin.

Dr. Babette Renneberg is not only concerned with fear as a scientist: She still works as a psychotherapist, especially with patients who suffer from anxiety and personality disorders.

Reading against fear

"Fear is not for cowards: My exit from panic":

The journalist Susanne Kaloff reports very personally and cheerfully about her anxiety disorder and how she managed to get it out (240 pages, 16 euros, Fischer).

"Don't panic about fear! Understanding and defeating anxiety disorders":

The book will not appear until November 9th, but it is way ahead in terms of the competence of the authors Andreas Ströhle and Jens Plag: The two specialists in psychiatry and psychotherapy run the Anxiety Outpatient Clinic at the Berlin Charité (250 pages, 20 euros , Kailash).

"Fear, Panic and Worry":

On psychologische-coronahilfe.de (an initiative of the German Society for Psychology) there is the article with a lot of well-founded information and concrete tips on how to prevent emotional crises in the current situation.

Would you like to read more about the topic and exchange ideas with other women? Then take a look in the "Fears, Panic, Phobias Forum" of the BRIGITTE community past!

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