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Anxiety in the Body

Anxiety is on the rise with more and more people experiencing its symptoms in their bodies. This mind-body event goes way beyond these symptoms, paving way for countless other disorders and nervous states. Learn how to decode and manage anxiety using not just your mind but also your body.


"The mind and the body are like parallel universes. Anything that happens in the mental universe must leave tracks in the physical one." Deepak Chopra

The idea that mind influences body is not a novelty. In the early 20th century, German physician Johann Heinroth coined the term “psychosomatic” to describe physical symptoms that were believed to be caused by emotional or psychological factors. The word comes from the words "psyche" (in Greek “psykhe”), meaning "mind" or “soul”, and "soma" (in Greek “somatikos”), meaning "body".


The concept of psychosomatic illness gained popularity in the mid-20th century, particularly in the fields of psychiatry and psychology, as researchers began to recognize the important role that psychological and emotional factors play in physical health and illness.


In the present, different lines of research, like psychoneuroimmunology and psychoneuroendocrinology, explore the dynamics within this relationship. More and more tangibly, we understand how psychological stress can lead to lower immunity and imbalanced hormone levels.


On the other end of the spectrum, we have researchers focused on understanding how the body influences mental processes, like those in the field of embodied cognition. We’re not talking about the impact that injuries or illnesses can have in someone’s mental health, but rather “basic” processes that happen in our bodies on a daily basis and influence our minds, such as movement, tonus and posture. These notions will be of extreme importance as we navigate this mind-body event that is anxiety.


"The body is like a web, where everything is interconnected. Every part has a role to play, and everything affects everything else." Dr. Amy Myer

If we literally see the body as a web, we can’t ignore one very specific tissue that connects and keeps everything together. This tissue is often overlooked, yet it has a significant impact on both physical and mental health – the fascia.


Fascia is the connective tissue that covers every muscle, bone, nerve, and organ in the body. It's a continuous web that extends from the top of our heads to the tips of our toes, providing support and stability to our bodies.


While the fascia was initially viewed as an inert structure, recent scientific research has shown that it plays a crucial role in our overall health and wellness, including our mental health. In addition to providing support, the fascia also provides a means of communication between muscle and organ tissues and the nervous system.


American-born physiotherapist Stanley Rosenberg wrote and entire book explaining how the nervous system and the fascia play crucial roles in anxiety, depression and other mental health disorders. According to his writings, simple aspects can have a significant impact.


For instance, one scar can lead to an anxiety disorder. Once cut and back together, the cicatricial tissue will pull the fascia together, creating enough tension to influence all the fascia in the body. While small scars might not be enough to impact mental health, scars that result from surgeries can create or add to an anxiety disorder.


The main focus of Rosenberg’s work is to restore the healthy function of the autonomic nervous system. In his practice, he realized that his clients would respond better to his interventions once their nervous systems were regulated. He also realized that inadequate tone on one of a few nerves could leave someone stuck in a state of hypervigilance or shutdown.


So, by restoring balance in these nerves, he would reduce the physiological responses like anxiety, depression and others.


These are cranial nerves, which are the backbone of the parasympathetic nervous system. One of these nerves in particular, the now so popular vagus nerve, plays the greatest role in our parasympathetic function. We’ll dive deeper in the vagus on the next post, where we’ll explore the autonomic nervous system responses beyond “fight-or-flight” or “rest-and-digest”.


The point here is to understand that the body is equipped with nervous structures that can make us feel either activated, lethargic, or safe. Activation is from the domain of the sympathetic nervous system, the autonomic part that operates through spinal nerves and which tries to keep us alive at any cost. And this is exactly the process through which anxiety happens.


Anxiety is a complex emotion that derives from fear and generates a body response. While fear makes us vigilant, informing us that we should be ready for a possible threat, anxiety is what makes us actually ready.


As a physiological response, it’s very similar to stress, as it is governed by the sympathetic nervous system and occurs when processing danger. But differs from it, since stress occurs while facing an external threat, and anxiety doesn’t require the presence of such threat – rather, it’s about thinking of it or considering further consequences or negative scenarios related to it.


Observed as a bodily response, anxiety isn’t good or bad, it just serves its purpose of anticipating threats that can affects us. It’s when anticipation becomes disproportionate that we start seeing it as an anxiety disorder.


The distinct forms of anxiety disorders that exist differ in terms of the object of fear but they manifest physically in very similar ways. Taking two from the most common forms of these disorders, we have Generalized Anxiety Disorder – an excessive and persistent worry about certain life domains, such as work, with a central theme of losing control – and Social Anxiety Disorder – an extreme discomfort while facing social situations, with a central theme of being judged, humiliated or rejected.


Physically, both are accompanied by body tension, intense activation, and difficulty to relax or focus, even though the triggers and the cognitive narratives around each of them differ.


We’re talking about a survival mechanism that evolved along with our bodies during our evolutionary journey. It’s the somatic decision to face a threat or move away from it in its full power and complexity, engaging all our muscles, demanding more oxygen, and processing more calories. All the heart acceleration, the over-breathing, the tension, and the inebriating state of hyper-alertness, are about life saving nervous impulses, hormonal discharges, and fascia dialogues.


“According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime.” Dialogues in Clinical Neuroscience

There’s nothing new in knowing that anxiety is based on a hyper-alertness pattern. What’s new is the understanding that such pattern can result from inadequate function of nerves, fascia and muscle. Meaning, our bodies can get stuck in that mode due to physiological factors, even after the threat is gone.


And now this knowledge allows a more solid foundation for the postulations of last century’s somatic psychotherapists like Reich, Kelleman, and Lowen, which all defended that our bodies can store traumas and tensions that contribute to dysfunctional psychological patterns and, inclusively, physical illnesses.


We’re no longer viewing things separately. It’s no longer about the perception of a threat generating a survival response. Nor it’s about a metaphysical claim that trauma is stored somewhere in a mysterious part of the body and, later, might pop up sometimes when actioned by a trigger. We’re becoming aware of a constant feedback loop in the mind-body organism, in which a tense nervous system leads to actual feelings of unsafety that, in turn, makes us more susceptible to find situations more dangerous than they actually are. It’s about a loop that must be stopped by acting in the body and the mind simultaneously.


Contemporary names like Bessel van der Kolk, author of “The Body Keeps the Score”, and Gabor Mate, author of “When the Body Says No”, also highlight the importance of the body in recovering from mental health disorders. They describe how the body has an alarm system that goes off once it detects a threat, and how it affects every single organic system – from immunity to digestion, sexuality and so on.


Once the sirens sound, the adrenals start pumping adrenaline into the blood stream, the heart doubles its speed, muscles tense up, you know the rest.


These authors are focused on how a perceived threat activates the body, and how the body keeps memories that emerge later when triggered. And this goes way beyond the symptoms and the alarm system itself. It’s like memory is extended to the body tissues and remains there as a “note to self” regarding a response that is still going off. A sense of danger that was never fixed and that becomes registered in ourselves, both in our personal narratives and belief systems, as well as in muscle tone and posture of certain body areas, breathing pattern, circulating hormones, and intracellular communication.


Back in the time, successfully escaping from a predator meant we could relax. Then, our minds and bodies would, or would not, process sensations of safety – depending on what we’s do next. Better if we’d guide our breaths back to a slow pace, stretch key muscle areas and rest.


These days, escaping from the ongoing “micro” threats of our current lifestyles isn’t so obvious. We’re no longer running from predators but family or work-related situations, for instance, can keep us wired.


Hours, days, or weeks can go by, sustaining a feeling of danger, unease, or overwhelm – whether because the threat isn’t over or because there wasn’t an opportunity to properly relax. While this is being felt, the nervous system is sending information over through the fascia and ordering hormonal responses that sustain the activation state. It’s the best the body can do, since, in its perspective, it’s trying to protect us.


"The body is a remarkable self-regulating system, and by working with it instead of against it, we can tap into its incredible healing power." Stanley Rosenberg

Rosenberg’s work illustrated how the body and its states can act as triggers when they generate or maintain the response of anticipation, constantly. The inability to return to a sense of safety may leave the muscles in a state of tension, the digestive and other systems disengaged and activating hormones continuously being released.


Also, the perpetuation of this body state will inform the nervous system of an ongoing threat, contributing to the sensation of lack of safety. Thoughts emerge while body symptoms occur and, often, it’s hard to pinpoint which is the source of the activation.


The idea that processing the triggers cognitively will help reduce anxiety is a good one, as long as it doesn’t disregard the body. I believe that addressing both the mind and the body while therapeutically responding to anxiety is far more effective than acting on just one of the avenues. So let’s dive into the somatic expressions of anxiety to make sure we all recognize the signs, especially the less obvious ones, and find ways to get back into balance.


Face muscles, posture, and interaction

Cranial nerves responsible for the safety parasympathetic response (a.k.a. rest-and-digest) are switched off during stress and anxiety responses. For the sake of our survival, relaxation should not be an option until we’re safe. Also, the accumulated tension in muscles and fascia impairs the action of these nerves when they’re trying to get back online. Because these nerves control movement and function of our facial and postural muscles, it’s normal to find it hard to smile or respond empathetically using non-verbal cues, as well as to keep a correct posture when danger is being processed. This might or might not be a conscious process, and might last longer than the threat itself if there wasn’t a change to “shake off” the tension from the body.


Forward Head, Inward Chest, Back and Neck Pain, Headaches

The activation of the sympathetic spinal nerve chain (a.k.a. fight-or-flight) is what leads to all subsequent activation. As impulses travel along the spine, tension spreads over to prepare us for action. This creates neck and back rigidity, possibly resulting in headaches and muscle pain. Muscles also tense up when processing a threat for more specific reasons. Forward head can be simply the result of continuous muscle tension, but it can also be a result of the need to see closer, similarly to how the eyes get wide open to enhance perception during a fear-based response. Forward head also helps oral breathing, which might be necessary in extreme situations as a means of absorbing larger quantities of oxygen. Finally, slouching posture is also associated with protection of our frontal area, where we tend to be more sensitive and private. All the mentioned can escalate to neighbor areas such as the jaw and throat, creating long-lasting sensations of tension and tightness.


Chest and Diaphragm Discomfort

Heart-racing and fast-paced breathing were literally developed for fighting of flighting and aim for blood pumping and oxygen delivery. While breathing fast, we tend to use only the upper third of our chests, for quick gulps of oxygen. This also minimizes abdominal movement and blood flow to that area, which allows the body to channel all the energy to emergency responses and not to processes like digestion. The continuity of this mode of functioning will invariably lead to thoracic tension, with possible diaphragm stiffness and less mobility. Curiously, during stress responses, the esophagus usually shortens, pulling the stomach upwards, which can lead to further diaphragm discomfort as well as digestion issues and heartburn. If the stomach is pulled up to a point that its top passes through the hiatus (the area of the diaphragm through which the esophagus reaches the stomach), it’s normal to experience acid reflux and heartburn.


Digestive and Sexual Issues

Even though digestion and sexuality are related to survival, they’re not primary survival functions once under life threat. What the body does is to put “secondary” functions on hold, decreasing blood flow to those areas and the release of related hormones. While we’re processing danger, we’re less likely to have optimum levels of digestive enzymes and sexual hormones. For instance, with higher levels of cortisol, the enzyme aromatase converts testosterone in estradiol and androstenedione to estrone, in men.



Immunity

Our bodies see the fight of a threat as a whole process, meaning it will enhance immune cells to fight possible intruders. Cortisol is also anti-inflammatory, which combined with the other immune cells, with contribute to a short-term boost in our immunity. The inability to find safety and switch of stress or anxiety responses will lead to excessive energy consumptions and increased resistance to the mentioned cells, as well as the cortisol (similarly to how we can develop resistance to insulin). This means that, in the long term, we tend to experience a decrease in the efficacy of the immune response.



How to find balance?


While it might not be possible to live stress-free or keep anxiety away, it is possible to be conscious of our bodies and communicate with them. Since they’re always communicating with us, this should be rather simple. If we imagine a scale, where one plate is representing stress and the other is representing safety, we just need to add as much weight to the side of safety as we feel we have on the side of tension.


Literally, anything that leads to relaxation and playfulness is welcome, and this might differ from person to person. When it comes to more universal strategies, since all human bodies are equipped with identical nervous systems, there are simple exercises that can be done by everyone. In previous posts, I explored the potential healing benefits of breathing exercises as well as mindfulness practices. It’s my intention to explore the vagus nerve exercises in my next post, to stay tuned.


I also recommend combining psychotherapeutic work with other body-oriented approaches, such as physiotherapy and osteopathy. If possible, give preference to multidisciplinary work with the same team and enjoy the effectiveness of the results.


Finally, I must remind you that the healing process is slow and progressive, with frequent back and forth, in which the important thing is to become aware of yourself and develop tools that can be used autonomously.


"Healing is not a one-time event, but a lifelong process of self-discovery and growth. By embracing this process, we can create lasting change and find true wellbeing." Stanley Rosenberg


See this post on Instagram and visit my previous publications and illustrative content regarding the somatic approach:




References

  • Books

    • Keleman, S. (1992). Emotional Anatomy. Center Pr.

    • Lanius, U. F., Paulsen, S. L., & Corrigan, F. M. (2014). Neurobiology and Treatment of Traumatic Dissociation.

    • Mate, G. (2011). When the body says no: Understanding the stress-disease connection. John Wiley & Sons.

    • Roserberg, S. (2017). Accessing the Healing Power of the Vagus Nerve Self-Help Exercises for Anxiety, Depression, Trauma, and Autism. North Atlantic Books.

    • Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

  • Scientific Articles

    • Bandelow, B. & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327-335.

    • Michalak,J., Aranmolate, L., Bonn, A., Grandin, K., Schleip, R., Schmiedtke, J., Quassowsky, S., & Teismann, T. (2022). Myofascial Tissue and Depression. Cognitive Therapy and Research, 46, 560–572.

    • Poulsen, E. E., Mikkelsen, M. B., Michalak, J., Mennin, D., & O’Toole, M. S. (2022). Motor alterations in depression and anxiety disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 317(2), 373-387.


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