I recall vividly the first full-blown panic attack I ever witnessed. At the time I was 19 years old and did not know what was happening to my mother was a symptom of an underlying anxiety disorder. Like my mother in the throes of the debilitating attack, I thought she was about to die. The fear in my eyes further fuelled her anxiety, sending it spiralling out of control.
As she hyperventilated and turned bright red, then purple, I did my best to reassure her – and myself - that the ambulance would arrive soon.
In 2017, the Institute for Health Metrics and Evaluation, which studies global trends in health, estimated that anxiety disorders affected 284 million people around the world. Anxiety-related disorders have only recently overtaken depression as the world’s leading mental health issue and are now more commonly diagnosed, yet they remain the lesser-known cousins of depression and are talked about rather less.
That said, a recognition of the impact of anxiety has a long history going back centuries. In Victorian times, those stricken were said to have "a case of the vapours". Mrs Bennet in Jane Austen's Pride and Prejudice refers to her "nerves" when talking about her anxiety about getting her daughters married off. In Shakespearean times, a gloomy, pensive disposition was referred to as "melancholy", which was further articulated in Robert Burton's The Anatomy of Melancholy in the 1600s, while 10th century Iraqi physician Ishaq ibn Imran wrote in recognition of its symptoms: "Melancholy affects the soul through fear and sadness. Sadness is defined by the loss of what one loves; fear is the expectation of misfortune."
Today we describe anxiety disorders as a group of psychological problems characterised by excessive levels of fear, apprehension and worry. These disorders vary in their intensity, persistence and situational
triggers. For example, general anxiety typically involves low levels of chronic worry that never seem to subside. When one perceived threat fades, a new one arrives to take its place. Panic disorder, on the other hand, can involve acute feelings of extreme terror that seem to come from nowhere, leading to catastrophic misinterpretations such as: “I’m dying” or “I’m losing my mind”. Some sufferers start fearing the prospect of having panic attacks in public places, which can lead to another anxiety disorder, agoraphobia, or the fear of open spaces.
In addition to being the world’s most prevalent mental health issue, anxiety disorders are also on the rise, especially among young people. Earlier this year at a conference hosted by the Berkeley Institute for the Future of Young Americans, Richard Scheffler, professor of health economics and public policy, presented the findings of a decade-long study of anxiety disorders among US college students. It found the number of students being diagnosed or treated for anxiety disorders had doubled between 2008 and 2018, rising from 10 to 20 per cent. Prof Scheffler describes the situation as “a new epidemic”.
One of the critical factors associated with the presence of anxiety disorders in the study was digital device usage. Young adults who spent more than 20 hours on phones and computers per week were 53 per cent more likely to have experienced an anxiety disorder. Might our increasingly digital diet be fuelling these record levels of anxiety?
In his book Risk: The Science and Politics of Fear, author Dan Gardner talks about anxiety as one of the great paradoxes of our age. He argues that we are the healthiest, wealthiest and longest-living generation in the history of humanity, yet we are increasingly the most fearful and anxious. Objectively, on a day-to-day basis, we have a lot less to fear than our ancestors, who had to worry about basic survival, ever did, but we appear to suffer from anxiety disorders at a much higher rate.
Beyond anxiety, however, another thing we have in greater abundance than our ancestors is access to information. Our digital companions keep us up to speed, informing us of what’s going on in the world, from floods and famine to mass shootings. So, while our daily existence is far safer than it ever was, our impression of the world might be skewed by our newsfeeds and social media timeline. Giving excessive attention to bad-news stories and the accompanying social media chatter isn’t helpful if we’re already feeling slightly anxious.
Unsurprisingly, many of the most effective psychological therapies targeting anxiety disorders focus on training our attention. Even gimmicky-sounding interventions such as "caveman therapy" have brain-training at their heart. In the therapy, also known as hunter-gatherer mindfulness, one goal is to focus the mind on survival activities such as lighting fires without matches or building a shelter deep in the forest without modern tools. The nature of such activities leaves little room for the type of worry that can perpetuate and escalate into anxiety.
This type of therapy isn’t about burying one’s head in the sand and ignoring world affairs. Instead, it is about being better able to manage our attention, choosing where we place it and for how long.
When people say “don’t overthink it”, what they really mean is that we should dedicate our attention and mental resources elsewhere for a while. However, the ability to do that takes practice. Effective therapies encourage that practice.
If the rate of a disorder has doubled in just under a decade, then we need to try and find out why. The answer to this question might help us further improve existing psychological therapies or better still, figure out the most effective ways to prevent and reverse this troubling trend.
Justin Thomas is a professor of psychology at Zayed University