Be more Impala: dealing with anxiety

A casual flick through social or main stream media will leave the reader in no doubt the prevalence of mental illness is on the rise in the UK. It’s hard to avoid news and commentary programs on television that don’t frame stress and anxiety as part of the ‘permacrisis’ that seems to be integral part of everyday life. Indeed, a survey carried out by the NHS in 2014 revealed 1 in 6 people in the UK are experiencing a common mental health disorder, most commonly anxiety or depression. Now, NHS figures show this has risen to 1 in 4. 

The figures are alarming. Ironically stressful and depressing in fact, but they do require a certain amount of unpacking before they can be unquestioningly added to fuel the bonfire of worry engulfing the UK. In particular, questions about how anxiety is defined, about how it is experienced and about how it is treated both by health care professionals and addressed at a policy level by government should be addressed.  
 
The Oxford Dictionary of Psychology defines anxiety as a feeling of dysphoria (unease and dissatisfaction) together with symptoms of tension such as elevated heart rate, a tightening in the stomach and a dry mouth. This is a useful start, but it does little to explain the emotional impact and crippling dysfunction this can have on individuals and how it can make everyday life an insurmountable challenge for some.

 
How anxiety is experienced in the real world, and why it is a problem unique to humans is helpfully illuminated by Mark Williams, a Professor of Clinical Psychology at Oxford University. He asked an audience to imagine a scene from a wildlife documentary where a lion was circling a herd of gloriously oblivious impala. Gazing calmly, seemingly without a care in the world, when the impala become aware of the lion’s presence, they stop grazing and look up to locate the danger. As the lion charges, their natural ‘fight or flight’ instinct kicks in. Eyes widen, heart rate increases, muscles tense and the impala run flat out to escape unenviable prospect of being lion lunch. However, whether the lion is successful or not, it is only a matter of minutes before the impala resume their calm grazing. Seemingly oblivious to the recent attack and unconcerned about its inevitable reoccurrence.

​​Thankfully, most humans don’t have to deal with lion attacks but they do have to deal with attacks of different kinds all the time and, unlike the impala, have evolved a mind that is capable of remembering past traumas, projecting future ones and conjuring up the prospect of imagined ones, however fanciful, and adding them all to a complex social world. It seems humans don’t have the luxury of returning untroubled to peaceful grazing.  
  
This raises the question of whether anxiety, however unwelcome, is a natural and necessary state, an essential survival mechanism and something that should be accepted and managed as part of being human.

For those dealing with intrusive anxiety, a visit to the GP is often the first, and entirely sensible, point of call. Perhaps unsurprisingly, a doctor is likely to frame this as a pathological problem – an illness that needs to be treated and will respond by either.
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• Prescribing medication –The drug most commonly prescribed for anxiety is an antidepressant. The guidance used by doctors for diagnosing mental illnesses via symptoms described by patients, DSM5 now has 12 competing definitions for various types of anxiety and contains a list of symptoms open to interpretation. Psychoactive drugs alter brain chemistry to suppress symptoms rather than address causes and whilst they can be effective, challenges have been raised about their long term efficacy. 

 

• Recommending a talking therapy - Most commonly a type of Cognitive Behavioural Therapy (CBT). This aims to investigate the underlying thinking and feelings generated by anxiety and take practical steps to address any resulting unhelpful behaviours. Talking therapies for anxiety have been shown to be effective. However, questions have been raised about whether short course psychotherapy is really focused on making people economically productive by returning them to work rather than dealing with underlying problems

Importantly, the prescription of drugs, psychological therapy, or a combination of both, treat anxiety as a problem or deficiency centred in the individual. This frames the experience as a personal failing of biology or cognition and, by extension, something that is the responsibility of the individual to address, albeit with help.  

However, there is a growing recognition that humans are social animals and, unlike impala, live in a very complex social world. A study in evolutionary psychology indicated, when compared to other primates, a disproportionately large part of the brain has evolved to deal with negotiating our social structure, thinking about others, what others might think, what others might think about us and even what others might think about others. It’s perhaps unsurprising that, although our minds are adept at dealing with the social affairs of those we are intimate with, when faced with multiple social triggers, often delivered with urgency implicated in the bleeps and flashing lights by a treasured hand held device, we struggle to cope. We live in a world where it seems everything is after our immediate attention.

There is a body of evidence suggesting that poor mental health generally, and anxiety specifically, is influenced less by biology or cognition and far more by our social circumstances. Particularly relevant in a post Covid, cost of living crisis dominated world, studies have shown inequality, characterised by a growing gap between the ‘haves’ and the ‘have nots’, together with increasing individualism and materialism have significant negative impact on a sense of well-being and a healthy mental state.

The medicalisation of anxiety (and depression) also sidesteps a growing body of evidence showing that training and physical exercise is effective in relieving the intrusive symptoms of both. Simply, a daily 30 min walk outside can help but weight training and cardiovascular training is even better. However, drug companies don't make money by telling people to go for a walk. 

Arguably, against a background of the breakdown of the family and the erosion of trust in institutions, it is reasonable to question whether anxiety really is a problem that can be solved by medics, drugs and therapy or whether changes in public policy would be more effective. Whilst medical professionals should be the first port of call for those struggling with serious mental health problems, including anxiety at a debilitating level, it is inexcusable to ignore the evidence of a strong societal influence and the positive benefits of reconnecting with our environment through exercise. 

Rather than drugs and therapy, perhaps a more equal and accepting social landscape coupled with a daily walk would be more likely to support our return to peaceful grazing.  

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​Rich Smith is a psychology graduate and a British Cycling qualified Level 3 Road and TT coach supporting riders nationally and internationally. He is coach to the Great Britain Transplant Cycling team. He launched RideFast Coaching in 2015 to tell people how to ride a bike. Flush with meagre academic success, it seems he's now expanding his remit to tell people how to live their lives.