Man staring anxiously into the distanceAnxiety is a mental health condition, so it may seem logical to assume it primarily involves mental or emotional symptoms, not physical ones. But anxiety often also involves somatic symptoms, or symptoms felt in the body. In fact, some people may experience more physical symptoms than emotional ones.

Anyone who’s ever felt nervous can likely name many common physical symptoms, including:

But people living with chronic anxiety issues, including panic, phobias, general anxiety, or social anxiety, may experience more persistent symptoms, even when they don’t have any reason to feel nervous.

These symptoms can resemble those of serious health conditions, and some people may not recognize the nature of their distress. They may worry instead they have heart trouble, chronic migraines, or other health issues. Accordingly, these physical symptoms may not only cause immediate distress, they also often contribute to long-term confusion and stress around the true cause of symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Seven Physical Symptoms of Anxiety

Anxiety can cause plenty of physical complaints, so people living with anxiety could notice the following physical signs, in addition to mental health symptoms.

1. Anxiety and dizziness

Dizziness often arises as a symptom of anxiety. You might feel:

The relationship between anxiety and dizziness can go both ways, creating a feedback loop. People who worry about losing their balance, falling, or losing control in a public place may become anxious whenever they feel dizzy, and one symptom may worsen the other.

Research from the Academy of Neurologic Physical Therapy suggests this happens when the vestibular system, which helps regulate sensations of movement in your environment and the position of your body, interacts with the limbic system, which helps regulate emotional experiences.

These fears can lead many to cope by avoiding activities likely to cause one or both symptoms, including physical activity or experiences likely to provoke anxiety or stress. This can have a negative impact on quality of life over time.

2. Anxiety and chest pain

Chest pain is one anxiety symptom that often causes alarm, especially when pain accompanies a rapid increase in heart rate and shortness of breath. These symptoms, of course, can also suggest a heart attack, so many people who experience chest pain worry their symptoms are life-threatening. When seeking emergency medical care, they may feel frustrated and distressed when there’s no medical explanation for their pain and heart palpitations.

But according to one study of 151 patients reporting chest pain, 59 percent had symptoms of anxiety. Research from 2006 supports the finding that people who seek emergency care for chest pain often have anxiety rather than a cardiac condition. Panic attacks, in particular, may share many similarities with an oncoming heart attack.

Someone having a heart attack, however, will most likely experience a squeezing pain that may radiate toward the jaw or left arm. Women often notice pain in their upper back or shoulders.

3. Anxiety and headaches

Experts have linked anxiety to both tension headaches and migraines. Headaches can develop as a symptom of anxiety for many reasons, including the following:

4. Anxiety and digestive issues

Persistent gastrointestinal distress often occurs as a physical symptom of anxiety. Medical research suggests this happens because of the connection between the brain and the gut. Nerves shared by the gut and the brain can interact with each other and have a negative impact on normal bodily processes.

Most people have experienced stomach “butterflies” or nausea when nervous or worried about something. But people living with chronic anxiety might notice more serious issues, such as:

Worries about experiencing things like vomiting or diarrhea in public can contribute to increased anxiety and emotional distress. Long-term GI distress can even make it difficult for some people to function as they usually would, which can lead to significant negative consequences for their quality of life.

5. Anxiety and breathing difficulties

Many people experience breathing problems when feeling anxious. Breathing troubles can range from hyperventilation, or very rapid breathing, to sensations of choking or feeling unable to draw a breath.

These symptoms don’t typically persist over time. They generally happen whenever a situation becomes tense or involves some fear or nervousness. Panic attacks often involve choking sensations, and it’s not uncommon to feel as if you can’t breathe. These feelings can be very frightening, and they often worsen anxiety’s emotional symptoms.

6. Anxiety and numbness

Numbness or tingling can also occur as a physical sign of anxiety. People with anxiety tend to experience this sensation, often described as pins and needles, in the hands, arms, legs, or feet.

Experts believe it happens in response to bodily arousal. Anxiety symptoms develop when the body feels threatened. In response to this perceived threat, the body redirects its resources, like blood, away from the extremities and to the more essential organs, such as the heart.

Hyperventilation can also contribute to numbness and tingling. When you hyperventilate, you end up with an excess of oxygen in your blood. This excess of oxygen means the body doesn’t have enough carbon dioxide to maintain typical processes. As a result, blood vessels constrict, and blood doesn’t flow to areas the body considers less essential, like hands and feet. Other symptoms, including head pain, increased heart rate, and dizziness can also happen in response to this lack of carbon dioxide.

7. Anxiety and chronic pain

There’s plenty of scientific evidence supporting the connection between chronic pain and anxiety.

Results of one study from 2013 found that, among 250 people living with chronic pain, 45 percent of them also had symptoms of at least one type of anxiety. The chronic pain patients who also had anxiety tended to experience greater pain and lower quality of life than those who did not have anxiety symptoms.

People with both chronic pain and anxiety often have a lower tolerance for pain and become trapped in a distressing cycle of symptoms.

People constantly in pain may:

Long-term chronic pain has also been linked to depression. It’s not uncommon for people living with anxiety and chronic pain to also have symptoms of depression.

Long Term Effects of Anxiety

Anxiety symptoms develop because the body mistakenly believes it’s about to face a serious threat. Physical and emotional symptoms result from bodily changes known as the “fight-or-flight” response. Once the body engages in this mode, hormones enter the bloodstream at higher levels than usual, triggering those well-known symptoms of anxiety.

So, although anxiety serves an important purpose—to prepare the body to face threats in the environment—problems can develop when anxiety sends the body into fight-or-flight mode too often or the body remains in fight-or-flight mode for a long period of time, which can happen when you have trouble coping with anxiety symptoms.

Medical research has found evidence to suggest links between long-term anxiety and the following conditions:

To sum up, people with anxiety, especially untreated anxiety, don’t only experience immediate physical and emotional symptoms of anxiety. They may also see a decline in overall health over time.

Can Therapy Help with the Physical Effects of Anxiety?

Just as therapy can help address the emotional impact of anxiety, it can also help people manage physical symptoms. Addressing anxiety causes and triggers will generally lead to improvement of all symptoms, physical or mental.

People who experience physical symptoms of anxiety will typically work with a therapist who helps them identify and address possible causes or triggers of anxiety. Specific types of therapy, including cognitive behavioral therapy (CBT) or exposure therapy, can help people learn to address anxiety in the moment and learn potential methods of reducing anxiety in daily life.

But therapists can also offer guidance on specific ways to address physical symptoms. These might include:

Because many physical signs of anxiety do resemble symptoms of serious health conditions, it’s always wise (and highly recommended) to talk to a doctor about any concerning physical symptoms, especially if you have any doubt about what’s causing the symptom.

This is particularly important with chest pain. Since chest pain occurs during heart attacks as well as panic attacks, it’s often best to talk to a medical professional even when you feel certain anxiety has caused the pain. Once they’ve ruled out a heart attack or similar issues, talking to a therapist can be a helpful next step.

Find a compassionate, skilled therapist at GoodTherapy today.

References:

  1. Anxiety and physical illness. (2018, May 9). Harvard Women’s Health Watch. Retrieved from https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness
  2. Calm your anxious heart. (2019, October 1). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/calm-your-anxious-heart
  3. Chronic pain. (2016). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain
  4. Chronic pain sufferers likely to have anxiety. (2013, May 8). Health Behavior News Service. Retrieved from https://www.sciencedaily.com/releases/2013/05/130508213112.htm
  5. Demiryoguran, N. S., Karcioglu, O., Topacoglu, H., Kiyan, S., Ozbay, D., Onur, E., Korkmaz, T., & Demir, O. F. (2006). Anxiety disorder in patients with non-specific chest pain in the emergency setting. Emergency Medicine Journal, 23(2), 99–102. doi: 10.1136/emj.2005.025163
  6. Goodman, K. (n.d.). How to calm an anxious stomach: The gut-brain connection. Anxiety and Depression Association of America. Retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/how-calm-anxious-stomach-brain-gut-connection
  7. Komaroff, A. L. (n.d.). The gut-brain connection. Healthbeat. Retrieved from https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection
  8. Marksberry, K. (2012, August 10). Take a deep breath. The American Institute of Stress. Retrieved from https://www.stress.org/take-a-deep-breath
  9. Morris, L. O. (2015). Dizziness related to anxiety and stress. Retrieved from http://neuropt.org/docs/default-source/vsig-english-pt-fact-sheets/anxiety-and-stress-dizziness4ca035a5390366a68a96ff00001fc240.pdf?sfvrsn=80a35343_0
  10. Peres, M., Mercante, J., Tobo, P. R., Kamei, H., & Bigal, M. E. (2017). Anxiety and depression symptoms and migraine: A symptom-based approach research. The Journal of Headache and Pain, 18(1), 37. doi: 10.1186/s10194-017-0742-1
  11. Rajagopalan, A., Jinu, K. V., Sailesh, K. S., Mishra, S., Reddy, U. K., & Mukkadan, J. K. (2017). Understanding the links between vestibular and limbic systems regulating emotions. Journal of Natural Science, Biology, and Medicine, 8(1), 11–15. doi: 10.4103/0976-9668.198350
  12. Raymond, V. (2018, February 23). Is your chest pain a heart attack or anxiety? Right as Rain by UW Medicine. Retrieved from https://rightasrain.uwmedicine.org/well/health/your-chest-pain-heart-attack-or-anxiety
  13. Schwarz, J., Prashad, A., & Winchester, D. E. (2015). Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients. Critical Pathways in Cardiology, 14(1), 44–47. doi: 10.1097/HPC.0000000000000038
  14. Woo, A. K. (2010). Depression and anxiety in pain. British Journal of Pain, 4(1), 8–12. doi: 10.1177/204946371000400103
  15. Yoder, W. M. (2018, October 27). Anxiety and numbness—A typical reaction. Calm Clinic. Retrieved from https://www.calmclinic.com/anxiety/symptoms/numbness
  16. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018, September 7). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353. doi: 10.3389/fnhum.2018.00353

Blurred view of elderly woman with a migraineMigraine headaches are one of the most common chronic conditions worldwide. Depending on the study, chronic migraines affect around 1 in 10 people, with twice as many sufferers being female.

Migraine headaches are disabling and cause significant loss of productivity and quality of life. Once they strike, a migraine can last anywhere between 4 and 72 hours. In addition to substantially reducing quality of life, frequent migraines can place one’s job at risk and prevent daily functioning.

Currently, the causes of migraine headaches are not well understood. Genetics are thought to play a role as well as environmental effects and changes in the way the brain interacts with the trigeminal nerve, a pain pathway.

Maladaptive Response to Stress?

It may be that migraine headaches are a result of the brain’s maladaptive response to stress. Researchers have found that when a migraine is triggered, the body’s responses (pain, increases in stress hormones, nausea, and vomiting) are in excess of what is normal. Even during migraine-free periods, a migraine sufferer’s brain is more excitable in response to stimuli.

If we understand how the brain operates on a neural level, we know that much of what is going on inside the brain is inhibitory. It is not optimal to have cascades of neurochemicals circulating through the brain. Overexcitability in the brain reduces the effectiveness of the calming mechanisms in the brain and increase pain sensitivity. What this means is the brain’s response to stimuli between attacks is heightened in an abnormal way.

We know the experience of stress is a significant factor in migraines. Work stress and home stress contribute to the likelihood of a migraine episode.

Childhood Trauma and Headaches

We know that too much stress can change the brain and its reactivity to one’s inner environment, or thoughts, and one’s outer environment, or lights, sounds, and other stimuli. Adults who were exposed to ongoing stress or trauma while growing up often have an impaired ability to calm themselves both mentally and physiologically in response to stress.

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress.

When we look at migraine sufferers as a group, we see a connection between adverse childhood experiences (ACE) and migraine headaches. Examples of ACE are domestic violence, emotional neglect, emotional abuse, and sexual abuse.

Researchers have also begun to investigate the connection between adverse childhood experiences and headaches. Individuals who suffer from migraine headaches are more than twice as likely to have experienced ACEs such as domestic violence while growing up.

How Trauma Results in Migraine: A Possible Mechanism

The connection between childhood stress and migraines is likely linked, at least in part, through the hypothalamic-pituitary-adrenal axis (HPA axis).

The HPA axis is a complex set of interactions among the pituitary gland and the adrenal glands. This hypothalamic-pituitary-adrenal axis controls and regulates bodily processes related to stress reactions. It is easily understood as the fight or flight response. When an individual senses a threat, the body reacts appropriately. Energy is taken away from the digestive and immune systems and is moved to the muscles in order to get ready to run or fight. The adrenal glands are stimulated, and heart-rate, blood pressure, and breathing rates increase. This is an energy-expending state and not optimal for growth or restorative activities.

It is well understood that repeated exposure to stress and trauma during childhood often results in an impaired ability to regulate the stress response over one’s lifetime. Childhood trauma affects the HPA axis. What this means is that over time, the HPA axis loses its ability to effectively control the stress response. During times of upset, the person has an intense reaction that lasts too long. The result is overexposure of the body and brain to high levels of the stress hormone, cortisol.

Migraines may be tied to the same neurochemical conditions associated with trauma, depression, and anxiety, with an overactive stress response (de-regulation of the HPA axis) playing a role. An investigation into certain neurochemicals in migraine sufferers found abnormal patterns of hypothalamic hormonal secretion, a condition also associated with trauma and child abuse.

What Can We Do to Help?

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress. Exercise and meditation have been shown to help calm the mind and body. These activities can begin to reverse the damage caused by an overactive HPA axis. Cognitive behavioral therapy (CBT) is also an effective tool for learning coping strategies and allows individuals to take greater control of reactions to daily life events that cause stress.

Research on migraines and childhood trauma is relatively new and is not well understood. However, if we understand that stress plays a role in migraines, taking steps to reduce stress may help reduce the frequency and duration of migraine episodes. At the very least, a reduction in stress can help us in every area of life, giving us more resilience to deal with a migraine once triggered.

If you think stress or trauma are a source of migraines for you, learning how to manage your stress response in therapy could help. Begin your search for a licensed and compassionate counselor here.

References:

  1. Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache: The Journal of Head and Face Pain, 50(9), 1473-1481. doi: 10.1111/j.1526-4610.2010.01756.x
  2. Brennenstuhl, S., & Fuller‐Thomson, E. (2015). The painful legacy of childhood violence: Migraine headaches among adult survivors of adverse childhood experiences. Headache: The Journal of Head and Face Pain, 55(7), 973-983. doi: 10.1111/head.12614
  3. Dumas, P. (2014). Calling in sick? Good conversations about migraine at work. Retrieved from https://migraineagain.com/calling-sick-good-conversations-about-migraine-work
  4. Exercise and stress: Get moving to manage stress. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469
  5. Maleki, N., Becerra, L., & Borsook, D. (2012). Migraine: Maladaptive brain responses to stress. Headache: The Journal of Head and Face Pain, 52(2), 102-106. doi: 10.1111/j.1526-4610.2012.02241.x
  6. Migraine. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
  7. Goadsby, P. J. (2009). Pathophysiology of migraine. Neurologic Clinics, 27(2), 335-360. doi: https://doi.org/10.1016/j.ncl.2008.11.012
  8. Lubin, E. (2018). Migraine headache FAQs. Retrieved from https://www.emedicinehealth.com/migraine_headache_faqs/article_em.htm
  9. Nelson, S. M., Cunningham, N. R., & Kashikar-Zuck, S. (2017). A conceptual framework for understanding the role of adverse childhood experiences in pediatric chronic pain. The Clinical Journal of Pain, 33(3), 264-270. doi: 10.1097/AJP.0000000000000397
  10. Peres, M. F. P., Sanchez del Rio, M., Seabra, M. L. V., Tufik, S., Abucham, J., Cipolla-Neto, J., Silberstein, S. D., & Zukerman, E. (2001). Hypothalamic involvement in chronic migraine. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 747-751. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737637/pdf/v071p00747.pdf
  11. Understanding the stress response. (2018). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
  12. Woldeamanuel, Y., & Cowan, R. (2015). Worldwide migraine epidemiology: Systematic review and meta-analysis of 302 community-based studies involving 6,216,995. Neurology, 86(16). Retrieved from http://n.neurology.org/content/86/16_Supplement/P6.100

A dark-haired person in button-down shirt leans head against wallWhen I educate medical health professionals about the complex links between emotional functioning and physical health, many express a fear that their patients will respond to a referral to therapy by saying, “So, are you saying this is all in my head?” I will try to provide a useful, realistic answer to this potentially thorny question.

Body, Mind, or Bodymind?

Modern neuroscience has helped us begin to see that the separation of body and mind is more a matter of grammatical convenience than scientific truth. Our nervous system, the network of cells that helps our brains connect with the rest of our organs, links our emotional processing center to every structure of our physical being. This has led some to use the term “bodymind” in recognition of the idea we gain nothing by continuing to arbitrarily separate mental life and physical life when they are so clearly interwoven (e.g., Keleman, 1989). When we think about ourselves as bodyminds, it begins to make sense that many physical symptoms are exacerbated or caused by emotional processes.

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How Emotions Become Physical Symptoms

Much developmental theory and research has helped demonstrate that experiences in our development, especially with our caregivers, shape our relationship to our emotions (e.g., Felitti, et al., 1998). We tend to treat our emotions similarly to how they were treated by others (Frederickson, 2013). As a result, those of us who had parents who responded to our emotions with anxiety, misattunement, or even punishment may develop anxiety about our own emotions. Many people experience anxiety when emotions are triggered by relationships and events in their day-to-day lives.

Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

Anxiety can manifest physically in the body in many ways. It can cause our skeletal muscles to tense, leading to pain and cramps. It can cause tension in the smooth muscles of the bowels, vascular system, urogenital system, and bronchi, leading to a variety of symptoms such as irritable bowel, hypertension, sudden urge to urinate or defecate, and difficulty breathing. Anxiety at very high levels can even cause changes in the flow of blood and oxygen to the brain, leading to difficulties thinking and perceiving the world, such as dizziness or blurry vision (Frederickson, 2013).

I point all this out to illustrate that anxiety triggered by the emotionally evocative events of our daily lives can produce a huge variety of physical symptoms. These symptoms can easily be, and often are, diagnosed and treated as if they are purely somatic, without considering the possibility emotional factors might be a major contributor. This can result in failed treatments and frustrated patients. See my other articles for more detailed information on the links between emotions and physical symptoms.

So, Is It All in Your Head?

The fact that emotional factors are contributing to your symptoms does not mean your symptoms are fake, as the notion of “all in your head” seems to suggest. Emotional factors create very real physical symptoms that are often mistaken for symptoms that have a purely medical origin. A recent study even showed that the brain of a person in emotional pain, when observed under fMRI, has a similar appearance to the brain of a person in physical pain (Kross, et al., 2011).

When we treat emotion-driven symptoms as if they are purely physical, and deny the component that is “in the head,” health care costs go up, symptoms persist or worsen, and frustration grows. Alternatively, evidence is beginning to show we can save time and health care costs by treating medically unexplained physical symptoms with psychotherapy (Abbass, et al., 2010).

Despite this evidence, it seems many medical practitioners fear their patients will be hurt by a referral to psychotherapy. There is some truth to this: many health care consumers are upset by the possibility their physical symptoms may have an emotional engine, and sometimes they exhaust all other diagnostic and treatment options before pursuing counseling. I hope the information presented here and in my other posts on somatization will help patients and practitioners to reap the benefits of a clearer understanding of the bodymind and the links between emotions and physical symptoms. Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

References:

  1. Abbass, A., Campbell, S., Hann, G., Lenzer, I., Tarzwell, R., & Maxwell, D. (2010). Cost savings of treatment of medically unexplained symptoms using intensive short-term dynamic psychotherapy by a hospital emergency department. Journal of the Academy of Medical Psychology, 1, 34-43.
  2. Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., & Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
  3. Frederickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves.
  4. Keleman, S. (1989). Your body speaks its mind. Berkeley, CA: Center Press.
  5. Kross, E., Berman, M.G., Mischel, W., Smith, E.E., & Wager, T.D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of the Sciences of the United States of America, 108, 6270-6275.

Man in business wear sits on bench, holding his headAnxiety can manifest in a variety of ways in the human body. It can make us tense in our large, voluntary muscles, activate the involuntary muscles of our internal organs, and even cause changes in our thinking, sensation, and perception. I want to focus here on one particular pattern of anxiety—anxiety in the smooth muscles—and the style of self-punitive thinking that is associated with it.

Smooth muscle anxiety is linked with a wide range of physical problems that are emotional in origin but can be mistaken as medical, which can lead to misspent health care dollars, lost time, and dashed hopes. It is my hope to help you identify manifestations of smooth muscle anxiety, learn about the thoughts linked with smooth muscle anxiety, and gain exposure to intensive short-term dynamic psychotherapy, a model that has demonstrated effectiveness in treating smooth muscle anxiety.

What Are the Smooth Muscles?

The smooth muscle systems of the body include the gastrointestinal system, the vascular system, the bronchi, and the urogenital system. There are also smooth muscles in our skin and eyes. The muscles are called smooth because they are made up of small, mushy, somewhat elastic cells. They differ from our skeletal muscles, which have long, striated fibers that are less flexible.

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When our smooth muscles are functioning as they should, they regulate our blood pressure, digestion, sexual and excretory functions, and breathing—functions that are essential to human survival. However, the smooth muscles are linked to the emotional center of the brain by the nervous system, and they can be activated in response to anxiety (Janig, 2003). So what happens when anxiety impacts the smooth muscles? What symptoms are linked with dysregulation of the smooth muscle systems?

Conditions Linked with Smooth Muscle Activation

The following conditions are associated with involuntary tensing of the different smooth muscle systems (Abbass, 2015):

Are Types of Thoughts Associated with Smooth Muscle Anxiety?

Clinical researchers, especially in the literature on intensive short-term dynamic psychotherapy, have noted an association between self-attacking thoughts and smooth muscle symptoms. While it is not clear whether the self-punitive thoughts can cause a stomachache or migraine, harsh thoughts and smooth muscle symptoms do seem to show up together.

In ISTDP, we use collaborative, exploratory questions to support people as they learn to reflect on the emotions that are making them anxious and triggering self-attack.

Here’s a smattering of thoughts I have heard lately that have shown up alongside smooth muscle symptoms in people I work with:

As these examples from my practice demonstrate, negative thoughts going against the self seem to co-occur with nausea and migraines. If you find that these kinds of thoughts co-occur with your IBS, migraine, or other physical symptoms, or seem to trigger them, you may be experiencing smooth muscle anxiety that has been diagnosed as a medical syndrome.

What Triggers Self-Attack and Smooth Muscle Anxiety?

Clinical research in ISTDP has demonstrated a link between complicated, mixed emotions toward loved ones, tendencies toward self-attacking thinking, and smooth muscle anxiety (Abbass, 2015). The theory of smooth muscle anxiety in ISTDP, which has been repeatedly supported by my experiences as a therapist as well as in case series data (Abbass, 2002) and empirical research (Creed, et al., 2003; Guthrie, et al., 1993), is that mixed emotions toward our attachment figures trigger anxiety. These mixed emotions are anxiety- and guilt-laden because it feels dangerous to have rage toward people whom we long to be close with and depend on.

Because of the anxiety and guilt associated with these feelings, the feelings are repressed—not thought about or reflected on. In fact, self-attacking thoughts seem to have the function of turning the anger toward the loved one back against the self with harsh thoughts and against the body with smooth muscle activation. The beloved person is protected from the anger, and the body and the self are punished. It is almost as though an unconscious, automatic part of the mind says, “How dare you have rage toward your beloved! You must redirect the rage toward yourself and your stomach to protect them!”

The Role of ISTDP in Healing

In ISTDP, we use collaborative, exploratory questions to support people as they learn to reflect on the emotions that are making them anxious and triggering self-attack. Increased reflective awareness of emotions seems to reduce the anxiety connected to them—if it can be thought about, talked about, and felt, it is no longer as scary or guilt-ridden. The complicated emotions we have about our loved ones are no longer unconscious (out of awareness) and frightening but can be seen and felt by the light of day and recognized for what they are—just feelings! People learn that they have been getting punished for emotions, which are mental, bodily events that are not inherently dangerous or wrong. Fear and guilt about emotions are replaced with thoughtfulness, openness, and comfort (Abbass, 2015).

If you are experiencing self-attacking thoughts and smooth muscle anxiety and are looking for systematic support in overcoming the automatic emotional factors that trigger your symptoms, ISTDP may be a useful treatment for you.

References:

  1. Abbass, A. (2002). Office based research in ISTDP: Data from the first 6 years of practice. Ad Hoc Bulletin of Short-term Dynamic Psychotherapy, 6, 5-14.
  2. Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.
  3. Creed, F., Fernandes, L., Guthrie, E., Palmer, S. Ratecliffed, J., & Read, N. (2003). The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology, 124, 303-317
  4. Guthrie, E., Creed, F., Dawson, D., & Tomenson, B. (1993). A randomized controlled trial of psychotherapy in patients with refractory Irritable Bowel Syndrome. British Journal of Psychiatry, 163, 315-321.
  5. Janig, W. (2003). The autonomic nervous system and its coordination by the brain. In Davidson, R. J., Scherer, K. R., & Goldsmith, H. H. (Eds.), Handbook of affective sciences (pp. 135-187). Oxford: Oxford University Press.
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