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Truly understand Anxiety and Fear

What is anxiety actually, and when does it become a problem? In this article, I explain the difference between functional fears, as nature intended them, and dysfunctional fears that trigger suffering and restrict our lives. We take a look at how an anxiety disorder develops and explore potential paths out of fear.

ANGST

Sebastian Görne

3/27/202614 min read

What is Anxiety and Fear

We all have an idea of what anxiety is and how it feels: our stomach turns, our heart beats faster and more intensely, our hands might get clammy, and our entire body goes into alarm mode. Of course, anxiety exists in many different forms and intensities, ranging from mild discomfort to a full-blown panic attack. But what is anxiety, and why do we experience it?

"Anxiety is a natural survival mechanism of our body designed to protect us from danger and ensure our survival.

Without this natural alarm system, humanity would have gone extinct long ago. If our ancestors had felt no fear in the face of lions, tigers, snakes, and other predators, they would have become daily meals for their environment—and anyone who ends up as a meal cannot reproduce, meaning I wouldn't be able to write this article today.

Therefore, our fear center—specifically the amygdala (almond complex) in our limbic system—is an essential survival mechanism that serves us in many aspects of life. It plays a crucial role, particularly in learning and distinguishing between what is dangerous for us and what is safe. When we sense danger, our amygdala becomes active and signals to our brain: "Pay attention, this is potentially dangerous."

This triggers the release of hormones such as adrenaline, which prepare us to either fight off flight—the so-called fight-or-flight response. This is a natural reaction intended to ensure our survival.

The increased activity of the amygdala also causes our brain to store the experience more strongly and intensely. In short, our brain assigns greater significance to the event: "This is important for our survival, better not forget it." This ensures that in a future situation similar to what we experienced, we are ready to protect ourselves even faster.

This also explains why moments in which we felt fear burn themselves much deeper into our memory: our brain interprets these events as far more important than others in order to secure our survival.

Thousands of years ago, in a world full of real threats to life and limb, this system made complete sense and ensured our survival as the human species.

Now, however, the world has changed dramatically, and very few of us are confronted with the same threats to life and limb as our ancestors. We live in cities, apartments, and houses, and we are not exposed to the threat of lions, bears, and wolves looking for a meal.

Our world and the dangers we face have evolved rapidly, but our biology could not adapt at the same speed. Our fear center is still in the process of adjusting to these new circumstances. And this is where problems arise: a fear center that is constantly scanning for danger, combined with an environment that no longer presents as much physical threat to our existence, yet overwhelms us with constant stimuli. This leads to frequent misinterpretations by our fear center.

When does fear become a problem?

Now, anxiety per se is not a bad thing or a problem. It is useful and necessary for us to identify dangers and safeguard our health.

It becomes difficult when anxiety spins out of control and things that objectively pose no threat to life, body, or soul are suddenly viewed as dangerous and avoided. This often leads to avoidance behavior and severe restrictions in our daily lives.

Under normal circumstances, fear and the activation of our fight-or-flight response serve to help us react quickly to danger. Through the release of stress hormones, we are then able to confront the threat or escape it. Once the danger has passed, our alarm system powers down again and returns to a state of homeostasis (inner balance).

It becomes problematic when this system becomes overactive and senses danger everywhere—even where there is none—or when the alarm system fails to return to homeostasis. Instead, it remains in a state of continuous activation, causing our body to suffer from elevated levels of stress hormones. Aside from the emotional impact, this constant state of stress can also have long-term physical consequences.

How does an anxiety disorder manifest?

Anxiety disorders can manifest in many different forms. The more well-known and common ones include fear of flying, spider phobia, fear of dogs, social anxiety, claustrophobia, and so on. These tend to be more specific and do not necessarily lead to major disruptions in daily life.

However, anxiety disorders can also cause individuals to experience extreme limitations in their everyday routines, sometimes leaving those affected unable to leave the house, thereby neglecting work, friends, and family. The attempt to avoid subjectively perceived threats can lead to complete isolation, where sufferers are no longer able to carry out their daily activities.

The Origins of Anxiety Disorders – Theoretical Models

Now let's take a look at the following explanatory models and approaches that can help us understand how normal fear transforms into an anxiety disorder:

Psychoanalytic Approach
Behavioral Models
Cognitive Models
Biological / Neurobiological Approaches

The Psychoanalytic Approach according to Sigmund Freud

To understand Sigmund Freud's explanatory model, we first need to understand Freud's structural model of the psyche (Instanzenmodell). Freud divided the human psyche into three distinct structural agents:

The Id (Das Es): This structure represents our unfiltered drives and desires—such as aggression, sexual urges and impulses, or the craving for food. You could say that this is where our most primitive instincts reside.
The Superego (Das Über-Ich): This represents our learned and internalized values, morals, rules, and norms acquired through upbringing and society. These act as our internal legal code and compass according to which we have learned to live our lives, believing these expectations must be met or that following them ensures everything will be fine. The Superego stands in direct competition and forms the polar opposite to the Id.
The Ego (Das Ich): This represents the mediator between the raw drives of the Id and the strict demands of the Superego. The Ego attempts a threefold balancing act between everyday reality, the urges of the Id, and the moral demands of the Superego. When successful, the Ego finds a way to satisfy all three actors. The Ego should serve as the central executive authority, establishing inner balance.

Now, this doesn't always work out. When the Ego fails and the balance between the Id and the Superego breaks down, the Ego initially reacts by attempting to push the unresolved conflict into the unconscious. To achieve this, the Ego employs so-called defense mechanisms.

Here is a list of the most well-known defense mechanisms:

Repression (Verdrängung): Unpleasant, threatening, or painful thoughts, desires, impulses, or memories are pushed out of conscious awareness and banished to the unconscious so they cannot trigger acute anxiety or shame.
Displacement (Verschiebung): An unconscious impulse or emotion (often aggression or fear) is redirected from the original, threatening, or unattainable object to a safer, more innocent substitute object.
Projection (Projektion): One's own unacceptable desires, tendencies, or hostile impulses—which one cannot or will not acknowledge in oneself—are unconsciously attributed to other people or the environment.
Reaction Formation (Reaktionsbildung): To ward off a forbidden, anxiety-provoking, or shameful impulse, the exact opposite behavior or attitude is adopted and exaggerated in consciousness to mask the true wish.
Rationalization (Rationalisierung): Seemingly plausible, logical, and morally acceptable reasons are retroactively invented for hurtful actions, unfulfilled desires, or irrational behaviors to avoid admitting the true (and emotionally painful) underlying reason.

In the case of anxiety disorders, displacement is particularly relevant. Here, the Ego fails to functionally satisfy or regulate the drives of the Id, resulting in a profound fear of these uncontrolled urges colliding with the Superego. Instead of confronting these internal conflicts, the anxiety is displaced onto an external object or situation. This substitute target can be actively avoided, granting the individual a deceptive sense of control—such as in spider phobias or a fear of driving. By avoiding these external triggers, sufferers temporarily spare themselves from confronting the underlying intrapsychic conflict.

However, this is merely avoidance and offers no genuine relief to the psyche. The conflict continues to simmer in the unconscious, constantly pushing toward the surface, which causes the anxiety to intensify and spread to other areas of life. This frequently results in severe life restrictions, can lead to social isolation from friends and family, and significantly impairs the individual's quality of life.

Behavioral Models

Here we have a few different explanatory approaches; the first one is classical conditioning. In classical conditioning, an unconditioned stimulus is paired with a neutral stimulus so that eventually, the once-neutral stimulus triggers the same reaction as the original stimulus.

An example of this would be if you were in a car accident and a specific song was playing on the radio during the crash. Afterward, simply hearing that song alone can trigger an emotional reaction.

In this case, the accident was the unconditioned stimulus and the song was the neutral stimulus. However, the song was paired with the accident stimulus and erroneously stored by our brain as part of the accident, so that our brain now thinks danger is imminent whenever it hears the song. Thus, a neutral stimulus was conditioned and became a potential trigger for anxiety. Another example would be if we have a panic attack (unconditioned response/reaction) in an elevator (neutral stimulus): from then on, the elevator becomes linked with the experience of the panic attack, causing the affected person to develop a fear of elevators henceforth.

Operant conditioning is another approach used to explain the intensification of fears. Based on our elevator example, operant conditioning can now explain how this fear solidifies and intensifies. After the initial panic attack in an elevator, the individual experiences a certain level of discomfort. The next time they are supposed to use the elevator, they feel an inner discomfort rising, their heart beats harder and faster, and the anxiety gradually increases. When the time comes to enter the elevator, they can no longer bear the anxiety and decide not to take the elevator, choosing the stairs instead. This leads to an immediate drop in anxiety, which the person perceives as pleasant—almost like a reward. They learn that avoiding the elevator feels good, and in the future, they are highly likely to avoid the elevator again, which leads to an intensification of the anxiety. Eventually, they might even experience discomfort simply from knowing there is an elevator in the building, and they begin avoiding buildings with elevators altogether because they have realized: "If I avoid the anxiety trigger, I don't have to feel any anxiety." In technical terminology, this is called negative reinforcement. In this context, "negative" means the removal of something; in our example, the removal of anxiety through avoidance acts as negative reinforcement—the negative stimulus of fear is taken away.

Observational Learning (Learning by Model)

Another behavioral approach is observational learning, and I think we can all relate to this idea. The learning-theory model assumes that we are shaped by our environment, and especially that our parents' upbringing has a major influence on our later behavior. Thus, anxious behavior can also be acquired through observation. For example, if our parents are excessively fearful—say, of dogs, people, or illnesses—we may adopt these fears. If our parents raise us with the conviction that other people are dangerous, it is very likely that we, too, will become suspicious of others without any specific reason.

The Cognitive Modell of Anxiety

The fundamental assumption in the cognitive model is that the situation itself does not trigger anxiety; rather, it is our thoughts about the situation—how we cognitively evaluate it. The core mechanisms are:

Catastrophizing (Katastrophenisierung): For example, harmless physical symptoms are misinterpreted: a racing heart when climbing stairs is reinterpreted as a heart attack. A boss asking for a meeting means they are going to fire me, I won't be able to pay my rent, and I will become homeless.
Dysfunctional Core Beliefs (Dysfunktionale Grundannahmen): Deeply rooted convictions such as "The world is a dangerous place" or "I am completely helpless against things." We can also call this a fundamental pessimism in which the person approaches the world with a negative baseline attitude from the very beginning.

Attentional Bias / Selective Attention (Hypervigilance): Sufferers constantly scan their environment or their own body for potential threats. As a result, every normal bodily sensation or environmental cue is interpreted as confirmation of danger.

Biological & Neurobiological Approaches

Science shows us that individuals suffering from anxiety disorders do not only experience an altered emotional world—we also observe tangible physiological differences, whether triggered by the anxiety disorder itself or present as a genetic predisposition.

The primary focus here is on the brain, particularly the limbic system. Within this system sits the amygdala—the body's internal alarm system. The amygdala activates whenever we sense danger, controlling numerous hormonal processes throughout the body to prepare us to react to threats.

In people with anxiety disorders, this alarm system is hyperactive, constantly signaling that danger is imminent. This state of perpetual high alert causes sufferers to perceive threats where none exist. Furthermore, a hyperactive amygdala leads to chronically elevated levels of stress hormones, such as cortisol and adrenaline, which have far-reaching effects on physical health and severely impair our ability to relax. Simply put, human beings are not designed to live in a state of chronic fear—it causes profound physical and psychological harm.

Twin and family studies also demonstrate a genetic disposition (predisposition). While we do not inherit the anxiety disorder itself, we appear to inherit a heightened sensitivity in the alarm system—an amygdala inclined to detect danger more readily than in individuals without this predisposition. Consequently, people from families with a history of anxiety disorders exhibit a higher vulnerability to developing an anxiety disorder themselves.

Find new ways out of the Anxiety loop with the help of Therapy

The therapeutic approaches that I would like to present to you now are a logical consequence of how anxiety disorders develop or have developed. Depending on the explanatory model, there are also various therapeutic approaches.

The Psychoanalytical Approach to Healing Anxiety Disorders

From Symptom to Signal Anxiety: The therapist helps the patient understand what the internal system is actually warning against. The symptom (e.g., panic or phobia) is decoded to make the true underlying conflict visible—often revolving around early childhood conflicts concerning autonomy, attachment, or forbidden impulses.
Uncovering and Interpretation: Through free association, dreams, and the recognition of patterns, the patient approaches the core together with the therapist. The therapist offers interpretations that reflect back to how old defense mechanisms (such as repression or displacement) continue to operate unconsciously in the here and now, maintaining the anxiety.
Working Through (Durcharbeiten): A singular insight is not enough. Within the therapeutic relationship (often palpable in transference), the conflict is repeatedly worked through. The patient learns no longer to defensively or frantically push away or avoid the anxiety, but rather to endure it, integrate it, and replace it with more mature coping mechanisms.

Behavioral and Cognitive Approaches

In behavioral therapy, we assume that anxiety is learned behavior—and everything that has been learned can also be unlearned. This means the therapist works together with the patient to learn new ways to confront and extinguish their fears. A well-known method of choice here is systematic desensitization, in which a step-by-step approach to the feared object or situation is developed. Instead of direct confrontation, a 10-step hierarchy is created where the intensity increases from step to step. For someone with a fear of flying, for example, this might look like this:

Looking through an aviation magazine.
Planning a flight trip.
Visualizing the flight journey (in sensu, describing a process where the patient mentally places themselves in the situation).
Booking a flight.
Visiting an airport.
Sitting inside an airplane (rather a small sports plane than a commercial airliner).
Starting the engine of the aircraft while sitting inside.
Driving up and down the runway in the plane without taking off.
A 10-minute flight.
Finally, undertaking a full flight journey—for example, from Hamburg to Munich, instead of jumping straight into a 12-hour flight.

Of course, the example above is quite elaborate, but it is equally transferable to other fears such as a fear of dogs or spiders.

In contrast to systematic desensitization, with flooding, the patient is directly confronted with the worst-case scenario—skipping steps 1 through 9 and going straight to step 10. The patient must learn to endure the anxiety. Often, fear worsens because sufferers have unlearned how to tolerate anxiety and have chosen avoidance instead. Now, the patient must relearn that anxiety is merely an emotion and that it will recede if we endure it long enough. For this purpose, the patient is directly exposed to the anxiety-triggering object and must remain in the situation until they reach the peak of their anxiety and overcome it. It is essential that the patient experiences firsthand that anxiety subsides on its own even without avoidance. In short, we train the muscle of enduring our anxiety.

Ultimately, all behavioral therapy approaches aim for the patient to learn to endure their anxiety and realize that the anxiety will not kill them. Flooding has shown the best results, but patient willingness to participate is generally lower than with systematic desensitization. Nowadays, there is a wide variety of confrontation methods to help anxiety patients; an interesting newer method is the use of Virtual Reality (VR) to guide patients toward their fears, which has also yielded good results.

Cognitive Therapy

As I mentioned earlier, cognitive therapy assumes that it is not the situation itself that triggers anxiety, but rather our thoughts about that situation and its potential consequences. Therefore, cognitive therapy focuses precisely on this: restructuring and changing those thoughts. A prominent name here is Albert Ellis and his ABC(DE) Model. The model describes how our thoughts translate into emotional and behavioral consequences:

A (Activating Event): The triggering event (e.g., heart palpitations when climbing stairs or the announcement of a presentation).
B (Belief System): The evaluation or internal belief (e.g., "Oh no, I'm having a heart attack!" or "I'm going to humiliate myself and everyone will laugh!").
C (Consequence): The consequence—these are the feelings (panic, fear of death) and behavior (avoidance, flight).
D (Disputation): The therapeutic lever—the active examination, questioning, and challenging of these irrational thoughts ("Is it really a catastrophe if I'm nervous? Is there actual evidence for this thought?").
E (Effect): The new effect—by replacing dysfunctional thoughts, a healthier, milder emotional reaction emerges.

Cognitive Distortions (Thinking Traps) in Anxiety

In anxiety disorders, typical cognitive misinterpretations often run in the background. The therapist helps the patient unmask these "thinking traps":

Catastrophizing: Expecting the absolute worst-case scenario ("The plane is definitely going to crash, and I am going to die").
Overgeneralization: Turning a single negative experience into an absolute rule for the future ("I was bitten by a dog once, which means all dogs are dangerous").
Dichotomous Thinking (Black-and-White Thinking): Seeing only perfection or total loss of control ("If I am not perfect, I will fail and be rejected").

The goal here is to expose and question these distorted thought patterns and core assumptions. Patients must realize for themselves that their thoughts and conclusions are irrational and sometimes nonsensical. This helps them reduce the intensity of their thoughts and the heavy burden they carry. Sufferers realize that they can influence their thoughts and thereby regain more control over their anxiety.

Within cognitive therapy, there is a wide variety of methods to treat not only anxiety disorders but other conditions as well. In general, however, they all share one thing in common: when we change our thoughts and our perspective, our life changes as well.

Since covering everything in depth would exceed the scope of this blog, I have focused on the most important points and will delve into them in more detail in separate blog posts. So, if this topic interests you, keep your eyes open for my upcoming posts on the subject!

I hope the information above has helped you better understand anxiety as such. Thank you for making it this far, and I look forward to welcoming you back to my next blog for more insights into mental health and psychology.

Thank you for your attention and time, and until next time.