Anxiety Sensitivity: The Fear of Fear

From age 13 to about 30, this was how my life ran: feel something in my stomach, freak out that I might throw up AT ANY MOMENT and execute vomit prevention plan of praying, drinking a Coke, sucking mints and only eating “safe” foods like Saltines and rice — all the while vigilantly checking and monitoring my “symptoms” until they (inevitably) passed.

Since I was an extremely anxious kid, I always had stomach aches.

The only episodes I remember actually throwing up were a few horrible episodes of food poisoning. Eventually, I learned there was a name for what I had. It’s called emetophobia, or the fear of vomiting. I was scared of vomiting, but I was also scared of how sensations (namely anxiety) in my stomach felt. To my brain, feeling those butterflies meant danger, vomiting ahead. As I mention in my book Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way, it wasn’t until I became a mom that I got over this.

If you had asked me 30 years ago what my triggers were, the list would be quite long. Here’s the thing. The problem wasn’t any of those things. The real culprit was my fear of anxiety and how it felt, known as anxiety sensitivity.

So, what exactly is anxiety sensitivity?

The term anxiety sensitivity was coined in 1985 by 2 psychologists Drs. Reiss and McNally. Before that, people spoke of “fear of fear” or “first and second fear,” as Dr. Claire Weekes refers to it.

Steven Taylor defines anxiety sensitivity as “the fear of arousal-related bodily sensations, arising from beliefs about the meaning of the sensations (Reiss, 1999). People with high levels of anxiety sensitivity tend to believe that arousal-related bodily sensations are dangerous.”

When people with high anxiety sensitivity experience the sensations of anxiety, they interpret them as dangerous. This causes more sensations, creating a self-perpetuating loop.

When measured, concerns are organized into 3 main categories:

  1. Somatic
  2. Cognitive
  3. Social

In the somatic category, the usual suspects are the heart, lungs, breathing and sometimes stomach. A typical thought in this category is: When I get worked up, my heart races, and I’m convinced I’m going to stroke out.

For cognitive, it’s that the anxiety symptoms may lead to losing control, “going crazy,” dementia, ALS, etc. Clients will say, “Every time I panic, my mind goes blank. I swear I’m getting dementia, and this freaks me out since my grandmother had Alzheimer’s. It was awful.”

The third area of concern is social, where you fear anxiety symptoms because of the perceived judgment and evaluation from others. I’d DIE if people notice me sweating, blushing, trembling. Once you start this panic loop, more adrenaline gets released, which is further confirmation of your “symptoms.”

Claire Weekes, MD referred to this as second fear because we cannot control the presence of the first fear sensations. Those are automatic. How we respond to those sensations is under our control, however hard it is to believe sometimes.

Why is it important to work on getting better at being anxious?

If you’re like me, you’ve probably spent a good amount of time either trying to get rid of your anxiety, wishing you “didn’t have it,” or fearing when you’d experience it again. To no avail.

Not only is it impossible to get rid of anxiety, but even if you could, you wouldn’t want to. You need it if you’re in danger. When it misfires in situations that aren’t dangerous, you want to respond in ways that teach the brain safety. When we misinterpret these feelings as dangerous, we inadvertently intensify the feelings. We then use safety behaviors to prevent, avoid or mitigate the feelings. These can include only traveling with someone, not leaving a certain radius from home, not traveling on the highway, avoiding traffic, avoiding crowded places, taking mints, water, sucking candies, Xanax at all times, etc.

Life becomes smaller, as the anxiety and avoidance grows.

When someone has more anxiety sensitivity, they are at greater risk for developing an anxiety disorder.
We can stay stuck in our behaviors if we don’t change how we interact with the fear stimulus (trigger) AND the fear (feelings and sensations). No amount of talk and insight-oriented therapy will change your fear of your heart racing when you get anxious.

TL;DR: What do I do about anxiety sensitivity?

We can stay stuck in our behaviors if we don’t change how we interact with the fear stimulus (trigger) AND the fear (feelings and sensations).

Here are 4 ways we target anxiety sensitivity in treatment:

  1. Psychoeducation. Psychoeducation is really important to challenge anxiety’s overestimation of the threat. It’s a normal side effect of adrenaline that your legs will feel wobbly, but that doesn’t mean they can’t support you. Experiencing anxiety and panic may feel dangerous but that doesn’t mean it is dangerous. Discomfort, not danger.
  2. Interoceptive exposures. This type of exposure puts you in contact with the sensations you’ve been avoiding or fearing. It could be through exercise, spinning in a chair, breathing through a straw, looking at a strobe light, etc.
  3. In-vivo exposure. Putting yourself in situations where you’re exposed to the sensations you don’t like. This could be social situations, driving, leaving your house, etc.
  4. Mindfulness practices. This may not be a popular opinion, but I think there’s no better place to learn how to surf our internal experience than when we meditate. Doing it in low distress, low discomfort situations first is ideal to learn and practice the skill of surfing. Surfing an itch and surfing panic are the same skill, one is just MUCH MUCH more intense and uncomfortable.

Knowing that anxiety sensitivity exists can help us determine where we go from here. You can’t be recovered and still fearful of getting anxious. That’s like riding a bike with the brakes on. If you know this about yourself, you also know you’ll want to work on it in treatment.