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    Paradoxical anxiety: why are you stressing yourself trying to relax?

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    Robert Maurer
    @robertmaurer
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    Nobody wants to feel anxious. The tension, anguish, and stress that accompany anxiety are not good travel companions. Therefore, it is understandable that we try to combat anxiety by all means at our disposal. However, sometimes treatments and strategies to promote relaxation have counterproductive results in some people and end up triggering paradoxical anxiety.

    What is paradoxical anxiety?

    Paradoxical anxiety is an adverse reaction to the expected effect of a treatment specifically designed to reduce anxiety. It therefore involves worsening anxiety after administering an anxiolytic or performing a relaxation technique with symptoms ranging from emotional lability and agitation to mental confusion, tachycardia and tachypnea.



    There are some medications, such as citalopram which is used to treat early depressive episodes and panic disorders, which increase anxiety symptoms at the start of treatment. It is a paradoxical reaction that usually disappears after two weeks of continuous treatment, which is why it is advisable to start with low doses to reduce the possibility of the anxious effect.

    However, paradoxical anxiety is not just a reaction to anxiolytics. A study conducted at Alliant International University, for example, found that 30,8% of the group of people who suffered from anxiety and had undergone a progressive relaxation session and 53,8% of those who did meditation reciting mantras, he reported an increase in tension due to the relaxation session.

    Another study developed at the University of Virginia revealed that intentional relaxation in situations of high mental load, stress and anxiety can produce an increase in skin conductance. Skin conductance is a fairly reliable measure of the level of stress and anxiety since when we are tense and distressed, a constriction of the skin blood vessels occurs which temporarily changes the physical structure of the skin and the excitation of the Central Nervous System also triggers sweating. , which varies the conductance. In fact, the more tense people who tried to relax showed a higher conductance index than those who were stressed, but did not try to eliminate the anxiety.



    What are the causes of paradoxical anxiety?

    The pathophysiological process behind paradoxical anxiety is unclear. It has been speculated that some anxiety medications, such as benzodiazepines, may contribute to the loss of cortical containment in some people by facilitating a state of arousal. In other words, they can cause the cortical areas to lose control, which would lead to anxiety. It is also known that there is some genetic susceptibility to this type of drug, which can increase the chances of these people experiencing a paradoxical reaction.

    In the case of relaxation techniques, such as diaphragmatic breathing, mindfulness or muscle relaxation, paradoxical anxiety is due to a psychological response. In fact, it's called "relaxation-induced anxiety".

    A study conducted at Pennsylvania State University found that, for some people, relaxation conflicts with the strategy they use to reduce the impact of negative events: worry continues. In practice, they found that people with generalized anxiety disorder were more sensitive to extreme emotional changes and tended to feel more anxious while practicing relaxation techniques.

    In 2011, psychologist Michelle G. Newman developed the "contrast avoidance" theory that people can intentionally become anxious as a coping strategy to avoid the emotional contrast that could produce an adverse event.

    In practice, people with a tendency to anxiety use worry to avoid the experience of a negative emotional contrast. These people develop a strong aversion and extreme sensitivity to negative emotional contrasts, so that in order not to be vulnerable to these conflicting experiences, they prefer to remain worried, stressed or anxious rather than being relaxed and calm. This way, if something negative happens, the emotional impact will be less and if something positive happens they will be happier.



    In essence, these people "pay in advance" by worrying about what might happen. They always think of the worst so that adversity does not take them by surprise. I am always on the defensive, in an attitude of survival.

    On the other hand, if they are completely relaxed they feel more vulnerable and less in control. That is why they cling to their worries, so that relaxation techniques are seen as a threat to the defensive balance. This is why they end up experiencing relaxation-induced anxiety.

    How to cope with relaxation-induced anxiety?

    If you experience paradoxical anxiety, the conclusion isn't that you shouldn't try to relax. In fact, the people who find it harder to relax and those most vulnerable to anxiety are the ones who most need to disconnect and find peace of mind.


    We all know people who find it difficult to lie on the beach, sit down to read or just do nothing, relax. But contrast avoidance is not an adaptive coping strategy, it condemns you to live permanently in discomfort and anxiety.

    People who don't know how to stay quiet could actually benefit from downtime or doing nothing. They may feel anxious at the prospect of relaxing, but the truth is, it's healthy to allow yourself to let your guard down and relax. They may experience paradoxical anxiety at first, but if they continue they will find that they can relax and even enjoy the experience. This way they will realize that there is another way to live.

    People with an aversion to relaxation should follow exposure therapy, which means gradually exposing themselves to situations that make them feel calm, so that the transition is easier and they can understand that they don't need to be on the defensive all the time. , with emotional armor to protect themselves from potential threats.


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