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Section 2
Levels of Anxiety

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In the last section, we discussed the three basic manifestations of anxiety, which were adaptive anxiety, unadaptive anxiety, and agoraphobia. 

Have you found, like I, that each client experiences anxiety in different levels of intensity? Some start at a high level of anxiety which slowly decreases over a few hours. Other clients’ anxiety, however, shoots up in intensity in a very short period of time.

In this section, we will examine three gradations, or successive stages, of anxiety intensity. These three gradations are spontaneous anxiety; situational anxiety; and anticipatory anxiety.

Three Stages of Anxiety Intensity

♦ Stage # 1 - Spontaneous Anxiety
The first level of intensity is spontaneous anxiety also known as panic, depending on the magnitude. In this type of anxiety, the client experiences a great deal of emotions, and such symptoms as rapid heartbeat, sweating, and trembling become more noticeable, severe, and less controllable. Also, spontaneous anxiety begins at a high level of anxiety and slowly decreases over several minutes to an hour.

One client, Stan, suffered from spontaneous anxiety or panic. Stan described the feeling as "overwhelming."  He stated, "I can’t ever remember being as frightened." Stan had been washing up before bed when it happened. All of a sudden, he felt engulfed by a feeling of dread and impending doom. The sudden rush of anxiety Stan described as "waves that would not stop beating against the shore." As you can see from the suddenness of the panic, Stan was suffering from spontaneous anxiety. Think of your anxious client. Does he or she experience unpredictable waves of anxiety? 

♦ Technique:  Stop and Relax
To help Stan with his panic, I asked him to try the "Stop and Relax" technique. I told Stan that when he began to feel the emotions of panic becoming overwhelming to try the following breathing exercise:

Throughout the section, I will be presenting many different breathing techniques that my panic disorder clients have found helpful in conjunction with therapy. When I give an exercise to a client, I generally record it onto a tape so that the client may have it whenever they wish and can play the tape while performing the exercise. You might consider this with some of your panic disorder clients as well.

♦ Stage # 2 - Situational Anxiety
The second gradation of intensity is known as situational anxiety or phobic anxiety. This is a kind of anxiety in which triggers are involved. In situational anxiety, a certain situation or event will slowly bring on the symptoms of anxiety. Unlike spontaneous anxiety, situational anxiety slowly increases in intensity and then quickly drops off. 

Also, the symptoms of situational anxiety are the same as spontaneous anxiety, except that phobic anxiety never reaches the intensity of spontaneous anxiety. An example of a trigger for situational anxiety would be public speaking. Many people experience this fear. In fact, it is one of the most common phobias. Lori, a marketing director at a company, stated, "I know that when people speak in public, they experience butterflies in their stomach, but how come my butterflies always feel like elephants?" 

When Lori said that, she was very much afraid of how bad she would feel when she had to get up and speak. Lori thought that all of her physical symptoms were danger signals. She stated that she thought her symptoms were warning signs that she should avoid any experience that would bring this on. 

♦ Stage # 3 - Anticipatory Anxiety
In addition to spontaneous and situational anxiety, the third level of anxiety intensity is anticipatory anxiety, or phobic panic. In this type, like situational anxiety, a trigger is again involved, except that the already existing fear of the trigger is so great that the client may feel almost the same intensity of emotions as those with spontaneous anxiety.

Anticipatory anxiety occurs when the client is dreading a certain event for which they already hold a pre-existing phobia. Slowly, the feelings of anxiety build until they hit the breaking point and the client nearly loses control of all faculties. After such a climax, the feelings quickly dissipate. Katie held a deep instilled fear of dogs since she was four. She would cross roads and would not visit friends who had dogs.  Katie said that once she hit that peak point, she would begin to cry and cower. 

In our first session together, I brought in a very small, non-threatening dog.  I patted the dog and encouraged Katie to follow suit. At first she was terrified, and backed away. But as her anxiety disappeared, she began to pet the dog. As you can see, to treat this type of simple phobia, gradual exposure to the trigger can reduce the feelings of anxiety associated with it. 

In this section, we discussed three gradations of anxiety intensity, which were spontaneous anxiety; situational anxiety; and anticipatory anxiety.

In the next section, we will examine three aspects to keep in mind when diagnosing clients, which are diagnostic differentiation; common panic disorder personality types; and panic disorder controlled by substance abuse.

- Swede, S., & Jaffe, S. S., M.D. (2000). The Panic Attack Recovery Book: Step-by-Step Techniques to Reduce Anxiety and Change Your Life—Natural, Drug-Free, Fast Results. New York, NY: Penguin Putnam.
Reviewed 2023

Peer-Reviewed Journal Article References:
Allan, N. P., Albanese, B. J., Judah, M. R., Gooch, C. V., & Schmidt, N. B. (2020). A multimethod investigation of the impact of attentional control on a brief intervention for anxiety and depression. Journal of Consulting and Clinical Psychology, 88(3), 212–225.

Barber, J. P., Milrod, B., Gallop, R., Solomonov, N., Rudden, M. G., McCarthy, K. S., & Chambless, D. L. (2020). Processes of therapeutic change: Results from the Cornell-Penn Study of Psychotherapies for Panic Disorder. Journal of Counseling Psychology, 67(2), 222–231.

Brydges, C. R., Liu-Ambrose, T., & Bielak, A. A. M. (2020). Using intraindividual variability as an indicator of cognitive improvement in a physical exercise intervention of older women with mild cognitive impairment. Neuropsychology, 34(8), 825–834.

Jacobson, N. C., & Newman, M. G. (2017). Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychological Bulletin, 143(11), 1155–1200. 

Naragon-Gainey, K., Prenoveau, J. M., Brown, T. A., & Zinbarg, R. E. (2016). A comparison and integration of structural models of depression and anxiety in a clinical sample: Support for and validation of the tri-level model. Journal of Abnormal Psychology, 125(7), 853–867. 

Rosnick, C. B., Wetherell, J. L., White, K. S., Andreescu, C., Dixon, D., & Lenze, E. J. (2016). Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 84(4), 345–352. 

QUESTION 2
What are three gradations of anxiety intensity? To select and enter your answer go to Test.

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