Julia Gilchrist had felt anxiety since she was at bullied as a profoundly deaf schoolgirl.
After navigating her way through university, Julia expected to enter the workforce free of the feelings of isolation and nervousness that she had experienced when she was younger.
She thought employers would accommodate her hearing loss, but that was not how it unfolded.
"I felt on tenterhooks the whole time," she said.
Despite working hard in various communication roles, Julia felt her competence was constantly questioned and she needed to prove to her employer that she was worth investing in.
Anxiety reared its head again — affecting not only her mind, but also her body.
"You just second-guess yourself, you get physically anxious," she said.
She would go hot, then suddenly cold, shake, suffer nausea and sweat.
Clinical psychologist Jodie Lowinger — the founder of the Sydney Anxiety Clinic — said the physical sensations caused by anxiety were a natural fear response, rooted in our instinct to protect ourselves and our loved ones.
However, she said a severe physiological reaction could cause great suffering.
"It can be terrifying," she said.
The survival instinct
Faced with a work situation that she thought threatened her job, Julia would sometimes descend into anxiety that was so severe it could cause her to throw up.
She said she now understands why this could happen: It was her mind preparing her body to defend itself.
"It's a physiological response that enables your body to be ready to take on something hard," Julia said.
As Dr Lowinger explained, anxiety occurs when the brain responds to something as if it is life-threatening.
The physical sensations occur because the fear centre in the brain prepares the body to either fight off the threat or to run away from it, Dr Lowinger said.
It was about survival and those instincts worked well in a primitive setting, when humans had to evade threats in the wild, such as marauding tigers.
The physical experience was designed to be unpleasant, Dr Lowinger said, so that it caught our attention.
Ignoring it could be dangerous.
"Then we'd get gobbled up by the tiger," she said.
Priming the body to take on a challenge
When the fear response goes into overdrive in a modern context, however, it becomes problematic.
And often it is distressing.
Arpit Chawla has had bouts of anxiety for as long as he can remember.
In the past two years, they became so overpowering, it was unbearable.
"That's when I realised this is something I need to deal with," Arpit said.
He would feel pain in his chest, his arms and shoulders would shake, and he would stutter or slur his speech.
Anyone who experiences symptoms like these should see a medical practitioner, Dr Lowinger said.
A doctor will check for a serious health condition, such as heart disease. But, often, these symptoms are just the brain's fear centre at work, she added.
Stress hormones are released into the body after a fear response in the brain.
This happens in the amygdala, the part of the brain that regulates emotions like fear, pleasure and anger.
You might feel muscle tension or a rapid heartbeat, all designed to prime your muscles with oxygen so that you can fight or flee.
"Chest pain might be muscle tension, or it might be [a] rapid heart [beat]," Dr Lowinger said.
Hypervigilance
As for the slurred speech, that could be a particularly cruel trick that anxiety plays.
Arpit said he was still working out what would set him off, but he knew social situations were a big part of his triggers.
This can be difficult to control.
In fact, Dr Lowinger said someone experiencing social anxiety could be so worried about stammering or slurring their speech that it only makes things worse.
When they worry about what's happening physically, their amygdala is activated even more, causing a distressing spiral of physical symptoms.
She said the physical sensations of anxiety were intended to help us, and that worrying about the experience could make it worse.
The best way to stop this, Dr Lowinger said, was to accept anxiety and try to understand what is causing it.
"When we hate it, we create more of it. When we accept it, that's when it dissolves," she said.
A vicious circle
Both Julia and Arpit described having periods of extreme anxiety that affected their appetite and digestion.
Julia said, once anxiety set in, she could suffer nausea and experience diarrhoea.
For Arpit, a bout of anxiety could last so long, he would not eat for two days.
Dr Lowinger said it was common for the digestive system to be affected, because the body was preparing for a physical challenge, which was not the time to eat.
However, if it continued for too long, she said, loss of appetite could make you extremely tired.
Dr Lowinger said it was common for a person who has experienced a panic attack or a long bout of anxiety to feel exhausted.
"You are burning energy and it is an incredibly exhausting experience," she said.
Arpit said that, during his worst period of anxiety, the more exhausted he became, the less he ate, and the less he ate, the worse he slept.
"The anxiety just snowballed into something really bad," he said.
Breaking the cycle
Now, when Arpit starts feeling anxious, he goes for a drive, or walks to a spot down by a nearby river.
It wasn't always that easy.
Part of the problem for Arpit was that, when he experienced anxiety, he could not muster the clear thinking to get out of it.
He described being overpowered by a feeling of hopelessness.
"It just feels like I can't function properly," he said.
Dr Lowinger said this was because the fear centre was taking control and shutting down the part of the brain that manages decision-making and planning, .
The purpose of such a response is to not clutter the brain with unnecessary thoughts.
"Then we get anxious about not being able to think clearly and then that just makes it worse," she said.
Arpit said he only realised last year that what he was experiencing was related to anxiety.
He said that, once he could give it a name, he was able to take on the challenge of dealing with it.
Now he is able to recognise how anxiety makes him feel and will tell himself it will pass in a few minutes.
"I've gotten better in managing it, but I'm still not there."
