Four stages of anxiety refer to the different forms that anxiety can manifest during an episode, ranging from mild to moderate, severe, and panic states. This article is based on content from neuropsychiatry and mental health nursing, noting that the forms can vary depending on the theory. For people who easily escalate in their anxiety, it’s possible to assess their current level of anxiety and how they are responding.
1. What is the Concept of four stages of anxiety?
Let’s explore what four stages of anxiety is and what the different stages are.
1) Definition of Anxiety
Anxiety is defined as a feeling of unease and nervousness, associated with thoughts of impending danger, uncertainty, and feelings of helplessness spread across worries.
Anxiety is very common in our society and can stem from the chaos and confusion present in today’s social environment.
Fear of the unknown and ambiguous situations can induce anxiety. While low levels of anxiety are adaptive and provide motivation necessary for survival, when anxiety exceeds moderate levels, it can interfere with daily activities and induce stress.
2) four stages of anxiety
Psychiatric nurse Hildegard Pepalu has described anxiety in four stages: mild, moderate, severe, and panic.
The reactions to different intensities of anxiety can vary and may be either beneficial or detrimental to life. Below, we will examine the forms of anxiety at each stage.
2. Exploring the four stages of anxiety
There are four stages of anxiety : mild anxiety, moderate anxiety, severe anxiety, and panic anxiety.
1) Mild Anxiety
The first of the four stages of anxiety, Mild anxiety, is a non-problematic stage of anxiety that involves tension in response to daily events.
It prepares individuals for action, enhances senses, motivates productivity, and increases perceptual fields, thereby heightening environmental awareness.
Mild anxiety can enhance learning and allow for optimal functioning.
2) Moderate Anxiety
The second of the four stages of anxiety, Moderate anxiety, is an intermediate stage where the range of perceptual fields decreases.
With moderate anxiety, alertness to surrounding events may decline.
At this stage, while individuals can address various issues with direction, both the duration and intensity of focus can diminish. Physical symptoms such as increased muscle tension and pronounced restlessness may appear.
3) Severe Anxiety
The third of the four stages of anxiety, Severe anxiety, is an intensely anxious stage where the perceptual field is greatly narrowed, focusing intensely on one particular detail or several unrelated details.
The ability to concentrate is extremely limited, and completing even simple tasks can be challenging.
Physical symptoms like headaches, palpitations, and insomnia, as well as emotional symptoms such as confusion, fear, and terror, can be pronounced. Actions in this stage are typically aimed at reducing anxiety.
4) Panic Anxiety
The fourth of the four stages of anxiety, Panic anxiety, is the most severe state of anxiety where concentration on even a single task becomes impossible.
Misinterpretations or loss of touch with reality are common.
Individuals may experience hallucinations or delusions, and exhibit rough and extreme behavior or severe withdrawal actions. Physical functioning and communication with others become ineffective.
Panic anxiety is associated with terror, potentially life-threatening conditions, or beliefs related to overwhelming fear, loss of control, or emotional frailty.
Delayed panic anxiety can lead to physical and emotional exhaustion and life-threatening situations.
3. Reactions According to the four stages of anxiety
Let’s explore the reactions that can occur at the four stages of anxiety. The image below shows the reactions that appear along the continuum of anxiety.
1) Coping with Mild Anxiety
At the level of mild anxiety, numerous coping behaviors aimed at achieving comfort can occur.
Karl Menninger, an American psychiatrist and psychologist, described the types of behaviors used to alleviate anxiety in stressful situations as follows:
– Sleeping
– Crying
– Yawning
– Swearing
– Eating
– Walking
– Drinking alcohol
– Nail biting
– Physical exercise
– Leg shaking
– Napping
– Finger tapping
– Smoking
– Fidgeting
– Joking
– Talking to a comforting person
2) Coping from Mild to Moderate Anxiety
As the intensity of anxiety increases from mild to moderate, responses of ego defense mechanisms can appear before reaching moderate anxiety.
Sigmund Freud described the ego as the realistic part of the personality dominated by problem-solving and rational thought. As anxiety levels increase, the power of the ego is tested, and energy is mobilized to face threats.
Anna Freud mentioned many defense mechanisms the ego uses when its biological and psychological integrity is threatened.
The defense mechanisms that appear to alleviate anxiety at this stage are not always adaptive, and the use of maladaptive defense mechanisms can promote ego disintegration.
Ego defense mechanisms include compensation, denial, displacement, identification, intellectualization, introjection, isolation, projection, rationalization, reaction formation, regression, repression, sublimation, suppression, and undoing.
3) Coping from Moderate to Severe Anxiety
Entering the moderate anxiety stage can elicit psychophysiological responses, which can be seen as physical reactions caused by the activation of the sympathetic nervous system.
Moderate to severe anxiety can cause many physiological disorders, and psychological factors can exacerbate symptoms, delay recovery, or interfere with medical treatment.
These conditions are initiated or worsened by environmental situations perceived as stressful by the individual, and notable pathophysiology can occur.
Psychological and behavioral factors can affect almost every disease, not limited to the cardiovascular, gastrointestinal, neoplastic, nervous, and pulmonary systems.
4) Coping with Severe Anxiety
If the severe anxiety stage persists, it can lead to psychoneurotic behavioral responses.
Neurosis is a mental disorder characterized by excessive anxiety that is either expressed directly or through altered defense mechanisms, presenting symptoms such as obsessions, compulsions, phobias, or sexual dysfunctions.
Common characteristics of people with neurosis include :
– Recognizing that they are experiencing distress.
– Being aware that their behavior is maladaptive.
– Being unaware of the potential psychological causes of stress.
– Feeling powerless to change the situation.
– Losing touch with reality.
Psychoneurotic responses to anxiety in DSM-5 include anxiety disorders (characterized by anxiety symptoms and avoidance behaviors), somatic symptom disorders (characterized by physical symptoms without organic pathology evidence), and dissociative disorders (characterized by breakdowns in the integration functions of consciousness, memory, identity, or perception of the environment).
5) Coping with Panic Anxiety
At the panic anxiety stage, psychotic reactions can occur. Extreme anxiety may prevent the handling of ongoing situations, and contact with reality can be lost.
Psychosis is defined as a severe thought disorder with impaired reality testing, causing delusions, hallucinations, disorganized speech, or catatonic behavior, and can exhibit the following characteristics :
– Showing minimal distress
– Emotional tone being flat, featureless, or inappropriate
– Not recognizing that their behavior is maladaptive
– Being unaware of psychological problems
– Escaping from reality into a less stressful world or attempting adaptation
Psychotic responses to anxiety include schizophrenia, schizoaffective disorder, and delusional disorder.
4. Conclusion and Q&A
We have learned that the stages of anxiety include mild anxiety, moderate anxiety, severe anxiety, and panic anxiety, and that the responses may vary accordingly. If an individual frequently experiences moderate or higher levels of anxiety, consulting a mental health professional may be necessary.
Below, we will address frequently asked questions related to anxiety and summarize the key points.
1) What causes the various symptoms that appear when you are anxious?
The activation of the sympathetic nervous system, known as the fight-or-flight response, prepares the body to either fight or flee effectively.
For effective fighting or fleeing, the heart and breathing rates must increase, and blood must be redirected to major muscle groups or the field of vision must widen. These reasons can lead to various physical changes.
2) How can severe anxiety be resolved?
When anxiety is severe, it is necessary to practice changing thoughts or focusing on the present, and training to weaken one’s beliefs. Cognitive-behavioral therapy, schema therapy, and mindfulness meditation training may be required for this.
If you are curious about the next part, the 5 stages of depression, or want to know more about the fight-or-flight response, which is the cause of various physical symptoms during anxiety, check out the article below!
► Source of Information and Reference Materials
Psychiatric Mental Health Nursing – Co-authored by Mary C. Townsend and Karyn I. Morgan / Published by Hakjisa Medical Textbook of Neuropsychiatry The Korean Neuropsychiatric Association / Published by I.M. E-Z Company
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