Anxiety can have many different causes including childhood trauma, abuse in adulthood (from a spouse or partner), stress at work, financial stress, near-accidents, injurious accidents, being a crime victim, etc. Once the fight-flight sensations of anxiety begin, from whatever cause, they can become generalized to many situations that seemingly have nothing to do with the original stimulus. That’s because our brains are trying to protect us and they create unconscious associations between the original fear stimulus and other situations that the brain sees as related, even if our conscious rejects the similarities. When you have a client who says I “feel anxious” it is important to use open-ended questions to discern what may have caused the anxiety in the first place. However, for treatment purposes it is very important to compile an exhaustive list of all the situations in which the client experiences anxiety and whether these specific situations trigger mild, moderate or severe anxiety. Over the years I have noticed that many anxious people fear crowds, whether in a mall, a grocery store, a movie theater, a theme park, or even public places in general. What’s the common denominator here? My hunch is that crowds are unpredictable. You never know what danger or dangerous person lurks in a crowd. In our recent past the news media has broadcast thousands of stories about shooters randomly firing into crowds and about crowds trampling and killing or severely injuring people when stampeded. This has happened during political protects, soccer games, rock concerts, and religious ceremonies to name just a few examples. I think it’s very conceivable that an anxious person who has suffered memorable abuse or injury from another person could associate this with danger from crowds. This being the case, when you inventory your brand new client’s list of anxiety triggers, it’s a good idea to ask about crowds and the locations of the crowds, because fear of crowds can be quite life-limiting.
