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Somatic Anxiety - Treating the Body vs. the Mind

Sally-Anne Soameson, Psychiatrist
Somatic Anxiety - Treating the Body vs. the Mind

Somatic anxiety is a name for the physical, as opposed to “cognitive” or "mental" manifestations of anxiety. People who react to anxiety mainly in a physical manner experience primarily somatic anxiety, whereas people who react to it mainly mentally experience primarily cognitive anxiety.

This article will explore how cognitive symptoms of anxiety differ from somatic symptoms, how you can tell whether your anxiety is primarily somatic or primarily cognitive, and how to decrease your somatic manifestations of anxiety.

Somatic vs. Cognitive Anxiety Symptoms

Anxiety can be marked by somatic or cognitive symptoms, though both types of symptoms may be present. Physical symptoms often affect how easy your anxiety is to treat and possibly what is done to treat it.

The word “somatic” is derived from Greek and means “of the body,” and specifically the body which is distinct from the mind. Somatic illnesses are sicknesses of the body more so than they are of the mind, meaning that automatic physical responses are more a cause of anxiety than cognition or thinking in people whose anxiety is mainly somatic in its presentation.

Primarily somatic anxiety is marked by somatic events such as:

This is not an exhaustive list by any means, and the reality is that in some cases the anxiety can cause symptoms that are incredibly unusual, such as nerve symptoms, trouble swallowing, feelings of lumps, unusual pains, and more. Anxiety can have an intense effect on the body, possibly leading to issues that create further anxiety.

On the other hand, primarily cognitive anxiety implies that the above physical symptoms are present to a lesser degree and that mental symptoms of anxiety happen most often without concurrent physical effects. The cognitive symptoms of anxiety include:

Both types of symptoms may be present, but it is thought that in most cases one or the other type of symptom is predominant. Additionally, it should be noted that somatic symptoms can cause cognitive symptoms and vice versa. For example, an anxiety headache might lead to further negative thinking creating possible reasons why the headache is there in the first place. This can lead to further somatic symptoms such as sweating or shaking, causing a potential panic attack. For this reason, it is important to find out if your anxiety symptoms are primarily somatic or cognitive, and take measures to address them specifically.

The Cognitive-Somatic Anxiety Questionnaire (CSAQ)

When it was proposed that a given case of anxiety could be defined as either somatic or cognitive, the Cognitive-Somatic Anxiety Questionnaire or "CSAQ" was born. The CSAQ is a survey divided into two scales of 7 items that measure cognitive and somatic symptoms in order to conclude what type of treatment a person should receive.

However, it should be noted that there is conflicting evidence concerning the effectiveness of the questionnaire in measuring or differentiating the types of anxiety. One test of the CSAQ yielded results that challenged its validity, whereas another study wherein treatment of subjects was based upon the results of the questionnaire showed marked improvement. This will be discussed in the following section. It has been suggested that the questionnaire be expanded to better encompass the multidimensionality of anxiety as a disorder.

Somatic Anxiety Treatments

Treating anxiety based on whether it is primarily somatic or cognitive has been shown to have beneficial effects, especially because both types of anxiety involve different types of challenges.

In a test of the predictive validity of the cognitive vs. somatic anxiety distinction from the Pavlovian Journal of Biological Science, 24 subjects who were shown to have either predominantly somatic or cognitive anxiety were either given treatment that addressed or “matched” their primary mode of anxiety, or treatment that addressed the opposite mode. The 12 subjects who were given “matching” treatments reported significantly fewer anxiety symptoms than the 12 subjects who were given “mismatched” treatments, indicating that treatment based on the mode of anxiety can be more effective than treatment that disregards it.

Treating somatic anxiety symptoms can be difficult, and often involves some type of comprehensive strategy that focuses on what it is like to live with anxiety symptoms. The more physical the symptoms are, the less some of the cognitive treatments will work.

However, even small changes can make a big difference in your somatic symptoms. Some examples of changes you can do today include:

These are only the first steps in reducing anxiety, but f you can decrease your physical symptoms a small amount you may find that your overall anxiety levels become easier to control.

Article Resources
  1. Freedland, Kenneth E., Robert M. Carney. Factor analysis of the cognitive-somatic anxiety questionnaire.” Journal of Psychopathology and Behavioral Assessment. Dec. 1988, Volume 10, Issue 4, pp 367-375.
  2. Tamaren, Allen J., Robert M. Carney, Thomas W. Allen. Predictive validity of the Cognitive Vs. Somatic Anxiety Distinction. The Pavlovian journal of biological science : official journal of the Pavlovian. Oct–Dec 1985, Volume 20, Issue 4, pp 177-180.
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