Anxiety

What is anxiety?

Everyone gets anxious from time to time – it’s that nervous feeling you can get before an exam or a presentation. This is a totally normal reaction, which usually passes.

Although unpleasant, anxiety can be beneficial as it gives you the motivation to work harder. It’s part of the survival response. When you feel under threat, your body releases hormones which:

• activate the ‘fight-or-flight’ system – this increases your breathing, heart rate and blood pressure to prepare you for danger
• suppress the ‘rest-and-digest’ system – these functions aren’t needed when you’re fighting or running for your life.

This mechanism was more useful to our ancestors, if they needed to run from a predator. Although we don’t face as many life-threatening situations now, our brains can sometimes misinterpret everyday life as threatening, triggering the internal alarm system.

If you have problematic anxiety, you can experience all-consuming worries and exaggerated fears. In this way, an imagined threat can trigger the fight-or-flight response. At its most severe, this can manifest as a panic attack.

Types of anxiety

If your symptoms meet a set of criteria, you may be diagnosed with a specific type of anxiety:

• Generalised anxiety (GA) – having lots of worries about lots of things
• Social anxiety – fear about looking foolish in a social situation
• Health anxiety – anxiety related to fears about having a physical illness
• Separation anxiety – fear of being away from loved ones or your home
• Phobias – anxiety triggered by a fear of something specific
• Agoraphobia – fear of being in situations that could cause a panic attack
• Panic disorder – having frequent panic attacks
• Post-traumatic stress disorder (PTSD) – reliving a distressing event and experiencing the same anxiety as during the original event
• Obsessive-compulsive disorder (OCD) – intrusive, unwanted thoughts that lead to repetitive behaviours, which relieve the anxiety.

What causes anxiety?

Whereas stress comes and goes due to external factors, anxiety can persist for a while and the cause isn’t always clear.

For some people, it can seem like anxiety creeps up on them, due to lots of little stressors building up over time without them realising.

For others, anxiety could be triggered by any of the following factors, or a combination of them:

• a traumatic incident
• a significant life event
• painful long-term health conditions
• certain medications
• misuse of alcohol or drugs.

Genetics can also play a role:

• You’re more likely to have problematic anxiety if a close relative also experiences it
• People with certain personality traits may be more prone to anxiety than others, for example overthinking and perfectionism
• Women are twice as likely to suffer from anxiety than men.

What are the symptoms of anxiety?

People experience anxiety in different ways. It can affect both your physical and mental health.

Physical symptoms can include:

• fast or irregular heartbeat
• shortness of breath
• excessive sweating
• dry mouth
• muscle aches and tension
• chest pain
• stomach issues – it has been linked to irritable bowel syndrome (IBS)
• feeling sick
• tiredness
• restlessness
• headaches
• feeling too cold or too hot
• getting ill more often, as your immune system is suppressed.

Psychological and behavioural symptoms can include:

• feeling nervous, tense or fearful
• constant worrying
• racing thoughts
• feeling on edge or hypervigilant
• feeling hyperaware of yourself, as if you’re stuck in your own head
• feeling that people are judging you and your anxiety
• feeling of unreality (derealisation)
• feeling of being detached from yourself (depersonalisation)
• irritability
• difficulty concentrating
• avoiding situations that you fear
• struggling to get to sleep, stay asleep and fall back to sleep (insomnia).

Panic attacks

In severe cases, you may also experience panic attacks. A panic attack is a sudden onset of intense fear that triggers your fight-or-flight response. Sometimes there’s an obvious reason for having a panic attack, and other times they can happen randomly.

Physical symptoms can include:

• fast, pounding heartbeat
• shortness of breath or difficulty breathing (hyperventilation)
• sweating
• trembling or shaking
• a choking feeling
• chest pain, pressure or discomfort
• stomach problems or sudden diarrhoea
• feeling sick
• feeling dizzy, lightheaded or faint
• hot flushes or chills
• numbness or tingling.

Psychological symptoms can include:

• feelings of intense terror or dread
• feeling like things around you are strange or feeling detached from your body
• feeling like you’re losing control or going crazy
• fear of fainting, having a heart attack or dying.

How is anxiety treated?

There are many ways to treat anxiety, depending on its severity and type. The nature of anxiety means people might put off seeking help, but it’s important that you do.

You should see your GP if:

• your feelings of anxiety are intense and long-lasting
• your worries are causing your distress
• your fears are irrational or exaggerated
• you stop doing certain things that might make you feel anxious
• you find it difficult to go about your day-to-day life
• you regularly experience psychological and physical symptoms of anxiety, such as panic attacks.

Treatment usually involves a combination of therapy and lifestyle changes. In some cases, medication may also be prescribed.

Therapy

The things you think, feel, and do when you’re anxious can actually keep anxiety going. Therapy aims to break this ‘vicious cycle’.

Here are the main types of therapy on offer:

• Cognitive Behavioural Therapy (CBT) – this is a talking therapy that can help you change what you think and do. You and your therapist work together to challenge your unhelpful thoughts, feelings and behaviours, and replace them with more helpful ones, so that you can proactively prevent anxiety in the future.
• Online therapy – we offer guided online therapy and self-guided online therapy, both of which give you the tools to improve your mental health.
• Counselling – this is another type of talking therapy, best suited for when you’re going through a change in circumstances and aren’t sure how to move on. It allows you to discuss your thoughts and feelings with your counsellor, so they can help you find a way forward.
• Self-help groups – some people find it helpful to meet up with people going through the same thing to share their experience and offer mutual support.

Lifestyle changes

Making small changes to your lifestyle can help you manage your symptoms. What might be beneficial for one person, might not be for another, so you should try a few things to see what works best for you:

• Exercise regularly as it releases anxiety-reducing chemicals, while acting as a healthy distraction
• Take part in activities that bring you into the present, so you aren’t worrying about the past or future, e.g. going for a walk, reading or doing something creative
• Try relaxation techniques such as yoga, meditation and mindfulness to activate your ‘rest-and-digest’ system
• Use wellbeing apps – here are 25 essential apps for a healthy mind and body
• Improve your bedtime routine so you can switch off and sleep easier
• Write in a journal to let out your thoughts instead of dwelling on them
• Spend more time outside in nature
• Eat healthily
• Avoid nicotine, caffeine and alcohol, as these can make your symptoms worse.

Coping with anxiety

With the right support and treatment, it is possible to live with and overcome anxiety:

• Follow your healthcare provider’s advice consistently
• Know your triggers and practice your coping strategies
• Learn as much as you can so you fully understand anxiety
• Speak to friends and family for support – they may have been through it too.

How to manage a panic attack

If you’re having symptoms of a panic attack, it can be quite scary. All too often people find themselves in A&E thinking they’re having a heart attack. But there are a few things you can do to calm yourself down:

• Recognise – notice that you’re having a panic attack, nothing worse, and remind yourself that you’ll be okay and that it’ll pass in a few minutes
• Breathe – focus on taking slow, deep breaths through your nose rather than your mouth, and breathe into your belly rather than your chest
• Practice mindfulness – bring your attention to what’s in the here and now by engaging your senses, like the sensation of your feet on the ground, or you could keep some lavender oil handy to sniff for a natural relaxant
• Close your eyes – this will help you block out extra stimuli, allowing you to focus on one thing: your breathing; what you can sense; a mantra (e.g. repeating ‘this will pass’); or you could even imagine yourself in a relaxing place.

Related problems

• Stress – This is the feeling of being overwhelmed and unable to cope with demands due to a build-up of stressful situations, which can lead to anxiety
• Depression – Similar physical symptoms to anxiety, but also involves feeling down or sad for long periods of time and a loss of interest in pleasurable activities.

Reviewed by: Brendan Street