This leaflet focuses on how to recognise the symptoms of anxiety, helps you to understand the causes and suggests some ways you can help yourself to cope with them.
How do I recognise anxiety?
You will probably have no difficulty recognising anxiety when it is a reaction to a particularly stressful situation. We can all remember that unpleasant feeling just before a driving test, an exam or a job interview. Anxiety can serve a useful purpose in these situations, toning up the body and making sure your reactions are spot on.
However, there are times when you might feel the symptoms of anxiety without any obvious cause. This in itself can be stressful because you may not recognise the symptoms of anxiety for what they are and think you are becoming physically ill. Uncontrolled long-term anxiety can in fact lead to real physical illness such as inflammation of the lining of the stomach (gastritis) and high blood pressure (hypertension).
Anxiety can affect you in four main ways:
- The way you think.
- The way you feel.
- The way your body acts.
- The way you behave.
- Thinking that you are losing control of your mind.
- Thinking you are going to faint or have a heart attack.
- Thinking you have to escape from a stressful situation.
- Thinking you will make a fool of yourself.
- Feeling nervous, frightened or worried.
- Feeling as if something terrible is going to happen.
- Feeling tense, on edge or unable to relax.
- Feeling detached from your surroundings or not real.
Your bodily reactions
- Your heart may beat rapidly or irregularly.
- You may develop chest pain or tightness.
- You may notice pins and needles or numbness in your fingers or toes.
- You may feel like you want to keep going to the loo.
- You may develop butterflies in your tummy.
- You may experience muscle tension and body aches.
- You may start perspiring.
- You may feel light-headed or dizzy.
- You may start to tremble or shake.
- Being unable to sit still.
- Having difficulty in completing a job.
- Having to be on the go all the time.
- Being talkative or talking faster than normal.
- Being short-tempered or irritable.
- Drinking or smoking more than usual.
- Bingeing or going off your food.
- Avoiding situations that make you anxious.
If you have some or all of these symptoms on a regular basis you probably have anxiety.
Why do I experience anxiety?
Anxiety is a basic emotion that can serve a useful purpose. When humans lived in caves it was very useful to be able to switch to a 'fight or flight' mode when faced with a threat such as a wild animal. This means you would be prepared to fight the threat or run away. Your heart would beat faster to pump blood around your body. Your muscles would tense ready for action, your breathing would become rapid in order to take more oxygen on board, and you would sweat in order to cool your skin. Unpleasant sensations may also occur such as a dry mouth and a rumbling tummy. Afterwards, you might feel exhausted and weak.
These days, things are a little more civilised but we still respond with the fight or flight reaction when faced with stress. Modern-day causes of stress include:
- Stress at home - money worries, trouble with the kids, problems with your partner.
- Stress at work - too much work, being sidelined for promotion, feeling undervalued or under-supported.
- Life in general - bereavement, divorce, redundancy.
Why doesn't my anxiety go away?
The fight or flight response is meant to be a short-term solution to a problem. But in some people, the symptoms of anxiety persist. There can be several reasons for this:
- You might be a 'born worrier'. In some people anxiety seems to be locked into their personality; they have grown up with the habit of worrying, and worry if they can't find anything to worry about.
- Early life experiences such as parental divorce or childhood abuse can sometimes lead you to have lifelong anxiety problems.
- Ongoing stresses can persist for a number of years and generate the habit of feeling anxious even when the original problem has been solved.
- Fear that the symptoms of anxiety mean you have a physical problem can lead you into a vicious cycle which feeds the anxiety.
- You might recognise the symptoms of anxiety for what they are but find them so unpleasant that this sets up a fear of anxiety itself. This is another anxiety-generating process,
- You might try to avoid stressful situations that make you anxious. These often include crowded places, public transport, eating out and social interactions. If this persists it can limit your quality of life and damage your self-esteem. Another vicious cycle is established, stoking up the anxiety even more.
How can I cope with my anxiety?
We all experience anxiety and as this leaflet points out, some anxiety is good because it helps to 'tune up' your body in order to cope with stressful situations. Anxiety therefore isn't a disease and cannot as such be cured,
There are, however, four main ways in which you can help to reduce your anxiety and manage it better:
- Understanding anxiety and combating some of the causes.
- Bringing your physical symptoms under control.
- Tackling the thoughts that bring on anxiety.
- Tackling the behaviours that lead to anxiety.
Understanding anxiety and managing the causes
Keeping a diary for at least a couple of weeks will help identify your personal anxiety trigger factors. Rate your anxiety from 0-10 every hour and note down the circumstances when your anxiety levels are high. For example:
- What were you doing?
- Who were you with?
- Where were you?
- What time of day was it?
Anxiety triggers vary so much from person to person it's difficult to suggest a 'one size fits all' solution., However, by looking at the circumstances it may be possible to devise ways around the trigger factors. For example, if your diary shows you regularly become stressed battling your way through a market on a crowded Saturday morning, is it possible to go on a different day or at a different time?
Sometimes anxiety is a perfectly logical reaction to a real problem. One way of coping with this is to write the problem down and think of as many ways as possible to solve it. Be as specific as you can. For example, instead of writing 'I am worried about my child', write down the main issue - such as 'I am worried about my child being bullied at school'. Then write down possible practical solutions, being as inventive as you can:
- Talk to my child to check the facts - is it more than one child involved; is it organised bullying or just a disagreement with another child?
- Why is my child being picked on?
- Do I need to talk to the school?
- Do I need to speak to the parents of the other child(ren)?
- Is there anything I can do to make my child less of a target?
- Do I need to change my child's school?
Then look at each possible solution and write down the pros and cons - for example, issues around the change of school option might include:
- Looking at travelling times to other schools.
- Looking at the practicalities - for example, do you still have to deliver siblings to the existing school?
- Is the bullying bad enough to separate my child from the friends at his/her current school?
- Will the bullying continue at the new school?
Coping with physical symptoms
I've you've read the information already covered in this leaflet you should by now be able to recognise the physical symptoms of anxiety. It helps to control these as soon as you become aware of them. You may have identified a tried and tested way of relaxing. For some people it will be listening to music; for others, reading. You can also learn to relax in the same way as you can learn to do any other activity such as riding a bike or swimming. You may find it easier to do this in a group; look out for local relaxation, yoga or exercise groups (for example, in your local paper, library or gym). On the other hand you may be the sort of person who prefers to 'go it alone'. In that case, a CD teaching you how to relax may be the best option. These are available from shops or online (some advice is downloadable for free). Some GP practices have relaxation CDs they can loan out to patients.
Deep muscle relaxation exercises
Some people find that by going through a set programme of exercises every day or on most days, it helps to keep the anxiety levels down.
One example of this is deep muscle relaxation. There are various ways of doing this but they all involve clenching and then relaxing various muscle groups.
Lie down in a comfortable, warm area where you won't be disturbed. Start by concentrating on your breathing. Breathe in and hold it for a count of two, then out and hold it for a count of two. Keep going for a few minutes.
Then move on to the muscle exercises. It doesn't matter in which order you do them but try to involve the muscles from head to toe. Some people find it best to start with their feet and work their way upwards or vice versa. So if you were starting with your feet:
- Clench your toes for a few seconds, then relax.
- Tighten your ankles for a few seconds, then relax.
- Clench your knees, then relax.
- Gradually work your way up, clenching and relaxing your thigh muscles, tummy muscles, your chest, your hands, shoulders and neck, and ending with your jaw, eyebrows and forehead.
Notice the feeling when your muscles relax. Try to reproduce that feeling, even when you are not doing your exercises.
You can also use some of these techniques during a stressful situation. When you become stressed notice what happens to your body. If you start to clench your hands, relax them. If you start to breathe faster, deliberately slow it down.
This involves thinking about something else as soon as you start to develop physical stress symptoms. Look at things in detail, such as what people are wearing, what's in a shop window, or the types of cars parked along the street. Do this for a few minutes until your symptoms reduce.
Don't worry if some of your physical symptoms remain despite using all these techniques. Remember that whilst the symptoms of anxiety may be uncomfortable they will not do you any harm and they will eventually disappear.
Changing the way you think about anxiety
Keep your anxious thoughts under control
Notice any thoughts that pass through your mind when you feel stressed or any scenes you imagine that cause you anxiety. For example, some people visualise themselves developing the physical symptoms of anxiety in the street and being carried off to hospital in an ambulance. Thoughts that stress people often involve over-exaggeration, jumping to conclusions, or being pessimistic (ie the glass is always half empty, never half full). The best way to combat this is to keep a diary of these thoughts so you can recognise them next time they occur. Then draw up a chart with the thought on one side and a logical response on the other. For example:
|I'm becoming breathless and going to collapse||The last time I became breathless it settled down by itself|
|My pulse is rapid so I must have heart disease||All my heart tests have come back normal|
|Monday was a dreadful day||I went out at the weekend and had a great time|
Set aside a 'worry time'
It might sound odd but if you're one of these people who is always worrying, it might help to have a dedicated 'worry time'. Set aside 20-30 minutes a day when you give yourself permission to worry. Whenever a worry comes into your head during the day, write it down and deal with it during worry time.
During worry time, use your problem-solving skills. Identify the issue as specifically as you can, Write down all the possible solutions and then list the pros and cons for each solution. Does your preferred solution need action now? Act, and then move on. Can you defer the solution till later? Schedule it for another time, then move on.
Sometimes, you may come to the conclusion that there is nothing you can do to solve the problem. Accept it, stop worrying about it and recognise that there are some things you can't do anything about.
Anxious people are sometimes control freaks. To reduce your anxiety levels you may need to accept that you can't plan everything that happens in your life. Try to be a bit more relaxed about the future and embrace uncertainty. Not everything that is unexpected will be unpleasant. Life is full of surprises, not all of them bad.
Challenge your views on the value of worry
People who worry a lot come to rely on worry to get them through life. They may feel if they give up worry, their life will fall apart. Remember that:
- Worrying about someone and caring for them are not the same thing.
- Worrying about a problem is not the same as solving it.
- Worrying about a problem may detract from the energy you need to solve it.
- Worrying about problems that may never happen is a waste of energy.
- Bad things happen, whether you worry about them or not.
This is a technique which has become increasingly popular as a way of getting 'in tune' with your thoughts and bodily feelings. It can be used to help manage anxiety. Entire books have been written about it and it's not easy to summarise the whole subject in a few lines. However, in a nutshell it involves focusing on what is happening in the present and not being distracted by the past or the future.
One exercise involves concentrating on your breathing whilst observing in an objective way whatever else is happening to your mind and body. If thoughts come into your mind, acknowledge them but bring your attention back to your breathing. You may notice physical feelings, emotions and sounds: notice them but let them drift away and come back to your breathing. If you do become distracted, recognise that this has happened but just bring your focus back on to your breathing,
People who practise this technique for 15-20 minutes a day have reported that it has helped them manage their anxiety.
Changing how you act
- Notice activities that you try to avoid and tackle them bit by bit.
- Make a list of small changes you would like to make. Start with the easy ones and tick off each goal as you achieve it.
- Do something you know will make you anxious, if only for a little while. Try to stay in that situation for as long as you can, and notice what happens to your anxiety level. You may be pleasantly surprised!
- Comfort activities that displace your anxiety - for example, lighting up a cigarette - may help reduce anxiety for a while, but will keep the anxiety going, because you never get to experience the anxiety getting less unless you confront your fear and meet it 'head on'.
- Challenge your assumptions. You may worry that if you remain in a stressful situation you will collapse. Stay a bit longer than usual and you'll discover that your fears are unfounded.
What other help is available?
- There is a lot you can do for yourself. Some ideas are listed in this leaflet.
- Your GP, health visitor or practice nurse may be able to provide further support.
- Details of local anxiety management groups may be available from your GP practice, library or online.
- If self-help measures are not enough, your doctor may suggest referring you to a mental health worker or counsellor.
- Your doctor may occasionally consider that you would be helped by medication. Antidepressants, whilst treating depression, are also sometimes helpful in managing anxiety.
Did you find this information useful?
- Generalised anxiety disorder and panic disorder in adults: management; NICE Clinical Guideline (January 2011)
- Rickwood D, Bradford S; The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review. Psychol Res Behav Manag. 2012 5:25-36. doi: 10.2147/PRBM.S23357. Epub 2012 Feb 27.
- Demarzo MM, Montero-Marin J, Cuijpers P, et al; The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review. Ann Fam Med. 2015 Nov 13(6):573-82. doi: 10.1370/afm.1863.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.