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Understanding anxiety
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What is anxiety?
Why are some people more anxious than others?
What are the effects of anxiety?
Can I learn to manage my anxiety myself?
What sort of treatment can I get?
How can friends and family help?
Useful organisations
Further reading
'A job interview usually makes me feel so on edge that I don't sleep the night before. But, probably, if I didn't feel the adrenalin pumping through me, or if I didn't feel nervous, I wouldn't do so well.'
'I stopped giving dinner parties, because I just couldn't bear the anxiety about getting everything ready in time. It sometimes got so bad that I'd start worrying days before the event.'
'I can never look forward to a holiday in the sun, as it involves flying. It just doesn't suit me. I get clammy hands, my heart races, I feel claustrophobic, and sometimes I just panic and want to escape.'
'I was so tense that my stomach was in knots the whole time. Everything I needed to do filled me with dread, and outings became a torment. I can remember sitting in my car, outside the office, and knowing that I couldn't open the door and get out.'
'Gradually, through the therapy, I learnt that I could take control of what was happening. Before, I was seeing everything in just two dimensions, good and bad, but mostly bad.'
This booklet is aimed at anyone who suffers from anxiety. It looks into the causes of anxiety, its effects and what to do to reduce it to a manageable level, as well as how to reassure and support friends and relatives with this problem.
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What is anxiety?
Anxiety is something we all experience from time to time. Most people can relate to feeling tense, uncertain and, perhaps, fearful at the thought of sitting an exam, going into hospital, attending an interview or starting a new job. You may worry about feeling uncomfortable, appearing foolish or how successful you will be. In turn, these worries can affect your sleep, appetite and ability to concentrate. If everything goes well, the anxiety will go away.
Short-term anxiety can be useful. Feeling nervous before an exam can make you feel more alert, and enhance your performance. However, if the feelings of anxiety overwhelm you, your ability to concentrate and do well may suffer.
The 'fight or flight' reflex
Anxiety and fear are actually important for survival because they act as a mechanism to protect the body against stress or danger. Anxiety and fear trigger the release of hormones, such as adrenalin. Adrenalin causes your heart to beat faster to carry blood where it's most needed. You breathe faster to provide the extra oxygen required for energy. You sweat to prevent overheating. Your mouth may feel dry, as your digestive system slows down to allow more blood to be deflected to your muscles. Your senses become heightened and your brain becomes more alert. These changes enable the body to take action and protect itself in a dangerous situation, either by running away or fighting a foe. It is known as the fight or flight reaction. Once the danger has passed, other hormones are released, which may cause you to shake as your muscles start to relax.
The response is useful for protecting you against physical dangers. However, your body reacts in the same way to situations that you find threatening, but which you can't deal with appropriately by fighting or running away. Situations like this may include public speaking, a driving test, or having an injection.
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Why are some people more anxious than others?
Anxiety can be triggered by a number of factors. Something distressing may have happened to you in the past, and because you were unable to deal with the emotions at the time, you may become anxious about encountering the situation again, just in case it stirs up the same feelings of distress.
You may worry about the future. Sometimes, if we feel we are not in control of different aspects of our lives, we can start to feel anxious about events beyond our control, such as the threat of nuclear war, of being attacked, of developing cancer, or of losing a job. (If you find worrying a problem, see Mind's booklet, How to stop worrying.)
Feeling anxious can also be a learned response - something that you picked up early on in life. Your family may have tended to see the world as a hostile and fearful place, for example. Research suggests that people may even inherit a tendency to be more anxious. We all become anxious under pressure, but one person may succumb more easily than another, because of a mixture of personality, current circumstances and childhood experience.
On a day-to-day basis, caffeine, excess sugar, poor diet, drug misuse, exhaustion, stress and the side effects of certain medication can also cause anxiety. After a while, people can start to fear the symptoms of anxiety, especially feeling out of control. This sets up a vicious circle. They feel anxious because they dread feeling the symptoms of anxiety, and then they experience those symptoms because they are having anxious thoughts.
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What are the effects of anxiety?
Anxiety will have an effect on both the body and the mind.
Physical effects
Increased muscular tension can cause discomfort and headaches. Breathing rapidly may make you feel light-headed and shaky, and give you pins and needles. Rising blood pressure can make you more aware of a pounding heart. Changes to the blood supply affecting the digestive system may also cause nausea and sickness. The effects on your nervous system may manifest themselves in an urgent need to visit the toilet, and butterfly feelings in the stomach.
Psychological effects
The psychological effects of anxiety include fear, heightened alertness, being on edge, irritable, and unable to relax or concentrate. You may feel an overwhelming desire to seek the reassurance of others, to be weepy and dependent. The way you think can be affected: you may fear that the worst is going to happen and slot everything that occurs into a pessimistic outlook on life. For example, if a friend is late, you worry that they have had an accident or don't want to see you, when in fact their train was delayed.
To cope with these feelings and sensations, people may start smoking or drinking too much, or misusing drugs. They may start steering clear of certain situations, and maintain relationships that either support their anxious outlook or help them avoid situations they find distressing.
Panic attacks
Sometimes, anxiety can take the form of a panic attack. This is the rapid build-up of overwhelming sensations, such as a pounding (and sometimes irregular) heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly. It can make people afraid that they are going mad, blacking out, or having a heart attack. They may be convinced they are going to die in the course of the attack, making this a terrifying experience.
Panic attacks may sometimes occur for no reason, and people may not be able to understand why. They may feel as if their mind has gone totally out of control. (See Mind's booklet, How to cope with panic attacks.)
Health problems
Long-term anxiety is bad for your health. It can weaken your immune system, lowering your resistance to infection. Increased blood pressure can cause heart or kidney problems, and contribute to the chances of having a stroke. You may experience digestive difficulties, along with other health problems.
You may also be depressed. Depression and anxiety often appear together, to the extent that doctors sometimes treat them in the same way. (See Mind's booklet, Understanding depression.)
Impact on work, leisure and relationships
You may find it difficult to hold down a job, develop or maintain good relationships, or simply to enjoy leisure time. Sleep problems may further aggravate anxious feelings and reduce your ability to cope. (See Mind's booklet, How to cope with sleep problems.)
For some people, anxiety becomes so overwhelming that it takes over their lives. They may experience severe or very frequent panic attacks, for no apparent reason, or have a persistent, 'free-floating' sense of anxiety. Some may develop a phobia about going out and about, or may withdraw from contact with people, even their family and friends. Others have obsessive thoughts or repetitious behaviour, such as endlessly washing their hands.
Problems of this kind are known as panic disorders or anxiety disorders. This does not mean a person has a serious mental health problem. However, it's important to consult your GP, not only because help is available to tackle these difficulties, but also to eliminate any possible physical cause for the symptoms. (See also Useful organisations and Further reading.)
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Can I learn to manage my anxiety myself?
There are many things you can do to reduce your anxiety to a more manageable level. Taking action may make you feel more anxious at first. Even thinking about anxiety can make it worse. But facing up to anxiety, and how it makes you feel, can be the first step in breaking the cycle of fear and insecurity. It's important to remember how much better you will feel when you can begin to relax, take control, and lead a fuller life.
Controlling the symptoms
The symptoms of anxiety can be controlled by breathing and relaxation techniques, and by replacing distressing, negative thoughts with positive, peaceful ones. These methods are straightforward and can be learnt from books, the internet, video and audio tapes, through counselling, and attending relaxation classes. Often the techniques employed are based on the principles of cognitive behaviour therapy, which your GP may be able to help you access. He or she can also advise you about local support groups run by and for people with similar problems. There are also classes in anxiety management. (See Useful organisations and Mind's booklets Making sense of cognitive behaviour therapy and The Mind guide to relaxation.)
Assertiveness training
Learning how to handle difficult situations and to stand up for yourself can make you feel more confident and, therefore, more relaxed. Some people find that learning self-defence makes them feel safer. (To find out about classes, ask at your library or look on the internet, and see Mind's booklet How to assert yourself.)
Complementary therapies
Complementary therapies can help you to relax, sleep better, and deal with the symptoms of anxiety. Yoga, meditation, aromatherapy, massage, reflexology, herbalism, Bach flower remedies, homeopathy, and hypnotherapy are some of the methods people have found successful. Many chemists and health shops stock different remedies and may be able to offer advice.
Exercise
Taking more exercise can help you cope with anxiety and feelings of tension, and make you sleep better. Exercise uses up the adrenalin and other hormones that are produced under stress, allowing muscles to relax. Also, certain brain chemicals are released during exercise, which can enhance your mood.
Walking and swimming allow you to be active at your own pace and you can do them alone or in company. If you feel embarrassed exercising in front of others, do it at home: dance, stretch or move along to music or a video. (See The Mind guide to physical activity for more information.)
Healthy living
Avoid stimulants, such as coffee, cigarettes and alcohol, which can promote anxiety. Eating a healthy diet and getting plenty of sleep can also make a big difference to your ability to cope with stress. (See The Mind guide to managing stress.)
Talking
It can relieve your feelings to talk to a friend or family member about what's making you anxious. You may find that they have encountered a similar problem and can help talk you through it.
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What sort of treatment can I get?
If you find the strategies suggested in this booklet aren’t enabling you to cope, go and see your GP or practice nurse.
Medication
Because of problems of dependency, doctors usually prescribe tranquillisers and sleeping pills only as a temporary measure for severe or disabling anxiety. They are given at the lowest possible dose, for the shortest possible time, and not longer than about four weeks. The side effects can include feeling sluggish, unable to concentrate, and not caring about anything. Withdrawal symptoms may occur, if you take them for any length of time. These can seem worse than the original feelings of anxiety. The long-term use of tranquillisers has also been linked with having panic attacks.
The tranquillisers can't tackle the root cause of the problem, but they can bring some relief, until such time as other forms of treatment can be put in place.
The National Institute for Health and Clinical Excellence (NICE) suggests that for particular kinds of anxiety, such as panic, social phobia and obsessions, GPs should prescribe antidepressants, especially certain SSRIs (selective serotonin reuptake inhibitors).
SSRIs are usually better tolerated than some other drugs, but, in some cases, they may increase anxiety and can cause problems with sleeping. Your GP should give you the recommended dose regimen for anxiety, and he or she should monitor your progress. SSRIs can take two to four weeks to work. Some people may have withdrawal symptoms when coming off these drugs, such as dizziness, tingling, stomach upsets or headache. It's therefore important to reduce the dose slowly.
If SSRIs don't work or aren't suitable, you may be offered a tricyclic antidepressant such as imipramine or clomipramine. These drugs may also take several weeks to work, and may cause side effects, which your doctor should discuss with you.
Doctors may also suggest beta-blockers to deal with symptoms such as palpitations, although the success of this treatment is variable. (To find out more about medication, see Making sense of antidepressants and Making sense of sleeping pills and minor tranquillisers.)
Talking treatments
Talking treatments can help you to understand and deal with the causes of your anxiety and to find strategies for coping. (See Mind’s booklet Understanding talking treatments.) They have proved to have longer-lasting benefits than other treatments for anxiety problems. Ask your GP if there is a practice counsellor available. If not, you may be able to access talking treatments on the NHS, if your GP refers you. There are also many voluntary organisations offering counselling or psychotherapy (see Useful organisations).
There are various different types of counselling and psychotherapy available, in groups or individually. It may be short-term or open-ended and take place between one and four times a week. Some types help with how you are feeling, others look into reasons why you may be experiencing anxiety.
CBT is a short-term therapy and increasingly available on the NHS. It encourages you to develop positive ways of thinking and to construct strategies for managing anxiety, so you feel in control. You can receive CBT as part of face-to-face counselling, but it is also now available in computerised CBT programmes that you can use as a self-help aid. (See Making sense of cognitive behavioural therapy for more information.)
Decisions about your treatment should be made jointly with your GP. Don't be afraid to ask questions about the problems you are experiencing, the treatments suggested, their side effects, any possible alternatives and about how long it might take to feel better.
If none of these treatments make a difference, your GP can refer you for specialist help. This could be through your Community Mental Health Team (CMHT), which is made up of a number of different healthcare professionals who can assess you and offer you a treatment plan.
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How can friends and family help?
Recognising how you feel when you are anxious can help you to empathise with a friend or relative who is going through a bad patch. People with severe anxiety often feel very negative about themselves. Keep reminding them of their good points.
Being supportive can be a question of finding the right balance. You need to accept the person as they are, and not push them into situations that are beyond them. Yet, at the same time, you should avoid being too protective, and assist them to overcome small challenges. In this way, they can build up their self-confidence and feel in control.
It may be a good tactic to try and strike a bargain with your friend or relative. If they will agree to go to a relaxation class, for instance, you could promise to travel with them and meet them afterwards.
If someone is distressed, they may need reassurance that it’s OK to cry. Letting out feelings can relieve tension. Laughter is relaxing; helping your friend to have fun may be one of the most useful things you can do for them. They may also need support in finding appropriate channels to express anger, even if this is just bashing a few cushions about.
Some people may be embarrassed at not feeling in control. They may blush or shake, and need reassurance that this is not obvious to others. Sometimes, physical closeness, such as a touch or a hug, can be very comforting. A gentle massage to neck or shoulders may also be soothing.
Look after yourself
Supporting someone else through emotional problems can be very rewarding, but it can also be very frustrating. Look after yourself, or else you are likely to become impatient with them, and tense and irritable yourself. Finding someone you can confide in might be very useful.
If you are living with the person, make sure that you have a break. Their anxiety may stop them doing things, but it shouldn’t stop you, as well. You should not feel guilty doing things on your own. If you are enjoying life, you will find it easier to be loving and supportive. But if your friend feels you are being a martyr, they will feel anxious about spoiling your life.
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Useful organisations
Anxiety Care
Cardinal Heenan Centre, 326 High Road, Ilford, Essex IG1 1QP
helpline: 020 8478 3400, tel. 020 8262 8891
web: www.anxietycare.org.uk
Helps people to recover from anxiety disorders
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
Victoria Buildings, 9–13 Silver Street, Bury BL9 0EU
tel. 0161 797 4484
web: www.babcp.com
Can provide details of accredited therapists
British Association for Counselling and Psychotherapy (BACP)
BACP House, 15 St John’s Business Park, Lutterworth,
Leicestershire LE17 4HB
tel. 0870 443 5252
web: www.bacp.co.uk
Contact for details of local practitioners
The British Psychological Society
St Andrews House, 48 Princess Road East, Leicester LE1 7DR
tel. 0116 254 9568
web: www.bps.org.uk
Produces a directory of chartered psychologists
First Steps to Freedom
tel: 0845 120 2916
web: www.first-steps.org
Offers practical help to those who suffer from anxiety problems
The Institute for Complementary Medicine (ICM)
Unit 25, Tavern Quay Business Centre, Sweden Gate,
London SE16 7TX
tel. 020 7231 5855
web: www.i-c-m.org.uk
Has a register of professional, competent practitioners
National Phobics Society
Zion CRC, 339 Stretford Road, Hulme, Manchester M15 4ZY
tel. 0844 775 774
web: www.phobics-society.org.uk
Support, help and information for those with anxiety disorders
No Panic
93 Brands Farm Way, Telford, Shropshire TF3 2JQ
helpline: 0808 808 0545
web: www.nopanic.org.uk
Provides a helpline, step-by-step programmes, and support for those with anxiety disorders
UK Council for Psychotherapy (UKCP)
2nd Floor, Edward House, 2 Wakley Street, London EC1V 7LT
tel. 020 7014 9955
web: www.psychotherapy.org.uk
A membership body of almost 80 psychotherapy organisations in the UK. Maintains a voluntary register of qualified psychotherapists
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Further reading
Coping with anxiety and depression S. Trickett (Sheldon Press 1997)
How to assert yourself (Mind 2006)
How to cope with exam stress (Mind 2006)
How to cope with panic attacks (Mind 2006)
How to cope with sleep problems (Mind 2005)
How to cope with the stress of student life (Mind 2006)
How to deal with bullying at work (Mind 2004)
How to increase your self-esteem (Mind 2007)
How to stop worrying (Mind 2006)
How to stop worrying F. Tallis (Sheldon Press 2001)
Learn to balance your life M. & J. Hinz (DBP 2004)
Making sense of antidepressants (Mind 2006)
Making sense of counselling (Mind 2008)
Making sense of cognitive behaviour therapy (Mind 2007)
Making sense of sleeping pills and minor tranquillisers
(Mind 2007)
Making sense of psychotherapy and psychoanalysis (Mind 2004)
The Mind guide to managing stress (Mind 2006)
The Mind guide to physical activity (Mind 2006)
The Mind guide to relaxation (Mind 2006)
Mind troubleshooters: panic attacks (Mind 2007)
Overcoming anxiety H. Kennerley (Robinson 1997)
Overcoming social anxiety and shyness: self-help guide usingcognitive behavioural techniques G.Butler (Robinson 1999)
Relaxation: exercises and inspirations for wellbeing Dr S. Brewer(DBP 2003)
Understanding depression (Mind 2007)
Understanding obsessive-compulsive disorder (Mind 2004)
Understanding phobias (Mind 2004)
Understanding talking treatments (Mind 2005)
When panic attacks A. Tubridy (Newleaf 2003) (includes CD)
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tel. 0844 448 4448
fax: 020 8534 6399
email: publications@mind.org.uk
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This booklet was written by Kaaren Cruse
First published by Mind 1989. Revised edition © Mind 2008
ISBN 9781874690931
No reproduction without permission
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