Anxiety and panic attacks
Explains anxiety and panic attacks, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.
About anxiety and panic
Read a transcript of the Mindcast.
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.
This type of 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 can protect you from danger. When you feel under threat, 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 sent to your muscles. Your senses become heightened and your brain becomes more alert.
These changes make your body able to take action and protect you in a dangerous situation either by running away or fighting. It is known as the 'fight or flight' reflex. Once the danger has passed, other hormones are released, which may cause you to shake as your muscles start to relax.
This response is useful for protecting you against physical dangers; for example, it can help you run away from wild animals, attackers, fires etc very quickly. The response is not so useful if you want to run away from exams, public speaking, a driving test, or having an injection. This is because, if there is no physical threat, and you have no need to physically run away or fight, the effects of adrenaline subside more slowly, and you may go on feeling agitated for a long time.
If the anxiety stays at a high level for a long time, you may feel that it is difficult to deal with everyday life. The anxiety may become severe; you may feel powerless, out of control, as if you are about to die or go mad. Sometimes, if the feelings of fear overwhelm you, you may experience a panic attack.
What is a panic attack?
A panic attack is an exaggeration of the body’s normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations, such as a pounding heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly. If you experience this, you may fear that you are going mad, blacking out, or having a heart attack. You may be convinced you are going to die in the course of the attack – making this a terrifying experience.
Panic attacks come on very quickly, symptoms usually peaking within 10 minutes. Most panic attacks last for between 5 and 20 minutes. Some people report attacks lasting for up to an hour, but they are likely to be experiencing one attack after another, or a high level of anxiety after the initial attack. You may have one or two panic attacks and never experience another. Or you may have attacks once a month or several times each week. For some people they seem to come without warning and strike at random.
I’m walking to the village shop, then the earth shifts to one side, my heart’s hammering as if it will explode, my vision is blurred and my hands are sticky with sweat. And I’ve no idea why.
Panic attacks can also come in the night and wake you up. These nighttime attacks occur if your brain is on 'high alert' (due to anxiety) and can detect small changes in your body which it then interprets as a sign of danger. Night-time attacks may be particularly frightening, as you may feel confused and are helpless to do anything to spot them coming.
Why do some people feel more anxious than others?
If you worry more than others, it could be because of your personality, current circumstances or your past or childhood experience; it could be a mixture of these.
If something distressing happened to you in the past, and you were unable to deal with your emotions at the time, you may become anxious about facing similar situations again in case they stir up the same feelings of distress.
Feeling anxious could also be something you learned early on in life; for example, your family may have tended to see the world as hostile and dangerous and you’ve learned to respond in the same way.
Some theories suggest that you may inherit a tendency to be more anxious, and so it is a part of your personality.
Everyday life and habits
On a day-to-day basis, caffeine, excess sugar, poor diet, drug misuse, exhaustion, stress and the side effects of certain medication can also mimic and trigger symptoms of anxiety.
Fear of losing control
You may worry about the future. Sometimes, if you feel you are not in control of many aspects of your life, you can start to feel anxious about events beyond your control, such as the threat of global warming, of being attacked, of developing cancer, or of losing a job.
After a while, you can start to fear the symptoms of anxiety, especially feeling out of control. This sets up a vicious circle. You may feel anxious because you dread feeling the symptoms of anxiety, and then you experience those symptoms because you are having anxious thoughts.
What are the effects of anxiety?
Anxiety can have an effect on both your body and your mind.
- Increased muscular tension can cause discomfort and headaches
- Rapid breathing 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 in the blood supply to your digestive system may cause nausea and sickness.
- You may feel an urgent need to visit the toilet, and get 'butterflies' in your stomach.
- Fear combined with tension and lack of sleep 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.
- You may also feel depressed. (See Depression)
Anxiety can make you more fearful, alert, 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: if you fear that the worst is going to happen, you may start to see everything negatively and become very pessimistic. For example, if a friend is late, you may imagine and worry that he or she has had an accident or doesn’t want to see you; even though your friend may simply be late because their train was delayed.
To cope with these feelings and sensations, you may feel tempted to start smoking or drinking too much, or misusing drugs. You may hold on to relationships that either encourage your anxious outlook or help you avoid situations you find distressing – and so stop you dealing with what’s worrying you.
Impact on work, leisure and relationships
If your anxiety is severe, you may find it difficult to hold down a job, develop or maintain good relationships, or simply to enjoy leisure time. Sleep problems may make your anxious feelings even worse and reduce your ability to cope. (See 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 people may develop a phobia about going out, or may withdraw from contact with people – even their family and friends. Others have obsessive thoughts or compulsive behaviour, such as endlessly washing their hands.
What type of anxiety disorders are there?
There are several types of anxiety and panic disorders, because people respond to anxiety and panic attacks in different ways. Some of the more common disorders are outlined below.
Phobia is about irrational fear. If you have a phobia, your anxiety will be triggered by very specific situations or objects; such as spiders, heights, flying or crowded places, even when there is no danger to you. For example, you may know a spider isn’t poisonous or won’t bite you, but this still doesn’t reduce your anxiety. Likewise, you may know that it is safe to be out on a balcony in a high-rise block, yet, feel terrified to go out on it or even enjoy the view from behind the windows inside the building. (See Phobias for further information.)
Generalised anxiety disorder (GAD)
You may be diagnosed with generalised anxiety disorder if you have felt anxious for a long time and often feel fearful, but are not anxious about anything in particular. The strength of symptoms can vary.
Obsessive Compulsive Disorder (OCD)
Obsessive thoughts and compulsive behaviour are typical for this disorder. You may, for example, have obsessive thoughts about being contaminated with germs or fear that you have forgotten to lock the door or turn off the oven. You may feel compelled to wash your hands, do things in a particular order or keep repeating what you are doing a certain number of times. (See Obsessive-compulsive disorder.)
Post-traumatic stress disorder (PTSD)
If you have experienced or witnessed a very stressful or threatening event, e.g. war, serious accident, violent death or rape, you may later develop post-traumatic stress disorder. You are likely to experience flashbacks and have dreams about the event, and these are likely to trigger strong anxiety and feelings you experienced during the actual event. (See Post-traumatic stress disorder.)
Panic attacks may sometimes occur for no reason, and you may not be able to understand why. You may feel as if your mind has gone totally out of control . When you experience panic attacks that seem completely unpredictable and you can’t identify what has triggered them, you may experience panic disorder. Because the onset of panic seems unpredictable, you may live in fear of having another panic attack. This fear can become so intense it can trigger another panic attack.
How 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. Therefore, a common – and natural – response to anxiety is to avoid what triggers your fear. For example, if you are afraid of spiders, running away every time you see one, is likely to increase your fear. Avoiding an exam because you feel anxious is likely to make you feel worse. Therefore facing up to anxiety, and how it makes you feel, can be the first step in breaking the cycle of fear and insecurity.
At the onset of panic, I keep telling myself that I have been here before and that I get through it again. It will pass if I try to keep as calm as I can.
Controlling the symptoms
You may find that your symptoms can be controlled by breathing and relaxation techniques. Books and CDs on the topic are available both online and from bookstores to help you with this – also see Mind’s booklet How to manage stress for some exercises. Several self-help programmes on relaxation are available online, or you could attend a relaxation class. In some areas there are also classes in anxiety management (see ‘Useful contacts’).
Being assertive means you can stand up for yourself while also respecting other people and their opinions.
Learning how to handle difficult situations and to assert 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 local classes, ask at your library or look on the internet.
I have found that activities that involve ‘putting myself out there’ – e.g. dance classes that involve having to perform on stage for an end of year show or exam – very helpful in developing confidence and assertiveness, especially as they make you stand up straight and ‘walk tall’ rather than ‘hide’.
Some people may find that complementary therapies help them 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 helpful. Many chemists and health shops stock different remedies and may be able to offer advice.
I find chamomile tea helpful when feeling very anxious. It calms my body down without the horrible side-effects of medication. Massage has also been very helpful. Listening to a relaxation CD everyday was also a life-saver during a period of extreme anxiety.
Mindfulness-based cognitive therapy (MBCT) is recommended by NICE (National Institute for Health and Clinical Excellence) for recurrent depression. Some people find that it can also help with anxiety. MBCT is based on Mindfulness-based stress reduction (MBSR). This was developed to help people with a range of disorders, including chronic pain, hypertension and heart disease, as well as emotional distress such as anxiety and panic. The treatment is usually done in groups and includes learning how to be more aware and mindful about what you are experiencing. It will teach you techniques for how to deal with your problems, including yoga, relaxation and meditation.
(See 'Useful contacts' for organisations that can provide further information and list of registered practitioners).
A healthy lifestyle
Exercise uses up the adrenalin and other hormones that are produced under stress, allowing muscles to relax. It can therefore help you to cope with anxiety and feelings of tension, and may help you sleep better. Walking and swimming allow you to be active at your own pace and you can do them alone or in company.
Eating a healthy diet and getting plenty of sleep can also make a big difference to your ability to cope with stress (see How to manage stress). You may find it easier to relax if you avoid stimulants such as coffee, cigarettes and alcohol.
Talking to a friend or family member about what's making you anxious can help. You may find that they have encountered a similar problem and can talk you through it; however, just having had someone listen to you and showing that they care, can help in itself.
What sort of treatment can I get?
If you find that anxiety is affecting your ability to cope with everyday life and want help, your GP can help you find out what options are available. The most common forms of treatment offered are talking treatments and medication. You may also be offered, for example, exercise on prescription.
Talking treatments (counselling and psychotherapy) can help you to understand and deal with the causes of your anxiety and to find strategies for coping (see Talking treatments).
There are different types of counselling and psychotherapy available in groups or individually. Some types help with how you are feeling; others look into reasons why you may be experiencing anxiety; some may do both. Most services offer time-limited counselling or therapy – usually between 6-12 sessions, and usually one session a week. Some GP surgeries – and many voluntary organisations – offer a variety of counselling and psychotherapy services.
If you want to try a talking therapy, your GP can provide information and refer you to a local service. Also see ‘Useful contacts’ for organisations listing local practitioners.
When the GP said he could help, I didn’t believe him at first, I’d felt so embarrassed telling him what was happening to me. He said he’d wished I’d made an appointment sooner as severe anxiety like mine can usually be tackled, even ‘cured’.
Cognitive Behavioural Therapy (CBT)
CBT is recommended by NICE for anxiety and panic disorders. It is a short-term therapy that is increasingly available on the NHS. CBT encourages you to develop new ways of thinking and to work out strategies for managing anxiety, so you feel in control.
CBT is usually offered as face-to-face therapy; however, some CBT programmes are available as online programmes that you can use as a self-help aid. The availability of CBT has developed fast under the government-funded programme ‘Access to Psychological Therapies (IAPT). However, in some areas the service is still patchy. (See Cognitive behavioural therapy for more information and see BABCP in for a list of practitioners.)
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).
SSRI antidepressants 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 for anxiety, and he or she should monitor your progress. If SSRIs don't work or aren't suitable, you may be offered a tricyclic antidepressant, such as imipramine or clomipramine.
All these drugs may take several weeks to work, and may cause side effects, which your doctor should discuss with you. When you stop taking the drugs, you may experience withdrawal symptoms, such as dizziness, tingling, stomach upsets or headache. It is therefore important to reduce the dose slowly.
Doctors may also suggest beta-blockers to deal with symptoms such as palpitations, although the success of this treatment is variable. They may also help with anxiety in particular situations; for example, sitting an exam or flying.
Tranquillisers and sleeping pills
Doctors usually prescribe tranquillisers and sleeping pills (benzodiazepines) only as a temporary measure for severe or disabling anxiety, as some people become dependent on these drugs and have difficulty coming off them. 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. Withdrawal should be done slowly. Long-term use of tranquillisers has also been linked with having panic attacks.
Tranquillisers can't tackle the cause of your problems, but they can bring some relief, until other forms of treatment can be put in place.
Exercise on prescription
Many GPs can prescribe exercise for a variety of problems, including mental health problems. If you are prescribed this, you will be referred to a qualified trainer who can help set up exercises and a training programme that suits you.
Don't be afraid to ask questions about the problems you are experiencing, the treatments suggested, their side effects, possible alternatives and how long it might take to feel better.
If none of the treatments offered to you 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.
Friends and family
How can friends and family help?
If you have a friend or relative who experiences high levels of anxiety, it can help if you are able to think about how you feel yourself when you are anxious. This might help you to understand how they feel when they are going through a bad time.
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, it can be helpful to encourage 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.
One thing that really helped me overcome the fear of going out as a result of panic attacks, was being made to go out for walks or to a cafe with a friend... rather than let me stay in, I was made to face my fears... Although I sometimes felt very panicky, it gradually became easier and easier...
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.
People with severe anxiety may feel very negative about themselves. Keep reminding them of their good points.
tel. 07552 877 219
Helps people to recover from anxiety disorders.
tel. 08444 775 774
Support, help and information for those with anxiety disorders.
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 705 4304
Can provide details of accredited therapists.
British Association for Counselling and Psychotherapy (BACP)
tel. 01455 883 300
For Information about counselling and therapy. See website or sister website, itsgoodtotalk, for details of local practitioners.
The British Psychological Society
tel. 0116 254 9568
Produces a directory of chartered psychologists.
The Complementary Medical Association (CMA)
tel: 0845 129 8434
Has a register of professional practitioners and training courses.
Institute for Complementary and Natural Medicine (ICNM)
tel. 020 7922 7980
Has a register of practitioners.
Mindfulness Based Cognitive Therapy
Information about the therapy, classes in Mindfulness and training.
NICE (National Institute for Health and Care Excellence)
Information and guidelines on recommended treatments for different disorders.
helpline: 0800 138 8889
Provides a helpline, step-by-step programmes, and support for those with anxiety disorders.
24-hour helpline: 08457 90 90 90
Freepost RSRB-KKBY-CYJK, ChrisPO Box 90 90
Emotional support for anyone feeling down, experiencing distress or struggling to cope.
UK Council for Psychotherapy (UKCP)
tel. 020 7014 9955
Has a voluntary register of qualified psychotherapists.
To be revised 2014
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