This article is part of a series of help & information based articles created for publication for the Manchester Institute for Psychotherapy based in Chorlton, Manchester. The aim of this series of articles is to provide information that will help individuals who feel they want to explore the differing options in relation to treatment of their issues, with or without seeking professional help.

The aim of this article is to explore the many ways that anxiety takes hold in our lives & what you can do about it. This article will help you understand anxiety & will therefore hopefully reduce the level of fear that can build up around a lack of understanding. This also helps with the feelings of lack of control that often go hand-in-hand with feelings of anxiety. In this article, I have explained what anxiety is, how it can manifest itself in your life, some of the differing types of anxiety, what you can do to help yourself, & what help is available for you.

This article will hopefully be a useful starting point for you in the management of your anxiety, whether you choose to tackle it alone, involve friends & family members, or seek medical/professional help.

Please note that some types of anxiety may require medical treatment. If you are in doubt at all, then please contact your GP, speak to them about your issues, & discuss whether seeing a Psychologist or Psychiatrist would be helpful for you.

I feel anxious ….what do I need to think about first?

Most forms of Anxiety can be managed – this is the great news….but the longer you leave it to be dealt with, the harder it can become. Anxiety is not just a psychological issue. It can affect you physiologically also.

How can anxiety affect me/my body?

Physical changes:                                        Mental/emotional changes:

Headaches                                                      Feelings of panic

Stomach upsets or feeling sick                      Irritability

Chest pain/tightness                                        Depression

Trembling                                                        Poor concentration

Sweating                                                         Feeling helpless & lack of control

Difficulties sleeping                                         Lacking confidence

Breathing issues e.g. shallow breath             Not wanting to socialise

Mood swings Restless sleep &/or Insomnia

Bad dreams/nightmares

The initial things for you to think about are:

1. Do I want to live my life in a more fulfilling way for me?
2. Has anyone else ever dealt with his or her anxiety issues, & if so, is it possible for me to control my feelings in time?
3. Is anyone available to support me?
4. Am I taking this issue seriously (& will I therefore seek extra help, e.g. from my GP, if needed)?

As with dealing with any emotional & behavioural problem, there may be times that you feel like you are not getting anywhere, you might have a bad few days, or a bad week. This can happen. The important thing here is getting back to working through your issues as soon as you practically can.  Working with & through anxiety can be hard, & there are some really great practical things you can do to help yourself:

Helpful Tips:

1. Ask for support from family & friends
2. Explain to them what happens to you when you feel anxious, what goes through your head, & tell them what is & what isn’t helpful for you
3. Write down your experience of anxiety & think about how it really affects you
4. Consider when your anxious feelings started, & ask yourself the following
   1. Can I correlate the start of my anxiety with an event in my life (whether happy   or sad)?
   1. If yes, what am I feeling now as I think about it? Am I starting to get anxious as I think about that event (or events)?

What happens to me when I get anxious?

Before we look at Anxiety Management, it is helpful to understand what happens to you when you become anxious.

Anxiety & the emotions of fear & anger are often related. For most people who suffer from anxiety, fear may be a familiar feeling in particular. Fear is a normal emotion that everyone feels from time to time. Anxiety is an extension of fearful feelings, & often suppressed anger & irritation, with a desire & need to gain control are bundled together & become known as “anxiety”. So we can say here that both fear & anxiety are both emotional responses.

What are the differences between fear & anxiety as emotional responses?

• Fear is a rational emotional response to a real threat
• Anxiety is an irrational emotional response to an imagined threat

For instance, imagine you are walking down a dark alley at night, & a person with a menacing look approaches you with a knife, what you then experience is fear. Fear is a normal reaction in this situation. However, if you walked down a familiar street in broad daylight & you began to imagine & worry that someone was going to attack you or some form of a disaster was going to occur without warning, then you are experiencing anxiety. Many people with anxiety cannot distinguish the difference between fear & anxiety, & they are frequently entangled in an emotional disturbance that is known as an anxiety disorder.

When defining anxiety, it is appropriate to speak of “worrying about worry”. Individuals with anxiety tend to over-think their issues & some worry more about having a disorder than about the actual situation(s) that have caused the anxiety. There is a circular aspect to this kind of thinking, & the circle can develop into a more severe case of anxiety if the person suffering does not receive help/treatment.

When someone is worried, they may find it very hard to focus on other tasks. The fantasies & random thoughts associated with anxiety can therefore draw attention away from our everyday lives & being present in the world. Some individuals with anxiety therefore start to withdraw, into themselves, & away from the world. An internal world & life that is subjective is then favoured (because it feels safe), over an external world & life that is objective (& doesn’t feel safe). Individuals may feel extremely distressed. Excessive distress in hand with the subjective thinking that often goes with anxiety, can lead to the start of a phobia &/or obsessive thinking & behaviour. Phobias & Obsessive issues are explored further ahead in this article.

What happens to my body when I feel frightened?

When we feel frightened or stressed, the first thing that usually happens that our body goes into a state called Fight or Flight. Difficult & dangerous situations in our lives can still evoke this basic human chain reaction in our bodies, but today it might be a telephone call with an urgent request, a job interview, an argument with your partner, or facing financial issues that cause this response.

During the Fight or Flight response, adrenalin, noradrenaline & cortisol chemicals get released into our bloodstream, our heart rate increases, & the blood (with the chemicals) is pumped to our extremities, enabling us to stay & fight, or run (take flight) from the dangerous or difficult situation. Our thinking quickens, enabling us to have more thoughts per second than we usually do. If we do not fight or run, therefore using up this chemical release, then the chemicals stay in our body. This is when we feel wound up but with no release.

Individuals who suffer with anxiety issues are also therefore usually very stressed & feel wound up with no release. The emotion of fear can & usually does put our body into a state of Fight or Flight.

Helpful tips:

1. It may help you to think of, & write down, some of the questions you ask yourself & some of the thoughts you have when you are feeling anxious, & what you then say to yourself in reply. Do you then make a decision about yourself or the action you will or won’t take? Take a few minutes to think about this & write down your reply.
2. Don’t underestimate what you are feeling.
3. Don’t put reasons or excuses in the way of you getting help, e.g. I’ll be ok when I’ve had a holiday or a decent night’s sleep…There is always a “good” reason why people can’t help themselves. Your behaviour may be the key to why you feel the way you do, so give yourself a break, & go & get some help & ask for support today.
4. Take one step at a time. Anxiety can often make you feel rushed. Take a breath & sit for a while, calming yourself with slow breathing as the wave of anxiety passes over you.
5. Try to not cling to the irrational thoughts that often go hand-in-hand with anxiety. Let them go when they enter your head. This may take some practice, & try this with something small first.
6. Don’t let the problem escalate. Deal with it NOW, before you get to a position where you become ill & probably need to take a long period of time to recover.
7. If you start to feel anxious, try the following Grounding exercise:

Sit with your feet firmly on the floor, so you are in a strong postural position.

It is good to have your feet roughly shoulder width apart,

Feel the solidity of the ground underneath you,

Close your eyes & imagine that your feet are rooted to the floor, & you feel strong & stable,

Breath deeply through your nose & out of your mouth, slowing your breath,

Imagine you are exhaling the frustration you have felt through the day,

Breathe normally now,

Open your eyes & still feel your feet on the floor & the stability of your posture,

Repeat this exercise as needed. It can be done with your eyes open, if you need to do it at your desk.

Are there different types of Anxiety?

Yes, there are many different types of anxiety. You will find an explanation & outline below of some of the differing types of anxiety. Explained below are the following:

• Panic attacks
• Panic disorders
• Social anxieties
• Generalised anxiety & Generalised anxiety disorder

In accordance with the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association, the following disorders/ issues fall within the category of Anxiety Disorders:

• Agoraphobia
• Panic Disorder with or without Agoraphobia
• Specific Phobia
• Social Phobia
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder
• Acute Stress Disorder
• Generalised Anxiety Disorder
• Anxiety Disorder due to a General Medical Condition
• Substance-Induced Anxiety Disorder
• Anxiety Disorder Not Otherwise Specified

You will find details of Post Traumatic Stress Disorder & brief details about Acute Stress Disorder in my separate article on Stress, entitled The Stress Response. Phobias are briefly covered in this article. This article has been generated to predominantly look at general anxiety & types of anxiety that a large proportion of individuals will suffer with at some point in their lives.

Panic Attacks

The following is taken from the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association:

“A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, & fear of “going crazy” or losing control are present”.

There are essential features of a Panic Attack & these include the individual having at least 4 out of 13 possible somatic (body related) or cognitive symptoms (please see the list below), & the attack has a sudden onset & builds to a peak rapidly (usually in 10 minutes or less) & is often accompanied by a sense of imminent danger or impending doom, & an urge to escape.

1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, light-headed, or faint
9. derealization (feelings of unreality) or depersonalisation (being detached from oneself)
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flushes

Panic Attacks are completely different to Generalized Anxiety, due to the immediacy of the attack, it’s seemingly random nature & the immense feelings that occur during the attack are perceived to have a greater severity. Panic Attacks that meet all of the other criteria, but have less than 4 symptoms are referred to as “Limited-symptom attacks” rather than a full-blown Panic Attack.

There are 3 types of Panic Attacks:

Unexpected (uncued)

Situationally bound (cued)

Situationally predisposed

Each type is defined by a different set of relationships between the onset of the attack & the presence/absence of situational triggers that can include cues that are either external (e.g. someone with claustrophobia has an attack in lift), or internal (e.g. catastrophic thoughts about the significance of heart palpitations).

Unexpected Panic Attacks are when the individual does not associate the start of their attack with an internal or external situational trigger. Individuals who have Unexpected Panic Attacks usually describe the fear to be intense & report that they thought they were about to die, lose control, have a heart attack or stroke, or “go crazy”. Usually these feelings go in hand with the need to urgently escape from wherever the attack is occurring. Evidence has shown that over a period of time, an individual who has Unexpected Panic Attacks can usually relate the attack to a certain place, memory or situation. However, sometimes unexpected attacks do persist.

Situationally bound (cued) Attacks occur immediately, or almost immediately, when the individual is exposed to (or expects to encounter) a situational trigger e.g. a person with a Social Phobia expecting to have to stand up at a dinner in a restaurant & give a toast.

Situationally predisposed Attacks are similar to Situationally bound, but are not always related to the “cue” & do not always occur after exposure to the cue, e.g. the person may have an Attack once when driving, but not again for months whilst still driving every day.

Agoraphobia

The following is taken from the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association:

The essential features of Agoraphobia are:

“Agoraphobia is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms”.

Individuals with Agoraphobia may isolate themselves, & in severe cases, may rarely go out, affecting their everyday lives considerably. In severe cases, individuals with Agoraphobia may therefore find it impossible to leave the house, attend a workplace (so would have to work from home), would feel incapable of going shopping (so would order everything via the internet or get a friend to do the shopping), & would only maintain existing relationships with people they felt able to cope with.

If you feel you may have Agoraphobia, it may be useful for you to ring NHS Direct (the number is provided at the end of this article), &/or ring & speak to your GP (if you cannot leave the house & go to the surgery). You can also contact your local branch of Mind, & a local community Mental health nurse may come to see you to do an assessment.

Panic Disorders

The following is taken from the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association:

“Panic Disorder without Agoraphobia is characterized by recurrent unexpected Panic Attacks about which there is persistent concern. Panic Disorder with Agoraphobia is characterized by both recurrent unexpected Panic Attacks & Agoraphobia.

Agoraphobia without History of Panic Disorder is characterized by the presence of Agoraphobia & panic-like symptoms without a history of unexpected Panic Attacks”.

The essential feature of Panic Disorder is the presence of recurrent, unexpected Panic Attacks followed by at least 1 month of persistent concern about having another Panic Attack, worry about the possible implications or consequences of the Panic Attacks, or a significant behavioural change related to the attacks. You do not have Panic Disorder if the attacks are due to a general medical condition, or you have taken a substance that has caused the attacks, or they are due to another mental health issue.

Social Anxieties & Phobias

The following is taken from the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association:

“Specific Phobia is characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.

Social Phobia is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour.

Obsessive-Compulsive Disorder is characterized by obsessions (which cause marked anxiety or distress) &/or by compulsions (which serve to neutralize anxiety).”

Phobias are very complex & hence the diagnosis of these has not been included in this article. If you think you may have a Social Anxiety or Phobia, it may be useful for you to speak with your GP or local branch of MIND for support & advise.

Generalised anxiety & Generalised anxiety disorder

The following is taken from the Diagnostic & Statistical Manual of Mental Disorders, 4^th Edition by the American Psychiatric Association:

“Generalized Anxiety Disorder is characterized by at least 6 months of persistent & excessive anxiety & worry.

Anxiety Disorder Due to a General Medical Condition is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition.

Substance-Induced Anxiety Disorder is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure.

Anxiety Disorder Not Otherwise Specified is included” for when “prominent anxiety or phobic avoidance “..”do not meet criteria for any of the specific Anxiety Disorders defined”.

The essential features of Generalized Anxiety Disorder is excessive anxiety & worry that occurs on more days than not for a period of at least 6 months, about a number of events or activities. If you have Generalized Anxiety Disorder, it may be hard for you to control the worry, & the anxiety & worry are accompanied by at least 3 additional symptoms from a list that includes:

1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind goes blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

In addition, the focus of the anxiety & worry is not confined to having a Panic Attack, being embarrassed in public, being contaminated, being away from home or people close to you, gaining weight, or having a serious illness, & the anxiety & worry do not occur exclusively during Posttraumatic Stress Disorder. 

Further, the anxiety, worry or physical symptoms must cause significant distress or impairment in social, occupational or other important areas of functioning in your life. You do not have Generalized Anxiety Disorder if your symptoms are due to a General Medical Condition, due to substance abuse, or another mental health issue.

Is Anxiety increasing?

Our society has changed dramatically over the last 25-50 years. Where we could leave our doors unlocked before, with no anticipation of anyone breaching our physical boundaries, we now find ourselves in quite a different society. The increase of media, TV, radio & newspapers, rarely includes “good news”. It is fair to say that we are regularly bombarded with a negative perception of our society, & we are regularly warned about protecting ourselves.

As boundaries have been breached more & more over the years, investment in house & personal alarms has rocketed. I believe that many companies have profited immensely from our imagined fear, therefore our anxieties. Our everyday living has become surrounded with security issues, & these, at some level, inform our own personal sense of security & safety in the world.

Ask yourself the following questions:

• How safe do you feel in the world?
• How safe do your friends & family feel?
• When you think of bad things that may happen to you, has this happened to you, or someone you know, in the past?
• How many precautions do you take on a daily basis to prevent an imagined threat occurring to you?

I recently visited a friend & she forgot to shut & lock her patio door when we went out for the day. When we returned, she was horrified to find that she had forgotten to do this. However, no one had come in & nothing had been stolen. She expressed surprise to me, because she realised that the level of anxiety she holds is an irrational fear. The subjective thought she had was that if she left her door open while she was out, she would come back to a ransacked house.

Of course, we need to do what we can in a rational manner to feel safe in our environment. I am not advocating that you leave your doors & windows open (therefore invalidating your home insurance if a claim was needed to be made), but this illustrates very simply how anxiety can affect us all.

Causes of Anxiety

There are many things that you can do that will help you cope with anxiety. Some helpful tips have already been provided & more will follow. We can encounter anxious feelings from one or a mixture of the following situations. This list gives you a general idea of areas where anxiety may arise (& is not exhaustive):

Relationship problems:                                          

Perceived issues with compatibility with partner or friends              

Feeling dissatisfied in your relationship(s) but not wanting to leave/exit

Unresolved issues from your childhood                                

Feelings of mistrust, jealousy &/or paranoia

Partner not understanding your issues & you being fearful of abandonment & rejection

Family problems:

Perceived issues within family relationships

Responsibilities being avoided

Unresolved issues from childhood

Feelings of mistrust, jealousy &/or paranoia

Family not understanding your issues & you being fearful of abandonment & rejection

Workplace problems:                                              

Unrealistic & unachievable targets being set & you fear the ramifications of not being able to meet the demands        

Anticipation of bullying or harassment                                                                      

Workplace disputes (& your anticipation is that you will be marginalized for speaking out)                        

Health problems:

Feeling unwell regularly & believing you have a particular illness (without medical confirmation)

Feelings of lack of control

Lack of understanding of illness & being scared of learning more for what you may find out scares you more

Limited or no support

Environment problems:                                          

Having been the victim of a crime or on the receiving end of someone else’s bad or unreasonable behaviour

Unsuitable living arrangements                                 

Financial pressures                                                                                        

Excessive noise/smell/disturbance

Feeling unsafe at home

Anxiety Management Tips

Below are some helpful tips for you to manage your Anxiety: There are many ways you can help yourself.

1. Learn to feel & be safer:

You can learn to control your fear & anxiety. Why not consider taking up a martial art or boxing? Single-sex classes are offered at some locations, if that will help you on your way. Learning to defend yourself is a great way of feeling safer. Some police forces offer &/or can recommend self defence classes. Exercising helps get rid of the levels of tension & adrenalin that can build up, & gets rid of the chemicals that are released when our body goes into Fight or Flight mode. 

• Find & join a support group:

Ask your GP, or speak to your local Health Authority or NHS Direct & ask if there are any local support groups that run in your area & would be useful for you to attend. If not, check your local Yellow Pages, Thomson Local & other directories for Support Groups.

• Speak to your GP & ask for help:

Make an appointment to see your GP. Before you go, list the things you want to tell him about. The following may be useful: (a) How your anxiety affects you physically, e.g. breathing, chest pain, etc.. (b) How your anxiety is affecting you emotionally & mentally, e.g. sleeping issues, repetitive thoughts, feeling terrified or afraid at certain times, (c) tell your GP what you have done yourself to try to help yourself, e.g. like preparing to see him/her, going to a support group, getting help from your family, reading books on Anxiety etc..

• Reduce your frustrations:

Do you know who you feel anxious around, what topics of conversation upset you, the situations that invite your anxiety? Can you avoid them? Reducing your contact with things that make you anxious can help you while you work through learning to manage your anxiety. It is not a long-term solution, but can help in the short-term. Even if you can’t permanently avoid a person or situation, staying away for a few days could help you reduce the anxiety & think of better ways of dealing with the situation in hand.

• Try reducing your fantasies & even stopping them:

Preoccupation with a situation, including repeatedly thinking about it &/or talking about it, may only increase your anxiety. Having feelings & thoughts that are “left over” from a situation are important to deal with. Tips for dealing with this are:

• Talk it over with someone you know is a calm person until you have finished & there is nothing left over for you
• Put the following 4 headings on a sheet of paper & write/list what is going on for you until you have finished. This task will help you process what is going on for you:
  • I am glad about/that…..
  • I am sad about/that…..
  • I am scared about/that…
  • I am angry about/that…

• Record the triggers of your anxiety & consequences of your anxiety:

To help you manage your anxiety, write down:

• What triggers your anxiety?
• The nature & intensity of your anxiety?
• Your thoughts & views of the situation immediately before & during the anxiety?

• What self-control methods did you use & how well did they work?
• The consequences (how others responded & other outcomes) following your emotional reaction?

Recording this information for a week or two can really help you in your steps to managing your anxiety & can highlight for you that you are probably not anxious all of the time, even though you may feel that at times.

• Reward yourself:

Think about how well you have done, even in taking small steps to change & manage your anxiety. It is hard. Reward yourself by doing something nice for yourself. This will help you recognise your achievements.

• Meditation & relaxation:

Meditation or yoga & relaxation can be used to help with feelings of anxiety. Taking time out to learn to breathe well & properly encourages not only a physical release of tension, but also emotional releases too. Both meditation & yoga will help you “get out of your head” for a short period of time, & therefore leaving your anxiety at the door.

• Learn to be assertive with others:

Assertiveness is tactful but firm; it is reasonable. Aggressiveness is inconsiderate, unreasonable, abrasive, & often an unfair angry over-reaction. Obviously, there will be less anxiety if you can be assertive rather than aggressive.

Depending on your type of anxiety:

• Learn to express your feelings, to stand up for your rights, to state your preferences & opinions, to immediately negotiate minor inconveniences or irritants. This is assertiveness. Quick effective action can help avoid the build up of anxiety.

1. Challenge your irrational ideas:

Anxiety-generating irrational ideas or beliefs come in various forms. Irrational ideas & beliefs generate anxiety. Are your ideas causing your anxiety? Write down & consider some of your beliefs. Talk them over with a good friend & see what their opinion is. Do you agree with what you have written down or are your beliefs someone else’s viewpoint that you have just taken on?

1. Find a therapist:

Seeing a Psychotherapist may really help you. People who suffer with anxiety often feel isolated, & often do not feel or think that they want to discuss their issues with family or friends. Whether you have an existing support network or not, seeing a Therapist may help you in your journey to changing your behaviour, while getting objective support, & will enable you to gain professional advise & guidance. You do not have to go forever, you can make an agreement with a therapist to go for a short time, & review after every 4-6 sessions or so to see how you are doing, & whether you want to remain in therapy.

Website for seeking a therapist in the UK:

www.uktherapists.com

 

What other help & information is available to me?

Below is a list of organisations that you can contact for help & advise. Please note that it is worth checking with the organisation whether there will be any costs around the help they can offer you. Many may only be able to offer you support in the form of sending you information, rather than practical or one-on-one support.

International Stress Management Association (ISMA)   

www.isma.org.uk

Tel: 07000 780430

PO Box 348, Waltham Cross, EN8 8ZL

A registered charity, promoting sound knowledge & best practice in the prevention & reduction of stress. Sets professional standards.

Mental Health Foundation              

www.mentalhealth.org.uk

Tel: 020 7802 0300

Email: mhf@mhf.org.uk

83 Victoria Street, London SW1H 0HW

Researches into mental health issues & produces information sheets & other publications.

Mind                                                  

www.mind.org.uk

Info line: 08457 660 163 (Mondays to Fridays 9.15am-4.15pm)

Campaigns for better mental health services in England & Wales through its variety of offices. Publishes leaflets & books. Local groups offered.

NHS Direct

www.nhsdirect.nhs.uk

Open 24 hours a day, every day. Tel: 0845 4647

Bibliography & References

Books:

“Diagnostic & Statistical Manual of Mental Disorders- 4^th Edition”, American Psychiatric Association. 2000, American Psychiatric Association

Magazines/Other articles:

“The Science of Meditation”, Time Magazine, October 17^th 2003 edition

Websites:

www.ask.co.uk