[Article updated on 11 September 2017]
Understanding your anxiety
According to its medical definition, anxiety is a state consisting of psychological and physical symptoms that are brought about by a sense of apprehension at a perceived threat. These symptoms vary greatly according to the nature and magnitude of the perceived threat, and from one person to another.
Symptoms of anxiety
Psychological symptoms may include feelings of fear, an exaggerated startle reflex or alarm reaction, poor concentration, irritability, and insomnia. In mild anxiety, physical symptoms arise from the body’s so-called fight-or-flight response, a state of high arousal that results from a surge of adrenaline. These physical symptoms include tremor, sweating, muscle tension, a fast heartbeat, and fast breathing. Sometimes people can also develop a dry mouth and the irritating feeling of having a lump in the throat. In severe anxiety, hyperventilation or over-breathing can lead to a fall in the concentration of carbon dioxide in the blood. This gives rise to an additional set of physical symptoms including chest discomfort, numbness or tingling in the hands and feet, dizziness, and faintness.
In an anxiety disorder, exposure to the feared object or situation can trigger an intense attack of anxiety called a panic attack. During a panic attack, symptoms are so severe that the person begins to fear that she is suffocating, having a heart attack, losing control, or even ‘going crazy’. As a result, she may develop a fear of the panic attacks themselves, and this fear begins to trigger further panic attacks. A vicious circle takes hold, with panic attacks becoming ever more frequent and ever more severe, and even occurring completely out of the blue. This pattern of panic attacks is referred to as ‘panic disorder’, and can in some cases lead to the development of secondary agoraphobia in which the person becomes increasingly homebound so as to minimise the risk and consequences of having a panic attack. Panic attacks can occur not only in anxiety disorders, but also in depression, alcohol and drug misuse, and certain physical conditions such as hyperthyroidism. They can also sometimes occur in people who are not otherwise ill.
Managing your anxiety
The first step in managing anxiety is to learn as much as you can about it, as a thorough understanding of your anxiety can in itself reduce its frequency and intensity. It can be tempting to avoid any objects or situations that provoke or aggravate your anxiety, but in the long term such avoidance behaviour is counterproductive. When anxiety comes, accept it. Do not try to escape from it, but simply wait for it to pass. Easier said than done, of course, but it is important that you should try.
Making a problem list
One effective method of coping with anxiety that is related to a specific object or situation is to make a list of problems to overcome. Then break each problem down into a series of tasks, and rank the tasks in order of difficulty. To take a simple example, a person with a phobia of spiders may first think about spiders, then look at pictures of spiders, then look at real spiders from a safe distance, and so on. Attempt the easiest task first and keep on returning to it day after day until you feel fairly comfortable with it. Give yourself as long as you need, then move on to the next task and do the same thing, and so on. Try to adopt a positive outlook: although the symptoms of anxiety can be terrifying, they cannot harm you.
Using relaxation techniques
If a given task or situation is particularly anxiety-provoking, you can use relaxation techniques to manage your anxiety. These relaxation techniques are very similar to those used to manage stress, and can also be used for generalised anxiety, that is, anxiety that is not related to any particular object or situation, but that is free-floating and non-specific. One common and effective strategy, called ‘deep breathing’, involves modifying and regulating your breathing:
—Breathe in through your nose and hold the air in for several seconds.
—Then purse your lips and gradually let the air out, making sure that you let out as much air as you can.
—Continue doing this until you are feeling more relaxed.
A second strategy that is often used together with deep breathing involves relaxation exercises:
—Lying on your back, tighten the muscles in your toes for 10 seconds and then relax them completely.
—Do the same for your feet, ankles, and calves, gradually working your way up your body until you reach your head and neck.
Other general strategies that you can use for relaxing include listening to classical music, taking a hot bath, reading a book or surfing the internet, calling up or meeting a friend, practising yoga or meditation, and playing sports. As you can see, there is no shortage of things that you can do.
Implementing simple lifestyle changes
Simple lifestyle changes can also help to reduce anxiety. These might include:
—Simplifying your life, even if this means doing less or doing only one thing at a time.
—Having a schedule and keeping to it.
—Getting enough sleep.
—Exercising regularly (for example, walking, swimming, yoga).
—Eating a balanced diet.
—Restricting your intake of coffee or alcohol.
—Taking time out to do the things that you enjoy.
—Connecting with others and sharing your thoughts and feelings with them.
If you continue to suffer with severe anxiety despite implementing some of these measures, you can get in touch with one of several voluntary organisations which, amongst others, organise self-help groups and operate telephone help-lines. You can also speak to your family doctor who may suggest ways of helping you. For example, he or she may suggest referring you for a talking treatment or starting you on antidepressant medication, which can be used both in the treatment of depression and in the treatment of anxiety.
If your anxiety is especially disabling, your doctor may start you on a benzodiazepine sedative. Such sedatives are not a cure for anxiety, but they can provide short-term relief from some of your symptoms. Their long-term use should be avoided because they carry a high risk of tolerance (needing more and more to produce the same effect) and dependence or addiction. ‘Beta blockers’ are also occasionally prescribed to control some of the symptoms of anxiety, such as palpitations associated with a fast heart rate. However, they should be avoided in certain groups of people, most notably people with a history of asthma or heart problems.
Medication is usually most effective if it is combined with a talking treatment. Cognitive-behavioural therapy or CBT is commonly used in the treatment of anxiety. CBT for phobias may involve making a list of problems to overcome, and then breaking down each problem into a series of tasks that can be attempted in ascending order of difficulty. Relaxation techniques may also be taught so as to help you manage your anxiety and cope with each task more comfortably. CBT for panic disorder may also involve such graded exposure and relaxation training, but there is often also an added emphasis on modifying how you interpret changes in your body: for example, you may learn to interpret a fast heart rate in terms of the symptoms of anxiety rather than ‘catastrophically’ in terms of having a heart attack. You may also be taught how to control your breathing and thereby prevent some of the more alarming symptoms of anxiety.
Neel Burton is author of Heaven and Hell: The Psychology of the Emotions, Growing from Depression, The Meaning of Madness, and other books.