Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future. Anxiety is a natural human response when we perceive that we are under threat. It can be experienced through our thoughts, feelings and physical sensations.
Anxiety can feel as if everyone in the world is waiting for us to trip up, so that they can laugh at us. It makes us feel nervous and unsure whether the next step we take is the correct one.
Most people feel anxious at times. It’s particularly common to experience some anxiety while coping with stressful events or life changes, especially if they could have a big impact on your life.
‘Fight, Flight or Freeze’ response
Like all animals, human beings have evolved in various ways to help us protect ourselves from danger. When we feel under threat our bodies react by releasing certain hormones, such as adrenaline and cortisol. These hormones:
Often make us feel more alert, so we can act faster
Often make our hearts beat faster, quickly sending blood to where it’s needed most.
After we feel the threat has passed, our bodies release other hormones to help our muscles relax. This can sometimes cause us to shake.
This is commonly called the ‘fight, flight or freeze’ response – it’s something that happens automatically in our bodies, and we have no control over it.
“Leaving the house is a challenge because we have a fear of panicking and feel that were being watched or judged. It’s just horrible. We want to get help but were afraid of being judged.
When is anxiety a mental health problem?
Anxiety can become a mental health problem if it impacts on your ability to live your life as fully as you want to. For example, it may be a problem for us if:
- our feelings of anxiety are so strong or last for a long time
- our fears or worries are out of proportion to the situation
- we avoid situations that might cause you to feel anxious
- our worries feel very distressing or are hard to control
- we find it hard to go about your everyday life or do things you enjoy.
If our symptoms fit a particular set of medical criteria then we might be diagnosed with a particular anxiety disorder. It’s also possible to experience problems with anxiety without having a specific diagnosis.
What is an anxiety disorder?
Anxiety can be experienced in lots of different ways. If our experiences meet certain criteria our doctor might diagnose us with a specific anxiety disorder.
Some commonly diagnosed anxiety disorders are:
- Generalised anxiety disorder (GAD) – this means having regular or uncontrollable worries about many different things in our everyday life. Because there are lots of possible symptoms of anxiety this can be quite a broad diagnosis, meaning that the problems you experience with GAD might be quite different from another person’s experiences.
- Social anxiety disorder – this diagnosis means we experience extreme fear or anxiety triggered by social situations (such as parties, workplaces, or any situation in which you have to talk to another person). It is also known as social phobia.
- Panic disorder – this means having regular or frequent panic attacks without a clear cause or trigger. Experiencing panic disorder can mean that we feel constantly afraid of having another panic attack, to the point that this fear itself can trigger our panic attacks.
- Phobias – a phobia is an extreme fear or anxiety triggered by a particular situation (such as social situations) or a particular object (such as spiders).
- Post-traumatic stress disorder (PTSD) – this is a diagnosis we may be given if we develop anxiety problems after going through something we have found traumatic. PTSD can cause flashbacks or nightmares which can feel like you’re re-living all the fear and anxiety experienced during the actual event.
- Obsessive-compulsive disorder (OCD) – you may be given this diagnosis if your anxiety problems involve having repetitive thoughts, behaviours or urges.
- Health anxiety – this means we experience obsessions and compulsions relating to illness, including researching symptoms or checking to see if we have them. It is related to OCD.
- Body dysmorphic disorder (BDD) – this means we experience obsessions and compulsions relating to our physical appearance.
- Perinatal anxiety or perinatal OCD – some women develop anxiety problems during pregnancy or in the first year after giving birth.
You might not have, or want, a diagnosis of a particular anxiety disorder – but it might still be useful to learn more about the different diagnoses to help us think about our own experiences of anxiety, and consider options for support.
What does anxiety feel like?
Anxiety feels different for everyone. We experience some of the things listed below, and we might also have other experiences or difficulties that aren’t listed here.
Effects on our bodies
- a churning feeling in our stomach
- feeling light-headed or dizzy
- pins and needles
- feeling restless or unable to sit still
- headaches, backache or other aches and pains
- faster breathing
- a fast, thumping or irregular heartbeat
- sweating or hot flushes
- grinding our teeth, especially at night
- nausea (feeling sick)
- needing the toilet more or less often
- changes in our sex drive
- having panic attacks
Effects on our minds
- feeling tense, nervous or unable to relax
- having a sense of dread, or fearing the worst
- feeling like the world is speeding up or slowing down
- feeling like other people can see we’re anxious and are looking at us
- feeling like we can’t stop worrying, or that bad things will happen if we stop worrying
- worrying about anxiety itself, for example worrying about when panic attacks might happen
- wanting lots of reassurance from other people or worrying that people are angry or upset with us
- worrying that we’re losing touch with reality
- rumination – thinking a lot about bad experiences, or thinking over a situation again and again
- depersonalisation – feeling disconnected from our mind or body, or like we’re watching someone else (this is a type of dissociation)
- derealisation – feeling disconnected from the world around us, or like the world isn’t real (this is a type of dissociation)
- Worrying a lot about things that might happen in the future
What is a panic attack?
Panic attacks are a type of fear response. They’re an exaggeration of your body’s normal response to danger, stress or excitement.
What is Panic Disorder?
What do panic attacks feel like?
During a panic attack, physical symptoms can build up very quickly. These can include:
- a pounding or racing heartbeat
- feeling faint, dizzy or light-headed
- feeling very hot or very cold
- sweating, trembling or shaking
- nausea (feeling sick)
- pain in our chest or abdomen
- struggling to breathe or feeling like we’re choking
- feeling like our legs are shaky or are turning to jelly
- Feeling disconnected from our mind, body or surroundings
During a panic attack you might feel very afraid that we’re:
- losing control
- going to faint
- having a heart attack
- going to die.
We might find that we’ve become scared of going out alone or to public places because we’re worried about having another panic attack. If this fear becomes very intense, it may be called agoraphobia
When might I have panic attacks?
Panic attacks can happen during the day or night. Some people have one panic attack then don’t ever experience another, or we might find that we have them regularly, or several in a short space of time. We might notice that particular places, situations or activities seem to trigger panic attacks. For example, they might happen before a stressful appointment.
Most panic attacks last between 5–20 minutes. They can come on very quickly. Our symptoms will usually peak (be at their worst) within 10 minutes. We might also experience symptoms of a panic attack over a longer period of time. This could be because you’re having a second panic attack, or you’re experiencing other symptoms of anxiety.
What helps to manage panic attacks?
Panic attacks can be frightening, but there are things we can do to help ourselves cope.
During a panic attack:
- Focus on our breathing. It can help to concentrate on breathing slowly in and out while counting to five/ten.
- Stamp on the spot. Some people find this helps control their breathing.
- Focus on our senses. For example, taste strong-flavoured sweets or gum, or touch or cuddle something soft.
- Try grounding techniques. Grounding techniques can help us feel more in control. They’re especially useful if we experience dissociation during panic attacks.
After a panic attack:
- Think about self-care. It’s important to pay attention to what our body needs after we’ve had a panic attack. For example, you might need to rest somewhere quietly, or eat or drink something.
- Tell someone we trust. If you feel able to, it could help to let someone know eve had a panic attack. It could be particularly helpful to mention how they might notice if were having another one, and how you’d like them to help us. Can we educate them?
What is panic disorder?
If we’re having lots of panic attacks at unpredictable times and there doesn’t seem to be a particular trigger or cause, we might be given a diagnosis of panic disorder. It’s common to experience panic disorder and agoraphobia (a type of phobia) together. People who experience panic disorder may have some periods with few or no panic attacks, but have lots at other times.
Panic disorder and high sensitivity
Some of our research suggests that people who have panic disorder might be very sensitive to sensory experiences (such as sunlight, smells and changes in the weather), but there’s still not enough evidence yet to say for sure. Also it’s not clear whether having a high level of sensitivity to these sorts of things is something that might cause you to develop panic disorder, or whether it may be an effect of having it.
What causes anxiety?
No one knows exactly what causes anxiety problems, but there are probably lots of factors involved. Below covers some things which make anxiety problems more likely to happen:
Can anxiety problems be inherited genetically?
Research shows that having a close relative with anxiety problems increases our chances of experiencing anxiety problems ourselves. At the moment there is not enough evidence to show whether this is because we share some genetic factors that make us more vulnerable to developing anxiety, or because we learn particular ways of thinking and behaving from our parents and other family members as we grow up.
Past or childhood experiences
Difficult experiences in childhood, adolescence or adulthood are a common trigger for anxiety problems. Going through stress and trauma is likely to have a particularly big impact if it happens when we’re very young. Experiences which can trigger anxiety problems include things like:
- physical or emotional abuse
- losing a parent
- Being bullied or being socially excluded.
- Having parents who don’t treat you warmly, or who are overprotective or are emotionally inconsistent can also be a factor.
Our current life situation
Current issues or problems in our life can also trigger anxiety. For example:
- exhaustion or a build-up of stress
- long working hours
- being out of work
- feeling under pressure while studying or in work
- having money problems
- homelessness or housing problems
- losing someone close to us
- feeling lonely or isolated
- Being bullied, harassed or abused.
Physical or mental health problems
Other health problems can sometimes cause anxiety, or might make it worse. For example:
- Physical health problems – living with a serious, ongoing or life-threatening physical health condition can sometimes trigger anxiety.
- Other mental health problems – it’s also common to develop anxiety while living with other mental health problems, such as depression.
Drugs and medication
Anxiety can sometimes be a side effect of taking:
- some psychiatric medications
- some medications for physical health problems
- Recreational drugs or alcohol.
How can we help ourselves?
Living with anxiety can be very difficult, but there are steps we can take that might help. Here are some suggestions for us to consider.
Talk to someone we trust
Try to manage our worries
Look after our physical health
Try breathing exercises
Keep a diary
Try peer support
What treatments are available?
There are various evidence-based treatments that have been found to help with anxiety problems and panic disorder. They could be:
- Accessing Treatment
A self-help resource might be the first treatment option our doctor offers us. This is because it’s available quickly, and there’s a chance it will help you to feel better without needing to try other options.
Self-help can be delivered through:
- Workbooks. For example, your doctor/GP might recommend particular titles from a scheme that has helped others. These schemes are supported by most libraries, so you can go and check the books out for free – we don’t actually need a prescription from a doctor.
- A computer-based Cognetive Behaviour Therapy programme for treating anxiety and panic attacks. There are several app-based CBT courses recommended on the NHS apps library, which you can search to find any app that may work for us.
We might be offered resources to work through on our own, or on a course with other people who experience similar difficulties. Group classes can be very successful and allow us to understand how others can be affected
Talking as a treatment
If self-help resources aren’t likely to help with the anxiety problems we experience or we’ve already tried them and they haven’t helped, our doctor should offer us a talking treatment. There are two types of talking treatment recommended for anxiety and panic:
- Cognitive behavioural therapy (CBT) – this focuses on how your thoughts, beliefs and attitudes affect our feelings and behaviour, and teaches us coping skills for dealing with different problems.
- Applied relaxation therapy – this involves learning how to relax your muscles in situations where we normally experience anxiety.
Our doctors might offer to prescribe us medication to help manage some symptoms. Some people find it helpful to try talking treatments and medication at the same time, but medication shouldn’t be the only things were offered.
Below are some medications we might be offered and based on personal education
Usually this will be a type called a selective serotonin reuptake inhibitor (SSRI), but these drugs can sometimes cause side effects such as sleeping problems or feeling more anxious than we did before. If SSRIs don’t work or aren’t suitable we may be offered a different kind called a tricyclic antidepressant.
In some cases, such as if you have a diagnosis of generalised anxiety disorder (GAD), your doctor may decide to prescribe you a drug called pregabalin. This is an anti-seizure drug which is normally used to treat epilepsy (a neurological disorder that can cause seizures), but is also licensed to treat anxiety.
Beta-blockers are sometimes used to treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations and tremors (also known as shaking). However, they are not psychiatric drugs so they don’t reduce any of the psychological symptoms. They may be helpful in certain situations; such as if we have to face a phobia(s)
If you experience very severe anxiety that is having a significant impact on our day-to-day lives, we may be offered a benzodiazepine tranquilliser. These drugs can cause unpleasant side effects and can become addictive, so your doctor should only prescribe them at a low dose for a short time, to help you through a very troubled period.
Before deciding to take any drug/medicine, it’s important to make sure we have researched all the facts we need to make an informed choice.
To get treatment on the NHS, the first step is normally to visit our doctor (also known as your GP). They will do an assessment, which might include asking us to fill in a questionnaire about how often we feel worried, anxious and nervous. They should then explain our treatment options to us, and we can decide together what might suit us best.
Unfortunately NHS waiting lists for talking treatments can be very long (I have often waited up to 18 months). If finding it hard to access talking treatments we could consider:
- Charities and specialist organisations. A list of organisations that may offer therapy or be able to put you in touch with local services can be found on the internet.
- Private therapy. Finding a private therapist is another option some people choose to explore, but it’s not suitable for everyone because it can be expensive.
Will my anxiety stop me from seeking help?
It can be especially hard to access treatment if making or attending an appointment with your doctor involves doing something that causes anxiety for us. For example, you might not feel able to talk on the phone or leave the house or as with me driving a car to a place that involves passing pedestrians.
Here are some things we should try:
- Ask our doctor if they offer home visits or telephone assessments. If not, they might be able to book us an appointment at a time when the surgery tends to be quiet.
- Some GP practices will allow someone else to ring up and book appointments for us (with your consent). It could also help to have someone come with us to the appointment for support.
What if we don’t feel better?
Your doctor should offer us regular appointments to check how we’re doing, and see how well any treatment is working for us. Different things work for different people, so if a particular medication or talking treatment doesn’t work for us, our doctor should offer an alternative.
If you’ve tried a range of treatments and none of them have helped, your doctor might refer you to a community mental health team (CMHT). This is made up of a number of different healthcare professionals, such as psychiatrists and clinical psychologists. Your CMHT can assess you separately and offer you a personalised treatment plan.
This is particularly recommended if:
- our symptoms are making it very difficult to carry out everyday activities
- we have a serious physical health problem or another mental health problem
- We’re having thoughts of self-harm or suicide.
It’s important to remember that recovery is a journey, and it won’t always be straightforward. We might find it more helpful to focus on learning more about ourselves and developing ways to cope, rather than trying to get rid of every symptom of our anxiety problem.
How can other people help us?
It can be really difficult when someone you care about is experiencing anxiety problems or panic attacks, but there are things you can do to help.
Don’t pressure them
Try not to put pressure on your friend or family member to do more than they feel comfortable with. It’s really important to be patient, listen to their wishes and take things at a pace that feels okay for them.
It’s understandable to want to help them face their fears or find practical solutions, but it can be very distressing for someone to feel they’re being forced into situations before they feel ready. This could even make their anxiety worse. Try to remember that being unable to control their worries is part of having anxiety, and they aren’t choosing how they feel.
Helping someone who is having a panic attack
It’s understandable to feel frightened if someone you care about experiences a panic attack – especially if it seems to happen without warning. But it can help if you:
- try to stay calm
- gently let them know that you think they might be having a panic attack and that you are there for them
- encourage them to breathe slowly and deeply – it can help to count out loud, or ask them to watch while you gently raise your arm up and down
- encourage them to stamp their feet on the spot
- Encourage them to sit somewhere quietly until they feel better.
You should never encourage someone to breathe into a paper bag during a panic attack. This isn’t recommended and it might not be safe.
Try to understand
- Find out as much as you can about anxiety. This will help you understand what they are going through. Reading personal experiences can help too.
- Ask about their experience. You could ask them how anxiety affects their day-to-day life, and what makes it better or worse. Listening to their experience could help you to empathise with how they feel.
Ask how you can help?
Your friend and family member may already know how you can support them – for example, it might help to take them out of the situation, talk to them calmly or do breathing exercises with them.
By asking them what they need or how you can help, you can support them to feel more in control of them. Knowing that there is someone around who knows what to do if they start to feel frightened or panicked could help those feels safer and calmer.
“Reminding me to breathe, asking me what I need…”
Support them to seek help
If you think your friend or family member’s anxiety is becoming a problem for them, you could encourage them to seek appropriate treatment by talking to a GP or therapist. You could:
- Offer to help them arrange a doctor’s appointment. If they are scared of leaving the house, you could suggest they ring their GP to find out if they will do home visits.
- Offer support when they attend appointments. You could offer to go with them to their appointments and wait in the waiting room. You can also help them plan what they’d like to talk about with the doctor.
- Help them seek help from a therapist.
- Help them research different options for support, such as community services or peer support groups such as those run by Anxiety UK and No Panic.
Look after yourself
It can sometimes be really challenging to support someone with a mental health problem – you are not alone if you feel overwhelmed at times. It is important to remember to look after your own mental health too, so you have the energy, time and distance you need to be able to help.
- Set boundaries and don’t take too much on. If you become unwell yourself you won’t be able to offer as much support. It is also important to decide what your limits are and how much you feel able to help.
- Share your caring role with others, if you can. It’s often easier to support someone if you’re not doing it alone.
- Talk to others about how you’re feeling. You may want to be careful about how much information you share about the person you’re supporting, but talking about your own feelings with someone you trust can help you feel supported too.