What is anxiety?
Anxiety is a word we use to describe our feelings when we are uncomfortable or frightened. So, if something frightens us, we get anxious. For example, if you are walking down a street and suddenly a vicious dog runs up to you, snarling and baring its teeth, you will almost certainly feel anxious because you are frightened that the dog will attack you.
Of course in this situation, you can easily see what has made you anxious and so you will tend not to worry about it after it is all over because it makes sense and it is quite normal and the anxiety will soon fade away. However, if we get those feelings of anxiety when nothing frightening has happened, we tend to worry that there is something wrong with us. Most people who seek help because of anxiety are like this. They find themselves getting anxious when there is nothing happening to them which should make them feel that way.
Anxiety really affects people in three ways:
Firstly, there are the physical symptoms of anxiety, changes that occur in the body.
Secondly, there are psychological symptoms of anxiety, what you feel and what you think when anxious.
Thirdly, there are the behavioural symptoms of anxiety, what you actually do when you are anxious.
The PHYSICAL symptoms of anxiety include:
- Heart racing - palpitations;
- Dizziness or light-headedness;
- Legs feeling weak, 'like jelly';
- Stomach churning ('butterflies'), feeling sick;
- Shakiness (especially hands and arms);
- Tingling Sensations;
- Dry mouth, difficulty in swallowing ('lump in throat');
- Feeling hot and sweaty, flushed;
- Wanting to go to the toilet;
- Muscle tension;
- Rapid breathing, tight 'band' across chest.
These are the main physical symptoms of anxiety. You may not experience all of them and of those you do experience some will be stronger than others. You may also suffer some other physical symptoms which are not here but which are related to the main symptoms on the list.
Behavioural Symptoms of Anxiety
The BEHAVIOURAL symptoms of anxiety include the things you actually do when you are anxious.
What you do will depend on the situations you find particularly stressful. Here are a few examples:
- Making excuses to avoid going out or doing something;
- Only going to quiet places or being in very small groups;
- Only going to places where you can get lost in a crowd and avoid being alone with people;
- Crossing the street to avoid people;
- Rushing out of places or situations when feeling anxious;
- Going to the toilet to escape from things;
- Not saying anything when with other people;
- Talking all the time to avoid feeling uncomfortable;
- Using 'props' before you go out - alcohol or drugs for example;
- In buildings, sitting near the doors, at the end of rows or as far back as possible.
Again, this is only a list of the main things people do when they are anxious and you may be able to think of other different things that you do. However, you will probably find that whatever it is you do, it comes down to either avoiding situations or escaping from them.
Psychological Symptoms of Anxiety
The PSYCHOLOGICAL symptoms of anxiety include what you feel when anxious, (that is, your emotions) and what you actually think and say when anxious.
Here is a list of some of the feelings and thoughts people get when anxious:
Feeling frightened or 'panicky';
- Feeling that you wont be able to cope;
- Thinking that you may be losing your mind;
- Thinking that you may be having a heart attack;
- Feeling that you are losing control;
- Worrying that you may be faint or sick;
- Thinking that there may be something wrong with your brain (for example, a tumour);
- Worrying that people are looking at you and thinking that you might be acting strangely;
- Worrying that you might be making a fool of yourself or doing or saying something silly;
- Wanting to escape and get to a safe place.
You might not experience all these things and one thought or fear might be particularly strong. Again, there might be a particular worry which is not included here, but which is similar to one on the list.
What is happening to me? - Physical Changes
To help you understand what is happening to your body when you get anxious let's take an example of a situation in which almost everyone would experience the symptoms of anxiety.
Imagine you are crossing a busy road, when suddenly you hear a very loud car horn go off a few feet away from you and a screech of brakes. What you will most likely do is immediately to jump or run, even before you've had the time to think what is happening. Having got out of the way of the car, you'll then be left feeling a bit shaky, with your heart thumping as well as some of the other symptoms in the previous list. Now what has happened is that a split second after you heard the horn and screech of brakes, what is called the 'anxiety response' has been switched on. What the anxiety response does is prepare your body for immediate action in the face of danger. What this means in practice is the following:
- Your heart rate shoots up: it does this as it can pump blood to the muscles of your arms and legs much more quickly, because it will be your arms and legs which will get you out of danger;
- To keep your heart beating at this faster rate, you need extra oxygen to give the heart energy - so you breathe much more quickly as well to get this extra energy for the heart;
- Because of the extra energy being sent to your arms and legs, the muscles are more tense, more ready to spring into action;
- Because your arms and legs need this extra blood for the muscles, much of the blood which usually goes to the stomach area is redirected away from the stomach (which can cope with less during this emergency) and is sent to the arms and legs, this leads to the churning feeling in the stomach, the 'butterflies';
- Just as your stomach can go on with a reduced blood supply in order that your arms and legs get an extra supply, so also your brain can easily cope with less blood for the same reason. this leads to your feeling light-headed and dizzy;
- As your heart is pumping blood more quickly around your body, especially to the muscles, your temperature increases so to cool your body down, you perspire more. Hence you feel hot and sweaty.
All this is carried out by the anxiety response. As you can see from the example, the anxiety response is automatic, you do not 'consciously' switch it on. This is because it needs to work immediately you are aware of the danger.
Thoughts, Feelings and Behaviour
Thoughts and Feelings
Many of these symptoms relate to a fear of losing control. If you don't know what the physical symptoms mean, you cannot understand what is happening to you and your body. This is where nearly everyone will tend to think the worse - "I'm having a heart attack" - "I am going crazy". These thoughts themselves will make you even more anxious and this leads to a vicious circle.
Sometimes your anxious thoughts and feelings may trigger off the physical symptoms. For example, you are about to go into an exam and suddenly the thought hits you "what if I panic?" - this thought will trigger off the panic and the vicious circle will make it worse.
You may do one or more of the things we have already listed. However, perhaps the most important thing you do which keeps things going is avoiding situations. If you do avoid a situation which makes you feel anxious, it may stop you feeling anxious in the short term. But, in the long term, it means that you will never get a chance to overcome your anxiety and will always feel frightened by that situation. If you avoid something once, probably next time it will be even more difficult. Other things on the list, such as taking a friend along with you when you go out, will also not help you overcome anxiety in the long run. You will come to rely on these ways of avoiding anxiety, rather than learning the better ways of dealing with it.
This is a difficult question to answer as each individual has a different story to tell. Nevertheless, there are some general reasons which can lead to a tendency to anxiety problems. They can be loosely described as springing from external (i.e. the outside world) or internal (your inner emotional life) sources.
Include threats which the individual feels unable to control such as breakdown of a relationship, excessive demands at work or by the family, or the end of a University course and no future plans. They also include uncertainties about important lifetime decisions such as the decision to withdraw from a course or to continue with a pregnancy. Phobic situations can arouse tremendous anxiety.
These are more complex but include unresolved trauma, where anxiety provoking intrusive thoughts, upsetting images or distressing emotions have their origins in earlier experiences. Some people, perhaps because of upsetting childhood experiences, have not developed the interpersonal skills which will equip them for the demands of social situations, thereby arousing considerable anxiety. Others have assumptions about themselves and others which almost guarantee that self or others will fail to live up to them. Some of us have a self-image that leads to closely monitoring and responding to our own sensations and reactions. This 'over-awareness' can mean we look out for any signal or evidence that appears to confirm our worst fears. This means we get more distressed, the anxiety response is triggered off and we have even greater confirmation of these fears.
Whatever the origins, anxiety can become a vicious circle in its effects and can exacerbate the original problem. Some of the self-help techniques developed can help to break the vicious circle but some people prefer to use counselling to help them understand and confront deep-rooted or troubling difficulties with anxiety. Both can complement the other as part of the helping process.
Self-control of anxious thoughts
While you are learning to control the physical symptoms by relaxation training, you also need to learn to control the emotional and psychological responses of anxiety.
You can learn to control thoughts and feelings by basically talking yourself through the anxiety, and also distracting yourself from the fear by concentrating on something else. 'Self-talk' can play an important role in this, with some of the following phrases as examples:
"this is a natural response. I know what is happening to my body"
"I am not going to die or have a heart attack"
"These feelings will fade away - they wont last forever"
"I know how to control these feelings. I must concentrate on relaxing myself"
"I am not going mad"
"I will begin to feel better soon"
"even though I feel shaky, I'm not going to faint or fall over"
"no-one is looking at me. I am not going to make a fool of myself"
If you find it difficult to talk yourself through your anxiety in this way despite practising, you may find it easier to concentrate on something else to take your mind off your anxiety. You can do this in several ways. Here are some examples:
- Mental tasks - e.g. going through times tables, counting backwards in 3's from 1000, thinking of poetry;
Imagining a relaxing scene - a beach, sitting in front of a coal fire;
- Concentrating on your immediate surroundings, counting lamp-posts, adding up the items in your shopping basket etc;
- Doing Things Differently
The main thing people do when they have an anxiety problem is to avoid situations in which they fear they will become anxious. To help you start to face up to situations, you need to set yourself daily behavioural targets and try to achieve them. For example, if you are anxious staying in groups or noisy places you can set yourself the target of staying for 30 minutes before leaving. The following day you set yourself the target of staying 45 minutes etc. By setting yourself these targets regularly and consistently, you will find that you gradually become better at letting go when you are tense by using relaxation, and better at replacing the anxiety-provoking thoughts. You will also find that the temptation to avoid situations gets steadily weaker the more you practice using behavioural targets. To put it simply, you will be learning to control anxiety.
Some ways of helping you set behavioural targets might be:
- to list all the situations you tend to avoid - from the easiest to the most difficult;
- each day set a target for one of the easier situations as you will find it easier to control anxiety in these situations;
- as you find it easier to control anxiety in the easier situations, begin to work towards the more challenging situations, setting targets for yourself.
- Try to review your progress and ensure that the targets you set are realistic and achievable. Don't give yourself a hard time if you don't always succeed - just re-adjust your target and try again. In time, your anxiety will come under your control and begin to ease.
Help with anxiety
In addition to counselling, there are some self-help techniques that can be important in dealing with anxiety related problems. See our pages on relaxation for more information, or for a relaxation programme.
Relaxation works in several ways to help you control anxiety. Obviously if you can get into a state of deep relaxation before doing something you find difficult and anxiety-provoking, then this will make you less likely to become anxious.