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.

Your Behaviour

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.

Why Me?

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.

External 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.

Internal Sources
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.