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Anxiety can be defined, very broadly, as ‘a state consisting of psychological and physical symptoms brought about by a sense of apprehension at a perceived threat’. Fear is similar to anxiety except that with fear the threat is, or is perceived to be, more concrete, present, or imminent.
The psychological and physical symptoms of anxiety vary according to the nature and size of the perceived threat, and from one person to another. Psychological symptoms include feelings of fear and dread, an exaggerated startle reflex, poor concentration, irritability, and insomnia.
In mild to moderate anxiety, physical symptoms such as tremor, sweating, muscle tension, a faster heart rate, and faster breathing arise from the body’s so-called fight-or-flight response, a state of high arousal fuelled by a surge in adrenaline.
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, among which chest discomfort, numbness or tingling in the hands and feet, dizziness, and faintness.
Panic attacks and panic disorder
In an anxiety disorder, exposure to the feared object, activity, or situation can trigger an attack of paroxysmal anxiety, or ‘panic attack’.
During a panic attack, symptoms of anxiety are so severe that the person fears that she is suffocating, having a heart attack, or losing control. In time, the person develops a fear of the panic attacks themselves, which itself sets off further panic attacks. A vicious circle takes hold, with the panic attacks becoming ever more frequent and severe and even occurring ‘out of the blue’.
This pattern of recurrent panic attacks, referred to as ‘panic disorder’, can superimpose itself onto any anxiety disorder, as well as depression, substance misuse, and conditions such as hyperthyroidism.
Panic disorder often leads to so-called secondary agoraphobia, in which the person becomes increasingly homebound so as to minimize the risk and consequences of suffering further panic attacks.
Managing your anxiety
The first step in managing anxiety is to learn all about it, as a thorough understanding of anxiety can in itself reduce its frequency and intensity.
It is of course tempting to avoid the things or situations that trigger our anxiety, but in the longer term such avoidance behaviour is very counterproductive.
When anxiety comes, accept it. Don’t try to escape from it, but simply wait for it to pass. Much easier said than done, of course, but it’s important that you try.
Breaking down the problem
An effective method of coping with anxiety related to a specific thing 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 might first think about spiders, then look at pictures of spiders, and 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.
Try to adopt a positive outlook: although the symptoms of anxiety can be deeply unpleasant, they cannot actually harm you.
Relaxation techniques
If a particular task or situation is very anxiety provoking, use deep breathing to manage your feelings:
- Breathe in through your nose and hold the air in for several seconds.
- Purse your lips and gradually let the air out. Exhale as far as you comfortably can.
- Carry on with this cycle until you are feeling much less anxious.
Deep breathing can also be used for generalized anxiety, that is, free-floating anxiety that is not tied to any particular object or situation, as well as for stress and physical pain. Think of it as a natural physical and psychological painkiller.
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.
General strategies
General strategies for relaxing include listening to soft music, taking a hot bath (dim the lights and add in a few drops of lavender oil), reading a good book, calling or meeting with a friend, exercising, practising yoga or meditation, and giving and receiving massage.
Stress and anxiety usually go hand in hand, such that working on the one is bound to help with the other. We tend to respond to stress and anxiety by trying to exert ever more control, although, often, the better strategy is to accept that we cannot always be fully in control.
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.
- Getting enough sleep.
- Going for a daily walk, or some other form of exercise.
- Eating food that is tasty, nutritious, and varied.
- Restricting your intake of coffee and alcohol, e.g. limiting alcohol to just wine with dinner.
- Taking the time to do the things you enjoy.
- Connecting with others by sharing thoughts and feelings.
These lifestyle changes are useful not only for reducing anxiety, but also for improving your overall health and quality of life.
Though individually small and simple, their cumulative effect can be absolutely transformative.
Seeking help
If you carry on suffering with severe anxiety despite having given these measures a good go, get in touch with one of the voluntary outfits which, among others, co-ordinate self-help groups and operate telephone helplines.
You can also speak to your doctor, who may refer you for a talking treatment or suggest other ways of helping you. The most common talking treatment for all forms of anxiety is cognitive-behavioural therapy.
A note on antidepressants and other drugs
Antidepressant drugs are commonly prescribed for anxiety, as well as for depression. If you do decide to start on an antidepressant, keep in mind that antidepressant treatment is most effective when combined with a talking treatment.
If your anxiety is especially severe and disabling, your doctor may recommend that you start on a benzodiazepine. Such sedatives are not a cure for anxiety, but can provide short-term relief from some of its symptoms. But be careful: owing to their high potential for tolerance (needing more and more to produce the same effect) and dependence, they should only be used sparingly over short, discrete periods.
Read more in Growing from Depression.
