Coping with Anxiety

[Article revised on 4 May 2020.]

Anxiety can be defined 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 magnitude of the perceived threat, and from one person to another.

Psychological symptoms may 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 and deeper 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, over-breathing (hyperventilation) 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

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 of anxiety are so severe that the person fears that he or she is suffocating, having a heart attack, or losing control. Very soon, the person develops a fear of the panic attacks themselves, which in turn sets off further panic attacks. A vicious cycle 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 certain physical 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 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.

Breaking down the problem

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 really harm you.

Relaxation techniques

If a particular task or situation is very anxiety provoking, use deep breathing to manage your anxiety.

• Breathe in through your nose and hold the air in for several seconds.
• Purse your lips and gradually let the air out. Let out as much air as you can.
• Carry on until you feel 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.

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

Other general strategies that you can use for relaxing include listening to music, particularly classical music like Bach or Chopin, having a hot bath (add in a few drops of lavender essential oil), reading a book, calling or meeting with a friend, exercising, practising yoga or meditation, and giving and receiving massage.

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 continue to suffer with severe anxiety despite implementing some of these measures, you can get in touch with one of several voluntary outfits that organise self-help groups and operate telephone help-lines, among others.

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

Antidepressants 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 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. 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.

Neel Burton is author of Growing from Depression and other books.