Anxiety can be a mixture of feelings such as apprehension, fear, agitation, nervousness, tension, stress and foreboding. Everyone experiences anxiety at some time in their lives, especially when faced with new, uncertain or challenging experiences such as exams, starting a new job or school, being unwell or meeting new people.
Being anxious can sometimes be helpful. The changes that happen in our bodies are part of a natural response that helps us become alert and ready to respond to something that feels challenging or threatening.
However, when anxiety becomes persistent, overwhelming or difficult to manage, it can begin to affect everyday life. People may find themselves avoiding situations, withdrawing from things they would normally do or becoming increasingly restricted by their worries.
Feeling Anxious
Feeling anxious can be very distressing, particularly when the level of fear seems out of proportion to what is happening or appears to arise without an obvious reason. Prolonged periods of anxiety can also take a toll on us emotionally and physically.
People often describe anxiety affecting their digestive system, causing symptoms such as nausea, diarrhoea, constipation or general discomfort. Anxiety and stress can also interact with gastrointestinal conditions such as Irritable Bowel Syndrome (IBS).
Anxiety can be accompanied by a wide range of physical sensations. Some people experience headaches, aches and pains, pins and needles, dizziness, sweating, trembling or feeling unusually hot or cold. They may feel restless or agitated, notice changes in their breathing or become particularly aware of their heartbeat.
Although these kinds of physical sensations can occur with anxiety, they can have other causes too. New, severe, persistent or concerning physical symptoms should not automatically be assumed to be anxiety and may need medical assessment.
Anxiety can also affect our thoughts. You might find yourself repeatedly imagining frightening outcomes or fearing the worst in situations. You may become particularly conscious of other people watching or judging you, find it difficult to relax or notice that worry continues even when you would like it to stop.
Sleep can also be affected. You might become more tearful or emotionally sensitive, and it can be difficult not to start worrying about the anxiety itself, particularly if you have experienced panic attacks.
During periods of intense anxiety or panic, some people also experience forms of dissociation such as depersonalisation or derealisation. You may feel detached from yourself or your emotions, as though you are not quite yourself, or the world around you may seem distant, unreal or somehow different. These experiences can be frightening, particularly when you don’t understand what is happening.
Panic Attacks
When anxiety becomes particularly intense, some people experience panic attacks.
A panic attack is a sudden surge of intense fear or discomfort that can develop very quickly and is accompanied by strong physical and emotional sensations. Sometimes there is an identifiable trigger and sometimes the attack can seem to come unexpectedly.
When our brain detects or anticipates danger, the body’s threat response can become activated. This involves several interconnected systems in the brain and body and can produce changes intended to prepare us to respond quickly.
Stress hormones such as adrenaline contribute to changes in heart rate, breathing, alertness and muscle tension. When this response is intense, the sensations themselves can feel frightening.
During a panic attack, someone might experience a pounding or racing heart, changes in breathing, sweating, trembling, dizziness, nausea, chest discomfort, tingling sensations or feeling unusually hot or cold.
Because these sensations can be so intense, people sometimes become frightened about what is happening to them. They may worry that they are losing control, going to faint, having a heart attack or even dying. Becoming frightened by the sensations can then add another layer of anxiety to an already activated system.
Panic attacks themselves can be extremely frightening. However, symptoms such as chest pain, significant difficulty breathing, fainting or other new or concerning physical symptoms should not simply be assumed to be panic or anxiety. If you are unsure about physical symptoms, seek appropriate medical advice.
Some people also experience depersonalisation or derealisation during panic. You might feel detached from your body, as though you are observing yourself from a distance, or the world around you might feel strange or unreal. Your sense of time or connection to your emotions may also feel different.
For some people, anxiety occurs mainly around particular situations or triggers. For others, there may be many different sources of anxiety throughout the day. If you are experiencing frequent anxiety, panic attacks or dissociation, simply getting through an ordinary day can sometimes feel exhausting.
When someone is under this much strain, work, relationships, everyday activities and looking after themselves can all become more difficult. Even new experiences, or things that were previously enjoyable, may begin to feel overwhelming.
When Might Anxiety Be a Problem?
If anxiety is persistent, difficult to manage or significantly interfering with your everyday life, it may be helpful to talk to your GP, counsellor or another appropriate professional.
You may sometimes be asked to complete a questionnaire such as the GAD-7, which asks about anxiety symptoms experienced during the previous two weeks. Questionnaires like this can be useful screening and monitoring tools and may help begin a conversation about what you are experiencing.
A questionnaire score on its own, however, cannot diagnose an anxiety disorder. Diagnosis involves considering your experiences more broadly, including the nature, duration and impact of your symptoms and whether there might be other explanations for them.
Different Experiences of Anxiety
There are several different anxiety disorders, and anxiety can also occur alongside many other physical and psychological experiences. Some examples include:
- Generalised Anxiety Disorder (GAD) – persistent and difficult-to-control worry about a range of areas of everyday life, accompanied by other symptoms and causing significant distress or difficulty.
- Panic Disorder – recurrent panic attacks alongside ongoing concern about further attacks or changes in behaviour related to them.
- Specific Phobias – intense fear or anxiety associated with a particular object or situation, such as certain animals, heights or flying.
- Social Anxiety Disorder – significant anxiety associated with social situations in which someone fears being scrutinised, embarrassed, rejected or negatively judged.
- Agoraphobia – significant fear or anxiety associated with situations in which escape or obtaining help might feel difficult if panic-like or other distressing symptoms occurred.
Obsessive-Compulsive Disorder (OCD) can involve considerable anxiety but is now classified separately from anxiety disorders. It involves experiences such as intrusive thoughts, images or urges and/or repetitive behaviours or mental acts that someone may feel driven to perform.
Whatever name is given to an experience, anxiety can be exhausting and significantly affect someone’s life. If you are struggling, you do not have to work everything out by yourself. It may help to talk to somebody you trust or seek support from your GP, a counsellor or another appropriate professional.
What Can I Do?
There isn’t one technique that works for everybody, but there are things that some people find helpful in managing anxiety. You can experiment gently and notice what seems useful for you rather than feeling that you have to do everything correctly.
Making Space for Worries
Trying to force yourself not to worry can sometimes make the thoughts feel even more persistent. Some people find it helpful to create a particular time to pay attention to their worries rather than feeling that they have to engage with them throughout the day.
You might write down what is worrying you and consider whether there is anything practical you can do about it. You might ask yourself: Is there something I can do now? Is there information I need? Or is this something uncertain that I cannot resolve at the moment?
The aim isn’t to prove that your worries are irrational, but to create some space between having a worrying thought and becoming completely caught up in it.
Helping Yourself
When anxiety is taking up a lot of energy, looking after yourself can become more difficult. Rather than seeing self-care as another list of things you should be doing, it can help to think about small things that might make life a little more manageable.
- Basic care. Eating, drinking, washing, changing clothes or brushing your teeth can sometimes feel surprisingly difficult when you are overwhelmed. If this is happening, small steps still count.
- Food, rest and sleep. Eating regularly where possible, drinking enough fluids and allowing yourself to rest can support general wellbeing. Alcohol can sometimes make anxiety or sleep difficulties worse, so it may be useful to notice how it affects you.
- Writing things down. Some people find journalling useful for noticing thoughts, feelings and patterns or simply getting things out of their head and onto paper.
- Movement. Walking, stretching, exercise or other forms of movement can help some people with tension, restlessness and general wellbeing. This does not have to mean strenuous exercise.
- Rest and enjoyable activities. Reading, listening to music, watching something familiar, cooking, spending time outside, mindfulness, yoga or having a warm bath are examples of things some people find calming or restorative.
- Connection. Talking to someone you trust can help you feel less alone with what you are experiencing. You can also let friends and family know what kind of support is useful to you.
None of these things needs to make anxiety disappear in order to be worthwhile.
Grounding During Anxiety or Panic
If you notice yourself becoming overwhelmed or panicky, grounding techniques can sometimes help bring your attention back towards the present moment.
You might notice your feet against the floor, identify things you can see or hear around you, hold an object and notice its texture, or gently orient yourself to where you are and what is happening around you.
Grounding is not about forcing anxiety to stop or switching the “rational” part of your brain back on. It is simply one way of helping yourself reconnect with the present when thoughts, sensations or feelings are becoming overwhelming.
Different approaches work for different people, so if a particular grounding technique does not help you, that does not mean you are doing it wrong.
If anxiety, panic or dissociation is having a significant impact on your life, or you are finding it increasingly difficult to manage on your own, consider talking to your GP, counsellor or another appropriate professional about what you are experiencing.
Cover image courtesy of:Anh Nguyen