4.
“Fear of Fear” - Someone who has experienced anxiety in a
certain situation may start to predict feeling anxious, and become
frightened of the symptoms themselves, this in turn actually causes the
very symptoms that are feared.
5.
Avoidance
- once a vicious circle has developed with lots of anxious thoughts
increasing the anxiety symptoms, avoidance is often used as a way of
coping. It is natural to avoid something that is dangerous, but the
sorts of things that people tend to avoid when they suffer from anxiety
are most often not real dangers but busy shops, buses, crowded places,
eating out, talking to people etc. Not only are these things not
dangerous, but they are quite necessary. Avoiding them can make life
very inconvenient and difficult. This sort of avoidance can also result
in a great loss of confidence which can affect how good you feel about
yourself, which in turn makes you feel more anxious - another vicious
circle!
To summarise: - Anxiety is often the body’s response to stress, although some of us may be a bit more prone to anxiety and worry than others.
- When we are suffering from anxiety, whilst it can be unpleasant it
is our body’s normal response to threat or danger and is not dangerous.
- Anxiety symptoms are part of the fight or flight response and are intended to be helpful in spurring us into action.
- Anxiety becomes a problem when the symptoms are:
- severe and unpleasant;
- going on too long;
- happening too often;
- causing us to worry that there is something seriously wrong;
- stopping us doing what we want to do.
- Anxiety often becomes a vicious circle where our symptoms, thoughts and behaviour keeps the anxiety going.
Now spend a few moments trying to write down any of these ways that your anxiety may be being kept going.
1) unpleasant/frightening symptoms you experience;
2) your beliefs and thoughts about these symptoms;
3) everyday things that you are avoiding;
4) current stresses in your life.
How can I manage my anxiety better?
As we have learned,
anxiety is not an illness and so can’t be cured. If we can break into
the vicious circle, however, we can learn ways of reducing our anxiety
and getting it to be more manageable. We can work on at least four
different areas:
- Understanding our anxiety better
- Reducing physical symptoms
- Altering our thoughts related to anxiety
- Changing our behaviours related to anxiety
1. Understanding anxiety
You may already by now have
some ideas about what is causing your anxiety. The following sections
will give advice on how to break out of the vicious circle that keeps
anxiety going. Before you can do this though, it is really useful for
you to understand your own anxiety better. Is your anxiety related to
certain situations, places or people, is it worse at particular times
of the day, are there realistic worries you have that would make anyone
anxious? The following two exercises should help you to understand your
anxiety better.
i)
Anxiety Diary - for a period of two
weeks (or longer if you prefer) keep an hourly diary of your anxiety
and activity level. Rate your anxiety from 0-10. Note down anything
that seems important. Were you at work or home, who were you with, what
were you doing, what were you thinking about? You may start to become
more aware of situations that make you anxious or that you may even be
avoiding. What is your general level of stress like? This information
will help you begin to tackle your anxiety.
ii) If you become aware that you have a realistic worry or problem that you feel may be causing you anxiety, a
problem solving approach may help.
A
good way to begin is to write down a problem. Define it as clearly as
you can, for example “I never have any money”, is too vague, something
like “I owe £3000 to different credit card companies”, is more helpful.
Next, write down as many possible solutions as you can. It doesn’t
matter how silly you may think the solutions are, the point is to think
of as many as you can. Try to think how you have solved similar
problems in the past. Ask a friend what they might do. Think to
yourself what you might advise a friend to do if they had the same
problem, eg possible solutions:
- Get all debts on one loan with less interest
- Agree on affordable payments
- See a debt counsellor
- Get a part time job
- Sell car
If you have a problem that may be making you anxious, try writing it down.
Now list as many possible solutions as you can:
Choose what seems like the best solution and write
down all the steps it would take to achieve that solution. Who might
help?, What might go wrong? Often it is helpful to think, “What is the
worst thing that could happen?” If you can think of a plan to cope with
this, your anxiety might reduce.
If you are trying to come up
with a plan to tackle a problem that has been worrying you for some
time, it is often helpful to discuss this with a friend or even your
doctor.
Stressful lifestyle - general tips
Nowadays
life is often stressful, and it is easy for pressures to build up. We
can’t always control the stress that comes from outside but we can find
ways to reduce the pressure we put on ourselves:
- Try to identify situations you find stressful by noticing the beginnings of tension.
- Take steps to tackle what it is about these situations that you find stressful.
- Make sure you have time for things you enjoy.
- Take up a relaxing hobby.
- Make sure you get enough sleep.
- Eat a well balanced diet.
- Take regular exercise.
- Learn to relax.
2. Reducing physical symptoms
Relaxation
In order to reduce the severity
of physical symptoms it is useful to “nip them in the bud”, by
recognising the early signs of tension. Once you have noticed early
signs of tension you can prevent anxiety becoming too severe by using
relaxation techniques. Some people can relax through exercise,
listening to music, watching TV, or reading a book.
For others
it is more helpful to have a set of exercises to follow. Some people
might find relaxation or yoga classes most helpful, others find
tapes/CDs useful. You may be able to obtain a relaxation tape/CD from
your GP, and there are also a wide number of relaxation tapes/CDs
available in the shops.
Relaxation is a skill like any other
which needs to be learned, and takes time. The following exercise
teaches deep muscle relaxation, and many people find it very helpful in
reducing overall levels of tension and anxiety.
Deep muscle relaxation
- It is helpful to read the instructions first and to learn them
eventually. Start by selecting quite a warm, comfortable place where
you won’t be disturbed. Choose a time of day when you feel most relaxed
to begin with. Lie down, get comfortable, close your eyes. Concentrate
on your breathing for a few minutes, breathing slowly and calmly: in
two-three and out two-three. Say the words “calm” or “relax” to
yourself as you breathe out. The relaxation exercise takes you through
different muscle groups, teaching you firstly to tense, then relax. You
should breathe in when tensing and breathe out when you relax. Starting
with your hands, clench one fist tightly. Think about the tension this
produces in the muscles of your hand and forearm.
Study the
tension for a few seconds and then relax your hand. Notice the
difference between the tension and the relaxation. You might feel a
slight tingling, this is the relaxation beginning to develop.
Do the same with the other hand.
Each
time you relax a group of muscles think how they feel when they’re
relaxed. Don’t try to relax, just let go of the tension. Allow your
muscles to relax as much as you can. Think about the difference in the
way they feel when they’re relaxed and when they’re tense. Now do the
same for the other muscles of your body. Each time tense them for a few
seconds and then relax. Study the way they feel and then let go of the
tension in them.
It is useful to stick to the same order as you work through the muscle groups:
- Hands - clench fist, then relax.
- Arms - bend your elbows and tense your arms. Feel the tension
especially in your upper arms. Remember, do this for a few seconds and
then relax.
- Neck - press your head back and roll it from side to side slowly.
Feel how the tension moves. Then bring your head forward into a
comfortable position.
- Face - there are several muscles here, but it is enough to think
about your forehead and jaw. First lower your eyebrows in a frown.
Relax your forehead. You can also raise your eyebrows, and then relax.
Now, clench your jaw, notice the difference when you relax.
- Chest - take a deep breath, hold it for a few seconds, notice the tension, then relax. Let your breathing return to normal.
- Stomach - tense your stomach muscles as tight as you can and relax.
- Buttocks - squeeze your buttocks together, and relax.
- Legs - straighten your legs and bend your feet towards your face. Finish by wiggling your toes.
You may find it helpful to get a friend to read the instructions to you. Don’t try too hard, just let it happen.
To make best use of relaxation you need to:
- Practise daily.
- Start to use relaxation in everyday situations.
- Learn to relax without having to tense muscles.
- Use parts of the relaxation to help in difficult situations, eg breathing slowly.
- Develop a more relaxed lifestyle.
Remember, relaxation is a skill like any other and takes time
to learn. Keep a note of how anxious you feel before and after
relaxation, rating your anxiety 1-10.
Controlled breathing
Over-breathing: it is
very common when someone becomes anxious for changes to occur in their
breathing. They can begin to gulp air, thinking that they are going to
suffocate, or can begin to breathe really quickly. This has the effect
of making them feel dizzy and therefore more anxious.
Try to
recognise if you are doing this and slow your breathing down. Getting
into a regular rhythm of in two-three and out two-three will soon
return your breathing to normal. Some people find it helpful to use the
second hand of a watch to time their breathing. Other people have found
breathing into a paper bag or cupped hands helpful. For this to work
you must cover your nose and mouth.
It takes at least three minutes of slow breathing or breathing into a bag for your breathing to return to normal.
Distraction
If you take your mind off your
symptoms you will find that the symptoms often disappear. Try to look
around you. Study things in detail, registration numbers, what sort of
shoes people are wearing, conversations. Again, you need to distract
yourself for at least three minutes before symptoms will begin to
reduce.
Whilst relaxation, breathing exercises and distraction
techniques can help reduce anxiety it is vitally important to realise
that anxiety is not harmful or dangerous. Even if we did not use these
techniques, nothing awful would happen. Anxiety cannot harm us, but it
can be uncomfortable. These techniques can help reduce this discomfort.
3. Altering your thoughts related to anxiety
We
have seen the role that thoughts have in keeping going the vicious
circle of anxiety. Sometimes there may also be pictures in your mind.
To
give an example, imagine you are running for a bus one day. All of a
sudden you get a pain in your chest and feel really breathless. The
thought goes through your mind, “I’m having a heart attack”. This
thought is of, course, very frightening, and so your heart starts to
beat faster which makes you think “there really must be something wrong
with my heart”. You may very well have a picture of the ambulance on
its way and you on a stretcher.
Now think about the following questions and write down the answers:
1) What are the thoughts that most often go through your mind when you feel anxious?
2) Do you have any pictures of what might happen?
3) Are there any thoughts that make you feel worse?
It isn’t always that easy to know what you are thinking that is making your anxiety worse.
The
sort of thoughts that make people anxious can come and go in a flash,
and may be so much of a habit that they are automatic. They may be so
familiar that they just feel like part of you.
Try to keep a diary over the course of two weeks. Write down your own thoughts in situations where you are anxious.
Now,
try to imagine the last time you felt very anxious. Try to run through
it like a film, in as much detail as you can. See if you can write down
any frightening thoughts now.
Remember any thoughts can count.
No thought is too small or too silly. Even “oh no” or “here we go
again” can increase tension and anxiety. Some thoughts are like
unpleasant pictures in your mind.
Frightening Thoughts:
Once you know what it is you are thinking, you can begin to fight back, and break the vicious circle. In particular, ask yourself:
- Am I exaggerating, eg “everything is bound to go wrong it always does”.
- Am I jumping to conclusions, eg “I have a pain in my chest therefore it must be my heart”.
- Am I focusing just on the bad things, eg “I had a really bad day yesterday” (ignoring that this followed a few good days).
Use these questions to help yourself answer back. A good way of
doing this is to write two columns - one for your thoughts that make
you anxious, and the other for a more balanced thought, eg:
Anxious thought
|
Balanced thought
|
The dizzy feeling means I'm going to faint.
|
I have had it many times before and have not fainted. I have fainted once and that felt really different
|
I'm going mad
|
I have not gone mad yet, and the doctor tells me anxiety is not madness.
|
Write down some of your thoughts now and write as
many answers as you can. This question might also help. What would you
say to a friend who was thinking that way?
The aim is to get
faster at “catching” these anxious thoughts and answering back almost
instantly. It takes a lot of practice, but really does work.
4. Changing behaviour related to anxiety
- Try
to recognise when you are avoiding things and wherever possible try to
tackle these fears, not all at once but in a gradual way.
- Set yourself very small goals. Write down here goals that you would
like to tackle. Start with the easiest first and tick off any activity
you achieve.
- People often get into the habit of escaping from situations that
make them anxious. Instead of escaping try gradually to increase how
long you stay in a situation that makes you anxious. Anxiety often
reaches a peak, then starts to go away naturally. If you stay in an
anxious situation what do you predict will happen to your anxiety?
People often think it will just keep getting worse and worse. This is
not the case. It will start to come down.
- People not only avoid situations and try to escape, they also often
do things to make themselves feel more safe, eg hanging on to a
shopping trolley, lying down. These “safety behaviours” may help at the
time, but they also help to keep the anxiety going because the anxious
person never learns that nothing awful would have happened even if the
trolley wasn’t there. Also, imagine how frightening it would be if no
trolley was available.
- Try to do things to test out whether your anxious thoughts are realistic, eg “would I really faint if I didn’t get out?”
It really is very important to recognise that the more you
avoid something, the more difficult it will seem to overcome, which
will in turn make you more anxious.
What treatment is available for anxiety?
- Most people with anxiety can benefit from self help such as this self-help guide.
- Your family doctor, health visitor or practice nurse may also be able to give you further help in dealing with anxiety.
- Occasionally, doctors prescribe tablets for anxiety. There should
only be taken for short spells to get over specific anxiety provoking
situations.
- Your doctor may also refer you to a mental health worker or counsellor if your anxiety does not respond to self-help alone.
- Anxiety Management Groups or classes are often run in local
surgeries or Community Health Centres. Please let your doctor know if
you would be interested in such classes.
Where can I find help if I think I am suffering from anxiety?
First,
we hope you will use the advice in this guide. You should find it
helpful. If having used the guide you feel you need more help, you
should discuss this with your GP, who will tell you about alternative
treatments and local services. There are a number of self help books
that other people have found helpful. These books may be available from
your local library.
Helen Kennerley: (1997) Overcoming Anxiety. Robinson London
David Burns: (1980) The Feeling Good Handbook. New American Library
Dr Clare Weeks: Self Help for your Nerves.
Susan Jeffers: Feel the Fear and Do it Anyway.
The following organisations and help lines may also be useful:
Cruse Bereavement Care - for bereaved people and those caring for bereaved people.
Tel: 0844 477 9400
Mind InfoLine
Tel: 0845 766 0163
National Debt Line. Help for anyone in debt or concerned they may fall into debt.
Tel: 0808 808 4000
Relate - help with marital or relationship
Tel: 0845 456 1310
Samaritans
Confidential support for anyone in a crisis
Tel: 08457 90 90 90
No Panic - National Self Help Organisation for phobias, anxiety, panic.
Helpline: 0808 808 0545
NHS Direct. A free 24 hour helpline.
Calls charged at local rate: 0845 4647
Different sorts of anxiety
This guide has
tackled generalized anxiety. There are other more specific anxieties,
and also other problems associated with anxiety. Some of the following
self-help guides may be also useful.
- Social anxiety - fear of being with people.
- Obsessive Compulsive Disorders - having to do things over and over.
- Panic Disorder - suffering from frequent severe anxiety attacks which come “out of the blue”.
- Depression - low mood and lack of energy.
- Dealing with stress.
These self-help guides may be available in your local surgery from:
Your Doctor, Health Visitor, Practice Nurse, District Nurse or Receptionist.
© EMIS and PiP 2008 Updated: 23 May 2008
