Anxiety and worry are fundamental human emotions that we will all feel at times. Some people suggest that we only notice them when they occur in excess. Many people adapt to very high levels of anxiety and do not consider it a problem until they meet people who are less worried.
Anxiety has a very healthy purpose. If we did not feel anxious about certain situations then we would risk falling over cliffs, stepping into fires and so on. Similarly, if we had no anxiety about ourselves in relation to others, we might well behave with great insensitivity.
Sometimes anxiety can become excessive and unhealthy. In what follows we shall endeavour to identify levels of anxiety and worry which are suitable for remedy and to give some ideas about responding to them. However, we do this bearing in mind that anxiety is a necessary feature of living.
Symptoms of Anxiety
Here is a list of symptoms. You may experience only one of these or you may have several physical signs - racing heart, dry mouth, increased rates of breathing, increased sweating, disturbances of bladder and bowel functions, trembling, and disturbed sleep.
Tense muscles lead to increased fidgeting, prickling sensations in the skin and stiffness in the joints. There may be unpleasant sensations in the abdomen, headaches and aching elsewhere in the body.
When we are anxious our mind often produces sharp flashes of imagination (e.g. of us in a feared situation such as an exam) with pessimistic overtones. These can be very vivid and disturbing thoughts. Anxiety tends to increase the amount of thinking we do in the area of concern. Usually the thoughts are selective - isolating and magnifying the worst aspects of the feared situation.
Relations with others
Two opposing tendencies may be experienced here. The anxious person can isolate themselves and withdraw from people. Alternatively there can be increased dependence upon others - such as asking repetitive questions, looking for reassurance, or just needing to be in the presence of others to bring about calm.
We either become more frenetic and over-active or else (more commonly) we avoid the source of the worry entirely - sometimes even to the extent of not allowing ourselves to think or imagine the worry. For example, a person who is worried about speaking in a seminar may decide not only to not do this, but also avoid imagining doing it and may even hide all the lecture notes associated with the subject of the seminar.
Hard to capture in words but usually described as uncomfortable, pressured feelings with a keen edge to them. Such feelings interfere with everyday activity and take away the fun in life.
Identifying the trigger for the anxiety
Identifying symptoms of anxiety is one step, but another feature of higher levels of anxiety is that it doesn't always affect us uniformly. Quite often there are just one or two situations which bring it out. The anxiety can be experienced by just imagining the situation. There is often nothing so powerful in triggering anxiety as picturing yourself in some feared situation or state even if in reality you are unlikely to be within a million miles of it actually happening. Finally, anxiety takes different forms and expressions.
These forms include:
- General Anxiety (being anxious about many aspects of your life)
- Worry (continually thinking over a problem beyond what is needed to produce a solution)
- Specific Anxiety (anxiety over a certain situation - e.g. exams, social situations etc.)
- Phobia (an excessive fear of a particular situation or item leading to avoidance)
- Hypochondria (an anxiety about suffering illness)
- Panic attacks (a sudden uncontrollable triggering of physical anxiety symptoms).
These forms can be chronic (i.e. be in the background and have a long history) or can be acute (i.e. be sharp and in the present). They could combine elements of both.
So here are four steps for classifying any anxiety you may have:
- Decide if time duration makes it a chronic concern, an acute one or both
- Place it in a general group
- Locate triggers or situations which lead to anxiety
- Identify how it is experienced and expressed.
Therefore someone who gets severe butterflies just before presenting a paper but is otherwise socially at ease might say: "I have an acute (time duration) specific anxiety (general group) about pre-planned public speaking (trigger) which always makes me feel sick and gives me an upset stomach just before I have to do it (experience and expression)."
Responding to anxiety
Modern approaches are now tending to shy away from the endless lists of things one should do to relax - partly because anxiety is a functional and general part of our lives and partly because this is not helpful for specific anxieties. The approach nowadays is to come to some understanding about the anxiety at the same time as generating possible control or relief from the symptoms. The following paradoxes about worry may become apparent when you start to deal with it:
- You may create more anxiety if you become too concerned to control or relieve all the symptoms.
- You may find you maintain your anxiety because you believe it is wrong not to worry and so you feel more insecure if you relax. This is particularly true of exams where people can feel something is wrong if they are not hyped-up.
- You may worry about worrying because it seems uncool. This is often true of a fear of speaking in public, which most people have but to which few admit.
- You may worry about not solving the whole worry all at once. Usually there is not a simple single solution to such things as exam fear - the way forwards is a mixture of anxiety control, practice, revision and acceptance of some degree of nerves.
Coping with anxiety
- Do not immediately consider complete relief as the only solution. Much anxiety is completely survivable and may even help you.
- Take an interest in exactly how your anxiety manifests itself. Modern thought would suggest that we might gain from being informed and monitoring ourselves.
- Identify what sort of worry you have. If it takes a particular form, you may need to seek a treatment which is appropriate to it. Panic, for example, will not respond to techniques and strategies aimed at reducing and dealing with general worry. Nor will a particular phobia give way to general advice about keeping relaxed - specific approaches designed to meet the particular anxiety are more helpful.
- Talk about your worry to a counsellor [link to how to book an appointment/drop-ins etc.] so you can become more objective about it and begin to understand any paradoxes.
- Take a measure of how you react in different situations and review the ingredients which are particularly worrying.
- Look at the situations you are avoiding because of anxiety and consider how you could begin to expose yourself to these in small but increasing steps.
- Seek to learn more about your anxiety. Reading may be a tool to help in this [link to books section (if they're still relevant).
- Develop a problem-solving attitude to allow you to dismantle the large problems into lots of smaller ones and then to resolve them by practical steps. For example, small steps to deal with a large anxiety over public speaking could include: talking to a counsellor; observing how others cope; making your tutor aware of the problem you have; preparing the subject; rehearsing in private; taping your voice; practicing with a friend; getting as relaxed as possible on the day; doing it.
- Do not completely disregard general stress management and relaxation - they will not banish a specific anxiety, but they will make you generally happier and therefore more able to deal with the things you find difficult.
- Medication can be very useful for some people when they are coping with specific crises or when anxiety needs an initial reduction to allow for planned action to be taken. Be very wary of using alcohol or non-prescription drugs to overcome anxiety as they rarely offer more than a fleeting solution.
In summary, the suggested approach is not to immediately run for medication, relaxation exercises or the avoidance strategy but to stay in there and come to some understanding of how to manage the anxiety. Changes are made to the level of worry by changing your adaptation to it and by taking an incremental problem-solving approach.
- Feel the fear and do it anyway - Susan Jeffers - Rider 1987.
- How to Stop Worrying - Dr Frank Tallis. Sheldon Press 2009
- Overcoming Social Anxiety and Shyness: a self-help guide using cognitive behavioural techniques - Gillian Butler. Robinson 1999
- Overcoming Anxiety - Helen Kennerley. Robinson 2009
- Overcoming Health Anxiety - David Veale and Rob Willson. Robinson 2009
- An introduction to Coping with Health Anxiety - Brenda Hogan and Charles Young. Robinson 2007
- The four titles above are recommended on the national Reading Well Books on Prescription list.
- Understanding anxiety and panic attacks (booklet) - Inger Hatloy - Mind Publications 2012
- Briefly covers what anxiety is and how to get help. Gives useful addresses and help lines.