Coping with anxiety
Introduction Everyone gets anxious from time to time and for some people it can be quite debilitating. This handbook explores what anxiety is, what happens when we become anxious and suggests tips for reducing the symptoms.
What is anxiety? Anxiety is a normal reaction to danger. When we are in a threatening situation, we need to think and act fast so that we can either get away from the danger as fast as possible or defend ourselves against it. This is known as fight or flight. For example, if we discover a fire in our home we need to think and act fast to either put it out (fight it) or escape from it (flight). In order to do this, the body triggers a series of physical reactions to help us think and act quickly. Adrenaline is
released into the body, the heart rate increases, we breathe rapidly to take in more oxygen and our muscles tighten ready for action. However, if the fight or flight reaction is triggered when there is not a genuine threat, we are unable to make use of it and can feel very uncomfortable. We may feel nauseous, faint, shaky, hot or cold, breath too quickly (hyperventilate) and have many other distressing symptoms. This is why anxiety feels so unpleasant.
What is a panic attack? When someone feels very anxious and is unable to slow down their natural fight or flight response, the symptoms can get much worse. If they hyperventilate, this can cause them to breathe in too much oxygen and too little carbon dioxide, while the increased level of adrenaline can lead to reduced blood flow to the head both of these can cause dizziness and lightheadedness. At this point, anxiety becomes a full-blown panic attack.
feeling dizzy, unsteady, lightheaded, or faint
Physical symptoms There are many symptoms that are triggered by anxiety and panic attacks: feeling of choking palpitations, pounding heart, or accelerated heart rate hyperventilation (rapid breathing), shortness of breath chest pain or discomfort nausea or abdominal discomfort
derealisation (feelings of unreality) or depersonalisation (being detached from oneself) fear of losing control or going mad fear of dying tense muscles chills or hot flushes numbness or tingling sensations sweating trembling or shaking
Automatic negative thoughts Extreme anxiety and panic attacks are characterised by a sense of fear or terror, as
that long-term anxiety may weaken your immune system and lead to increased blood pressure. It is therefore important to reduce the symptoms.
Avoidance negative thoughts will occur automatically whenever the anxiety-provoking situation is encountered.
Can panic attacks harm me? Panic attacks themselves are not harmful. However, the presence of negative and fearful thoughts can exaggerate the symptoms and there are some indications
It is human nature to avoid dangerous things and this appears to be the case even when the danger is just imagined. Many people will avoid situations that trigger their anxiety or panic attacks. Likewise, when people are in situations where they become anxious, their natural reaction is to leave as quickly as possible. Although avoidance may bring temporary relief, it can actually increase the fear associated with the situation which can, in turn, increase the symptoms.
What will trigger a panic attack? This varies greatly from one person to another depending on what situations they find challenging. There are however other factors which can increase the chances of a panic attack, including: exertion hormonal changes being very tired being under a lot of stress hunger too much caffeine alcohol
How to manage anxiety There are a number of things that may reduce the symptoms of anxiety and prevent panic attacks: understanding what is happening learning how to prevent or stop hyperventilation stopping the avoidance of anxietyprovoking situations finding ways of challenging the automatic negative thoughts developing relaxation techniques making changes to lifestyle and diet medication talking treatments such as CBT, counselling or psychotherapy
The next section explores these options in a bit more detail.
Avoidance
If your breathing speeds up and becomes shallower you are at risk of hyperventilating; if you can regain control of your breathing you will be able to reduce the risk of a panic attack. There are a number of breathing exercises that will help you regain control, some of which are described at the end of this handbook.
If we avoid situations that make us anxious, we are likely to increase the intensity of the symptoms and broaden them to even more situations. In addition, many people believe that if they stay in an anxiety-provoking situation, their symptoms will just increase more and more until something terrible happens, e.g. they collapse, faint, have a heart attack or go mad.
It is important to practise these when you are not feeling anxious as it is very hard to learn a new skill when you are panicking. If you practise them regularly you will be able to use them when you feel anxious and should find that you can reduce the symptoms significantly.
The reality is that their anxiety symptoms will soon begin to decrease as it is not possible for our bodies to maintain the intense symptoms for long. However, if these situations are always avoided, they would never find this out and so continue to believe that something terrible will happen.
Controlling your breathing
Tackling negative thoughts Automatic negative thoughts always accompany acute anxiety and these thoughts will build on themselves they can trigger anxiety symptoms which in turn can lead to even more negative thoughts and so on. It is important to break this cycle by: distraction techniques challenging the facts taking a reality check Distraction techniques may include anything which takes your focus away from your negative thoughts e.g. reading, completing a task, physical activity, having a conversation about something else or setting yourself a mental challenge, such as completing a crossword or puzzle.
To challenge the facts you need to ask yourself questions about your negative thoughts. For example, if your thought
do I have for my belief? Why do I think that? Why would they be so interested in me? Take a reality check what is the worst thing that might happen? When we become very anxious we tend to think in dramatic and exaggerated terms but in reality it is rare that our fears will come true.
Relaxation When we feel anxious or stressed, one of the most common symptoms we experience is muscular tension. This tension can cause a range of uncomfortable feelings including headaches, neck and back pain, tight chest etc. Relaxation techniques are useful as they can reduce the tension in our muscles and eliminate many of these unpleasant feelings. As with the breathing techniques, it is important that relaxation skills are developed and practised regularly. There are many different relaxation techniques and it is worth trying a few to find which suits you best. You may find that yoga, or another form of exercise that incorporates meditation, is beneficial.
Many people also find a technique known as progressive muscle relaxation to be helpful. This is a technique whereby all the muscles in the body are tensed and then relaxed, one by one, working through the body from head to toe; this helps you to discover where you are holding tension and how to release it. There are a number of books and CDs which will guide you through the process. Another technique, known as guided fantasy or guided visualisation invites you to imagine a scene and its images, sounds, sensations and smells. Again CDs of guided visualisations can be used to take you through this form of relaxation.
How to control a panic attack If your panic has escalated to the point that you feel unable to use any of the above techniques, the following tips should help: If possible find somewhere quiet to sit down, preferably next to a table where you can lean forward. You need to increase the amount of carbon dioxide you are breathing in to restore the balance. The best way of doing this is to hold a paper bag (not plastic!) over your nose and mouth and breathe in through your nose and out through your mouth until you feel your breathing is returning to normal. Each time you breathe out you are breathing out a higher percentage of carbon dioxide which
you will then breathe back in with your next
Tranquillisers, once the treatment of choice,
hand you can still achieve this by cupping your hands over your nose and mouth.
are now prescribed less frequently due to their addictive nature, their side-effects and the withdrawal symptoms. On occasions, GPs will prescribe them on a short-term basis if the symptoms are severe.
The role of medication There are different views about the effectiveness of medication in the management of anxiety. Some GPs are very reluctant to prescribe any medication and will encourage their patients to learn selfmanagement techniques, whilst others may prescribe tranquillisers, anti-depressants or beta-blockers.
Anti-depressants may alleviate anxiety symptoms as well as symptoms of depression. (Many people experience anxiety in conjunction with some degree of depression or low mood.)
Beta-blockers, drugs which stabilise the heart beat, are sometimes prescribed to reduce palpitations. There are also many herbal remedies on the market; talk to your chemist or ask in a health food shop for further information.
Healthy living
impact significantly on both our physical and mental well-being. Stimulants such as caffeine, alcohol and cigarettes all stimulate the body; if you already have an increased level of adrenaline, due to anxiety, stimulants can increase the symptoms of anxiety further so it is worth thinking about reducing your intake. Exercise can also be beneficial as it makes use of the excess adrenaline and reduces tension in the muscles. A combination of a healthy diet and regular exercise is likely to reduce anxiety symptoms significantly.
Talking treatments There are a number of talking treatments available and many people have found these are key to overcoming anxiety because they focus on the underlying cause and not just the symptoms. Your GP should be able to provide you with more information. You may want to consider counselling or psychotherapy. Alternatively, your GP may refer you to an anxiety management group or may recommend cognitive behavioural therapy (CBT). CBT is a goal-oriented technique which aims to alter unhelpful thinking patterns and behaviours and has been found to be particularly effective in the management of anxiety conditions.
Summary of key points Anxiety symptoms result from the body’s natural fight or flight response to protect us from danger Although the symptoms feel extremely unpleasant they are not harmful To overcome anxiety you need to: control your breathing, develop relaxation techniques and challenge negative thoughts. All of these need to be practised It can also help to make some lifestyle changes and consult your GP to discuss talking treatments and medication In the case of a panic attack, breathing in and out of a paper bag, or your hands, can stop you from hyperventilating.
Support at Brunel
Online support:
There are a number of services available at Brunel providing support:
BBC Online: Anxiety (www.bbc.co.uk/health/mental/anxiety) Part of the BBC's Mental Health site, with user-friendly advice and info about anxiety disorders.
Advice and Representation Centre Tel: 01895 269169 | Email: advice@brunel.ac.uk Brunel International Tel: 01895 265519 Email: international@brunel.ac.uk Chaplaincy Tel: 01895 266459 Email: meeting-house@brunel.ac.uk Counselling Service Tel: 01895 265070 Email: brunel-counselling@brunel. ac.uk Disability and Dyslexia Service Tel: 01895 265213 | Email: disability@brunel.ac.uk Medical Centre Tel: 01895 234426 Union of Brunel Students (UBS) Tel: 01895 269269 Email: ubs.helpdesk@brunel.ac.uk For further information go to: www.brunel.ac.uk/life
First Steps to Freedom (www.firststeps.demon.co.uk) Voluntary organisation offering help to those who suffer from phobias, panic attacks, general anxiety, obsessive compulsive disorders, and tranquilliser withdrawal. National Phobics Society (www.phobics-society.org.uk) Largest anxiety disorders association in the UK, run by sufferers and ex-sufferers and supported by a highprofile medical advisory panel. Helpline: 0870 7700 456 - open Monday to Friday from 10.30am to 4pm. Triumph Over Phobia (TOP U.K.) (www.triumphoverphobia.com) TOP U.K. runs a national network of structured self-help groups Information and advice available Monday to Friday 9.30am - 4.00pm. Telephone: 01225 330353 Anxiety Care (www.anxietycare.org.uk) Helps people to recover from anxiety disorders and to maintain that recovery. Telephone: 020 8262 8891| Helpline: 020 8478 3400
Breathing techniques Normally we don’t think about our breathing – we just do it! However, to avoid hyperventilation it’s necessary to give it some thought. When we begin to feel anxious, our breathing is likely to become shallower and faster; this can lead to hyperventilation and potentially to a panic attack. To combat this we need to breathe using our full lung capacity at a steady and controlled pace.
Breathing exercise 1 Place one hand on your chest at the top of your ribcage and your other hand close to your stomach at the bottom of your ribcage – you should be able to feel where your ribcage ends. Take a slow breath in and, as you do so, watch your hands. Visualise your lungs as a container that you can pour air into. Imagine the air is coloured and you can see your lungs filling up. As you pour the air in, your lungs will gradually fill up from the bottom to the top; the hand at the bottom of your ribcage should gently rise first, closely followed by your other hand. If only your top hand rises, your breathing is too shallow. Then breathe out gently. Practise this to ensure you are taking full breaths.
Another way to ensure you are breathing properly is to place both of your hands at the base of your ribs with the finger tips just touching. As you slowly breathe in, your fingertips should part and then come closer together again as you breathe out.
Breathing exercise 2 Inhale slowly through your nose, counting to 5. Then slowly exhale through your mouth, again to the count of 5. Count as slowly as possible. Repeat this twice and then take two normal breaths in and out. Repeat this cycle several times until you have regained control of your breathing.
Disability and Dyslexia Service Tel: 01895 265213 | Email: disability@brunel.ac.uk | Web: www.brunel.ac.uk/disability Opening hours: Monday-Friday 9am to 4.30pm | Drop-ins:Wednesday 1-4pm