Anxiety

Summary

Anxiety is an emotion that everyone experiences from time to time. It is part of our body’s natural response to situations that feel uncertain, important or threatening. Anxiety can be helpful because it prepares us to respond to danger and focuses our attention on what is happening around us. However, anxiety can become difficult to manage when it is very intense, happens frequently, continues when there is no immediate danger, or starts to interfere with everyday life.

In your thoughts, you might experience racing or busy thoughts, find it difficult to switch off, worry about what might go wrong or imagine the worst possible outcome. You may find it harder to concentrate, have worries that keep you awake at night, or spend a lot of time worrying about your health, safety or whether something bad might happen.

Anxiety can also cause physical changes. Your heart might beat faster or harder, you may experience butterflies or discomfort in your stomach, feel shaky or restless, become tense or develop aches and pains in your muscles. You might sweat more than usual or feel unusually hot or cold.

Anxiety can affect how you behave and interact with other people too. You might become more irritable or snappy, even when you do not mean to, or seek reassurance from people you trust. You may avoid situations that make you anxious or find it difficult to try new things because you are worried about what might happen.

Different types of anxiety disorders
There are several different anxiety disorders. Although they can look different, they generally involve anxiety or fear that is persistent, difficult to control and has a significant impact on everyday life.

Generalised Anxiety Disorder (GAD)
GAD involves excessive and difficult-to-control worry about a range of everyday things. You may find yourself worrying about different areas of your life, such as health, relationships, school, work, money or what might happen in the future. This worry can be accompanied by physical symptoms such as restlessness, muscle tension, tiredness or difficulty sleeping.

Agoraphobia
Agoraphobia involves significant fear or anxiety about situations where you feel it may be difficult to escape or get help if you become distressed or experience panic. This can include using public transport, being in crowded or open spaces, being outside alone or being away from home.

Panic Disorder
Panic disorder involves repeated, unexpected panic attacks and ongoing worry about having another attack or changes in behaviour to avoid situations because of this fear. Panic attacks can involve intense fear alongside physical symptoms such as a racing heart, dizziness, shaking, breathlessness or feeling out of control.

Specific Phobias
A specific phobia involves an intense fear or anxiety about a particular object or situation. Examples include fears of animals, heights, injections, flying or certain environments. The fear can lead you to avoid the thing you are afraid of or experience significant distress when you encounter it.

Social Anxiety Disorder
Social anxiety disorder involves significant fear or anxiety about social situations where you may feel watched, judged or embarrassed. This might include meeting new people, speaking in groups, eating or drinking around other people, performing or giving a presentation.

Separation Anxiety Disorder
Separation anxiety disorder involves excessive fear or worry about being separated from someone you are strongly attached to. You might worry that something bad will happen to them or to you while you are apart, find it difficult to be away from them or avoid situations that involve separation.

Obsessive-Compulsive Disorder (OCD)
OCD involves obsessions, compulsions or both. Obsessions are unwanted and intrusive thoughts, images or urges that can cause significant distress. Compulsions are repetitive behaviours or mental acts that someone feels driven to carry out, often in an attempt to reduce distress or prevent something they fear from happening.

Health Anxiety
Health anxiety involves excessive worry about having or developing a serious illness. This may lead to repeatedly checking your body, researching symptoms online, seeking reassurance or avoiding situations because of concerns about your health.

Body Dysmorphic Disorder (BDD)
BDD involves becoming very preoccupied with perceived flaws or imperfections in your appearance that are not noticeable, or appear minor, to other people. This can cause significant distress and may lead to behaviours such as repeatedly checking your appearance, comparing yourself with others or trying to hide the perceived flaw.

Post-Traumatic Stress Disorder (PTSD)
PTSD can develop after experiencing or witnessing a traumatic event. It can involve unwanted memories or flashbacks, nightmares, avoidance, feeling constantly on edge and changes in thoughts, emotions and behaviour. Anxiety and fear can be an important part of PTSD, particularly when reminders of the traumatic experience trigger a sense of danger.

How to help myself

Talk to someone you trust about how you are feeling. You do not have to wait until your anxiety feels overwhelming before reaching out. Talking to a friend, family member, teacher, GP or mental health professional can help you feel less alone and make it easier to understand what is making you anxious. You could let them know whether you want them to listen, help you think through a problem or support you to find further help. If you are not sure who to talk to, you can explore the support options in this booklet.

Try to notice what tends to make your anxiety worse and what helps you feel calmer. Keeping a simple note of situations, thoughts, physical sensations and what you did afterwards can help you spot patterns over time. You might notice that anxiety is more difficult when you are tired, stressed, hungry, overwhelmed or facing a particular situation. Understanding your triggers can help you prepare for situations that you know are likely to feel difficult.

Moving your body can be a useful way of managing anxiety and releasing some of the physical tension that comes with it. You could go for a walk, stretch, dance, exercise, play a sport or do another activity that you enjoy. You do not need to do intense exercise for it to be helpful. Even a short walk or a few minutes of movement can give you a break from anxious thoughts and help you reconnect with what is happening around you.

When you notice anxiety starting to build, try slowing your breathing and taking a few slow, comfortable breaths. You could breathe in gently through your nose and slowly breathe out through your mouth, making your out-breath a little longer than your in-breath. There is no need to take very deep breaths, as this can sometimes make you feel more light-headed. Practising slow breathing when you are calm can make it easier to use when anxiety starts to increase.

Grounding can also help when anxious thoughts feel overwhelming. Try focusing your attention on what is happening around you rather than on what might happen next. You could notice what you can see, hear, feel, smell and taste, hold something with an interesting texture, listen to a familiar song or describe your surroundings in detail. The aim is not to make the anxiety disappear immediately, but to give your attention something else to focus on.

Try to challenge the urge to avoid everything that makes you anxious. Avoiding situations can provide short-term relief, but it can sometimes make the anxiety feel more difficult to manage in the future. Where it feels safe and manageable, you could gradually approach situations that you have been avoiding, starting with something that feels challenging but achievable. You may find it helpful to do this with support from a trusted person or mental health professional.

Looking after your basic needs can also make anxiety easier to manage. Try to maintain regular meals, drink enough water, get enough sleep and make time for activities that help you relax. It can also be useful to take breaks from social media or news if you notice that these increase your worries. Having a balance between responsibilities, rest, enjoyable activities and time with other people can support your overall wellbeing.

How to help a loved one

It is natural to want to quickly reassure your loved one or fix the problem when you can see that they are distressed. Reassurance can feel comforting in the moment, but repeatedly trying to remove anxiety or telling someone that there is “nothing to worry about” may not help them understand or manage the feelings in the longer term. It can be more helpful to listen, understand what is happening for them and work out together what might help.

Take time to listen to your loved one’s worries without immediately trying to solve them. Let them know that their feelings make sense, even if you do not experience the situation in the same way. You could ask whether they want you to listen, help them think through the problem or simply sit with them while the feelings pass. When they feel calmer, you can work together to think about practical ways forward.

Helping your loved one name and understand what they are feeling can make emotions feel less confusing and overwhelming. You might notice changes in their behaviour or body and gently ask whether they are feeling worried, overwhelmed, frustrated, frightened or something else. Avoid telling them what they are feeling; instead, give them space to work it out for themselves.

If anxiety is making everyday tasks feel overwhelming, help your loved one break things down into smaller, manageable steps. For example, if they are worried about going to school, you could focus first on getting dressed, then having breakfast, and then getting to school, rather than trying to solve the whole situation at once. Give them opportunities to do things for themselves where possible, while offering support when they need it.

Work together to identify what helps when anxiety starts to build. Different people find different things calming. Your loved one might want a hug or other physical reassurance, while someone else might prefer some space, a quiet environment or a break before talking. You could agree on a plan when they are feeling calm so that you both know what to do when anxiety becomes more difficult to manage.

It can also be helpful to support your loved one to gradually face situations they are avoiding when this is safe and appropriate. Avoiding something can reduce anxiety in the short term, but it can sometimes make the fear feel stronger over time. Rather than forcing them into situations they are not ready for, encourage small, manageable steps and recognise their effort. If anxiety is significantly affecting their everyday life, a mental health professional can help them develop a suitable plan.

You may hear people say that they “have anxiety” when they are describing feeling nervous, stressed or worried. Anxiety is a normal emotion that everyone experiences, and feeling anxious does not automatically mean that someone has an anxiety disorder. Anxiety can help us recognise when something is important, prepare for challenges and respond to potential danger.

For some people, anxiety becomes much more frequent, intense or difficult to control. It may continue even when there is no immediate danger and can begin to interfere with everyday life. Someone might start avoiding school, work, social situations or activities they usually enjoy, or find that anxiety affects their sleep, relationships, appetite or ability to concentrate. If anxiety is having this level of impact, it may be helpful to seek support from a GP or mental health professional.

Myth Buster

Myth: “People with anxiety just need to calm down.”
Truth: Anxiety is more than simply feeling nervous or worried. It can affect your thoughts, emotions, body and behaviour, and can sometimes feel very difficult to control. Learning to manage anxiety can take time, practice and support. Telling someone to “just calm down” does not necessarily reduce the anxiety and may leave them feeling misunderstood.

Myth: “You can always tell when someone is anxious.”
Truth: Anxiety is not always visible. Some people may become quiet, avoid situations or appear restless, while others may continue behaving as usual even when they are struggling internally. People may hide their anxiety because they are unsure how to talk about their feelings, worry that they will be dismissed or feel pressure to keep functioning as normal. You cannot always know how someone is feeling just by looking at them.

Myth: “Young people do not experience anxiety or depression. What do they have to worry about?”
Truth: Anxiety and depression can affect people of all ages, including children, teenagers and young adults. Young people can experience significant pressures relating to school, exams, friendships, relationships, family difficulties, bullying, social media, identity, self-esteem and uncertainty about the future. These experiences can have a real impact on mental wellbeing.

Myth: “Anxiety is always a bad thing.”
Truth: Anxiety is a normal emotion that can be useful. It can help us recognise potential danger, prepare for challenges and pay attention when something is important to us. It becomes more difficult when it is very intense, happens frequently, continues when there is no immediate danger or starts to interfere with everyday life.

Myth: “Avoiding what makes you anxious is the best way to manage it.”
Truth: Avoiding something can make anxiety feel better in the short term, but it can sometimes make the fear stronger over time. When it is safe and appropriate, gradually approaching situations that make you anxious can help you learn that you can cope with them. A mental health professional can help you work out how to do this at a manageable pace.

Myth: “If you have anxiety, you will always feel this way.”
Truth: Anxiety can change over time, and people can learn ways to understand and manage it. This might involve developing coping strategies, making changes to your routines or environment, talking to people you trust or accessing professional support. How someone experiences anxiety can also change depending on what is happening in their life.

Myth: “Reassuring someone that everything will be fine always helps their anxiety.”
Truth: Reassurance can feel comforting, but repeatedly trying to convince someone that nothing bad will happen may not

Support

If anxiety is having a significant impact on your everyday life, it can be helpful to talk to a professional. Support can help you understand what you are experiencing, develop strategies for managing anxiety and gradually feel more confident in situations that feel difficult.

Support might involve learning more about how anxiety affects you, including how it feels in your thoughts, emotions and body, and how it might appear in your behaviour. Understanding your own early warning signs can make it easier to recognise when anxiety is starting to build and take steps to manage it before it becomes overwhelming.

You can explore the situations, experiences or thoughts that tend to trigger your anxiety and identify patterns in what makes it better or worse. You might also look at the relationship between your thoughts, feelings, physical sensations and behaviours, and how these can influence one another.

Support can help you develop a range of coping strategies for managing anxiety. This might include breathing and grounding techniques, relaxation, problem-solving, managing worries, improving routines and finding ways to look after your physical and emotional wellbeing. You can build a personal “toolbox” of strategies and work out which ones are most useful in different situations.

You may also work on understanding and responding to unhelpful or frightening thoughts. This does not mean simply replacing negative thoughts with positive ones. It can involve learning to question anxious predictions, consider different possibilities and respond to uncertainty in a more balanced way.

If anxiety is leading you to avoid particular situations, support can help you gradually approach them at a manageable pace. This can give you opportunities to build confidence and learn that you can cope with uncomfortable feelings without needing to avoid everything that makes you anxious.

Support can also involve working with family members, school or other people around you where appropriate. This can help the people around you understand what you are experiencing and identify practical ways they can support you without unintentionally maintaining your anxiety.

Therapy

Different types of therapy can help with anxiety. The most appropriate approach will depend on your age, symptoms, what is maintaining the anxiety and what you would like support with.

• Cognitive Behavioural Therapy (CBT) – can help you understand the relationship between your thoughts, feelings, physical sensations and behaviours. It may involve learning ways to manage worries, challenge unhelpful thinking patterns and gradually face situations you have been avoiding.
• Exposure Therapy – can help you gradually approach situations, objects or experiences that you are afraid of or avoiding. This is usually done in small, manageable steps and can help you learn that anxiety can reduce over time and that you can cope with uncomfortable feelings.
• Acceptance and Commitment Therapy (ACT) – can help you notice difficult thoughts and feelings without having to fight or avoid them. It focuses on developing psychological flexibility and taking steps towards things that are important to you, even when anxiety is present.
• Mindfulness-based approaches – can help you develop awareness of your thoughts, feelings and physical sensations without immediately reacting to them. This may be useful for managing worry and becoming more aware of what is happening in the present moment.
• Counselling – can provide a supportive space to explore worries, emotions, relationships and experiences that may be contributing to anxiety. It can help you develop a better understanding of yourself and identify ways to cope.
• Family Therapy – may be helpful for children and young people where anxiety is affecting family life. It can help family members understand anxiety, improve communication and work together to support recovery.
• Depending on the type and severity of anxiety, medication may also be considered alongside psychological support. A GP or mental health professional can help you explore the options that are appropriate for you.

Helplines

Childline
Childline is a free service for young people to talk to a counsellor about anything. The service is available 24 hours a day, 7 days a week. Childline is available to anybody who is 18 years old or younger.

Phone: 0800 1111
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
You can also find helpful resources, speak to a counsellor online or send a message on their site.
Website: www.childline.org.uk

For adults concerned about a child, the NSPCC can be contacted 

NSPCC

NSPCC is a children’s charity that works to protect children and prevent abuse and neglect. They provide support and advice for adults about child abuse, neglect, child safety, online safety and children’s mental and emotional wellbeing. 

Phone: 0808 800 5000
Opening times: 10 am–4 pm, Monday–Friday
Email: help@nspcc.org.uk
Email opening times: 11 am–4 pm, 7 days a week
Website: www.nspcc.org.uk

Samaritans

Samaritans is a charity providing emotional support to anyone who is struggling to cope or needs someone to talk to. They are there for people experiencing all sorts of difficulties, including stress, anxiety, loneliness, relationship or family problems, bereavement, feeling overwhelmed and concerns about mental health or suicide.

Phone: 116 123
Opening times: 24 hours a day, 7 days a week, 365 days a year
Website: http://www.samaritans.org

Mind

Mind is a mental health charity providing information, advice and support for people experiencing mental health difficulties. They cover a wide range of mental health and wellbeing issues, including anxiety, depression, stress, relationships, loneliness, coping with difficult experiences and managing everyday life. Mind provides information to help people understand what they are experiencing, know their rights, find appropriate support and feel less alone.

Phone: 0300 123 3393
Opening times: 9am–6pm, Monday to Friday (excluding bank holidays
Email: info@mind.org.uk
Website: www.mind.org.uk

Shout
Shout is a free, confidential text messaging service that provides support to anyone who is struggling to cope. It can help with a wide range of issues, including stress, anxiety, low mood, loneliness, relationship difficulties, bullying, self-harm, suicidal thoughts, feeling overwhelmed and other mental health challenges.

Text: SHOUT to 85258
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
Website: www.giveusashout.org

Kooth
Kooth is a free online mental health and wellbeing service for young people. It offers a safe and confidential space where young people can access information, read helpful resources, take part in online discussions and receive support from trained professionals. Kooth can help with all sorts of issues that may affect young people’s mental health and wellbeing, including stress, anxiety, relationships, bullying, family difficulties, low mood and other challenges they may be experiencing.

Website: www.kooth.com
Online support: Available 24 hours a day, 365 days a year
Live chat with a practitioner: 12 pm–10 pm Monday to Friday; 6 pm–10 pm Saturday and Sunday

Hub of Hope

Hub of Hope is a mental health support database that brings together information about a wide range of mental health services and organisations. It covers support for issues such as anxiety, depression, stress, self-harm, suicidal thoughts, addiction, bereavement and other mental health difficulties.

Website: http://www.hubofhope.co.uk
Opening times: Online service available 24 hours a day

CALM (Campaign Against Living Miserably)
CALM (Campaign Against Living Miserably) is a charity providing support for people who are struggling with their mental health or experiencing emotional distress. They support people with issues including low mood, anxiety, loneliness, stress, suicidal thoughts and difficult life experiences.

Phone: 0800 58 58 58
Opening times: 5pm–midnight, every day
Webchat: 5pm–midnight, every day
WhatsApp: Available through the CALM website
Website: http://www.thecalmzone.net