What is anxiety?

Getting to grips with anxiety

Anxiety is an emotion that occurs as a result of your brains response to a perceived threat, and it consists of a subjective experience (trigger), a physiological response (symptoms) and a behavioural response.

Dr Elaine Ryan

Table of Contents

The emotion of anxiety

Emotions prepare us to deal with events without having to think about them; we don't choose to feel them; they just happen to us automatically.

Paul Ekman1

For example, you automatically feel sad, happy, scared or anxious.

You don’t choose to feel anxiety; the emotion occurs automatically to help you deal with a perceived threat and is very similar to fear with one crucial difference.

Fear is the emotion you feel when there is a real danger present ( a bull charging down the street), whereas anxiety is the emotion you feel when there is no real danger present (about to give a speech), i.e. your brain responds to a perceived threat.

Dr Elaine Ryan

When the emotion of anxiety occurs automatically it consists of


  • a subjective experience – eg about to give a speech- can think of this as the trigger
  • a physiological response – dry mouth, sweating – these are your symptoms
  • behavioural or expressive response – shaking or ask someone else to make the speech. 2


Self-help options and psychological treatment such as CBT help you to change this automatic response.





How do I know if I have anxiety?


Many people who attend a psychologist do not arrive with a clear idea that they are suffering from anxiety. Instead, they might have been referred as they have trouble sleeping, or feel irritable, or have been feeling unwell.


There are many ‘markers’ that show during our initial meeting that will alert me to that fact that it sounds like anxiety and many more ‘markers’ that will allow me to rule out other conditions. 


After having medical conditions ruled out, someone like myself (a psychologist) will test for anxiety.


How is it diagnosed?

Mental health professionals use what is called The Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnosis. According to the DSM, the criteria for anxiety include;

  • excessive anxiety and worry most days about many things for at least six months
  • difficulty controlling your worry
  • the appearance of three of the following six symptoms: restlessness, fatigue, irritability, muscle tension, sleep disturbance, and difficulty concentrating
  • symptoms significantly interfering with your life
  • symptoms not being caused by the direct psychological effects of medications or medical conditions
  • symptoms aren’t due to another mental disorder (e.g. anxiety about oncoming panic attacks with panic disorder, anxiety due to a social disorder, etc.)

You might also complete a self-report questionnaire, such as the Beck Anxiety Inventory (BAI). 

I have anxiety, now what?

Once you have discovered that you have anxiety, you most likely want to find out how to recover, and I shall discuss the treatment options open to you now.

Do I need to see a doctor or therapist, and what will they do?

If you follow a stepped care approach, you may not need treatment by a psychologist, as you can start with self-help.

The National Institute for Health and Care Excellence (NICE for short) gives guidance on a Stepped Care Approach which suggests

Stepped Care Approach for treatment of anxiety

  1. Assessment, education and discussion of treatment options

    This could be a meeting with your local GP, who either diagnoses anxiety or refers you to a psychologist for psychological assessment. Your GP or mental health consultation will explain anxiety to you and recommend treatment options, which may start with self-help.

  2. Self Help

    This can be self-help that you undertake alone or may include psycho-educational group sessions.

  3. Psychological intervention CBT or medication

    If self-help did not work for you, you might be referred for CBT with a psychologist or prescribed medication to help manage your anxiety.

  4. Highly specialised treatment

    This can include psychological intervention, medication and multidisciplinary teams or inpatient care.

Start with Self Help.

People come to see me after trying many things or attending for counselling or cbt.

CBT is excellent, but not a one-stop cure-all for the many forms of anxiety.

CBT is beneficial for the thought processes involved in anxiety and also great for changing any anxious behaviours that you have (e.g. overworking, always predicting the worse). But for many of you, you will simply feel anxiety in certain places or ways, without many thought processes being present.  This is because your brain remembers to be anxious! The emotion of anxiety is an automatic response.

Your brain remembering to be anxious is explained in the video below taken from my online course Retrain Your Brain®


As I said above, CBT is excellent for the thought processes associated with your anxiety and is useful for helping with anticipatory anxiety, where you quite literally create anxiety over events that have not yet happened. 

However, if you can relate to feeling anxious in situations where no thoughts are present or can relate to the video above, where your brain remembers to be anxious, we need to start looking at your brain, in particular, we need to look at the role of your amygdala in anxiety.

What causes anxiety?

Anxiety is caused when your stress response is triggered, either through your thought processes or through an inbuilt response, designed to keep you safe.

At the beginning of this article, I said that anxiety is an emotion that occurs as a result of your brains response to a perceived threat. 

Reminder: anxiety is what is referred as a complex emotion in that it has several components

  • a subjective exerience – this is the trigger
  • a physiological response – this is the stress response, and a
  • behavioural response – this is what you do.

Your perceived threat could be

I am going to make a fool of myself in this meeting. This is known as thought based anxiety, but for some forms of anxiety, there are no clear cut thoughts. In this case, your anxiety bypasses thought process – it operates without thinking and is known as amygdala based anxiety

If you are experiencing anxiety, the root cause will be down to a particular pathway in your brain.

The following video is taken from my online course Retrain Your Brain® and explains one of the pathways in the brain that can result in anxiety


As a quick rule of thumb, thought based anxiety is where you can apply rational thought to your anxiety, whereas, in amygdala based anxiety, your anxiety bypasses thought process – it operates without thinking. 

The video below is only a few seconds long and a bit ‘rough and ready’ but helps to explain the point.


In the video, you do not stop to decide if you see a bear or not, rather you immediately feel anxious; better safe than sorry, this is your amygdala preparing you for danger. The fear you feel, bypasses rational thought, as there is no time to think.

Afterwards, if you were to fret about what happened, and scared that it would happen again, this would be thought based anxiety.

 “What causes anxiety?” it is down to one of two things

  • Your thought processes, and/or
  • Experiencing a stress response when not needed – the automatic activation of your amygdala


Reminder: The emotion of anxiety has 3 components; subjective experinces, physioloigcal response and behavioural response. The symptoms that you experince are the physiological response.

Physical Symptoms

Chest Pain

This can include pain or tightness anywhere in your chest and your rib cage. It can feel like a tightness or fullness, pressure, or muscular pain.

If you have a clean bill of health and do not have an underlying medical cause for your chest pain, (such as heart problems, asthma, or stomach related issues), then you are probably experiencing anxiety.

Chest pain, although very frightening, will go away, when your nervous system calms down, and your breathing returns to normal.

The pain is due to breathing more than you need to. You might notice during levels of high anxiety, or during a panic attack, that your muscles above your rib cage are expanding and contracting your chest muscles. This can cause pain, as when relaxed, you will breathe from your diaphragm.

You are hyperventilating due to a stress response which is causing your blood vessels to contract. The stress response is causing your muscles to tighten. These two things combined can cause chest pain.

Heart Palpitations

Heart Palpitations, pounding, and rapid heartbeat are common with anxiety. It can feel like your heart is pounding out of your chest, or that it is about to give up. You can hear your heartbeat in your ears, especially if you are lying down, it can seem like it is pounding on your pillow.

You would expect this to happen and even appreciate it if you were in real danger. It is needed for you to take action fast. It will pound harder to make the blood flow faster and to enable more oxygen to be at your disposal.

You are comfortable with the idea that if you got up now, and went out for a run for five minutes, that your heart would beat fast, it may even pound out of your chest if you are not a regular runner. Your heart needs to beat faster, to pump more blood when you are active.

If your sympathetic nervous system gets activated, when it is not necessary, your heart will start to pound. This is alarming, if you are just sitting at home watching the TV.

Once this starts, you are more likely to stop watching the TV and your mind will start to worry,

  • I’m having a heart attack
  • What’s happening?
  • Am I dying?

You will probably feel your pulse. When you do, and feel it beating almost too fast for you to count, you get terrified. This fear sends a clear and definite signal, that there is really something to worry about, and your sympathetic nervous system is really firing now. Your heart beats faster still.

Difficulty breathing or catching your breath – smothering sensations

Can’t catch your breath?

Breathing problems that are caused by anxiety can feel like

  • You are gasping for air
  • You cannot get enough air
  • You are gulping air
  • You are not breathing at all
  • You are suffocating and or/ feeling like you are smothering

Why does it feel like I can’t breathe, or that I am always aware of my breathing?

You are focusing on your breathing – you become incredibly aware of it. In life before anxiety, you probably never thought about breathing. You did not have to, as it is outside of your control, you do not have to remember to do it.

Many people become acutely aware of the change in their breathing once they start experiencing anxiety. You are more than likely over-breathing.

When you are relaxed and calm, you may not think about it, your intake of breath is natural and occurs at the right time, when you need it. During high anxiety or panic, you are consciously thinking about breathing – afraid of it stopping. This awareness may cause you to start to take your ‘in-breath’ before it is needed.

Numbness, and Pins and Needles

When you are experiencing anxiety or panic attacks, the feeling of numbness and pins and needles is common. Blood quickly gets diverted away from areas that are not necessary, to allow your heart to beat faster. When the blood is getting diverted, your blood vessels contract. Your breathing has also increased.

You are receiving more oxygen. You are also experiencing less carbon dioxide, which results in the numbness, pins and needles, and tingly feelings you may have.


Many people find it difficult when they blush, as they are worried that other people can see that they are anxious.

You can feel the heat coming up over your throat and neck and then the burning in your face. If this happens to you, all you can think about is, the other person can see that you are anxious, which in turn, makes you blush more.

Adrenalin is released into your body, causing your heart rate to beat faster. It also results in your blood vessels dilating. This is necessary (in a real emergency) to allow blood to pump faster.

This is what you feel in your face, more blood flow. 

Tummy Problems

These include

Irritable Bowel Syndrome




Stomach pain/cramps

Pain from wind

Acid reflux problems

Why does this happen?

Your digestion slows down

The acid in your stomach increases

This happens because in times of emergency it is not that important that your body focuses on digesting your last meal. It is much more important to focus on supplying power to your heart and muscles for you to respond to the emergency.

If you are experiencing chronic anxiety, your ability to digest becomes slightly impaired and may result in the stomach problems listed above.

Frequent urination

Why do I need to go to the loo when anxious?

That old expression “I nearly wet myself” has to come from somewhere!

Have you noticed that when you are anxious, you need to “wee” more often? It is a perfectly natural thing that happens when you get anxious.

If you were in danger, your bowels and bladder could empty on the spot. If you have a life-threatening situation in front of you, you do not want to be weighed down with the contents on your last meal. Your body can dispose of them; rapidly.

Emotional Symptoms

  • Feeling like you are going to die
  • Terror
  • Feeling like you are losing your mind
  • Unable to sleep
  • Fear of losing control
  • Feeling not real
  • Intrusive thoughts and/or images


  1. Ekman P. Basic Emotions. Handbook of Cognition and Emotion. 2005:45-60. doi:10.1002/0470013494.ch3
  2. Hockenbury, D. and Hockenbury, S.E. (2007). Discovering Psychology. New York: Worth Publishers.

Further Reading