What is anxiety?
Anxiety is a normal response to stressful situations and is an emotion that causes changes in how you think, feel and behave. When anxious, you may worry or have racing thoughts; your heart can beat faster, leaving you feeling wound-up, restless and edgy.
Anxiety can start to cause problems if you begin to regularly activate the stress response when there is no threat or danger present or your feelings of anxiety are more significant than the situation warrants. According to the APA, up to 30% of adults experience any anxiety disorder at some point during their lifetime.
This article shall explain what anxiety is, how it can result in anxiety disorders, how to spot the signs of more severe anxiety, and outline treatment options.
Not all anxiety is a disorder
Many people say they have anxiety or getting CBT or medication for anxiety, but if you are receiving treatment, you will be referring to having an anxiety disorder. Anxiety, the emotion, is not a mental health condition; it is part of life, helpful on occasion and unavoidable.
There is a big misconception that all anxiety is a disorder. However, this is not the case. While some people may experience anxiety more often than others, it is not always a sign of a problem. In the same way, you can be sad but not depressed; you can feel anxious and not have an anxiety disorder.
How is anxiety helpful and unavoidable?
Anxiety exists to protect and help you avoid danger. If you step onto the road without checking for traffic first, the emotion of anxiety gives a lightning-fast reaction to help you get back on the pavement. The jitters before exams force you to prepare, revise and stay alert when needed.
There will always be aspects of life where you need to react quickly, feel afraid, or face a novel situation for the first time. Consequently, the emotion you experience, anxiety, is unavoidable.
How do I know if I have an anxiety disorder?
Some signs and symptoms are common to the emotion and all anxiety disorders, but some symptoms are unique to specific anxiety disorders. The ability to differentiate between them can help signpost whether your anxiety is normal or more indicative of a disorder.
The National Institute of Mental Health explains how everyone can have temporary anxious feelings relating to life events such as health and finances. Still, with anxiety disorders, this feeling of anxiety does not go away, and the symptoms start interfering with the person’s daily life and ability to get things done.
As a rule of thumb, appropriate anxiety is temporary. It is related to a unique event such as an interview or change in finances and does not interfere with your ability to live your life.
If your anxiety is interfering with your quality of life. For example, changes in your sleep pattern, changes in your behaviour such as avoiding things and the feeling does not go away or gets more intense; you should meet with a mental health professional to see if you have an anxiety disorder.
What are anxiety disorders?
Anxiety disorders are a group of mental illnesses that cause constant and overwhelming anxiety and fear.
Anxiety disorders can make you avoid work, school, family, and other situations that you believe might trigger or make your symptoms worse.
What are the types of anxiety disorders?
There are several types of anxiety disorder, sharing some similar characteristics as well as symptoms that are unique to each disorder.
All anxiety disorders can include the following symptoms.
Generalised anxiety disorder
The symptoms of GAD include a worry or fear that is both difficult to control and out of proportion to the thing that you are worried about.
A person with panic disorder experiences frequent panic attacks.
Unlike the other anxiety disorders, panic attacks are necessary diagnostic criteria, i.e. you will not be given a diagnosis of panic disorder without having recurring panic attacks.
Can I prevent anxiety?
In a word, no. As explained at the start of this article, anxiety is unavoidable and is there to help you in situations where you experience a threat. However, there are things you can do to stop anxiety from developing into an anxiety disorder.
Can anxiety disorders be prevented?
Yes, you can prevent anxiety disorders by taking steps to control or reduce your symptoms.
Towards the end of this article, there are tips on how to reduce anxiety.
How do I recover?
Your first need to get a diagnosis.
How is it diagnosed?
Mental health professionals use 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 condition, etc.)
You might also complete a self-report questionnaire, such as the Beck Anxiety Inventory (BAI).
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
- 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.
- Self Help
- This can be self-help that you undertake alone or may include psycho-educational group sessions.
- 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.
- Highly specialised treatment
- This can include psychological intervention, medication and multidisciplinary teams or inpatient care.
Their G.P. often refers people to psychologists for Cognitive Behavioural Therapy when a diagnosis of anxiety has been given.
If you are considering therapy for anxiety, this series of articles explains in more detail how CBT helps with anxiety.
I shall start by talking to you about the most well known therapy option for anxiety, and that is CBT, but (and this is important) I also want to talk to you about how to get the right treatment based on the kind of anxiety that you have.
You might not be aware that there are different pathways in your brain that can cause anxiety, and understanding how your anxiety is created affects the type of treatment you need.
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.
Many treatments do not focus on how your brain works, or the pathways that exist in your brain that create anxiety. The key to my success in helping people with anxiety is understanding the different pathways to anxiety in your brain, as well as being an expert in CBT.
CBT is beneficial for the thought processes involved in anxiety and great for changing any anxious behaviours you have (e.g., overworking, always predicting the worse). But you will feel anxiety in certain places or ways with little thought processes being present for many of you. This is because your brain remembers to be anxious!
Your brain remembering to be anxious is explained in the video below taken from my online course.
Recap: CBT is great for the thought processes associated with your anxiety and is useful for helping with anticipatory anxiety, where you 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 look at your brain, in particular we need to look at the role of your amygdala in anxiety.
You need to learn to react differently to situations
You need to know to activate the rest and digest response more often
It would help if you changed the way you interact with the thoughts in your head
It’s important that you calm down your nervous system.
The way your brain works for you needs to be changed.
It is not necessary for you to see me in person to get help with anxiety. self-help is enough for most people.
Recovering from anxiety is not so much about what you say to the therapist, but what you are told to do.
Let me explain. There are tried and tested models of therapy that are shown to work with anxiety. These are highly directive (you are told what to do, what to change, what not to do.)
But what about making it personal? If you were in session with me right now, I would have to tailor any treatment to suit you. How I do this is to explain what I need from you to make it personal. Give you instructions on how to do this, and collect all of this information between sessions. The reason we do it this way is that you have to be out and about in your daily life to see what is.
triggering your anxiety,
how you react,
what you do that needs changing.
And the changes that you make, based on the all the information you collect between session, are undertaken by you, outside of therapy sessions.
Most of the therapy for anxiety, if you are working within, for example, CBT, is the therapist explaining what to do, and most of your work is practice between sessions.
This is what I mean when I say you don’t need to come to see me. I can take you through this process, in your own time, at your own pace.
My course covers everything that I have been talking to you about in this article.
What causes anxiety?
There are different theories of anxiety, and I shall outline some of those theories now.
Cognitive theory of anxiety
According to cognitive theory, anxiety occurs when a false assumption is made about a situation, i.e., that it is dangerous without having direct evidence to prove the threat.
For example, someone with social anxiety may believe that an upcoming event is something to be feared. This appraisal of the event leads to a myriad of cognitive errors, resulting in faulty thoughts, such as I cannot do this, I will make a fool of myself, which affects future behaviour; they may avoid the event.
Behavioural learning theory
According to behavioural theories, anxiety is acquired through learning. For example, someone who had been anxious while shopping might pair the experience of shopping with feelings of anxiety; this pairing is inadvertent learning that shopping results in stress.
New theories on anxiety
Dr Ellen Vora (3) makes a important distintion in what she calls true and false anxiety and notes that there is a lot going on in our world that we can be afraid of, which ultimately gives us a fear response. According to Vora false anxiety is something that we can do something about; it is avoidable. It can be from a blood sugar crash, too much stimulus, caffeine, diet or lack of sleep.
I can concur with some of her theories after restricting sugar and caffeince from my diet, focusing on an anti-inflammatory diet and prioritising sleep.
Neuroscience has shed new light on anxiety pathways, which I explain in the following video.
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 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.
Very important point to note. Both processes involve your amygdala, as thinking alone cannot produce the anxiety that you feel; rather the thoughts have to activate your amygdala to create the stress you feel!
How to deal with anxiety right now
Short term ways to manage anxiety.
If you are feeling anxious right now, the following brief videos will help you manage the anxiety that you currently feel.
Controlled breathing to manage anxiety
The following video will help you to control your breathing.
Focusing on your breathing helps you manage anxiety in two important ways.
- It will allow your breathing to settle and calm your nervous system
- It will stop you from focusing on everything else that may increase or contribute to your anxiety.
Remove yourself from anything anxiety provoking
This could mean,
- getting out of your head if you are ruminating
- walking away from a confrontation or argument
In both these instances, focusing on your breathing will help you with this. If you are in the middle of a confrontation or ruminating about it afterward, it can be hard to leave it alone. If this is the case for you, tell yourself to
- Get offside
- Focus on what you are then doing
and quite literally just follow the instructions you have given yourself. For example if you are ruminating;
Stop, get offside will be getting out of your thought processes, do a crossword, read a book, focus on your breathing, go into a different room, get outside. Whatever you choose, focus all your intention on your new task.
It might not be possible to get away, for example, if you are at work, but you can still return to your breathing, as you bring it everywhere with you!
If you can, go for a walk. If you are at work you an do this on the stairs, or walking through the office, or on the way to the bathroom.
Walking mindfully is the opposite of moving while you keep all the anxiety provoking thoughts in your head.
Instructions for walking mindfully.
Pay attention to everything that are doing with no judgement. Pay attention to one foot being placed in front of the other, the feeling of your body as you move. Focus all your attention, and therefore, thought processes on the activity of walking.
Notice your environment as you walk. If your mind wanders onto telling you that you are anxious, gently acknowledge this and carry on with what you are doing; just walking.
Long term ways to deal with anxiety
In the first part of this article I showed you some ways to deal with anxiety if you were feeling anxious right now. If you continue to feel anxious on a regular basis, I would advise looking at more formal ways to reduce your anxiety, as opposed to managing it everyday.
More formal ways would be looking at models of therapy that may help you. I have information on my site that you should read. I would start with reading about
- Cognitive Behavioural Therapy, this will help manage anxious thoughts and behaviours
- Educate yourself on the emotion of anxiety
Once you have read the above, you can find more information on anxiety in these articles.
- Ekman P. Basic Emotions. Handbook of Cognition and Emotion. 2005:45-60. doi:10.1002/0470013494.ch3
- Hockenbury, D. and Hockenbury, S.E. (2007). Discovering Psychology.New York: Worth Publishers.
- Vora, E. (2022) The anatomy of anxiety. Orion Spring