Anxiety; what it is and how to manage it

Dr Elaine Ryan

Retrain Your Brain®

If you want my help with anxiety please see my online course

Table of Contents

What is anxiety?

Anxiety is an emotion that occurs as a result of your brain's response to a perceived threat, and it consists of a subjective experience (trigger) such as speaking in public, a physiological response (symptoms) such as palpitations and a dry mouth and a behavioural response, avoiding the presentation.

Dr Elaine Ryan

If this is your first time on my site, my name is Elaine. I am a psychologist, and I also had anxiety and panic attacks, so I understand what you are going through, from a personal perspective and a professional one. Anxiety is what I specialise in.

If you’ve been googling or reading books, you will have read that anxiety is perceived to be unease, etc. I won’t repeat that (although I will explain the symptoms later) rather I want to give you a more scientific explanation of anxiety, as opposed to something descriptive.

Anxiety is driven by fear when there is nothing concrete to be afraid of or no immediate danger to you. Even though you are not in immediate danger, you still feel the effects of fear.

It is necessary to understand the difference between fear and anxiety to understand anxiety.

Fear and anxiety.

Fear is a primitive response to immediate danger, such as being chased by a bull. With anxiety, there is no immediate danger; there is no bull chasing you; instead, anxiety is an emotion driven by anticipation about an event that has not yet happened. The exception to this is panic. Panic is acute, and anxiety is more future-orientated.

Fear helps you to avoid danger. You only have to touch a hot stove once to learn not to do it again. This learning occurs through negative reinforcement; you do not have to think about it too much for this learning to occur.

Anxiety is a complex emotion that developed as we as humans developed. Once we have developed an area in the brain to allow us to think, plan, and weigh up scenarios, we can now worry about what other bad things may happen and how will we look to other people, i.e. it is future-orientated.

For example, if you have to give a presentation, now with the capacity for thought, your brain can mull over previous times you gave presentations. If you were anxious before, you now worry that you will be nervous again. This capacity for thought can lead to anticipatory anxiety.

Quick recap

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.
When the emotion of anxiety occurs automatically, it consists of a subjective experience – e.g. 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 asking someone else to make the speech. 2

Types of anxiety disorder

There are several types of anxiety disorder.

How do I know if I have anxiety?

Anxiety has particular signs and symptoms, which I shall detail below.

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.

Many ‘ markers ’ show during our initial meeting that will alert me to 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.

Anxiety symptoms

This can include pain or tightness anywhere in your chest and 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 (heart problems, asthma, or stomach-related issues), 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. During levels of high anxiety or a panic attack, you might notice 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, 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, 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 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 more quickly and 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, 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 active.

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

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

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

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

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 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 your control; you do not have to remember to do it.

Many people become acutely aware of their breathing changes 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. You are consciously thinking about breathing during high anxiety or panic – afraid of it stopping. This awareness may cause you to start to take your ‘in-breath’ before it is needed.

When you are experiencing anxiety or panic attacks, the feeling of numbness and pins and needles are typical. Blood quickly gets diverted away from areas that are unnecessary 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 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 that the other person can see that you are anxious, which 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.

These include

  • Irritable Bowel Syndrome
  • Diarrhoea
  • Constipation
  • Bloating
  • 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 it is not that important that your body focuses on digesting your last meal in times of emergency. It is much more important to focus on supplying power to your heart and muscles for you to respond to the crisis.

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

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

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 of your last meal. Your body can dispose of them; rapidly.

  • 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 images

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

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!

The stress response

Your body, your brain, is equipped to help you respond to stress. By stress, I mean when you are in danger, such as a bull charging up the street towards you. The bull is the stressor and represents an obvious danger to you.

If you were strolling up the street and then see the bull, something needs to happen in your body to help you get out of danger, i.e. get away from the bull. Your body responds to this type of stressor by giving you the energy and stamina to get away from the bull, i.e., respond to the danger.

Your body changes from your leisurely stroll, to giving you enough energy in your muscles to run, without having to think what to do. You have responded to the immediate danger–the stressor.

You have heard that before, but stop and think about it. If you are sitting down now, calm, reading this article, think what would have to happen to send energy to your muscles, make your heart beat faster, to change your physiology? You can’t sit there and will this physiological change. But your body manages this incredible feat to keep you safe. For the sake of the example, think of it as a switch that gives you energy to getaway.

When you are out of harm’s way, your body seeks balance and quickly calms down your breathing, slows your heart rate and returns everything back to normal. It turns the switch off.

 

In this example with the bull, what I was, in fact, describing was fear. Both fear and anxiety can give the same feelings, but there are big differences between the two. 

 

Fear is what you feel when there is an immediate, real danger in your environment, such as the bull.

Anxiety is what you feel when there is no real danger.

 

This is an important point, so take time to get to grips with it. If you remember my definition of anxiety,

Anxiety is the term used to describe the physical symptoms and the emotional and cognitive changes that you experience when you activate the stress response for a prolonged time and in situations where you do not need it.

In my example above with fear and the bull, it is appropriate to experience the stress response. My definition of anxiety states that you experience anxiety when you activate the stress response in situations where it is not needed.

How you can activate the stress response when there is no real danger?

The problem is, even without a bull chasing you, you can worry yourself into getting this anxiety switch turned on. You could sit in an office (with no bull) but the worries inside your head can still turn on that switch, which leads to the same physiological response that happened with the bull. This is important as it handles the physical symptoms that you experience and I shall talk about that later.

In this modern-day world, the stressors that start the process are no longer life and death situations. They are worries and remembered stressful situations. In the absence of real danger (the bull), this ‘switch’ to change your physiology, i.e. your heart rate, breathing etc (the common symptoms of anxiety) can get turned on by.

  • Anticipating things that could go wrong in the future, such as worrying about work, money, and bills. By thinking or.

  • By activating fear, using emotional memories (remembered instances in the past when you felt fear or anxiety).

Your brain; your nervous system and anxiety.

When you feel anxiety, it has a lot to do with what is going on in your brain. 

Your Anxious Brain

Your brain has grown to keep you safe. Watch out for, and monitor, ‘threats’ that could cause you harm. For example, if you were at the zoo and saw that a lion had escaped, you don’t have to think about whether this is a threat. Your brain has you covered and you have already started running before you realise it. You feel fear and respond.

If you watched the video, you can see that your brain can markup some harmless scenarios as threats, for example, meeting, speaking up in public, can be identified as threats.

When this happens, your brain gives you anxiety (as opposed to fear) as there is no real danger present.

Your brain learns from your reactions. The more you experience anxiety in these situations or the more you try to avoid them, the more your brain learns.

Autonomic nervous system comprises
  • The sympathetic nervous system–sometimes referred to as the STRESS RESPONSE, or fight or flight, and

  • The parasympathetic nervous system is also referred to as the REST AND DIGEST nervous system.

I find this easier to explain by giving an example. You are out for a walk, and out of the corner of your eye, you see a shadow. It is large, has four legs, mouth open, and you can see pointy teeth.

You will get a stress response.

Why and how does this happen?

Your brain does not wait for you to weigh up all the options and decide what to do next. There is no time to think. You get a stress response through a series of communications in your brain.

This is a major over simplification, but helps to make the point. Once you spot the shadowy image out of the corner of your eye. This image is sent to your hippocampus and your Pre-Frontal Cortex.

If you can imagine that your brain has a series of images, and what you see out of the corner of your eye is quickly matched up with some sort of animal that could be dangerous.

This occurs in a region of your brain called the hippocampus. Could be a wild animal–could be danger. It’s a threat.

Once this match is made, and to give you the best possible chance of making sure that you come to no harm. It is this potential threat that is first detected in your hippocampus that waves a red flag at what is called the amygdala. You can think of your amygdala as an alarm.

Your alarm bells are ringing (amygdala), which sets off your fight-or-flight response. Your sympathetic nervous system has been activated.

Activation of your sympathetic nervous system.

Within the blink of an eye,

  • Your heart is pounding, cortisol is released, as if the scary animal injures you, you need this to reduce the inflammation that will result from your wound.

  • As your pupils have dilated, your vision is sharp.

  • If your life is in danger, you don’t need your stomach to digest dinner.

  • You are primed and ready to act.

All of this happens when your hippocampus matches up a potential threat. The image reaches other areas of your brain, such as your prefrontal cortex, to check out this shadowy image further. Here you can inspect what is going on in more depth. It could be a dangerous animal, but how many dangerous wild animals do we have in Ireland, you might think?

The sun is high, and is making the shadow bigger than the animal is. You see, a small domestic cat.

Danger over!

Your heart stops pounding, and everything is your body relaxes. This relaxation is because of activation of your parasympathetic nervous system — the rest and digest.

What has this got to do with anxiety?

Everything!

The key points to take from what I said above are:

  • POTENTIAL THREATS first go to your hippocampus–which acts on a ‘better safe than sorry’ basis

  • this RINGS THE ALARMS BELLS (your amygdala) before you have had a change to assess whether you need a full-blown stress response.

  • how do you assess threats?

Threats in this modern world are someone not replying to your text on time, not having prepared for a deadline, worrying about what other people are thinking about you, finances.

The more you react to these situations with even a mere hint of stress, the more likely matches for your hippocampus can make them as a danger for you.

The alarm bell rings and it all starts over again.

How do I recover from anxiety?

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

  1. Assessment, education and discussion of treatment options
  2. 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.
  3. Self Help
  4. This can be self-help that you undertake alone or may include psycho-educational group sessions.
  5. Psychological intervention CBT or medication
  6. 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.
  7. Highly specialised treatment
  8. This can include psychological intervention, medication and multidisciplinary teams or inpatient care.

Treatments

The primary treatment for anxiety is

  • psychological therapy, or
  • medication.

Psychological therapy is where you meet with a licensed mental health professional and are offered Cognitive Behavioural Therapy, CBT.

Your GP, or psychiatrist can prescribe medications for anxiety.

Psychological therapy for anxiety

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. 

Anxiety counselling

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.

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.

7-11 breathing

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

  • Stop
  • 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!

Walk mindfully

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

Once you have read the above, you can find more information on anxiety in these articles.

Outlook

Anxiety, although debilitating, can be effectively treated with the right help. Whether you start my Retrain Your Brain® course or meet with a therapist, getting help is the first step to recovering from anxiety.

References
  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.
  3. Vora, E. (2022) The anatomy of anxiety.  Orion Spring
Dr Elaine Ryan

Dr Elaine Ryan

Dr Elaine Ryan is a Counselling Psychologist with 20 years experience. She specialises in OCD and anxiety related conditions. She worked in the National Health Service before setting up private practice. Dr Ryan obtained her PsychD from The University of Surrey.