anxiety

ANXIETY MANAGEMENT
Anxiety is a normal healthy human emotion. We all experience it when faced with situations we find difficult or threatening. It helps us to avoid dangerous situations, makes us alert and gives us the motivation to deal with problems. Moderate levels of anxiety actually improve our performance. Anxiety becomes a problem when it is:

• Excessively intense or out of proportion to the situation
• Continues long after the threat/difficult situation is over
• Triggered by situations known to be harmless
• Occurs without cause
  

SYMPTOMS
When we feel anxious a sequence of automatic events occurs in our bodies to prepare us for action; this is known as "fight or flight". Symptoms can be of three types:
Physical symptoms can include:

• Sweating, blushing
• Shaking, muscle tension (giving rise to headaches and muscle pains)
• Dry mouth, difficulty swallowing
• Heavy or fast breathing, dizziness, faintness, tingling sensations
• Racing heart, blurred vision
• Indigestion, feeling sick, diarrhoea
• Sleep and appetite disturbance

Psychological symptoms can include:

• Poor concentration, irritability
• Worry, dread
• Negative thoughts (e.g. "I'll lose control/be humiliated... I'll die from a heart attack... Everyone will laugh at me")
• Feeling 'keyed up' or 'on edge'
• Experience of feeling unreal or of surroundings being unreal
• Feeling out of control

Behavioural symptoms can include:

• Avoiding situations or people
• Escaping from situations as quickly as possible

Anxiety persists because there is a vicious circle of physical symptoms, worrying thoughts and changes in behaviour. When anxious, we worry more. We focus on a particular physical symptom and become more aware of it. This is likely to make us worry more which in turn worsens the symptom. It is important to remember that the symptoms of anxiety can be uncomfortable and unpleasant but they are not dangerous and the symptoms may pass over a period of time. Initially avoiding situations that cause anxiety may bring relief but in the longer term, avoidance may make the anxiety worse

PANIC
This is the name given to a sudden period of intense anxiety characterised by intense fear and discomfort. It is usually experienced as a sudden attack and often occurs unexpectedly. Symptoms may include:

• Breathlessness, dizziness
• Pounding heart, chest pain
• Sweating, faintness
• A feeling of unreality
• Fear of dying
• A desire to escape
  

The sudden and intense nature of the attacks can lead people to think that they are in danger of some physical or mental disaster such as fainting, having a heart attack, losing control or 'going mad'

TYPES OF ANXIETY PROBLEMS
Panic disorder
This consists of recurrent attacks of very severe panic which may occur unpredictably and may not be specific to any situation. There is usually freedom from anxiety between attacks although people are often anxious about the possibility of having an attack

Free floating anxiety
Anxiety is present all the time and is not restricted to any particular situation. Both physical and psychological symptoms are present

Specific phobias
A phobia is a strong fear and avoidance of one particular type of object or situation. Exposure to the feared object/situation may cause a panic reaction e.g. fear of spiders or fear of heights

Social phobia
Here the anxiety occurs in social situations. People fear being looked at, negatively evaluated, rejected or criticised by others

Agoraphobia
People are affected in a range of situations such as entering crowded places or being far from home

TREATMENT AND SUPPORT
Anxiety and panic are treatable. Overcoming these problems can be done using specific techniques and/or making changes in your lifestyle. You could discuss this with a member of staff at your practice

Relaxation
Various simple techniques can be easily learnt, including breathing exercises and progressive muscle relaxation

Problem solving
This encourages us to list our problems, prioritise them and deal with the first on the list. Read the Depression Leaflet for more details

Distraction techniques
These techniques can include:

• Focusing on an object and describing it in detail - shape/size/colour
• Imagining pleasant situations such as an enjoyable holiday or a favourite walk
• Physical activity

Talking treatments and therapy
Cognitive Behavioural Therapy (CBT) helps people think more positively and leads people to adapt their behaviour. Several good self help books are available - some are listed below:

Lifestyle changes

• Try to reduce caffeine, alcohol and smoking
• Try to spend more time with others
• Find someone to confide in

Medication
Medication may be useful in some but not all cases. Please discuss this with your GP

SELF HELP BOOKS

• Overcoming Anxiety: A five areas approach, Christopher J Williams (Hodder Arnold H & S)
  
• Managing Anxiety and Depression - A self help guide, The Mental Health Foundation www.mentalhealth.org.uk
  
• Mind over Mood: Cognitive Treatment Therapy Manual for Clients, Christine Padesky & Dennis Greenberger (Guildford Press)

HELP AND SUPPORT

• First Steps to Freedom National Helpline: 01926 851 608 www.first-steps.org
• No Panic National Helpline: 0808 808 0545 www.nopanic.co.uk
• National Phobics Society 0870 7700 456 www.phobics-society.org.uk
• Triumph over Phobia 01225 330353 www.triumphoverphobia.com
• Age Concern Information Line - 0800 009 966. Service for older people, relatives, friends, professionals and carers (7am-7pm, seven days per week)
• Samaritans - 08457 909 090. Free phone line offering emotional & confidential support for people who are experiencing feelings of distress or despair, including those which may lead to suicide (24 hours)
• NHS Direct - 0845 46 47 (24 hours). Free information service on all aspects of health problems, NHS services and other local services www.nhsdirect.nhs.uk
• MIND Infoline - 08457 660 163. Free national information line (9.15am-5.15pm, Monday-Friday) - interpretation available for over 100 languages www.mind.org.uk
• Mental Health Foundation: www.mentalhealth.org.uk
• Rethink: www.rethink.org
• www.besttreatments.co.uk (provides clinical evidence for patients on a range of problem areas)

NHS Direct 0845 46 47 www.nhsdirect.nhs.uk