Anxiety
Anxiety covers a wide range of situations, from brief moments of nervousness, to situationally-specific issues such as exam/driving test nerves to generalised anxiety disorder, where someone feels persistently worried to the point where it affects their everyday life, and the person has trouble relaxing, sleeping or even concentrating.
Cognitive aspects of anxiety include thoughts of being in danger, threatened or vulnerable. Physical aspects include increased heart rate, insomnia, rapid breathing, nausea, light-headedness, trembling, sweating, blushing and jitteriness. Behavioural aspects can include avoiding the situation that triggers the anxiety, which is perhaps tolerable if, for example, fire is the trigger, but not so bearable if open spaces spark the anxiety. By addressing the cognitive and behavioural aspects, it is possible to remove or reduce the anxiety experienced.
Because of the diversity of anxiety issues, examples of common ones are given a brief description below.
Generalised anxiety disorder
Generalised anxiety can affect and limit someone’s life extremely negatively, and is discussed in the opening paragraph of this ‘anxiety’ section.
Health anxiety
If you worry constantly about your health, check your body frequently for signs of pain, lumps or other signs of illness, need frequent reassurance about your health, worry that medical tests have missed something, read obsessively about health problems (such as consulting ‘Doctor Google’), or avoid situations that remind you of or could cause you health issues, then you might have health anxiety.
Therapy can help with health anxiety by encouraging you to deal with facts and evidence (such as “I have no firm evidence that I am ill”) and by challenging your thoughts and perceptions about your health and body.
Panic attacks
Panic is extreme anxiety or fear; some or all of the anxiety symptoms described previously on this page can be present, but they are present to a severe degree; for example, rapid breathing in a panic attack can feel more like suffocating hyperventilation along with a feeling of impending catastrophe.
A panic attack can be so severe that it mimics a heart attack or severe respiratory distress, which of course makes the attack even worse, thereby triggering a most unfortunate vicious circle. People might even visit the local A&E department, only to find that everything is physically normal.
Therapy can be used to help panic attacks. This includes such strategies as decreasing your perception of danger and increasing your confidence in dealing with the attack. For example, if you examine the evidence that supports the panic-provoking thought, in most cases, your perception of danger will decrease.
Learning breathing, relaxation and mindfulness techniques can also help. For example, hyperventilation happens when we breathe rapidly and shallowly, thereby causing an imbalance in CO2 in our lungs and bloodstream that makes us feel as if we are suffocating. The temptation is to gasp for more air, which only makes things worse. Breathing in a slower, controlled manner can end the hyperventilation relatively quickly. Longer-term, learning how to relax and live in the ‘here and now’ can help defend against anxiety-provoking thoughts.
Performance anxiety
It is natural, useful perhaps, to be slightly anxious when tackling a situation that requires a certain level of performance. However, when the anxiety becomes so powerful that it affects performance negatively or creates distress, it becomes anything but useful.
Therapy can intervene by breaking down all of the thoughts and beliefs about the situation (such as “I’m going to fail this exam”) and rationalising them (e.g. “I’m going to do the best I can on the day and focus on that”).
Phobias
A phobia is an irrational, overpowering, incapacitating fear of an object, place, situation or feeling. Symptoms can range from relatively mild symptoms such trembling, shaking and sweating, or they can be severe and trigger a panic attack.
Therapy helps people identify ‘hot thoughts’ that accompany the object of their phobia and come up with an action plan for managing the situation. For example, you might examine the worst than can happen and then break it down into its component parts before addressing each one in detail.
Desensitisation and response prevention are key parts of the therapy. For example, for arachnophobia, we might start with imagining a spider, then move onto looking at photographs of spiders, then touching the photograph and finally being exposed to situations where you are likely (and then certain) to experience a spider. This step-by-step approach allows you to feel steadily less anxious about your phobia.
Trauma
An overwhelming event can result in your brain trying to keep you safe from the danger long after the event is over. This topic is covered in full depth on the trauma/complex trauma page.