Anxiety

Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.

When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry, if it is a sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, we call it fear.

Normally, both fear and anxiety can be helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However, if the feelings become to strong or go for too long, they can stop us from doing the things we want to and make our lives miserable.

Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite and see the future as bleak and hopeless.

About 1 in 10 people will have troublesome anxiety and phobias at some point in their lives.

I hope this booklet helps you to understand your feelings of anxiety and how to cope with them reassuring you that they are not life threatening just normal body reactions to everyday problems.

What are the symptoms of Anxiety?

  • Blurred vision
  • Trembling
  • Feeling of choking and cannot breathe
  • Sweaty palms, cold hands
  • Trembling legs
  • Pins and needles in hands or arms
  • Pain in centre of chest
  • Feeling faint
  • Fatigue
  • Headache
  • Repeated deep sighing/excessive yawning
  • Heart pounding
  • Frequency to urinate

When suffering with Anxiety you may have one or all of the following symptoms. These may stop you from doing everyday things i.e. shopping, socialising, standing in a queue, going into crowds even going out of the front door.

PHOBIAS

Anxiety and panic attacks can lead to certain phobias, going on buses, queuing, shopping, supermarkets, fear of not being able to get out of a large building always looking for the exit

Also all of these can be controlled once you have learnt how to cope with anxiety and realise it is not harmful.

AVOIDANCE

When suffering from anxiety/panic attacks try not to avoid situations you would have normally enjoyed or done.

SOCIAL PHOBIA

Someone who has a social phobia feels anxious when observed by other people.  Their anxiety focuses on the fear that others are thinking badly about them or judging them.  This ‘fear of negative evaluation’ may also reflect beliefs about being ‘not as good as others’, ‘or not quite up to scratch’.  Social anxiety may give rise to extremely unpleasant but physically harmless reactions such as blushing, sweating and trembling.  It may also produce distressing feelings of self-consciousness or embarrassment, especially if the symptoms of anxiety are easily noticeable to other people.  Some of the more common situations causing such anxiety are eating, speaking or writing in front of others, talking to strangers and going to shops, pubs or parties.

Social phobias are quite common, and they affect men and women equally.  They are distressing because they make everyday situations difficult and uncomfortable, and so often restrict day-to-day activities.  The problem is real and a difficult one, and it may not ‘go away by itself’.  With help you can learn how to bring it under control.

CAUSES OF SOCIAL PHOBIA

Social phobia is not associated with serious or mental disorder, or with any known physical illness.  It is rather that everyday situations provoke distressing feelings of fear and anxiety.  A person with social phobia reacts to such everyday social situations as if they were dangerous or frightening.  Strong fear reactions, or feelings of anxiety, are associated with places, events or activities involving contact with other people.  The strength of this association may grow until making contact with others, or even thinking about doing so, automatically produces feelings of anxiety.  It is like a bad habit.

This may have started in time of difficulty or strain, when bodily reactions can become oversensitive.  It may be hard to remember when or why it first happened.  In the same way it is often hard to remember how a bad habit is first started.

Some people seem to have a natural ability to cope well with social situations while others find them much harder, or may always have been shy.  These people are more likely to react with anxiety.  If you are shy, or have difficulty making friends, it does not mean you cannot be helped.  On the contrary those with less natural ability are very likely top benefit from learning how to cope better with their social phobia.

THE CONSEQUENSES OF PERSISTANT PHOBIA

What keeps a phobia going?

Reactions to the problem keep a phobia going.  These reactions create vicious circles of anxiety that prevent the phobia dying away.  There are three main types of vicious, which are:

1. Avoidance keeps anxiety going.

As symptoms of anxiety are unpleasant and distressing, you want to avoid having them.  So anxious people avoid the situations that provoke their symptoms of fear.  But this reaction is unhelpful because avoiding situations restricts day-to-day activities.  It also encourages the belief that  situations will always cause anxiety.

In fact the symptoms experienced are not actually harmful.  Nor are the situations that provoke anxiety actually dangerous.  Fear and anxiety have just become so strongly associated with them that you react as if they were.  The more this happens the more uncomfortable those situations become, and so the person with the phobia avoids them even more.

Avoiding situations makes it difficult to weaken this association between the particular situation and the reaction of fear.

As well as avoiding things that you find difficult, for example meeting people, or eating in restaurants, there may be less obvious kinds of avoidance.  Examples of these are 1) avoid thinking about difficult situations, 2) avoiding parts of social interactions like introducing people to each other or starting conversations, and 3) not looking at people in the eye.

Unfortunately, although avoiding something may be a relief, it does not always provide a solution because:

The relief is only temporary.  You may worry about how you will be able to go on avoiding it.

Every time you avoid something it makes it harder to face it next time.

Gradually you grow to want to avoid more and more things.  The anxiety spreads.

2. Fear of fear keeps anxiety going.

Feeling anxious in situations that are not truly dangerous is distressing.  There seems to be little you can do about it.  So you may start to anticipate and to dwell on the symptoms themselves “ what if my hand shakes when I pick up a drink?” “I may blush and everyone may notice”, “Supposing my mind goes completely blank?”  These thoughts reflect socially phobic reactions to social situations.

In the end people with  phobias may fear the symptoms as much as they fear the situations that cause them.  This sort of worry is called ‘fear of the fear’, or secondary anxiety.  It is often expressed by the thoughts such as “ I know I will make a fool of myself”, or “ this always makes me feel dreadful”.

Fear of fear can provoke symptoms and prevent anxiety from dying down.  This in turn produces worry, or fear of fear, which leads to another increase in symptoms.

3. Loss of confidence keeps anxiety going.

Anxiety reduces confidence because it makes it hard to do things that others seem to find easy.  Confidence comes from succeeding in the things that you do, and it is built up by doing things.  Finding out that you can manage things that you thought were difficult builds your confidence.  Thinking that other people might be judging you, ‘evaluating you negatively’, or thinking that you are pathetic, odd or abnormal, undermines your self-confidence.

No one can ‘give’ you the confidence because it comes from your own success.  Alcohol or tablets may bolster your confidence temporarily, but do not build it up from long term.

When you lose confidence, or undermine yourself by thinking that others think badly of you, you can come to dread contact with others or doing something and another vicious circle of symptoms and reactions comes into play.

It also influences your reactions to the problem: the avoidance, fear of fear and loss of confidence keep anxiety going.  The temptation to avoid exposing yourself and to keep out of such situations is very natural.  However keeping away from difficulties only reduces the confidence that you can handle them, so they worry you more next time and so on.

OVERCOMING THE PHOBIA

You can overcome the problem by learning how to break the vicious circle of symptoms and reactions that keep the  phobia going.  The three main steps are explained separately.  Each of them involves different skills of controlling your anxiety.

DEALING WITH UPSETTING THOUGHTS

Why learn to control upsetting thoughts?

You may have noticed yourself that thoughts can make you feel anxious, or keep anxiety going.  Some of your thoughts may be in words.  Some may be more like half formed ideas, or pictures in your mind.  Expecting to be judged may be more like an attitude than a thought, and low self-confidence is a kind of belief about yourself (or lack of belief in yourself).  Ideas, images, expectations and beliefs reflect what goes on in your mind in different ways.  In that sense they are all different ways of thinking, and can all play a major part in the vicious circles described, helping to keep the  phobia going.

An example may help you make it clearer.  Imagine you arrive at a friend’s house for a meal and find the room full of people you do not know.  There is a pause in the conversation as you walk in and you think everyone is looking at me.  This makes you nervous, so you leap at the offer of a drink but feel hot and blush when someone asks you your name.  You think they must have all notice you shaking as you avoid catching everyone’s eye as you look around.  You start sweating uncomfortably the louder people talk the more you think I do not want to be here, you retreat into your shell and leave early.  The next day you think you will never do that sort of thing again.  Other thoughts also go through your mind, about how hard it is to make friends, and whether there is something wrong with you, and these make you feel sad and lonely.  In this way thoughts, feelings and behaviour influence each other all the time, and help keep the social phobia going.  Now think about a recent situation in which you felt anxious.  When you can remember the situation quite clearly think about the answers to these questions:

What went through your mind when you started to feel anxious?

Did your thoughts make you feel worse?

If so which ones?

FIND OUT WHAT YOU ARE THINKING

The first step is to become aware of what runs through your mind when you feel anxious.  This is easier said than done because the sorts of thoughts that make anxiety worse are often difficult to identify.  They come and go quickly, and may also have become automatic.  This means that they are like bad habits.  You may not be fully aware of them because they are so familiar, as if you were looking at the world through coloured spectacles.

The best way to find out what you are thinking is to write it down.  Keep a record for a few days of situations in which you feel anxious or  upset, and use theses as cues to help you identify what you are thinking.  You should note down

Details of the situations, what it was and where it occurred.

What feelings you experienced (e.g. fear, anxiety, fed up shaky)

Your thoughts, or what was in your mind when you felt that way.

Pay close attention to your thoughts next times you feel anxious or upset.  See if you can put into words the thoughts that went through your mind as anxiety builds up.  Remember that thoughts may come in the form of images, or reflect attitudes and beliefs.  In particular watch out for predictions.  Predicting that something will go wrong, or that you will not be able to do anything about it when it does, is very common in anxiety.

It is important to be accurate in observing your feelings and thoughts as you can.  So try to make a record at the time.  If this is not possible, make a mental note of what happened and write it down as soon as you can.

RE-EXAMINING YOUR UPSETTING THOUGHTS

Once you know what you are thinking the next step is to learn how to re-examine your thoughts.  The aim is to learn to question your thoughts, rather than accept them as facts.  When you do this you will find that there is no one right way of seeing things.  Rather there are many possibilities, some of which make you feel worse while others make you feel better.  This gives you a choice of ways of thinking, just as you could think of a glass of water being half full or half empty.  In this case either description right or wrong but the one you choose may affect the way you feel.  Learning how to think things through so as to make a realistic and reasoned choice gives you more control over the way you feel.

You can learn to find answers to upsetting thoughts, below are some examples that other people have found useful.

  • · What are the facts? What evidence do you have to support what you think? What evidence is there against it? The fact that you think something does not make it true.
  • · What possible alternatives are there?  What would you think if you were more confident? How might someone else who had this problem?
  • What is the worst possible way of seeing things, or the worst thing that could possible happen? What is the best way of seeing things, or the best things that could happen? Which is most realistic? Or most likely to happen?
  • What errors are you making in your thinking? For example are you jumping to conclusions? Exaggerating? Or over generalising? Are you behaving like a fortune-teller and predicting the future as a certainty? Or focusing on the black side of things at the expense of anything else?
  • · What can you do next? What personal skills and strengths do you have to help? What past experience of dealing with similar problems? What help, advice and support are available to you, from others? Or from books? What can you do to change things? If you can you do to change your own thoughts and feelings about it?

Use these questions to re examine your thoughts about being ignored by someone who knows you well.  Can you find another way of thinking? Learning to re examine your thoughts takes practice.  Once again it helps to keep a record.

After you have found out more about the way you think when in situations that you find difficult, and re examined these thoughts so as to keep them in perspective, you should test the thoughts out in action.  Thoughts, feelings and behaviour are closely related, so it is important to act differently as well as to fins a different way of thinking.  The two together will help you to feel better.

OVERCOMING AVOIDANCE

Why should you face the things you fear?

Avoiding things only makes them harder.  It reduces confidence further, as was shown in the vicious circles described.  Facing difficulties gradually can help both avoidance and loss of confidence.  This technique is called graded practice.

SUBTLE KINDS OF AVOIDANCE

There are many subtle types of avoidance.  You could avoid looking at people in the eye, starting conversations, contacting a new friend, expressing your opinion, or talking about your feelings and personal matters. You could make a habit of leaving early or arriving late.  Social anxiety makes people particular uncomfortable because it is so hard to be sure what the other person, the cause of the difficulty, is going to do next.  So some people become very good at skimming the surface of social situations.  At a party you could still avoid talking to people by handing round plates of food, or finding a way of only half paying attention to what is going on.

Think about what you avoid.  You are probably the only person who knows exactly what you avoid, and how you manage to do it.  Try to notice when this happens.  A good test of whether you are avoiding something or not is to ask, “If I were confident would I do it?”

Remember all types of avoidance keep the problem going.

Experimenting with new ways of doing things, such as being more outgoing, ask more questions, or making the efforts to meet new people, allows you to discover whether the alternatives to your anxious thoughts are realistic and helpful.  Experiments provide a direct test to what you think.  This is especially clear when your thoughts involve predictions about what will happen next.  If you think, “ I shall feel dreadful the whole time”,  or  “ I won’t be able to get my point across.  I will get muddled and confused”, you may well avoid doing things.  Then you will never know if your predictions were right.  However, if you make yourself do them, then you can find out whether the prediction was right or wrong.  You may have been upsetting yourself for no good reason.

This is where the second part of the treatment, overcoming avoidance, becomes important.  Most people with  phobias wish to avoid  situations that they may find difficult, and they all succeed in doing so in one way or another.  Often the way they are thinking makes avoidance seem like the only sensible option.  Dealing with thoughts is a beginning, but changing behaviour is also important.

WHAT IS AVOIDANCE?

Avoidance is trying not to do something because it makes you fearful and anxious.  There are many kinds of avoidance, and some are easier to

Recognise than others.  Examples of obvious types of avoidance include not going to places where you will meet people, not eating in public, not going out where there are a lot of people or to busy shops and so on.

TWO QUESTIONS ABOUT GRADED PRACTICE

I am always trying to face the difficult situations.  Why is this any different?

Of course you are trying, but perhaps you are picking something too hard, and throwing yourself in at the deep end before your confidence has come back.  You might also find it much easier to remember the things that went badly than those that went well, or those that just felt normal.  Perhaps the difficult times seem more important than the easy ones, which then get forgotten.

PLANNING GRADED PRACTICE

Planning the right kind of practice for you means going through the following stages;

  • Make a list of the situations you avoid, or that make you anxious.
  • Arrange these in order according to how difficult it would be for you to face each other.

Select the easiest item on the list as a first target when you practice.

If something is too hard, look for ways of breaking it down, and practising small parts of it by themselves.  Or work out what would make the situation easier for you.  For instance you may find it easier to do things with a friend, or you might want to do things alone first, where no one you know can see you.  You may feel better if you wore very comfortable clothes, or thought up before hand sorts of things you could talk about.

HOW TO PRACTICE

  • Set small targets to begin with.  Do not throw yourself in at the deep end all at once, but get used to less demanding situations first.
  • Decide exactly what you are aiming for at each step, a target must be clearly described so you know exactly what you’re aiming at.
  • Practice often.  To be useful practice must be regular and frequent.  If you leave ling gaps between practice times you will lose much of the benefit.  You should practice every day.
  • · Practice long enough.  You should practice for an hour a day if you can.  Sometimes this could be made up of many short tasks, such as saying good morning to various people, or if you do not like shopping supermarkets etc just walk through the door stay.

KEEP THE PRACTICE GOING

Keep a record.  Keep an accurate, written record of the practice you carry out.  Otherwise you will not know how you are getting on.  It is surprising how easy it is to forget, especially when a success for you may feel like ‘normality’.

Keep going.  Some people give up practice because they do not consider that they have made progress.  This can happen even though other people see a change.  Try not to underrate your achievements.  Watch out for upsetting thoughts about your progress.  Progress can seem slow at first but it will build up later.  If it were easy, you would have done it before.

Graded practice means setting goals to begin with.  You may need help in choosing the right things to try.

I do not think I avoid anything.  How can graded practice be relevant to me?

As already mentioned, you might be doing some things that count as avoidance without being aware of it.  It may not be easy to recognise these habits.  It takes careful thought, particularly when the problem has gone for a long time so that you now accept them as normal.

If you are unconfident the more practice you have the more confident you will become.

ADOPTING AN EVER READY ATTITUDE

If avoidance keeps the problem going, then being prepared to face the difficulties helps to overcome it.  So take every opportunity that arises to do ‘unplanned practice’.  For instance, you may have an unexpected chance to go to the pub, or talk to someone in a bus queue.  Think of the unexpected chances as more opportunities to tackle the difficult situations.  You will find, if you can do this, both that you will improve faster and that ordinary everyday activities become less of a strain.  You will no longer react to them as if they were really dangerous or frightening.

Try to build an extra practice element into everyday tasks, look at ordinary activities to see if you can find a way of turning them into useful practice tasks.

What if graded practice makes me very anxious?

You will not be able to overcome the problem without experiencing some degree of anxiety.  If you think of the situations provoking anxiety as opportunities to practise, then you will improve faster.  However, if you are concerned that facing situations you usually avoid will be impossibly difficult or painful, you may want to use other skills as well.

Downgrading your success makes you feel bad, and it makes it hard to keep trying.  Upsetting thoughts, as already mentioned, affect both your feelings and your behaviour.  Make sure you know how to deal with them.  Encouragement works far better than criticism because it helps you feel better and helps you keep trying.

Graded practice rarely goes completely smoothly.  Everyone has ups and downs, and what you did successfully yesterday may seem impossible today.  It is important you realise that set backs are a normal part of progress and that you have no need to be discouraged by them.

If at any stage you seem to be stuck, or even to have slid backwards, it could be because you have planned too bigger step in your practice.  Once again, try to find more intervening tasks to work at on the way.  You can try difficult tasks once your confidence has returned.  The secret is kept practising and all your confidence will slowly return.  So expect a few set backs but take them in your stride.  If you do not give up you will overcome your problem in the end.

Set backs are more apparent than real.  You may have a bad day because you are tired or not well.  It is not that you have got worse, but rather than being tired or unwell makes everything you do a lot harder.  Remember that other people are far less aware of your anxiety than you are.  They may not even notice it at all.

If you learn how to praise yourself for your success your confidence will grow.  Each time you achieve something it is a success.  Give yourself credit for all of them.  Make a habit of giving yourself a mental pat on the back, and see if you can get someone else to notice your achievements.  You can tell a friend a colleague or a relative about them.

If the target is a hard one there may be many steps to take on the way.  Do not let this discourage you, as each step is a step in the right direction.  Provided you practice regularly you will get there in the end.

You may sometimes have to practice the same thing many times before your confidence returns.  This is not unusual, and does not mean that you are not making progress. When this happens it may be helpful to find a number of similar tasks to practise, or to change a task in minor ways.  If you do this you will find it widens the basis of your improvement and provides a more satisfying sense of achievement.  It will also help you not get bored with practice.

Once you have achieved a target move on to the next one.  But before you move on, make sure you have really mastered the first one.  Practise it more than once until you are certain that you feel happy with it.

Even though you have moved on to a new target, you should still practise earlier targets from time to time.  If possible, allow them to become a normal part of everyday routine.  This will give a firm foundation to your improvement and will strengthen new habits.

until you feel comfortable, then go back the next day and stay longer and slowly graduate yourself back into those uncomfortable situations.

  • Do not be put off by feeling anxious.  You are bound to feel anxious if you try something difficult.  You are learning to master a problem instead of avoiding it.

Now try and list all the things you avoid or that cause you so much anxiety that you are reluctant to engage in them.

So make a list of all those situations that you avoid or that make you anxious.

Arrange these in order of difficulty.

Express each one in very clear terms, and write it down on the list.

RELAXATION

Why is relaxation helpful?

Because muscular tension causes uncomfortable bodily sensations such as headache and backache.

Because the aches and pains of tension can add to your mental worry.

Because persistent tension is so tiring

THE AIMS OF MANAGING ANXIETY

The three methods, relaxation, distraction and panic management all help to change your reactions to the problem, and in this way they contribute to breaking the vicious circles.  They make it easier to face situations that you would like to avoid, help you to dread your symptoms less and to reverse the downward spiral of confidence

The main message of anxiety management is that the symptoms can be controlled by you.  You do not have to live with the problem forever, or accept it as inevitable.  So you should learn to notice your own ‘early warning signals’ that symptoms are increasing and ask yourself there and then.  “What can I do about this?”  From now on, anxiety or tension should become a cue for action, rather than a sign that the vicious circle of symptoms and worrying reactions to them has taken hold again.

DISTRACTION

Why is distraction useful?

Thinking about your symptoms, or worrying about what other people think of you, tends to make you feel worse.  It reminds you how unpleasant the symptoms are and increases your fear of them.  It focuses your attention on what others think, and increases your self-consciousness as well as your fear for their reactions.

If instead of paying attention to your worries and symptoms, you pay attention to something else you are less likely to get caught up in the vicious circles we have described.  So your anxiety may die away instead of increasing.

As you know it is very difficult to turn your attention away from unpleasant feelings.  This is where learning to distract yourself is helpful.  There are two parts of distraction.

1. Deciding not to think about unpleasant feelings

2. Filling your mind with something else

HOW WILL I LEARN TO RELAX?

  • You should learn how to relax your whole body completely.  Tape recorded relaxation instructions may be available to listen to at home.  If so you should practise daily using this tape.
  • Then you should learn how to shorten the exercises so as to be able to relax more quickly.
  • · Finally you should learn to use exercises when you are feeling anxious or tense.

HOW CAN YOU DISTRACT YOURSELF?

There are many ways in which you can distract yourself.  All of them involve taking your mind off the problem and occupying yourself with something that does not make you anxious.  Some of the activities others have found useful include

1. Focusing on what is happening around you.  You could listen to someone else’s conversation, look out for people with curly hair or beards, count the number of red objects in a room, or describe to yourself everything you can see or hear.  Focusing on the outside world helps to prevent you thinking about what is going on inside.

2. Mental activity.  This includes activities such as doing mental arithmetic, calculating prices, reciting a poem to yourself or even doing a crossword puzzle.  You could also concentrate on memories of past pleasant experiences, or on fantasies about the future.  What would you do with the money if you won the lottery?

3. Physical activity.  Keeping yourself busy is another helpful way of distracting yourself, though it is important to choose activities that absorb your attention, rather than things you can do automatically which allow room for anxious thoughts.

WHERE TO FIND HELP

Tel: Tony Davis 07813 596505

Or 01482 870577

Will offer support and advice on how to deal with anxiety and utilising cognitive behaviour therapy to overcome the problem

MIND

Offers help and support , they hold  group meetings where you can meet other people and will be offered help on ways to cope.

SAMARITANS 24 hour national line 08457 909090

This is run by volunteers who will give advice and a chance to speak to someone who understands how you feel.

National Numbers

MIND

Offers help and support , they hold group meetings where you can meet other people and will be offered help on ways to cope.

www.mind.org.uk

 

SAMARITANS

24 hr National Help line 116 123

This is run by volunteers who will give advice and a chance to speak to someone who understands how you feel.

www.samaritans.org

 

 

 

TONY DAVIS EMPLOYEE SUPPORT

Tel: 07813 596505 Or 01482 870577

Will offer support and advice on how to deal with anxiety and utilising Cognitive Behaviour Therapy to overcome any problems or difficulties you may have.

Email: tonydavis@tonydavis.karoo.co.uk

Regional Numbers

Hull

Mind – www.mindhey.co.uk

01482 240200

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01296 437328

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01744 677058

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01302 812190

Wimbledon

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020 8788 0070

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0151 4953 991

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01264 332297

Kent

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01622 692383

Huntingdon Cambridge

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01223 311320

Leicestershire

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01455 890168

Exeter Devon

Mind – www.mindex.org.uk

01392 204493

Berkeley Gloucestershire

Mind – www.mind.org.uk

01453 54739