Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life  for example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal.

However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

Anxiety is the main symptom of several conditions, including:

Main signs and symptoms

Do your symptoms indicate an anxiety disorder?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder:

  • Are you constantly tense, worried, or on edge?
  • Does your anxiety interfere with your work, school, or family responsibilities?
  • Are you plagued by fears that you know are irrational, but can’t shake?
  • Do you believe that something bad will happen if certain things aren’t done a certain way?
  • Do you avoid everyday situations or activities because they cause you anxiety?
  • Do you experience sudden, unexpected attacks of heart-pounding panic?
  • Do you feel like danger and catastrophe are around every corner?

Because anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything.

Despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:

  • Feelings of apprehension or dread
  • Trouble concentrating
  • Feeling tense and jumpy
  • Anticipating the worst
  • Irritability
  • Restlessness
  • Watching for signs of danger
  • Feeling like your mind’s gone blank

Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Common physical symptoms of anxiety include:

  • Pounding heart
  • Sweating
  • Stomach upset or dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Tremors and twitches
  • Muscle tension
  • Headaches
  • Fatigue
  • Insomnia

Anxiety attacks and their symptoms

Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger—getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.

Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of anxiety attacks include:

  • Surge of overwhelming panic
  • Feeling of losing control or going crazy
  • Heart palpitations or chest pain
  • Feeling like you’re going to pass out
  • Trouble breathing or choking sensation
  • Hyperventilation
  • Hot flashes or chills
  • Trembling or shaking
  • Nausea or stomach cramps
  • Feeling detached or unreal

It’s important to seek help if you’re starting to avoid certain situations or places because you’re afraid of having a panic attack. The good news is that panic attacks are highly treatable. In fact, many people are panic free within just 5 to 8 treatment sessions.

 

What are the causes?

Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives.

Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk" - a habit of always telling ourselves the worst will happen.

Anxiety caused by environmental and external factors

Environmental factors that are known to cause several types of anxiety include:

  • Trauma from events such as abuse, victimization, or the death of a loved one
  • Stress in a personal relationship, marriage, friendship, and divorce
  • Stress at work
  • Stress from school
  • Stress about finances and money
  • Stress from a natural disaster
  • Lack of oxygen in high altitude areas

Anxiety caused by medical factors

Anxiety is associated with medical factors such as anemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include:

  • Stress from a serious medical illness
  • Side effects of medication
  • Symptoms of a medical illness
  • Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)

Anxiety caused by substance use and abuse

It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from:

  • Intoxication from an illicit drug, such as cocaine or amphetamines
  • Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates

Anxiety caused by genetics

It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Anxiety caused by brain chemistry

Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety.

How common is it?

Anxiety disorders are the most common of all mental health problems. Research into these disorders has shown that up to 1 in 4 adults will have an anxiety disorder in their lifetime, and that up to 1 in 10 people will have an anxiety disorder each year.

What are the options for treatment and help?

What main treatments are available?

The most common treatments that  your GP might offer you for anxiety and panic disorders are:

The kind of treatment your GP offers you might vary depending on your diagnosis, but ideally they should offer you a talking treatment before prescribing medication (this the recommendation of the National Institute for Health and Care Excellence (NICE), who produce guidelines on best practice in healthcare).

Talking treatments

Talking treatments (also known as counselling or therapy), are a process in which you work with a trained therapist to understand the causes of your anxiety, and to find strategies to manage it.

There are lots of different types of talking treatments available, but the most commonly prescribed talking treatment for anxiety is cognitive behavioural therapy (CBT), because there is reliable evidence that it can be effective. 

Self-help resources

Self-help resources are tools that have been developed by health care professionals for you to use by yourself, and can be helpful in managing anxiety. They can be in the form of: 

  • workbooks
  • computer programmes, such as Fearfighter
Fearfighter is a computer-based CBT (CCBT) programme for treating anxiety, panic and phobias, which is freely available on prescription through the NHS. Some people prefer CCBT to seeing a therapist in person, particularly as a first step.

To access self-help resources:

  • You can buy self-help workbooks from various bookshops and specialist organisation websites, such as No Panic
  • Your local library might be able to order certain self-help books for you to borrow for free.
  • Your GP might be able to prescribe you self-help resources through the NHS – it's worth asking them if this is an option for you.  

What could this mean for the future/progress?

Getting help

Anxiety is very common and many of us overcome it or cope with it without professional help. However, if it is severe or goes on for a long time, anxiety can affect your physical health, and stop you doing the things you want to do. The good news is that there are ways to help yourself.

Helping yourself

  • Talk about it. This can help when the anxiety comes from recent knocks, like a partner leaving, a child becoming ill or losing a job. Who should you talk to? Try a friend or relative who you trust and respect, and who is a good listener. They may have had the same problem themselves, or know someone else who has.
  • Self-help groups. These are a good way of getting in touch with people who have similar problems. They can understand what you are going through. As well as having the chance to talk, you may be able to find out how other people have coped.  Some of these groups are specifically about anxieties and phobias. Others may be for people who have been through similar experiences - women's groups, bereaved parents' groups, survivors of abuse.
  • Learning to relax. It sounds too obvious - surely everyone can relax? But if your anxiety just won't go away, it can be really helpful to learn some special ways of relaxing, to be a bit more in control of your anxiety and tension. You can learn these through groups, with professionals, but there are several books and self-help materials you can use to teach yourself. It's a good idea to practice relaxation regularly, not just at times of crisis.
  • Using a self-help book. This works well for many people. Most of the books use the principles of Cognitive Behavioural Therapy (CBT) - see below.

Family and friends

Someone with troublesome anxiety or a phobia may not talk about their feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may easily be startled by normal sounds such as a door-bell ringing or a car's horn. They may be irritable and this can cause arguments with those around them, especially if they don't understand why the person feels that they cannot do certain things. Although friends and family can understand the distress of an anxious person, they can find them difficult to live with, especially if the fear seems unreasonable.

Getting help

If you have an anxiety problem which just won't go away, you may not ask for help because you worry that people might think that you are "mad". They won't. It's a common problem and it's much better to get help rather than suffer in silence.

 

Where can I find further help and advice?

Whatever it is that scares you, here are 10 ways to help you cope with your day-to-day fears and anxieties.

1. Take time out

It feels impossible to think clearly when you're flooded with fear or anxiety. A racing heart, sweating palms and feeling panicky and confused are the result of adrenalin. So, the first thing to do is take time out so you can physically calm down.

Distract yourself from the worry for 15 minutes by walking around the block, making a cup of tea or having a bath. When you've physically calmed down, you'll feel better able to decide on the best way to cope.

 

 

 

 

 

 

 

 

2. What's the worst that can happen?

When you're anxious about something  be it work, a relationship or an exam  it can help to think through what the worst end result could be. Even if a presentation, a call or a conversation goes horribly wrong, chances are that you and the world will survive. Sometimes the worst that can happen is a panic attack.

If you start to get a faster heartbeat or sweating palms, the best thing is not to fight it. Stay where you are and simply feel the panic without trying to distract yourself. Placing the palm of your hand on your stomach and breathing slowly and deeply (no more than 12 breaths a minute) helps soothe the body.

It may take up to an hour, but eventually the panic will go away on its own. The goal is to help the mind get used to coping with panic, which takes the fear of fear away.

3. Expose yourself to the fear

Avoiding fears only makes them scarier. If you panic one day getting into a lift, it's best to get back into a lift the next day. Stand in the lift and feel the fear until it goes away. Whatever your fear, if you face it, it should start to fade.

4. Welcome the worst

Each time fears are embraced, it makes them easier to cope with the next time they strike, until in the end they are no longer a problem. Try imagining the worst thing that can happen – perhaps it's panicking and having a heart attack. Then try to think yourself into having a heart attack. It's just not possible. The fear will run away the more you chase it.

5. Get real

These tips are designed for people who are coping with day-to-day fears and anxieties. If you have been diagnosed with an anxiety-related condition, see our page ongeneralised anxiety disorder.

Fears tend to be much worse than reality. Often, people who have been attacked can't help thinking they're going to be attacked again every time they walk down a dark alley. But the chance that an attack will happen again is actually very low.

Similarly, people sometimes tell themselves they're a failure because they blush when they feel self-conscious. This then makes them more upset. But blushing in stressful situations is normal. By remembering this, the anxiety goes away.

6. Don't expect perfection

Black-and-white perfectionist thinking such as, "If I'm not the best mum in the world, I'm a failure," or, "My DVDs aren't all facing in the same direction, so my life is a mess," are unrealistic and only set us up for anxiety.

Life is full of stresses, yet many of us feel that our lives must be perfect. Bad days and setbacks will always happen, and it's essential to remember that life is messy. 

7. Visualise

Take a moment to close your eyes and imagine a place of safety and calm  it could be a picture of you walking on a beautiful beach, or snuggled up in bed with the cat next to you, or a happy memory from childhood. Let the positive feelings soothe you until you feel more relaxed.

8. Talk about it

Sharing fears takes away a lot of their scariness. If you can't talk to a partner, friend or family member, call a helpline such as the Samaritans (08457 90 90 90, open 24 hours a day). And if your fears aren't going away, ask your GP for help. GPs can refer people for counselling, psychotherapy or online help through an online service calledFearFighter.

9. Go back to basics

A good sleep, a wholesome meal and a walk are often the best cures for anxiety. The easiest way to fall asleep when worries are spiralling through the mind can be to stop trying to nod off. Instead, try to stay awake.

Many people turn to alcohol or drugs to self-treat anxiety with the idea that it will make them feel better, but these only make nervousness worse. On the other hand, eating well will make you feel great physically and mentally.

10. Reward yourself

Finally, give yourself a treat. When you've picked up that spider or made that call you've been dreading, reinforce your success by treating yourself to a candlelit bath, a massage, a country walk, a concert, a meal out, a book, a DVD, or whatever little gift makes you happy.

What medication is available?

As part of your treatment, your doctor might offer to prescribe you some medication. There are 4 types of medication which can be helpful in managing anxiety:

According to the National Institute for Health and Care Excellence (NICE) – the organisation that produces health care guidelines – ideally your doctor should offer you other kinds of treatment for anxiety first, before prescribing these drugs.

(See our pages on psychiatric medication for guidance on what to know before taking any medication, your right to refuse, coping with side effects and coming off medication.)

Antidepressants

  • Antidepressants might help you feel calmer and more able to benefit from a more long-term treatment such as a talking treatment.
  • However, they can sometimes cause unwanted side effects, such as increasing your anxiety or causing problems with sleeping.

(See our pages on antidepressants for more information on what they are, what to know before taking them, possible side effects and withdrawal. You can also look up detailed information about specific antidepressants in our antidepressants A-Z.)

Beta-blockers

  • Beta-blockers, such as propranolol, can treat some of the physical symptoms of anxiety, including a rapid heartbeat, palpitations and a tremor (shaking).
  • They can be helpful when you have to face a particular phobia, such as going on an aeroplane.
  • However, they are not psychiatric medication, so they won’t reduce any of your psychological symptoms.

(See our page on treatments available for phobias for more information about beta-blockers.)

Tranquillisers

  • Your doctor might prescribe you tranquillisers (benzodiazepines) if your anxiety is very severe or disabling.
  • Tranquillisers can't tackle the cause of your problems, but they can bring some relief until you have another form of treatment in place.
  • Tranquillisers should only be a temporary measure, because it’s possible that you could become addicted to these drugs and have difficulty coming off them.

(See our pages on sleeping pills and minor tranquillisers for more information about what they are, how they can help, possible side effects and withdrawal.)

Pregabalin (an anticonvulsant drug)

In some cases, such as if you have a diagnosis of generalised anxiety disorder (GAD), your doctor may decide to prescribe you a drug called pregabalin (Lyrica).

This drug is an anticonvulsant medication which is normally used to treat epilepsy, but is also licensed to treat anxiety.

    

Useful Documents

Useful Links

Anxiety UK

0844 477 5774 
anxietyuk.org.uk

Support, help and information for those with anxiety disorders.

Anxiety Care UK

07552 877219 
anxietycare.org.uk
Helps people to recover from anxiety disorders.

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

0161 705 4304 
babcp.com 
Provides details of accredited cognitive behavioural therapy (CBT) therapists.

British Association for Counselling and Psychotherapy (BACP)

01455 88 33 00 
bacp.co.uk
Provides information about counselling and therapy. See the BACP's sister website,itsgoodtotalk.org.uk, to find a therapist near you.

The Complementary Medical Association (CMA)

the-cma.org.uk
Provides a register of professional complementary medicine practitioners and training courses.

Elefriends

elefriends.org.uk 
A supportive online community which provides online peer support for anyone experiencing a mental health problem.

Fearfighter

fearfighter.com 
A computer-based CBT (CCBT) programme for treating panic and phobias. 

Improving Access to Psychological Therapies (IAPT)

nhs.uk/Service-Search
Use the NHS service search to find psychological therapies services near you.

Institute for Complementary and Natural Medicine (ICNM)

020 7922 7980 
icnm.org.uk
Provides a register of practitioners of complementary medicine.

The Medicines and Healthcare Regulatory Agency (MHRA)

mhra.gov.uk 
The MHRA is responsible for regulating all medicines and medical devices in the UK.

The National Institute for Health and Care Excellence (NICE)

nice.org.uk 
Information and clinical guidelines on recommended treatments for different conditions, including anxiety disorders.

No More Panic

nomorepanic.co.uk

Provides information, support and advice for those with panic disorder, anxiety, phobias and OCD, including a forum and chat room.

No Panic

helpline: 0844 967 4848 (10am–10pm) 
nopanic.org.uk 
Provides a helpline, step-by-step programmes, and support for those with anxiety disorders.

Triumph Over Phobia (TOP UK)

www.topuk.org 
Provides self-help therapy groups and support for those with OCD, phobias and related anxiety disorders. 

Turning Point

turning-point.co.uk
Offers information, support and services for people experiencing drug and alcohol issues, mental health problems and learning disabilities.