All of us experience some anxiety from time to time.

This is normal and may help us cope with a difficult or stressful situation. Feeling anxious before an examination for example increases the levels of adrenaline and other stress related hormones in our bodies and enhances performance. We are more alert and clear thinking. Normal anxiety is rarely problematic and once the stressful situation passes we quickly return to normal.

An anxiety problem is a more severe form of normal anxiety. It is more intense, more frequent or longer lasting and can become a habit that is difficult to break. Severe or chronic anxiety can stop you doing many things in your day-to-day life. You may be unable to walk down the street, go to the supermarket, into a lecture theatre or a pub without feeling anxious, uncomfortable and upset. Over time you may avoid going to these places to avoid feeling so bad. In the long-term anxiety may make holding down a job very difficult or impossible. Enjoying leisure time and forming rewarding relationships will become increasingly problematic. An anxiety problem is not a physical illness but health problems may develop if anxiety persists for a long time. Depression creeps in. The immune system becomes less effective in fighting off infections. High blood pressure can cause heart problems. The digestive system functions less efficiently, leading to ulcers and other digestive disorders. Some skin conditions are associated with anxiety. Some people suffer hair loss. Of course these health issues can have other causes; it is important to be in touch with your doctor.

Some typical anxiety responses

  • unpleasant body sensations (heart pounding, sweating, tense muscles, dry throat, shaking, feeling or being sick, dizziness)
  • inability to concentrate
  • worrying thoughts or unpleasant memories coming into your mind
  • intense dislike or fear of some situations and therefore avoidance of them (e.g. talking to people you don't know, walking in the street, being in a tutorial class)
  • panic attacks coming out of the blue, and once one has happened fearing that another will strike at any time
  • disturbed sleep, with unpleasant dreams or nightmares

Why do you feel so bad when you are anxious?

When you are anxious your body reacts in certain ways that can be helpful in dealing with whatever it is that is making you anxious. Your mind believes that you are in danger and this triggers the production of certain chemicals, or stress hormones, in your body that prepare you to face the danger or harm. The body and mind reactions are the same whether you are facing actual danger (a street mugger) or a perceived but distorted danger (standing quietly in the supermarket queue).

The effects of these hormones in your bloodstream can be strong and overwhelming. When faced with real danger your body will quickly utilise these chemicals to help you fight the mugger or save yourself by running away. The associated physical sensations will quickly subside as the chemicals are used up, although you may feel shaky for a while afterwards. This is called the fight or flight response.

If the danger is not real, as in the supermarket queue, then the chemicals are not used up and continue to circulate in your body, leading to the physical sensations mentioned above. A panic attack occurs when there is an extra strong surge of stress hormones that aren't rapidly used up and can't be dispersed quickly enough by the body's natural internal balancing mechanism.

What can you do?

It is possible to control anxiety, to reduce it to an acceptable and manageable level or even get rid of the problem completely. It isn't easy but is very worthwhile when you think of how much more enjoyable life will be when you aren't so anxious all the time. Courses of action will be much the same whether your anxiety is clearly defined, (e.g. exam anxiety or fear of flying) or more generalised and without an obvious cause. The most important thing to bear in mind is that you can and will overcome your anxiety problem, with a bit of work and perhaps some outside help.

Learn to control the flight or fight response. There are several different techniques to help here. Relaxation, yoga, meditation, hypnosis and t'ai chi help you learn to control your breathing, relax your muscles and empty your mind of fears and worrying thoughts. Self-help books and tapes are readily available to get you started. There are usually local classes to teach you a bit more. All require courage to take the first step and patience and practice to achieve results.

Counselling or other therapy.In counselling you explore what is worrying you. A counsellor can help you understand what is happening to you, what your anxiety may be related to and may teach techniques to control the symptoms. Counsellors use different approaches but all are there to listen to you and support you. A counsellor will help you find other help if that is thought necessary. The University counsellors have plenty of experience in helping students and staff with anxiety.

Drugs.Minor tranquillisers, sleeping pills and/or beta-blockers are prescribed frequently to help anxiety problems. These help control the physical symptoms and do have a place in treatment of chronic and acute anxiety. However some drugs are addictive and drugs alone don't tackle the source of the anxiety. Once the drugs are withdrawn the anxiety problem invariably returns. If you are depressed because of your anxiety anti-depressants may be prescribed. These can be helpful on their own but may be more effective when combined with counselling. Always keep in touch with your doctor if you are prescribed medication. Some non-prescription drugs cause or exacerbate anxiety and lead to panic attacks. Included here are alcohol, caffeine, nicotine and use of other substances. The anxiety may occur while taking these substances or some time afterwards. You may feel very good at the time but extremely anxious on waking the next morning. Watch out for combinations of different substances; the effects may be unpredictable and inconsistent.

Have a look at your lifestyle. It is always worth reviewing your diet. Fluctuating blood sugar levels lead to bodily sensations similar to anxiety in some people. Try to eat regularly, with plenty of complex carbohydrates (bread, potatoes, pasta) and fewer simple carbohydrate foods (biscuits, chocolate bars, crisps, fizzy drinks, beer). A cola drink and a cigarette for breakfast isn't the best start to the day. Exercise is a very effective means of reducing stress and using up the stress-related hormones in your body that accompany anxiety. This need not be too strenuous or competitive. Walking, swimming, cycling are fine. Having fun, laughing and relaxing also help you feel good. When busy and under pressure from work, exams, family or personal problems we tend to let these slip, just when we need more of them to help us keep anxiety at bay.

Panic attacks

Symptoms of panic:

  • fast, shallow breathing
  • thumping, rapid heartbeat
  • feeling dizzy or faint
  • chest pain or tightness in the chest
  • sweating profusely
  • ringing in the ears
  • feeling, or being, sick
  • feeling very hot or very cold and shivery
  • tingling or pins and needles in hands or feet
  • feeling distant and disconnected from what is going on around you.

Causes of panic

Panic attacks often come unexpectedly. If you don't know what is happening to you, or if you have never had one before the experience can be very frightening. You may think that you are going mad, that you are having a heart attack or going to die. None of these are likely because of a panic attack, but see your GP if you are worried about your health and need some reassurance. A panic attack may have an identifiable trigger or cause; if you are terrified of spiders and one falls on your head you may panic. Usually the cause is more complex and less obvious. See the previous paragraph Why do you feel so bad. A panic attack is the most severe form of acute anxiety and what happens in your body is in response to, not the cause of, a sudden, excessive amount of adrenaline and other hormones in your bloodstream. The trigger is usually psychological (your belief that a situation is threatening) but may be physical (intake of a substance that disturbs your body's equilibrium in some way) or a combination of the two. If you wait the symptoms of panic subside and you will return to normal. As this can take between 5 and 20 minutes most people find it extremely difficult to just wait. Your own fear of what is happening sets off further panic and more adrenaline is produced. This fear of fear means you are hypersensitive to your own body sensations and as soon as you feel anything that reminds you of a previous panic you tense up, thus making a further panic attack more likely. Remember that feeling very hot or a bit dizzy can be because of other things, such as sitting in an overheated, stuffy room, being hungry or dehydrated.

One of the most common causes of a panic attack is hyperventilation, or overbreathing. We do this to meet extra demand from our muscles for oxygen (the fight or flight response). As the body tries to take in more oxygen our breathing rate increases as it would if we were running. However when anxious we tend to tense up, making our breathing shallower and faster. Our lungs can't fully inflate with each breath when our chest muscles are tight. Shallow, rapid breathing and overbreathing disturb the balance of carbon dioxide in our bodies and can bring on symptoms of panic. The same physiological reactions can happen after taking certain drugs.

What can you do?

Keeping your general anxiety levels as low as possible will minimise the likelihood of panic attacks. Check out the advice given earlier in this leaflet on how to reduce your anxiety. You may not realise just how anxious you are.

If you begin to feel panicky stop what you are doing and try to regulate your breathing. Fairly slow, steady breathing will rapidly reduce the horrible sensations. Concentrate on your breathing rather than on the bodily sensations. Practise this method of breathing when you are not panicking so that you find it easier to do when you need it. Breathing slowly and regularly in and out of a paper bag held over your mouth and nose for about 10 minutes works very well. Carry one around in your pocket. Even cupping your hands over your mouth and nose can help raise the levels of carbon dioxide in your blood and reduce the sensations. Try running on the spot, or doing something else physical to use up the adrenaline. Some people find that shouting or singing very loudly is effective. Eating or drinking something sweet can also help if you think that your panic is associated with low blood sugar. If you think that your (or someone else's) panic attack is because of taking drugs seek medical help at once.

If you have tried all the self-help methods without success or your life is being disrupted by panic and anxiety do seek help. Doctors and counsellors are very familiar with these difficulties and will be ready to help you.