Managing anxiety

Anxiety is a feeling of unease, worry, or fear that can range from mild and manageable, to overwhelming and debilitating. We all feel anxiety some of the time; it is completely normal to have an anxious reaction to common life circumstances, such as a job interview, a medical exam, and so on. 

What can cause anxiety?

External circumstances and events

Anxiety can be caused by normal events like those described above, but for some others, it can be triggered by unresolved childhood issues (such as childhood abuse or neglect, bullying, loss, and bereavement at a young age). It can be caused by physical and mental health issues (such as living with chronic illness or as a symptom of other mental health problems), or as a reaction to certain prescribed medications. For some, alcohol and recreational drug use can also cause feelings of anxiety. 

For many, the way that we live our lives now also induces feelings of anxiety: working long hours, too much screen time, feeling financial pressures, and so on. 

Our thoughts

Our thoughts have a powerful impact on our emotional experiences. Ruminative worry can have a life of its own, consistently interfering with all other thoughts. It is common to have a negativity bias and an internal negative critical voice. These things, combined with not being present (i.e. our minds being too much in the past, the future, or locked into a critical running commentary), can all create an overwhelming sense of unease and anxiety. 

Sometimes, we are not even consciously aware this is what is happening, and we have to learn to become aware of what our default thought processes are and the emotional responses they create.

The body

The mind and body are highly interconnected. Not getting enough sleep, feeling overly hungry, and having a glucose spike a few hours after a very sugary meal can all result in spiked levels of anxiety. This anxiety can be easily ‘post-rationalised’ in the brain and assigned meaning. 

For example, if it is 10am, I have missed breakfast and I am getting too cool sitting under the office air conditioning, my brain will begin to signal all of this as distress and a sense of anxiety will now start to flood through me. If I am not attuned enough to myself, I may not catch any of this happening in time. I could be at risk of misreading an email from my manager which has just arrived in my inbox, interpreting the tone as harsh and, in my anxious state, assuming I have done something wrong. Messages coming up from the body can often be ‘misinterpreted’ in the brain like this, with stories created in the prefrontal cortex to explain the feelings (and are very often wrong).

When thinking about managing anxiety, we must include the body as part of that, not just our thoughts. Especially if we have now started to experience a constant low-level hum of anxiety. 

Anxiety creates a hormonal response (the creation of cortisol, adrenaline, and testosterone). Having a constant low level of anxiety could mean these levels are always slightly too high – hence we feel on edge, and unable to relax. 

Our brain wiring

Certain parts of the brain, such as the amygdala, hippocampus, and brainstem are all associated with our anxiety responses. The amygdala processes threat a bit like a fire alarm system. The hippocampus and brainstem are responsible for helping us self-regulate and recover from our anxiety and stress responses. People who have certain experiences in childhood events have different densities and sizes of these parts of the brain, so the ease with which anxiety is created and then managed can be different for some. We also know that our attachment (created in early childhood) affects the shaping of some of this brain circuitry. 

Managing anxiety

Manage the body

In times of acute stress and anxiety, it is very important to do the basics: eat well, avoid alcohol, nicotine, sugar, and caffeine, and exercise regularly. These all help the body manage the physical responses to stress. 

Look out for patterns

Make a note of what happens when you get anxious or have a panic attack. This could help you spot patterns in what triggers these experiences for you, or notice early signs that they are beginning to happen. You could also make a note of what's going well. Living with anxiety can mean you think a lot about things that worry you or are hard to do.

It's important to be kind to yourself and notice the good things too.

Be careful how you talk to yourself

When stressed, our inner critic is usually loudest, which is not motivating or helpful. It often makes us feel worse – more defeated and less confident. What is needed is a kinder, compassionate, and soothing voice. When we feel safe and connected, we can regulate difficult emotions better, increase confidence and have the motivation to try again. Supportive language helps us cope and get through the hard times. 

Make time for things that comfort you and make you happy

Sometimes, when we are anxious, we take life very seriously and stop doing the things that actually bring us comfort and release. It is important to catch ourselves doing this and stop. Make time for things that make you happy and feel good - whatever that may be; going to the cinema, having a bubble bath, reading a book…

Keep your worries contained 

It can be really hard to stop worrying when you have anxiety. You might have worries you can't control. Or you might feel like you need to keep worrying because it feels useful – or that bad things might happen if you stop.

It can be helpful to try different ways of addressing these worries. For example:

• Set aside a specific time to focus on your worries – so you can reassure yourself you haven't forgotten to think about them. Some people find it helps to set a timer.
• Write down your worries and keep them in a particular place – for example, you could write them in a notebook, or on pieces of paper that you put in an envelope or jar.

Focus on how the feelings will change

Feelings are fluid and inevitably change and it is very important to remember this. If you start to feel anxious about something, write down the expected changes you think will happen later. For example, if you are nervous about a presentation, you might write down something like:

“I am feeling nervous, which is a perfectly normal and natural response. But this will pass, and I will begin to feel calm and relaxed again.”

Having the expectation of a shift in how we feel for the better, can help us bring it about. 

Respond in a ‘normal’ way

Anxiety is a survival response, not an illness. But it’s a response that can go wrong, sometimes to the point that it hinders rather than helps. One way to train anxiety to be selective and ‘behave’ is to find ways to give it feedback to let it know that it is not needed. Because anxiety takes its lead from what we do, if we act in ways we wouldn’t in a real emergency, the anxiety will shift. For example, during an emergency we wouldn’t:

• Talk softly and calmly
• Breathe deeply
• Have an open body posture

If we adopt some of these behaviours when we begin to feel stressed, then we alter the feedback to our fear response system. We send it a message that we are safe, and that there is nothing to get anxious about.