What are the common signs that you have anxiety?
It is very common to get temporary feelings of worry or anxiety. It is our nervous system getting primed to deal with real or perceived danger. That is usually not a problem in itself. After all, we need to be able to deal effectively with threats so an early warning system from our body can be a useful resource. We may experience physical symptoms like a racing heart, dizziness, a dry mouth, headaches, tummy aches or muscle pain, as we prepare to deal with the threat at hand. These symptoms may be discomforting in the short term but they can also serve a purpose if they help us to focus or take extra care when needed.
Anxious feelings become more serious when we start to feel overwhelmed and this begins to affect our daily routine, our ability to cope and when there is a negative affect on our relationships. This is usually when our anxious feelings are persistent in nature, and especially intense or out of proportion to the threat, or indeed when there is no threat actually present, or the threat has passed. We start to worry a lot about seemingly minor issues or relatively harmless situations. We might begin to enact avoidances around perceived threatening situations and this can actually compound our feelings of anxiety. Our sleep pattern becomes dysregulated and is subject to a lot of disturbance in the night.
What triggers anxiety?
Everyone’s anxiety levels are very different and unique to them. Some people find some situations more stressful and more challenging than others, and they get more anxious as a result. But they then might find other situations less stressful when others are triggered. What is certain is that everyone will have their own particular stressor and perceived threat which will emerge under the appropriate conditions.
Some people are more prone to anxiety due to a mix of genetics, brain chemistry, life experiences, and personality traits.
Possible causes of anxiety include:
Our genes: Whilst anxiety has a strong genetic component, there is no evidence to suggest that it is caused by a single gene. Research shows that anxiety disorders run in families, with an estimated heritability of about 30% to 50%. This means having a close family member, such as a parent or sibling, with an anxiety disorder can increase your risk of developing one, but it does not guarantee that you will get it.
Brain chemistry: Anxiety is deeply connected to how our brain processes threat, safety, and emotional responses. It involves a complex interplay between chemical messengers, brain regions, and hormonal systems.
Neurotransmitters such as GABA Gamma-Aminobutyric Acid, Serotonin, Norepinephrine (Noradrenaline) and glutamate are chemical messengers that brain cells (neurons) use to communicate in the nervous system. Anxious feelings can become more intense when imbalances or altered sensitivities in these systems start to occur. Certain key pathways with chronic anxiety can become dysregulated, remaining switched “on” and continuously ommiting these hormones even when the threat has passed.
Life experiences: Early life trauma and abuse strongly increases vulnerability to anxiety. Growing up with bullying, exclusion and/or discrimination, leaves long-lasting effects on how a person perceives safety and social threat.
Upbringing/attachments: A child can be prevented from developing independent coping skills due to overprotective, harsh, or unpredictable parenting styles. Children can observe and absorb anxious reactions from parents or close caregivers.
Environment: High-pressure work environments, heavy academic study loads, and major life changes (such as redundancy, moving house, or poor quality of housing, marriage, or divorce) can trigger or worsen anxious responses. Loneliness, living alone, social exclusion, bereavement, and a lack of community cohesion or support networks significantly elevate risk.
These factors all affect our mental health and influence how we think and respond to situations. It can also depend on how well other parts of our life are going or how supported we feel. The quality of your social support structure and self care regime are vital components in dealing with stress as are the tripartite foundations of a healthy lifestyle of good nutrition, robust exercise and restorative sleep.
What calms anxiety down immediately?
When you are having an anxiety attack you essentially need to activate the body’s natural “rest and digest” brake system. In technical terms this means activating your parasympathetic nervous system, which will counteract the adrenaline and cortisol that is flooding your body. Grounding techniques to use right now:
Shift Your Breathing (The Physiological Sigh): This exercise involves taking two quick inhales through your nose (one deep inhale, followed immediately by a sharp “top-off” inhale), then exhale completely and slowly through your mouth.
Force a Physical Temperature Reset: The 5-Second Muscle Release: This exercise involves tensing your shoulders up to your ears as hard as you can for 5 seconds, then dropping them down completely. A grounding experience can be had by noticing the physical contrast of the relaxation.
Ground Your Senses (The 5-4-3-2-1 Method): This exercise is particularly helpful when your mind is racing with future “what-ifs,” it forces your brain back into the present moment by scanning your current environment. Name out loud or in your head:
5 things you can see, 4 things you can physically feel (e.g., your feet on the floor, the fabric of your trousers), 3 things you can hear (e.g., a clock ticking, traffic outside), 2 things you can smell and 1 thing you can taste.
Move to Burn Off Adrenaline: This exercise involves shaking out your hands and arms, pacing up and down a corridor, or do 10 jumping jacks. Giving that adrenaline a physical outlet signals to your nervous system that the threat has been dealt with and has passed.
Can anxiety be fixed without medication?
Therapy helps to resource people with increasing reflexiveness in their ability to cope with stressors in their lives. When you practice reflexivity, you move away from just telling stories about what happened to you, and start examining your internal emotional system with greater insight and awareness. While medication introduces external chemicals to alter neurotransmitter levels, psychotherapy leverages the brain’s neuroplasticity. Under the right fertile conditions the brain has a natural ability to reorganise itself by forming new neural connections in response to learning and experience.
Psychologist David Rennie described reflexivity in therapy as a “radical self-awareness” where you gradually begin to actively examine your own mind so that you may have greater control of your actions and choices throughout the course of your day.
A consultation with your doctor about symptoms of anxiety will most likely see them apply screening tools to check for a generalised anxiety disorder (GAD), such as the GAD-7 standard questionnaire. They will seek to diagnose this condition through a clinical evaluation of your symptoms, medical history, and this psychological screening tool.
Whether you want to start a course of medication or not, seeing your doctor can be a fruitful exercise to check that there is nothing else in your physical health impacting on your anxious feelings. Blood tests cannot directly diagnose anxiety, of course, but medics use them in order to check for physical health issues that can cause the same or similar symptoms. For example, your doctor could check your bloods for some of the following conditions:
- Overactive thyroid (hyperthyroidism): which mimics panic and anxiety,
- Vitamin B12 and Vitamin D: which checks for nutritional shortages that affect brain function and mood,
- Iron and ferritin: which screens for anemia or low iron, that can cause a rapid heartbeat and fatigue,
- Blood Glucose/Fasting Sugar: Checks for unstable blood sugar levels that trigger shakiness and panic,
- Complete Blood Count (CBC) and Electrolytes: Evaluates overall metabolic balance so that hidden infections or deficiencies can be ruled out.
Medication could be offered for GAD if your symptoms are deemed moderate or severe, especially if talking therapies have not provided relief. Doctors are guided by the NICE guidelines and NHS diagnostic frameworks. These set out the grounds for when medication is considered appropriate and you can check these yourself.
I am not a medically qualified therapist so for more information on the types of medication you could be offered please check the NHS website.
What is effective psychological therapy
Psychotherapy plays a key role in helping to manage the symptoms of anxiety by leveraging the brain’s neuroplasticity. However, it can be a difficult search for good psychotherapy given that there are over 500 approaches in the field, and that number increases seemingly with each passing year. There is no universal service called “therapy”, even if the numerous approaches share commonalities.
Here are some approaches that involve working with a therapist to understand how to contain anxiety and to uncover the root causes and learn strategies to control symptoms.
Cognitive Behaviour Therapy (CBT)
CBT is the most common therapy offered for the relief of anxiety. Supporters of the approach claim that there is strong evidence to suggest that CBT, backed by extensive clinical trials and meta-analyses, is a first-line, empirically validated psychological treatment for anxiety and stress-related disorders.
The chief aim of the CBT approach seeks to correct ingrained patterns of negative thoughts and behaviours. The cognitive aspect focuses on changing cognitive loops that prevent the overcoming of fears and the behavioural aspect primarily seeks to transform reactions from the events that trigger anxiety. Skills-building means implemementing new strategies in your life like mindfulness, relaxation training, and problem-solving. The goal of CBT is to break the chain between negative thoughts and maladative behaviours.
However, CBT is not a universal cure. People often drop out of the treatment as they feel that they are speaking to a robot within a manualised approach.
Whilst evidence might show usefulness of CBT there’s still a question about whether it get to the root of the problem or if it just deals with surface issues. A lot of therapists view CBT as a mere sticking plaster for relieving short term distress but is less useful when seeking to provide a long term solution that offers long term real resilience and robust recovery. Furthermore, not all counsellors and therapists are especially trained in CBT. Even integrative therapists might have had just a small component of the approach in their training programme.
The deeper work could entail looking at your internal mental structure and to identify troubling parts of self that can be the contributing factors in prompting the anxious feelings in the first place. CBT can potentially help in this process but deeper therapy work could also entail somatic based techniques and dialoguing with these parts so that greater integration is achieved.
Exposure therapy
A wise person once said that what we resist will persist. In therapy speak this means that avoidance behaviours typically lead to a compounding of the very anxiety we are seeking to get rid of. Whatever we are avoiding will ultimately come back and hit us harder. You may have heard of the saying “do the worst first” at motivational management courses. This is always a good idea as we are not only resisting the temptation to avoid, but we achieve a spike in the feel-good hormone dopamine by completing a task.
Behavioural exposure work involves gradually and systematically confronting feared stimuli, physical sensations (interoceptive exposure), or social/trauma memories without resorting to avoidance or safety behaviors.
Integrative/insight orientated
Integrative therapy can embrace the tools and techniques of trauma informed care. This can look at what happened to you in the past, not just what actually happened but what subsequently happened to your internal mental and emotional world. What did you make of the events that you experienced, especially at a formative age? Is there a wound from these past emotional events and is the wound open or raw? When we experience anxiety we may get triggered, which can mean that a difficult experience touches an open wound. The trouble with a wound is that people can spend decades trying to cover that vulnerability with all sorts of avoidances, addictions, complexes and fear-based behaviours.
Rollo May, a great Existential therapist, once said that the purpose of therapy is to set people free. Freedom could be defined by being able to see reality for what it is, not distorting life events like you are stuck in the tyranny of the past. Therapy can uncover the meaning you gave to past difficult experiences and how that meaning continues to play out in life. A useful exercise is to ask yourself what are the negative self beliefs that are continuing to block your compassionate self care. Sometimes the best breakthroughs come when there is a realisation of the personal weight that is still being dragged around.
However, therapy is not a magic broom. You must bring a willingness to want to change and to do the work in the sessions and between sessions for it to make a difference in your life. Sometimes the so-called “heavy lighting” of personal transformation is to face your fears at a safe pace, address hesitancies in your decision making, identify internal troubling parts and to avoid taking the easy way out. Your therapist is a guide, albeit an important one as they need to have done their own personal work, but you are the one who must actively execute the changes in your own life in order to lead a more transformed life.
What not to do with someone who is anxious?
Saying things like “Just calm down,” “stop worrying” “You’re overreacting,” or “Think positive.” are not helpful for an anxious person to hear. Telling them to “calm down” implies that they are actively choosing to feel this way, which could add an additional layer of shame and frustration to their panic. They usually know that their rational mind is overreacting, but are left with their nervous system physically taking over. Stating the obvious to them compounds their frustration.
The far more supportive approach is to give clear, positive low-pressure options or take the lead on small steps. You could say something like: “We can leave this room if you want to. Let’s walk to that quiet corner over there.” Don’t bombard them with logical questions, demanding that they make a choice, or forcing them to stay in a crowded environment to “face their fear.” It will be a reassuring and grounding affect if they see your own physical presence as an anchor. It would be more beneficial to keep your voice quiet, slow, and low-pitched as well as keeping your body language open and your posture calm.
Ask permission and empower them by offering a choice. You could say something like: “Do you want me to talk to you right now to distract you, or do you just want us to sit here in silence?” This helps to give them greater opportunity to have a grounding experience as they begin to feel safe again.
The aforementioned guidelines apply when someone in your life is having body image anxiety in an era of social media.
Noel Bell is an experienced UKCP accredited psychotherapist and qualified clinical supervisor with a proven track record of helping people to overcome addictions, anxiety, relationship difficulties, stress, dating anxiety and low self-esteem.
