Anxiety and Panic Attacks

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you sweat more, your peripheral vision fades out as all your focus is on the threat factor, etc.

Your body is now ready to fight or run away from the tiger.

In extreme (life-threatening or highly traumatic) situations, the body has a third option which

is “freeze”. Thankfully most people never experience it but if you have, remember that it is a

natural, built-in evolutionary response and you couldn’t help it – it happens when your anxiety

level shoots up to sky-high. Following all the advice in this helpsheet should help you with the

after-effects of such an experience.

Here are some of the physical sensations you may notice when you are anxious, or having a

panic attack, which are a result of these rapid changes in your body, even when there are no

tigers around!

Palpitations/racing heart Trembling Weak knees

Dizziness Chest pains Pins and needles

Hot/cold Nausea Light-headed

Muscle pains Diarrhoea Short of breath

“Keyed up” Feeling of unreality Weak bladder

Visual disturbances Tension Problems swallowing

Dry mouth Sweating Stomach pains

These symptoms are very unpleasant but will eventually disappear on their own, with the help

of the Parasympathetic Nervous System. The PNS is your built-in calming down mechanism.

You can assist the P.N.S. to kick in more effectively and calm yourself down more quickly,

with simple coping methods. If you don’t assist it, it will kick in anyway, which is why panic

attacks do eventually subside – but why not help it along if you can?

How to Combat Anxiety

Anxiety is a vicious circle of anxious thoughts (T), anxiety sensations(S) and anxiety-

maintaining (even anxiety-increasing) behaviours (B).

T - Thoughts

S – Physical sensations

Anxious behaviours – B

In the cognitive-behavioural model, (and assuming no encounters with tigers) the origins of

an anxious mood lie with thoughts – even thoughts that we are not aware of having! (This is

why your experience might be that the first thing you notice is your heart thumping or your

palms sweating but in fact your body is reacting to your mental anxiety, conscious or

unconscious). Anxious thoughts will lead to anxiety reactions in the body, which are then

reinforced by what we think, and what we do or fail to do behaviour-wise. An anxious person

biting their nails and stressing can get stuck in a vicious circle. “Oh no I’ve got to do a

presentation in front of twenty people tomorrow, I know I’m going to mess it up!” Such3

thoughts can lead to shakiness, feeling hot and nauseous, made worse by pacing the room,

putting off preparation of the presentation, drinking a fourth cup of coffee, leading to more

panicky thoughts about how untogether you are!

To fight this vicious circle, you need to break into it on a Thoughts level, a physical

Sensations level and a Behaviours level. Remember – TSB.

T - Challenging your Anxious THOUGHTS

There are various common patterns of anxious thinking that you can spot and challenge:

1) All or Nothing Thinking : i.e. you’re either “brilliant” at something or “rubbish” at it. If

you make a mistake, you’re “a total failure”.

2) Overgeneralising : i.e. if you didn’t get on with people at a party once, you tell yourself

“I never get on with people at parties”. “I always fluff it”.

3) Crystal ball-gazing : i.e. assuming you can see into the future – “I’ll only get a Third

and then I won’t be able to find a decent job”.

4) Ignoring the Positive, i.e. dismissing any success or good qualities you have,

rationalising that they “don’t count” for some reason – or not even noticing them in the

first place. “Being a good mate isn’t going to get me a decent job”.

5) Mind-reading, i.e believing you know what others are or will be thinking – “they think

I’m stupid/useless/a prat”; “she’ll think I’m really immature”.

6) Catastrophising, i.e. immediately worrying about the worst case scenario – if you have

chest pains you worry that you’re having a heart attack; if you’ve got a headache you

worry that you’ve got a brain tumour.

How to Challenge Such Thoughts

a) Notice if they fall into one of the above patterns of anxious thinking. Be honest.

b) Ask yourself – what’s the evidence to support this thought? And what’s the evidence

against it? What would be a fairer thing to be saying to myself?

c) Ask yourself – what are the chances of such and such happening? Force yourself to

be realistic here. If you’ve been anxious for years but have never actually fainted from

it, the chances are you’re not going to start now.

d) What would you say to your best friend if they came out with your thoughts? Now say

that to yourself.

e) Tell yourself that you CAN cope, you CAN handle it – don’t undermine yourself and

don’t underestimate your determination, resilience and ability to learn new coping

skills. You are not weird or inadequate; you are simply coping with anxiety.

FIND A POSITIVE THOUGHT TO REPLACE EVERY ANXIOUS THOUGHT AND

MAKE AN EFFORT TO BELIEVE IT!

S - Calming Your Physical SENSATIONS

Essentially you are trying to stop anxiety symptoms escalating, and to reinforce your natural

bodily calming-down mechanism (the P.N.S.). There are two simple and effective ways of

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intervening on a body level and they work even better done together: they are abdominal

breathing, and relaxation.

Abdominal Breathing

Whether you are generally in an anxious mood or especially if you are having a panic attack,

the chances are that you are hyper-ventilating (breathing too quickly). This upsets the all-

important balance of oxygen and carbon dioxide in your blood, leading to some of the

unpleasant symptoms of anxiety and panic already mentioned.

1) You need to SLOW DOWN your breathing. Aim for a maximum of 10-12 breaths per

minute (time yourself) whenever you are at rest. Try to pause between breaths. Also

try to breathe out for at least as long as you took to breathe in. If it helps, count ‘in’ for

5, ‘out’ for 8 and ‘hold’ for 2. You will also breathe more slowly if you breathe through

your nose instead of through your mouth.

2) You need to breathe deeply, into your belly (abdomen), taking air steadily right down

into the bottom of your lungs, so that your stomach pushes out. Anxious breathing

tends to lift up the chest only – the air never gets further down the lungs and the

diaphragm muscle doesn’t move. It sits underneath your lungs. When air is taken all

the way to the bottom of your lungs the diaphragm gets pushed down, which then

pushes your stomach wall out. Look down and you’ll see this happening! The

diaphragm then helps you to expel all that air, squeezing it up right from the bottom of

your lungs, as you breathe out. This is a much more efficient way of breathing, as well

as helping to calm you down!

3) Try this exercise:

Put one hand lightly on your chest and one just above your belly-button. Take 10-15

slow deep breaths in a row and try to get your stomach moving in and out with your

chest staying still, or very nearly still. This takes practice! Once you can keep your

chest still, you can do “3-6-9” breaths. Imagine each of your lungs as a building with

three floors that you are going to fill with air whilst counting to 9. Breathe in to three

filling the top floor, into 6 filling the middle floor, and up to 9 filling the ground floor of

both your lungs. (Your stomach should now be sticking out because all that air is

forcing down the diaphragm muscle underneath your lungs). Now breathe out from 9

to 1 imagining that you are emptying first the top floor (9,8,7) then the middle floor

(6,5,4) and finally the ground floor (3,2,1). Do this 4 more times.

Do this exercise 2-3 times a day until it feels easy and natural. The more you do it, the

more likely it is that you will breathe more deeply at other times of the day when you’re

not even trying to. That is excellent for keeping your anxiety level down.

Time your breaths per minute to check against your previous total. Hopefully you will

have knocked off at least 3 breaths from when you started. Then put breathing and

relaxation together in a simple way as follows:1

COPING WITH ANXIETY AND PANIC ATTACKS:

Some Cognitive-Behavioural Self-Help Strategies

What is Anxiety?

Anxiety is a normal and useful emotion when we feel under threat: it puts us on the alert and

gets our body ready to cope with the danger. It saves your life if you run to make it across the

road because a car is speeding too fast towards you!

However problems arise when the threat is in our minds rather than a real physical danger,

and when our thoughts and behaviours reinforce our anxiety instead of helping it melt away.

Some people live in a state of constant low level anxiety, which is exhausting.

Anxiety involves our thoughts, body reactions and behaviours. It does not mean you are

“crazy”, it is a common psychological problem – and it can not lead, in itself, to death or

mental illness.

Some common symptoms of anxiety are :

Worrying a lot Loss of self-confidence

Self-consciousness Inability to relax

Constant feeling of dread Irritability with others

Loss of concentration/focus Forgetfulness

Fear of criticism/rejection Nightmares

Fear of being alone Fear of being with people

Sleeplessness Loss of sexual interest

Avoidance of anxiety-provoking situations Always “wound up”, “on edge”

Afraid to face the day

Anxiety is tiring and demoralising to live with but the good news is that there are tried and

tested ways to tackle it which this article will give you. With a willingness to learn and

practise the coping methods, you can free yourself from anxiety for good – even if you have

“always been this way”. It’s not written in your genes or your stars!

The Science Bit

You may have heard of the “Fight/Flight” response. If you were walking in the jungle and a

tiger appeared you would have a huge anxiety reaction in mind and body. Under threat your

Sympathetic Nervous System kicks in to prepare you to fight or flee (run away) – the so-

called “Fight/Flight” response.

Adrenaline and noradrenaline are now pouring through your system; your digestion shuts

down because your energy is more useful to you being used to save yourself; blood is

diverted from hands, feet and skin and gets pumped to your major muscle groups, especially

the legs; your heart beats faster; your breathing speeds up increasing the oxygenation of

your blood; your liver releases stored sugar into your bloodstream to give you more energy;