Anxiety & Panic

What is anxiety?

Anxiety is a normal response to feeling threatened. People differ as to how vulnerable they feel in different situations; this feeling can be influenced by past experiences as well as by the beliefs and attitudes they hold about these situations.

Some general situations which often cause anxiety include:

leaving home
coping with work and exams
dealing with relationships or the lack of relationships
sexuality issues
preparing to leave university
new job
moving to new area

But sometimes it is specific situations that are anxiety provoking:

apprehension about going into new or social situations
having to deal with people in authority
worrying about whether you have chosen the right course or job
panic about preparing for and facing exams or making a presentation
fears about health

The experience of anxiety can range from mild uneasiness and worry to severe panic. At a reasonable level, short bursts of anxiety can motivate us and enhance our performance. If anxiety becomes too severe or chronic, however, it can become debilitating.

Anxiety typically involves an emotional component (e.g., fear, nervousness), a physical component (e.g., trembling, dry mouth, heart racing, stomach churning) and a cognitive component (frightening thoughts, e.g., “I'm going to fail/make a fool of myself/lose control”). These thoughts can then affect our behavior, in ways such as by putting off or stopping work, avoiding people, not sleeping, or drinking too much.

How you can help yourself

First of all, you need to know that anxiety is entirely normal. Everyone feels anxious when they are in a stressful situation where they feel vulnerable, so being anxious does not mean that you are "weak" or "abnormal". In fact, a certain level of stress can be very helpful--it can motivate us, be exciting or invigorating, and enable us to reach higher goals and meet new challenges. After all, if we never tackled things that we found challenging, we would stop learning or moving on in life.

However, it is also the case that too much stress can seriously interfere with living a normal life. Nonetheless, acute anxiety states are time-limited and will start to fade away in a relatively short period of time. Even when the anxiety is intense, you can still probably function better than you expect, and other people are often unaware of how you are feeling.

Here are some strategies you can try for yourself:

1. Review the stressful circumstances in your life

Think about all the things that are going on in your life which might be causing you stress. When possible, try to find practical solutions to reduce these sources of stress. This might include:

saying "no" to things you do not want to do
giving up unnecessary, time-consuming activities and responsibilities
confronting work problems by talking to your tutor, director of studies or supervisor/manager
using an organized and realistic plan of action to tackle projects
asking for information or feedback if helpful
discussing a relationship problem

Be prepared to acknowledge what feels right for you and be kind enough to yourself to respond to your needs. Increase your ability to cope with stress by looking after your health, which includes trying to eat well, exercise regularly and rest properly. Support from other people is very important, so spend time with supportive friends and/or family members. Engaging in enjoyable activities, either on your own or with other people is also important, so continue with your hobbies or interests and consider taking up something you have wanted to do for awhile.

If you are uncertain about what is making you anxious, talk this through with a psychologist to explore and understand the anxiety and how to deal with it.

2. A rational approach to challenging negative thoughts

When people are very anxious, they tend to exaggerate how threatening a situation is, and to underplay how effectively they can cope with that situation. Our thoughts are distorted by our emotional state, and it can help to "stand back" and evaluate the situation more realistically when you feel calm. Below is a rational approach to put the fears into perspective, to challenge their validity, or to find an alternative view of your situation. Ask yourself questions such as these:

Are you judging yourself harshly?

Are you focusing on your failures and forgetting your successes? Have you managed to survive similar situations in the past (or even to succeed despite them!)? Are you judging your entire existence on the basis of this one event or one part of life, or are you expecting to be perfect?

Are you "catastrophizing"?

Are you seeing things in all or nothing terms, or assuming that to not succeed would be an absolute catastrophe?

Are you worrying about the future?

Are you assuming that you know what will happen in the future?
What evidence proves that your fears are valid?
Are you exaggerating the chance of something going wrong or minimizing the possibility of your working it out fine?
Are you spending time frightening yourself about situations that you aren't actually facing at present, and which may never happen?

Are you comparing yourself to others?

Are you assuming that everyone else is doing fine except you, when you don't actually know how others are feeling or managing?
Are you blaming yourself for things that you cannot control, or that are not your responsibility?

Two examples of challenging irrational thinking:

Example 1
- Irrational: "I'll make a fool of myself in front of all these new people and they won't like me."
- Rational: "A lot of people will be feeling anxious like me. When I have been friendly and pleasant in the past, people have responded well to me. I should be able to do it this time as well."
Example 2
- Irrational: "I’m going to fail my exams."
- Rational: "I have been doing some revision. I've done OK with the course work. The work is supposed to be more challenging. I've passed exams before."

3. Distract yourself

Some people find it more effective to distract themselves from their frightening thoughts, perhaps by repeating a calming phrase to themselves such as "Stay calm and relaxed. I will feel better soon", or by doing mental arithmetic or saying the alphabet backwards. You can also try to distract yourself by focusing your attention on some external stimulus such as listening to a conversation, watching television, or becoming aware of what is going on around you. If you can stop attending to frightening thoughts, the thoughts will no longer be able to fuel your anxiety. You can also listen to relaxation tapes, exercise, or do yoga.

This is not the same as avoidance! It aims to help you stay in the stressful situation, not to opt out of it.

4. Face the situation

Confronting, rather than avoiding, anxiety-provoking situations also helps. When anxiety occurs in certain situations, it has become a learned response to those situations and it is a question of learning a new (relaxed) response. If you make yourself stay in the feared situation for long enough, the anxiety will reduce over time until it is completely extinguished. You could draw up a hierarchy of your feared situations, confronting the least threatening situation first and experience the diminution of your anxiety in that situation before progressing to a slightly more threatening situation in your hierarchy.

5. Learn to relax

The physical symptoms of anxiety occur because adrenaline is released by the nervous system into the blood stream and affects organs such as the heart, stomach and muscles. Relaxation and breathing exercises can help you to control these symptoms. You can learn how your body feels when it is relaxed if you tense different parts of your body (e.g. arms, hands, legs, neck, shoulders, forehead) for a few seconds, and then allow them to relax. Try to keep your breathing slow and regular so that you do not hyperventilate, making the physical symptoms worse.

It may help you to join a relaxation class. Relaxation exercises need to be practiced initially when calm. You will become better able to relax in stressful situations with increasing practice.

Panic Attacks

A panic attack is a severe experience of anxiety. People may feel intense dread, experience various physical symptoms and have extreme thoughts of losing control, going crazy, having a heart attack or dying. It is also possible to become afraid of panic attacks themselves because the experience can be so unpleasant. Paradoxically, this experience tends to make a person even more prone to having an attack!

Although panic attacks can be very frightening, they are not actually harmful. People do not actually have heart attacks or die from them!

Here are some strategies to help in the event of a panic attack:

Remind yourself that a panic attack will end!
Remind yourself that panic attacks are not actually dangerous!
Remind yourself of any previous occasions when you handled a similar situation well.
Picture a person you trust or who cares about you and imagine the person is with you offering encouragement.
Focus on the present moment and on the things around (outside of) you - observe their shape, color, sounds...
Stop what you are doing and slow yourself down for a moment! Breathe more slowly and gently (though not actually holding your breath). Then continue what you were doing slowly.
Take a big sigh, stretch out, and then flop and relax.
If you are able, take some gentle exercise (e.g., go for a stroll).
Get angry! Don't let this anxiety (or situation) get the better of you!

When to seek further help

Anxiety can affect your health only when it becomes chronic and severe; therefore, it is important for you to seek help if you think the following is occurring:

if the anxiety problems do not start to improve despite trying the ideas above
if your fears are persistent and difficult to control
if your anxiety is stopping you from living a normal life, or if you are avoiding important activities.

Where to get help

Speak to a close friend or family member, Tutor, Supervisor, or Director of Studies.
Talk to your physician or a nurse
Speak to someone at Counseling and Psychiatric Services where psychologists and psychiatrists can help you understand and deal with your anxiety. For students, a psychologist can help with cognitive-behavioral work. You can be seen on a one-to-one basis or join an anxiety management group.