Barnet, Enfield and Haringey Mental Health NHS Trust

Understanding Anxiety An information and guidance booklet

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What is Anxiety? Most people experience some anxiety when faced with situations they find threatening or difficult to deal with. Anxiety is a normal healthy emotion, which helps us to avoid dangerous situations, makes us more alert and gives us the motivation to deal with problems. Most people can relate to feeling tense, unsure and maybe fearful of sitting an exam, having a driving test, or attending an interview. Anxiety becomes a problem when it is: • Extremely intense or out of proportion to the situation • Continues long after the threat or difficult situation is over • Triggered by situations known to be harmless • Caused by no obvious trigger Anxiety can sometimes be a symptom of other mental or physical illnesses so it is a good idea to have a medical examination to be sure that your anxiety is not due to physical causes. Who suffers from anxiety? People, who are put under a lot of pressure, may feel anxious and fearful for much of the time. What are the symptoms of anxiety? There are three ways anxiety can affect you. It affects: How your body behaves: • Sweating, blushing • Shaking, muscle tension • Dry mouth, difficulty swallowing • Heavy or fast breathing, hyperventilation, dizziness, faintness, tingling sensations • Racing heart, blurred vision • Indigestion, feeling sick, diarrhoea • Sleep and appetite disturbance

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How you feel: • Poor concentration, irritability, worry, dread • Negative thoughts e.g. "I'll die from a heart attack...Everyone will laugh at me" • Feeling ‘on edge' • Experience of feeling unreal or of surroundings being unreal • Feeling out of control How you behave: • Avoiding situations or people • Escaping from situations as quickly as possible It is important to remember that the symptoms can be uncomfortable and unpleasant but they are not dangerous. They will go away in time. Initially avoiding situations that cause anxiety may bring relief but, in the longer term, avoidance will make the anxiety worse. What causes anxiety? Anxiety can be triggered by a number of things including: • Experience of one or more stressful life events such as bereavement, an accident, divorce or redundancy • The thought of going through something distressing that happened in the past again • Growing up in an environment that taught you to be anxious early on in life e.g. protective/ worried parents • Excess caffeine and or sugar, poor diet, drug misuse, exhaustion, stress and the side effects of certain medication The cause of anxiety may not always be clear. It may be due to a mixture of personality and things happening around you.

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How does it start? When faced with a potentially distressing situation, the body automatically gets itself ready to take action and protect itself from danger (this has been called the ‘fight or flight' response). These reactions occur in a matter of seconds and can happen in moments of enjoyment as well as in frightening or threatening situations. Most anxiety or panic attacks last between 5 to 20 minutes. However it is possible to have one after another. Some people may experience one or two panic attacks and never have another. What are the different types of anxiety? It is not uncommon for people to have more than one of the following types of anxiety, as these tend to overlap: • Generalised anxiety disorder (GAD) is when you experience a lot of anxiety symptoms that are there all the time, about everyday things and they affect your daily life. • Panic disorder is when you suffer from regular feelings of very intense fear or panic, which happen suddenly and often without an obvious reason. The attacks feel like they are going on for a long time, but actually last only a few minutes, and at the longest they last around an hour. • Specific phobias, (a phobia is a strong fear and avoidance of a particular type of object or situation e.g. fear of spiders or heights). When you experience the feared object or situation it may cause you to panic. You will usually try to avoid the feared situation to help reduce the anxiety. • Post-traumatic stress disorder (PTSD) is sometimes experienced after a very threatening or distressing event e.g. car crash or psychical attack, which would cause distress in almost anyone. Symptoms include flashbacks (vivid memories of the event), nightmares, avoiding

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• anything associated with the stressful event and being on edge. • Obsessive-compulsive disorder (OCD) OCD differs from other forms of anxiety due to the uncontrollable and obsessional thoughts that come repeatedly into your mind causing you to carry out repetitive actions (rituals) to alleviate the anxiety, however if you are interrupted or stopped from completing the ritual this will provoke other anxiety symptoms. Thoughts may include: A fear of dirt or germs, doubting that you have locked the door or turned the lights/appliance off. You may also experience unpleasant and graphic images of harming yourself or others. You usually will not carry out or act on any of these unpleasant thoughts, but are afraid you will. What can I do to help myself? There are many things you can do to reduce your anxiety to a manageable level. Thinking about or facing up to how anxiety makes you feel can be the first step in breaking the cycle of fear helping you to begin to relax, take control and lead a fuller life. Taking control of the physical symptoms: • Keeping a paper bag available for use in the event of hyperventilation • Learning breathing techniques with progressive muscle relaxation • Replacing distressing and negative thoughts with positive and peaceful ones can help. These methods are straightforward and can be learnt from books, video and audiotapes, through counselling, and attending relaxation classes. • Doing more exercise can help you cope with anxiety, feelings of tension, and you might get a better night's sleep. Exercise uses up the adrenaline and other hormones that are produced under stress, allowing muscles to relax.

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• Also, certain brain chemicals are released during exercise, which can enhance your mood. • Walking and swimming allow you to be active at your own pace and you can do them alone or in company. If you feel embarrassed exercising in front of others, do it indoors; dance, stretch or move along to music or a video. Lifestyle changes can include: • Reducing caffeine and alcohol consumption • Cutting down on smoking • Spending more time with people and social support • Finding someone to confide in • Trying to reduce life stresses • Learning how to handle difficult situations and standing up for ourselves can make us feel more confident and thereby relaxed • Listing the problems, prioritising them and dealing with them one at a time. Finding ways to distract your thoughts by: • Doing a crossword or jigsaw puzzle • Counting backwards from 1000 in seven's • Thinking of animals'/girls'/boys' names or countries beginning with each letter of the alphabet • Focusing on an object and describing it in detail - shape/size/colour • Imagining pleasant situations such as an enjoyable holiday or a favourite walk

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What treatment is available for anxiety? Anxiety is treatable. Making changes in lifestyle or using specific techniques as discussed above can overcome/lessen symptoms: • Most people with anxiety will benefit from self help such as leaflets, DVD's and CD's • Health professionals, such as your GP, can help by giving a clear explanation of your symptoms and information and advice. • There are different counselling therapies available such as talking therapies and Cognitive Behavioural Therapy (CBT). Some help with how you are feeling, others look into reasons why you may be experiencing anxiety. You can usually access these through your GP. • There are also many voluntary organisations offering counselling and anxiety management groups. Your GP or health worker might also prescribe tablets for your anxiety. The medications prescribed for anxiety include: • Anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRI's) may be helpful. Examples are Paroxetine, Citalopram and Sertraline. • Short-term use of medication called benzodiazepines (diazepam, lorazepam, oxazepam) can provide relief in very severe, disabling anxiety. However benzodiazepines are addictive and can lead to both psychological and physical dependence if taken for more than a few weeks. • Low doses of anti-psychotic drugs such as trifluoperazine and haloperidol offer some sedative and calming effects but should not be prescribed in the long-term because of their side effects. The aim of any treatment should be to try and help you reduce your symptoms of anxiety to an acceptable level, so that it no longer interferes with day-to-day living.

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What can partners; friends and relatives do to help? People with severe anxiety can often feel bad about themselves and may need reminding that they are not bad people and have many good points. • Be supportive and accept them as a person • Be patient - there might be times when you really don't understand what he or she is going through but try not to get visibly angry or annoyed. Remember it is not their fault. • Help them to overcome small challenges without pushing them into situations they might not be able to cope with. • Spend time with them doing something they like - this will help build confidence and take their mind off things. Letting out feelings can also help relieve tension. • If someone is distressed, they may need to be reassured that it is OK to cry. • Laughter is relaxing; helping your friend to have a good laugh may be one of the most useful things you can do for them. • They may also need support in finding appropriate channels to express anger, even if this is just bashing a few cushions about. • Some people may be embarrassed at not feeling in control. They may blush or shake, and need reassurance that it is not as obvious to other people as it is to them. Supporting someone else through emotional problems can be very rewarding, but it can also be very frustrating. It is important to look after yourself. Finding someone you can confide in may be very useful. If you are living with the person, make sure that you have a break. If their anxiety is stopping them doing things it doesn't mean you should stop as well. You should not feel guilty about doing things on your own. If you enjoy your life you will find it easier to be supportive.

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Useful Organisations Anxiety Alliance Tel: 0845 2967877 (10am-10pm everyday) Email: [email protected] Web: www.anxietyalliance.org.uk The Anxiety Alliance is a registered charity offering help, advice and support to people suffering from general anxiety, phobias, panic attacks and their friends and family. Confidential support is offered through the helpline, email and online resources OCD-UK PO Box 8955 Nottingham NG10 9AU United Kingdom Tel: 0845 120 3778 (admin enquiries only) Email: [email protected] Web: www.ocduk.org OCD-UK is a national charity working with and for people with ObsessiveCompulsive Disorder (OCD). Service include 24/7 online support and information and advice for those suffering from OCD, their families and carers. No Panic 93 Brands Farm Way Telford Shropshire England TF3 2JQ Helpline: 0808 808 0545 Email: [email protected] Web: www.nopanic.org.uk No Panic provide support and advice for people suffering from anxiety disorders.

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SANE 1st Floor Cityside House 40 Adler Street London E1 1EE Tel: 020 7375 1002 Email: [email protected] Saneline: 08457 678 000 (6-11pm) Email: [email protected] Web: www.sane.org.uk SANELINE is the national out-of-hours telephone helpline that offers emotional and crisis support to people coping with mental illness, their families and friends, and information to professionals and organisations working in the mental health field. Relate - North East London Tel: 01708 441722 Telephone counselling booking line: 0300 100 1234. (Open Mon - Thurs: 8am to 9pm, Friday: 8am to 5pm and Saturday: 9am to 5pm (excluding Bank Holidays). Email: [email protected] Web: www.relatenelondon.org.uk Relate is a national charity providing relationship counselling for individuals, couples, families, children and young people. Services also include online and telephone counselling. North London Cruse Tel: 01923 857612 National Helpline: 0844 477 9400 Email: [email protected] Web: www.northlondoncruse.org.uk North London Cruse is part of national charity Cruse Bereavement Care. They provide bereavement support on a one-to-one basis or by telephone. For more information on support organisations please visit: www.beh-mht.nhs.uk/wereheretohelp

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Produced By: Date of Publication: Page 12 Review Date: Reference:

Communications 02/07/2014 02/07/2017 lc00004486