The Counselling Centre
Anxiety & Panic
What is anxiety?
Anxiety is a normal emotional and physiological response to feeling threatened. People differ as to how vulnerable they feel in different situations: this can be influenced by past experiences as well as by the beliefs and attitudes they hold about these situations.
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, but if anxiety becomes too severe or chronic, however, it can become debilitating.
Anxiety typically involves an emotional component (e.g. fear, nervousness), a physiological component (e.g. fast breathing, trembling, dry mouth, heart racing, stomach churning) and a cognitive component (frightening or negative thoughts, e.g. I'm going to fail/make a fool of myself/lose control). These can then affect our behaviour, for example by putting off or stopping work, avoiding people or situations, not sleeping, drinking too much or taking illicit substances.
Types of Anxiety Disorders
As the name suggests, panic disorder is expressed in panic attacks which occur without warning, accompanied by sudden feelings of terror. Physically, an attack may cause chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality and fear of dying. When a person avoids situations that he or she fears may cause a panic attack, his or her condition is described as panic disorder with agoraphobia.
Phobias are divided into two categories: social phobia, which involves fear of social situations, and specific phobias, such as fear of flying, blood and heights.
People with social phobia feel a paralyzing, irrational self-consciousness about social situations. They have an intense fear of being observed or of doing something horribly wrong in front of other people. The feelings are so extreme that people with social phobia tend to avoid objects or situations that might stimulate that fear, which dramatically reduces their ability to lead a normal life.
Fear of flying, fear of heights and fear of open spaces are some typical specific phobias. People suffering from a specific phobia are overwhelmed by unreasonable fears, which they are unable to control. Exposure to feared situations can cause them extreme anxiety and panic, even if they recognize that their fears are illogical.
Post-Traumatic Stress Disorder
A terrifying experience in which serious physical harm occurred or was threatened can cause post-traumatic stress disorder. Survivors of rape, child abuse, war or a natural disaster may develop post-traumatic stress disorder. Common symptoms include flashbacks, during which the person re-lives the terrifying experience, nightmares, depression and feelings of anger or irritability.
This is a condition in which people suffer from persistent unwanted thoughts (obsessions) and / or rituals (compulsions) which they find impossible to control. Typically, obsessions concern contamination, doubting (such as worrying that the iron hasn't been turned off) and disturbing sexual or religious thoughts. Compulsions include washing, checking, organizing and counting.
Generalized Anxiety Disorder
Characterized by repeated, exaggerated worry about routine life events and activities, this disorder lasts at least six months, during which time the person is affected by extreme worry more days than not. The individual anticipates the worst, even if others would say they have no reason to expect it. Physical symptoms can include nausea, trembling fatigue, muscle tension, or headache.
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 and meet new challenges. After all, if we never tackled things that we found challenging, that we were uncertain that we could succeed at, 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 a few strategies you can try:
Review and address 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.
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. Doing 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 been wanting to do for a while.
If you are uncertain about what is making you anxious, talk this through with a counsellor to explore and understand the anxiety and how to deal with it.
Take a rational approach and challenge unhealthy and unrealistic 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.
Ask yourself the following questions:
Are you judging yourself too 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 "catastrophising"?
- Are you seeing things in all or nothing terms, or assuming that to not succeed would be an absolute catastrophe?
Are you guilty of always imagining a "worse-case scenario"?
- Are you assuming that you know what will happen in the future? What evidence have you got 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 are not your responsibility?
Two examples of challenging irrational thinking:
- 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. If I try to be friendly and pleasant, people have responded well to that in the past - I should be able to do it this time as well." 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."
Distract yourself if necessary, but do not avoid what it is you are anxious about
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, these will no longer be able to fuel your anxiety.
Note that this is not the same as avoidance! It aims to help you stay in the stressful situation, not to opt out of it.
Face the situation
Confronting, rather than avoiding anxiety-provoking situations is probably the single most important way to reduce your stress and anxiety. 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.
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, and 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, which makes the physical symptoms worse.
Relaxation exercises need to be practiced initially when calm - you will become better able to relax in stressful situations with increasing practice.
Dealing with 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 mad, 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 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, develop psychiatric illnesses 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, colour, 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 such as going for a walk.
The Counselling Centre offers individual counselling to help with issues related to anxiety and stress. For more information, call The Counselling Centre at 902-420-5615 or drop by our office on the 4th floor of the Student Centre.