tips for managing anxiety better

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How can I manage my anxiety better?

As we have learned, anxiety is not an illness and so can't be cured. If we can break into the vicious circle, however, we can learn ways of reducing our anxiety and getting it to be more manageable. We can work on at least four different areas:

Understanding our anxiety better.
Reducing physical symptoms.
Altering our thoughts related to anxiety.
Changing our behaviours related to anxiety.

1. Understanding anxiety
You may already by now have some ideas about what is causing your anxiety. The following sections will give advice on how to break out of the vicious circle that keeps anxiety going. Before you can do this though, it is really useful for you to understand your own anxiety better. Is your anxiety related to certain situations, places or people? Is it worse at particular times of the day? Are there realistic worries you have that would make anyone anxious? The following two exercises should help you to understand your anxiety better.

i) Anxiety Diary - for a period of two weeks (or longer if you prefer) keep an hourly diary of your anxiety and activity level. Rate your anxiety from 0-10. Note down anything that seems important. Were you at work or home, who were you with, what were you doing, what were you thinking about? You may start to become more aware of situations that make you anxious or that you may even be avoiding. What is your general level of stress like? This information will help you begin to tackle your anxiety.

ii) If you become aware that you have a realistic worry or problem that you feel may be causing you anxiety, a problem solving approach may help.

A good way to begin is to write down a problem. Define it as clearly as you can. For example "I never have any money", is too vague, something like "I owe £3000 to different credit card companies" is more helpful. Next, write down as many possible solutions as you can. It doesn't matter how silly you may think the solutions are, the point is to think of as many as you can. Try to think how you have solved similar problems in the past. Ask a friend what they might do. Think to yourself what you might advise a friend to do if they had the same problem, eg possible solutions:

get all debts on one loan with less interest;
agree on affordable payments;
see a debt counsellor;
get a part time job;
sell car.
If you have a problem that may be making you anxious, try writing it below:




Now list as many possible solutions as you can:











Choose what seems like the best solution and write down all the steps it would take to achieve that solution. Who might help?, what might go wrong?, often it is helpful to think "what is the worst thing that could happen?" If you can think of a plan to cope with this, your anxiety might reduce.

If you are trying to come up with a plan to tackle a problem that has been worrying you for some time, it is often helpful to discuss this with a friend or even your doctor.

Stressful lifestyle - general tips
Nowadays life is often stressful, and it is easy for pressures to build up. We can't always control the stress that comes from outside but we can find ways to reduce the pressure we put on ourselves:

Try to identify situations you find stressful by noticing the beginnings of tension.
Take steps to tackle what it is about these situations that you find stressful.
Make sure you have time for things you enjoy.
Take up a relaxing hobby.
Make sure you get enough sleep.
Eat a well balanced diet.
Take regular exercise.
Learn to relax.
2. Reducing physical symptoms

Relaxation
In order to reduce the severity of physical symptoms it is useful to 'nip them in the bud', by recognising the early signs of tension.

Once you have noticed early signs of tension you can prevent anxiety becoming too severe by using relaxation techniques. Some people can relax through exercise, listening to music, watching TV or reading a book.

For others it is more helpful to have a set of exercises to follow. Some people might find relaxation or yoga classes most helpful, others find tapes useful. You may be able to obtain a relaxation tape from your GP, and there are also a wide number of relaxation tapes available in the shops.

Relaxation is a skill like any other which needs to be learned, and takes time. The following exercise teaches deep muscle relaxation, and many people find it very helpful in reducing overall levels of tension and anxiety.

Deep muscle relaxation - it is helpful to read the instructions first and to learn them eventually. Start by selecting a quiet, warm, comfortable place where you won't be disturbed. Choose a time of day when you feel most relaxed to begin with. Lie down, get comfortable, close your eyes. Concentrate on your breathing for a few minutes, breathing slowly and calmly: in two-three and out two-three. Say the words "calm" or "relax" to yourself as you breathe out. The relaxation exercise takes you through different muscle groups, teaching you firstly to tense, then relax. You should breathe in when tensing and breathe out when you relax. Starting with your hands, clench one first tightly. Think about the tension this produces in the muscles of your hand and forearm.

Study the tension for a few seconds and then relax your hand. Notice the difference between the tension and the relaxation. You might feel a slight tingling, this is the relaxation beginning to develop.
Do the same with the other hand.

Each time you relax a group of muscles think how they feel when they're relaxed. Don't try to relax, just let go of the tension. Allow your muscles to relax as much as you can. Think about the difference in the way they feel when they're relaxed and when they're tense.

Now do the same for the other muscles of your body. Each time tense them for a few seconds and then relax. Study the way they feel and then let go of the tension in them. It is useful to stick to the same order as you work through the muscle groups:

Hands - clench first, then relax.
Arms - bend your elbows and tense your arms. Feel the tension especially in your upper arms. Remember, do this for a few seconds and then relax.
Neck - press your head back and roll it from side to side slowly. Feel how the tension moves. Then bring your head forward into a comfortable position.
Face - there are several muscles here, but it is enough to think about your forehead and jaw. First lower your eyebrows in a frown. Relax your forehead. You can also raise your eyebrows, and then relax. Now, clench your jaw, notice the difference when you relax.
Chest - take a deep breath, hold it for a few seconds, notice the tension, then relax. Let your breathing return to normal.
Stomach - tense your stomach muscles as tight as you can and relax.
Buttocks - squeeze your buttocks together, and relax.
Legs - straighten your legs and bend your feet towards your face. Finish by wiggling your toes.
You may find it helpful to get a friend to read the instructions to you. Don't try too hard, just let it happen. To make best use of relaxation you need to:
Practise daily.
Start to use relaxation in everyday situations.
Learn to relax without having to tense muscles.
Use parts of the relaxation to help in difficult situations, eg breathing slowly.
Develop a more relaxed lifestyle.
This relaxation exercise may be available on tape from your GP.
Remember relaxation is a skill like any other and takes time to learn. Keep a note of how anxious you feel before and after relaxation, rating your anxiety 1-10.

Controlled Breathing
Over-breathing: it is very common when someone becomes anxious for changes to occur in their breathing. They can begin to gulp air, thinking that they are going to suffocate, or can begin to breathe really quickly. This means they end up with the wrong amount of carbon-dioxide. This has the effect of making them feel dizzy and therefore more anxious.

Try to recognise if you are doing this and slow your breathing down. Getting into a regular rhythm of in two-three and out two-three will soon return your breathing to normal. Some people find it helpful to use the second hand of a watch to time their breathing. Other people have found breathing into a paper bag or cupped hands helpful. For this to work you must cover your nose and mouth.

It takes at least three minutes of slow breathing or breathing into a bag for your breathing to return to normal.

Distraction
If you take your mind off your symptoms you will find that the symptoms often disappear. Try to look around you. Study things in detail, registration numbers, what sort of shoes people are wearing, conversations. Again, you need to distract yourself for at least three minutes before symptoms will begin to reduce.


Whilst relaxation, breathing exercises and distraction techniques can help reduce anxiety it is vitally important to realise that anxiety is not harmful or dangerous. Even if we did not use these techniques, nothing awful would happen. Anxiety cannot harm us, but it can be uncomfortable. These techniques can help reduce this discomfort.

3. Altering your thoughts related to anxiety
We have seen the role that thoughts have in keeping going the vicious circle of anxiety. Sometimes there may also be pictures in your mind.
To give an example, imagine you are running for a bus one day. All of a sudden you get a pain in your chest and feel really breathless. The thought goes through your mind, "I'm having a heart attack". This thought is of, course, very frightening, and so your heart starts to beat faster which makes you think "there really must be something wrong with my heart". You may very well have a picture of the ambulance on its way and you in a stretcher.

Now think about the following questions and write down the answers:


1) What are the thoughts that most often go through your mind when you feel anxious?



2) Do you have any pictures of what might happen?



3) Are there any thoughts that make you feel worse?



It isn't always that easy to know what you are thinking that is making your anxiety worse.

The sort of thoughts that make people anxious can come and go in a flash, and may be so much of a habit that they are automatic. They may be so familiar that they just feel like part of you.

Try to keep a diary over the course of two weeks. Write down your own thoughts in situations where you are anxious.

Now, try to imagine the last time you felt very anxious. Try to run through it like a film, in as much detail as you can. See if you can write down any frightening thoughts now.

Remember any thoughts can count. No thought is too small or too silly. Even "oh no" or "here we go again" can increase tension and anxiety.

Frightening Thoughts:


Once you know what it is you are thinking, you can begin to fight back, and break the vicious circle.

In particular, ask yourself:

1. Am I exaggerating, eg "everything is bound to go wrong it always does".
2. Am I jumping to conclusions, eg "I have a pain in my chest therefore it must be my heart".
3. Am I focusing just on the bad things, eg "I had a really bad day yesterday" (ignoring that this followed a few good days).

Use these questions to help yourself answer back. A good way of doing this is to write two columns - one for your thoughts that make you anxious, and the other for a more balanced thought, eg:


Anxious thought Balanced thought
The dizzy feeling means I'm going to faint. I have had it many times before and have not fainted. I have fainted once and that felt really different
I'm going mad I have not gone mad yet, and the doctor tells me anxiety is not madness.

Write down some of your thoughts now and write as many answers as you can. This question might also help. What would you say to a friend who was thinking that way? The aim is to get faster at "catching" these anxious thoughts and answering back almost instantly. It takes a lot of practice, but really does work.

4. Changing behaviour related to anxiety

Try to recognise when you are avoiding things and wherever possible try to tackle these fears, not all at once but in a gradual way.
Set yourself very small goals. Write down here goals that you would like to tackle. Start with the easiest first and tick off any activity you achieve.
People often get into the habit of escaping from situations that make them anxious. Instead of escaping try gradually to increase how long you stay in a situation that makes you anxious. Anxiety often reaches a peak, then starts to go away naturally. If you stay in an anxious situation what do you predict will happen to your anxiety? People often think it will just keep getting worse and worse. This is not the case. It will start to come down.
People not only avoid situations and try to escape, they also often do things to make themselves feel more safe, eg hanging on to a shopping trolley, lying down. These "safety behaviours" may help at the time, but they also help to keep the anxiety going because the anxious person never learns that nothing awful would have happened even if the trolley wasn't there. Also, imagine how frightening it would be if no trolley was available.
Try to do things to test out whether your anxious thoughts are realistic?, eg "would I really faint if I didn't get out?"
It really is very important to recognise that the more you avoid something, the more difficult it will seem to overcome, which will in turn make you more anxious.
What treatment is available for anxiety?

Most people with anxiety can benefit from self help such at this leaflet.
Your family doctor, health visitor or practice nurse may also be able to give you further help in dealing with anxiety.
Occasionally, doctors prescribe tablets for anxiety. These should only be taken for short spells to get over specific anxiety provoking situations.
Your doctor may also refer you to a mental health worker or counsellor if your anxiety does not respond to self-help alone.
Anxiety Management Groups or classes are often run in local surgeries or Community Health Centres. Please let your doctor know if you would be interested in such classes.
Where can I find help if I think I am suffering from anxiety?

First, we hope you will use the advice in this self help guide. You should find it helpful. If having used the guide you feel you need more help, you should discuss this with your GP, who will tell you about alternative treatments and local services. There are a number of self help books that other people have found helpful. These books may be available from your local library.

Helen Kennerley: Managing Anxiety.
David Burns: The Feeling Good Handbook.
Dr Clare Weeks: Self Help for your Nerves.
Susan Jeffers: Feel the Fear and Do it Any