Anxiety audio transcript

Anxiety –  An NHS self help guide
The written version of this guide was Commended at the British Medical Association Patient Information Awards 2013.

“Bad with your nerves”

“A worrier”

“Stressed out”

“Unable to relax”

“Tense and nervous”

… are all words we might use to describe someone who has a problem with anxiety. If someone has too much stress for too long anxiety is very often the result. This guide is about anxiety, and aims to help you to:-

• Recognise whether or not you may be suffering from symptoms of anxiety. 

• Understand what anxiety is, what can cause it, and what can keep it going. 

• Overcome your anxiety by learning better ways of coping with it.

• It may also be really useful for family and friends to listen to this guide so that they can understand anxiety better and support you in coping with it.

What is anxiety?

Anxiety is something we all experience from time to time. It is a normal response to situations that we see as threatening to us. For example, if we had to go into hospital for an operation, or had to sit a driving test, or take an exam, it would be natural to feel anxious. Anxiety at certain levels can even be helpful in some situations such as when we need to perform well, or cope with an emergency.

Some anxiety is not at all helpful because:

• Symptoms of anxiety, whilst not dangerous can be uncomfortable.
• Symptoms can also be frightening, particularly if someone does not know that these symptoms are just signs of anxiety.
• Sometimes people with anxiety symptoms worry that they may have something seriously wrong with them. This worry can then produce more anxiety symptoms which of course increases the worry!
• When anxiety is severe it can stop people doing what they want to do.
• If anxiety goes on for a long time it can sometimes make physical problems worse, such as stomach problems, high blood pressure etc.

Am I suffering from anxiety?

• “I worry about everything, I get tense and wound up, and end up snapping at the children”.
• “Even before I get there I start to worry about all the things that might go wrong. When I arrive my heart starts to pound, my legs turn to jelly and I just know I’m going to make a fool of   myself. I have to get out”.
• “It feels as though there is something in my throat. My mouth is dry and I can’t swallow properly and then I begin to get panicky. I think I’m going to stop breathing”.
• “My mind starts to race, I feel like I’m going to lose control and go mad or something”.
• “I often wake up in the night with my mind racing, and then can’t get back to sleep for worrying”.

These are some typical experiences of people who suffer from anxiety.  If you are suffering from anxiety you may have thoughts like these yourself.

Sometimes it is possible to be suffering from anxiety and not even know it, particularly if you don’t think of yourself as an anxious person. People often mistake symptoms of anxiety for a physical illness. Therefore, the first step in learning to deal with anxiety is recognising whether anxiety is a problem for you.

Anxiety can affect us in at least four different ways.  It affects:

• The way we feel.
• The way we think.
• The way our body works.
• The way we behave.

In order to check out whether you may be suffering from anxiety, write down any of these symptoms you experience regularly:

How you feel

• Anxious, nervous, worried, frightened
• Feeling something dreadful is going to happen
• Tense, stressed, uptight, on edge, unsettled
• Unreal, strange, woozy, detached, panicky

How you think

• Constant worrying
• Can’t concentrate
• Thoughts racing
• Mind jumping from one thing to another
• Imagining the worst and dwelling on it
• Going over the same worries again and again

Common thoughts

• “I’m losing control”
• “I’m cracking up”
• “I’m going to faint”
• “My legs are going to collapse”
• “I’m going to have a heart attack”
• “I’m going to make a fool of myself”
• “I can’t cope”
• “I’ve got to get out”

 What happens to your body

• Heart pounds, races, skips a beat
• Chest feels tight or painful
• Tingling or numbness in toes or fingers
• Stomach churning or butterflies
• Having to go to the toilet
• Feeling jumpy or restless
• Tense muscles
• Body aching
• Sweating
• Breathing changes
• Dizzy, light headed

What you do

• Pace up and down
• Start jobs and not finish
• Can’t sit and relax
• On the go all of the time
• Talk quickly or more than usual
• Snappy and irritable behaviour
• Drink more alcohol
• Smoke more
• Eat more (or less)
• Avoid feared situations

If you are regularly experiencing some or all of these symptoms, then it is likely that you are suffering from anxiety.

What causes anxiety?

Anxiety is the feeling we get when our body responds to a frightening or threatening experience. It has been called the fight or flight response. It is simply your body preparing for action, either to fight danger or run away from it as fast as possible. The purpose of the physical symptoms of anxiety therefore is to prepare your body to cope with threat.

To understand what is happening in your body, imagine that you are about to be attacked. As soon as you are aware of the threat, your muscles tense ready for action.  Your heart beats faster to carry blood to your muscles and brain, where it is most needed. You breathe faster to provide oxygen which is needed for energy. You sweat to stop your body overheating. Your mouth becomes dry and your tummy may have butterflies. When you realise that the attacker is in fact a friend, the feelings die away, but you may feel shaky and weak after the experience.

The fight or flight response is a really basic system that probably goes back to the days of cave men, and is also present in animals who depend on it for their survival. Fortunately, nowadays we are not often in such life or death situations, but unfortunately many of the stresses we do face can’t be fought or run away from, so the symptoms don’t help. In fact they often make us feel worse, especially if we don’t understand them.

Causes of anxiety

There may be many causes of anxiety:

• Some people may have an anxious personality and have learned to worry.
• Or have had early experiences that make them feel anxious and insecure.
• Others may have a series of stressful life events to cope with, for example bereavements, redundancy, divorce, illness.
• Others may feel under pressure at work, for example, working long hours, feeling understaffed.
• Or at home for example because of financial, family or relationship problems.

A physical health problem, misuse of substances or a history of depression are known to affect anxiety (please consult your doctor if you think any of these may apply to you).

Anxiety is a very common problem and at least one in four people will have high levels of anxiety at some point during their life.

What keeps anxiety going?

Sometimes anxiety can go on and on, and become a lifelong problem.  There can be a number of reasons for this:

• If someone has an anxious personality and is a worrier, then they will probably be in the habit of feeling anxious.
• Sometimes people have ongoing stresses over a number of years which means they develop the habit of being anxious.
• Sometimes a vicious circle of anxiety develops. As the bodily symptoms of anxiety can be frightening, unusual and unpleasant, people often react by thinking that there is something physically wrong, or that something truly awful is going to happen. This in itself causes more symptoms, and so a vicious circle develops.

For example:

• You find yourself in an anxious situation.
• You feel bodily symptoms
• These produce thoughts such as ‘something awful is going to happen to me’
• This makes you feel more anxious and you have thoughts like ‘Now I really am in danger’. These thoughts cause more bodily symptoms, and so a vicious circle develops.

Fear of Fear – Someone who has experienced anxiety in a certain situation may start to predict feeling anxious, and become frightened of the symptoms themselves, this in turn actually causes the very symptoms themselves, this in turn actually cause the very symptoms that are feared.

Avoidance or escape – once a vicious circle has developed with lots of anxious thoughts increasing the anxiety symptoms, avoidance is often used as a way of coping. It is natural to avoid something that is dangerous, but the sorts of things that people tend to avoid when they suffer from anxiety are most often not real dangers but busy shops, buses, crowded places, eating out, talking to people etc. Not only are these things not dangerous, but they are quite necessary.

Avoiding them can make life very inconvenient and difficult. Similarly, people often start out okay, but when the anxiety symptoms come on, feel that they have to escape from the situation, and leave quicker than they would have chosen to.

Avoidance and escape can result in a great loss of confidence which can affect how good someone feels about themself, which in turn makes them feel more anxious, another vicious circle!

To summarise:

• Anxiety is often the body’s response to stress, although some of us may be a bit more prone to anxiety and worry than others.
• When we are suffering from anxiety, though it can be unpleasant, it is our body’s normal response to threat or danger and is not dangerous.
• Anxiety symptoms are part of the fight or flight response and are intended to be helpful in spurring us into action.
• Anxiety becomes a problem when the symptoms are:

– severe and unpleasant;

– going on too long;

– happening too often;

– causing us to worry that there is something seriously wrong;

– stopping us doing what we want to do.

• Anxiety often becomes a part of a vicious circle where our symptoms, thoughts and behaviour keep the anxiety going.

Now spend a few moments trying to write down any of these ways that keep your anxiety going:

• Unpleasant/frightening symptoms you experience.
• Your beliefs and thoughts about these symptoms.
• Everyday things that you are avoiding.
• Current stresses in your life.

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 your anxiety and getting it to be more manageable. We can work on at least four different areas:

• Understanding anxiety better and beginning to tackle some of the causes.
• Reducing physical symptoms.
• Altering thoughts related to anxiety.
• Changing behaviours related to anxiety.

Understanding and beginning to tackle 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 should help you to understand and begin to manage your anxiety better.

• 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 zero to 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.
• Problem Solving
  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 the 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, think of 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.  Then, write down all the possible solutions.

Problem
“I owe £3000 to different credit card companies”

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
• work some overtime.

Next spend some time looking at the pros and cons of each solution.

If you have a problem that may be making you anxious, try writing it down

 Then list as many possible solutions as you can

Choose what seems like the best option 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.
  • If you feel stressed at work, consider talking to your manager.
  • Take up a relaxing hobby.
  • Make sure you get enough sleep.
  • Eat a well-balanced diet.
  • Take regular exercise.
  • Learn to relax.
  • Aim towards personal and/or career goals that are important to you and that you really value. This can make you feel like your life has meaning and can reduce stress.

 Further information about managing stress can be found in the Stress guide in this series.

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 CDs useful. You may be able to obtain a relaxation CD from your GP, and there are also a wide number of relaxation CDs available in the shops. If you have access to the internet, there are a number of Apps or MP3 recordings that you can download often free of charge. Examples of these can be found in the written version of this guide.

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 listen to the instructions first and then gradually learn them off by heart. Start by selecting quite a warm, comfortable place where you won’t be disturbed.  To begin with choose a time of day when you feel most relaxed.

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.

Starting with your hands, clench one fist tightly. Think about the tension this produces in the muscles of your hand and forearm.

Now do the same with the other hand.

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. Now 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 too hard 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 fist, 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 listen to the instructions with you. Don’t try too hard, just let it happen.

To make best use of relaxation you need to:

• Practice 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, e.g. breathing slowly.
• Develop a more relaxed lifestyle.

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
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 has the effect of making them feel dizzy and therefore more anxious.  This is called over-breathing, or hyperventilation.

Try to recognise if you are doing this and slow your breathing down. Getting into a regular slow 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.

If you are over-breathing it usually 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.

Altering your thoughts related to anxiety

Controlling your anxious thoughts
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 on a stretcher.

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

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

 Do you have any picture of what might happen? 

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.

Some thoughts are like unpleasant pictures in your mind.

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

In particular, ask yourself:
Am I exaggerating, e.g. “everything is bound to go wrong, it always does”.

Am I jumping to conclusions, e.g. “I have a pain in my chest therefore it must be my heart”.

Am I focusing just on the bad things e.g. “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 make two columns – one for your thoughts that make you anxious, and the other for a more balanced thought,  For example an anxious thought could be:

‘The dizzy feeling means I’m going to faint’, and the more balanced thought could be ‘I have had it many times before and have not fainted. I have fainted once and that felt really different’

Or an anxious thought could be ‘I’m going mad’, and the more balanced thought could be ‘I have not gone mad yet and my doctor tells me anxiety is not madness’

Write down some of your thoughts now and 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.

Managing worry
If you find that upsetting thoughts are going round and round in your mind, without leading to any solutions and making you feel very anxious, you may be able to use the following approaches to manage these worries.

Worry time
Keep a pen and pencil at hand, or your phone or tablet if you prefer to write things down there. Set a convenient time for yourself each day which can be ‘worry time’ where you can allow yourself 20-30 minutes quiet time for problem-solving. Throughout the day each time you are aware of your mind worrying, tell yourself you will come back to this at ‘worry time’.  Write the worry down if you find this helpful.  That way when worries come in to your head at any time of the day you can plan to think about them only in your ‘worry time’.  Once you have decided to do this your focus can shift back on to the here and now.  When you return to your worries at ‘worry time’, it may be helpful to use the following technique:

The Worry Tree
The worry tree allows you to think how to begin to manage worries.

• The first step, at the bottom of the tree, is to notice the worry
• Ask yourself “What am I worrying about?” and   “Can I do something about it?If you decide you can’t do anything about it, follow the branch to the left which tells you to let the worry go and change the focus of your attention
• If you decide you can do something about it, follow the branch to the right which tells you to make an action plan to include what you can do, when, and how you will do it.
• The next step, to the top of the tree, is to decide whether you are going to do that now or later.
• If it’s now, do it, let the worry go and change the focus of your attention
• If you decide it’s later then schedule a time, let the worry go and change the focus of your attention. 

Become more comfortable with uncertainty 
We know that worry can be triggered by feelings of uncertainty. People who worry would prefer to have 100% certainty in what they do and what will happen in the future. When they are not 100% sure of something, they are likely to worry about it, even when there is nothing to fear.  It is helpful for anxious people to try to become more comfortable with and accept uncertainty as part of life. If you are a worrier then it is most likely that you are trying to achieve 100% certainty when you worry. But as 100% certainty is not often possible you have probably noticed this is not very successful. To become more comfortable with uncertainty try and change your behaviour to act ‘as if’ you are comfortable with it. For example try to reduce your tendency to ‘over plan’. Try to be more spontaneous. Let go of control of some events and allow others to plan things for you. It’s hard at first but will help you to reduce worry.

Challenge your beliefs about the value of worry
If you are a worrier then you may struggle to let worry go because some of the following beliefs. You may need to challenge them:

• Worrying shows that I am caring
  Try to challenge this belief by reminding yourself that there are other ways of more helpfully showing you care. Think of people who are caring but do not worry.
• Worrying makes me prepared and helps to problem solve
  Remind yourself of the worry tree and begin to problem solve more effectively.
• Worrying can motivate me
  Worrying and anxiety may actually demotivate you and reduce your focus.
• Worrying prepares you for bad things happening
  You may spend a lot of time and emotion focused on things that will never happen. And in any case if a bad thing does happen, does having worried about it really make it any easier to cope with?

Finally, it can really help to limit the amount of time that you worry. It allows you to feel more in control of your worry if you put aside a small amount of ‘worry time’ each day. In worry time, say thirty minutes each evening, you focus on worries, problem solve, then put them aside. This means that that when worries come in to your head at any time of the day you can plan to think about them only in your ‘worry time’. Once you have decided to do this, your focus can shift back on to the here and now. You may have to accept a certain level of anxiety but by focusing on identifying and getting on with your goals for life this may become less troublesome in time.

Mindfulness
This is a slightly different approach to managing anxiety.  Mindfulness is a form of meditation that involves being totally in the present moment. It involves observing what is happening with a calm, non-judging awareness, allowing thoughts and feelings to come and go without getting caught up in them. The aim is to concentrate only on what is happening in the here and now, not the past and not the future. We know that worrying about the past and the future is a major problem for anxious people. Studies show that practicing mindfulness can help reduce worry and anxiety.

The following mindful breathing exercise may be useful:

• Find a quiet space where you won’t be disturbed. Sit comfortably, with your eyes closed or lowered and your back straight.
• Bring your attention to your breathing.
• Notice the natural, gentle rhythm of your breathing as you breathe in and out, and focus only on this.
• Thoughts will come into your mind, and that’s okay, because that’s just what the mind does. Just notice those thoughts, then bring your attention back to your breathing.
• You may notice sounds, physical feelings, and emotions, but again, just bring your attention back to your breathing.
• Don’t follow those thoughts or feelings, don’t judge yourself for having them, or analyse them in any way. It’s okay for the thoughts and feelings to be there. Just notice them, and let them drift on by; bringing your attention back to your breathing.
• Whenever you notice that your attention has drifted off and is becoming caught up in thoughts or feelings, simply note this has happened, and then gently bring your attention back to your breathing.
• Thoughts will enter your awareness, and your attention will follow them. No matter how many times this happens, just keep bringing your attention back to your breathing. If you are very distracted it might help to say ‘in’ and ‘out’ as you breathe.

The more you can practice this exercise the more it will help you to manage your anxiety.  At least 15-20 minutes a day is recommended.

Changing your behaviours 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 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 safer, e.g. hanging on to a shopping trolley, lying down. 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 without the safety behaviour. Relying on safety behaviours in the long term tends to make anxiety worse, so it is important to become aware and reduce them if possible.
• Try to do things to test out whether your anxious thoughts are realistic, e.g. stay in a situation a bit longer to see if you really do faint.

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. It really helps to prevent yourself from avoiding and from carrying out safety behaviours in all situations. Keep at it!

What treatment is available for anxiety?

• Most people with anxiety can benefit from self help such as this guide.
• 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. Some antidepressants can help reduce anxious symptoms. You might like to discuss this with your doctor.
• 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
• Computerised cognitive behaviour therapy – online can also be helpful and prescribed by your GP or therapist.

Where can I find help if I think I am suffering from anxiety?
First, we hope you will use the advice in this 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.

Different sorts of anxiety
This guide has tackled generalised anxiety.  There are other more specific anxieties, and also other problems to do with anxiety.

• Social anxiety – fear of being with people.
• Obsessive Compulsive Disorder – having to do things over and over.
• Panic Disorder – suffering from frequent severe anxiety attacks which come out of the blue.
• Post Traumatic Stress Disorder – high levels of anxiety following a distressing event.
• Health Anxiety – worrying specifically about your health.
• Depression – low mood and lack of energy, often comes with feelings of anxiety.
• Stress – when demands on us are just too great.

Details of guides in this series for these, and other common mental health problems, can be found in the written version of this guide.

A list of useful contacts, books and references are available in the written version of this guide.

Written by Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS healthcare staff, service users and local voluntary sector groups.