Psychologists give their perspectives on anxiety

Anxiety is a normal emotion for everyone, and lots of everyday experiences can make us feel anxious, but sometimes it can escalate and become a mental health issue. 

To explain more about anxiety, and when normal feelings become a problem, we asked BPS members Dr Jo Allen, a clinical psychologist, and Dr Neha Cattra, a counselling psychologist, for their perspectives from helping people with anxiety during their careers. 

As a psychologist, how would you describe anxiety? 

Dr Jo Allen: 

"Anxiety is a fear or threat response. Physiologically, it is adrenaline's impact on the body and part of the body's fight or flight system. It will cause one's heart rate to go up, sweating, a red face and quick, confused thoughts that go round and round.  

"Anxiety comes along when someone feels threatened. What causes anxiety can be wide ranging, but is often to do with fear of death or loss - particularly of relational loss. It is a very natural normal and important psychological and physiological process. It helps us know there is danger around.  

"However, often in our lives the fear response is more than might be necessary in any situation. This is due to previous experiences that heighten our threat response or mean it sticks around longer than is helpful.  

"How one's parents and loved ones respond in difficult situations can give us messages about how threatening a situation can be and thus how much anxiety we experience in situations. Likewise, we can learn to tolerate anxiety if we have secure relationships or attachments which support a sense of security." 

Dr Neha Cattra: 

"I would describe anxiety as a part of the human experience - it is an alarm system, it keeps us vigilant and safe. Without it we would be fearless of cars on the road, of allergens in our food and so on. In some ways it is very sophisticated - it happens quickly and sets in motion several physiological, emotional and cognitive processes to protect ourselves appropriately.   

"Unfortunately, it is unsophisticated in others - as it can both be 'easily' or needlessly triggered and by several types of threat. A well-known example is that, evolutionarily speaking, we would necessarily need to be anxious about a lion attack in the wild, whereas in the modern world, we're less likely to be in situations where this is the threat - now we need to be wary of cars on the road, and of social threat such as ostracisation. 

"Indeed, we know that social threat has an evolutionary element to it as well, as we would rely on our 'tribe' to gather resources and share safeguarding duties. The reasons for and degree to which anxiety is triggered in any given situation will depend on a lot of factors such as a person's previous experiences, emotional world and the meaning they make of the experiences they have." 

Feelings of anxiety are normal, and nearly everyone experiences them at some time in their life, when do you think they become something to worry about? 

Neha: 

"I agree that anxiety is normal, but too much of it can be difficult - anxiety is characterised by a lot of worry or a sense of dread, so I want to be cautious not to create more worry. I think anxiety can become something to worry about when it inhibits a person from doing things that they have previously derived enjoyment or other types of value from.  

"Anxiety can create a chain of 'what if?' thoughts and the fear of these can be paralysing - it makes logical sense that our minds would say 'it's best not to do that as it will only make things worse' but, in the longer term, avoidance makes worry grow. As we know, worry can at times be unfounded and feed into a 'better safe than sorry', mentality which ultimately makes our world so much smaller as we are avoiding engaging with it. 

"If a person finds themselves caught in loops of worrying and over-planning, and their lives get more and more curtailed, then I would be starting to consider whether anxiety is troubling them on a more clinical level.  

"It may be that the person themselves doesn't necessarily pick up on it themselves, but that others around them do, it would be important to gently share these concerns with your loved one if you suspect they are anxious. It may be a transient pre-occupation, or it might be a long-standing issue that is becoming compounded." 

Jo: 

"The simple answer is when it gets in the way of people living the lives they want to live. The problem with anxiety is not the anxiety itself, but the response to the anxiety. Often it makes people avoid things or gets people into patterns which limit them as a way to reduce the anxiety, but this often just means people don't get to experience the natural process of anxiety reducing in a situation.  

"People try and get rid of the anxiety, often getting angry with themselves or others. They may try to fight the anxiety. These responses can create more anxiety or other difficult emotions that feel unmanageable and mean someone feels overwhelmed." 

What are the first steps that you would recommend to someone who thinks their feelings of anxiety are becoming a problem? 

Jo: 

"Talk to someone you can trust. Talking can help someone to explore whether the anxiety is proportionate to the situation.  

"Anxiety makes people retreat and keep quiet, but this is something that can make the anxiety grow. Try not to stop doing things that make you anxious if you want to do these things, and you can rationalise that the fear response is more than the situation requires. Avoidance will increase the anxiety." 

Neha: 

"I would suggest talking to your GP, as they can refer you for some treatment within the NHS if you would like some. There are services all around England that offer this kind of help for people called NHS Talking Therapies, for anxiety and depression - as it is such a large part of mental health.  

"Remember different people need different types of treatment - from talking therapies to medication, some of which might be started by a GP." 

What kinds of help are available to people experiencing feelings of anxiety? 

Neha: 

"As above, the NHS services commissioned within primary care are there to treat people who experience these difficulties. For some people, anxiety might be part of a longer-term mental illness, and some of those people might be better served in secondary care services.  

"Secondary care services usually have a number of different professional groups working together with peoples' anxiety and depression from a range of angles, such as physical health, doing daily activities, managing medication and risk." 

Jo: 

"The good news is that therapy for anxiety can really help. Cognitive Behavioural Therapy for anxiety is supported by research. Most impressive are what we call third wave interventions. These are ones that involve exploring goals, mindfulness and compassion.  

"Mindfulness is a technique that helps people to develop skills at sitting with anxiety and ride its intensity rather than responding in ways that create more fear and anxiety. Building compassion is important to managing those thoughts and feelings that follow from anxiety. Mindfulness is training the brain and bringing awareness of the physical experiences and feelings. Building compassion is important to managing those thoughts and feelings that follow from anxiety.  

"Anxiety is often also impacted by relationships around us so often exploring the relational elements of the fear is important. My experience is that often fear orientates from attachment fears, fear of rejection or relational loss which get ignited in certain context or traumas." 

Even if it doesn't require any specific help, are there things we can all do to help us manage feelings of anxiety? 

Jo: 

"Build space in your lives for connection and self-soothing. Be curious about your anxiety rather than fearful of it, explore how it affects your body and mind, talk about these or write them down. When you notice anxiety, keep going with your daily activities but be compassionate to the challenge you face.  

"Don't try to push it away or be critical of yourself for having such a natural emotion. Talk to others about these and look for relationships which can nurture and support you. Use positive statements to support coping." 

Neha: 

"I think the first step is normalising anxiety as a typical human feeling. When we understand that anxiety makes us feel all sorts of physical sensations, we can use strategies to calm our minds down a bit so that we can think more clearly and attend to the fear if there is one. Some such strategies include using your senses to orientate yourself to your surroundings to bring your attention off your thoughts and the physical sensations.  

"Other strategies might involve using your breath to centre yourself more calmly in your body. Once we've sent messages back to the brain that things are okay, then the parts of the brain that are responsible for planning and thinking logically can take over and problem solve if there is something that is causing anxiety that needs to be deal with, or can move on to something else, if it was a false alarm." 

You can find out more about Mental Health Awareness Week, and this year's theme of anxiety, by visiting the Mental Health Foundation website.