For a lot of people, to live in the time of coronavirus is to live with a sense of anxiety. A survey conducted by Women’s Health of over 2,500 readers found that of those of you who responded, 70.3 per cent reported that your mental health has deteriorated since the start of the pandemic. This, of course, has knock-on implications for other areas of your life. A study conducted by King’s College London found 50 per cent of the population struggled with sleep during the national lockdown.
But, how can you tell if your sweaty palms and rapid heartbeat are a normal response to a high phone bill or the global pandemic or the state of worldwide politics, or are actually anxiety attack symptoms? This is when understanding anxiety — what it is, the symptoms and causes — is a key part of identifying and dealing with it.
What is the difference between an anxiety attack and a panic attack?
The terms are sometimes used interchangeably, but anxiety attacks are not the same as panic attacks. The former is a longer-lasting period of worry and tension, the latter is a relatively short period of overwhelming anxiety with physical symptoms, like shortness of breath, palpitations and a sense of detachment from yourself or your surroundings.
“A panic attack is characterised by a sense of doom; an unshakable feeling that something terrible is about to happen,” says Nicky Lidbetter, chief executive of Anxiety UK. “When something stressful is sensed, neurons in our brain stem start firing more intensely than usual. A chemical called adrenaline is released from the nerve endings to act on the heart, blood vessels and respiratory centres, causing your heart to start pounding, your blood pressure to elevate and your breathing to quicken.”
While panic attacks are usually linked to panic disorder, anxiety attacks can be caused by a whole range of conditions.
What does an anxiety attack feel like?
“Anxiety is the feeling you have when you think that something unpleasant is going to happen in the future. It is something we all experience from time to time and it can be beneficial, helping you to prepare for an event and improve your performance,” says Nicky Lidbetter, CEO for Anxiety UK.
“However, anxiety can lose all proportion and become so severe and intense that it starts to restrict daily life,” Lidbetter says. This can manifest in a whole range of ways, but you may feel inclined to cancel work and social plans, generally feeling safest when cocooned under the duvet.
Lidbetter adds: “At this point, you can be said to be suffering from an anxiety disorder.” And this is what’s being referred when you hear about ‘anxiety’ in the press.
Let’s look at the stats:
- Anxiety affects around one in 20 people each year (Mind)
- 244,000+ new cases of work-related stress, depression or anxiety were diagnosed in the UK in 2015 – that’s one every 2.1 minutes (Anxiety UK)
- More women than men report common mental disorders in one week (Anxiety UK)
Like core-busting variations of the plank, anxiety disorder takes many forms.
What happens during a anxiety attack?
Symptoms of anxiety are varied and differ from person-to-person, but generally include:
- Shortness of breath
- Sweaty palms
- Constant fretting over ‘what if’
- Loss of concentration
- Overwhelming desire to avoid absolutely everything
While they may be less intense than a panic attack, rather than lasting 10 minutes, they can seem more pronounced over a short period but last days, weeks or even months.
“There are three aspects to anxiety,” says Lidbetter. “The physical, the psychological and the behavioural. To begin to control anxiety, it is useful to understand the three.”
Let’s get to the detail…
What are the physical symptoms of anxiety?
Remember that time you picked up your pace taking a late-night shortcut through the park? And you felt your pulse quicken and your chest tighten as fear kicked in? That’s the hormone adrenaline flooding your system and is a key example of the ‘fight or flight’ response.
“When you’re anxious, you end up breathing out more than you need to, which causes the levels of carbon dioxide in your blood to drop,” explains Professor Stephen Spiro, clinical adviser to the British Lung Foundation.
“The low CO2 levels make the blood more alkaline, which acts as an alarm signal for the brain,” adds Dr Sunjeev Kamboj, a pharmacology expert at University College London.
“The threat is then relayed to the amygdala, the brain’s fear centre. What follows is a chain of biochemical events that trigger the adrenal glands to release adrenaline and cortisol, the body’s stress hormone. Next, acid censors in the brain pick up the pH imbalance, which in turn activate your panic responses.”
Taken to the extreme, bad breathing can turn anxiety into a full-blown panic attack: as you start to breathe quicker, your body enters fight or flight mode.
“Your sympathetic nervous system is activated when the central nervous system detects that you feel under threat,” says Dr Kamboj.
Historically, this was used by our cave-dwelling ancestors to outrun bears, wolves and other predators. In that situation, it’s pretty vital. Less so, when your boss emails or you receive a plan-related WhatsApp notification.
“The problem is that people with anxiety have their fight or flight system ‘turned on’ when it’s not needed,” says Lidbetter. “Which can make them feel worse because they’re feeling fearful for no obvious reason.”
Cue hyperventilation and tetany, that tingly-fingered sensation which often follows. Not a state you want to be in.
Examples of the physical symptoms of anxiety:
- Shortness of breath
- Sweaty palms
- Tight chest
- Butterflies in the stomach
What are the psychological symptoms of anxiety?
It’s not just a question of how the body is feeling, but what is going on in the mind too.
“What you will find is that your thoughts are nearly always negative and follow a pattern whereby you believe that the worst is going to happen,” Lidbetter says. In short, those molehills will seem more like mountains.
Examples of the psychological symptoms of anxiety:
- Thoughts that you might die or have a heart attack
- Feelings that people are looking at you and judging your anxiety
- A desire to run away
- Feeling on edge and panicky
- A sense of detachment from your surroundings
How might you act, when you have anxiety?
“The most common behavioural symptom of anxiety is avoidance,” Lidbetter says.
But “avoidance only serves to reinforce the message of danger and is only a short-term solution, so do your best to resist the urge to flee and stay put until the anxiety subsides – which it will.”
Examples of the behavioural symptoms of anxiety:
- Only shopping when it is quiet
- Crossing the road to avoid people
- Rushing out of situations where you feel anxious
- Making excuses to avoid social occasions
What triggers an anxiety attack?
The exact causes of anxiety and panic attacks are unclear and differ from person-to-person. However, there is a tendency to for this overwhelming anxiety and fear to run in families.
It can also be triggered by an event or a challenging time, maybe a sudden change in circumstances or environment, but sometimes as a response to something that happened many years before. It can feel out of the blue, but generally there’s a reason why it arises.
Symptoms have been linked to numerous health conditions, including obsessive compulsive disorder (OCD) and trauma.
“Feelings of anxiety can often snowball quickly, so putting measures in place to “melt these snowballs” before they become unmanageable is one of the best approaches to continued mental health self-care,” Lidbetter says.
(If you are dealing with intense feelings of panic and anxiety, speak to your GP or mental health professional for advice.)
How do you calm an anxiety attack?
1/ BREATHE — SLOWLY AND STEADILY
When you’re feeling panicked, you breathe out more than you need to, which causes levels of carbon dioxide in your blood to drop. “Low CO2 levels send a signal to your brain, which activates your panic responses,” says Dr Kamboj.
Break the cycle by drawing air deep into your belly and exhaling in a short, sharp burst. Repeat until your heart rate starts to fall.
The idea, which is common in eastern health practices, was popularised in the west by Harvard cardiologist Dr Herbert Benson in the 1970s. The claim is that the movement of the diaphragm massages other organs and encourages what Benson termed ‘full oxygen exchange’.
Meaning? More oxygen enters the body as more carbon dioxide leaves it, slowing the heart rate and stabilising blood pressure – two things that, as Benson noted, are the exact opposite of an anxious response and key to reducing panic attacks.
A 2015 review of studies in the journal Applied Psychophysiology and Biofeedback concluded that slow, deep breathing techniques shift the nervous system from sympathetic to parasympathetic (rest and digest) mode.
Meanwhile, ongoing research at the University of Southampton found that 20 minutes of yogic breathing, five times a week, reduced the physical and psychological symptoms of generalised anxiety disorder in patients who hadn’t responded to common anxiety meds such as Prozac or Lyrica.
A long term practice that might help to prevent future attacks, “this is a great technique to train your brain and learn self-relaxation techniques,” says Lidbetter.
3/ SEEK PROFESSIONAL SUPPORT
“Counselling, Neuro-Linguistic Programming and Cognitive Behavioural Therapy (CBT) can all be helpful in managing anxiety symptoms,” says Lidbetter.
“CBT, in particular, is an evidence-based talking therapy treatment that is recommended by the National Institute of Clinical Excellence (NICE).”
See what you get on with. For some CBT works wonders, while for others talking therapy gets to the root of the problem. Speak to your GP for advice.
4/ DON’T BE OPPOSED TO MEDS
“Antidepressants most widely prescribed for anxiety are Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine and sertraline,” says Lidbetter. “These work by increasing the amount of serotonin in our brains; serotonin being a hormone that makes us feel good.”
People can be reluctant to seek help from medication and, while talking therapies can seem less of an undertaking, they can be a good option to help get your symptoms to a manageable level. Think of anxiety as a health issue; you would accept medication for physical conditions, so be open to them for mental ones. Ask your GP what might be best for you.
5/ TAKE REGULAR EXERCISE
“Long-term changes to your lifestyle and diet can make a difference,” says Lidbetter. “Regular exercise releases endorphins which trigger a feeling of positivity, similar to morphine; while substituting coffee for chamomile tea can help to relax your muscles and reduce irritability. Caffeine being directly linked to the production of adrenaline, which itself can then trigger panic and an anxiety attack.”
6/ EAT RIGHT
According to Dr Rupy Aujla, author of The Doctor’s Kitchen (£14.99, Harper Thorsons), the foods you eat on a daily basis play a role in your mental wellbeing. So, if you experience attacks, what you put on your plate could make a difference.
“It’s not that there’s a magic superfood that is going to reverse anxiety issues but when we put the body in the best environment, using simple lifestyle strategies such as diet, it can work wonderfully,” Dr Aujla says.
HERE ARE HIS TIPS ON WHAT TO EAT:
1/ Enjoy healthy fats. Turns out the quality fats found in foods like avocados contain special types of fatty acids that have been shown to improve behaviour and mood. They also serve to reduce inflammation. Walnuts, sunflower seeds and oily fish such as mackerel and salmon are also good sources.
2/ Fill up on fibre. Think asparagus stems, onions, leeks, chicory and garlic; these are fibre-rich veggies will look after your gut microbiome (the collection of bacteria, fungi and viruses that live in and around your body), which can have a positive impact on mental health, including anxiety.
3/ Eat the rainbow. Eating a nutrient dense and varied diet with many coloured vegetables can reduce inflammation in our bodies, as well as providing an abundance of minerals and vitamins. Opt for berries, greens, beets, broccoli and cauliflower for maximum benefit.
4/ Limit your intake of alcohol. While alcohol can be seen as a relaxant that can aid sleep, it is a well-known depressant, which can lead to depression and anxiety. Trying to cut down your alcohol intake while simultaneously balancing anxiety symptoms and low mood can be hard; always seek help from a doctor.
5/ Curb your sweet tooth. Excess sugar from soft drinks, alcohol and refined carbs can raise inflammation levels and increase anxiety risk.
Can anxiety attacks come on suddenly?
It can feel like anxiety attacks hit out of the blue, but they’re generally linked to triggers like a perceived stress or threat. Even if there is a noticeable cause, the feelings of anxiety can last for far longer than feels logical.
Can anxiety go away by itself?
It’s best to seek some sort of help for anxiety. Try the following suggestions:
TRY AN ALTERNATIVE THERAPY
“Acupuncture has been shown to alleviate symptoms of anxiety,” says Lidbetter.
“Remember you are not alone,” says Lidbetter. “At Anxiety UK, we have a message board where people can interact with others and discuss their own experience of an anxiety attack. We also offer specialist support by phone and provide a weekly blog with tips and further information.”
LOOK AFTER YOURSELF
It’s easy to get frustrated with yourself during periods of high anxiety, but it will make things worse. Acceptance and self-care are important, so try imagining it’s a friend that’s suffering rather than yourself and treat yourself as you would them.
In the long-term, symptoms of anxiety will vary. It’s not something that will ever entirely ‘go away’ as it’s a natural physiological response. The good news is that you can control your reaction to the response so, instead of viewing the feelings as negative, they will be become more manageable.
By pinpointing causes, identifying triggers, understanding your thoughts, learning about why it happens, finding ways to control it when it arises and stop attacks occurring, and overall reducing how anxious you feel will make things easier. There are many things that can help, but speaking to a GP is a good first step.