The Anti Anxiety Hand Book

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TO SUPPORT YOUR AND HOW BENEFITS OF A
ANXIOUS CHILD? IT CAN HELP DIGITAL DETOX

ANTI-ANXIETY
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The

ANTI-ANXIETY

handbook

A s attitudes towards mental
health change and the
pressures of everyday life
increase, it’s no surprise that
more of us than ever before
are suffering from anxiety. From worries
that keep us up at night to crippling anxiety
that leaves us housebound, none of us
are immune to the stresses of life. But
when does simple stress cross over into
anxiousness? How bad do we need to feel
before we take action? In this brand-new
title, we reveal the effects that anxiety has
on your brain and your body, as well as tips
to help you manage day-to-day stresses. We
also share expert advice on taking control
of more intrusive anxiousness, including
when to see a doctor and how CBT might
change your outlook.

If you, or anyone you know, is affected by anxiety, the following
charities and helplines are ready to offer free support.

UK US Australia
Mind – www.mind.org.uk SANE Australia – www.sane.org
Anxiety and Depression Association of
Samaritans – 116 123 America – https://adaa.org Lifeline – 13 11 14

National Alliance on Mental Illness (NAMI)
– 800-950-NAMI (6264)

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not be relied on as health or personal advice. Never disregard professional advice or delay seeking it.
Always consult your pharmacist or GP for guidance and before using any natural, over-the-counter or prescription

remedies, and read any instructions carefully.
In an emergency, call the emergency services and seek professional help immediately.
Readers rely on any information at their sole risk, and The Anti-Anxiety Handbook, and its publisher, Future

Publishing Ltd, limit their liability to the fullest extent permitted by law.

The

ANTI-ANXIETY

handbook

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CONTENTS

6

CONTENTS

CONTENTS

08 46 82 98

THE SCIENCE OF ANXIETY GROUNDING TECHNIQUES TO OVERCOMING IMPOSTER WORRY EATING
The brain’s natural fear response STOP ANXIETY SYNDROME Discover how what we eat can
evolved to keep our species safe, so affect how we feel and the ways we
what happens when it goes wrong Coping mechanisms to do to stop It’s a self-inflicted feeling that holds can restore balance and combat
your mind spinning out of control you back, burns you out and saps
– your motivation – and it’s time to get anxiety
– –
14 it sorted
56 – 104
ANXIETY DISORDERS
The most common disorders PROFESSIONAL THERAPIES AND 86 EXERCISE FOR ANXIETY
associated with anxiety and TREATMENT Jogging, yoga, dancing… whatever
how they might be negatively HOW ANXIETY AFFECTS OUR exercise you choose, it can really lift
Whether to ease recurring symptoms RELATIONSHIPS
influencing our daily lives or pinpoint major underlying issues, your spirits
– Discover the different ways anxiety –
these methods can target and can impact on our personal
20 control anxiety disorders 110
– relationships and some of the ways
THE CYCLE OF ANXIETY we can manage it MEDITATION & THE BRAIN
How the ancient foundations of our 60 – Training the brain to remain in the
brain can trap us in anxiety in the present moment can ease stress,
THE TALKING THERAPY THAT WORKS 90
present Cognitive behavioural therapy is the reduce anxiety and even lower
– standard treatment for anxiety for a STOP WORRYING, START blood pressure. But how does it
SOCIALISING
26 very good reason work?
– Are you more likely to get butterflies –
FEAR EXPLAINED at a social event than be a social
The biology of being afraid & why 68 116
this primal emotion is key to your butterfly? Find out how to burst more
WORRYBOOK confidently out of your cocoon THE GREAT ESCAPE
survival How social media is fuelling anxiety – Escapism is often denounced as a
– waste of time, but are there hidden
and depression 92 benefits that are being overlooked?
34 –
SAY YES TO THE POWER OF NO! –
THE SCIENCE OF STRESS 74 Agreeing to everything may keep
What happens to your body when 118
BREAK UP WITH SOCIAL MEDIA others happy, but often at a
it’s put under pressure? Step away from the Likes, the personal cost. Here’s why sometimes HOW TO GET TO SLEEP
– intrusive algorithms and the life Anxiety and insomnia are closely
comparisons, and discover the saying no means saying yes to related. Here are some strategies to
40 benefits of disconnecting from your self-worth
– get a good night’s sleep
ANXIETY IN CHILDREN digital life –
Up to one in five children will – 94
experience anxiety during their 124
childhood. As parents it’s difficult to 76 MAKE ME TIME A MUST-DO
know when – or even if – we should Feeling frazzled? By making a small HELP!
seek professional support. Dr Sinead DEALING WITH amount of time for yourself, you’ll be How to care for loved ones suffering
Doyle answers commonly asked PROFESSIONAL ANXIETY
questions to put your mind at rest How to recognise and tackle anxiety instantly refreshed – and happier with anxiety
in the workplace and the classroom

7

INSIDE ANXIETY

THE SCIENCE OF

ANXIETY

The brain’s natural fear response evolved
to keep our species safe, so what happens

when it goes wrong?

T he word anxiety comes from the WORDS LAURA MEARS One of the first researchers to investigate
Latin ‘angere’, which literally means anxiety was Ivan Pavlov. The physiologist
‘to choke’. It describes the feeling or psychological, real or hypothetical. noticed strange behaviour in his animals after
of physical and emotional unease In times of physical danger, the changes a traumatic event. In September 1924, a storm
we experience when anticipating a the fight or flight response triggers are flooded St Petersburg. Pavlov’s dog kennels
threat. It has been critical to our success as essential. But, often in the case of anxiety, were submerged. To escape the rising water,
a species, making us feel uncomfortable in the source of the threat is less tangible. the dogs had to swim to the laboratory
the face of danger for thousands of years. on the floor above. They
When there is nothing to fight against endured terrifying sights
The purpose of anxiety is adaptation. or flee from, the physical fear reaction and sounds on their
It prepares us to fight or flee if possible, can feel very unpleasant. Side effects journey, including
or freeze in place if not. It initiates rapid include nausea, tingling, dizziness, hot
activation of the sympathetic nervous system, flushes, restlessness, trouble concentrating,
a network of nerves that reach into every irritability, and a feeling often described
corner of the body. These nerves spit out a as an unshakeable sense of dread.
chemical called noradrenaline, also known
as norepinephrine. Related to adrenaline, Anxiety disorders
this chemical initiates a wave of changes Many people experience cycles of anxious
that prepare the mind and body for physical thoughts and feelings that become so
action. The heart rate rises, the breathing intense that they start to impact their
quickens, the blood vessels in the muscles everyday lives. This is when normal human
dilate, and the mind becomes hyper alert. anxiety becomes an anxiety disorder. This
group of psychiatric conditions can be
Researchers disagree about whether acute or chronic, lasting a short amount
anxiety and fear are the same. They both of time or persisting for years. There are
alert us to danger and trigger similar many types, ranging from generalised
protective biological responses. But, while anxiety and panic attacks to phobias
the focus of fear is often external danger, the and obsessive compulsive disorder.
focus of anxiety can be anything, physical
Doctors have known about anxiety
“SIDE EFFECTS disorders for centuries. The father of
INCLUDE NAUSEA, medicine, Hippocrates, described a man
called Nicanor, who had a phobia of the flute
DIZZINESS, HOT more than 2,000 years ago. Hearing the sound
FLUSHES AND of the instrument would cause him intense
IRRITABILITY” anxiety. At the time, there was no diagnosis
and no treatment. Clinical understanding
of anxiety has improved dramatically over
the centuries, but it wasn’t until relatively
recently that the biology of fear, panic
and anxiety started to become clear.

8

INSIDE ANXIETY

9

INSIDE ANXIETY

THE ANXIETY RESPONSE A8 THE EFFECTS OF ANXIETY
3
A CORTEX 1 PALPITATIONS
B
The brain’s information-processing areas trigger 21 Adrenaline ramps up the heart rate, causing the
anxious feelings, consciously or subconsciously. heart to pound or flutter in the chest.
5
AMYGDALA 6 2 BREATHLESSNESS

The fear centre senses danger and initiates the fight 4 The muscles scream for oxygen as the body prepares to
or flight response. 7 fight or flee, causing a sensation of breathlessness.

LATERAL PERIAQUEDUCTAL GRAY 3 HOT FLUSHES

The amygdala sends signals to the lateral The blood vessels widen to deliver more oxygen to the
periaqueductal gray, which tells the muscles to muscles, making the skin feel hot.
prepare for action.
4 SWEATING
HYPOTHALAMUS
The nervous system triggers sweating in the hands,
The amygdala contacts the hypothalamus, telling it to feet, face and armpits.
switch on the sympathetic nervous system.
5 NAUSEA
PITUITARY GLAND
Blood moves away from the intestines and the
The hypothalamus sends chemical messages to the muscles slow down causing cramping and nausea.
pituitary gland, which starts pumping hormones into
the blood. 6 DIARRHOEA

ADRENAL GLANDS Contractions in the large intestine speed up to
empty the bowel.
Hormones from the pituitary gland arrive at the
adrenal glands, telling them to make the stress 7 TREMBLING
hormone cortisol.
The muscles prepare to jump into action, and become
SYMPATHETIC NERVOUS SYSTEM twitchy and overexcited.

The sympathetic nervous system releases 8 PANIC
noradrenaline, and the adrenal glands release
adrenaline, two major fight or flight chemicals. The physical symptoms feed back to the brain,
magnifying feelings of restlessness and panic.
B HEART AND LUNGS
lashing rain, crashing waves and falling
The body responds by increasing the heart rate, quickening trees. After the storm subsided, some dogs
the breathing, and diverting blood to the muscles. returned to their training as though nothing
had happened. But others became troubled
WHAT CAUSES and withdrawn. Writing about one of the
PANIC ATTACKS? dogs, Pavlov explained, “The animal was
abnormally restless and all conditioned
Panic attacks can start without warning, flooding the body with a reflexes were practically absent… the animal
wave of physical symptoms that seem to have come from nowhere. now would not touch the food”. This dog was
But these events don’t happen totally out of the blue. Researchers experiencing post-traumatic stress disorder.
All the staff could do to reassure it and restore
at Southern Methodist University have shown that signs of an its normal behaviour was to keep it company.
impending panic attack can begin up to an hour beforehand.
Monitoring people with panic disorder revealed that, in the run-up Why only some of the dogs developed
to a panic attack, blood carbon dioxide levels start to fall. Then, just anxiety after the flood is a big question in
before the panic attack begins, they suddenly rise. This makes the anxiety research. Individuals can experience
brain think that it is suffocating, triggering feelings of intense fear. the same life events and emerge with
The link between carbon dioxide and panic attacks might explain completely different psychological reactions;
why slow, deep breathing is such an effective treatment. It helps to they seem to have their own thresholds for
anxiety disorder development. It is likely that
restore the body back to its normal balance. these thresholds are influenced by genetics.

10 Genetic causes
The centre of the brain’s fear response is
a pair of walnut-sized structures called
the amygdala. This cellular junction box
communicates across the brain. It receives
inputs from the sensory system, keeping

INSIDE ANXIETY

“RECENTLY, THE
BIOLOGY OF

FEAR, PANIC AND
ANXIETY BECAME

CLEAR”

a constant watch for signs of danger. If it The amygdala (red) is
detects a problem, it sends signals to the part of the brain’s limbic
hypothalamus and the brain stem, which system and plays a key role
activate the fight or flight response. in processing emotions

One of the brain areas that sends
signals into the amygdala is a group of
cells called the raphe nuclei. These cells
send out the feel-good brain chemical
serotonin. This chemical has gained a
reputation for being the ‘happy hormone’,
but its role in anxiety is not so positive.

A group of antidepressants called selective
serotonin reuptake inhibitors (SSRIs) help
to improve mood by keeping serotonin
around in the brain for longer, but they can
also increase anxiety. Researchers at the
University of North Carolina Healthcare
wanted to understand why, so they tracked
the activity of serotonin nerves in the brains
of mice. They traced serotonin-induced
anxiety back to a group of cells that connect
the raphe nuclei to a brain area called the
‘bed nucleus of the stria terminalis’.

Sometimes known as the ‘extended
amygdala’, this brain area links the parts of
the brain that sense danger with the parts of
the brain that trigger a response. Serotonin
signals here change the messages that
reach the brain’s fight or flight switchboard,
the hypothalamus. When serotonin
levels increase, the hypothalamus flips
the parasympathetic nervous system
‘off’, and the sympathetic nervous system
‘on’. This causes anxiety to rise.

Changes to the serotonin signalling system
appear frequently in studies searching for the
genetic causes of anxiety. Researchers have
identified mutations in several serotonin-
related genes that appear to increase the
risk of anxiety disorders. These include
the genes for the receptor that detects
serotonin, the transporter that clears it away,
and the enzyme that breaks it down.

Some individuals with these genetic
changes even have visible differences inside
their brains. Scans have shown that genetic
differences in serotonin signalling can alter
the connections between the amygdala and
a part of the brain called the fusiform gyrus,
which is responsible for face detection.

Another group of brain chemicals that
play a role in anxiety are the catecholamines.
These include the fight or flight chemicals

11

INSIDE ANXIETY

adrenaline and noradrenaline (also known
as epinephrine and norepinephrine).
Nerves that make noradrenaline start in a
part of the brain called the locus coeruleus,
or ‘blue spot’, which communicates with
the amygdala. It has a powerful role to
play in vigilance and attention, and it
helps to tune incoming sensory signals.

Nerve impulses from the locus coeruleus
dial up the amygdala’s fear response. They
instruct the fear centre to send messages
to the hypothalamus that tell it to release
a chemical called corticotropin-releasing
hormone. This tells the brain’s pituitary gland
to release a hormone that prepares the body
for incoming stress. Researchers at Boston
Children’s Hospital found that blocking
corticotropin-releasing hormone makes
cautious mice fearless. They visit brightly lit
areas, walk across narrow planks, and don’t
hesitate to investigate strange new objects.

Environmental factors
Not everyone with alterations in their
genetic makeup will go on to develop
anxiety. Genetics might determine
a person’s underlying threshold for
developing a particular anxiety disorder,
but life events determine whether that
threshold will ever be breached.

Research has shown that anxiety disorders
rarely occur on their own. In fact, 60-90% of
people with anxiety also have another mental
health condition. This might be depression,
substance misuse or another type of anxiety
disorder. Sometimes one disorder directly
causes another. Other times, several disorders
have the same underlying causes, making
people likely to develop them in combination.

Treatments
The frontline treatment for those struggling
is cognitive behavioural therapy (CBT), a
talking therapy that helps people learn to
break out of cycles of negative thoughts.
It encourages people to look closely at
the connections between their thoughts,
feelings, physical sensations and actions.

According to researchers at the Norwegian
University of Science and Technology, CBT
is far more effective than medication for
treating anxiety. Drug treatments might
dampen the physical and psychological
symptoms, but the effects are often only
temporary. CBT addresses negative
thought patterns directly. In a trial that
compared the two types of treatment, 85%
of participants improved using CBT alone.

One of the challenges in treating anxiety
is the amount of time it takes for people to
come forward and ask for help. According
to a paper published in Nature Reviews, it
often takes between three and 30 years. But
research has also shown that asking for help
early can make anxiety easier to manage.

12

INSIDE ANXIETY © Getty Images; Shutterstock

DO ANIMALS
GET ANXIOUS?

The brain chemistry that triggers anxiety evolved because it is essential
for our survival. The pathways that drive our overactive fear response
are the same ones that underpin our ability to sense and respond to real
threats. We share those pathways with all other mammals, making it likely
that they are capable of experiencing anxiety too. It’s hard for scientists to
measure anxiety in animals because they can’t tell us how they’re feeling.
But their behaviour can be a giveaway. In dogs, for example, separation
from a trusted owner can trigger the same kinds of physical anxiety
symptoms seen in humans. They become agitated, their muscles tremble,
and they can be sick or lose control of their bowels. Treatment for anxiety
in animals is similar, too. It involves making them feel safe, providing
distractions during distressing situations, and seeking professional support

when it becomes too much to manage at home.

13

ANXIETY DISORDERS

ANXIETY

DISORDERS

The distinction between ‘normal’ levels
of anxiety and intrusive, detrimental
thoughts can be difficult to make. We
look at the most common disorders
associated with anxiety and try
to understand how they might be
negatively influencing our daily lives

WORDS BEN GRAFTON

F rom worrying about credit card mental health conditions and disorders.
bills, to starting a new job, or even Many of these are treatable, but there is
becoming a parent for the first often not a ‘one size fits all’ solution. For
time, anxiety inevitably affects all example, anti-anxiety medications, such
of us at some point in our lives. as selective serotonin reuptake inhibitors
The advantages of living and working in a (or SSRIs), might be a godsend for some,
24/7 inter-connected world are often offset while for others mindfulness or cognitive
by our inability to switch off from life’s behavioural therapies (which ‘retrain’ the
demands, and the physiological symptoms brain to process stressful emotions) might
are all too familiar: a racing pulse, clammy be far more effective.
palms, and that constricting or crushing
sensation in our chest. Anxiety can be If you are struggling with anxiety it is
easy to dismiss as we fail to recognise the therefore important to seek expert advice,
unhelpful thought patterns that precede it. whether from your GP or a qualified mental
While feelings of worry are part of being health professional, to get to the root cause
human, one in six adults regularly struggle and find a treatment that works best for you,
with common mental health problems, so that you can keep on living your best life.
such as anxiety or depression, which
impact negatively on their daily life. This “IF YOU’RE
leads to avoidant behaviours, problems
such as sleep difficulties and potentially STRUGGLING
impacts on both professional and personal
relationships. If you recognise that anxiety WITH ANXIETY IT IS
is negatively influencing your life, you
might be living with an anxiety disorder. IMPORTANT TO SEEK
It is important to recognise that anxiety
disorders can go hand-in-hand with other EXPERT ADVICE”

14

ANXIETY DISORDERS

15

ANXIETY DISORDERS

GENERALISED SOCIAL ANXIETY
ANXIETY
DISORDER More than extreme shyness
(GAD)
The Covid-19 pandemic has been difficult for many, in particular due to
The ‘catch-all’ condition the level of social isolation felt during the numerous lockdowns. As we
enter the ‘recovery’ phase, many of us are re-adjusting to normal social
By far the most common anxiety
disorder is generalised anxiety interchange, of which we have been deprived for so long.
disorder (GAD). Affecting up to For some, however, this recovery may be more challenging, in particular
5% of the UK population, it is for those who struggle with social anxiety. What once might easily have
characterised by persistent and been dismissed as extreme shyness, social anxiety frequently manifests
pervasive feelings of anxiety
about a range of subjects, often as the fear of being judged, either by one’s peers or by complete
based on unrealistic or extreme strangers. Crippling symptoms of anxiety can prohibit, for example,
‘worst-case’ outcomes. Common public speaking, or natural communication during a romantic date.
symptoms include restlessness,
insomnia and heart palpitations. Everyday tasks,
If you’ve got GAD you might not such as a visit to
be able to remember the last
time you did not feel anxious. the post office,
Reasons for this vary, and might can provoke
be attributed to anything from physiological
an imbalance of brain chemicals, symptoms such
as blushing,
genetics, or as a result of sweating or
previous life experiences. trembling,
For a typical GAD sufferer, while making
mundane things like long- eye contact is
distance road trips can trigger also difficult.
fears of a fatal road accident, While we are
while social occasions might yet to fully
cause premonitions of complete comprehend
social embarrassment and scorn. the medium
In short, no subject is off the and long-term
table when it comes to creating effects of
the Covid-19
unnecessary worry. pandemic
on adults
“BASED ON and children,
UNREALISTIC OR social anxiety
EXTREME ‘WORST-
CASE’ OUTCOMES” classically starts
during teenage
16 years, and can
have long-lasting

effects into
adulthood, when
sufferers avoid
attending certain
social settings and
even suffer from
panic attacks.

ANXIETY DISORDERS

POST-TRAUMATIC STRESS
DISORDER (PTSD)

The fallout from trauma

Post-traumatic stress disorder war, victims of violence and sexual anxiety, including panic attacks, and
(PTSD) is an anxiety disorder that assault, traumatic accidents and the diagnosis is usually made where
is triggered by a traumatic event, grief can experience PTSD, and it is these symptoms persist for over a
either experienced or witnessed. It recognised that first responders and
was first recognised in soldiers during members of the emergency services month. Sufferers may experience
World War I, who presented with feelings of persistent irritability and
post-traumatic symptoms labelled as are also at risk. hyperarousal, and may demonstrate
‘shell shock’. As well as survivors of Symptoms of PTSD include behaviours which seek to avoid the
flashbacks, nightmares and severe
trigger or other stressful settings.

17

ANXIETY DISORDERS

AGORAPHOBIA PHOBIAS

No way out Sweating the small stuff

In ancient Greece, the ‘Agora’ was a public area intended for meetings Who hasn’t experienced a phobia
or gatherings, which is why agoraphobia is commonly believed to be the of some description? From the
fear of crowded spaces. However, more accurately, this anxiety disorder house spider that climbs up your
is characterised by a fear of being unable to escape, meaning that it can bed in the middle of the night,
manifest anywhere from public transport to shops or simply leaving the to the waiting room jitters at the
comfort of your own home – something we can all relate to after the last dentist? Those suffering from
acute phobias might experience
two years. dizziness, nausea, trembling,
Sufferers of agoraphobia experience anxiety and panic attacks which and heart palpitations, making
are triggered by certain situations. It is the avoidance of these situations
that can eventually lead to more extreme forms, in which a person feels what might seem a trivial fear far
uncomfortable leaving their home. This can impact severely on a person’s more unnerving. While the fear
life, including their professional and financial situation, and for some, is often exaggerated, the impact
is real, and in some cases can be
working from home is the only option. debilitating and cause misery to a
If you think you might be experiencing symptoms and the thought of
visiting your GP to discuss treatment options feels too difficult, help can person’s life.
Phobias might begin after a
be sought over the phone or online. traumatic event, and can be wide-
ranging. They commonly include
PANIC DISORDER fear of animals, environmental
factors such as heights, certain
Fear of fear itself situations such as flying, or even
bodily phobias, such as the fear of
Most people will experience a panic attack in their lifetime. This is blood. However, what the medical
defined by a short time period in which an overwhelming surge of anxiety profession refers to as ‘simple
is triggered, accompanied by symptoms such as a racing heartbeat, chest phobias’ can also be superseded
pain, trembling limbs and difficulty catching your breath. For many this is by ‘complex phobias’, such as
social phobia or agoraphobia.
likely to be an infrequent or one-off event. Depending on the type of phobia
Panic disorder, however, is defined as having frequent panic attacks you have and how often you come
which are not attributed to a particular cause or trigger. It often leads into contact with it, the impact on
to a fear of panic attacks themselves, and a vicious cycle of anxiety and daily life and subsequent need for
treatment can vary greatly.
worry. The causes can include biological or psychological factors.
Panic attacks can be alarming but they are not in themselves dangerous.
However, they can evolve, to include, for example, agoraphobia, and can
wreak havoc with a person’s sense of wellbeing. It is therefore important

to seek treatment if you think you might be affected.

18

ANXIETY DISORDERS “TICS ARE MOST © Getty Images
COMMONLY SEEN
OBSESSIVE-COMPULSIVE IN CHILDREN AND
DISORDER AND TOURETTE’S YOUNG PEOPLE”

SYNDROME 19

Commonly associated with anxiety

Obsessive-compulsive disorder (OCD) is closely associated
with anxiety. It is a common disorder in which a person has
uncontrollable, intruding recurring thoughts (obsessions) and/
or repetitive behaviours (compulsions) that, when enacted,
alleviate anxiety. Typically this might present as a fear of
germs, leading to excessive cleaning and hand washing, or an
obsession with order, leading to continuously rearranging or
organising objects, for example. It is recognised that certain
personality types, who prefer neatness and order, may have

a propensity to develop this condition.
Tic disorders (known as ‘Tourette’s syndrome’ where tics
have been present for over a year) also have a strong
association with anxiety. Tics are defined as sudden
involuntary movements or vocalisations which are

repetitive and unwanted. They can be defined as
‘motor’ tics, such as facial twitching, eye blinking or
head or limb jerking, or as ‘vocal’ tics, which might
include repetitive throat clearing, grunting or calling out.
Sufferers of tics often describe a strong need to carry out
the movement or noise before it happens, and a strong
sense of relief once it is done. Tics are most commonly
seen in children and young people, and for most, disappear
by adulthood. While for many sufferers treatment is not
needed, you should seek help if they are impacting significantly

on your daily life.

EXPERT ADVICE

It is important to remember that anxiety overlaps with a host
of other mental health and neurodevelopmental conditions,
including depression and low mood, eating disorders, autism

and ADHD (attention deficit hyperactivity disorder). It is
therefore important to seek appropriate professional support

if you are concerned.

THE CYCLE OF ANXIETY

THE

C Y C L E OF
ANXIETY

How the ancient foundations
of our brain can trap us
in anxiety in the present

20

THE CYCLE OF ANXIETY

Pity our poor brains. They evolved WORDS EDOARDO ALBERT “ANY ACTION,
to deal with the challenges facing NO MATTER HOW
small bands of nomads in Africa. uncomfortable itch of uncertainty pushed us UNWISE, CAN MAKE
As nomads, we had to venture into out of the cave to find out if that scratching YOU FEEL BETTER BY
unknown territories, climb over noise was a bear or just a tree branch REDUCING ANXIETY
hills that no one had ever climbed before, scraping against a rock. It’s this urge to action
swim across new rivers and venture into produced by overwhelming uncertainty LEVELS”
strange forests. Whenever we went into that explains the doomed teenager going
new, unfamiliar territory, our brains put back into the haunted house in a horror
themselves on high alert, drinking in all the film: sometimes uncertainty is so unsettling
information they could gather. that any action, no matter how unwise, can
Entering alien lands, we were alive and actually make us feel better by reducing
alert, every sense stretching out, our minds anxiety levels.
picking up every cue. Was that the rustle of
the wind through the grass or the stealthy
movement of a lion, stalking us? Senses
now on even higher alert, our ancestors
spread out, signalling from one to the other
as they moved around that thick clump of
rustling grass, looking, looking…
It was just the wind. Even across the
gulf of millennia we know exactly how
our ancestors would have felt when they
discovered there was nothing bad hiding
behind the clump of grass: the sheer
relief, the deep breaths, the stretching up
and out. Smiles, laughs, maybe some
ribaldry directed at the person who first
called out, “Lion!”
That we know exactly how people who
lived so long ago would have felt at this
moment shows the deep, deep roots that
feed anxiety, for our brains evolved to deal
with the uncertainty of confronting new
situations. Moving into new territories,
our brains went on full alert, searching for
anything that might prove dangerous to
us or our tribe. But as we became familiar
with the new territory, learning its geography
and assessing it as safe, then our brains
slowly relaxed. We became confident, secure.
We could let the children play without
having to keep them constantly in sight.
We could relax.
Relaxation comes with the removal of
uncertainty. As we became confident in
a new territory, the uncertainty lessened
until we felt secure… only for the herds to
move on and the whole cycle of uncertainty
and anxiety to begin again.
No one is saying that our ancestors had
it easy. Few of us today have to face the
prospect of being attacked by a lion or an
angry hippo. But our ancestors had one great
advantage when it comes to anxiety: their
worries were definite. It did not take long
to see whether or not there was a leopard
hiding up that tree. Our uncertainties are
less defined and longer lasting. This is where
the roots of anxiety lie.
Mental uncertainty provokes action.
From an evolutionary point of view, the

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THE CYCLE OF ANXIETY

THE CYCLE OF ANXIETY

ANXIETY AVOIDANCE

Fear is natural. It is our quickest and When our brain is telling us to do something
deepest way to learn. But when fear to reduce the feelings of anxiety, we might
is matched by uncertainty, it produces sometimes decide to avoid what needs to
feelings of anxiety, as our brain desperately
signals to us that it needs more information. be done. Physically avoiding an anxiety-
It is telling us to do something. The feelings producing situation, such as calling in
that accompany anxiety – sweating, heart
beating fast, jitters – are its way of telling sick rather than giving a talk, successfully
us that it is fearful but that it does not removes the feelings. Or if we are feeling
nervous about talking to new people at
know what is going on. a party, a few drinks might enable us to
overcome those feelings. We are on the

way towards developing a habit.

ANXIETY

LONG-TERM AVOIDANCE
ANXIETY
GROWTH ANXIETY
CYCLE

SHORT-TERM RELIEF
FROM ANXIETY

LONG-TERM ANXIETY GROWTH SHORT-TERM RELIEF

By developing behaviours that avoid FROM ANXIETY
our anxieties rather than facing and
understanding the reason for these Having skipped the talk, we feel better.
feelings, we increase our own sensitivity After a few drinks, we find our nervousness
to feelings of anxiety. This makes it
more likely we will resort to avoidance gone. Watching YouTube rather than
behaviour, embedding the pattern in our writing that essay. All these behaviours –
brains and in our lives. It can be very physical avoidance, alcohol, procrastination
– reduce or remove the immediate feelings
difficult to break this cycle. of anxiety. We have done something, as
requested by our brain. But next time, we’ll
be more likely to use the same behaviours

again, rather than facing our fears.

22

THE CYCLE OF ANXIETY

“AVOIDANCE
BRINGS IMMEDIATE,
SHORT-TERM RELIEF

FROM ANXIETY”

Anxiety and stress compel us to do to overcome anxiety and the behaviours we to do. This brings immediate, short-term relief
something… anything. devise to defuse or avoid anxiety. from anxiety. It makes us feel better.

The driver to these overwhelming feelings This is how the cycle of anxiety works. We Unfortunately, this is also stored away in
is the deepest, oldest part of our brains. are faced with uncertainty, with a situation or our deep memory, the memory we share
We share these ancient systems with other problem that causes stress. But because we with sea slugs, so that next time we face
animals because fear is the oldest driver of live modern lives, this uncertainty is not going similar feelings of anxiety (sweaty palms,
behaviour there is. You are exploring a cave. to be a roar in the night. It’s going to be giving butterflies, shortness of breath) our brains
It’s dark, quiet. Then something leaps out of a presentation in front of your managers at will present to us the same method of dealing
the dark at you, roaring. work. It’s going to be asking someone you like with these very unpleasant feelings: avoid
out on a date. It could also be something like them. If we do the same thing again the next
Standing, panting, outside the cave, you the fear of catching Covid-19 or the political time we face feelings of anxiety, then the
won’t need to be reminded that this cave situation in the world. memory becomes deeper and avoidance is
is the home of a rather grumpy bear. Nor set on a track towards becoming a habit.
will you ever again enter a dark cave Our old brains, faced with uncertainty, fill
without first checking that it’s not home to us with the need to do something to make Of course, there are times when avoidance
something nasty. Negative reinforcement these feelings go away. We could prepare the is the right action. For instance, imagine
is the oldest, most fundamental sort of talk. We could screw up our courage and ask you are trying to cross a very busy road,
learning. The sea slug, with its 20,000 the person on a date. But there are situations and thinking of whether to make a run for it
neurons compared to a hundred billion for that cause uncertainty over which we have during a break in the traffic. But then you see
humans, learns these sorts of lessons the no control – there is nothing that we can do. that there is a pedestrian bridge further up
same way we do. the road, so you cross there. Here, avoidance
The feelings grow until we think, maybe I’ll makes perfect sense.
Unfortunately, this deep and unconscious call in sick. Someone else can do the talk. Or
way of learning is the driver that can put us I decide that person doesn’t like me after all, The cycle of anxiety can be further
onto the treadmill of the cycle of anxiety. so I won’t ask them for a date. In these cases, deepened because so many anxieties we face
Because negative reinforcement evolved by doing something we suddenly reduce the today are beyond our control. The Covid-19
before the conscious parts of our brains, it is anxiety we were under before, but we have pandemic was one example and now we are
hard to use our conscious mental faculties done this by avoiding doing what we wanted moving into very uncertain political times

23

THE CYCLE OF ANXIETY

where the threat of war is escalating. These person never really liked you makes it harder Unfortunately, that solution is avoidance.
things naturally produce anxious feelings to believe that anyone would. While avoidance brings a short-term
within us, but with situations like this there reduction in anxiety, each time we avoid
is nothing we can do. We can’t turn back However, the worst thing about reducing uncertainty and its accompanying feelings,
a pandemic or make the world peaceful. anxiety through avoidance is that it causes we are building a bigger wall of habit.
a long-term growth in anxiety. It means that
When faced with these uncertainties, the next time an uncertain situation or problem As the habit of reducing anxiety by
brain might deal with the feelings of anxiety causes feelings of anxiety to spike, it will be avoidance becomes more ingrained, our
by avoiding them through distraction: watch harder to deal with these feelings head on anxiety levels actually increase each time
some cat videos on YouTube, do some because they will have become more intense. we are faced with uncertainty. It’s that old
gardening, drink. All of these might serve to That old part of your brain has learned that lizard brain pushing us to do something
reduce anxiety but they also serve to groove by increasing the uncomfortable feelings – anything. As the pattern becomes deeper,
the avoidance channel more deeply into our that accompany anxiety, it can force you it can cause feelings of anxiety to spike
repertoire of behaviours. into a solution more quickly. Remember, the even when there is no apparent cause.
feelings accompanying anxiety exist to make This can lead to people waking up in the
While avoidance reduces feelings of us do something: that old lizard brain doesn’t middle of the night even when, so far as
anxiety in the short term, it carries penalties. care what we do, so long as it makes the they know, they have nothing to worry
Avoiding the talk means someone else gets feelings go away. about. But the mere fact they have woken
a pay rise. Convincing yourself that that

24

THE CYCLE OF ANXIETY

“ANXIETY CAN MAKE SPREADING FEAR
PEOPLE WAKE UP IN
THE NIGHT FOR NO Anxiety is not just personal, it’s social too
APPARENT REASON”
Anxiety can spread. We are fundamentally social creatures and when we
see people around us exhibiting signs of anxiety, then we are probably
going to start feeling anxious too. This is called social contagion and it
makes perfect sense in our evolutionary past. Seeing another member of
the tribe suddenly standing tall, shielding his eyes against the sun while
scanning the tall grass would immediately alert us to possible danger.
Our survival brain kicks in: get more information.

Social anxiety even affects high finance: the Volatility Index on Wall Street
is colloquially known as ‘the fear index’. With anxiety triggers being
provided by the people around us or the wider culture, it can be very

difficult to counteract the feelings of fear/anxiety by any rational response
to what is going on. For instance, in the early months of the Covid-19

pandemic, when no one knew how dangerous the disease was nor how it
spread, the uncertainty was real and impossible to relieve by finding out
actual information. No one knew the answers. In these circumstances, it
is easy for anxiety to spiral out of control, leading to panic. Think of the
supermarkets stripped bare of toilet paper, pasta and rice. This was anxiety
amplified by social contagion into widespread panic buying. The cycle of
anxiety is not just personal, it can spread to take in much of society too.

So, uncertainty and fear over Covid-19 translated into the avoidance
behaviour of buying stockpiles of toilet paper. However much toilet paper

someone bought, it would not stop them catching the virus, but by
doing something it reduced the overwhelming feelings of anxiety.

means that surely there must be something
to worry about, so the cycle gets deeper.
For some people, the act of worrying – and
worrying is a behaviour – becomes the
avoidance mechanism by which they
reduce feelings of anxiety. After all, worrying
seems like you’re doing something and that
allows the lizard brain to ramp down the
feelings of anxiety.

The cycle of anxiety is the result of
different parts of our brains each trying to
solve problems in the ways they know best.
That is what makes it so difficult to break
once the cycle has been established. But,
thankfully, there are now some excellent
therapies and mental tools to help break the
cycle of anxiety.

25

THE SCIENCE OF FEAR

FEAR

EXPLAINED

The biology of being
afraid & why this primal

emotion is key to your
survival

WORDS JACKIE SNOWDEN

Home alone at night, you hear a
loud crash. In an instant your
heart starts racing, your muscles
tense and your breath quickens.
You are immediately alert, primed
to fight or flee the source of the sound, which
turns out to be a pile of books falling off that
shelf you’ve been meaning to fix. But in that
moment, your brain and body reacted as if
you were in mortal danger.
Fear is one of our strongest and most
primal emotions. It’s a big bad world out
there, and being afraid of certain things
protects us from potential danger to make
sure we survive. Some evolutionary fears
are hard-wired into our brains, but we can
also develop new fears throughout our lives.
As children we pick up on what makes our
parents anxious, and we may also learn to
fear certain things after negative experiences.
Despite this, most of us are able to ignore
our fears when it’s clear we aren’t in any

26

THE SCIENCE OF FEAR

immediate danger. We can enjoy the view somebody may develop
from the top of a skyscraper rather than cynophobia – the fear
worry about falling, or turn out the lights of dogs – after being
safe in the knowledge that a predator won’t bitten. But whether
devour us in the night. the trigger is rational
or irrational, as soon
However, people with phobias have an as the brain registers
excessive fear response that causes both a scary stimulus, it
physical and psychological distress. These activates the fight-
extreme fears are divided into three different or-flight response,
groups: agoraphobia, social phobia and thus preparing the
specific phobias. Agoraphobia is generally body for action.
referred to as the fear of open spaces, but it
applies to the dread of any situation that is “EVEN TODAY, THE MAJORITY
difficult to escape from, or where help would OF AFRICAN LION ATTACKS
not be available if something went wrong. ON HUMANS OCCUR
Social phobia is the intense fear of interacting AFTER DARK”
with people or performing, while specific
phobias are the fear of a particular situation,
activity or thing.

These irrational fears can cause major
disruptions to everyday life; somebody with
acrophobia – an extreme fear of heights –
may experience a panic attack simply trying
to walk across a bridge. Depending on the
trigger of their phobia, sufferers often go to
great lengths to avoid situations that could
affect them.

The cause of phobias is not always clear,
but many cases are linked to experiencing or
witnessing a traumatic event. For example,

NATURAL FEARS

Some of our fears have developed as an evolutionary response to danger

DARKNESS HEIGHTS POISONOUS CREATURES

Sight is arguably our most A fear of heights is necessary to our While we may not be terrified
important sense. When we are survival, ensuring we are cautious of them from birth, evidence
faced with pitch-darkness we are in situations where we might injure suggests that we are predisposed
left vulnerable, unaware of what ourselves. To study this, researchers to detect and recognise spiders
is around us. At night, our early set up a platform surrounded by and snakes quicker than non-
ancestors were at risk of being a transparent material, giving the threatening animals. One theory is
attacked by nocturnal predators. that our early mammal ancestors,
A study from 2011 found that even illusion of a cliff, and put young evolving in a world dominated by
today, the majority of African lion children on the platform to test reptiles, needed to identify and
attacks on humans occur after their reaction. They found that react to snakes to avoid becoming
dark, and are more likely when most infants didn’t try to move onto dinner. Another hypothesis is
the Moon is below the horizon. the transparent section, suggesting that our ancestors evolving in
Although being hunted while we that they inherently avoided risking Africa coexisted with a number of
sleep isn’t a risk for most of us, a drop. As our ancestors explored poisonous spider species for millions
we are instinctively more anxious the world, this fear ensured they of years, so being able to spot and
avoid them was a vital skill.
when unable to see. were wary of climbing to
dangerous heights.

27

THE SCIENCE OF FEAR

FIGHT OR FLIGHT

UHow your brain and body trigger this evolutionary survival instinct
nder normal circumstances, the thalamus also sends the raw sensory Not many of us experience life-threatening
sensory information from your information via a shortcut, directly to the situations day-to-day, so more often than not
body is sent to the thalamus in amygdala. As soon as the amygdala is our fight-or-flight response is triggered by a
the brain. The thalamus relays alerted, it signals the hypothalamus. This false alarm. The moment of panic that you
feel after hearing a loud bang, for example,
these signals to the cortex and part of the brain activates systems that is because neural signals from the shortcut
reach the amygdala first. The fight-or-flight
the hippocampus for further processing, release around 30 different hormones into response automatically kicks in before
the brain evaluates the situation, just in
to provide a better understanding of what the bloodstream. One hormone in particular, case. Once the amygdala receives more
information and concludes that you are not
you’re experiencing and put it into context. adrenaline, causes a variety of physiological in danger, it signals the thalamus to stop the
fight-or-flight reaction, returning your body
This analysis is forwarded to the amygdala, reactions all around the body. In the lungs it to normal.

which triggers an appropriate emotional makes smooth muscle cells relax, expanding The human brain is an inredible organ,
and one that is hard-wired to prepare for
reaction to the situation. the air passages so more oxygen can reach the worst; it might seem silly to treat every
loud noise as a danger, but if the threat turns
When your brain receives signals that the blood. It also stimulates cardiac cells so out to be real, this overreaction could save
your life.
indicate some kind of danger, the course the heart beats faster, and makes muscles

of action is slightly different. The process in the eyes contract to dilate the pupils.

above still occurs, but this higher-level The physical changes produced by this

analysis takes precious time. The fraction sudden flood of hormones make up what is

of a second it takes to fully understand known as the fight-or-flight response. This

what’s happening might be the difference instinctive reaction gets you ready to either

between life and death. To make sure your take a stand and defend yourself, or escape

body is instantly prepared to face a threat, to safety.

FEAR ON THE BRAIN

What happens when the brain goes into survival mode?

THALAMUS 3 SENSORY CORTEX
The thalamus is the first port Specific regions of the brain analyse
of call for most sensory signals 1
from the body. It relays this 4 the sensory information from each
information to the relevant areas of our different senses. They process
of the brain, like a switchboard. 2
5 the signals passed on from the
HYPOTHALAMUS thalamus to give them meaning.
The hypothalamus’s primary role is
to maintain homeostasis – keeping HIPPOCAMPUS
the body in a stable condition. It The hippocampus plays an
also regulates the secretion of important role in long-term
hormones and initiates the memory formation. It compares
fight-or-flight response. incoming sensory information to
past events to help establish a
AMYGDALA context for the situation you face.
The amygdala processes our emotional
reactions and plays a role in decision-
making and the formation of memories.
It moderates our responses to events
that affect our survival.

1 STIMULUS 2 ACT FIRST 3 ANALYSIS 4 FIGHT OR FLIGHT? 5 JUDGEMENT

When a potential threat The first pathway The same information The hypothalamus Once the situation has
is detected, the thalamus immediately assumes is sent along the more activates both the been analysed by the
sends signals to the there’s danger even if there investigative route. sympathetic nervous longer pathway, the
amygdala via two different is none – a safer option Signals from the thalamus system and the adrenal- hippocampus sends
pathways. One route is than vice versa. It goes are sent to the sensory cortical system to trigger signals to the amygdala
fast and direct, while the directly to the amygdala, cortex, which interprets the fight-or-flight reaction. to either seize the fight-
slower path analyses the which sends signals to the the data, followed by the The impulses and hormones or-flight response if
situation and decides what hypothalamus to initiate hippocampus, to analyse produced prepare the body there is no danger, or to
should happen next. the fight-or-flight response. the context of the situation. for action. maintain it if there is.

28

THE SCIENCE OF FEAR

ANATOMY OF FEAR HORMONES

The extreme reactions that occur when The activated sympathetic nervous system
your body is put on high alert and adrenal-cortical system release
dozens of hormones into the bloodstream
WIDE-EYED
to cause changes in the body.
The pupils dilate to let in more light,
so you can take in more of your ENERGY BOOST
surroundings and identify the threat.
Your liver starts breaking
GOOSEBUMPS down glycogen into glucose,
ready to supply the body
As your muscles tense up,
the small hairs on your skin with instant energy.
are forced upright. This
evolutionary reflex probably COLD SWEAT
helped our hairier ancestors
look bigger and scarier. Your body anticipates
immediate action, so you
RESPIRATION pre-emptively start to sweat
INCREASES in order to keep cool.

Faster breathing sends more HEART RATE INCREASES
oxygen to your muscles to
prepare them for action. The hormones adrenaline and
noradrenaline are released to increase
BLOOD your heart rate, sending more blood to
RUNS COLD your muscles and brain.

The vessels in your BUTTERFLIES
skin constrict to help divert
more blood to your muscles and Blood flow is diverted away from
reduce blood loss from potential non-essential systems such as
injury. This makes you feel cold. digestion. This causes the nervous
‘butterflies in your stomach’ feeling.
SHAKING MUSCLES
WHY DO WE SCREAM?
More blood is pumped to the muscles so
you can defend yourself or make a quick Screaming is an innate reflex; it’s usually the first thing
getaway. This can make your limbs feel you do when you’re born. Although we might also
tense and twitchy.
scream from excitement or pleasure, it is most often
“THE TIME IT TAKES a cry of distress. Researchers from New York University
TO UNDERSTAND conducted an experiment using brain scans to see how our
WHAT’S minds react to screams. When we listen to normal speech,
HAPPENING what we hear is sent to the auditory cortex for processing so
MIGHT BE THE
DIFFERENCE we can make sense of the sounds.
BETWEEN LIFE However, the study showed that when we hear a scream, the
AND DEATH” signals are sent straight to the amygdala to activate the brain’s
fear response. The team also found that ‘rougher’ screams

– those that change volume more quickly – were the most
distressing. The results show that screams are a very effective
method of communication in humans. They not only help convey
danger, but also help make those who hear them more alert.

29

THE SCIENCE OF FEAR

ARE FEARS GENETIC?

Your phobias could be passed down through generations in DNA

It was previously assumed that all their children and even their grandchildren. It is not clear exactly how the conditioned
irrational fears are learned through The mice were conditioned to fear the fear is passed on to future generations
personal experience or taught to us by scent of acetophenone – a sweet-smelling of mice, but the current theory is that it
others. In cases where a person develops chemical. Researchers found that the pups, is down to something called epigenetic
inheritance. The original conditioning
a phobia related to a traumatic event and even the grand-pups, of the conditioned process leads to chemical modifications
that change gene expression (which genes
in their past, this is most likely the case. If mice were startled by the scent too. are switched on or off), without changing
the DNA sequence itself. The researchers
somebody nearly drowns while swimming One explanation for this could be that found that the conditioned mice and their
offspring developed more scent receptors in
in the sea, for instance, it wouldn’t be parent mice communicate with their pups their brains compared to non-conditioned
mice. With more of these receptors, they can
surprising if they develop aquaphobia, the to effectively teach them what to fear. detect the presence of acetophenone at
lower concentrations and so are alerted to
fear of water. The brain makes a connection Studies have found that when mice are it more easily.

between the situation and the feeling of scared, they release pheromones that act Epigenetics is a relatively new area of
research, but it stands to reason that fears
pain and panic, and commits it to memory. as an alarm signal to other mice. However, and other memories may well be inherited
this way in humans too.
However, it is now thought that in the acetophenone experiment, the pups

some phobias have a genetic origin. proved to be sensitive to the scent from the

Identical twins are more likely to share the very first time they encountered it. What’s

same irrational fears than non-identical more, some pups of conditioned mice were

twins, even if they are raised apart from fostered by non-conditioned mice. The non-

one another. conditioned foster parents were not afraid of

Experiments with mice have shown that the scent, but the pups were, suggesting the

fears they develop can be passed down to fear’s origin was genetic rather than social.

INHERITING FEARS “IDENTICAL TWINS
OFTEN SHARE THE SAME
A study with lab mice suggests that fear is a family affair
IRRATIONAL FEARS”
1

GENETIC CHANGE SHOCK SCENT NON-CONDITIONED MOUSE
The foster parent has not been taught
The conditioning Every time the The mouse is
caused a small scent is released, exposed to to fear the smell of acetophenone.
change in the parent the mouse is the scent of
mouse’s DNA, which given a mild acetophenone, 2
was inherited by electric shock. a chemical
the pups. that smells like
FEAR CONDITIONING cherry blossom.

2 The mouse learns to associate the
smell of acetophenone with pain, and
becomes startled by the scent alone.

PUPS

The conditioned mouse has pups, some
of which are given to non-conditioned

foster parents to be raised.

FUTURE GENERATIONS FOSTER PARENT 3
The foster mouse doesn’t react to
The study found that 3 the scent, so it is unlikely the pups’
a second generation fear was passed on socially.
of pups were also
more sensitive SCARED PUPS
to acetophenone. Both sets of pups are
startled by the scent of
acetophenone, despite never
encountering it before.

30

THE SCIENCE OF FEAR

LIVING FEARLESSLY

Self-help gurus and motivational posters encourage us to be fearless, but in
reality a life without fear would be incredibly dangerous. Studies have shown
that when the region of the brain called the amygdala is damaged, people are
more likely to take risks. Severe damage can even leave people with no sense

of fear whatsoever – which can land them in some pretty scary situations!
For the past 25 years, scientists have been studying a patient (known as SM
for anonymity) who lacks an amygdala. SM has experienced many traumatic
events in her life – she has been held at both knife and gun-point, and was
nearly killed during a domestic violence attack – but she did not react with any

sense of desperation or urgency, even though her life was in danger.
Researchers took SM to an exotic pet store where, despite claiming she hated

them, the snakes and spiders captivated her. Scientists noted her curiosity
and compulsive desire to touch some of the more dangerous creatures,

following repeated warnings from staff. The researchers concluded that SM’s
inability to detect or react appropriately to threats likely contributed to her

disproportionate number of traumatic experiences.
By studying patients like SM, it is hoped that scientists can understand more

about fear, and discover new methods of helping people whose lives are
plagued by it. For example, treatments that target the amygdala could benefit

those who suffer from post-traumatic stress disorder.

SCARED TO DEATH

It’s not just a figure of speech – it turns out you really can die of fright. The adrenaline released
during the fight-or-flight response can be damaging in large amounts. This stress hormone
encourages the heart muscle to contract, but if your body releases too much adrenaline,
your heart is unable to relax again. Adrenaline can also interfere with the cells that
regulate your heart rhythm, causing it to beat abnormally, which could be lethal.
While not directly deadly, prolonged anxiety can have a significant negative impact
on your health. The fight-or-flight response suppresses the immune system, leaving
you vulnerable to illness. Going into survival mode on a regular basis can lead to
digestive disorders as this non-essential system is repressed. Long-term stress can
also lead to weight issues by disrupting the metabolism; elevated levels of cortisol
can make the body less sensitive to insulin. Muscles that are constantly tense
and ready for action can cause headaches, stiffness and neck pain. The list
doesn’t end there; chronic anxiety has also been linked to cardiovascular
problems, asthma and insomnia. Such a broad range of effects can be
harmful to both physical and mental wellbeing.

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THE SCIENCE OF FEAR

© Getty Images, Alamy, Dreamstime, Pixabay FACING YOUR FEARS PHOBIA

Can you retrain your brain to overcome a phobia? TREATMENTS

Some phobia triggers are much easier to avoid than EXPOSURE THERAPY
others. For example, people who suffer from a fear of bats
(chiroptophobia) are highly unlikely to be plagued by these The aim of exposure therapy is to gradually
creatures day in, day out. Someone suffering from a social desensitise the patient to the source of their

phobia, however, will struggle to lead a normal life. phobia. The patient ranks situations from
There are a variety of different methods used to treat phobias. least to most terrifying. For example, an
arachnophobe might place thinking about a
Among the most popular are talking treatments, such as spider at the bottom of their list, and having
cognitive behavioural therapy and exposure therapy, which a spider crawl along their arm at the top.
work by retraining the brain to change how it responds to a The patient works with a psychologist to
phobia trigger. The approach is essentially the opposite of fear systematically work their way through the list,
conditioning – the patient learns to associate their trigger with using relaxation techniques or other coping
mechanisms until they are comfortable with
more rational, positive thoughts. each stage. The patient’s brain learns to relate
Another approach being investigated is tricking the brain each scary situation to being calm, reducing
into treating itself. Mentalist and illusionist Derren Brown
their anxiety.
conducted an experiment on his programme Fear And
Faith, in which he gave people with different phobias a new COGNITIVE BEHAVIOURAL
wonder drug called Rumyodin. One subject, usually terrified THERAPY
of heights, was comfortably able to sit on the edge of a tall
bridge. Another volunteer with a fear of performing in public The aim of cognitive behavioural therapy
was able to go to an audition. It was revealed that Rumyodin (CBT) is to change how we think about certain
(an anagram of ‘your mind’) didn’t exist, and the participants situations. It is thought that irrational anxiety

had simply been injected with saline issues are caused by a patient’s negative
solution and given sugar pills. interpretation of events, rather than the events
The incredible results are themselves. CBT is a talking therapy that helps
a demonstration of the
placebo effect, a patients assess their reactions to situations,
phenomenon in which replacing the worry cycle with more useful or
a fake treatment has realistic thoughts. Patients’ brain scans indicate
a very real result.
Scientists are that CBT reduces the overactivity in the
investigating how amygdala and hippocampus associated with
this effect can phobias. Studies have also shown that CBT is
be exploited as effective as medication in the treatment of
to treat both
physical and many anxiety disorders.
psychological
problems. VIRTUAL REALITY THERAPY

32 Exposure therapy isn’t a viable option for all
phobias, but modern technology offers an
alternative. Advancements in virtual reality

systems mean that patients can now face their
fears through a headset rather than in the real
world. This enables patients to face any number

of situations relating to their phobia, while
knowing they are in no physical danger. For
example, somebody with a phobia of flying can
take a course of sessions – in which they board
a virtual plane and experience announcements,
take-off, turbulence and landing – without

having to buy a plane ticket each week.

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THE SCIENCE OF STRESS

THE SCIENCE

OF

What happens to your
body when it’s put
under pressure?

WORDS LAURA MEARS

T he man who first defined stress, Hans fear, sends a message to the hypothalamus, Rather than revving the body up for
Selye, once told reporters: “Everyone setting off a chain of electrical and chemical physical activity, this response helps to
knows what stress is, but nobody messages that prepare the body to respond. minimise bleeding in case of injury. Though
really knows.” From a mental health The first step is to put the nervous system most stresses we experience now don’t carry
perspective, stress describes the into ‘fight or flight’ mode. It does this by a risk of physical harm, this would have
feeling of excessive emotional pressure. signalling to the adrenal glands to increase been useful in our evolutionary past. Which
It can manifest itself as anxiety, trouble production of adrenaline. response is chosen varies on circumstances,
sleeping, altered eating patterns, destructive but individuals are more likely to favour
behaviour, headaches or muscle pain. This This chemical messenger surges into the one or the other, and it’s thought that these
is the stress we are all familiar with. But, from bloodstream, triggering a wave of energy patterns are set early in life.
a broader biological perspective, stress is the release by raiding the body’s stores of fats
body’s response to any kind of disruption, and glycogen. Blood sugar rises and fatty At the same time, a slower but more
whether it’s psychological trauma, extreme acids are released to fuel the body in its time persistent stress response is also activated.
temperature, lack of food, or confrontation of need. These molecules are then shuttled The hypothalamus pumps out a molecule
with a predator. to the muscles and brain by the bloodstream. called corticotropin-releasing factor (CRF).
Blood vessels in non-essential areas This is the trigger for the biological response
There’s no proper medical definition constrict, heart rate increases and breathing that puts the body into survival mode.
of stress, but when it comes to biology, it becomes faster, diverting extra resources From the hypothalamus, CRF hops a short
describes any threat to the body’s normal to the places that need them most. Senses distance through the bloodstream to the
balance. In order to cope with that threat, become heightened and the brain is put pituitary gland, where it triggers the release
whether it’s real or imagined, the body takes on alert. This response happens instantly, of a second, longer-range chemical message.
steps to protect itself. The bloodstream sometimes even before the conscious brain Known as adrenocorticotropic hormone
floods with chemical signals that heighten has processed it. (ACTH), this molecule travels around the
awareness, increase heart rate, quicken body in the bloodstream, reaching the
breathing, dull pain, and even induce Depending on the situation – and the kidneys, where it triggers the next step in the
euphoria. At the same time, non-essential individual – the exact pattern of these
functions like digestion and growth slow chemical surges differs. If escape or “SURVIVING
right down. When the stress response confrontation is not an option, another
is activated, surviving becomes the key response, known as ‘aversive vigilance’ BECOMES THE
concern; the future becomes less important. might replace ‘fight or flight’. Under these
circumstances, movement stops, and blood is KEY CONCERN”
The brain kick-starts the stress response. diverted away from the skin and extremities
The amygdala, which deals with emotion and to the organs in the core.

34

THE SCIENCE OF STRESS

THE STRESS RESPONSE 1 HYPOTHALAMUS 7

The body has a well-tuned system for RELEASING FACTOR 4
dealing with the first signs of stress

1. HYPOTHALAMUS 8 2 ANTERIOR PITUITARY
This part of the brain is responsible for maintaining
balance in the body, and it kicks off the stress response. 12 ACTH (THROUGH BLOOD) 5
3
2. PITUITARY 3 ADRENAL CORTEX
This pea-sized organ produces many hormones, including
the stress messenger adrenocorticotropic hormone. CORTISOL 6

3. ADRENALS 6
These glands are found on top of the kidneys, and 5
produce steroids in response to stress.

4. CORTICOTROPIN-RELEASING FACTOR
This chemical messenger carries the stress signal from
the hypothalamus to the pituitary.

5. ADRENOCORTICOTROPIC HORMONE
This hormone travels through the bloodstream, carrying
the chemical message to the kidneys.

6. CORTISOL
These natural steroids trigger changes across the body,
helping it to deal with stress.

7. ACTIVATION
Several areas of the brain feed into the hypothalamus,
triggering the stress response.

8. SUPPRESSION
High levels of glucocorticoids in the blood feed back to
the brain, switching off the stress response.

STRESS ISN’T JUST HUMAN

BACTERIA PLANTS FISH BIRDS MICE
These microbes cope Water stress can be a Fish have a similar Like us, birds make These rodents are often used
with changes to their real problem for plants, stress response to other corticosteroids in response as a model for human biology,
environment by altering the vertebrates, with a cycle to stress. The amount goes but recent research showed
way they use their genes. so they respond by of chemical signals up in birds that breed in
Molecules called sigma conserving moisture. that starts in the brain, higher places, which helps that they are stressed by
factors change which genes This includes producing preparing the body to them to cope with the risks male scientists. The effect
are switched on, and which rapid chemical signals release energy and shut associated with nesting at seems to be related to their
that close the pores in down unnecessary activity. smell, and it may skew the
are turned off. high altitudes.
their leaves. results of tests.

35

THE SCIENCE OF STRESS

THE EFFECTS OF STRESS The pituitary gland is packed
with hormone-producing
Too much stress can have a negative endocrine cells
effect on different parts of the body
NERVES
BREATHING
Stress during brain development can
An increased breathing rate can result affect the structure of the growing brain.
in panic attacks and hyperventilation.
MUSCLES
HEART RATE
Tense muscles in the head, shoulders
Raised heart rate and blood pressure and neck can lead to headaches.
can cause gradual damage to the
cardiovascular system. HORMONES

RESPIRATION Stress hormones like cortisol
INCREASES affect cells all over the body,
including dampening the
Faster breathing sends immune response.
more oxygen to your
muscles to prepare them DIGESTION
for action.
Changes in blood flow to
“IT TURNS the digestive system and
OUT THAT different eating patterns
IF WE can affect bowel function.
BELIEVE
THAT REPRODUCTION
STRESS
IS BAD, IT Fertility and libido can be
IS MORE affected by chronic stress in
LIKELY TO both men and women.
DO US
HARM”

36

THE SCIENCE OF STRESS

stress response process. dampens the immune response; and it even term, chronic problem.
On top of each kidney is a hormone affects the formation of memories. Humans are unique among animals (as far

factory known as an adrenal gland, and Short-term stress is quickly corrected by as we know) in that we think abstractly about
within each is a compartment known as the body, and, to prevent the cycle the world and ourselves. Our huge brains are
the adrenal cortex. The cells here produce continuing forever, the cortisol also acts as a gift, but can also lead to long-term stress as
glucocorticoids, the body’s natural steroids. an off switch. It feeds back to the brain, letting we worry over problems that just wouldn’t
And it’s these steroids that help the rest of the it know that the stress response has been occur to other animals, like work and money.
body to deal with stress. Cortisol interferes fully activated, and helps to switch off the
with insulin, helping to keep blood sugar production of CRF and ACTH. But While the stress response has been
levels up. It helps to balance the body’s pH; it sometimes, stress can develop into a long- honed by evolution to boost the chances of
survival during short periods of increased
EUSTRESS VS DISTRESS environmental pressure, in the long term it
can cause damage. Ultimately, it can lead to
How can stress levels affect our ability to work? illness if left unchecked.

Exposure to stress during childhood, be
it war, neglect or even divorce, can make
people more likely to experience mental

OPTIMAL PERFORMANCE

UNDER PRESSURE BREAKING POINT GOOD
STRESS?
Increased stress, After a certain level, too
provided it’s much pressure negatively
managable, can affects performance.
improve productivity.

PERFORMANCE In 1936, endocrinologist Hans
Selye wrote a letter to the
CALM EUSTRESS DISTRESS
LEVEL OF STRESS scientific journal Nature, describing
the “general alarm reaction of the
STRESS-RELATED DAMAGE organism.” He was one of the first
people to identify and investigate
Long-term, or chronic, stress can be bad for our health, but it’s challenging biological stress. He continued his
to pin down exactly why. Is it to do with poor lifestyle choices made under
pressure, or is there something happening inside the body as a result of a investigations, and after nearly
40 years of research, Selye came
prolonged stress response?
In 2004, a research team from the US published a paper in the journal to the conclusion that stress
PNAS that investigated what happens to our cells under stress. They wasn’t all bad.
looked at the genetic code, homing in on the protective caps that cover the
ends of each chromosome. Known as telomeres, these structures shorten People had known for a long time
as cells get older. An enzyme called telomerase can replenish telomeres, that there’s a link between ‘stress’

but stress diminishes the supply of this regenerative enzyme. and productivity. In 1908, two
The team studied a group of 58 women, and they found that the longer the researchers, Yerkes and Dodson,
women had been stressed, and the more stressed they felt, the more likely showed that there’s a sweet-spot,
where there’s just enough pressure
they were to have shortened telomeres – a sign that their bodies were to encourage productivity, but not
feeling the strain. Exactly why this happens is not currently known. so much that it becomes too much

for the person to handle.
Selye was interested in the idea
that the feeling of stress isn’t so

much about what happens to
the body, but about how each
individual reacts to the changes.

In the 1970s, he introduced
two new words, ‘eustress’ and
‘distress’, to describe what he saw.
Eustress was beneficial stress, and

distress was bad.

37

THE SCIENCE OF STRESS

health problems as adults. During this period, off infection, but the stress steroid cortisol is the change in shape or size of an object as
the brain is still developing, and chronic affects their function in the long term. In fact, a result of an external force, and stress is the
stress can cause structural changes that drugs based on cortisol are used to dampen internal force associated with it. The
affect the way that it functions. As adults, down the immune system in patients in need use of the same word links the two in
chronic stress puts strain on the heart and of immunosuppression. people’s minds.
blood vessels, contributing to cardiovascular
disease, heart attacks and strokes, and it can Long-term stress can be a real problem. Not Astonishingly, changing the way you think
also damage the immune system. only does the response itself put pressure on about stress seems to be able to change the
the body, but coping mechanisms, including effect it has on you. Seeing sweaty palms,
During an acute stress response, immune drinking and smoking, can all damage our increased heart rate and rapid breathing as
cells are mobilised in case they need to fend insides. However, it’s not just about the signs that your body is trying to help you
physical effects. ‘Stress’ is a loaded word, and alters your internal response. Heart rate still
recent research has been looking at how our increases, but blood vessels can stay relaxed,
perceptions of stress affect its impact on the which is much better for the cardiovascular
body. It turns out that if we believe stress is system. What’s more, there’s another
bad, it is more likely to do us harm. component to the stress response that is
often overlooked: oxytocin.
Studies in the US have shown that people
who are stressed have an increased risk of Popularly known as the ‘cuddle hormone’,
dying. But – and this is critical – only if they oxytocin helps mothers to bond to their
believed that stress itself could cause them babies, and it’s released by the brain when
harm. In fact, people who were stressed but we are hugged. It is also produced during
didn’t believe it was bad for them had a lower stress, helping us to seek social support.
risk of dying than those who were barely Oxytocin also helps by dilating blood vessels,
stressed at all. lowering blood pressure and even helping to
repair the heart.
The negative connotations of the word
‘stress’ bothered Hans Selye, who had first While stress can feel unpleasant, it is there
pointed out the stress response in the to help us deal with life’s challenges. Believing
1930s. Part of the trouble is that stress isn’t in your body, and seeking support when
just used to describe the body’s response to things become too much, can help keep it
challenging situations. In physics, strain under control.

BLOCKING STRESS MONITORING
MOLECULES
STRESS
The hypothalamus is the part of the brain responsible for kicking off the
The tech that can tell if you’re
stress response, and it does this by producing corticotropin-releasing factor having a tough time

(CRF). This hormone travels to the nearby pituitary gland, where it tells the There are several electronic gadgets
that claim to be able to track your
cells to begin pumping out adrenocorticotropic hormone (ACTH), which in
stress levels by tapping in to your heart
turn tells the kidneys to make the stress steroid cortisol. One of the critical rate, breathing, skin conductance and
blood oxygen. The idea is to help you to
molecules in this pathway is known as CRF1: corticotropin-releasing factor identify, and avoid, your stress triggers.
However, although some of the science
receptor 1. It is the molecule that detects the CRF, and in 2013, scientists behind the measurements they take is
sound, it’s not always easy to decipher
managed to work out its shape. what they mean. For example, the time
between heartbeats varies less when
CRF1 sits on the surface of cells in the pituitary, and other structures in you are stressed, but also when you are
excited. A device that picks up on these
the body, and waits changes won’t be able to tell you which
mood you are in unless it knows what
for CRF to arrive. This is corticotropin-
When it does, the releasing hormone. It binds else is happening around you.
hormone sticks to the
to CRF1 to trigger part of
the stress response

receptor and triggers STRUCTURE DISEASE
molecular pathways
that contribute to CRH is Increased CRH
the stress response. comprised of 41 production is
Understanding its amino acids. associated with
shape could help drug Alzheimer’s.

developers to design treatments that

interfere with this interaction, stopping the

© Getty Images hormone from slotting into its hole in the receptor,

dampening the stress.

38

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ANXIETY IN CHILDREN

ANXIETY IN

CHILDREN

Up to one in five children will experience anxiety during
their childhood. As parents it’s difficult to know when – or
even if – we should seek professional support. Consultant
Paediatrician Dr Sinead Doyle answers commonly asked

questions to put your mind at rest

WORDS BEN GRAFTON

How do I know if my child is suffering of physical symptoms. These include DR SINEAD DOYLE
from anxiety? dizziness, pain (such as head and tummy CONSULTANT COMMUNITY
Many parents might ask themselves this aches), nausea or change in appetite, and
question and it’s not something that gets difficulty sleeping. Older children might PAEDIATRICIAN
talked about enough. I always say to parents describe more typical symptoms, such as
it’s important to trust your parental instinct. chest tightness or difficulty catching their Dr Sinead Doyle is a Consultant
If you think something is not right with your breath. In some cases, medical advice is Community Paediatrician, specialising
child, or they appear to be more worried sought for these physical symptoms before in the care of children with physical,
than they should be, it’s really important to the possibility of underlying anxiety is
seek advice and support. considered. It is therefore always important emotional and learning difficulties.
to consider whether a physical symptom in During her career she has worked with
In some cases, children can be labelled as a child or young person might be their way children for whom anxiety has been a
‘difficult’ or ‘attention seeking’, when in fact of expressing their emotional needs.
they might be displaying signs that they are key feature of their condition.
struggling with their mental and emotional For other children, however, anxiety might
health. Children’s behaviour is often a form be demonstrated in their behaviour. They For babies and toddlers, anxiety around
of communication, and I think it’s important might be expressing frequent worry or everyday life is less common because the
that in some cases we consider what they’re seeking constant reassurance. They might world in which they live is much smaller, and
trying to tell us. be demonstrating avoidant behaviours, such their cognitive and emotional understanding
as refusing to go to school, or comforting of the world is a lot less developed. They
It can of course be entirely normal for behaviours, such as comfort eating. For won’t worry about bullying or not having
children and young people to have worries. many children of school age, they may their homework done on time, for example.
However, if these are starting to significantly be able to talk to you about their worries
impact on their daily life at home or at directly. However, for children with speech As infants, we are wholly dependent on
school, you might want to consider seeking or communication difficulties, for example, our parents, and so our main concerns are
further support. different strategies may be needed to help around having our physical and emotional
them communicate their feelings. needs met. We know that having a secure
What are some signs of anxiety in attachment as an infant to our main
school children? Do babies and toddlers experience caregiver is important for our future mental
As with adults, anxiety can often manifest anxiety, too? and emotional health. Where consistent
in children and young people in the form

40

ANXIETY IN CHILDREN

“CHILDREN CAN BE LABELLED
AS ‘DIFFICULT’ OR ‘ATTENTION
SEEKING’, WHEN IN FACT THEY
MIGHT BE DISPLAYING SIGNS THAT
THEY ARE STRUGGLING WITH THEIR
MENTAL AND EMOTIONAL HEALTH”

41

ANXIETY IN CHILDREN

care and nurture isn’t provided, this can lead new environment can be useful. It can
to anxiety, as well as other developmental be difficult emotionally for parents, too,
difficulties, in later childhood. and so it is important to seek support if
you’re worried. Depending on the age of
As toddlers, we start to widen our social your child, you could consider speaking
network – we develop relationships with to your child’s health visitor – these are
other children, and attend group settings, specialist nurses who are trained in the care
such as playgroups and nursery. For and development of young children. Or if
some children there can be some anxiety applicable, you could speak to staff at your
associated with this transition, which some child’s nursery or school.
might term ‘separation anxiety’.
What sort of anxiety disorders do
What exactly is separation anxiety? children commonly experience?
The emotional attachment between children This book covers some of the main anxiety
and their parents is a natural biological disorders, all of which can present in
imperative which ensures that as children childhood and adolescence. For some
we are kept safe and our needs are met. children, their symptoms will be fairly clear
However, as we grow and begin to explore cut, allowing a specific diagnosis (such as
the world around us, it is important for ‘obsessive compulsive disorder’) to be made
our development that we can feel able to by an appropriately trained professional.
detach from our parents. This might be more Having a specific diagnosis in some cases
difficult for some children, and anxiety might can be useful in deciding the best way
develop during periods of transition into forward in terms of treatment and support.
nursery or school, for example. Children For some children, more than one diagnosis
might struggle to settle without their parents might be given (‘anxiety and OCD’, for
being present in the room, or may look to example) as it is well recognised that many
them frequently for a sense of reassurance of these disorders coexist or overlap.
and security.
For many children, however, any
Separation anxiety is common and there symptoms of anxiety may be mild, fluctuant,
are strategies which can help your child or even appropriate to the situation. We can
to overcome it. In some cases comfort all appreciate that exam periods, for example,
objects, or a gradual introduction into a

or even world events, such as the recent
Covid-19 pandemic, are inevitably going to
impact on mental health. As professionals,
when we discuss mental health with
children or young people, we try to think
about what we call their ‘lived experience’.
What is their family life like? Where do they
go to school? We try to build a picture of
the child’s life, and think about some of the
things that are going well for them, as well
as the areas that they feel need more
support. Approaching children individually,
focusing on their specific symptoms, needs
and goals, allows their management to be
tailored to them.

My child has a phobia. Is it normal?
Certain fears or anxieties as children are
normal, as we try to process and make sense
of the world around us. We can all recall as
children the fear of ‘what’s under the bed’
or ‘what’s in the cupboard’. Fear of the dark,
for example, is common, and night lights or
comfort toys at bedtime often help children
to settle and sleep well.

Some perceived irrational fears might
persist into later childhood and even
adulthood, however, we only start to worry if
these fears begin to have a significant impact
on a child or young person’s daily life. For
example, if the fear means that they’re not
able to attend school or take part in play or
leisure activities, then professional support

42

ANXIETY IN CHILDREN

may be needed. There are ‘desensitisation’ young people, as well as other avenues of “CERTAIN FEARS
strategies, among others, which can help a support such as parent support groups. For OR ANXIETIES AS
child to overcome or adapt to their phobia. most of these services, you will be able to self- CHILDREN ARE
refer without going through your GP. NORMAL, AS WE TRY
Could my child’s anxiety be linked to TO MAKE SENSE OF
something more serious? For children who are school age there is the
For many children, symptoms of anxiety will school nursing service. You can speak to your THE WORLD”
fall into what is perceived as the ‘acceptable’ child’s school or your GP about how to access
or ‘normal’ range, although this might be this. School nurses are trained in supporting
different for different people. Children also emotional and behavioural health, including
cope differently, and some children are support with anxiety.
very good at finding strategies to support
themselves, whether that’s through peer Schools themselves may also be able to
relationships or through hobbies. Many offer advice and support. Many have access
children and young people cope with a
certain degree of anxiety without the need
for professional support.

In some cases, however, there may be
concerns that anxiety is significantly
impacting a child’s mental or physical
health. If you are concerned that your
child’s anxiety is impacting on their physical
health – for example, if their sleep or their
growth is being affected – you should
seek support. You should also seek
support if you feel their mental and
emotional health, or their learning,
is being impacted. For example,
if they are increasingly
withdrawn, struggling with
friendships or relationships,
or if they are not able to
attend school. For some
children, consideration
may be given to the
possibility of an underlying
neurodevelopmental
disorder, such as autistic
spectrum disorder or
attention deficit and
hyperactivity disorder (ADHD),
depending on their specific
needs and difficulties.

What are some good sources
of information if I am worried
about anxiety in my child?
If you are concerned, there are a
number of easily accessible avenues of
support. You can discuss any difficulties
with your GP in the first instance. They
should be able to sign-post you to the
appropriate service or support.

For preschool-aged children, they should
have an allocated health visitor who will
be trained and experienced in supporting
children with issues including sleep
difficulties, toileting, eating, and emotional
and behavioural support.

Every area has what’s termed the ‘Local
Offer’ – this is the range of services available
in your area, and is usually accessible via
your local council website. This includes
mental health support accessible through
the NHS, local charities for children and

43

ANXIETY IN CHILDREN

to counselling services, and other forms of book’, where they can write down their With the advent of social media, there are
therapy, such as ‘play therapy’ or ‘art therapy’. worries before they go to bed. For other new wider social pressures on young people,
They are also able to link in with community children, it might be the use of picture cards and it is therefore important to manage
mental health support teams. or the ‘traffic light system’ to describe how your child’s screen time, and consider the
they are feeling. importance of ‘online safety’ and what they
Finally, there are larger, nationally run are being exposed to through social media.
charities such as Mind (www.mind.org.uk), For children, ‘mental health hygiene’ is
Young Minds (www.youngminds.org.uk) and no less important than in adults. By this How has addressing anxiety in children
Childline (www.childline.org.uk), which all we mean, taking time to do things which changed in recent years?
have excellent resources for young people are positive for our mental and emotional One of the key things is that people are
and families seeking support with mental wellbeing. This might include making time talking about mental health in a more open
and emotional health. to exercise, time to see friends and play, time way. I think children and young people are
for hobbies, eating healthily and regularly, becoming more literate in the language of
How can I help my children in their and making sure we get a good night’s sleep.
struggles with anxiety?
The first thing I would suggest is to simply
try and have a dialogue with your child. It’s
not always easy, but reassuring your child
that they can approach you and talk to you
about their worries is a great first step. If you
are able to identify specific triggers for your
child’s anxiety, it is then easier to address
them as a family, with support from other
professionals as needed. Don’t be afraid
to speak to the professionals who support
your child, including medical professionals,
teachers, social care workers and other
support workers.

Simple strategies can be useful – there are
some excellent ones listed on the Young
Minds website. These might include, for
example, providing your child with a ‘worry

44

ANXIETY IN CHILDREN

mental and emotional health. The stigma COVID-19 pandemic, we carry out increasing effective at offering support. A small
that used to surround mental health numbers of consultations online through minority of children may receive medication
difficulties is starting to dissipate, which is ‘video’ consultations. This can be useful for treatment, usually where there is a specific
such a positive thing. The media has played children who may feel more comfortable underlying diagnosis and with specialist
a role in this, as has the voice of charities speaking to a professional from home rather support. This is more likely in older school-
through their advocacy and campaigns. I than in a clinical setting. age children and adolescents, and is often
talked earlier about the negative impacts of used in conjunction with therapies.
social media, however, in some cases social Do you think technology will ever
media can be a positive force, and I think it replace human contact? How can I feel less alone in dealing with
too has helped to spread positive messages I’m not sure if technological advances, my child’s anxiety?
about the importance of mental health, such as artificial intelligence, can replace I think the key message is you’re not
particularly during the Covid-19 pandemic. the human experience or human ‘touch’, alone, even though at times it might feel
particularly when it comes to mental like it. There is a lot of support out there,
Everyone who cares for or works with and emotional health. When someone is particularly since the Covid-19 pandemic,
children in some capacity now plays a role struggling, one thing they need is to feel not only from professionals, but also from
in ensuring they are supported with their listened to and heard, and I’m not sure if other parents through parent support groups.
mental and emotional health. that can be achieved through a computer. Speaking to another parent who has been
That’s not to say that there isn’t a role in a similar situation can be very useful.
Can technology help my child with for technology, and I think as medical Don’t be afraid to ask for help – if in doubt,
their anxiety? professionals, we are very open to embracing speak to someone you feel you have a good
Yes. Many adolescents might not want to new ways of working, with the goal of understanding with, such as your child’s
speak to their parents or their GP. They might improving patient care and experience. teacher, or another keyworker or mentor. If
want more non-traditional ways of getting they don’t have the answers, they should be
support. Many local services supporting Are children ever prescribed able to direct you to someone who does.
young people’s mental health now offer medication for anxiety?
other ways of making contact, such as It is not common to prescribe anxiety It’s also important that parents remember
through text message or online chat. There medication for children, and these would to look after their own wellbeing. Caring for
are also websites and online resources for only be prescribed by specialists working a child with anxiety and other emotional
young people, as well as phone lines where in the area of children’s mental health. health needs can be a worrying and stressful
young people can receive direct support. For many children, support strategies, time, and I try to remind parents that to do
counselling, and other therapies are very the best for their children, they also have to
Technology is also changing the way that do the best for themselves.
we provide healthcare services. Since the

© Getty Images

45

GROUNDING TECHNIQUES TO STOP ANXIETY

GROUNDING
TECHNIQUES

TO STOP
ANXIETY

Things to do to
stop your mind
spinning out of

control

WORDS EDOARDO ALBERT

C hronic anxiety is bad enough
but sometimes these thoughts
and feelings can spiral out of
control, leading to a full-on
panic attack. Panic attacks
are deeply scary. While gripped by one, it
can feel as if you are about to die. So it is
important to find techniques and exercises
that can calm us down from a panic attack.

Panic attacks happen when the feedback
loop of the cycle of anxiety runs wild. The
deep parts of our brain, in particular the
amygdala, which produces fear, pick up
on a trigger that has become attached to
something that makes us anxious. It could
be as simple as a passing thought. Where
anxiety has become chronic, embedding
itself in our thoughts and behaviours, it
could simply be the spike in hormones
caused by eating a sugary snack is enough
to cause our amygdala to kick in. The
amygdala evolved to deal with immediate

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GROUNDING TECHNIQUES TO STOP ANXIETY

danger. When a trigger activates it, the the amygdala lies beneath our conscious “DIFFERENT
amygdala immediately floods our bodies minds. To approach it, we have to go TECHNIQUES WORK
with hormones so that we are ready to through the body – which is where these
fight or flee. Our hearts beat faster, muscles grounding techniques come in. FOR DIFFERENT
tense, breath speeds up. PEOPLE… SO TRY
There are many different techniques A FEW TO FIND
But with no perceptible threat, our but they all work towards bringing us
body, which is now poised for immediate out of a panicked mental state and into SOMETHING
danger, does not know what to do. With no the immediate present – where there is THAT WORKS BEST
information telling it whether to fight or run no danger. Different techniques work for
away, the amygdala continues pumping us different people so it might be necessary FOR YOU”
with action-stations hormones until a full- to try a few before you find something that
blown panic attack ensues. works best for you. It is best to practise
them before a panic attack so that you
To stop this, we need to signal to the know the exercise: the middle of a panic
body and the brain that it’s all right: there’s attack is not the time to be trying to
no danger. Consciously telling ourselves remember what to do next.
to calm down does not work because

ANXIETY APPS

There are apps for everything nowadays

CALM MINDSHIFT FINCH REFLECTLY HEADSPACE

£28.99 annually Free Free/in-app $9.99/month or 14 days free, then
Calm is primarily Mindshift is purchases for $59.99/year £49.99/year
a cognitive more features Reflectly
a meditation behavioural Finch works by Headspace is a
app, guiding the therapy (CBT) having the app’s works well with meditation and
user through a based app that titular bird stand journaling and mindfulness app
uses established in for you. So you mood tracking,
wide range of methods of take care of the providing different designed by
meditations. CBT to help bird by taking care ways to record former Buddhist
It also plays overcome anxiety. of yourself. Unlike your emotions and
calming sounds It’s particularly other apps, it has situation. The app monk, Andy
and features a useful to use after no pressure-based asks you questions Puddicombe.
growing set of completing a reinforcements, to prompt more The app has
stories designed CBT course with which makes guided meditation
for restfulness. It’s a therapist as it it suitable for insight and exercises as well
had ten million helps remind the anyone who finds engagement with as a large number
downloads and user to continue more goal-based your feelings, as of mindfulness
consistently with the strategies apps too difficult well as providing scenarios, some
receives positive or stressful. motivations and expressly designed
reviews from learned. to help users cope
reminders to with anxiety
its users. keep going. and stress.

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GROUNDING TECHNIQUES TO STOP ANXIETY

5-4-3-2-1 TECHNIQUE

Employing the five senses to return to the present

During a panic attack, or when we technique, slow the breath. Breathe we are conveying a message to
can feel anxiety ramping up, the in for a count of four and then out our amygdala, which listens to the
body and brain are locked into a senses much more closely than it
feedback loop. Feelings of anxiety for a count of four. Repeat. listens to our conscious thoughts,
make the deep brain think it is in Keep this breathing pattern
danger, which leads to it pumping throughout the exercise but the that everything is all right.
out emergency hormones while next time you breathe out, look The fourth step is to name two
getting the body ready to fight or around your surroundings and things we can smell. For those of
flee. These elevated physical levels say, out loud, the names of five us who don’t have particularly
feed the physical sensations that things you can see. They could be sensitive senses of smell it might
accompany anxiety, making us in the room with you – the chair, work to carry around something
more anxious, which leads to the a bookcase – or outside, visible that has a distinctive odour that
deep brain pumping out even more through a window – a tree, the sky, we can focus on when we need
emergency hormones. But all of this someone passing by. Then, again to employ the 5-4-3-2-1 technique.
is going on inside us. There is no speaking out loud, say the names of A bottle of perfume or a stick of
danger. Even if the anxiety trigger four things you can hear. They can chewing gum. The chewing gum will
is something like a forthcoming be things loud or quiet, near or far. come in useful for the final step:
event, the event is not yet: there The point is to focus the attention taste. It does not matter what you
is no need to panic. However, the in your ears at this point. The third use to engage the sense of taste
deep part of the brain does not step is to say three things you but something pleasant will help to
can feel. This could be the chair wind the exercise down calmly.
know this. under your bottom to the weight The 5-4-3-2-1 technique is a focused
Future fear has translated into of clothes on your shoulder to the sensory technique to shift our
a panic attack in the present. If touch of a breeze on the cheek. focus away from the storm of
we can pull our focus back to the We are working our way through internal thoughts and feelings of a
present, where in fact there is the five senses, employing each panic attack to the world outside
nothing dangerous, then the body sense in turn to turn our attention ourselves. The technique conveys
can respond in turn. The 5-4-3-2-1 from the thoughts and feelings the message to our autonomic
technique is a way of dissolving inside our mind to the exterior nervous system through all five
future fears into the immediate world immediately around us – a senses that everything really is
reality of our surroundings. To world which is calm and safe. By all right and it can switch off its
begin, as an immediate calming going through the senses in turn,
emergency response.

SIGHT SOUND TASTE TOUCH SMELL

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GROUNDING TECHNIQUES TO STOP ANXIETY

BREATHE

When panic takes over, controlling our breath is one of the best ways of getting back in control

P anic attacks produce At the start, when panic breathing signals being sent to it. Using calm, slow
hyperventilation. has kicked in, it might be difficult to breathing, with an even breath count puts
Hyperventilation floods our breathe through the nose but as soon us into a neutral physiological state, ready to
muscles with oxygen, making it as it is possible, we should switch to respond to external stimuli. This allows the
ready to fight or to run away. But nose breathing. The difficulty with this deep brain to reset itself and us to come out
in a panic attack, there is nothing to run technique is holding on to the slow, even of the panic attack. The best way to prepare
away from. Our deep brain is preparing us breath count no matter what thoughts and for dealing with a panic attack is to practise
for a situation from our deep past when feelings are assailing us, because it takes a the long, 4/4 breath pattern beforehand, so
what we are actually facing is the fear of little while for the message of slow, steady that it has become grooved by repetition.
giving a presentation or nerves before an breathing to get through to the deep brain.
exam. The situations that produce anxiety But holding to slow, even breathing will “BY CONTROLLING
in the modern world are rarely resolved by send a message through the body to the OUR BREATHING
fighting or running away. deep brain: there is no emergency, switch WE CAN NUDGE
off the danger hormones. THE BRAIN AND
One way to tell our amygdala that there NERVOUS SYSTEM
really is nothing to worry about is to Note that some magazine articles
control the breath. By controlling our advocate breathing out for twice as long as OUT OF THE FLIGHT/
breathing we can nudge the brain and the inbreath, so an inbreath to the count of FIGHT RESPONSE”
nervous system out of the flight/fight four and an outbreath to the count of eight.
response. To do so, we need to change the This rarely works as that breathing pattern
breath pattern into an inbreath to a slow works to put our system into its rest/digest
count of four and an outbreath to a slow state. Trying to switch immediately from
count of four, preferably through the nose. the fight/flight response to rest/digest is
It’s important that the count is the same simply too big a step – the body might panic
length for both. even further at having these contradictory

INHALE 4 SECS,
HOLD 4 SECS

EXHALE 4 SECS,
HOLD 4 SECS

REPEAT
X5

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GROUNDING TECHNIQUES TO STOP ANXIETY

PROGRESSIVE MUSCLE RELAXATION

Learning how to relax the muscles of the body

W hen we are anxious, our open them. Finally, tense your forehead by
muscles tense. They do raising your eyebrows as high as you can,
this because the deep and then relax.
brain is preparing the
body for action, getting Once the exercise is familiar and you
it ready to fight or run. However, people know what a relaxed muscle feels like,
suffering from generalised anxiety disorder you might want to switch to tensing and
(GAD), the most common form of anxiety releasing sections of the body together: both
disorder, who live in a constant state of legs, torso, arms and neck, head. Finally,
chronic anxiety, can have their muscles it may become possible to skip tensing
in a habitual, permanent state of tension. completely and simply work through the
Progressive muscle relaxation is a way to body, relaxing each muscle group in turn.
systematically work through the muscle
groups of the body, learning the difference The end result should be a relaxed body.
between tension and relaxation, and As our brains work in partnership with our
discovering how to successively relax the bodies, this will tell the brain that it can
muscles in one’s body. relax too.

This is one technique that must be “THE END RESULT
thoroughly practised, ideally twice a day at
first. It takes about 15 minutes and you will SHOULD BE A
need a room where you won’t be disturbed.
Start by lying on the ground or sitting RELAXED BODY
comfortably in a chair. Take five long, slow
even breaths. AND MIND”

Progressive muscle relaxation works
by targeting muscle groups in turn. You
first tense the muscle group as much as
possible, for instance by squeezing your
hand into the tightest fist you can manage.
After five seconds, breathe out and relax
those muscles. Concentrate on how the
muscles feel when relaxed as opposed to
when they are tense. You are learning what
a relaxed muscle feels like.

People usually find it most effective
working from feet to head or head to
feet. We will look at feet to head but the
sequence can be reversed. Some people
find it helpful to have a recording to take
them through the different muscle groups
until they have learned them all.

Start by tensing one foot, curling the toes
downwards. Hold, then relax, concentrating
on the feel of a relaxed muscle. Then
tighten the calf of the same leg by curling
the toes upwards. Finish the leg by tensing
the thigh muscles. Repeat on the other leg.

Clench one hand, then relax. Tense the
whole arm by drawing your clenched fist to
your shoulder. Repeat with the other arm.

Moving on to the trunk, start by
tightening and then releasing the buttocks.
Next, tense and relax your stomach. Tense
the chest by taking and holding a really
big breath, then breathe out.

To tense the neck and shoulders,
hunch your shoulders towards your
ears and then relax. Open the mouth as
wide as it will go and then relax. Squish
your eyes as tight shut as possible and then

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