Dealing with anxiety

Anxiety is the body's threat system doing exactly what it evolved to do — releasing adrenaline, speeding the heart, tensing muscles, sharpening attention — at a moment when there is no physical threat to run from.

That is why the symptoms are so physical: a racing heart, tight chest, shaky hands, nausea, needing the toilet, a feeling of unreality. People often think they are having a heart attack. They are having a surge of adrenaline, which is unpleasant and not dangerous.

Understanding this matters practically. Much of the distress of a panic attack comes from the fear that the symptoms mean something catastrophic. Knowing what the sensations are takes a good deal of the fuel away.

The aim is not to make the feeling stop instantly — fighting it tends to escalate it. The aim is to bring your body back down and let the wave pass, which it always does.

1. 1Slow the out-breath. Breathe in through the nose for about four counts, then out slowly for about six to eight. The long out-breath is the part that calms the nervous system; breathing fast and deep makes it worse.
2. 2Put both feet flat on the floor and press down. Feel the ground taking your weight.
3. 3Name five things you can see, four you can hear, three you can touch, two you can smell and one you can taste. This pulls attention out of the spiral of thoughts and into the room.
4. 4Unclench. Drop your shoulders, unclench your jaw, let your hands go loose. The body reads that as safety.
5. 5Let it pass without checking. Panic peaks and falls, usually within about ten to twenty minutes. Repeatedly checking your pulse keeps the alarm on.

• Regular movement. Exercise is one of the better-evidenced treatments for mild to moderate anxiety. It does not need to be intense — a brisk daily walk counts.
• Sleep. Anxiety and poor sleep drive each other, and fixing sleep often lifts anxiety more than expected.
• Caffeine. It produces the exact physical symptoms of anxiety. If you are anxious and drinking a lot of coffee, energy drinks or strong tea, cutting down is a free experiment worth running.
• Alcohol. It settles anxiety for an hour and raises it substantially the next day. It is one of the most common reasons anxiety gets steadily worse over months.
• Avoidance. Avoiding what makes you anxious brings relief now and makes the fear bigger next time. Approaching it gradually, in steps you can manage, is how it shrinks.
• Talking to someone. Naming it out loud to one person you trust changes it, and it is often the step that leads to getting proper help.

Anxiety is worth treating when it is interfering with your life rather than when it reaches some threshold of severity. If it is affecting your work, your sleep, your relationships or your ability to leave the house, that is enough of a reason.

Talking therapy — particularly cognitive behavioural therapy — has strong evidence for anxiety and is the first-line treatment for many people. Medication is also effective, and the two together often work better than either alone.

When medicines are used, longer-term treatment is usually an antidepressant such as escitalopram (Cipralex) or sertraline (Zoloft), despite the name — these are standard treatments for anxiety, not only for depression. They take two to six weeks to work, and can make anxiety feel slightly worse in the first week or two, which is why stopping early is common and unfortunate.

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