When anxiety attacks
What to do
Anxiety can make your life hell and it takes many different forms. At the ‘normal’ end it can just be a response to a hurdle you’re facing such as a medical test or interview or imminent redundancy. Your body will then release hormones which make you feel more alert so you can react more quickly and which send blood to where it’s needed most by making your heart beat faster. These responses die down once the hurdle is cleared.
But anxiety becomes a problem when it’s intense, long-lasting, frequent, hard to control or out of proportion to what you’re facing. In other words it becomes problematic if the level of anxiety gets high enough to significantly impact on your life. In that case, depending on the circumstances, it can manifest in phobias, obsessive-compulsive behaviour, social anxiety or PTSD.
Or in Generalized Anxiety Disorder. Some people (commonly between the ages of 35 and 59) live more or less constantly with feelings of dread, tension, restlessness, fear or pressure – sometimes linked to specific situations and sometimes harder to pin down. A wide range of physical symptoms such as palpitations, insomnia, dizziness and headaches may also figure.
Other people, though, may be more prone to anxiety attacks. These are not constant but episodic, although perhaps still of significant duration.
What happens when you have an anxiety attack
Anxiety attacks are often confused with but are different from panic attacks. A panic attack tends not to have a specific trigger, comes out of the blue, lasts between a few minutes and an hour, and may well generate feelings of overwhelming fear and, say, shortness of breath to the point where a person fears impending death or complete loss of control.
Whilst there are similarities between anxiety attacks and panic attacks (and the two can occur together), what happens when one has an anxiety attack is usually distinct. It’s typically linked to something specific that feels threatening or stressful, it may gradually develop when a person is already feeling anxious, it may last some time and it won’t usually entail a fear of dying or losing control.
Physical symptoms are common to both conditions and may include accelerated heart rate, trembling, sweating, nausea or upset stomach, shortness of breath, chest pains or feeling faint.
Someone having a panic attack may have a distinctive sense of detachment from the world (derealization) or a sense of detachment from themselves (depersonalization). That is not normally what happens when you have an anxiety attack.
Finally, where panic attacks may require medical assistance, anxiety attacks generally don’t.
How to prevent anxiety attacks
The first thing to say when considering how to overcome anxiety attacks is that, although there are lots of self-help websites, books, podcasts and articles on the subject, it can be misleading to diagnose oneself. It’s always a good idea to talk to your GP. They can assess the degree, causes and form of anxiety. Where relevant they can also offer suggestions as to how to prevent anxiety attacks.
Warning signs and triggers
Generally, however, it can be useful to recognize the warning signs that anxiety is building up and to identify your particular triggers. Some people also find it helpful to accept and not fight what they’re experiencing – reminding themselves, for example, that the symptoms will pass.
Relaxation techniques such as yoga, aromatherapy, guided imagery, muscle relaxation and even taking a bath can make a difference, as can practising mindfulness and meditation.
Those who offer practical guidance on how to overcome anxiety attacks often speak too of the importance of exercise such as daily walks and of eating healthily and not too fast. Concentrating on slow, central breathing (ie from the diaphragm) may also be effective in calming you down – perhaps inhaling and exhaling on a count of four.
Isolation is not good for anxiety. So when you’re considering how to overcome anxiety attacks remember that spending time with friends or family or in groups of one kind or another may distract you and dissipate anxiety.
Distracting your thoughts can also be achieved by watching TV, listening to a podcast, reading, singing, listening to or playing music, playing with pets, writing and drawing.
Targets and limits
Finally, the reduction and management of sources of stress in your life is very important. Creating a plan can stop you feeling overwhelmed. Perhaps writing it out and setting priorities, goals and limits for the day, week, month or year can be effective in reducing stress – not least through seeing things ticked off your list and having permission to say ‘no’ to additional tasks.
Other anxiety attack tips
CBT and Psychodynamic psychotherapy
Many of the above anxiety attack tips are things you can try for yourself. But the time can come when you feel that professional help is needed. I’ve said that a GP can offer suggestions on how to prevent anxiety attacks but they may also prescribe medication to combat them. This can be used instead of or in conjunction with a talking therapy such as Cognitive Behavioural Therapy (CBT) or psychodynamic psychotherapy.
As I wrote in my previous blog about depression, the two therapies can both be very valuable but they’re also very different. CBT (not a therapy I offer) is usually a time-limited treatment lasting anywhere between six weeks and six months. It’s focused on precise goals agreed with the client and uses structured sessions and ‘homework’.
Psychodynamic psychotherapy – the type of therapy that I practise – isn’t as structured as that. CBT aims to consciously alter an individual’s unhelpful thoughts, perceptions and behaviours in order to change how they feel and behave. Psychodynamic therapy aims to uncover why they’re feeling and behaving as they are and works deeply with the unconscious mind to do that. (The mind is like an iceberg with seventh-eighths hidden below the waterline – that’s the unconscious).
Psychodynamic therapy also works with past causes of a person’s present struggles whereas CBT tends to stay in the present. Psychodynamic sessions are not planned out as in CBT and the overall aim is not just symptom modification but also holistic change – growth in the whole individual. Going, as it does, to the roots of a condition like anxiety, psychodynamic therapy often takes longer than CBT – a year upwards – although changes may start to be noticed after only a few months.
Which approach appeals?
Ultimately the choice of CBT or psychodynamic therapy depends on what you want. Along with the ‘conscious you’ are you interested in exploring parts of yourself that are out of your conscious awareness? What are the financial and time considerations in your life? Do you want to stay in the present or also look at your past?
Reaching out to a doctor or a therapist has an additional benefit – namely engaging you with another human being and helping you share with them the distress you’re suffering. The very act of doing so can already discharge some anxiety. That leads me to add that, in my experience, small psychotherapy groups of up to eight people can also be powerful environments for modifying anxiety. Again it’s about freeing you from just living in your own head where the anxiety swirls around with nowhere to go. Anxiety needs ventilating.
The words of the prose poem Desiderata come to mind: ‘Many fears are born of fatigue and loneliness’.
© Brian Shand 2021
More of my posts here https://www.guildfordtherapy.co.uk/blog/