You wouldn’t know it if you met me (though you will now), but I haven’t slept properly since I was a child.
Not only do I take forever to get to sleep, but I wake about 10 times a night, worrying whether I’ve locked the back door or even if my friend is annoyed that I didn’t reply to her text. Every night is the same: I lie awake staring into the darkness as my thoughts race and I struggle to calm my short, shallow breaths. So ingrained is this nightly routine, that even if nothing immediately bothers me, I find my mind scrabbling around for something to worry about.
Sometimes I even have nightmares about my A-level exams that were over a decade ago. It always plays out the same way: I realise I haven’t done any revision for my maths A-level and I have an ever-expanding text book which I know I won’t be able to read in time, so failure is inevitable. I dropped my maths A-level just weeks after starting it. Clearly my subconscious hasn’t forgiven me.
I’ve lived with this nagging, low-level panic all my life. It’s even become a bit of a family joke. So much so that when my brother gave me a copy of Scott Stossel’s study into the condition and vivid memoir My Age Of Anxiety, I laughed it off. Doesn’t everyone feel like this? After all, my friends, outwardly successful, smart young women who you’d assume wouldn’t be phased by much, all confess to living in fear of everything from missed meetings to the safety of loved ones.
What’s surprising is that anxiety – a feeling that starts in the amygdala region of the brain (the section that controls intense emotional responses) – is quickly translated into a physical reaction, when neurotransmitters carry chemical signals to the nervous system. Our response? Increased heart and breathing rates, tense muscles, a diverted blood flow from our abdominal organs to our brains, and often nausea and diarrhoea as our body goes into full alert.
The reason that happens is that anxiety is essentially our fight or flight response. All very well (and useful) when faced with a wild animal who fancies a light snack, not quite so appropriate when we’re trying to locate the fitting rooms in the Topshop sales.
The problem is that in our non-stop, fast-paced existence, sometimes our brains are simply unable to differentiate between physical and non-physical threats, meaning that our bodies are on edge far more often than they should be.
So it comes as no surprise that increased levels of anxiety have been associated with an increase in depression, insomnia, IBS, migraines and respiratory disorders, and if left untreated can contribute to an early death due to its links with heart disease. In fact, the World Health Organisation stated that anxiety was the sixth leading cause of chronic ill health in 2012. Yet, despite all the warning signs, we just carry on in our fretful lives like it’s all perfectly normal.
Anxiety is all around us, and it’s on the rise. A 2008 Harvard Health Publication, Anxiety And Physical Illness, stated that out of the estimated 57 million adults who have anxiety disorders, two-thirds are women. In 2013, the Office for National Statistics published statistics that showed nearly 20% of the UK population over the age of 16 displayed evidence of anxiety and depression, with women (21%) more likely than men (16%) to report symptoms. Dr Michael Rutherford, a psychiatrist at London’s Springfield Hospital agrees: “Women are two to three times more likely to suffer from anxiety than men.”
“Anxiety disorders affect a significant proportion of the population,” adds Dr Rutherford. “But many suffer in silence.”
The real figures are disguised by the fact anxiety is such a nebulous beast. The term covers everything from post-traumatic stress disorder to phobias, to OCD and panic attacks. To complicate matters further, it often goes hand-in-hand with depression, making it harder still to pin down.
The anxiety experience varies hugely from one person to the next. For some, it’s very specific – say, a phobia of travelling on the underground – but one of its most common manifestations is generalised anxiety disorder (GAD), which is characterised by ongoing worry about anything and everything, often touching on money, health and other elements of daily life. It can lead to sleeplessness, breathlessness, fatigue, nausea and a heightened state of tension.
So if women are more emancipated, educated and empowered than ever, why are we so gripped by fear? “Many women feel under increased pressure today, often juggling a job, childcare and a busy social schedule, without the time to look after their own wellbeing,” says Stephen Buckley, head of information at mental health charity Mind.
And this can manifest into anxiety: even those who from the outside have seemingly enviable lives are often privately battling spiralling thoughts; Jennifer Lawrence, Kate Moss, Emma Stone and Scarlett Johansson have all spoken out about being plagued by anxiety.
“I have created what from the outside looks like a great life. But I waste so much time worrying about it unravelling,” admits my friend Amy, 35, an accountant from south London, who lives with a constant – and utterly unfounded – fear of losing her job. This pinpoints one of the most debilitating features of anxiety disorders – our fears are based on something that has never happened and most likely never will.
So how do we know when it’s gone too far, and regular worries have turned into full-blown anxiety? After all, left unchecked, anxiety can pose a serious threat to our careers, our relationships and our health. The most obvious sign is when daily life becomes completely unmanageable. If your worrying is both persistent and excessive, to the point that it is disrupting your normal activities then it’s most likely gone beyond the norm.
There are also physical symptoms too. If you’re experiencing chronic sleep problems over a long period of time – struggling to fall asleep, waking up panicked in the night, recurring nightmares – it can be a tell-tale sign. Muscle tension, chronic indigestion and repeated panic attacks are also indicators of a more serious affliction. Combined, the symptoms can be debilitating. “It can take over people’s lives and cause sufferers to withdraw from contact with people,” says Buckley.
But happily, there are proven ways to manage and cope.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) has proven to be very effective in treating anxiety, in that it makes patients question their actions and learn to manage the thoughts that increase anxiety.
“CBT works on unhelpful behaviour,” says Dr Rutherford. “Often, people who are anxious will avoid activities or particular situations out of fear that they will make them more anxious, which only reinforces the anxiety and makes these activities more difficult.” For example, if you’re scared of public speaking, ask a question at a small team meeting. “CBT can help people ease themselves back into their usual activities by starting small and building up slowly,” says Dr Rutherford. “Eventually, you’ll master your anxiety.”
Be prepared to share every detail. With anxiety you might find that you can’t concentrate in meetings or make a simple decision because you’re locked in a negative thought loop (“What if I don’t say the right thing? What if I seem like an idiot? What if I get it wrong?”). A therapist will be able to teach you how to tackle these thought loops, but you have to be honest about these thoughts, no matter how embarrassing or trivial they might sound
Don’t be put off by cost. Waiting lists for NHS psychotherapists can be very long so if your anxiety is becoming unmanageable, perhaps consider going private. “Often private psychotherapists are willing to reduce their rates if you explain your situation,” explains Eleanor Morgan author of the upcoming Anxiety For Beginners. “Call and give them a brief overview of your anxiety and the impact it is having on your life and most will be willing to organise a reduction.” Find a therapist through welldoing.org or through the British Association for Counselling and Psychotherapy (BACP) website (bacp.co.uk).
Diet and exercise
Somewhat surprisingly, what you eat can affect anxiety. The Mediterranean diet, which is low in saturated fats, is particularly good for mental health. “Try to increase your intake of Omega 3 fatty acids found in fish, which aid brain function, and minerals such as zinc and magnesium, which can be found in red meat and spinach and promote mental health,” recommends Stephen Buckley.
Up the ante. Exercise increases mental resilience and reduces anxiety long-term and the more intense the exercise, the more your brain produces neurohormones that improve cognitive function and elevate mood. So if you can, go for a run rather than a walk, or swap leisurely breast-stroke for front crawl. But the important thing is to keep the exercise manageable for your fitness level.
Keep a diary. Recording your activities and feelings is especially helpful if you suffer from panic attacks, as it makes it easier to spot a pattern and understand the cause. In your diary, as well as noting down your activities and feelings, record what you eat and drink as things like caffeine and alcohol are known to trigger symptoms of anxiety. Moodtracker, a free app available on the NHS health store, is great for keeping a calendar of your thoughts and helps identify patterns.
Relaxation and meditation
Mindfulness is described by the Mental Health Foundation as “paying attention to the present moment, without getting stuck in the past or worrying about the future.” It can help you reduce stress and irritability so that you can deal with low moods which would have previously escalated into anxiety. A tutor will help you get to grips with the meditation, you’ll need four to six sessions to learn the technique.
Learn how to breathe. “If you feel a panic attack coming on, try and breathe easy,” says Dr Nick Grey, consultant clinical psychologist at the Centre for Anxiety Disorders and Trauma in London. “Remind yourself that although it feels horrible, panic attacks aren’t actually dangerous. So reduce your breathing to a slow, even pace. Be aware of the breath slowing down. Focus on the inhalation and exhalation rather than everything else around you. It’s a really effective way to be in the present moment.”
Take five minutes to meditate. “Even if you’re tied to your desk, there’s still ways you can meditate,” says Professor Sir Cary Cooper, expert in occupational anxiety and clinical advisor to Anxiety UK. “Close your eyes, breathe deeply and think about something that makes you happy or calms you and focus on that. Listen to relaxing music if you need to shut out background noise and close your mind. After five minutes, you should begin to feel calmer and the situation should seem more manageable.” Try the Headspace app which teaches you how to meditate in 10 minute daily sessions.
‘Sleep hygiene’ is all about the development of good bedtime habits which can also help combat insomnia, a common symptom of anxiety. The key principle is to establish a rest pattern and stick to it. Go to bed and get up at the same time every day, and even if you’ve had a terrible night, don’t lie in as it will disrupt the pattern. If you are having trouble going off, after 15 minutes get out of bed and read. Only tuck yourself back in once you feel sleepy again. Developing a ‘winding down’ routine – putting your phone away, having a bath, listening to an audiobook – can help teach your body that it’s time to rest.
Do a ‘tech check’. Screen time is one of the primary causes of disrupted sleep, which can cause anxiety. “Bright light from screens can disrupt your circadian rhythms (the changes in your brain over a 24 hour period) making it harder for your body to understand that it’s time to switch off and sleep,” says Stephen Buckley. “Switch off your gadgets an hour before bed and charge your phone in a different room to where you sleep.”
If you think you are suffering from anxiety, your first step should always be to talk to your GP. While a doctor may suggest alternative routes first, prescription drugs can help alongside therapy.
“It’s perfectly understandable to be reluctant about starting medication, but if you’ve undertaken therapy and are still feeling overwhelmed, you might benefit from a multi-pronged attack,” says Dr Justin Sauer, who treats anxiety patients at Bupa Cromwell Hospital’s Memory Clinic. “Adding medication to your treatment could help get your anxiety under control quicker.”
Write down your symptoms. GPs tend to only have 10 minutes with each patient, so it’s a good idea to write down a list of the symptoms that you most want to discuss to make sure you get the right help. For example, if your anxiety is causing a lot of negative thoughts, you may be prescribed an SSRI (selective serotonin reuptake inhibitors) like Prozac, which is used to address symptoms of depression, obsessive-compulsive disorder and panic disorder.
Explain your symptoms. Sometimes the reason for your anxiety might be temporary; for instance, if you have a large work project or are going through a stressful domestic crisis. In this case, your doctor may be able to prescribe beta blockers. “These work by slowing the heart beat and reducing blood pressure to tackle the physical symptoms of anxiety such as pounding heart, tremors, sweating and blushing,” says Dr Sauer. “This, in turn, can make you feel more in control. But it’s important to understand that while they are good for getting you through a stressful event, they aren’t a solution to generalised, long-term anxiety.”
This article was originally published in October 2015 but has been updated throughout.