WHAT IS ANXIETY?
COPING WITH YOUR ANXIETY
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Anxiety is a normal reaction that helps us deal with difficult or
dangerous situations. Other words for anxiety might be:
NERVOUS
SCARED
PANICKY
FRIGHTENED
If we are faced with a dangerous situation we feel anxious and get
ready to either fight or run away. This type of anxiety is called your
ANXIETY RESPONSE and it is good and natural.
Here is an example:
If you are crossing a road and notice a
fast car coming straight for you, it is
your ANXIETY RESPONSE that helps
you jump out of the way.
In this example it is easy to see what made you scared and these
feelings soon disappear. Sometimes, however, we get scared about
things that are not dangerous, like meeting new people or going to
new places. This sort of anxiety stops people doing the things they
would like to, and becomes a problem.
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Anxiety can affect us in 3 different ways:
1. PHYSICAL

Affecting how our bodies feel
2. MENTAL
 Affecting how we think
3. AVOIDANCE

Affecting how we behave
Often we can feel stressed about all sorts of things. For example,
going to a new school, or a new place and problems in relationships
with friends and family. When we are already stressed it doesn’t take
much to trigger the anxiety response. In these sorts of situations
anxiety doesn’t really help and it’s sometimes difficult to see why we
feel anxious. If we get feelings of anxiety when nothing really
frightening has happened, we tend to worry that there might be
something wrong with us.
Although sometimes it feels like anxiety comes out of the blue, there is
always some reason why we get anxious or start panicking. These
reasons are called TRIGGERS.
It is important to find out just what triggers the anxiety response for
you. Once you know what this is, you can find better ways of
preparing yourself for when you start to feel anxious and then
controlling your feelings.
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There are 3 kinds of triggers in anxiety:
1. SITUATIONS AND PLACES
e.g. crowded places, the dentist’s waiting room, going
to school, arguing with friends
Add your own examples below:
2. THOUGHTS
e.g. “I can’t cope”, “I’ll make a fool of myself”, “I’ll
have a panic attack”.
Add your own examples below:
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3. HOW YOUR BODY FEELS
e.g. heart pounding, feeling hot, butterflies in your
stomach.
Add your own examples below:
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Here is a list of some of the ways our bodies feel when we feel scared
or worried.
Some people get all these symptoms and others only get a few. Some
get symptoms not listed here.
Tick any of the symptoms you get and write in any others in the
spaces below.
Feeling short of breath 
Feeling tight across the chest 
Chest pains 
Dizziness 
Blurred vision 
Tingling in fingers, arms, legs or feet
Heart racing or pounding 
Muscle pains and headaches 
Shakiness 
Legs feeling weak 
Butterflies or stomach churning 
Sweating 
Feeling hot and cold 
Dry mouth, difficulty swallowing 
Feeling sick 
Urge to go to the toilet 

_______________________________________
_______________________________________
_______________________________________
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All of these symptoms are very unpleasant,
however, they are NOT PHYSICALLY HARMFUL
OR DAMAGING IN ANY WAY!
When we are faced with a scary situation the body ‘prepares’ for
danger so that it can either fight or run away. To do this the body has
to be ready to spring into action immediately. Our body does this by:

Making us over breathe

Putting a substance called Adrenaline into
the bloodstream
This is fine when we need to fight or run, but if we get scared in other
situations, this can cause physical anxiety symptoms. This is how it
happens:
OVER BREATHING
When we feel scared we need to breathe harder, with quick deep
breaths through the chest. This helps to get more oxygen to the
muscles in case we need to fight or run. But, if we don’t fight or run
we don’t actually need the extra oxygen. This means we actually take
in too much oxygen.
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What happens is that our body actually tries to stop us from over
breathing. It does this by making our chest muscles tense. This can
feel like a tight band around the chest and cause chest pains. This is
also what makes us feel short of breath (or even suffocating). But in
fact we don’t need any extra air – we actually need less!
Overbreathing at rest alters the mixture of gases in the lungs and
blood and this causes symptoms like:
THESE FEELINGS ARE FRIGHTENING BUT NOT
DANGEROUS!
ADRENALINE
Anxiety makes the body produce adrenaline which has the following
effects:
It INCREASES THE STRENGTH AND SPEED
OF THE HEART BEAT to pump more blood around
the body for exercise, fighting or running. This can
cause the feeling of the heart pounding or racing,
which can be frightening but isn’t dangerous.
It INCREASES THE TENSION IN THE
MUSCLES, preparing them to spring into action. This
makes us feel tense all over. The muscles that get the
most tense are the scalp, neck and shoulder muscles,
causing headaches, neck ache or a feeling of s tight
band around the head.
Sometimes the muscles
tremble or shake because of the tension, especially in
the hands, arms and legs.
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Adrenaline sends blood to the muscles and
DRAINS BLOOD AWAY FROM THE STOMACH area.
This causes a churning feeling in the stomach and
‘butterflies’.
Sometimes adrenaline SENDS BLOOD TO THE
SKIN to help cool the body down. Sometimes it
DRAINS BLOOD AWAY FROM THE SKIN to send
more to the muscles. This can make you feel hot or
cold or even both. This is also what makes your face
go pale or causes blushing.
Adrenaline also DRAINS BLOOD AWAY
FROM THE BRAIN. This may make it difficult to
concentrate and can affect your memory. It also adds
to your feelings of light-headedness or dizziness.
Adrenaline INCREASES SWEATING to cool the
body down when it gets hot with action.
Other uncomfortable feelings due to adrenaline are:
Dry mouth
Blurred vision
Difficulty swallowing
Wanting to go to the toilet
All of this is very tiring and often leaves people feeling exhausted.
HOWEVER, NONE OF THESE PHYSICAL SYMPTOMS OF
ANXIETY ARE DANGEROUS.
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RELAXATION
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There are at least 5 things you can do to help with the symptoms of
anxiety:
These techniques are helpful for a number of reasons:

They can help you to deal with stressful situations and
lower your levels of anxiety.

They can ‘nip anxiety in the bud’, stopping the
cycle that leads to full blown panic by reducing anxiety
symptoms and preventing you from getting too worked up.

They can be used when you are trying not to get
Scared, to help you cope with situations of fear.

Being relaxed and breathing calmly is the opposite
Of being worked up.
To begin with it is best to practice regularly when you
are not anxious. Look on it as getting into training.
You would not enter a race without training for a while
first!
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RELAXING ACTIVITIES
People relax in many different ways, e.g.:
Reading a book
Watching TV
Listening to music
What do you do to relax? Write down six things you do, or
could do to feel good e.g. swimming, reading and walking.
As well as finding everyday ways of relaxing, there are special
RELAXATION TECHNIQUES which can help with specific symptoms
of anxiety.
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COPING WITH YOUR ANXIETY
PHYSICAL RELAXATION
We have already seen that one of the things that happens when you
panic is that your muscles tense up. To help yourself you should try
to relax your muscles whenever you start to feel anxious. Relaxing in
this sense is different from the everyday ways of relaxing like putting
your feet up and having a cup of tea (although that is just as
important!). It is a skill to be learnt and practised.
Try to practice the following technique every day:
1. Close your eyes lightly, rest your head against a chair or bed,
flop out your arms and let your legs go limp. Keep your breathing
light and regular.

2. FACE
Clench your teeth while pressing the tip of your tongue against
the roof of your mouth. At the same time shut your eyes tightly
and frown as hard as you can. Hold for a count of 5 and then
relax. Allow your tongue to lie loose in your mouth, parting your
jaws slightly. Open your eyes and allow your brow to smooth
out.

3. NECK
Press back against the support on which you are sitting or lying.
Increase the tension, feeling it build up in the muscles, and hold
for a count of 5. Relax and let the head rest lightly back against
the support.

4. SHOULDERS
Hunch them up as hard as you can. Raise them upwars….higher
and higher. Hold for a count of 5 then drop the shoulders and
feel them flop.

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5. ARMS AND HANDS
Clench your hands into fists as tight as possible. While doing so,
try and touch your shoulders with the back of your wrists. Feel
the tension building up. Hold it for a count of 5, then let go
completely, allowing your hand to rest beside you and feel the
tension disappear.

6. TORSO
Tense your chest and stomach muscles by taking a very deep
breath. Draw the air far into the lungs until the chest seems
incapable of expanding any further. While doing this, flatten the
stomach muscles by drawing the tummy into the spine. Hold for
a count of 5. Breathe out and allow your stomach muscles to
relax.

7. LEGS
Tense your legs by stretching them out and pointing your toes
down towards the floor. Hold for a count of 5 and then relax.
PHYSICAL EXERCISE
Some people find that PHYSICAL EXERCISE is as effective as
systematically tensing and relaxing their muscles. After all, physical
exercise does exactly the same thing – it tenses then relaxes your
muscles.
Going for a walk, going running or going swimming can help you get
rid of any angry or anxious feelings.
If physical exercise works for you, then use it! It may be particularly
useful to try it at those times when you notice strong unpleasant
feelings.
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CONTROLLED BREATHING
When someone becomes frightened they start to breathe more quickly
so that oxygen is pumped more quickly round the body. However,
breathing too fast or too deeply can lead to more symptoms of panic,
such as faintness, tingling and dizziness.
If breathing can be
controlled, these symptoms may be reduced. You must breathe more
slowly. If you breathe calmly and slowly for at least 3 minutes, the
alarm bell should stop ringing. This is not as easy as it sounds.
Sometimes in the middle of a panic attack focusing on breathing can
be difficult. One of the effects of over-breathing is that you feel you
need more air, so it is difficult to do something which makes you feel
as though you are getting less!
CONTROLLED BREATHING is a quick method in which you
concentrate and gain control of your breathing. You can use this
method anywhere and often people don’t even notice what you are
doing! To begin with it’s a good idea to practice while you are not
feeling anxious. This technique works much better in the very early
stages of panic. Practice the following as often as you can.
Fill your lungs with air. Imagine you are filling up a
bottle so it fills from the bottom up. Your stomach
should push out too.
Do not breathe in a shallow way, from your chest, or too
deeply. Breathe in through your nose and out through
your mouth.
Slowly draw in a deep breath, hold it for 5 seconds and
then very slowly let it out.
As you breathe, say to yourself ‘relax’.
Keep doing this until you feel calm.
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CALMING PICTURES
Another technique that can be used to reduce anxiety is
VISUALISATION or CALMING PICTURES. With this method you
make yourself feel calmer by thinking about things which you find
relaxing.
Think about your dream place. It could be somewhere you’ve been or
an imaginary place. Imagine a picture of it and make the picture as
real as restful and peaceful as possible. Try to make the picture as
real as you can and think about the following:
WHAT CAN YOU SEE?
e.g. a beautiful beach and
palm trees
WHAT CAN YOU
FEEL?
e.g. the sun
shining on your
face
WHAT CAN YOU
HEAR?
e.g. the sound of the
waves crashing on
the shore
WHAT CAN YOU
SMELL?
e.g. the smell of
tropical flowers
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UNHELPFUL THOUGHTS
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The anxiety response also changes the way we think and the way we
look at what is going on around us. It makes us watch out for
possible dangers around us so we can fight or run away on time. If we
lived in a dangerous jungle it would help us survive, however, it may
become a problem if we get scared in everyday life situtions. In these
situations the anxiety response then makes us think there is danger,
even when there is none.
When we get scared, our minds can be full of all sorts of worrying
thoughts and feelings. It makes it hard to concentrate and think
straight. Sometimes the thoughts are about various problems, but
they are often about the anxiety, particularly the physical anxiety
itself. THESE THOUGHTS CAN ACTUALLY MAKE THE ANXIETY
WORSE.
The most common types of thoughts are listed below. Tick any that
apply to you and write any others in the spaces below.
“I can’t cope”

“I’ll make a fool of myself”
“I’ll faint”

“I’m going mad”



“I’m having a heart attack” 
“I can’t breathe” 
“I’ve got to get out” 
“I’m going to lose control”
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All of these thoughts are very frightening. Anyone thinking these
would feel terrified and that is how these thoughts make the original
symptoms worse. When the symptoms get worse this makes us even
more certain that what we are thinking is true, so we can become even
more frightened, have more terrifying thoughts, and so on…..
Often anxiety symptoms make us feel frustrated or even guilty. Many
people also get frightened that the symptoms will return.
Unfortunately all these feelings cause anxiety and make the original
anxiety worse. This makes us even more frightened, frustrated etc.
REMEMBER THE THINGS YOU THINK CAN MAKE
ANXIETY WORSE AND EVEN TRIGGER IT.
There are at least three things that you can do to help get rid of
unhelpful thoughts:
1. Stop focusing on your body.
2. Distract yourself from unhelpful thoughts.
3. Question and test your unhelpful thoughts.
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STOP FOCUSING
Try to notice whether you are focusing on your symptoms, or scanning
your body for something wrong.
There really is no need to do this and it makes the problem far worse.
It may be useful to use the next technique to stop the habit. In
particular, focus on what is going on outside rather than inside you.
DISTRACTION
This is a very simple but effective technique. Again you need to keep
distracting yourself for at least three minutes for the symptoms to
reduce. There are lots of ways you can distract yourself. For example,
counting the number of red doors you see on your way home, listen
very carefully to someone talking, think of a pleasant scene or your
favourite TV programme, doing sums in your head or singing a song.
Really concentrate on it. The important thing is that your attention is
taken off your body and on to something else. Use whatever works
best for you.
Some people distract themselves by doing something else.
read a book or play a game or have a go on your bike.
Go and
Distraction really does work. Have you ever been in the middle of a
panic attack when something happened that totally took over your
attention e.g. the phone ringing?
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QUESTION YOUR
UNHELPFUL THOUGHTS
Sometimes, rather than distracting yourself from your anxious
thoughts, it is more helpful to challenge them. In the long run it is
more helpful to challenge your worrying thoughts so that you no
longer believe them.
If you are going to change this anxious way of thinking to a way that
is less upsetting, you first need to recognise these anxious thoughts
and then change them to more reasonable thoughts.
1. Next time you feel scared or worried, try to pick out
The thoughts you are having. They will be thoughts
like:
- “I won’t be able to cope”
- “Something bad will happen to me”
- “I’ll never get better”
2. Using the chart on the next page, first write down
the situation in the first column (e.g. going out for a
walk).
3.
Next write down the worrying thoughts you are
having in the second column named ‘frightening
thoughts’.
4. After you have written them down, look at these
anxious thoughts and think about what might not be
true about them.
5.
The next job is to substitute them with more
reasonable, realistic thoughts that don’t make you feel
as worried. It may help to imagine what someone else
might say or think, someone who is good at making
you feel better.
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Try asking yourself the following questions:
What is really the worst
thing that could
happen?
How likely is it that this
will happen?
What else might
happen instead?
What would my mum
or dad tell me to make
me feel better?
What would I
tell a friend who
was feeling
worried about
this situation?
6. Write the answers to these questions in the third
column named ‘new thoughts’.
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SITUATION
(What am I
doing/What is
happening around
me?)
FRIGHTENING
THOUGHTS
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NEW (MORE
REALISTIC)
THOUGHTS
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Avoiding situations that make us feel frightened is natural but makes
us feel worse. In real danger it is good to get away quickly, but when
we feel scared there is often no REAL danger. Avoiding these things
means that we stop ourselves from learning that the situations are
really okay and not going to cause us any harm.
Avoiding a scary situation makes us feel better at first, but then we
will be even more worried about it the next time. The worry about the
situation just gets worse the more we avoid it.
Here are the sorts of situations that some people avoid:
Tick the ones that apply to you and add your own in the spaces below.

Shops 
Crowds
Meeting people

Leaving the house
Heights


Some things are a little less obvious:
Putting things off

Not facing up to difficulties
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We get confidence by doing things. Avoidance means stopping doing
things and leads to LOSS OF CONFIDENCE. Loss of confidence
means more anxiety and feelings of failure. Avoidance can spread to
more and more situations.
It is natural to try to avoid or get away from situations that make you
feel scared or worried. Some situations are difficult to deal with and
will make you feel scared. When you are scared, you feel uneasy and
may have uncomfortable physical sensations (e.g. heart pounding and
butterflies in stomach).
Your first reaction is to escape and avoid getting into a similar
situation again. This way you can prevent scared feelings, but in the
long run you are adding to the problem. By escaping and avoiding
you aren’t getting the chance to learn:
a) How to cope with difficult situations
b) That the scared feelings do not increase to the point
where you lose control or where something dreadful
happens
.
Avoiding situations can become a habit and you may again begin to
avoid more and more situations. As a result you may feel bad for not
being able to do some things. You also miss out on things you would
have enjoyed. After a time you lose more and more confidence in
yourself, which only adds to your problems.
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Exposure is a really good way of dealing with the habit of avoiding. It
means that you face up to your fears and expose yourself to those
situations that you have been avoiding, perhaps for a very long time.
The aim of exposure is to learn that you can in fact cope with the
difficult situations, whether it is going into a park, leaving the house
on your own, or remembering bad things that have happened.
There are some important things to remember about this strategy:
BE SPECIFIC ABOUT WHAT YOU ARE GOING
TO DO e.g. plan to spend one hour in the park or plan to
walk up and down the street three times in one day.
EXPECT TO FEEL ANXIOUS – no one is
expecting that you won’t be worries whilst you are doing
this.
The point is for you to LEARN THAT YOU CAN
COPE with these scared feelings and the situation you
are in.
DO NOT LEAVE THE SITUATION WHEN THE
ANXIETY MOUNTS – put up with those feelings, they will
not harm you and you will begin to feel better if you stay.
Doing this once is not enough.
PRACTISING - repeat the exercise several times.
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KEEP
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