Anxiety

Anxiety is the word we often use to describe our feelings when we are worried, tense, or afraid. Often we use the word to express how we feel about things that are about to happen, or which we think could take place.

Anxiety can lead us to experience physical sensations, like shortness of breath, and can make us change our behaviours in response. For example, if we are feeling anxious we might act overly careful, or avoiding things that we think might make us feel more anxious.

Experiencing feelings of anxiety is very common, and everyone feels this emotion from time-to-time. Even people who seem confident and positive on the outside might experience anxiety.

It takes courage and strength to acknowledge that you are struggling with your emotions, but remembering that anxiety is a normal human experience (particularly during stressful periods) can be helpful.

The ability to experience anxiety is a natural part of the way we keep ourselves safe. When we feel like we might be in danger our brain tells our body to get ready to deal with it immediately. As a result, you can experience a range of different feelings in your mind and body, and this can also lead to changes in your behaviour.

Anxiety is felt differently by everyone, but some commonly described feelings are listed below:

In your body (physically) you may experience:

• Breathing more quickly (shallow, short breaths)
• Feeling faint, lightheaded or having shaky legs
• Racing heart
• Feeling sick and having a churning or upset stomach 
• Restlessness or fidgetiness
• Tense and tight muscles
• Headaches
• Insomnia (trouble sleeping)

In your mind (psychologically) you may experience:

• Intensely worrying thoughts
• Feelings of anger or upset
• Feeling afraid, as if something awful might happen
• Intrusive thoughts (unpleasant thoughts that you can’t get rid of) that keep coming back

In your actions (behaviour) you may experience:

• Repeatedly checking things
• Seeking reassurance from others
• Putting off doing things
• Avoiding certain situations or things

We all experience anxiety, but like most human traits how we experience anxiety varies from person to person. Some people don’t get anxious very often, whilst other people can imagine lots of things to worry about.

Some people experience anxiety when doing or thinking about doing certain activities, or being in certain situations. For example, hanging out in big groups, attending assembly, or taking public transport. Certain school subjects may also be more challenging, like drama, or having to read aloud in class. People can develop avoidance behaviours, or rely on having a ‘safe space,’ like their bedroom.

Some people experience a continuous feeling of anxiety, and have worrying thoughts about many different things, which may feel difficult to control.

Some people experience an intense fear of particular objects, places, or situations. This is commonly referred to as a phobia. When someone has a phobia they will experience a very high sense of danger around the thing they have a phobia about.

Others can experience upsetting and intrusive thoughts or pictures in their mind, which can develop into a mental health condition called obsessive-compulsive disorder (OCD). People with OCD may get urges to do things that they feel they are unable to resist. They may feel the need to carry out certain behaviours to try and stop these distressing thoughts and get a feeling that something bad may happen if they don’t do them.

Some people experience episodes of panic, called panic attacks, where their feelings of anxiety become overwhelming. Panic attacks are usually short lived but intense. During a panic attack, as well as feelings of anxiety, the person might have frightening thoughts (like feeling as though something terrible may happen).

For most people feeling more anxious than usual is something they can manage and is part of the ordinary stresses and strains of growing up and being human. Sometimes anxiety becomes more persistent and has a significant on-going impact upon day-to-day life. If this happens to you, getting further information or support could be helpful. 

There are lots of different reasons someone may experience anxiety, but it’s hard to know exactly what causes it for any one person.

Having a close family member with anxiety can increase your chances of experiencing anxiety, but doesn’t mean you will automatically have those worries yourself.

We do know that challenging or difficult life experiences increase the likelihood of developing anxiety. Some examples of these challenges are given below. Remember though, we all react differently to our life experiences and something that makes one person anxious won’t necessarily cause anxiety in someone else.

Things that might increase your likelihood of getting longer lasting anxiety include:

• Lots of change or uncertainty in your life
• Ongoing family conflict
• Problems with housing, such as eviction, or not having a permanent address
• Problems with money, like your parents not being able to afford to pay bills or rent
• Someone close to you dying (bereavement)
• Experiencing a distressing or traumatic event (like being assaulted or being in a car accident)
• Worries about issues in the news (for example the environment or wars)
• Bullying, discrimination, and exclusion (in person and on the internet)
• Stress caused by exams or school work
• Ongoing physical health problems
• Using recreational drugs, medications and alcohol
• Big changes in your day-to-day life
• Physical, sexual or emotional abuse, and neglect (a persistent lack of love, care, and attention)

If you are experiencing (or have experienced) abuse of any kind and feel in current danger, call the police immediately.

If you feel unable to do that, we encourage you to reach out to an adult you trust (like a teacher, family member or doctor) or contact a support service, such as Childline to get further advice and support. You can find out more about services available at the end of this resource.

The ‘fight, flight or freeze response’

It can help to learn a bit about anxiety and how it works. An important part of anxiety is the ‘fight, flight or freeze response’ (also known as the stress response).

Many thousands of years ago, humans faced many dangers from our environment, including from predator animals and other humans. In order to survive, our bodies have been designed with an alarm system to protect us from any possible danger. When this system is activated, our body gets ready to fight, run away or freeze.

When this system is activated, it causes an increase in our heart rate and breathing, directing energy to our muscles. Our thoughts become quicker so we can scan the environment for signs of danger and react quickly. Sometimes our body can also ‘freeze’ and stop moving so as not to alert the predator to where we are.

Nowadays we don’t have to worry as much about these physical dangers, but our body is still using the same alarm system. It might be more likely to be triggered by things we see as psychological dangers, such as a fear of being judged or failing.

This is why anxiety is not an illness or disease, but a normal part of our biology. It can, however, become a problem to us when our worries stop us from being able to function and get on with the things we want to do. 

Find out more about the ‘fight, flight or freeze response’.

Facing your fears

We can help to overcome our anxieties by facing the things we are afraid of.

Gradually

Some people face their fears gradually. For example, if you have a fear of dogs that you want to get rid of, you could take several steps to help you get used to dogs:

• you could start by looking at pictures of dogs
• once you’re comfortable with this, you could watch videos of dogs
• then you could visit a friend who has a dog
• finally, you could practice going to a park where less familiar dogs are present

Head on

Other people prefer to face their fears head on. In the example of a fear of dogs, this would mean going to the park where there are dogs and staying there until your fear starts to reduce.

There is a simple biological reason why these methods work. When we are scared of a thing, place or situation, it is usually because we feel something bad will happen if we are exposed to it. If we can spend time doing the thing we are scared of and the bad thing doesn’t happen, we can start to believe that the bad thing probably won’t happen after all, and our stress response will reduce.

Using the example of a fear of dogs, some people are scared of dogs because they are worried they will be bitten or attacked. By spending time around dogs and proving to yourself that you are unlikely to be bitten or attacked, the stress response in your body will naturally reduce.

Doing this can seem quite scary at first, but the more times you do it, the more your body and mind will get used to the feelings and the stress response will eventually become less powerful.

Focusing on your breathing and your body

Breathing exercises

Some people find simple breathing exercises can help them reduce or get rid of their stress response. Here are two exercises you might find helpful:

• 4-7-8 breathing
• Box breathing

Don’t do either of these exercises if they cause you to feel out of breath, lightheaded or uncomfortable.

Exercise and getting the body moving

Some people find activity or exercise helps their body to relax and reduces their stress response.

This could mean going for a short walk or a run, marching on the spot or doing star jumps. All of these activities can help to reduce tension in your muscles, helping you to calm down when your anxiety levels are high.

The website Open Minded Online has many examples of exercises that you may find useful, including power punching, yoga punching, face self-message, chair yoga, tension release exercises, and brain ‘gym’. Find out more here.

Focusing on the here and now

Bringing your mind into the present and focusing on the here and now can help reduce your stress response. One particular method that can be helpful involves using your five senses to help focus your attention on the present. This is done by naming:

• Five things you can see
• Four things you can touch
• Three things you can hear
• Two things you can smell
• One thing you can taste

This can help to refocus your thoughts away from the anxiety. 

Creating a ‘calm box’ can also help with focusing on the here and now. Fill a box with things that you associate with feeling happy and calm. You could include photos of your pets or friends, objects that you can fidget with (like stress balls or puzzles) and anything else you associate with feeling calm.

Distracting yourself with your favourite music, games, or films can also be helpful.

Expressing how you feel

Talking it through

Sharing your worries with family, friends or a counsellor can help to reduce feelings of anxiety. It can also help to reduce feelings of isolation and help you to connect with others who might have had similar experiences and have advice to share.

Keeping a journal

Some people find recording how they are feeling and what’s been happening in their life helpful. Getting things down on paper can help you get your feelings out, reflect on your experiences and work out what is causing your worries. It can also give you space to think about ways you could tackle things that have become a worry.

Setting time aside to address your worries

Setting time aside to focus on your worries can help you to let go of your worries for the rest of the day. Some people like to keep a ‘worry pot’, where they can store the concerns they have written down, and then only open the worry pot when it is the set ‘worry time’.

With anything you decide to try, it’s always good to remember that we all need the help of others at times throughout our lives. Don’t feel afraid to open up and share the way you are feeling.

If your anxiety is causing you a lot of problems, getting some professional support may be helpful. You may want to speak to your GP about how you are feeling. They will have a discussion with you about the options available, and help you decide which is the most suitable for you. These include:

Child and Adolescent Mental Health Services (CAMHS)

CAMHS have a range of different specialists working in them, all with training in child and adolescent mental health problems. Different teams have a variety of different professionals, including psychiatrists, psychologists and nurses. They provide specialist assessments and make recommendations for treatment.

Paediatrics

Paediatricians are doctors who assess and treat young people, usually from birth to 16 years of age. Your GP may refer you to a paediatrician if they are concerned that you have an underlying physical health condition that might be linked to your mental health and needs to be assessed (for example fainting could be due to anxiety, but it may also be due to a physical illness that needs to be diagnosed and treated).

Schools

If your problem is mainly school based, then it may be best to approach the school or local education authority to help resolve it. Schools often have specific services that can help. These include school-based therapy or counselling, educational psychologists, and other teams with a specific responsibility (i.e. behavioural problems, autism, or learning difficulties).

All schools and education authorities should have policies and procedures for issues like bullying or getting extra support in class.

Social services

Social services can offer practical support to families, particularly where they have children with learning disabilities. This can include funding to access services or social activities, fostering and adoption support, and support and advice for parents. They also have a specific duty to safeguard children and as a result are involved in organising child protection processes where there is a concern about the safety and welfare of a young person.

Charity services

Charities offer services to support people with their mental health, though these services will vary depending on where you live. Some organisations may have been set up to support the needs of particular groups. For example ethnic minority communities, or families of children with specific conditions. Others may be national, such as YoungMinds, Relate, Childline and the National Autistic Society.

Private therapy

Some people choose to pay for private therapy. Private therapists can give counselling, behavioural therapies, psychodynamic therapies, humanistic therapy, family and systemic therapies, and many others.

Costs vary, but are often between £40 and £100 per session. Some private therapy services offer reduced rates to people who are on a lower income.

If you are using a private therapist, you should make sure that they belong to a registered accreditation institution, such as BACP (British Association for Counselling and Psychotherapy) or ACP (Association of Child Psychotherapists).

It’s good to avoid working with two different therapists at the same time, unless they are from the same team and work closely together. This is because different therapists can use different methods that don’t work well together.

• Childline – A source of information and support for any concerns a young person may be experiencing. You can phone for free and confidential advice on 0800 1111 or contact them by email/message board.
• Young Minds – Provides information and advice for young people and their parents about young people’s mental health.
• Mind - Provides advice and support to empower anyone experiencing mental health problems.
• Anxiety UK - Provides information and support for people suffering with anxiety problems.
• Youth Access - Offers information, advice, and counselling. They will also help you find local support services in your area.

Video links from:

• Fablefy - The Whole Child
• Sunnybrook Hospital
• Anxiety Canada
• Minded Online

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Marianne Hilton, Dr Sami Timimi and Dr Tze Hui Phang

Special thanks to the young people who provided feedback on the contents of this resource.

Full references for this resource are available on request.