Explains anxiety and panic attacks, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

About anxiety

What is anxiety?

Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future. Anxiety is a natural human response when we perceive that we are under threat. It can be experienced through our thoughts, feelings and physical sensations.

For me, anxiety feels as if everyone in the world is waiting for me to trip up, so that they can laugh at me. It makes me feel nervous and unsure whether the next step I take is the best way forward.

Most people feel anxious at times. It's particularly common to experience some anxiety while coping with stressful events or changes, especially if they could have a big impact on your life.

What is the 'fight, flight or freeze' response?

Like all animals, human beings have evolved ways to help us protect ourselves from danger. When we feel under threat our bodies react by releasing certain hormones, such as adrenaline and cortisol. These hormones:

make us feel more alert, so we can act faster
make our hearts beat faster, quickly sending blood to where it's needed most.

After we feel the threat has passed, our bodies release other hormones to help our muscles relax. This can sometimes cause us to shake.

This is commonly called the ‘fight, flight or freeze’ response – it’s something that happens automatically in our bodies, and we have no control over it.

Going out of the house is a challenge because I [have a] fear of panicking and feel that I'm being watched or judged. It's just horrible. I want to get help but I'm afraid of being judged.

When is anxiety a mental health problem?

Anxiety can become a mental health problem if it impacts on your ability to live your life as fully as you want to. For example, it may be a problem for you if:

your feelings of anxiety are very strong or last for a long time
your fears or worries are out of proportion to the situation
you avoid situations that might cause you to feel anxious
your worries feel very distressing or are hard to control
you regularly experience symptoms of anxiety, which could include panic attacks
you find it hard to go about your everyday life or do things you enjoy.

If your symptoms fit a particular set of medical criteria then you might be diagnosed with a particular anxiety disorder. But it's also possible to experience problems with anxiety without having a specific diagnosis. Our pages on self-care and treatment for anxiety problems offer suggestions for help and support.

What do anxiety problems feel like?

Watch Lewis, Polly, Faisal, Shelley and Brian talk about what living with anxiety problems feels like for them, and what helps them cope:

listen to Talking about anxiety on Audioboo

Read a transcript of Heart FM DJ Matt Wilkinson talking about his experience of anxiety and panic attacks.

You know that feeling when you’re rocking on the back legs of your chair and suddenly for just a split second you think you’re about to fall; that feeling in your chest? Imagine that split second feeling being frozen in time and lodged in your chest for minutes/hours/days, and imagine with it that sense of impending doom and dread sticking around too, but sometimes you don’t even know why.

What does anxiety feel like?

Anxiety feels different for everyone. You might experience some of the things listed below, and you might also have other experiences or difficulties that aren't listed here.

Effects on your body

a churning feeling in your stomach
feeling light-headed or dizzy
pins and needles
feeling restless or unable to sit still
headaches, backache or other aches and pains
faster breathing
a fast, thumping or irregular heartbeat

sweating or hot flushes
problems sleeping
grinding your teeth, especially at night
nausea (feeling sick)
needing the toilet more or less often
changes in your sex drive
having panic attacks.

Watch Alex talk about the physical impact anxiety has on his body in this video:

Effects on your mind

feeling tense, nervous or unable to relax
having a sense of dread, or fearing the worst
feeling like the world is speeding up or slowing down
feeling like other people can see you're anxious and are looking at you
feeling like you can't stop worrying, or that bad things will happen if you stop worrying
worrying about anxiety itself, for example worrying about when panic attacks might happen
wanting lots of reassurance from other people or worrying that people are angry or upset with you
worrying that you're losing touch with reality

rumination – thinking a lot about bad experiences, or thinking over a situation again and again
depersonalisation – feeling disconnected from your mind or body, or like you're watching someone else (this is a type of dissociation)
derealisation – feeling disconnected from the world around you, or like the world isn't real (this is a type of dissociation)
worrying a lot about things that might happen in the future – you can read more about these sorts of worries on the Anxiety website.

(See our pages on sleep problems, panic attacks and dissociative disorders for more information about these topics, and tips on how to cope.)

I could feel all these physical symptoms building inside me, literally filling every part of my body until I felt completely light-headed and disembodied.

Anxiety and physical health problemsSome studies suggest that experiencing anxiety could increase the risk of developing certain long-term physical health problems, including diabetes, stomach ulcers and heart problems. But there's not enough evidence to say for sure exactly what the risks are, or what groups of people are most likely to be affected. Having a physical illness or disability can also make you feel stressed and anxious, so it might sometimes feel like your anxiety problems and physical health problems are part of a vicious circle.

Sometimes it might be difficult to work out whether your symptoms are totally related to anxiety, or might be related to a different illness. If you're experiencing any physical symptoms it's best to talk to your GP, so they can check out what may be causing them.

I constantly thought I was dying of undiagnosed illnesses, because I was convinced that the physical symptoms were too bad to be ‘just anxiety’.

How else might anxiety affect my life?

Anxiety symptoms can last for a long time, or come and go. You might find you have difficulty with day-to-day aspects of your life, including:

looking after yourself
holding down a job
forming or maintaining relationships
trying new things
simply enjoying your leisure time.

Read's Max's blog about the impact of social anxiety when he started University, and how he confronted it.

In some cases anxiety can have a serious impact on your ability to work. (See our pages on how to be mentally healthy at work for information on how to cope. Our legal pages on discrimination at work can provide information about your rights in the workplace.)

If you drive you may have to tell the DVLA that you have anxiety.

What causes anxiety?

No one knows exactly what causes anxiety problems, but there probably lots of factors involved. This page covers some things which make anxiety problems more likely to happen:

Can anxiety problems be inherited genetically?

Research shows that having a close relative with anxiety problems increases your chances of experiencing anxiety problems yourself. But at the moment there is not enough evidence to show whether this is because we share some genetic factors that make us more vulnerable to developing anxiety, or because we learn particular ways of thinking and behaving from our parents and other family members as we grow up.

Past or childhood experiences

Difficult experiences in childhood, adolescence or adulthood are a common trigger for anxiety problems. Going through stress and trauma is likely to have a particularly big impact if it happens when you're very young. Experiences which can trigger anxiety problems include things like:

physical or emotional abuse
neglect
losing a parent
being bullied or being socially excluded.

Having parents who don't treat you warmly, are overprotective or are emotionally inconsistent can also be a factor.

I was sent to boarding school and suffered acute separation anxiety, being away from home, and my brother nearly died when I was 12. My mum had an acute breakdown for a period of about a year and had to be home-nursed.

Your current life situation

Current issues or problems in your life can also trigger anxiety. For example:

exhaustion or a build up of stress
long working hours
being out of work
feeling under pressure while studying or in work
having money problems
homelessness or housing problems
losing someone close to you
feeling lonely or isolated
being bullied, harassed or abused.

(See our pages on managing stress, staying mentally well at work, student wellbeing, money, housing, bereavement, loneliness and abuse for more information and sources of support on these issues.)

I have recently realised that I spend money when anxious, which in turn makes me feel anxious about how much I’m spending.

Physical or mental health problems

Other health problems can sometimes cause anxiety, or might make it worse. For example:

Physical health problems – living with a serious, ongoing or life-threatening physical health condition can sometimes trigger anxiety.
Other mental health problems – it's also common to develop anxiety while living with other mental health problems, such as depression.

Drugs and medication

Anxiety can sometimes be a side effect of taking:

some psychiatric medications
some medications for physical health problems
recreational drugs or alcohol.

(See our pages on psychiatric drugs and recreational drugs and alcohol for more information. You can also report medication side effects on the government's Yellow Card website.)

Could diet be a factor?
Some types of food or drink can trigger symptoms of anxiety or panic, or make them worse. These include sugar and caffeine. (See our pages on food and mood for more information about the relationship between what you eat and how you feel.)

I have… cut out alcohol. Many think [drinking alcohol] helps with anxiety, but it actually makes it worse in the long run.

What are anxiety disorders?

Anxiety can be experienced in lots of different ways. If your experiences meet certain criteria your doctor might diagnose you with a specific anxiety disorder.

Some commonly diagnosed anxiety disorders are:

Generalised anxiety disorder (GAD) – this means having regular or uncontrollable worries about many different things in your everyday life. Because there are lots of possible symptoms of anxiety this can be quite a broad diagnosis, meaning that the problems you experience with GAD might be quite different from another person's experiences.

Social anxiety disorder – this diagnosis means you experience extreme fear or anxiety triggered by social situations (such as parties, workplaces, or any situation in which you have to talk to another person). It is also known as social phobia. (See our page on types of phobia for more information.)

Panic disorder – this means having regular or frequent panic attacks without a clear cause or trigger. Experiencing panic disorder can mean that you feel constantly afraid of having another panic attack, to the point that this fear itself can trigger your panic attacks. (See our page on panic attacks for more information.)

Phobias – a phobia is an extreme fear or anxiety triggered by a particular situation (such as social situations) or a particular object (such as spiders). (See our pages on phobias for more information.)

Post-traumatic stress disorder (PTSD) – this is a diagnosis you may be given if you develop anxiety problems after going through something you found traumatic. PTSD can cause flashbacks or nightmares which can feel like you’re re-living all the fear and anxiety you experienced during the actual event. (See our pages on PTSD for more information.)

Obsessive-compulsive disorder (OCD) – you may be given this diagnosis if your anxiety problems involve having repetitive thoughts, behaviours or urges. (See our pages on OCD for more information.)

Health anxiety – this means you experience obsessions and compulsions relating to illness, including researching symptoms or checking to see if you have them. It is related to OCD. (You can find out more about health anxiety on the Anxiety UK website.)

Body dysmorphic disorder (BDD) – this means you experience obsessions and compulsions relating to your physical appearance. (See our pages on BDD for more information.)

Perinatal anxiety or perinatal OCD – some women develop anxiety problems during pregnancy or in the first year after giving birth. (See our pages on perinatal anxiety and perinatal OCD for more information.)

You might not have, or want, a diagnosis of a particular anxiety disorder – but it might still be useful to learn more about these different diagnoses to help you think about your own experiences of anxiety, and consider options for support.

Read Zoe's blog about her experience of being diagnosed with generalised anxiety disorder (GAD) after her Dad passed away.

[It's like] like a swarm of bees just buzzing buzzing buzzing, not stopping, making it impossible to focus and seemingly impossible to slow down and take a breath.

Anxiety and other mental health problems

It's very common to experience anxiety alongside other mental health problems, such as depression or suicidal feelings. If you have symptoms of both anxiety and depression but don't fit one more clearly than the other, you might be given a diagnosis of mixed anxiety and depressive disorder.

(See our pages on depression and coping with suicidal feelings for more information on these topics.)

Read Pete's blog about living with anxiety and bipolar disorder.

I have generalised anxiety disorder and depression which seem to come in cycles. It is the unexpected attacks that I find the hardest.

What is a panic attack?

Panic attacks are a type of fear response. They're an exaggeration of your body's normal response to danger, stress or excitement.

I can’t sleep due to panic attacks and nightmares. When I fall asleep within an hour I am up, soaked, heart racing and shaking.

What do panic attacks feel like?

During a panic attack, physical symptoms can build up very quickly. These can include:

a pounding or racing heartbeat
feeling faint, dizzy or light-headed
feeling very hot or very cold
sweating, trembling or shaking
nausea (feeling sick)
pain in your chest or abdomen
struggling to breathe or feeling like you're choking
feeling like your legs are shaky or are turning to jelly
feeling disconnected from your mind, body or surroundings (these are types of dissociation – see our pages on dissociative disorders for more information).

During a panic attack you might feel very afraid that you're:

losing control
going to faint
having a heart attack
going to die.

My teeth would chatter uncontrollably and my whole body [would] tremble, I’d hyperventilate and cry with panic as the feeling that I was going to fall unconscious was so convincing.

You might find that you become scared of going out alone or to public places because you're worried about having another panic attack. If this fear becomes very intense, it may be called agoraphobia (see our pages on phobias for more information).

I felt like I couldn't breathe, I just wanted to get out, to go somewhere else, but I couldn't because I was on a train.

Watch Polly, Lewis, Faisal, Brian and Shelley share how panic attacks feel for them, and talk about what helps:

When might I have panic attacks?

Panic attacks can happen during the day or night. Some people have one panic attack then don't ever experience another, or you might find that you have them regularly, or several in a short space of time. You might notice that particular places, situations or activities seem to trigger panic attacks. For example, they might happen before a stressful appointment.

Most panic attacks last between 5–20 minutes. They can come on very quickly. Your symptoms will usually peak (be at their worst) within 10 minutes. You might also experience symptoms of a panic attack over a longer period of time. This could be because you're having a second panic attack, or you're experiencing other symptoms of anxiety.

My panic attacks seem to come out of the blue now. But in fact, they seem to be triggered mainly at night when I want to go to sleep but cannot stop my mind racing, experiencing worry and panic about anything that may be on my mind.

What helps to manage panic attacks?

Panic attacks can be frightening, but there are things you can do to help yourself cope. It could help to keep print these tips out and keep them somewhere easy to find.

During a panic attack:

Focus on your breathing. It can help to concentrate on breathing slowly in and out while counting to five.
Stamp on the spot. Some people find this helps control their breathing.
Focus on your senses. For example, taste mint-flavoured sweets or gum, or touch or cuddle something soft.
Try grounding techniques. Grounding techniques can help you feel more in control. They're especially useful if you experience dissociation during panic attacks. (See our page on self-care for dissociative disorders for more information on grounding techniques.)

After a panic attack:

Think about self-care. It's important to pay attention to what your body needs after you've had a panic attack. For example, you might need to rest somewhere quietly, or eat or drink something.
Tell someone you trust. If you feel able to, it could help to let someone know you've had a panic attack. It could be particularly helpful to mention how they might notice if you're having another one, and how you'd like them to help you.

(See our pages on self-care for anxiety and treatments for anxiety for more information on what could help.)

Read Hannah's blog about how she's coped with panic attacks and social anxiety.

What is panic disorder?

If you're having lots of panic attacks at unpredictable times and there doesn't seem to be a particular trigger or cause, you might be given a diagnosis of panic disorder. It's common to experience panic disorder and agoraphobia (a type of phobia) together. People who experience panic disorder may have some periods with few or no panic attacks, but have lots at other times.

Panic disorder and high sensitivity
Some research suggests that people who have panic disorder might be very sensitive to sensory experiences (such as sunlight, smells and changes in the weather), but there's not enough evidence yet to say for sure. Also it's not clear whether having a high level of sensitivity to these sorts of things is something that might cause you to develop panic disorder, or whether it may be an effect of having it.

Never knowing when I was going to [have] a panic attack was the worst feeling in the world.

What treatments are available?

There are various evidence-based treatments that have been found to help with anxiety problems and panic disorder. This page covers:

Self-help resources

A self-help resource might be the first treatment option your doctor offers you. This is because it's available quite quickly, and there's a chance it could help you to feel better without needing to try other options.

Self-help could be delivered through:

Workbooks. For example, your GP might recommend particular titles from a scheme called Reading Well Books on Prescription. This scheme is supported by most local libraries, so you can go and check the books out for free – you don't actually need a prescription from a doctor. (Find out more on the Reading Well website).
A computer-based CBT programme for treating anxiety, panic and phobias, such as Fearfighter. Fearfighter costs money if you use it privately, but in some areas it's free to use on the NHS with a referral from your GP. (Read more about Fearfighter on the NHS website.)

You might be offered a resource to work through your own, or on a course with other people who experience similar difficulties.

Talking treatments

If self-help resources aren't likely to help with the anxiety problems you're experiencing, or you've already tried them and they haven't helped, your doctor should offer you a talking treatment. There are two types of talking treatment recommended for anxiety and panic:

Cognitive behavioural therapy (CBT) – this focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems.
Applied relaxation therapy – this involves learning how to relax your muscles in situations where you normally experience anxiety.

(See our pages on talking treatments and CBT for more information on these and other kinds of therapy.)

Read Sarah's blog about how doing a course of CBT helped her manage her anxiety disorder.

I was diagnosed with generalised anxiety disorder, depression and OCD traits. I had cognitive behavioural therapy for almost a year, which was very helpful.

Medication

Your doctor might offer to prescribe you medication to help manage some symptoms. Some people find it helpful to try talking treatments and medication at the same time, but medication shouldn't be the only thing you're offered.

Medications you might be offered include:

Antidepressants. Usually this will be a type called a selective serotonin reuptake inhibitor (SSRI), but these drugs can sometimes cause side effects such as sleeping problems or feeling more anxious than you did before. If SSRIs don't work or aren't suitable you may be offered a different kind called a tricyclic antidepressant. (See our pages on antidepressants for more information.)
Pregabalin. In some cases, such as if you have a diagnosis of generalised anxiety disorder (GAD), your doctor may decide to prescribe you a drug called pregabalin. This is an antiseizure drug which is normally used to treat epilepsy (a neurological disorder that can cause seizures), but is also licensed to treat anxiety. (See our pages on anti-anxiety medication and pregbalin more more information.)
Beta-blockers. Beta-blockers are sometimes used to treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations and tremors (shaking). However, they are not psychiatric drugs so they don’t reduce any of the psychological symptoms. They may be helpful in certain situations, such as if you have to face a phobia (see our page on treatment for phobias for more information).
Benzodiazepine tranquillisers. If you experience very severe anxiety that is having a significant impact on your day-to-day life, you may be offered a benzodiazepine tranquilliser. But these drugs can cause unpleasant side effects and can become addictive, so your doctor should only prescribe them at a low dose for a short time, to help you through a crisis period. (See our page about benzodiazapines for more information.)

Before deciding to take any drug, it's important to make sure you have all the facts you need to make an informed choice. See our pages on things to consider before taking medication and your right to refuse medication for more information. Our pages on coming off medication give guidance on how to come off medication safely.

I take medication and this helps, but I have also had online [cognitive behavioural therapy] which was invaluable and [cognitive analytic] therapy as an outpatient at a psychiatric hospital. Talking cures are fantastic tools.

How do I access treatment?

To get treatment on the NHS, the first step is normally to visit your doctor (also known as your GP). They will do an assessment, which might include asking you to fill in a questionnaire about how often you feel worried, anxious and nervous. They should then explain your treatment options to you, and you can decide together what might suit you best. (See our pages on seeking help for a mental health problem for more information on how to prepare for an appointment and having your say in treatment.)

Unfortunately NHS waiting lists for talking treatments can be very long. If you're finding it hard to access talking treatments you could consider:

Charities and specialist organisations. See useful contacts for a list of organisations that may offer therapy or be able to put you in touch with local services. Mind's Infoline could also help you find services near you.
Private therapy. Finding a private therapist is another option some people choose to explore, but it's not suitable for everyone because it can be expensive. (See our page on private treatment for more information.)

What if my anxiety stops me from seeking help?It can be especially hard to access treatment if making or attending an appointment with your doctor involves doing something that causes anxiety for you. For example, you might not feel able to talk on the phone or leave the house.

Here are some things you could try:

Ask your doctor if they offer home visits or telephone assessments. If not, they might be able to book you an appointment at a time when the surgery tends to be quiet.
Some GP practices will allow someone else to ring up and book appointments for you (with your consent). It could also help to have someone come with you to the appointment for support.
Depending on what's available in your area, you may be able to refer yourself for talking treatment at a local Improving Access to Psychological Therapies (IAPT) service. Some IAPT services are delivered over the phone.

If you don’t know what is wrong with you, how do you know how to fix it? For me, actually being diagnosed with anxiety and panic disorder came as a relief! It meant that I wasn’t imagining the awful symptoms I’d been experiencing.

What if I don't feel better?

Your doctor should offer you regular appointments to check how you're doing, and see how well any treatment is working for you. Different things work for different people, so if a particular medication or talking treatment doesn't work for you, your doctor should offer an alternative.

If you've tried a range of treatments and none of them have helped, your doctor might refer you to a community mental health team (CMHT). This is is made up of a number of different healthcare professionals, such as psychiatrists and clinical psychologists. Your CMHT can assess you separately and offer you a personalised treatment plan.

This is particularly recommended if:

your symptoms are making it very difficult to carry out everyday activities
you have a serious physical health problem or another mental health problem
you're having thoughts of self-harm or suicide.

It's important to remember that recovery is a journey, and it won't always be straightforward. You might find it more helpful to focus on learning more about yourself and developing ways to cope, rather than trying to get rid of every symptom of your anxiety problem.

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Anxiety and panic attacks