In this month’s instalment of the Exploring Mental Health series, we’re looking at anxiety. Anxiety is something we all experience at some point during our lives, often at times of change or as a result of stressful events. But when does anxiety become a mental health problem, what are the symptoms to look out for, and how can you manage your anxiety?
 
When is anxiety a mental health problem?
 
Feeling anxious is a normal emotion that everyone experiences sometimes. It’s our body’s response to stressful situations or events, and is usually temporary.
 
Anxiety becomes a mental health problem when feelings of anxiety, worry or fear don’t go away, and you experience them all or most of the time, even when there doesn’t seem to be a particular cause.
 
If you can answer yes to any of the following, your anxiety may have become a mental health problem:

• It has become hard to control your worries
  
• Your feelings of anxiety are strong and it’s difficult to relax
  
• You’ve felt anxious for a long period of time
  
• You’re avoiding situations because they make you feel anxious
  
• You’re not getting pleasure from things you usually enjoy
  
• Your feelings of anxiety are affecting your daily life
  
• There doesn’t seem to be a particular cause for your anxiety
  
• You regularly experience anxiety symptoms
  

 
If any of these sound familiar, the first step is to visit your GP. They can provide a diagnosis and offer advice on getting support and treatment. There are also some tips on how to manage your anxiety below.
 
What are the symptoms of anxiety?
 
Anxiety can affect our bodies and minds in lots of different ways. Some of the most common symptoms are:
 
Physical symptoms

• Feeling light-headed or dizzy
• Feeling sick
• Needing to use the toilet more/less frequently
• A fast or irregular heartbeat
• Faster, shallower breathing (hyperventilating)
• Tightness in your chest
• Shaking
• Tingling in parts of your body
• Pins and needles
• Headaches or aches in other parts of your body
• Increased sweating or hot flushes
• A dry mouth
• Grinding your teeth
• Feeling restless
• Having panic attacks
  

 
Cognitive symptoms

• Thinking you might die
• Thinking you have a serious health condition
  
• Thinking you might lose control
• Thinking others can see your anxiety and are looking at you
• Feeling disconnected from the world around you
• Feeling disconnected from your body or mind
• Feeling a sense of dread and fearing the worst
• Worrying about ‘what ifs’ and things that might happen
• Thinking about a situation over and over again
• Wanting to run away or escape from the situation
• Feeling alert and on edge

 
How to manage your anxiety
 
There are lots of things you can do to control and reduce your anxiety, including:

• Visit your GP – your doctor can give you advice on getting support and treatment

 

• Take medication – in some cases, your GP might prescribe medication to help control your anxiety symptoms

 

• Have counselling – talking to a counsellor can help you identify the causes and triggers for your anxiety, and find ways to reduce and manage it. If you’d like to make an appointment to discuss your anxiety, get in touch.
  

 

• Talk to someone you trust – this might be a friend, colleague or family member. Opening up about how you’re feeling can create a support network for when you’re finding things tough

 

• Contact support organisations – organisations such as Samaritans and Anxiety UK have helplines you can call when you need support
  

 

• Join online support groups or forums –these give you the chance to link up with others who understand what you’re experiencing

 

• Keep a journal or diary – this can help you to identify triggers for your anxiety and learn any early warning signs. You can also use it to remind yourself of all the good, positive things in your life, which anxiety can often make you overlook

 

• Plan ‘worry time’ – set aside an amount of time each day to think about what’s worrying you. Between these times, tell yourself to let go of those thoughts until your next worry time. This can feel challenging but also give a greater sense of control over your anxiety

 

• Look after your physical health – a good diet, limiting alcohol and caffeine, getting enough sleep, and exercising regularly can all help to improve your mental wellbeing

 

• Practice mindfulness – relaxation techniques, such as mindfulness, can help to bring you back into the present moment and interrupt anxious thoughts about ‘what ifs’, creating a sense of calm. They can also teach you breathing techniques to help control your anxiety symptoms
  

 
It’s important to note not all of these tips will feel helpful for everyone. We’re each individual, so it’s about trying different ways to manage your anxiety until you find the ones that work best for you.
 
If you’d like to make an appointment to talk about your anxiety, find out how to get in touch.

This year’s Mental Health Awareness Week is focusing on body image. Running from 13th-19th May, the aim is to increase awareness of how we think and feel about our bodies, and how that affects our mental health.
 
What is body image?
 
Body image refers to how we see our bodies, and what we feel about them. This can be our body size or shape, skin colour, appearance, facial features or physical disabilities. It’s also how we believe others see us.
 
What influences body image?
 
Often, we hold an image in our head of what our bodies “should” look like. This image may come from seeing pictures of people on social media, or in films, music videos, on television or in magazines.
 
Our ideal image of ourselves may also be the result of comments from family and friends, or from childhood or adult bullying.
 
Cultural expectations, as well as those related to our age and gender, also play a part in creating our view of what our bodies “should” look like.
 
How does body image affect mental health?
 
When we look at ourselves in the mirror and we don’t see our ideal body, it can create feelings of disappointment, shame and distress.
 
The latest body image report by the Mental Health Foundation has found over a third of all adults have felt anxious or depressed because of concerns about their body image, while one in five have experienced shame.
 
Having a negative body image can result in low self-esteem, anxiety and depression. It can also lead to unhealthy exercise and eating patterns. For some, this can develop into eating disorders such as anorexia and bulimia, or into body dismorphic disorder.
 
How to improve your body image

It’s important to your mental wellbeing to have a positive body image. To help improve how you think and feel about your appearance, try these tips:

• Write down things you like about yourself – these don’t necessarily need to be related to your appearance. Look at the list often to focus on positives, rather than negatives

 

• Don’t dismiss compliments – people give compliments because they notice brilliant things about you. Rather than dismissing them, thank the person, accept the compliment, and write it down to remind yourself of it at difficult times

 

• Stop comparing yourself to others – notice when comparing yourself to others is making you feel worse about your body image. To stop doing this, you may need to…

 

• Change the way you use social media – surrounding yourself with filtered and airbrushed images is unhelpful. Consider unfollowing accounts that show “perfect” bodies, or take a break from using it

 

• Think what you would say to a friend – what would you say to a friend who felt negatively about how they look? Use the same kind, compassionate voice to talk to yourself

 

• Surround yourself with people who make you feel good – if you know people who make you feel worse about your appearance, try to spend less time with them. Focus on relationships that are positive and supportive – people who can be your cheerleaders

 

• Do regular self-care – listen to what your body needs, and look after it. This might be taking a nap, relaxing or having a bath. Doing this shows you love and care for your body

 

• Celebrate your body – think of all the amazing things it’s allowed you to do: your successes, achievements and the things you’ve experienced. Your body is amazing!

 
Seeking help and support
 
If you’re struggling with your body image and it’s affecting your mental health, talk to someone you’re close to, your GP or to a therapist. Talking through your thoughts and feelings can be really helpful, because body image isn’t about how you look, but how you feel about how you look.
 
Visiting your GP is particularly important if you’re concerned you may have an eating disorder or body dismorphic disorder. Your GP will be able to discuss treatment options, which may include medication, therapy or a referral to a specialist service. There may also be local support groups or services your GP can recommend.
 
If you’re experiencing difficulty with your body image and it’s affecting your mental health, get in touch to make an appointment and take a step towards making positive change.

In the previous article of this Exploring Mental Health series, we explored mindfulness – something that would be helpful for managing this month’s topic: panic attacks. Find out what panic attacks are, when they happen and what they feel like. And discover how to manage a panic attack if you experience one.
 
What is a panic attack?

Panic attacks are intense moments of anxiety that can occur suddenly, usually with accompanying physical symptoms.

During a panic attack, your body is in ‘fight or flight’ mode. ‘Fight or flight’ is your body’s automatic response to danger, a response that evolved in humans as a way of protecting us from harm. When we feel under threat, our bodies react by releasing hormones that make us more alert and prepare us to either fight or run. This means we experience physical changes in our body that are designed to increase energy levels and strength so we can survive the threat.

With panic attacks, your body’s ‘fight or flight’ response can be triggered at unpredictable moments, when there is no apparent danger. (Unlike our prehistoric ancestors, our ‘threats’ tend to be stressors such as deadlines and traffic queues, rather than life-threatening situations.) This exaggerated response can be frightening to experience.
 
When do panic attacks happen?
 
Panic attacks can happen without warning. This can be at times when you’re anxious or stressed, or even when you feel relaxed - sometimes even when you’re asleep.
 
Events that trigger feelings of stress or fear may lead to a panic attack, as can experiences such as bereavement, trauma, ill health, redundancy or divorce. Life transitions such as getting married, having a baby or moving house can also be triggers. Panic attacks may also be a side effect of some prescribed medications or drugs, as well as the use of alcohol, nicotine or caffeine.
 
You may experience only a couple of panic attacks in your lifetime, or you may experience them more regularly, Recurrent panic attacks can occur as a result of anxiety or depression, or be triggered by a particular place or situation, particularly if it has triggered a panic attack before. Regular, recurrent panic attacks may be a sign of panic disorder, which you can read more about in ‘When to seek help’ below.
 
What do panic attacks feel like?
 
Panic attacks typically last between 5-30 minutes, with symptoms at their worst within the first 10 minutes. During this time, you may experience any number of the following symptoms, at varying levels of intensity:

• Struggling to breathe or hyperventilation
• Irregular, pounding or racing heartbeat
• Chest pain or discomfort
• Trembling or shaking
• Sweating
• Feeling of choking or suffocation
• Nausea or upset stomach
• Feeling dizzy, light-headed or faint
• Numbness or tingling sensations
• Feeling very hot or very cold
• Feeling disconnected from your mind, body or surroundings
  
  

During a panic attack, you may also fear you’re losing control, going to faint, having a heart attack or dying.

How to manage a panic attack
 
During a panic attack it’s important to remember:

• There’s nothing seriously physically wrong
• You’re not in any danger
• You won’t come to harm
• You’re not going to die
• It will pass

 
Focus on slowing down your breathing, and taking deep, regular breaths. This will slow down your heart rate and begin to reduce the physical symptoms you’re experiencing.
 
Concentrate on counting to five as you breathe in through your nose, and again as you breathe out through your mouth – this will provide you with something to focus on.
 
It can also be helpful to focus your thoughts on a particular image as you do this, such as a flower or a favourite place.
 
Other ways to help manage a panic attack are:

• Splash water on your face (to reduce your heart rate)[i]
• Massage your scalp (to send blood circulation to the brain)
• Shake out your muscles (to help reduce tension and fear)
• Repeat a phrase, such as ‘I’m safe and this will pass’ (to remind yourself you’re in control)

 
As difficult as it might seem, try not to fight the panic feelings as this can leave you overwhelmed, and increase the intensity and length of the panic attack. Accepting what’s happening, and sitting with it until it passes, can help to reduce the scariness of the attack and minimise the length of time it lasts. Repeatedly doing this can also reduce the number of panic attacks you experience.
 
How to reduce the chances of having a panic attack
 
You can help reduce or prevent panic attacks by:

• Learning about panic and anxiety so you understand what’s happening when you experience it

• Avoiding or reducing smoking, alcohol and caffeine

• Exercising regularly to help manage stress and reduce anxiety levels

• Practicing breathing exercises so you can calm yourself more quickly when you experience anxiety and panic

• Practicing relaxation techniques, such as mindfulness, to reduce tension

• Talking to family and friends to increase support and help others understand how you’re feeling

 
When to seek help
 
If you have panic attacks that occur repeatedly, or you’re constantly anxious about having a panic attack, you may have panic disorder. Panic disorder can affect your behaviour, mood and mental wellbeing, but it is treatable. If you’re concerned you may be experiencing it, speak to your GP. They’ll be able to give a diagnosis and suggest treatment options, which may be one or a combination of medication and therapy.
 
If you’re experiencing anxiety and having panic attacks, therapy can help. Take a look at how to get in touch to make an appointment.


[i] Everyday Health, 10 Ways To Stop A Panic Attack, Available: https://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-stop-panic-attack/

Last time in the Exploring Mental Health series, we looked at anger. This month, it’s the turn of mindfulness. Mindfulness is something that’s being talked about more and more in the media, but what exactly is it and how can practising it benefit your mental health?
 
What is mindfulness?
 
Mindfulness is a technique you can use to bring yourself into the present moment and pay attention to what’s happening around you. It focuses you on the here and now, enabling you to become more aware of your thoughts and feelings, without judging them.
 
Mindfulness originates from Buddhist meditation, but was adapted by Jon Kabat-Zinn into a non-religious practice that can be used by anyone. His belief was that focusing attention on the body and mind as it is moment-to-moment can help with pain, both physical and emotional.
 
As the popularity of the technique has grown, mindfulness practice has expanded to be used by schools, workplaces, sports teams and more, to reduce levels of stress, anxiety and depression, and improve general wellbeing.
 
How is mindfulness beneficial?
 
Have you ever driven somewhere and realised part-way through the journey you’ve been on autopilot and aren’t aware of driving there? That’s often how we go through life – doing one thing while our thoughts are on something completely different.
 
With mindfulness, you switch from a human DOing, to a human BEing. Instead of getting caught up in your thoughts and the busyness of life, you spend time being in the moment, noticing what you’re thinking and how you’re feeling. This can have lots of benefits for your mental health and wellbeing.
 
Mindfulness can help you:
 

• Notice thought patterns, and cope with difficult or unhelpful thoughts
• Feel calmer and less overwhelmed
• Be more aware of how you’re feeling - physically, mentally and emotionally
• Be more in control of your thoughts and emotions
• Be kinder to yourself and less self-critical
• Notice signs of anxiety and depression earlier
• Get better sleep
• Manage chronic pain
• Improve your immune system

 
Different ways to practice mindfulness
 
The fact mindfulness is a form of meditation doesn’t mean you need to sit cross-legged on the floor and completely clear your mind to achieve a perfect moment of zen. Mindfulness embraces the tendency of the human mind to wander. It’s about noticing when your mind has wandered, and bringing it back to the present moment, without criticising yourself.
 
Focusing on the present moment can be focusing on your breath, the sensations in your body, the emotions you’re experiencing, your thoughts, or your five senses as you eat something or look around you. As you do this, you remain open and accepting of whatever you notice.
 
There are lots of different ways to practice mindfulness, including:
 

• Body scan – paying attention to each part of your body, moving your focus slowly down from the top of your head to the ends of your toes, noticing how each part feels, including any aches, pains or places of tension

 

• Mindful meditation – focusing on your breath, and the sensation of it coming in and out of your body, noticing when your mind starts to wander and returning your attention back to your breath

 

• Mindful movement – noticing how your body feels as you walk, run, dance or move, including being aware of how the ground feels, the movement of your clothes, and the air against your skin

 

• Mindfulness in nature – paying attention to the natural environment as you sit in a garden or park, or as you walk, cycle or run; using your senses to notice what you can see, hear, smell and touch around you

 

• Mindful eating – focusing on the sight, smell, touch and taste of what you’re eating or drinking, noticing the textures, colours and scents, and how it feels on your tongue

 

• Mindful colouring – being aware of the colours and shapes on the page, and the sensations as you move your pen or pencil over the paper

 
How to get started
 
If you’d like to practise mindfulness there are lots of ways to get started, including:

• Apps – apps, such as Headspace and Calm have free and paid meditations and guides to help you begin practising mindfulness
  

 

• In-person – there are mindfulness courses throughout the UK where a qualified teacher will introduce you to mindfulness and help you learn different meditations. You can search the UK Mindfulness Network to find a teacher in your local area
  
  
• Online – if you want to learn from home, there are online mindfulness courses from organisations such as Breathworks and BeMindful
  
  
• Books – there are a whole range of books and audiobooks available on mindfulness, from short guides to more in-depth reading

 
Once you’ve chosen how you want to get started, it’s picking the right time and place. Remember, there’s no set amount of time for how long to spend practising mindfulness. It’s best just to try little and often.
 
Regular, short amounts of mindfulness practice are better than occasional longer sessions. The more regularly you practice, the easier it becomes to refocus your mind when it wanders. At first, it can be difficult notice when your thoughts have wandered and it can feel like you’re constantly trying to refocus. Start with just a few minutes of mindfulness practice at first, and slowly build up.
 
You can do mindfulness at any time during your day. Pick a time when there aren’t too many distractions, and you’re in a safe, comfortable space. Having a routine time (or times) each day, such as a lunchtime walk, can help you to remember to do it.
 
Is mindfulness right for me?
 
While some research studies have shown that mindfulness can have positive benefits for mental health and wellbeing, it won’t be right for everyone. Broader research studies are still being carried out to look at whether there are particular illnesses that mindfulness is more/less effective for, and in which environments.
 
The important thing to remember is that if it doesn’t suit you, you don’t enjoy it, or you don’t feel any benefits from it, then it doesn’t mean you have failed in any way. Different things suit different people – that’s what makes us all so brilliantly unique.

In this Exploring Mental Health series, we shine a spotlight on different aspects of mental health. First up is anger. What’s the difference between healthy and unhealthy anger, and how can we control angry behaviour if it becomes destructive?
 
Why do you experience anger?
 
Anger is a normal, healthy emotion and can be very helpful to experience. It alerts you to situations where you need to take action, motivates you to make changes, and helps you to stay safe when faced with a danger.
 
There are lots of things that can trigger you to experience anger, including:

• Events (such as a bereavement or other loss)
• Being threatened or attacked
• Being treated unfairly or being powerless in a situation
• Not achieving goals
• Substances (e.g. drugs or alcohol)
• Mental illness (e.g. anxiety or depression)

 
What influences your reaction to feeling angry?
 
The way you react to feeling angry can depend on:

• The situation you’re in (if you’re experiencing lots of difficulties or stresses in your life you may become angrier than usual, or find it harder to control your anger)

 

• Your family history (as a child you may have learned unhelpful responses to anger from the adults around you)

 

• Events in your past (if you have suppressed anger from past experiences)[i]

 
What are the symptoms of anger?
 
Anger feels different for everyone. You may experience any number of the following symptoms, to varying degrees:
 
Physical symptoms

• Churning sensation in your stomach    
• Tightness in your chest 
• Increased and rapid heartbeat    
• Tense muscles    
• Feeling hot
• An urge to go to the toilet    
• Sweating, especially your palms    
• Pounding head    
• Shaking or trembling    
• Dizziness
  
  

Cognitive symptoms 
   

• Being tense, nervous or unable to relax    
• Feeling guilty    
• Feeling resentful towards other people or situations    
• Getting easily irritated    
• Feeling a 'red mist' coming down on you    
• Feeling humiliated[ii]    

When is anger unhealthy?

Although anger is a normal, human emotion, it can become unhealthy, affecting your relationships, work, social life, and your physical and mental wellbeing. If you’re unsure whether your anger is unhealthy, ask yourself:

• Do you regularly express your anger through unhelpful or destructive behaviour, hurting yourself or others?
  
  
• Is your anger having a negative impact on either your physical or mental health?
  
  
• Is anger your go-to emotion, blocking out your ability to feel other emotions?[iii]

If you answered ‘yes’ to any of these, your anger has probably become unhealthy. Other signs that anger may be a problem include:

• Regularly feeling angry at an intense and overwhelming level
• Having difficulty controlling your anger
• Feeling you have to hide or hold in your anger
• Feeling distressed as a result of getting angry
• Using alcohol or drugs to manage your anger
• Withdrawing from people or situations
• Regretting things you said or did when you were angry[iv]

What are the different types of unhealthy anger?

There are many different types of unhealthy anger. These include:

• Chronic anger (this is long-term anger, and can impact the immune system and cause physical health issues such as high blood pressure and heart disease)
  
  

• Passive anger (this may be expressed as sarcasm, sulkiness, apathy or a refusal to engage with people or tasks)
  
  
• Overwhelmed anger (this is caused by life demands that are too much to cope with)
  
  
• Self-inflicted anger (this is directed inward towards yourself, and may be caused by feelings of guilt)
  
  
• Judgmental anger (this is directed outward towards others and may come with feelings of resentment)
  
  
• Volatile anger (this involves excessive, violent or aggressive anger responses)[v]

How can you manage your anger?
 
Using anger management techniques can help you control your anger outbursts when you experience them. While longer-term strategies can help to reduce your overall feelings of anger and prevent outbursts.
 
In the heat of the moment you can manage your anger by:

• Looking out for symptoms of anger, giving warning signs of an outburst (see ‘What are the symptoms of anger?’ above)
• Counting to 10 before responding to the person or situation
• Clenching and unclenching your fists and other muscles throughout your body to release physical tension
• Scribbling on or tearing up paper
• Screaming into or hitting a pillow
• Taking deep, controlled breaths, focusing on the sensation of breathing to take your attention away from the situation
• Removing yourself from the situation for at least a few minutes
• Doing something to distract yourself, such as having a shower or dancing to music
• Writing out your thoughts and feelings

 
In the longer-term you can control your anger by:

• Exercising regularly to reduce stress and tension levels
• Practising good sleep hygiene
• Having a balanced diet
• Avoiding drugs and alcohol
• Learning your anger triggers (keeping a diary can be helpful for understanding these and noticing any patterns)
• Identifying your thought patterns and challenging automatic negative thoughts (a therapist can help you do this if it feels tricky to identify and make changes to these)
• Talking to people around you about your feelings, before they become overwhelming
• Improving your communication skills so you can express your thoughts and feelings, without using anger or aggression

 
When to seek help
 
If you’re experiencing unhealthy anger, and it has become difficult to manage or is having a negative effect on your life and those around you, there is lots of support available.
 
The first step is to speak to your GP and explain what’s been happening and how you’re feeling. They can refer you for NHS counselling or to an anger management course. Your local Mind branch may also provide free counselling or anger management services. Alternatively, you can contact a private therapist and pay for counselling sessions. Your workplace may also offer access to counselling.
 
If you’d like to explore your feelings of anger, get in touch to make an appointment.



[i] NHS Moodzone, Why Am I So Angry?, Available: https://www.nhs.uk/conditions/stress-anxiety-depression/about-anger/

[ii] Mind (2018), How to Cope With Anger: Anger Symptoms, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/anger-symptoms/#.XGl3mNHgo_V

[iii] Mind (2018), How to Cope With Anger: What is Anger?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/about-anger/#.XGlal9Hgo_U
 
[iv] Headspace, What is Anger and Its Effects on Mental Health, Available: https://headspace.org.au/young-people/what-is-anger-and-its-effects-on-mental-health/

[v] PsychGuides.com, Anger Symptoms, Causes and Effects, Available: https://www.psychguides.com/guides/anger-symptoms-causes-and-effects/