Stress and Anxiety

Warning
Warning:

This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What do we mean by Stress and Anxiety?

Everyone feels the effects of stress at times, perhaps before exams or interviews, or during big events like moving house or changing jobs. This sort of stress has a start and a finish. But sometimes the demands stack up, and it all becomes too much: having to work in order to make money and pay the bills, or not having work and not having enough money, plus dealing with the strains (and pleasures) of family life, housework, school runs, being depended on by parents, kids, partner.

Perhaps you can juggle all this until something happens that just seems like the last straw. It doesn't have to be a big upset - divorce, bereavement or a house move. Big life-events like these certainly add to the pressures, but often what tips the balance is just the daily hassles that keep piling up, and then suddenly make us feel that we can't cope any more.

The things that stress us may not always be obvious, especially if they are persistent and long-standing. Some examples include poor nutrition, environmental pollution and an impossible job or relationship. And things that bother one person might hardly affect someone else at all. People respond differently to stress, and some people find their stress response gets turned on very easily. Others seem to have a temperament that is much more resilient so it takes a lot more to make them feel stressed.

We hope this leaflet will help you understand long-term stress and why it can be a problem, and give you some ideas that might help you cope better.

What is an anxiety disorder?

When you are under pressure or faced with a stressful situation, it's normal to feel worried or scared or tense. The body's alarm system works automatically when we feel there's danger around. This sort of 'stress response' is there to keep us on the alert and paying attention, so that we take action, and find a way of coping with threats and solving problems.

Some people feel anxious most of the time. Anxiety may feel like being frightened or very nervous for no obvious reason. It can make your body react as if you were frightened, even though what you feel isn't exactly fear. So, for instance, your heart might race, your palms sweat, your face go pale, and your mouth feel dry.

Panic attacks are sudden, overwhelming bouts of anxiety. Sometimes they come on only in certain situations: perhaps triggered by crowds, or queues, or tight spaces, or open spaces, or heights. To keep anxiety at bay, some people feel a compulsion to repeat certain actions that make them feel a bit better. All these kinds of anxiety disorder generally need specialist help. So if the anxiety you feel is constant or overpowering, and if it gets in the way of your relationships or it stops you doing things, then you have may have an anxiety disorder.

Anxiety can be so bad that it becomes a psychiatric problem. Anxiety disorders include obsessive-compulsive disorder (OCD), panic disorder, social phobia (including agoraphobia), generalised anxiety disorder (GAD), specific phobias and post- traumatic stress disorder (PTSD).

Do you have an anxiety disorder?

It is important to separate feeling stressed from generalised anxiety disorder. An over-active and persistent stress response will affect the mind, the emotions and the body. But people with an anxiety disorder experience severe symptoms every day (or nearly every day) and badly enough to make it difficult to cope with ordinary activities and relationships.

Signs and symptoms of generalised anxiety disorder (GAD) include excessive, and largely uncontrollable, worry, tenseness or restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbances, lasting for at least 6 months.

Some common symptoms of anxiety disorder

Ask yourself the following questions. If you answer yes to some of them, you should see your doctor to find out whether you have an anxiety disorder:

Anxiety and depression often go hand in hand. People who have anxiety disorders are often prone to depression, and people who get depression tend to get anxiety disorders as well.

Anxiety disorders are serious but treatable. And they need proper diagnosis and sometimes the help of a psychiatric team. If you think you might be suffering from an anxiety disorder, don't rely on this leaflet. Speak to your GP straight away.

Recognising and managing stress

Good stress, bad stress:
We can't avoid demands and pressures; nor should we. Being alive and awake puts lots of demands on the body and mind - think about the effort involved in standing or running, or the mental strain of a job interview. Human beings are designed to cope with difficulties and learn from them, so we usually take these demands in our stride, as long as there aren't too many of them and we feel strong enough. If there's some pressure, we feel energetic and rise to the challenge. In fact, the right amount of the right kind of stress feels good because it's stimulating. It makes us perform better, and we feel good about getting tasks done and solving problems.

On the other hand, if there's not enough stimulation we may feel bored and unmotivated; the body will feel stodgy and the mind sleepy. Sometimes a challenge may go on for a long time. Perhaps the situation can't be made any better or the problem can't be resolved. Even if your body and mind seem to have got used to the strain, in the long-term a persistent stress response may make you feel unwell. Many diseases are triggered or made worse by long-term stress.

What is the stress response?
We all know how it feels to face an emergency. Your heart starts to race, your muscles tense up, your breathing gets faster, your blood pressure rises, and your attention is totally focused on the threat. Like all animals, when confronted by danger we try to survive by tackling the threat or by escaping it. (This is known as 'fight or flight').

For as long as the emergency lasts, it takes up most of your attention. Your body forgets about digestion. Blood flows into muscles and away from the belly, causing the dry mouth and the 'butterflies in the tummy' feeling. This survival mode is part of our 'inner caveman.'

The problem is that 21st-century human beings don't usually face caveman challenges. But our brains and bodies are hard-wired to survive in the hostile environments where our ancestors lived. But you can't fight a mortgage, or run away from unemployment. These situations are not physically dangerous but they can still trigger the ancient alarm system inside us.

In today's fast-moving world, we all have to deal with ever-increasing pressure: work, money, housing, worries, conflicts and disagreements, even boredom. And these little threats and hassles can trigger a whole series of stress responses. Then, unless we know how to make the relaxation response kick in, these stress responses may begin to snowball and get out of control.

When does stress become a problem?

Some of the things that can cause stress are from outside: big life-events such as bereavement or long-term stresses due to noise, pollution or the general grind of daily life. Some stresses come from inside, such as painful memories, inappropriate expectations and feelings like guilt or insecurity. If these stresses pile up, it gets harder to cope with everthing. Sometimes the inner caveman/woman then gets into unhealthy ways of coping to find some way of quietening down the upset inside. This is how over-use of alcohol and sugary, fatty 'comfort' foods, and even addictions to drugs, sex, gambling and shopping get started.

There is plenty of evidence that continual stress can harm health and well-being. Long-term stress is related to some cardiovascular conditions, including high blood pressure (hypertension), heart attacks and stroke. Stress also makes some existing health conditions worse. Some long-term conditions flare up at times of stress, including irritable bowel syndrome, asthma, some skin problems and rheumatoid arthritis. People living with prolonged stress also tend to get more colds and infections because stress makes the immune system less efficient.

Stress-proofing: how to make yourself more resilient?
Often, people are not aware of just how stressed or anxious they are. Some actually rely on a constant adrenalin boost to keep going, and have forgotten what it feels like to relax. They may be irritable, sleeping badly, unable to wind down even on holiday, and perhaps find it difficult to concentrate or make decisions. Even so, they prefer to ignore the signs that they are beginning to burn out.

So the first step is to be aware of feeling stressed. You might not know why you feel this way, or what the pressures actually are. You might even be telling yourself that there's no reason to be stressed, that life is fine. All the same, certain symptoms are linked to the stressed state and it's important to recognise them as warning signs that your natural capacity to cope is getting stretched.

Recognising the symptoms of stress

When someone is in continually stressed state there are some typical symptoms:

FEELINGS

PHYSICAL SYMPTOMS

THOUGHT PATTERNS

BEHAVIOUR PATTERNS

It's important to spot these early warning signs, because prevention is better than cure. Eventually if the body can no longer regulate itself properly, health problems may follow: at first stress-linked symptoms, such as heart palpitations, dizziness, shortness of breath, and unexplained pain. If these sensations make you feel more stressed, the stressed state can become a vicious circle that undermines well-being and harms your health.

The relaxation response

Our bodies and minds are hard-wired to look out for challenges and respond to them. Then, when the danger has passed, all our revved-up preparations for action are supposed to go into reverse. So, just as we are designed for action, we are also hard-wired for the sort of calmness and self-healing that gets our bodies back into balance.

This natural set of calming-down reactions can switch off the hyped-up emergency state. As it does, your breathing and heart rate slow down, pumped up muscles loosen up and and your blood pressure drops to normal. The relaxation response draws cholesterol and inflammation chemicals out of the blood, helps your digestion to work properly, and helps your body resist infection. It can turn down the volume control on pain, and help warmth flow where it's needed in the body. It can even make you more peaceful, creative and patient!

In the 1960s Herbert Benson, of Harvard Medical School discovered that when people learned to turn on the relaxation response and practiced doing so regularly it reduced their stress levels a lot. His later research found that people had been doing this for centuries through prayer, chanting and rhythm.

20 tips for controlling your stress levels:

  1. When faced with a situation that winds you up, use 'first-aid diaphragmatic breathing' to diffuse tension. Take long, slow in-breaths and longer, slower out-breaths, using your belly. This needs practice.
  2. In a situation you can't do anything about (for instance, when you're stuck in a traffic jam or late for an appointment), give a mental shrug, sigh, drop your shoulders and tell yourself 'this will pass'. This also requires practice! Your body and mind need to rehearse these methods so that they are available when you need them.
  3. Eat a healthy, balanced diet. Good nutrition fuels your body systems so that you have more energy to deal with events and are less prone to exhaustion.
  4. Don't skip or rush meals or live on snacks and junk food. Don't skip breakfast (you need it to jump-start your metabolism) and make sure you take a lunch break. Don't rely on alcohol, cigarettes or other drugs to help you keep going.
  5. Exercise for at least 20 minutes, four times a week, to release the body's 'feel good' chemicals, known as endorphins.
  6. Take regular short breaks for a stretch, and do a little physical activity every day, even if it's only a short walk.
  7. Organise your day to avoid rushing and arrive at your workplace early enough to plan and allocate time for the day's tasks.
  8. Be appropriately assertive: decide what it is you want or feel and say so specifically and directly, then stick to your statement.
  9. Learn to say no to unnecessary requests so that you don't take on too much.
  10. Delegate: hand over jobs that other people can do so that you are not over-committed.
  11. Prioritise tasks to make the most efficient use of your time. Make daily lists: urgent, and not so urgent.
  12. Close the door and put the telephone on hold if there is something that must be finished and you can't afford to have interruptions.
  13. Make your workplace as comfortable as possible. if you're an office worker, ensure your chair, desk and workstation are ergonomically correct (good for your posture). Personalise your work area with a pot-plant or photograph.
  14. Avoid working late. Long working hours have been linked to mental and physical health problems.
  15. Spend a few quiet minutes alone, as a buffer zone between work and home.
  16. Keep the hour before bedtime free from daily hassles and aim for 6-8 hours sleep every night.
  17. Allow at least 20 minutes a day for your choice of relaxation, even if you have to mark it in your schedule.
  18. Find time in the week for pleasure and creativity. It doesn't have to cost. Seek out the little pleasures of life and try to appreciate them.
  19. If you go away on holiday, leave your work behind. Short breaks can be more restful than long holidays. Even if you cant afford a holiday away, try to get a change of scene.
  20. Get help when you need it. Open up to friends, family, and professionals. Being able to make use of social support at times of stress is good for everyone's mental and physical well-being.

Stress management - doing it yourself or getting help?

Later in this leaflet you will learn about several methods of reducing stress, from relaxation techniques to cognitive-behavioural therapy (CBT). Relaxation techniques are very helpful but they are not always the solution. For example, you may be getting stressed because you aren't working efficiently, in which case time management techniques could help you organise your internal (and external) clutter, and prioritise the things you have to do. Or it might be that you are feeling overloaded because you find it hard to tell people what you do or don't want. In that case, assertiveness and social skills training could help you deal with people, take more control, and gain self-confidence and self-esteem. There again, if your mind is buzzing with worries, conflicts and confused emotions, you may need to consider counselling or psychotherapy. And if you feel you need to start changing how you think and feel about the pressures you are under, then CBT may be very helpful.

Some problems appear too overwhelming until they are broken down into bite-sized challenges that seem more do-able. It's important to get a sense of proportion and think clearly enough to find some positive possibilities. If the ways you think and feel about a problem are partly what caused it, then using the same thoughts and feelings won't solve the problem. Often what's needed is an attitude change. CBT can help shift stuck and unhelpful attitudes and behaviours.

But some problems really are too big to solve alone. When that's the case, you may need some help, because major changes always require support, the right information and, most importantly, energy. It takes energy to change things for the better. If (as is likely at such times) you feel exhausted, do whatever you must to get the rest and recuperation you need so that you can begin to make sense of your situation.

Considering different types of treatment
If you feel very anxious or if tension is making everyday work difficult you should get expert advice. Stress levels are easier to handle if you learn the relaxation response, and get enough sleep. You might also need to put yourself under less pressure; take time off or get some help at home. Exercise and healthy eating are likely to help as well. In addition there may be some natural medicines, or treatments or classes that could reduce tension.

Other information that might be helpful

For further information see:

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When to see your doctor

As soon as you can:

Immediately:

simplechangesMake Some Simple Changes


pencil Eating a healthy diet

OverviewIt is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Improving your diet could help with your mood. The Food Standards Agency has eight tips for eating well:

1 Base your meals on starchy foods.
2 Eat lots of fruit and vegetables.
3 Eat more fish.
4 Cut down on saturated fat and sugar.
5 Try to eat less salt - no more than 6 g a day.
6 Get active and try to keep to a healthy weight.
7 Drink plenty of water.
8 Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing.

pencil Therapeutic lifestyle changes

OverviewYour way of life will obviously affect your well-being for better or worse. There is a lot of evidence showing that so-called therapeutic lifestyle changes (TLCs) can improve mental wellbeing as effectively as psychotherapy or medication. So what are these healthy lifestyle factors? Among the widely researched TLCs are exercise, improving diet, spending time in nature, attention to relationships and recreation, learning relaxation and stress management skills, religious or spiritual involvement, and voluntary service to others.

pencilTreatment Options:


simplechanges Cutting down caffeine

OverviewCaffeine is the stimulant in coffee, tea, cola and some energy drinks. It can disturb your sleep, upset your hormone balance, make you feel moody and boost your stress response. Some people feel jittery after only two or three cups of coffee. If you have a caffeine habit you may feel you need caffeine just to get going. But once the 'caffeine hit' has worn off, you're still tired and feel you need another one.
EvidenceSome surveys suggest that caffeine makes anxious people more anxious and prone to panic.
SafetyReducing your caffeine intake is safe. But if you are cutting down from large amounts of caffeine, headaches might be a problem for two or three days. It's better to reduce the amount of caffeine gradually, over a few days.
CostThere are no costs involved. In fact you will save money if you drink water rather than coffee.
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simplechanges Cutting down on alcohol and stopping smoking

OverviewMany people find that an alcoholic drink relieves that stressed-out feeling for a short time. So people who are dealing with financial stress, job stress, marital problems and other types of stress tend to drink more - especially if they don't have much social support. According to the research, the worse and more long-standing the stress, the greater the alcohol consumption. Anxiety disorders are more common among people with an alcohol problem, so giving up alcohol can reduce anxiety in the long run.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.
EvidenceSome research has found that alcohol increases anxiety levels. People who are heavy drinkers are most likely to suffer from worse anxiety. Suddenly stopping smoking can increase anxiety for a short period. But research shows that, after stopping smoking, people eventually have fewer anxiety symptoms.
SafetyThere are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you're cutting down.
CostThere are no costs. In fact you will save money.
Find out moreFor more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.
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simplechanges Exercise

OverviewDoing something that takes your mind off feeling worried can help. But try to make it something that builds health. Exercise can be a healthy distraction; so can gardening or working on an allotment, or voluntary work. It's good to get outdoors. One study found that people were much less depressed after taking a walk in the country than if they spent the same time walking round a shopping centre. So it seems that where you get active is almost as important as how active you get. Green spaces are good for your mood!

Being more active does more than keep you fit. It definitely makes a difference to all sorts of health problems. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis, triggers brain chemicals that lift your mood and can generate a glowing sensation of well-being. Exercising with others can also be a very good way of meeting people.

If you decide to take up more strenuous exercise, you might want to get some support and advice. Exercise classes include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. There are classes in Tai Chi, Qigong and yoga too. These supervised programmes are safe for most people, though at first you might feel more tired. It's best to increase your exercise slowly.
EvidenceResearch has shown that exercise helps people deal better with stress and anxiety.
SafetyIf you're not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn't helping or that you're getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and get advice from a healthcare professional.
CostYou can exercise at home for nothing - walking and gardening is all exercise - although you should get advice on the best exercises to do from a trainer first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.
Find out moreNatural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.
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simplechanges Following special diets

OverviewCould what you're eating make you feel more stressed or anxious? Probably not, though some people do say they think certain foods trigger odd symptoms. Others say they get irritable and anxious if they haven't eaten for three to four hours, and that eating makes them feel better within 15 minutes. If you think food(s) make a difference, it would be good to keep a food diary and record when you get your symptoms. If you are sure there is a link between food and your symptoms, don't change your diet until you have talked it over with your doctor. If you are anxiety-prone, giving up certain foods may send you down a slippery slope of giving up more and more, and you could end up with a diet that is too restricted.

If you think your blood sugar goes up and down a lot, reduce your sugar intake and instead eat more complex carbohydrates (such as baked potatoes, wholemeal bread and wholemeal pasta) and high-protein foods. Your body won't burn them up as fast as highly processed junk foods, sweets and biscuits. Eating 'slow-burn foods', and having smaller meals more often (breakfast, lunch, dinner and three in-between protein snacks), will help you avoid big blood-sugar swings. If this doesn't work or if your swings seem extreme, you really must talk to your GP.
EvidenceThere is very little research evidence as to how special diets affect people with stress or anxiety.
SafetyIf you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
CostEating a healthy diet need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice.
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simplechanges Learning the relaxation response

OverviewIn a constantly wound-up state we forget what deep relaxation and calm awareness feel like. Being able to switch on the relaxation response at will is a very valuable skill. It should be in everyone's mental toolkit because it helps break the vicious cycle of stress responses that send you on a downward spiral into the stressed state.

Stress raises your blood pressure, speeds up your heart, makes your muscles tense and increases your sensitivity to pain. It also affects the way your stomach and intestines work. Relaxation training can make you more aware of how your body reacts to situations that make you feel stressed. It can help you control your stress response and improve your mood. Useful relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques. Each of these methods can be used on its own, or in combination with one or more of the others.

Breathing calmly and relaxing the mind and body are vital parts of many relaxation techniques, like Tai Chi, yoga, meditation, autogenic training, visualisation and self-hypnosis. Which one you try is very much an individual choice and you may have to sample several before you find one that suits you. If you don't feel you can sit still, a moving technique, such as Tai Chi, may be the best option. And some people find they only get a relaxation response after strenuous exercise. Research has shown that exercise boosts brain chemicals, called endorphins that trigger relaxation. These endorphins provide part of the 'exercise high'.

Learning to switch on the relaxation response at will could help you cope better with stress and feel less anxious. Why not buy a relaxation CD or download some relaxation tracks for your MP3 player to talk you through the steps? Don't wait until you're too stressed to learn and practice the relaxation response.
EvidenceScientists have shown that relaxation response practices can slow the heart rate, lower the blood pressure and reduce oxygen consumption. What's more they improve symptoms of many health problems, including hypertension, arthritis, insomnia, depression, infertility, cancer, anxiety, even aging!
SafetyPracticing the relaxation response is safe unless you have a severe or long-standing mental health problem.
CostOnce you have learned the relaxation techniques, there are no costs.
Find out moreThere are many books and audio aids available. Visit The British Holistic Medical Association for free podcasts and leaflets.
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simplechanges Listening to music

OverviewMusic affects the body and mind in many powerful ways. It can change brain waves, heart rate and breathing. So it's no surprise that losing yourself in your favourite music can help you relax.
EvidenceThere is some research that suggests that music reduces anxiety, and it could work as well as other forms of relaxation.
SafetyListening to soft music is safe!
CostNo costs are involved.
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simplechanges Meditation

OverviewMeditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a 'relaxation response'. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don't need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.
EvidenceMeditation can be an effective way of reducing stress. It may also help people who are naturally anxious and some people who have generalised anxiety disorder. Its effectiveness for other forms of anxiety disorder has not been established.
SafetyMeditation is safe for healthy people. Rarely it may trigger or worsen certain psychiatric problems. If you have an existing mental or physical health problem let your meditation instructor know and ask them about their training and experience.
CostMeditation involves certain (simple) techniques, which can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially. Once you have learned how to meditate, there are no ongoing costs.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets. See also Yoga in the Classes section.
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simplechanges Progressive muscular relaxation (PMR)

OverviewProgressive muscular relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.
EvidenceTechniques such as progressive relaxation are useful when you're feeling stressed. They seem to lower anxiety levels in some types of anxiety disorder too. For other types of anxiety, treatments such as cognitive-behavioural therapy (CBT) may work better.
SafetyProgressive relaxation is generally safe but should be used cautiously in people with musculoskeletal injury or a long-standing or severe mental health problem.
CostOnce you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets.
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buysomethingBuy Something


pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

pencil Herbal remedies and food supplements

OverviewExercise is highly effective for generalised anxiety, and relaxation training definitely helps generalised anxiety, panic disorder, dental phobia and exam nerves . Working with written advice can help specific phobias. There is fair evidence for the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety.

But the evidence for things you can buy over the counter is not as good. A herb called kava can help generalised anxiety, but because kava is not available at the moment because of concerns about its side effects, we have not included it in this information. The evidence for for inositol as a treatment of panic disorder and obsessive compulsive disorder.

pencilTreatment Options:


buysomething Inositol

OverviewInositol is present in all animal tissue, with the highest levels in the heart and brain. It is part of the membranes (outer coverings) of all cells. It helps the liver process fats is important for proper function of muscles and nerves. In addition, inositol is involved in the action of serotonin, a chemical that transmit messages between nerve cells (neurotransmitter) and known to be a factor in depression.
EvidenceThere is some evidence that inositol may help with some anxiety problems such as phobias and obsessive compulsive disorder.
SafetyLarge doses of inisitol may cause diarrhoea.
CostInositol is generally inexpensive and can be bought from many high street pharmacies or health food shops.
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buysomething Over the counter medicines

OverviewThere are no standard medicines, you can buy without a prescription, which are likely to help with stress or anxiety.
Evidence:
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buysomething Passiflora (passion flower)

OverviewPassion flower (Passiflora incarnata) can be bought as tablets or drops containing only the extract (e.g. Natracalm) or mixed with other ingredients. It is a traditional medicine for calming the central nervous system.
EvidenceThere have been some small studies but there is no good evidence that passiflora helps with stress and anxiety.
SafetyNo serious side effects have been reported. But drowsiness or dizziness may occur. If they persist or worsen, tell your doctor or pharmacist promptly. A very serious allergic reaction to this product is rare.
CostPassiflora extract is generally inexpensive and can be bought from many high street pharmacies or health food shops.
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buysomething St John's Wort (Hypericum)

OverviewAnxiety and depression often come together. If you think you are depressed you should ask your doctor's advice. St John's wort has not been shown to help anxiety disorders though.

According to the available research, St John's wort is definitely not an effective treatment for serious depression but it may be a valuable treatment for mild to moderate depression.

No serious harm has been reported by doctors in Europe, where St John's Wort has been used very widely and in large doses for many years. But it would be unwise to take it until at least one month after you have stopped taking prescribed anti-depressants. You should discuss this with your doctor. St John's Wort may also interfere with certain prescribed medicines.
EvidenceAnxiety and depression often come together. But St Johns Wort is not known to be effective for anxiety disorders. There is some very good research showing that St John's Wort is as good as standard anti-depressant medicines (such as Prozac) for mild to moderate depression. But there are some concerns about safety and what the best dosage might be.
SafetySt John's Wort is generally safe, but you should always get medical advice before taking St John's Wort if you are on other medicines. This is especially important if you are taking: warfarin (anti-coagulant), digoxin (for heart failure), an oral contraceptive, protease inhibitors for HIV infection, chemotherapy or transplant drugs, or anti-schizophrenia drugs.
CostSt John’s Wort tincture or tablets can cost between £10-£20 for one month’s supply depending on the brand.
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buysomething Using self-help books and audio aids

OverviewBibliotherapy involves using books, leaflets, or self-help programmes on the Internet, CDs, downloads and DVDs to manage problems such as depression and anxiety.

Many public libraries run schemes using books to help people with stress problems and anxiety. These 'Books on Prescription' schemes have proved very popular with medical professionals and patients alike.
EvidenceThere is some evidence that bibliotherapy helps with problems like phobias but not other types of anxiety problems. It is not clear exactly which type of information works best, or whether bibliotherapy works for people who try this for themselves without help.
SafetyThere are generally no safety problems.
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buysomething Valerian

OverviewValerian, or Valeriana officinalis, is a perennial flowering plant with pink or white flowers. It is a mild natural sedative which may affect the same brain pathways as anti-anxiety drugs. It is also often taken for sleep problems (see also the information leaflet on Sleep Problems).
EvidenceThere has only been one very small study of valerian in people with anxiety, so it is not clear whether or not it has any beneficial effects. But valerian is a promising treatment for sleep problems. Research shows it improves the quality of sleep and reduces the time to fall asleep.
SafetyMost side effects from valerian are mild. If used for longer than two to four months it may actually cause sleep problems.
CostValerian extract is generally inexpensive and can be bought from many high street pharmacies or health food shops.
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attendvisitAttend Classes / Visit Practitioner


attendvisitTreatment Options:


attendvisit Acupuncture

OverviewAcupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.
EvidenceAcupuncture seems to help with short-term anxiety - for example, before a test or going to the dentist. But it is not clear whether it works for people who have long-term anxiety problems.
SafetyAcupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit Autogenic training (AT)

OverviewAT classes require time and discipline, but may have greater benefits than simple muscle relaxation. In AT classes you learn to create feelings of warmth and heaviness throughout your body, and this is said to bring about very deep physical relaxation, mental peace and a quietening of negative thoughts. AT uses simple phrases that you repeat to yourself as you release tension from each part of your body.
EvidenceThere is some research indicating that autogenic training reduces stress and may help with anxiety disorder. The research suggests that it is more effective if you learn the method in a class.
SafetyAT is best learned from an experienced teacher in a small class. There are no safety issues, though anyone with a long-term mental health problem should get advice from their psychiatrist before starting AT.
CostYou will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.
Find out more The British Autogenic Society (BAS) is the professional and educational organisation for autogenic therapists in the UK.
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attendvisit Hypnotherapy

OverviewA hypnotised a person is awake, alert, and focused, but also more susceptible to suggestion. So the therapist uses suggestions to bypass the conscious mind in order to bring about changes in behaviour, emotions or attitudes. Hypnosis is used to help people quit smoking or cope with stress, phobias, and therapeutic side effects, and to promote healing.

Hypnotherapy can make some people extremely relaxed. But the evidence suggests that it isn't much use for people with anxiety disorders.
EvidenceResearch has been carried out on hypnosis for different types of anxiety problems. So far, it is still not clear whether hypnosis helps to ease anxiety. But learning a self-hypnosis technique for relaxation might help a person cope better with stress.
SafetyThe safety and effectiveness of hypnotherapy largely depends on the skill of the practitioner and how you feel about working with them. It is unlikely that hypnotherapy will be formally regulated in the foreseeable future. Those who are doctors or psychologists have strong regulatory organisations (see below). Use cautiously if you have a longstanding mental illness or seizures.
CostA session may cost approximately £40-£70. Frequency of treatment will depend on you and your practitioner.
Find out moreAll full members of The British Association of Medical Hypnosis hold a medical or dental professional qualification in addition to their hypnotherapy training.
The National Council for Hypnotherapy and
The Hypnotherapy Association both claim to register approved hypnotherapists.
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attendvisit Massage

OverviewThere are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.
EvidenceMassage may help you feel more relaxed for a time, and boost your sense of well-being. But there is very little good research to say whether it helps with long-term anxiety problems.
SafetyMassage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Find out moreIt is important to find a qualified practitioner such as one registered with
The General Council for Massage Therapies
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attendvisit Mindfulness based-stress reduction (MBSR)

OverviewMBSR is a structured programme taught in groups, usually weekly for eight or so weeks. The systematic series of lessons and homework tasks are designed to help you develop enhanced awareness of what is going on in your body and mind from moment to moment. This awareness is believed to reduce anxiety and negative thoughts, improve mood, and enhance vitality and people's ability to cope. Over the last two decades, several research reports seem to have supported many of these claims. Home practice is an important part of the course, and participants need to do 40 to 60 minutes of this, six days per week, between each class.
EvidenceA review of research into MBSR concluded that it could reduce stress levels in healthy people. MBSR appears to be helpful for people with chronic health problems, even hard-to-treat health problems such as severe chronic pain and panic disorder.
SafetyMBSR is generally safe unless you have a severe or long-standing mental health problem.
CostA course might cost £10 to £30 a week, including course materials. The Mental Health Foundation have designed an affordable online course (see below). Once you have learned the technique, there are no ongoing costs.
Find out moreBe Mindful from the Mental Health Foundation offer Mindfulness courses and also provide a list of MBSR programmes and practitioners throughout the UK.
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attendvisit Psychological therapies

OverviewWhen people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.
EvidenceThere is good evidence that psychological therapy based on CBT helps people who suffer from long-term anxiety.
SafetyThese techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Tai Chi

OverviewTai Chi is also known as 'moving meditation' It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.
EvidenceThere is some good evidence that Tai Chi helps improve well-being, including anxiety, mood and self-esteem. It could be part a useful useful treatment package for anxiety disorders.
SafetyTai Chi is safe for most people. Though Tai Chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.
CostOnce you have learned the movements, you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services or you can contact the The Tai Chi Union.
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises and some types are much more strenuous than others. Others focus more on meditation, breathing and relaxation.
EvidenceSome studies have shown that people who practise yoga have lower anxiety levels. But better studies are needed to be certain that yoga helps in anxiety disorders.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
CostOnce you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services.
To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.
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