Anxiety is a normal human emotion. However, some people find themselves worrying or feeling anxious so often that it interferes with their day to day life. Anxiety disorders are very common, affecting approximately 15% of the population.
Anxiety disorders range from generalised anxiety disorder through to panic attacks, phobias, post-traumatic stress disorder and obsessive-compulsive disorder. Although it may sometimes feel like anxiety controls us, there are things you can do and skills you can learn to overcome anxiety.
Learn about anxiety and anxiety disorders to help you make sense of how you feel.
Break problems into simple goals and small steps.
Learn how to think constructively and positively.
Engage in techniques to help you relax.
Spend time with people who can support you and help you to handle negative emotions and thoughts.
What is an anxiety disorder?
Anxiety is a normal human emotion and most of us experience some degree of anxiety due to a stressful event or misfortune. However, some people find themselves worrying or feeling anxious so often, that it interferes with their day to day life and is formally recognised as one of the anxiety disorders.
Anxiety disorders are very common, affecting approximately 15% of the population. The categories of anxiety disorders include:
Generalised anxiety disorder.
Anxiety disorder due to a medical condition.
Panic disorder (with or without agoraphobia).
specific phobias– spiders, heights, flying, confined spaces, etc
agoraphobia – fear of open spaces
social phobia– also known as social anxiety disorder.
Generalised anxiety disorder is the most common type of anxiety disorder. This is when people are extremely worried about things or overwhelmed with anxiety and fear – even when there is little or no reason to worry about them
Generalised anxiety disorder presents with a range of psychological and physical symptoms such as:
a sense of dread
feeling constantly "on edge" or irritable
being easily distracted
irregular heartbeat (palpitations)
dry mouth or excessive sweating
shortness of breath
nausea and or stomach ache
painful or missed periods and many more.
Symptoms can come on gradually or build up quickly. As anxiety increases, it can lead to changes in your behaviour. You may find yourself withdrawing from social contact and not wanting to see your family and friends to avoid feelings of worry and dread.
People can also find themselves needing more 'sick' days and lacking self-esteem. With generalised anxiety disorder, it can be hard to know what the cause is or why certain things trigger you to worry.
Generalised anxiety disorder can be treated. There are a range of treatments available to you. The first step is to talk with your GP who will discuss these with you and together you can decide which is best for you. Your doctor may refer you to a mental health specialist. Aside from the self-help therapies discussed below, you can also try a talking therapy and/or medication, which your health professional will tell you about.
The choices we make every day of how we live, eat, work, relax and react are very important to reducing anxiety in our lives. The following are some of the things you can do to take control and reduce anxiety building.
Regular exercise, particularly aerobic exercise, such as walking, swimming or running, is an excellent antidote to reduce stress and tension. Our bodies are designed to move, not sit most of the day and being physically active for 30 minutes a day or more is one of the best things you can do for improving mental and physical health. It improves mood, energy levels, our immune system, reduces risk of diabetes, heart disease and many more besides. It also encourages your brain to release the chemical serotonin, which can improve your mood and wellbeing.
Smoking & alcohol
Smoking and alcohol have been shown to make feelings of anxiety worse. Aim to reduce your drinking to a maximum of 1 or 2 drinks per day. If you smoke, stop! Talk with your doctor/nurse or ring QuitLine for advice, support and nicotine replacement therapy.
Relaxing also helps. Find ways to learn relaxation and breathing exercises or try yoga, pilates or tai chi.
Check what you are eating. Too much caffeine, sugar or fast food can act like dirty oil and upset your system. Caffeine and energy drinks can disrupt sleep, speed up your heartbeat and increase anxiety. Try eating regular meals, a healthy breakfast, more fruit and vegetables and less processed foods.
There are many great online courses and programmes that you can do online that can help you with your anxiety such as:
The Journalfree personalised online programme via the National Depression website. Includes clips from Sir John Kirwan (JK)
Build your support network – a few people you can go to when things are tough. There are also a range of support organisations. Some offer face-to-face meetings where you can talk about your difficulties and problems with other people. Many provide support and guidance over the phone or by email.
Ask your GP about local support groups for anxiety in your area or look up online through links below.
There are hundreds of great books, workbooks, videos, online programmes and anxiety apps to help you understand anxiety and learn practical tips and skills for taking control of your thoughts, feelings and reactions. Most are based on cognitive behaviour therapy, an evidence-based approach previously limited to one-on-one therapy with a psychologist.
Identify and communicate the diagnosis of GAD as early as possible to help people understand the disorder and start effective treatment promptly. (1.2.2) Consider the diagnosis of GAD in people presenting with anxiety or significant worry, and in people who attend primary care frequently who:
have a chronic physical health problem or
do not have a physical health problem but are seeking reassurance about somatic symptoms (particularly older people and people from minority ethnic groups) or
are repeatedly worrying about a wide range of different issues.
Following assessment and diagnosis of GAD:
provide education about the nature of GAD and the options for treatment, including the ‘Understanding NICE guidance’ booklet
monitor the person’s symptoms and functioning (known as active monitoring).
This is because education and active monitoring may improve less severe presentations and avoid the need for further interventions. (1.2.9)
Step 2: Diagnosed GAD that has not improved after step 1 interventions
Low-intensity psychological interventions for GAD
For people with GAD whose symptoms have not improved after education and active monitoring in step 1, offer one or more of the following as a first-line intervention, guided by the person’s preference:
*A self-administered intervention intended to treat GAD involving written or electronic self-help materials (usually a book or workbook). It is similar to individual guided self-help but usually with minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes.
Key points to raise – related recommendations:
Individual non-facilitated self-help for people with GAD should:
include written or electronic materials of a suitable reading age (or alternative media)
be based on the treatment principles of cognitive behavioural therapy (CBT)
include instructions for the person to work systematically through the materials over a period of at least 6 weeks
usually involve minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes. (1.2.12)
Individual guided self-help for people with GAD should:
include written or electronic materials of a suitable reading age (or alternative media)
be supported by a trained practitioner, who facilitates the self-help programme and reviews progress and outcome
usually consist of five to seven weekly or fortnightly face-to-face or telephone sessions, each lasting 20–30 minutes. (1.2.13)
Psychoeducational groups for people with GAD should:
be based on CBT principles, have an interactive design and encourage observational learning
include presentations and self-help manuals
be conducted by trained practitioners
have a ratio of one therapist to about 12 participants
usually consist of six weekly sessions, each lasting 2 hours.* (1.2.14)
GAD with marked functional impairment or GAD that has not improved after step 2
For people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions offer either:
an individual high-intensity psychological intervention, or
Provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes.
Base the choice of treatment on the person’s preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better. (1.2.16)
High-intensity psychological interventions
If a person with GAD chooses a high-intensity psychological intervention, offer either cognitive behavioural therapy (CBT) or applied relaxation. (1.2.17)
If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). In this UK Guideline, sertraline is recommended as first-line because it is the most cost-effective drug, but at the time of publication of the guideline, (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. (1.2.22)
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the ‘British National Formulary’ on the use of a benzodiazepine in this context. (1.2.25)
Do not offer an antipsychotic for the treatment of GAD in primary care. (1.2.26)
Key points to raise – related recommendations:
If sertraline is ineffective, offer an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
the side-effect profile and the potential for drug interactions
the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)
the person’s prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person’s preference). (1.2.23)
If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. (1.2.24)
See recommendations which cover the issues to be considered when prescribing and monitoring drug treatment.
Step 4: Highly specialised care
Inadequate response to step 3 interventions.
Consider referral to step 4 if the person with GAD has severe anxiety with marked functional impairment in conjunction with:
a risk of self-harm or suicide or
significant comorbidity, such as substance misuse, personality disorder or complex physical health problems or
an inadequate response to step 3 interventions. (1.2.36)
Offer the person with GAD a specialist assessment of needs and risks, including:
duration and severity of symptoms, functional impairment, comorbidities, risk to self and self-neglect
a formal review of current and past treatments, including adherence to previously prescribed drug treatments and the fidelity of prior psychological interventions, and their impact on symptoms and functional impairment
support in the community
relationships with and impact on families and carers. (1.2.37)
Review the needs of families and carers and offer an assessment of their caring, physical and mental health needs if one has not been offered previously. (1.2.38)
Develop a comprehensive care plan in collaboration with the person with GAD that addresses needs, risks and functional impairment and has a clear treatment plan. (1.2.39)
Inform people with GAD who have not been offered or have refused the interventions in steps 1–3 about the potential benefits of these interventions and offer them any they have not tried. (1.2.40)
Consider offering combinations of psychological and drug treatments, combinations of antidepressants or augmentation of antidepressants with other drugs, but exercise caution and be aware that:
evidence for the effectiveness of combination treatments is lacking and
side effects and interactions are more likely when combining and augmenting antidepressants. (1.2.41)
Combination treatments should be undertaken only by practitioners with expertise in the psychological and drug treatment of complex, treatment-refractory anxiety disorders and after full discussion with the person about the likely advantages and disadvantages of the treatments suggested. (1.2.42)
When treating people with complex and treatment-refractory GAD, inform them of relevant clinical research in which they may wish to participate, working within local and national ethical guidelines at all times. (1.2.43)
Video series – Mental health in primary care (PHARMAC)
Seminar series of 7 video updates about "non-drug therapies for common mental health conditions in primary care: depression, anxiety and distress. With the aim being to encourage practitioners to talk first, get patients being physically and socially active, and see how they do. With prescribing coming later, if and when needed" – from 13th April 2017.
Guidelines and pathways
Access to the HealthPathways system is available by region and limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
There are a variety of mobile phone apps for anxiety, stress, depression and general mental health. They can help you learn about your condition, figure out whether your medication is working, record details about your symptoms and some provide tools to help you manage mental health problems. The Health Navigator team has reviewed some mental health and wellbeing apps that you may like to consider.
Online self-help programmes & courses
Here are some online resources that are designed to help people manage depression and anxiety. Some are free, some have a cost, and some require prescription from your doctor.