How to cope with anxiety attacks
IT’S hard to believe that it can disrupt the lives of high-fliers like PJ Gallagher or Ardal O’Hanlon, two of Ireland’s hottest comedians, let alone bestselling author Cecelia Ahern.
Yet this week, all three revealed the crippling anxiety which has dogged them for years — in Gallagher’s case, stage fright has affected him to such an extent that he physically dreads performing live.
Cecelia Ahern, daughter of former Taoiseach Bertie, spoke of the panic attacks which first began when she was 19 and travelling to college on the bus: “I felt full of fear; crippled with fear. I got off the bus. I was very shaken.”
The next day it happened again. Then “it started happening every day,” she told Gay Byrne in the RTÉ series, The Meaning of Life.
Ahern experienced pins and needles, dizziness, and a need to vomit. “I tried therapy and talking to people,” she says, recalling that she found some relief in deep breathing and changing the way she thought about things. In the end she came to realise that “it’s all training your brain.”
Anxiety is defined as a feeling of unease, such as worry or fear, which can be mild or severe.
It’s exceptionally common — in fact, it’s one of the core human emotions, says Dr Keith Gaynor, clinical psychologist at St John of God’s Dublin.
“There’s nobody who doesn’t feel anxious — your first day at a new job, your first date; it’s universal and normal.
“We should feel anxious, and we need to feel anxious,” he says, adding that the original role of anxiety was to provide the burst of adrenalin required to impel humans away from danger.
“However, very often in the modern world, there’s no physical danger as such, so our anxiety is more often set off by social or emotional things,” he says.
Ordinary anxiety levels generally go back to normal quite quickly — for example, a child who is nervous about the first day at school, can be quite happy by the end of it.
“Anxiety peaks and then it normalises,” Dr Gaynor says, adding however, that for about 10% of the population, anxiety levels don’t return to normal.
The anxiety may be related to everything from a fear of public speaking or small spaces to attending the dentist and it is constant.
“Their anxiety about these issues stays on a constant high — in fact, just the thought of it is enough to set it off.”
The natural response is to try and avoid the thing which is causing the anxiety, but this doesn’t work, he says — “the more we avoid it the worse it gets.
“It’s only when you take the bit between your teeth and do it that you realise the catastrophe doesn’t actually happen,” he says.
“We cannot guarantee that the experience will be great but the worst-case scenarios people are dreading don’t usually happen.”
Therefore, advises Gaynor, drop the avoidance and challenge the catastrophic thinking.
“Why is it that in the 10% who have chronic anxiety, it does not reduce?”
Because avoidance and catastrophic thinking are the very things they’re doing — and these keep anxiety levels high.
“If you have a bad experience and don’t get back on the horse it gets worse and worse,” he warns.
So when you find yourself worrying about something, ‘de-catastrophise’ your thinking. Don’t spend too much time over-thinking it, and focus on the other things in your life, he advises.
“When you notice a thought like ‘I am not going to be able to cope,’ tell yourself that that’s catastrophic thinking.”
Talk yourself down off the ledge by being firmly realistic about whatever it is that’s worrying you, he says, and physical symptoms such as a pounding heart or dry mouth will gradually disappear.
“It’s very much about the mind going one way and the body following, to either towards catastrophic thinking and the subsequent physical symptoms or towards benign reasonableness.”
Anxiety is often at the heart of issues which may initially present as being something else, says psychologist Patricia Murray. She believes anxiety is at the root of a wide range of social issues from violence to depression and marital break-up.
It’s about being fearful of the future, she believes, adding that if someone becomes stuck in an irrational fear, it can become seriously problematic.
If somebody has a fear of a particular thing, such as heights or driving a car, says Murray, it can help to temporarily reduce their exposure to it while working to uncover the root cause of it.
“It can sometimes help to reduce a person’s exposure to something that makes them nervous and supporting them while looking for what might be at the root of the problem, before gradually phasing the activity back in a way they feel in control of.”
However, she warns, it isn’t always possible to pinpoint the cause of the anxiety. It’s also worth trying the simple things when it comes to dealing with anxiety.
“I know a psychiatrist who firmly believes that long walks or short fast walks, where you have the time to think about the cause of things, can be helpful.
“He recommends a one-hour walk on your own three times a week. It’s the rhythm of walking which will help you to relax and to start thinking.”
The level of anxiety you suffer can be linked to how you deal with the ‘What if’, says Bernadette Ryan psychologist and therapist with Relationships Ireland.
The way to tackle a pervasive anxiety about something is to consider what you believe to be the worst-case scenario (the ‘what if’ ) and work out a strategy for dealing with it should it happen. Then you commit to doing whatever it is that’s been worrying you, such as speaking in public. However, getting stuck at ‘what if’ means getting stuck in a place of fear, and this creates anxiety, she says.
If you don’t address the ‘what if’ head-on, it can cause immense anxiety.
Anxiety, says Ryan can also result from the fact that in modern life there is nothing to actually physically run from to get relief, so the adrenal gland will often continue to pump out adrenaline and rack up the anxiety levels.
She recalls how a doctor friend of hers once said that people suffering extreme anxiety should try “running off” the adrenaline.
Controlling your breathing is another coping mechanism. “It is the exhalation that is the most important part,” she says, suggesting the popular four-seven-eight breathing routine: “You breathe right down into the belly to the count of four, hold to the count of seven and then let out the breath with pursed lips to the count of eight, keeping your tongue behind the ridge of your top teeth.
The exhalation sends a message to the brain that everything is ok.”
While these methods can be effective in dealing with anxiety, they may not work for anyone caught in a full-blown panic attack, she says.
Another way to tackle pervasive anxiety is to examine thought patterns.
“We tend to have very negative thoughts,” she says, adding that these can really fuel anxiety.
When we stop and challenge our thought processes, we quickly realise there are negative thoughts going through our heads all day. And this is what feeds our anxiety.
“There is a constant negative thought process going on that fuels anxiety. Challenging negative thoughts is a big issue in combating anxiety,” she says.
If you allow a low-grade anxiety to build unchecked, it can potentially result in the adrenal gland flooding the body with adrenaline resulting in a frightening panic attack.
Another cause of anxiety, believes Ryan, is simply life-style related — we can have too much adrenalin in the system from too little sleep, too much stress and too much coffee.
“Shortly after I joined the workforce, I experienced quite serious bullying from a superior and received very little support when I complained” — at the time, he was in his 20s.
“I was simply advised to transfer to a different department, which I did,” Michael says.
The traumatic period kick-started decades of pervasive anxiety.
“I’m now in my 40s and it has taken me many years to get to grips with it.
I believe the anxiety is directly related to that bullying, because my anxiety has always been work-related — to this day, I never worry about relationships or financial matters.
“I took a lot of courses, in things like personal development and assertiveness training, and got counselling in cognitive behavioural therapy.
“CBT is a great way to deal with anxiety, as it teaches you to gather the evidence to challenge the unrealistic worries you have that lead to dramatic increases in your stress level.
“My GP recommended that I attend a CBT therapist to learn coping skills to deal with my anxiety.
“I attended five sessions and would recommend it to anybody who suffers from anxiety.
“I learned to stand back and put the anxiety in perspective, so you will see that it is not as important as you think.
“For example, if the boss snaps at you in a meeting, my first reaction would be a flash-back to the bullying I received years ago and my anxiety levels would shoot up.
“Now, I’ve learned to step back and consider the possibility that the guy is simply having a bad day — and, nine out of 10, I’ve found that to be the case. “CBT is all about looking at your anxiety and finding evidence to challenge the unrealistic fears that are causing it.”
