A beginner's guide to anxiety

A is for Anxiety

Introducing Nigel

‘Nigel' is the name I have given to the lump that lives in my throat. He appears when I am at my most distressed and, prior to giving him a personality and moniker, I'd built him up in my mind as a malevolent force with total control over my mood and actions. The appearance of Nigel almost always precedes a panic attack and, as anyone who has ever had a panic attack will tell you, they feel like holy death on a stick.

A therapist advised me that, in an effort to make the prospect of my throat lump less terrifying, I should try to anthropomorphize it, i.e. give it human characteristics.

‘What you want is someone you consider to be evil, but who is also a figure of fun. Someone you can laugh at. A ridiculous person. No one with genuine power,' she cautioned.

That was how I came to name the most tangible attribute of my enduring anxiety disorder after the former leader of the UKIP party, Nigel Farage. And, reader, the further you take this analogy the more beautifully it works: my anxiety disorder thrives on irrational scaremongery and paranoia, it often demands booze (but should not be given alcohol because it only makes it worse) and just when you think you have got rid of it for good, it pops up again. It is an irritating fantasist, drunkenly shouting ridiculous, half-baked notions into the ether.

Nigel has been a presence in my life since I was ten years old, cycling about the countryside with reckless abandon and weeing in bushes. As children have a tendency to do, I assumed I was normal and that everyone had a Nigel. This presumption was only solidified by the fact that my mum has a Nigel (they can be hereditary, although whether through nature or nurture I am not sure) and would often talk about how she couldn't swallow or eat when she was distressed. Annoyingly, I developed the opposite inclination and would overeat when Nigel made an appearance, in a futile attempt to ‘squash him down'. This would lead me ultimately to spending eight years of my life with my head in a toilet, in the clutches of bulimia nervosa. But more on that anon.

It was only much later, when I was in my early twenties and my first long-term romantic partner remarked on how strange it was that he had never heard me raise my voice (in fact I found it impossible to muster even a whispered sentence during a conflict) that I considered myself to be in any way peculiar. Things that ‘should', according to the laws of more common human behaviour, scare me simply don't. I have been speaking in front of audiences of more than a thousand people since I was in Year Seven at school. Appearing on live television doesn't freak me out in the slightest. I've stood up in the Houses of Parliament and told politicians off without so much as a single heart palpitation. Yet put me in an intimate confrontation, or a situation where I have to voice an emotional need, and I'll flounder like a guppy out of water.

My theory is that it is all this swallowed energy and unarticulated pain that Nigel feeds on. But I've only come to this conclusion after a concentrated period of therapy and self-indulgent navel-gazing. Throughout my life, I've been so unaware, so cut off from my inner musings on a day-to-day basis, that it seemed as though Nigel made his appearances almost randomly and certainly without sufficient warning.

People often ask me if it feels as though I'm being strangled by invisible hands, but it's more like I'm choking on a great, spiky lump of tangible toxicity. It's as enjoyable as you would imagine from my description.

I didn't go to the doctor about Nigel until I was thirty-frickin-one. By that stage, I was spending three out of every seven days unable to function, seized by profuse sweating, wild, sporadic fluttering of my heartbeat and episodes of hyperventilating that could strike even as I was laying in bed. I was drinking heavily in a misguided attempt to self-medicate and was beginning to self-harm in more traditional ways. In fact, it was an episode during which I spontaneously took a bread knife out of the block on my kitchen counter and used it to carve up the skin around my hip bone that finally gave me the impetus I needed to seek professional help. It seems even I am not immune to the ridiculous and all-pervading notion that mental illnesses are only worthy of attention when they cause you some sort of visual, physical harm.

Since then, I've been trying to get the balance in my life right. I have restricted my alcohol intake. I try very hard only to eat when I am genuinely, physically hungry. I exercise regularly – running and boxing – after realizing the sum total of my physical exertions during my twenties had been confined to sexual activity and sporadic, Beyoncé-inspired booty-shaking. I got myself a counsellor. I sampled a variety of anti-anxiety medication, with varying degrees of success, until I found a type and dosage that allowed me to keep a lid on my panic attacks without either numbing my feelings or preventing me from being my (if I do say so) rather gloriously eccentric self.

Recovery is not an exact science. It requires monitoring and regular updating. Yet I cannot adequately convey how fantastic it feels to be able to say that my anxiety disorder is now simply a facet of who I am, just as it would be if I had a physical ailment, rather than an all-encompassing vortex pulling me closer and closer to the abyss.

Anxiety: The Emotion

According to the font of all knowledge and truth the Mail Online, the average human spends approximately six-and-a-half years of their life worrying. That's 3,416,400 minutes contemplating the past or the future and therefore not being fully immersed in the moment. Other animals do not do this, firstly because they don't have our brain capacity and secondly because if they did they'd probably be smart enough to realize it was completely pointless.

Anxiety is, in many ways, a gift from our unusually gigantic human brains. If you read the works of reproductive biologist Dr David Bainbridge you will learn that the development of our cognitive abilities was fundamental to our survival and evolution as a species. Human beings are, physically at least, a bit shit. We aren't strong or fast when compared with other mammals. So we needed to find more creative ways to ensure we weren't hunted to death and mauled into extinction.

Bainbridge's theory goes that, at some point in our history, a change in climate or natural disaster forced human beings out from the comfort and shelter provided by the forests where we had been dwelling and onto the open plains. Without the safety provided by tree cover, the most important commodity a person could possess became intelligence or ‘having your wits about you'. Cleverness literally became the season's must-have and that changed everything that was to come.

The necessity of prioritizing intelligence over other attributes marked the stage at which we began to find cleverness attractive in potential mates. (It's also interesting to note here that humour is an indicator of intelligence, which explains why pretty much all my adolescent, and indeed current, crushes are stand-up comedians.)

I know it's difficult to believe whilst reading comment threads on YouTube, but humans have since evolved so that the most stupid of us were weeded out. Today, our brains are approximately three times larger than they technically need to be.

In many respects, our superior intelligence is marvellous. Our gigantic human noggins have in turn given us society as we know it: science, art, culture, architecture, engineering, transport, sanitation, space travel and Pez dispensers. On the other hand, it is our extra, not-strictly-necessary cognitive capabilities that cause us to spend so much time worrying, fretting, working ourselves into a lather and generally sweating the small stuff. All that additional brain-space has to do something.

Next time you are watching a nature documentary, observe the way a herd of zebras go about their day. They graze away happily, until one of them does that twisty thing with their ear flap because they have detected an approaching lioness. They signal to the herd, who instinctually start pegging it in the opposite direction. They run as a group, swift and elegant and inexplicably hardly ever careering into one another, until the lioness manages to pick one of them off. The lioness drags her dinner to a convenient spot where she and her cubs can devour it and the zebras . . . just carry on grazing like nothing has happened.

You don't see the zebras reassembling for a debrief afterwards, wringing their hooves together and saying, ‘I can't believe she got Julie. The last words I ever whinnied to her were in anger. It could be me next time!' Zebras, as far as we know, exist entirely in the present and don't expend unnecessary time and energy considering anything which has or might occur outside of it.

During the episode with the lioness, the zebras have gone into what is usually referred to as ‘fight-or-flight response'. It should actually be ‘fight, flight or freeze response' but no one can be arsed to say that in real life. All animals including humans possess this ability, which transforms our bodies into faster and stronger machines.

When our mind considers us to be in danger, it puts us on autopilot, which is the realm of the unconscious. This harks back to a time when we were cave people and regularly encountered predators during our daily meanderings. When faced with a hungry bear, roaring and salivating, any hesitation would almost certainly result in instant death. Our only chance of living to tell the tale was to act swiftly and instinctually, without overthinking it.

The fight-or-flight response happens when a primitive part of our brain known as the amygdala goes ‘AAAAARGH!' causing our body to have two responses. The first is to shut down conscious thought, as described above. The second is to flood our system with a chemical called adrenaline. Adrenaline circulates around our bodies with impressive rapidity, feeding and enlarging our muscles. In fight-or-flight mode, we have the best possible chance of successfully running away from or (much less likely) fighting the hungry bear. Alternatively, we might ‘freeze', keeping perfectly still so that the bear isn't alerted to our presence, which is where not thinking consciously comes in handy. Conscious thinking often leads to verbal proclamations, unnecessary movement and general dithering, all of which aren't going to serve you particularly well in this situation.

The physical act of running away from or fighting our predator uses up the adrenaline our amygdala has released, meaning that once the encounter is over we are back to where we began. It's a perfect little system. If you're a caveperson.

Living as I do in twenty-first-century London, it's highly unlikely I'm going to bump into a sabre-toothed tiger on a leafy corner in Ealing Broadway. The problem is, the amygdala can't distinguish between generalized anxiety and danger. So, if I'm sitting on the number 73 bus on my way to a meeting (top deck at the front, pretending to drive it, like the cool kids do) and start to think ‘Oh, God. I'm dreading this meeting. What if . . .', that thought process might very well trigger a fight-or-flight response.

In this instance, I am now left with a body that is flooded with adrenaline, but no tangible outlet to release the chemical into the ether and get me back to a place where my conscious brain is fully functional. After all, I can't punch the bus driver and run away. That sort of behaviour is generally frowned upon.

If you cast your mind back to a time when you did something out of character, or behaved in a way you're not particularly proud of, or your body didn't seem to be obeying the commands of your mind, the chances are you were in fight-or-flight mode. There are a hundred things which could prod you towards fight-or-flight on any given day. Remember, you are part sophisticated, spiritual being and part shaven chimp in metallic brogues.

We aren't meant to be in fight-or-flight mode all the time, but overcrowding, excessive noise, relentless pace, never-ending to-do lists, stressful meetings, tricky social situations, exams, pressure to be ‘perfect', a barbed comment on social media can all provoke a fight-or-flight response. In the short term, adrenaline can cause us to shake, feel sick, faint or dizzy, have an uncontrollable urge to go for multiple excretions, hyperventilate or experience other uncomfortable changes in breathing (hello, Nigel), render us mute or unusually aggressive. In the long term, it can cause the body to overproduce a tricksy little chemical called cortisol, an excess of which is one cause of depression.

There's another undesirable long-term effect, too. When in the throes of fight-or-flight, we might develop above-average strength and agility, but this comes at a price. In order to garner and focus all the energy necessary, our body shuts down any physical or mental processes it doesn't consider to be essential in that moment. This includes hunger (which is why highly stressed people either don't eat or comfort eat in response to emotional rather than physical cues) and the immune system. Anxiety can both increase your vulnerability to viruses, stop cuts and bruises from healing and affect your skin, nails and hair, all for that very reason.

Given the plethora of anxiety-inducing stimuli in the modern world, is it any wonder that in 2016 the Guardian reported that anxiety disorders were the fastest-growing illness in young people? Or that the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is considered to be the ‘bible of psychological disorders' by those in the profession, identified no less than twelve different types of anxiety disorder?

I should point out, at this stage, that there is a great deal of difference between common-or-garden human stresses and worries (which, whilst annoying, aren't generally debilitating), a period of extreme anxiety in response to a stressful event (which is a healthy psychological response) and an anxiety disorder.

It was only about a century ago that anxiety started to be thought of as problematic. Before that, philosophers saw it as a welcome and inevitable side effect of the knowledge that we are mortal, the universe is infinite and death is inevitable (which, in fairness, are pretty terrifying concepts if you allow yourself to dwell on them and don't distract yourself with Twitter). To experience the emotion of anxiety was even thought of as enhancing for the human spirit; a consequence of genuine psychological freedom. Try telling that to Claire Eastham, founder of ridiculously popular blog ‘We're All Mad Here', author of a book of the same name and experiencer of an acute anxiety disorder. Claire suffers from social anxiety, which she experiences as an obsessive paranoia and fear concerning the way she is perceived by others as well as panic induced by social gatherings, meetings and public speaking. This is one of the commonest forms of anxiety disorder.

Others include:

Generalized Anxiety Disorder (GAD)

This is defined by the NHS Choices website as ‘a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event'. It is used to describe the phenomenon of feelings of distress which don't anchor themselves to a specific fear, but can strike at any time. Essentially, if you have GAD you're spending large quantities of your life responding as though a sabre-toothed tiger is in the room.

Obsessive Compulsive Disorder (OCD)

This is categorically not, despite the way the term is often used colloquially, ‘liking things to be neat and tidy'. It drives me to distraction whenever I hear someone say, ‘I'm a bit OCD. Everything on my desk is perpendicular. Mwah hahahahaha' and I have to quell the urge to grab them by the collar and screech, ‘DO YOU BELIEVE THAT IF EVERYTHING ON YOUR DESK ISN'T PERPENDICULAR YOUR FAMILY WILL DIE?' The ‘O' in OCD relates to thought patterns that are relentlessly repetitive in nature, for example ‘there are germs everywhere' (which there are, but most of us don't give it much thought). The ‘C' describes something one feels compelled to do in order to stop the obsessive thoughts – like washing hands. ‘Disorder' signals something which is happening long term. In this example, thoughts about germs return even after the person in question has washed their hands, so they wash them again, sometimes several times. If left unchecked, the person could develop other compulsive behaviours like not touching certain objects for fear of germs, until they reach the stage where they can't leave the sanctity of their disinfected house. Another common manifestation of OCD is convincing yourself that something terrible will happen to those you love. People experiencing OCD may develop a set of rituals in an effort to express and calm these kinds of distressing thoughts, like switching the lights on and off exactly twenty-five times before they go to sleep.

Post-Traumatic Stress Disorder (PTSD)

Another charming side effect of fight, flight or freeze is that our mind places anything it isn't able to deal with in the present moment – because it would distract us too much from the task in hand or is simply too overwhelming to contemplate – into a box labelled ‘things to deal with later'. Memories of events that have often been shielded from the conscious mind and ‘forgotten' will come hurtling back towards people with PTSD at unexpected, seemingly random moments.

PTSD is most often associated with the armed forces, since we now know that huge numbers of people who have served in combat have been left traumatized and therefore afflicted with the condition. However, it is also possible to develop PTSD in response to a wide range of events, not least of all sexual assault. In fact, the reason that it is important to acknowledge ‘freeze' when discussing the fight-or-flight response is that it answers the question that used to be asked routinely by judges to rape victims: ‘Why didn't you fight back or struggle?' The implication used to be that unless you fought back against your attacker you couldn't have been sexually assaulted, which led to hundreds of victims never receiving justice.

Now we understand not only that can we freeze in response to danger, but that our minds can produce a simultaneous ‘flight' response. Essentially, if you're physically unable to remove your body from a dangerous situation, your mind will shoot off anyway. That's why we so often go blank when we are nervous. It also explains some of the mechanisms involved in trauma.

A psychologist once told me if you want to understand what it's like to be traumatized, think of a time when you have drunk alcohol to excess. If you have ever woken up with a hazy-to-non-existent recollection of the night before, trying to piece together what happened from the fragments of memory, that is a very similar sensation to the effect of trauma. Trauma is often more subjective than we give it credit for. It is not for us to define what induces trauma in others. Bullying can cause trauma, whether it's emotional, physical, sexual, psychological or all of the above.

Trauma can induce painful and unexpected jolts as memories resurface, often as fresh as though the person were experiencing the incident anew. When this happens regularly it is the defining characteristic of PTSD.

Panic Attacks

Ah, the bane of my otherwise enjoyable life: the panic attack. Ask a professional and they'll tell you a panic attack is merely a concentrated, dramatic and fleeting manifestation of the fight-or-flight response, characterized by a heightened awareness of sound and colour, increased heart rate, feelings of dizziness and nausea and difficulty breathing normally. Ask a person who has had one and they'll say something like, ‘The world went in and out of focus like I'd taken something hallucinogenic, I couldn't breathe, I thought I was dying briefly and then I cried for half an hour and had the overwhelming urge to eat a packet of Hobnobs' (although the biscuit thing could just be me).

A beginner's guide to being anxious

To say ‘I feel anxious' is not automatically to perform an act of self-diagnosis. ‘Anxiety' is a perfectly common-or-garden type word, derived from the Greek ‘angh' meaning ‘to press tight or strangle'.

As a person who has, on most days, got to grips with panic disorder through a combination of medicine, sport, music and practising the Buddhist art of observing my emotions from afar and impassively thinking, ‘Oh, look at that. I'm feeling anxious' (or, as my husband describes it, ‘telling my brain to fuck off'), I make it my mission to explain to people the differences between my disorder and the more usual transitory feelings of worry, apprehension and dread.

The first question to ask yourself is this: is my anxiety in response to something specific and/or tangible? If the answer is ‘yes' then ask yourself ‘is this something most people would get at the very least a little nervous about?' If you're vomming at the very thought of your impending driving test but are perfectly content the rest of the time then that, whilst of course deeply unpleasant, is probably not a medical issue. It's an understandable response to what is generally acknowledged to be a stressful life event.

If, however, the prospect of doing things that are usually considered to be easy or pleasurable, like meeting friends for dinner or having a conversation with the person at the supermarket checkout leaves you quivering and sweaty, then you are meandering into ‘disorder' territory and should probably chat with your doctor. (Please note the importance of not self-diagnosing. Make sure you seek advice from a medical professional.) The first step in combating panic is almost always to try and regulate breathing. Traditional wisdom tells us to breathe into a paper bag to combat shallow breathing associated with anxiety. Even now, some doctors swear by this, but it's worth noting that the latest thinking doesn't recommend the paper-bag technique, firstly because there is a chance of sucking up a receipt or other sundry item and choking, and secondly because the benefits of the bag are in part psychosomatic (it gives you something to focus on when you're panicking) and of course you might not always have one to hand.

A useful technique I learned is to tense every single muscle in my body for a count of five and then release for a count of ten whilst exhaling. Either that or to bring my shoulders right up to my ears and then slowly lower to a count of seven, again whilst exhaling. Both these techniques make you seem slightly odd during a business meeting, but then again so does hyperventilating, shouting at people for no reason, becoming inexplicably mute, puking into a wastepaper basket or overheating and having the sudden urge to rip all your clothes off.

The next step is to think like a caveperson and identify an outlet for the adrenaline coursing around your system. Exercise is a great one, even if it's just going for a brief, brisk walk, doing a few star jumps or whacking on Queen's greatest hits and boogying around the room whilst hoovering, Freddie style. If the situation allows, there are some great apps available which have five- or ten-minute guided meditation or mindfulness exercises on them.

Experts differ on whether it's better to ‘ride the wave' of your anxiety or tell yourself to calm down. I tend to dwell with the former camp because I find the term ‘calm down', even when I'm saying it to myself, incendiary.

I'm quite contrary like that – I don't like even telling myself what to do. In fact, I find it effective to go in completely the opposite direction and say to my anxiety, ‘Come on then! Let's 'ave you!' When in this confrontational, channelling-Danny-Dyer-type state it's virtually impossible for me to feel anxious. Of course, medication might be necessary.

Ultimately, life is gloriously, sometimes terrifyingly random and you are a unique being trying to navigate it. Ignore anyone who tells you they have the definitive solution to anxiety, and concentrate on finding the combination of techniques that works for you.​

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In A Beginner's Guide to Being Mental: From Anxiety to Zero F**ks Given, Natasha Devon calls upon experts in the fields of psychology, neuroscience and anthropology to demystify mental health from A (anxiety) to Z (Zero F**ks Given – or the art of having high self-esteem).

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