tired man sitting on floor surrounding by boxes
Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

Anxiety is the term used to describe a set of emotional, physiological and behavioural responses that you experience when your brain detects a threat.

What causes anxiety?

There are different pathways in your brain that can result in the anxiety you experience, but each involves an alarm bell being set off to activate your stress response. I touch on the pathways in the video below.


The alarm bell can be activated by a ‘thinking’ route, where your thoughts and worries can make you anxious, and by a quicker route, where your brain remembers to be anxious.

You were not born anxious.

Things had to be repeated ( or practised) for you to feel anxiety when necessary. You undoubtedly did not do this on purpose.Your brain is primed to pay more attention to negative experiences than positive ones, as the negative ones may harm you.

It is not the anxiety that is the problem but how you think about it and respond to it.

Dr Elaine Ryan

For example, you worry about being late. You feel stressed, anxious or angry at being stuck in traffic; your brain is alert to this adverse situation. The dangers that your brain responds to are no longer life-or-death situations but day-to-day experiences.

Your anxious brain is always on the lookout for possible’ danger.’ When there is no real danger there, your mind takes over, and worries, races; you expect the worse.

Physical symptoms, maybe even panic attacks, develop. The pathway in your brain for anxiety becomes stronger. It can connect your worries with the physical symptoms in your body.

If you worry about a meeting or dread going somewhere with anxiety, your brain pays attention to this. New pathways are created relating to stress. Now, if someone mentions the ‘meeting’ or the place ‘you dread going’, your anxiety pathway is activated, and your brain can give you everything related to anxiety.

Your worries, the physical symptoms, they all appear automatically, just like reading this page. You can now feel anxiety in many situations and not know why.

You have your automatic pilot for anxiety. What your brain pays attention to becomes real. You are now living with an automatic stress response.

What is a stress response?

Let’s take the example of sitting in your favourite armchair after dinner. If your brain and body are working well for you, it will do the following:


Your rest and digest nervous system will give you a relaxation response to relax your body and help you to digest your food. You feel comfortable and relaxed. The relaxation response enables you to kick back and unwind from your day.

Suddenly there is a loud bang in the other room.


Your brain takes over and gives you a stress response to make you feel alert and move quickly to see what has happened.

One second you are almost asleep, and the next, your heart is pounding, and you are in the other room. Does that sound familiar? One second you feel ok, and the next, you feel stress or anxiety?


You see that your dog knocked over a stool, and you calmly walk back to your favourite armchair.

Soon your heart rate has slowed down, and you are feeling comfortable again, as your nervous system has replaced the stress response with a relaxation response (rest and digest.) You fall asleep.


This is how our nervous system should work for us, giving us stress when we need it and relaxation at other times. However, suppose you experience any form of stress. In that case, you will be feeling the effects of the stress response in many situations where you do not need to.


You may find it difficult to kick back and relax and feel the benefits of the relaxation response as you are on a constant high alert – getting the stress response too often when it is not needed.


Your brain is primed for stress and associates the small things in life with anxiety. Each time you encounter them, your mind gives you stress.


I want to reassure you that science shows that you can change how your brain works for you. Your brain changes during your life depending on your thoughts and how you react to all the different experiences you encounter in your life.

How do I know if I have anxiety?

You shall be suffering from a set of symptoms (that I shall discuss in more depth later in this article), such as a racing mind, palpitations, interrupted sleep that shall lead you to your doctor. Your doctor will check for medical explanations for your symptoms. Once ruled out, they may refer you to a mental health professional who can diagnose anxiety.
The mental health professional will also tell you which type, if any, of anxiety disorder you have.

Types of anxiety disorders.

All anxiety disorders have a specific set of signs and symptoms. It is essential to know what type of anxiety you are experiencing. Ask yourself the following questions.

If it does, your experience of anxiety may be cured by treating the medical condition as opposed to the anxiety.

If so, you may have Panic Disorder.
If you have Panic Attacks (Disorder) and avoid certain aspects of your life out of fear of an attack
or feeling trapped or unsafe, you may have Agoraphobia

If you repeat certain things, and experience anxiety if you cannot carry this out, you might have obsessive compulsive disorder.

If so, you might have health anxiety.

If you have answered the questions above, but your anxiety does not fall under a specific category, you might have what we call generalised anxiety disorder; GAD.

What are the symptoms of anxiety?

Many people feel that they can’t breathe properly during a panic attack or experiencing high anxiety. It may feel like you are gasping for breath or can’t get enough air into your lungs. You may also feel like you are suffocating or being smothered.
You usually don’t have to think about breathing; you do it automatically. The autonomic nervous system makes sure of this.

The key to restoring your breathing to normal can calm down your nervous system.

As explained above, the sympathetic nervous system produces a “fight or flight” response during high emotions. It is trying to protect you from danger (although there is no danger there.) It is the sympathetic nervous system that causes your breathing to change. It may also speed up and cause rapid shallow breathing.

You hyperventilate. You are still breathing. Your breath has just changed rapidly, and it feels uncomfortable, but you are still living.

Having difficulty breathing is one of the most frightening symptoms of panic attacks. The critical thing to understand is that this response is due to you getting a fear response in situations where you do not need it. Your nervous system has become over sensitised.

This symptom can feel like someone has put a belt around your chest and tightened it.
It can also feel like something is pressing down on your chest or squeezing it. Your heart may be beating out of your chest.
Chest pains such as these are usually why people, like yourself, attend their doctor, afraid that something has happened to their heart.

Once you have received the all-clear, the pain you are experiencing is down to breathing too fast (hyperventilation). Anxiety causes our hearts to beat more quickly than is needed. We overwork our chest muscles, which leads to the sensations we experience.

Chest pain may cause you to feel alarmed and fear that you have a heart attack. This fear often makes you panic more. As explained previously, you hyperventilate during a panic attack. When you puff regularly, you are over-breathing. You are using the chest muscles more often than usual. If these muscles are overworked too often, you will begin to feel chest pain.

As you breathe in normally, you breathe in oxygen and breathe out carbon dioxide. When you are breathing too fast or over-breathing during a panic attack, the carbon dioxide levels in your blood start to lower (as you are breathing it out too quickly.)
When this happens, your blood vessels will constrict, leaving you feeling dizzy.

Palpitations is one of the more frightening panic attack symptoms as you may think that your heart is about to give up.
Your autonomic nervous system controls your breathing and heart rate, amongst others. You don’t have to think about it.
During high emotions such as a panic attack, your sympathetic nervous system responds to prepare for a fight or flight. It is the sympathetic nervous system that is causing your heart to race.
Although unpleasant, it won’t harm you.

Again this is due to breathing faster than is necessary—carbon dioxide drops which result in tingling and tightness.
Think of it this way. This response is very adaptive when necessary. Suppose you fall and damage your leg, where part of your leg has been cut open. In that case, your body will immediately get a stress response, and your muscles will immediately tighten.

Your body is trying to protect you, although getting this symptom when nothing has happened to you is understandably worrying.

During a Stress Response, the large skeletal muscles contract in the neck and shoulder muscles to prepare you for action. This contraction is what causes your neck, back and muscles to ache. It can also give you a headache.

You might have found that your thought processes have changed since experiencing anxiety or panic attacks.

Typically thoughts include:

  • I’m going to die
  • I’m going crazy
  • I’m going to lose control
  • Something terrible is happening
  • I’m going to have a heart attack.

It’s natural to think thoughts such as these in the beginning. The symptoms you experience in your body come from a primitive part of your brain. It reacts first and thinks later. If your mind thinks you are in danger, it will not wait for you to think about it and decide what to do. Instead, it reacts for you, trying to keep you safe.

When the heart pumps blood around your body during the fight or flight response, your body cools itself by sweating. Blood vessels move closer to the skin’s surface and cause the redness you see – blushing.
Once you are aware that you are sweating and blushing, especially in front of others, your thought processes become preoccupied with what you must look like and whether the other person notices. This, in turn, may make you feel more anxious. Our thoughts are connected to what we think and can produce symptoms in the body.
This is quite common in social anxiety.

Your mind may be racing at night, and you may find it hard to “switch off.” This overactivity of your thought processes will keep you alert and make sleep difficult. You may then worry throughout the day that you will not sleep at night.
This worry is called “anticipatory anxiety.” We make ourselves anxious by worrying about the anxiety we might have in the future. In this case, the future is bedtime.
If your body is alert at night, once you fall asleep, you may wake up frequently in a startled state due to adrenal.

  • Trembling and Shaking
  • Tiredness and Fatigue
  • Digestive Problems, Irritable Bowel Syndrome
  • Blurred Vision
  • Urination
  • Panic Attacks

Women are more likely than men to experience anxiety disorders. Some studies have found that men and women may experience panic attacks differently.
Women are more likely to experience shortness of breath and the smothering sensation typical of panic. They are also more likely to feel ill.
In some studies, men reported feeling more pain in their stomachs and experienced sweating more than women.
This is not to say that men do not experience breathing difficulties and that women do not experience increased perspiration during panic attacks. Both men and women can, and indeed do, experience both.

Treatment and self-help

If you have already had your anxiety diagnosed, you might be offered the following treatments.

If you attended your doctor, you could be offered medication or referred to someone like me ( a psychologist) for talking therapy. A stepped care approach to anxiety treatment could be implemented.

Retrain your brain

If you would like my help, I have an online course for anxiety, based on my private practice.

Step 1: Use of Self Help for Anxiety.

This can include general self-help material such as books and guided self-help materials such as CCBT; Computerised Cognitive Behavioural Therapy. I have been working in psychology for almost 20 years, specialising in anxiety and finding that self-help is enough for most people.


Step 2: Psychological Anxiety Treatment.

You might attend a psychologist for CBT- Cognitive Behavioural Therapy. CBT is the most well-known anxiety treatment. However, CBT works best for what is known as cortex based anxiety. This means that it works best for anxiety primarily due to your thinking brain, i.e. your thought processes and worries.


However, if you find that your anxiety can arise for seemingly no reason or get anxious in the same situations, you might have what is known as amygdala based anxiety; this occurs mostly where you experience anxiety automatically or in situations where your brain has remembered to be anxious.


Amygdala based anxiety requires a different type of treatment, one which focuses on helping you to unlearn the stress response in situations where you experience anxiety.


I found that many people benefit from receiving both types of anxiety treatments, which is why I cover both in my online self-help course.




You might have been offered an SSRI that stands for Selective Serotonin Reuptake Inhibitors. Still, the first point of treatment is generally therapy, as opposed to medication. SSRI’s usually take about 4 to 6 weeks before they ‘kick in’ and help treat your anxiety by increasing your serotonin levels.



You might also have heard of these medications being shortened to ‘benzos.’ They can quickly help with the physical symptoms of anxiety for some people, as they act as a sedative. They can be highly addictive, and these should be used short term only.


If you would like my help, please see my online courses.

Table of Contents