Everybody experiences anxiety within their lifetime at some point. Anxiety is a natural response useful in helping us to avoid dangerous situations and motivates us to solve everyday problems. It can vary from mild uneasiness through to a terrifying panic attack. However, an anxiety disorder differs from normal anxiety in the following ways:

• It is more severe
• It is long lasting
• It interferes with the person's relationships and work life

Physical Effects:

• Palpitations
• Hyperventilation shortness of breath
• Dizziness, Headache sweating
• Muscle aches
• Dry mouth

Psychological Effects:

• Unrealistic and excessive fear and worry
• Difficulty in concentration
• Difficulty in making decisions
• Irritability impatience, anger
• Confusion
• Tiredness or sleep disturbances, vivid dreams
• Unwanted repetitive unpleasant thoughts

Behavioural Effects:

• Avoidance of situations.
• Distress in Social Situations.
• Urges to escape situations.
• Repetitive compulsive behaviour.
• Continually seeking reassurance.

There are two main types of anxiety disorders:

1. Generalised Anxiety Disorder (GAD). The main physical symptoms of GAD are pounding heart, headaches, stomach pains, inability to relax and a dry mouth. The main psychological symptoms of GAD: the inability to cope, excessive worry, irritability, restlessness, inability to focus and make decisions.
2. Panic disorder or panic attacks. A panic attack is a sudden onset fear of impending doom, terror or even death. A person who experiences these types of attacks will often avoid any situations similar to when it occurred previously, or in situations they perceive these things happening. 

It is common for people to have a panic attack at some point in their lives. Few go on to have repeated attacks, and fewer still go on to develop panic disorder. Some panic attacks don’t appear to be triggered by anything specific. These are called 'uncued' panic attacks. Other panic attacks may be associated with a feared situation. For example someone with social phobia may experience a panic attack in a social setting.

Symptoms of a panic attack can include:

• Increased awareness of heartbeat
• Sweating
• Trembling or shaking
• Chest pain or discomfort
• Fear of dying
• Nausea or abdominal distress
• Feeling of unreality or detachment from oneself
• Feeling dizzy, light-headed or faint
• Lock jaw

FIRST AID FOR ANXIETY DISORDERS

Everybody experiences anxiety within their lifetime at some point. Anxiety is a natural response useful in helping us to avoid dangerous situations and motivates us to solve everyday problems. However, for some people, anxiety is extremely distressing and can be life-changing.

ACTION 1 - Approach, assess and assist.

Approaching someone who you believe may be suffering from anxiety would be similar to approaching someone with depression. Proactively approach the person about your concerns and, if they don’t do so themselves, initiate a conversation with them about how they are feeling. Find a suitable time and space where you both feel comfortable and be mindful of the person's personal space when approaching them. If they feel anxious they may be more sensitive to keeping their own personal space and feel more anxious or comfortable if you come too close. Respect their privacy. As you talk with the person watch out for signs that they may be experiencing a crisis. Sometimes the crisis may be readily apparent as the first sign (e.g. if you encounter someone who is having a panic attack). At other times it may reveal itself as you work through the mental health action plan, for example when you are listening to someone. If the person has suicidal thoughts, follow the First Aid for suicidal crisis covered below.

What should you do if I think someone is having a panic attack?

If the person says they are having an attack as they have experienced the same before, or you think they are experiencing an attack:

• Help the person into a supported position e.g. against a wall.
• Reassure them that the frightening feelings they are experiencing will eventually pass.
• Encourage the person to try and focus on something that is non-threatening and visible, such as the time passing on their watch. It is important that you remain calm and you don’t start to panic yourself.
• Speak clearly and slowly, and use short sentences.
• Give them space and ask before touching them.
• Slow breathing - while the person is having a panic attack it may be helpful for them to focus on their breathing. Feelings of panic and anxiety can get worse if a person breathes too quickly. Breathing slowly and deeply while counting to three on each breath in and out may help bring about a state of calm.

ACTION 2 - Listen and communicate non-judgementally.

• Engage the person in a conversation about how they’re feeling.
• Listen to the person without judging.
• Remember that the difficulties they encounter are not due to weakness or laziness.
• Don’t be critical of the person and don’t express frustration with them for the symptoms they are experiencing. Remember that although it may be easy to jump to conclusions, you have a choice to set these aside while helping the person.
• Remember to allow silences. Be patient and don’t interrupt the person.
• Use phrases like “I see,” and “I understand.”
• Avoid confrontation or physical intervention, unless necessary to prevent harmful acts.

ACTION 3 - Give support and information

The support and information will be similar to that which you may give to someone experiencing depression and can include:

• Treat the person with respect and dignity.
• Don't blame the person for their difficulties.
• Have realistic expectations for the person.
• Offer consistent emotional support and understanding.
• Give the person hope for recovery.
• Provide practical help.
• Offer information.
• Highlight that anxiety can be unpleasant but rarely harmful.

It is important to be aware that recovery from anxiety involves facing situations which are anxiety provoking. However it is equally important not to dismiss their fears as trivial and force them into situations which might cause even greater distress.

ACTION 4 - Encourage the person to get appropriate help

Like depression, many people will not seek professional help for a while, with such delays likely to have a strong impact on their long-term recovery. They can also lead to complications in other areas of their life such as work or social relationships. It is therefore Important to encourage the person to seek help and not give up on finding the right help. First source of help will usually be their GP who can provide a full physical check to rule out any physical conditions causing the symptoms. Also, referring to other professionals who can offer more specialist assessment and treatment including psychotherapy and counselling.

What if the person doesn’t want help?

Find out if there are any specific reasons why. Reasons can be: costs for the service or doctors they don’t like or trust. Remember that stigma and fear of stigma can also be major barriers to seeking help. You must respect the person’s right not to seek help unless you believe they are at risk of harming themselves or others.

ACTION 5 – Supports and self-help strategies

There is evidence that family, friends and peer support groups can help with recovery from anxiety. They can also allow the person to learn from others' experiences of navigating health systems. Self-help is an important part of people's recovery, as they feel they are taking control of their lives and doing something positive. Things such as reducing caffeine or avoiding it altogether, regular daily exercise, engaging in leisure time and pleasurable activities, getting adequate sleep, creativity including journaling and writing and practising relaxation techniques can often be very successful in recovery.