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Stress, Panic & Anxiety

Introduction

This section explores the topics of stress, panic attacks, and anxiety. Each of these conditions are commonly experienced by survivors of rape and sexual abuse, but there are things that can help to make them more manageable. This section takes a look at the science behind each of these and explores possible causes and symptoms. It also includes a toolkit of coping mechanisms for each condition.

Click the links below to explore the sub-sections on this page:

1 – Survivor Stories
2 – Stress
3 – Panic Attacks
4 – Anxiety
5 – Helpful Resources

1 – Stress, Panic Attacks and Anxiety – Survivor Stories

Click the video below to hear from survivors of rape and sexual abuse about their experiences of stress, panic and anxiety.

Click the links below to watch the survivor interviews in full on YouTube:

Click the video below to hear tips and advice from survivors about what helps them to manage feelings of stress, panic and anxiety.

You may find that your experiences of stress, panic attacks and anxiety as a survivor are different from the ones we describe in this section, and that is completely normal.

You may find that you relate to all of the points below, some of them, or none at all. This guide may be a useful starting place for you to learn more about stress, panic and anxiety and find some ways to learn to manage experiencing these conditions, but it is not exhaustive.

You may find the exercises and tips useful, or they might not be the right options for you at this moment in time. We are all unique in our experiences and where we are in our recovery journey, so take this section at your own pace, and explore the suggestions that feel right for you at this moment in time.

2 – Stress

Everyone experiences stress from time to time. Sometimes stress can be positive to help you feel more alert and help you to achieve your goals. However, frequent episodes of stress, or stress that occurs repeatedly over a prolonged period of time, can affect day-to-day functioning.

Types of stress

There are different types of stress, and not all stress is bad. Positive stress or eustress releases the hormones adrenaline and cortisol which help you to focus and concentrate so that you can act faster and achieve your goals, which in turn can give you a positive sense of self and promote health and growth.

The most common stress is acute or tolerable stress which helps you to survive when you feel in danger, at risk of harm, or under threat, as it prepares the body to manage the threat. When under threat, your body releases adrenaline and cortisol to prepare the body to respond to threat through activating the fight, flight, freeze, friend, or flop responses. This happens automatically and is not under your control.


These hormones pump more oxygen to the brain and increase your heart rate, which forces your blood to pump harder and faster to parts of the body where it is most needed. They also help you to breathe faster and tense your muscles. Once the threat is over your body releases other hormones to help your muscles to relax, which can sometimes cause you to shake.


In non-life-threatening situations, acute stress can help to increase performance when facing a stressful event such as a test or job interview or when you face difficult demands, challenges, or responsibilities, or when you face change, loss, and a lack of control. Acute stress is usually temporary and ends once the threat is over. However, if you experience recurring episodes of acute stress your body will release high levels of stress hormones which can make you feel physically unwell and could affect your health in the longer term.

This occurs due to long term and persistent exposure to stressors or trauma which you have no control over, and which can leave you feeling exhausted, depleted and dejected. If you are under threat for the majority of your life and you are under constant high-level, toxic stress, your body may constantly pump cortisol around your body, which can be detrimental to your physical and mental health as your body does not return to normal functioning.


This can interfere with the way the body and mind functions and disturb the immune, digestive, cardiovascular, sleep and reproductive systems. These can lead to physical problems such as insomnia, respiratory problems and headaches along with emotional symptoms such as irritability, anger, mood changes and sadness. This prolonged extra strain on the body can contribute to health problems such as heart disease, high blood pressure, diabetes, and other illnesses, including mental health problems such as anxiety and depression.

Types of stress

People vary in how they experience and cope with stress, and how quickly they recover from stressful events. Stress can cause a range of difficulties, and the overactivation of the stress response system can cause further physical and mental health problems, especially repeated episodes of acute, chronic or toxic stress.

Yerkes-Dodson Performance and Stress Curve (1906)

Video – How stress affects your brain – YouTube

 

Click this link to watch a Ted-Ed animation on how stress affects your brain, including its size, structure, and how it functions, with Madhumita Murgia.

Please note: This link will take you away from The Survivors Trust Resources website. The link is being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

The cause of stress

Everyone experiences stress differently, and in different situations, and it can affect your body and mind, as well as your emotions and behaviour. Stress can be caused by a specific situation or can occur due to a build-up of small pressures. This means that sometimes you might be able to know straight away when you’re feeling stressed, while at other times you might keep going without recognising the signs. This may make it harder for you to identify what is making you feel stressed, or to explain it to other people.

Video – The Connection Between Stress and Disease – Dr. Gabor Maté – YouTube

 

Click this link to watch physician Dr. Gabor Maté explain the role the mind-body connection plays in illness and health.

Please note: This link will take you away from The Survivors Trust Resources website. The link is being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

Stressors

Stressors can be internal, such as thoughts, beliefs and attitudes, or external, such as losses, current or past trauma, or tragedy.

Stressors can be either biological, environmental, cognitive, behavioural or life changes all of which can trigger a stress response in your body. It can be really helpful for you to identify any external or internal stressors that trigger an increased stress response in you.

Factors that influence how much stress you feel
  • How you perceive a situation (which can be influenced by past experiences)
  • How you are feeling
  • How you interpret things
  • The meaning you make of things that happen to you, or situations you are in
  • The number of other pressures you are facing
  • Previous experience of managing pressure or stress
  • Your self-esteem and confidence
  • Your resilience
  • Your access to support.

Remember: you can learn to manage your stress by managing external pressures more effectively to reduce stress, and by developing strategies that help you to develop your emotional resilience so that you do not feel quite so stressed.

The degree of stress you feel can depend on a range of factors.

  • Feeling under pressure due to extra demands such as when you have a lot to do or think about. These can be daily responsibilities at home, work, or school
  • Daily repetitive routines with little variation, stimulation, or reward
  • Life changes and loss such as grief, separation, divorce, illness or losing your job
  • Traumatic experiences in which you are in danger of being harmed or killed, such as being in a serious accident or a natural disaster, being physically or sexually assaulted, or being in a war zone. These can all lead to traumatic stress
  • Feeling that you don’t have much control over what happens to you or the outcome of a situation
  • Feeling unable to cope
  • Responsibilities that are overwhelming
  • Worrying about something
  • Facing a lot of uncertainty and unpredictability.
Situations and life events that can cause stress
  • History of trauma, complex trauma, dissociation, DID , abuse or neglect
  • Difficult relationships with parents, siblings, friends or children
  • Being a carer
  • Long-term health problems, illness or injury
  • Losses such as death of a loved one, loss of relationship, divorce, loss of job or long-term unemployment, retirement
  • Pressures at work, managing deadlines, exams
  • Change and new challenges such as starting a new job, going to a new school, college or university, getting married or civil partnered, being pregnant and becoming a parent
  • Competing demands such as work, travel, family, relationships, responsibilities
  • Housing problems such as homelessness, poor living conditions, lack of security, moving house, problems with neighbours
  • Money worries such as benefits, poverty or debt
  • Organising events such as a wedding or group holiday
  • Stress due to the Covid-19 pandemic and resulting lockdowns.

Remember: happy events such as getting married or having a baby can create extra demands and pressures and can be stressful. This can be difficult as you might feel that you should feel positive rather than stressed, but your feelings are valid.

Experiencing stress
Signs of negative stress
  • Tiredness
  • Headaches
  • Upset stomach
  • Difficulties sleeping such as insomnia, staying asleep, waking late, or needing more sleep than usual
  • Not wanting to eat or eating too much, or craving comfort foods
  • Feeling irritable, aggressive, impatient or wound up
  • Feeling over-burdened
  • Feeling anxious, nervous or afraid
  • Racing thoughts that you feel you can’t switch off
  • Being unable to enjoy yourself
  • Being depressed
  • Losing interest in life
  • Losing your sense of humour
  • Feeling a sense of dread
  • Being worried about your health
  • Feeling neglected, abandoned and alone
  • Being unable to concentrate, focus or remember things
  • Not being able to think clearly or make decisions.

 

It can help to write down what the first signs of stress look like for you to help you to manage the stress before it builds up.

Impact of stress

Stress can have an impact on your body and mind, as well as your emotions and behaviour. This can be both positive, as in eustress, as well as negative in increasing your level of distress.

Impact of stress on the body, mind, emotions and behaviour
Positive stress, or eustress provides:
  • Mental alertness, motivation, and efficiency
  • Increased focus, concentration, and increased productivity
  • Increased self-esteem as it promotes belief in yourself and your ability to manage and complete tasks, and cope with stressors
  • Help you to feel that you can be the best you can be
  • Give you a sense of power and control over the situation and your life
  • Gives you a more positive mindset and positive outlook on life.
Acute or chronic stress

If you feel consistently overwhelmed by stress it can impact your physical and mental health.

Chronic stress can both cause mental health problems such as anxiety and depression
and make existing mental health problems worse as coping with symptoms, attending appointments, or taking medication can create extra sources of stress. This can feel like a vicious cycle, making it hard to see where mental health problems begin.

Remember: lack of stimulation or not having enough things to do can be just as stressful a situation as having too much to manage.

  • Tiredness and fatigue
  • Increased blood pressure
  • Shallow breathing or hyperventilating
  • Panic attacks
  • High blood pressure
  • Dizziness
  • Chest pains
  • Indigestion or heartburn
  • Bloating, constipation or diarrhoea
  • Weight gain or loss
  • Feeling sick or dizzy, or fainting
  • Headaches or migraines
  • Muscle tension
  • Grinding your teeth or clenching your jaw
  • Insomnia, difficulties staying asleep or nightmares
  • Low libido, erectile dysfunction, loss of interest in sex or being unable to enjoy sex
  • Menstrual problems and ovulation problems
  • Difficulty recovering from exercise
  • Illnesses such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome.

 

  • A loss of confidence
  • Tearful
  • Irritable
  • Anxious
  • Apprehensive
  • Apathetic
  • Hopeless
  • Negative
  • Depressed
  • Alienated
  • Suicidal.

If you have suicidal feelings, you can contact Samaritans on 116 123 (freephone) or email
jo@samaritans.org. If you are in immediate danger, call 999 or visit your local Accident and Emergency (A&E) department.

  • Lack of concentration and focus
  • Muddled thinking
  • Constantly worrying
  • Racing mind and overthinking
  • Finding it hard to make decisions, or making hasty decisions
  • Making poor judgements
  • Not being able to plan.
  • Feeling agitated
  • Avoiding situations that are troubling you
  • Snapping at people
  • Biting your nails
  • Picking at your skin
  • Eating too much or too little
  • Increased smoking or drinking alcohol
  • Restlessness and not being able to settle or calm yourself.
Stress Toolkit




While everyone manages stress differently, there are a range of things that you can do to help you cope with stress. Here are some tips that people have found helpful, although you should only try what is comfortable and manageable for you.

Identify triggers

It can be really helpful to work out what triggers your stress so that you can be more aware of what causes your stress. Knowing these can help alert you to potential stress so that you are more prepared to manage or solve it.

You could consider:

 

  • Situations and events that preoccupy your mind a lot
  • Recurring worries such as managing your health, attending appointments, managing your budget or paying bills,
  • Ongoing stressful events, like being a carer, worrying about a family member, partner or close friend, or problems at work.

 

Take a moment to reflect on the sort of things that trigger your stress such as feelings, events, situations or people. It might help to do this with a trusted friend or family member. 

Tip: You could also try writing down your stress triggers on a ‘stress thermometer’.

 

PDF – Stress thermometer

Organise your time

It can help to organise your time as this can help you to feel more in control of the challenges and more able to manage the pressure.

  • Identify the time of day when you are most alert, or feel most focused and able to concentrate, and try to do your most important tasks then. This could depend on whether you are a ‘morning person’ or an ‘evening person’
  • Make a list of things you have to do and arrange them in order of importance and try to focus on the most urgent first. Make a list of less urgent tasks and tackle these at a later point when you are less stressed
  • Consider creating a timetable so that you can plan when and how long to spend time on each task. It might also help to group similar tasks together such as phone calls or emails, or other work-related tasks as they require a similar mindset and approach
  • Try to avoid setting large goals which are hard to achieve as this can make you feel more stressed if you are not able to achieve your goal. It is more helpful to set smaller and more achievable goals as this can make you feel in more control and appreciate your achievements
  • Try to balance stressful tasks with easier, less demanding and more calming tasks, and vary mundane tasks with more interesting ones
  • Try to not spread yourself too thinly by taking on too many tasks at once as it will increase the pressure on you, and be harder to do any individual task well
  • Try to take regular breaks and take your time.
  • Sometimes slower is faster and it can help you to be more productive
  • Include rest breaks in your planning that allow time out for you to take care of yourself. This may be difficult if you have difficulty saying no to requests or always put other peoples’ needs or demands before your own
  • Reach out and ask for help with routine tasks in the home, or ask for extra support at work as this will give you more time to spend on completing the more stressful tasks.
Accepting things which you cannot control or change

There will be things that you cannot control or change, and it can help you to try to accept that. You might find it useful to list that which you can and cannot control and then focus your time and energy on what you can control.

Tip: try writing these down using our ‘Things I can/can’t change’ resource

PDF – Things I can/can’t change

While there may be some things that you cannot control or change, there may be some ways that you can improve some of the issues that are causing your stress.

Make time to address some of the causes of your stress such as your physical and mental health, relationships, work, finances or housing situation by seeking advice and other sources of help such as 
Mind, your GP, or your local citizens advice bureau.

Video – Stress Bucket – YouTube
Click this link to watch a short animation using the analogy of a bucket to explain how stress affects us.

Video – Managing your stress – Brainsmart – YouTube

Click this link to watch a video on managing stress, produced by the BBC.

Please note: This link will take you away from The Survivors Trust Resources website. The link is being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

There is no specific medical treatment for stress. If you are finding it difficult to manage your stress, there are a number of treatments that might help. To help you access these, talk to your GP:

  • Talking therapies, such as Cognitive Behavioural Therapy (CBT) which helps you understand your thought patterns, recognise your trigger points and identify positive actions you can take; or Mindfulness-Based Stress Reduction (MBSR), which combines mindfulness, meditation and yoga with a particular focus on reducing stress
  • Ecotherapy – spending time in nature. This can include physical exercise in green spaces or taking part in a gardening or conservation project
  • Complementary and alternative therapies such as yoga, meditation, acupuncture, aroma therapy and massage
  • Medication such as sleeping pills, tranquilisers, or antidepressants if you are experiencing depression or anxiety, or medication to treat other medical conditions such as high blood pressure.

3 – Panic Attacks

What is a panic attack?

Panic attacks are an extreme fear response in which you feel a sudden surge of intense anxiety and they can happen at different times for different people. Some people only experience a single panic attack, while others have recurring panic attacks over a short space of time, or over long periods of time. Some people have attacks once or twice a month, while others have them several times a week.

Most panic attacks last between five to twenty minutes, although some people experience these for up to an hour. The most intense symptoms occur within the first 10 minutes. If you are experiencing prolonged panic attacks, it may be that you are having a second panic attack or additional anxiety. Sometimes the symptoms seen in panic attacks can actually be caused by other medical conditions such as a racing heartbeat due to very low blood pressure, so you may not always be experiencing a panic attack.

 

Panic attacks can be triggered by something specific that is frightening, such as a particular place, person or situation, or as a response to stress, or they can occur spontaneously for no apparent reason. As they can happen any time, they can prevent you from going out for fear of having another panic attack. The fear of having a panic attack can lead to social withdrawal and fear of leaving the house, known as agoraphobia. Panic attacks can build up and intensify very quickly. Be aware that most of these symptoms can also be symptoms of other conditions or problems, so you may not always be experiencing a panic attack.

Remember: although panic attacks are very frightening, they are not dangerous. An attack will not cause you any physical harm.

What is panic disorder?

If you have recurring and unpredictable panic attacks without any specific triggers or cause, you may be diagnosed with panic disorder. Some people with panic disorder are thought to have a heightened sensitivity to sensory experiences such as smell, light, sound, changes in temperature, or foods.

Symptoms of panic attacks
  • Feeling out of control
  • Feeling like you are going to faint
  • Feeling like you are going to die
  • Shortness and shallowness of breath, struggling to breathe or feeling as though you are choking
  • Pounding, racing and irregular heartbeat which might feel as though you are having a heart attack
  • Pains or tightness in your chest
  • Unsteadiness, trembling and dizziness
  • Feeling that the world is spinning around
  • Feeling disconnected from your mind, body or surroundings, or experiencing other symptoms of dissociation
  • Excessive sweating, trembling, or shaking
  • Feeling faint, light-headed and dizzy
  • Feeling very hot or very cold, or experiencing hot flushes
  • Tingling in the hands and feet
  • Choking or feeling you are being smothered
  • Flushed skin
  • Urgent, intense need to run away
  • Feeling sick or nauseated
  • Feeling an urge to scream.

Video – What is a panic attack? – YouTube

Click this link to watch Psych Hub animation on what a panic attack is, including symptoms and how to manage future panic attacks.

Video – Panic disorder – YouTube

Click this link to watch a short animation by Osmosis on panic disorder, covering the clinical definition of panic disorder, signs and symptoms of panic attacks, complications and treatment methods.

Please note: These links will take you away from The Survivors Trust Resources website. The links are being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

Panic Toolkit

Panic attacks can be so overwhelming that they feel life-threatening, making it hard to manage them. One way to help you manage panic attacks is to understand the link they have to unprocessed feelings and experiences. It is also useful to identify any anxieties or areas of stress in your life that trigger the panic attacks.

There are many different ways that can help you cope with panic attacks, and it helps to find what works for you. As panic attacks are very frightening, it may be useful to write down what helps you the most and keep this list easily available, perhaps on your mobile phone, on the fridge door, or on your wardrobe in your bedroom.

Plan for panic attacks

Some people find it helpful to make a plan in advance, when you are not feeling anxious, on the steps you can take to help you manage a panic attack. Based on your experience of panic attacks, try to identify what helps to ground you and restore control. List all the things that help you and make sure that you include them in your plan for managing panic attacks. You can also use these strategies to make a safety card (to carry with you or store it digitally on your smartphone).

  1. Check and regulate your breathing by breathing fully and consciously
  2. If you are hyperventilating, hold each breath for three counts
  3. Touch an anchoring object, such as a toy or a pebble
  4. Sit down somewhere comfortable
  5. Try to think positive thoughts
  6. Remind yourself that you are not going to die, that you are not in danger, and that it will pass
  7. When the panic attack is over, try to think about what it is that is making you panic
  8. Contact a trusted friend who you can speak to.

Tip: try to build this plan with a trusted person, such as a partner, friend or family member, so that they know how they can help support you in the event of a panic attack.

Coping strategies

Other things that can help during a panic attack include:

 

  • Try to control your breathing by concentrating on slowing down your breath to the count of five. Some people find that stamping their feet on the spot helps them to control their breathing
  • Focus on your senses and try to find something that is calming for each of the sensory channels: smell, sound, taste, vision. This could include a calming smell, a favourite song or poem, a strong flavoured sweet, a calming image, or something soft and comforting to touch
  • Grounding techniques can also help you to feel more in control and are helpful if you dissociate during panic attacks. Click here to read more about grounding techniques on our Trauma webpage
  • Remind yourself what is happening – that this is a panic attack, that you are not in danger and that it will pass.
After a panic attack

Panic attacks can be really exhausting, and it is important to take care of yourself afterwards. Be mindful of what your body needs to recover after a panic attack. Try to rest quietly, have a warm drink, or eat something.


It can help to talk to someone you trust and tell them about the panic attack. This can help the trusted person to know the signs of when you are having a panic attack and how they can help you in the case of further attacks.

Treatment for Panic Disorder

If you think that you might have a panic disorder, talk to your GP about treatments available to you. These might include:

  • Talking therapy such as Cognitive Behavioural Therapy (CBT) which helps you understand your thought patterns, recognise your trigger points and identify positive actions you can take
  • Medication, which can include a type of antidepressant called Selective Serotonin Reuptake Inhibitor (SSRI), a tricyclic antidepressant (usually imipramine or clomipramine), anti-epilepsy medicine such as pregabalin, or, if your anxiety is severe, clonazepam
  • Remember that antidepressants can take two to four weeks before they start to work, and up to eight weeks to work fully.

4 – Anxiety

What is anxiety?​

Anxiety is a natural human response when we feel worried, tense or afraid. Most people feel anxious at times, especially when feeling stressed or worried about things which are about to happen, or that we think could happen in the future.

You can experience anxiety through how you think and feel, or through physical sensations. Anxiety can stop you from thinking clearly as a lot of your energy is taken up with worrying and managing your anxieties which can reduce your ability to make decisions. For more information on anxiety, visit the
Anxiety UK website.

The Science of Anxiety
Danger response

Anxiety is sometimes misunderstood as just being an emotional state, but it is also a physical condition. Anxiety is the body’s reaction to stress and is caused by the body’s ‘fight-or-flight’ response – the body’s physiological reaction to perceived physical or mental threats. The amygdala is a cluster of cells located near the base of the brain and helps to define and regulate emotions. When we perceive something as stressful, threatening or dangerous, the amygdala triggers a response which causes our body to initiate one of the five F responses – fight, flight, freeze, friend or flop. For more information on these responses, click here to visit the Trauma section of our website. This results in the release of a hormone called epinephrine, which increases the body’s heart rate and blood pressure – and can cause the symptoms commonly seen in anxiety.

Survivors of sexual abuse or rape may find a range of things trigger their stress response – and it might not be immediately obvious why this happens in connection to the experiences of rape or sexual abuse.

 

Exteroception, interoception and proprioception

Your body receives information and signals through your senses, from both your external environment, known as exteroception, and from inside your body, known as intereoception. In addition, awareness of your body in motion, your balance and orientation in space is perceived through proprioception. All of these signals can be both conscious and non-conscious.

Exteroception is the response to stimuli that originates outside of your body which are received through the five senses: sight; sound; smell; taste; touch.

 

Interoception is the way that you experience the internal sensation in your body such as your heart rate; breathing; dizziness; hunger; pain (known as nociception).

 

People vary in how sensitive they are of external and internal stimuli and how this impacts them.

 

A further source of body awareness is proprioception, which is the perception, often unconscious, of motion, movement and spatial orientation of your body, including movement of parts of your body to aid coordination and agility. Alongside this, kinaesthesia allows for awareness of your body in action through movement. Other types of proprioception include awareness of your balance (known as equilibrioception); awareness of temperature differences (known as thermoception); and awareness of direction (known as magnetoception).

 

People who experience anxiety or dissociation, or have been diagnosed with panic disorder or PTSD, are thought to have greater interoceptive sensitivity and therefore are more likely to experience intense fear and panic attacks and have a tendency to determine their reality on what they are feeling (their interoception) rather than the external environment (exteroception). If this applies to you, you might see danger when other people recognise no external threat, or you may fail to see potential danger if you are immersed in inner experiencing.

 

In order to have a stable and coherent sense of self, and to feel that your body is yours and belongs to you, it can help to integrate an awareness of exteroception and interoception so that you feel more in control.   

 

Balancing information you receive from your exteroceptors and your interceptors can help you to regulate your emotions, which can have a calming effect on your anxiety, or when you experience a panic attack or flashback. To help you become more aware of both exteroception and interoception, it is helpful to combine these when practising mindfulness.

 

 

Experiencing anxiety
Should I worry about my anxiety?

Although a degree of anxiety is normal, it can become a cause for concern and a mental health problem. This is especially the case when it impacts your ability to live your life as fully as you want to. It is not unusual to experience other mental health problems alongside anxiety such as depression, which could lead to a diagnosis of ‘mixed anxiety and depressive disorder’. Some people with anxiety might also have suicidal feelings. If you have suicidal thoughts, contact your GP or Samaritans by calling 116 123 (freephone) or emailing jo@samaritans.org.

Anxiety can be a problem if:

 

  • You regularly experience anxiety
  • Your anxiety is accompanied by panic attacks
  • Your feelings of anxiety are very overwhelming or last for a long time
  • Your anxiety and worries feel very distressing or are hard to control
  • Your anxiety, fears or worries are out of proportion to the situation
  • You find it hard to go about your everyday life or do things you enjoy
  • You avoid situations that might cause you to feel anxious.

 

It can help to make a list of your anxieties and order them into what makes you a little anxious, more anxious and very anxious on an anxiety thermometer.

 

Anxiety can come in many forms and does not necessarily mean you have a mental health problem or specific anxiety disorder. If you are worried about your anxiety or if think you might have an anxiety disorder, contact your GP to access help and support.

 

Causes of anxiety

There are many causes of anxiety, and because everyone’s experience is different, it is hard to know precisely what causes people anxiety problems. Some people may be more sensitive to anxiety if they have a close relative who suffers from anxiety. There are a number of other factors that can cause anxiety.

  • Past experiences of trauma, including childhood physical, emotional or sexual abuse, or physical or emotional neglect, or living with domestic abuse
  • Loss of a parent or feeling abandoned. This can include being separated from parents such as going to boarding school or being in care, or being a looked after child
  • Having parents or family members that are unbale to show warmth or affection, or who are overprotective
  • Being bullied or socially excluded in childhood, adolescence or as an adult
  • Your current life experiences such as acute or chronic stress, feeling under pressure, financial worries or debt, unemployment, housing problems or being homeless, loss of a loved one
  • Being bullied or abused including experiences of being sexually assaulted, raped, or being a victim of hate crime or racist abuse
  • Feeling lonely and isolated, or a lack of belonging
  • Worrying about the environment or natural disasters (known as climate or eco-anxiety)
  • Anxiety due to the coronavirus pandemic, including fears of lockdown ending (known as re-entry anxiety).

Video – The REAL cause of your anxiety – Dr Gabor Maté – YouTube

Click this link to watch Dr Gabor Maté explain how he believes that most mental health disorders – including Anxiety and Panic Attacks – originate in childhood experience as coping mechanisms.

Please note: This link will take you away from The Survivors Trust Resources website. The link is being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

Other conditions that can cause anxiety:
  • Living with a serious, ongoing, or life-threatening physical health problem
  • Mental health problems such as depression, Post-Traumatic Stress Disorder (PTSD), Complex Post-Traumatic Stress Disorder (C-PTSD), dissociation and Dissociative Identity Disorder (DID)
  • Side effects of drugs or medication for physical or mental health problems
  • Use of alcohol and recreational drugs
  • Some foods or drinks, especially those that contain sugar and caffeine, can trigger symptoms of anxiety or panic, or make existing symptoms worse.
Types of anxiety disorders

Some anxieties can be diagnosed under the umbrella term ‘anxiety disorder’ and your GP may diagnose this. It can be useful to know the range of anxiety disorders even if you do not have a diagnosis of a specific disorder to help you make sense of your experience of anxiety. For further information on each individual anxiety disorder visit mind Mind’s website or the NHS web guide on anxiety disorders.

Generalised Anxiety Disorder (GAD)
This is when you have regular, uncontrollable and repetitive worries about many different things in your daily life. As there are so many symptoms of anxiety, everyone will experience GAD differently.

Video – Generalised Anxiety Disorder – YouTube
Click this link to watch an animation by Osmosis on GAD – a condition characterised by excessive, persistent and unreasonable amounts of anxiety and worry regarding everyday things.*

Social Anxiety Disorder

This is when you experience extreme, uncontrollable fear in social situations such as everyday interactions with people, in your workplace, or social gatherings or parties, or imagining, or feeling left out. This is also known as social phobia.


Video – Your Brain on Social Anxiety Disorder – YouTube

Click this link to watch McMaster University Demystifying Medicine’s video on social anxiety disorder.*


Video – How I overcame social anxiety – Russell Brand – YouTube

Click this link to watch Russell Brand explain how he manages his social anxiety.*


Video – Nine things Social Anxiety makes us do – YouTube

Click this link to watch Psych2Go’s animation on how social anxiety can impact us.*

Panic disorder

This is when you experience frequent or recurrent panic attacks which have no specific cause or trigger. It can result in continually feeling fearful of having another panic attack, which in turn can trigger a panic attack.

Phobias

These are an extreme fear or anxiety triggered by a particular situation (such as being in an enclosed space, heights, or outside) or a specific object or living thing (such as dogs, spiders, or snake).


Video – Phobias – YouTube

Click this link to watch Osmosis’ animation on phobias.*

Post-Traumatic Stress Disorder (PTSD)

PTSD can occur if you have experienced trauma or traumatic events. PTSD symptoms include flashbacks, nightmares, and feeling as though you are reliving the traumatic event, feeling all the anxiety and fear you felt at the time of the trauma. You may be diagnosed with complex post-traumatic stress disorder (C-PTSD) if you have experienced prolonged trauma and have difficulty regulating or controlling your emotions, and if you feel angry and mistrustful towards others and the world.

Video – Post-traumatic stress disorder – YouTube

Click this link to watch Osmosis’ animation exploring the definition, diagnosis and symptoms of post-traumatic stress disorder.*

Video – The five types of post-traumatic stress disorder – YouTube

Click this link to watch Psych2Go’s animation on five different types of post-traumatic stress disorder.*

Video – 12 Signs of complex PTSD – YouTube

Click this link to The School of Life’s video on complex post-traumatic stress disorder.*

Obsessive-Compulsive Disorder (OCD)

This is when you have repetitive thoughts or ruminations, uncontrollable urges and behaviours such as checking, counting, or cleaning.

Video – Obsessive compulsive disorder – YouTube

Click this link to watch Osmosis’ animation exploring obsessive compulsive disorder, including causes, symptoms and pathology.*

Health anxiety

This is when you are preoccupied with fear and anxieties around having, or potentially having, a physical illness. Health anxiety is related to obsessive compulsive disorder, in which you may have recurring fears and negative or obsessive thoughts that sensations in your body are due to an illness, or severe medical condition. This can lead to compulsive behaviours such as continually researching your symptoms.


Video – Health anxiety – YouTube

Click this link to watch a short video on a tool used in cognitive behavioural therapy to reduce negative thoughts related to health anxiety.*


Video – Health anxiety – YouTube

Click this link to watch a short video about how you can learn from false alarms caused by health anxiety using a tool called ‘worry records’.*

 


Body Dysmorphic D
isorder (BDD)

This means that you are preoccupied by your physical appearance and spend a lot of time worrying about flaws in your appearance, even though these are not noticeable to others. BDD does not mean you are vain or self-obsessed. It can have a significant impact on how you feel about yourself and your life. Although you can have BDD at any age, it is most common in teenagers and young adults.


Video – Body dysmorphic disorder (BDD) – YouTube

Click this link to watch Medical Centric’s video on body dysmorphic disorder, discussing causes, signs and symptoms, diagnosis and treatment.*

 


Perinatal anxiety or perinatal OCD

This can develop during pregnancy or in the first year after giving birth.


Video – Perinatal Mental Health – YouTube

Click this link to watch Women’s College Hospital’s animation on perinatal mental health, covering mental health during pregnancy and postpartum.*

 


*Please note: These links will take you away from The Survivors Trust Resources website. The links are being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.
Click here for a guide on how to clear your YouTube browsing history.

The Impact of Anxiety

Anxiety can impact both your body and your mind. Frequent and prolonged anxiety can also lead to physical health problems such as heart problems, stomach ulcers, irritable bowel syndrome or diabetes. In turn, having a physical health problem or a disability can make you feel anxious and stressed.

Although anxiety impacts everyone differently, here are some common symptoms that you might experience.

  • Faster breathing
  • Fast, irregular, thumping heartbeat
    Sweating or hot flushes
  • Feeling light-headed or dizzy
  • Feeling sick, nauseated, or having a churning feeling in your stomach
  • Needing to go to the toilet more frequently or less often
  • Aches and pains such as backache and headache
  • Pins and needles
  • Feeling tense, nervous or unable to relax, leading to feeling restless or being unable to sit still
  • Sleep problems
  • Grinding your teeth, especially at night
  • A lower sex drive
  • Panic attacks.
  • Feeling fearful, fearing the worst, and experiencing a sense of dread and foreboding
  • Being unable to stop worrying. This might be about what might happen in the future, that people are angry or upset with you, that people are looking at you and can see you are anxious, losing touch with reality, worrying about anxiety itself, or worrying about when a panic attack might happen
  • Thinking over a situation, or bad experiences, again and again (known as rumination)
  • Always assuming that the worst will happen (known as catastrophising)
  • Fearing that bad things will happen if you stop worrying
  • Low mood and depression
  • Needing lots of reassurance.
  • Not taking care of yourself
  • Not taking pleasure in things such as enjoying your leisure time
  • Not trying new things
  • Difficulty making friends or maintaining relationships
  • Difficulty working or being able to hold down a job.

Remember: if you have an anxiety disorder you may have to tell the DVLA. For information regarding fitness to drive. Visit the GOV UK webpage on anxiety for more information.

Video – Self-help for social anxiety: A cognitive model – YouTube
Click this link to watch a video explaining a cognitive model which may help you to manage social anxiety.

 


Please note: This link will take you away from The Survivors Trust Resources website. The link is being provided for informational purposes only. The Survivors Trust bears no responsibility for any advertising content shown on external websites and videos nor does it endorse these.

Click here for a guide on how to clear your YouTube browsing history.

 

Anxiety Toolkit



Living with anxiety can be very difficult, but there are steps you can take that might help.

Talk to someone your trust

You may find it helpful to talk to someone you trust about what is causing your anxiety, as having someone listen and show they care can help you relieve some of the anxiety. If you don’t have anyone you feel you can trust, you can contact the Samaritans or Anxiety UK helplines.

Managing your worries

If you experience anxiety, it can be very hard to stop worrying, especially about things that are outside your control. Some people also find it hard to stop worrying because they fear that if they don’t worry that something bad will happen.

Survivors of sexual assault, abuse, rape or CSA may find some of these methods such as meditation, massage or mindfulness triggering which can make them feel worse or more dissociative. Please look after yourself and try strategies that work for you.

  • Make time to focus on your worries so that you can reassure yourself that you haven’t forgotten to think about these important things. It helps to set aside a specific time and to limit this with a timer for a maximum of 15 minutes
  • Try to accept things you cannot change, especially those you have no control over, as this can free up energy to focus on what you are able to control
  • Write down your worries. You could write these down in a notebook or store them on your mobile phone. Some people find it helpful to write their worries down on pieces of paper and put these into box, jar, or envelope. You could make a ‘worry box’ to store your worries and look at them at a later point with a trusted friend or your therapist who can help you talk through them
  • Keep a diary and make notes of what happens when you get anxious or have a panic attack. This can be useful to identify patterns in what triggers your anxiety, what are the early warning signs of your anxiety, and what helps you to manage it. A diary also helps you to note what is going well and to track your progress
  • Peer support can help you to connect to other people who have had similar experiences and is a great way to support each other by sharing ideas about how to stay well, connect with others and feel less alone. You can find details of support groups, forums and helplines on the Anxiety Care UKAnxiety UKNo More PanicNo Panic and Triumph Over Phobia UK  Alternatively you can join Side by Side, Mind’s supportive online community or Mind’s Infoline to ask about support groups near you
  • Make sure you look after your physical health by getting enough sleep so that you have enough energy to cope with difficult feelings, take regular physical exercise, and make sure you eat regularly and healthily as stable blood sugar levels can have a beneficial effect on mood and energy levels. Click here to find out more in our Wellbeing section
  • Try to do some physical activity. Exercise can be really helpful for your mental wellbeing. See Mind’s pages on physical activity for more information
  • Complementary and alternative therapies such as yoga, meditation, aromatherapy, massage, reflexology, herbal treatments, hypnotherapy can help. Some people find that one or more of these methods can help them to relax or sleep better, although they do not work for everyone. Another alternative therapy that has been found to help some.

Remember: some people find mindfulness makes them feel worse, especially if they have social anxiety. If mindfulness doesn’t work for you, or makes you feel worse, ask your GP or therapist about other things you could try.

Treatment for anxiety

There are a number of treatments that have been found to help with anxiety and panic disorder. To access treatment, you need to visit your GP who will carry out an assessment, including filling in a questionnaire about how often you feel worried, anxious, and how nervous you are. They should then explain your treatment options to you, and you can decide together what might suit you best. For more information, visit the National Institute for Health and Care Excellence (NICE)’s guidelines for treating anxiety disorders.

Your GP can help you with the following options:

Self-help resources might be the first treatment option offered by your GP, as these are the most easily available, and can help you to feel better without needing to try other options. Self-help resources include workbooks which you can either work through on your own, or on a course with other people who experience anxiety. Your GP might also suggest some ‘Books on Prescription’, which is part of part of scheme called Reading Well. This scheme is supported by most local libraries, and you can access these for free and don’t need a prescription from your GP.

Talking therapies may be recommended if self-help resources have not helped.

There are two types of talking therapies recommended for anxiety:

  • Cognitive Behavioural Therapy (CBT) focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with anxiety
  • Applied Relaxation Therapy involves learning how to relax your muscles in situations where you normally experience anxiety. These can be delivered face-to-face or online. There are several app-based CBT courses to treat anxiety and panic attacks. You can search the NHS apps library to find an app that may work for you.

Charities and specialist organisations may also be able to help if the waiting list for NHS talking therapy is too long. You could also consider private therapy, although this can be expensive and therefore not suitable for all.

 

Your doctor might offer to prescribe you medication to help manage your symptoms. Some people find it helpful to try talking therapies and medication at the same time, but medication shouldn’t be the only thing you are offered. You might be offered some of the following:

  • Antidepressants such as a Selective Serotonin Reuptake Inhibitor (SSRI). Some people experience side effects when taking SSRIs, such as sleep problems or feeling more anxious than you did before. Alternatively a tricyclic antidepressant (usually imipramine or clomipramine) can be helpful or, if your anxiety is severe, clonazepam may be more effective. If a particular type of antidepressant doesn’t work or isn’t right for you, you may be offered a different kind
  • Pregabalin may be prescribed by your GP if you have a diagnosis of Generalised Anxiety Disorder (GAD). This is an antiseizure drug which is normally used to treat epilepsy
  • Beta-blockers can be helpful in certain situations that trigger anxiety as they can treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations, and tremors (shaking). However, they do not reduce any of the psychological symptoms
  • Benzodiazepine tranquilisers may be prescribed if you have very severe anxiety which has a significant impact on your day-to-day life. These can sometimes cause unpleasant side effects and become addictive, so your doctor should only prescribe them at a low dose for a short time, to help you through a crisis period.

If part of your anxiety makes speaking to your GP or leaving your home difficult, this is a completely normal experience of anxiety and there are ways around it. If you are unable to speak to your GP, you can ask a trusted friend to contact the GP to see if they can speak on your behalf with your consent or see if the practitioner can make a home visit appointment. Alternatively, you might find it more manageable to come to the surgery during a more quiet time, accompanied by a friend. You may also be able to refer yourself for talking therapy at a local Improving Access to Psychological Therapies (IAPT) service. Some IAPT services are delivered online or over the phone. You can find more details on the NHS IAPT webpage.

If you don't feel better

Remember different things work for different people so if any of these treatment options or a particular therapist doesn’t work for you, your GP may be able offer alternative support such as a regular appointment with your GP, or they may refer you to your Community Mental Health Team (CMHT) who can offer you a personalised treatment plan with a number of different healthcare professionals, such as psychiatrists and clinical psychologists. This may be particularly helpful if your symptoms make it hard to manage your daily life, if you have a serious physical health problem, you have another mental health problem, or have thoughts of self-harm or suicide.

Remember: recovery and healing takes time and is a journey which is not always easy or straightforward. It may be that you will not be able to recover from all of your symptoms so it can help to focus on developing ways to cope and building your emotional resilience.

5 – Useful Resources for Stress, Panic & Anxiety

Useful contacts

The Survivors Trust
www.thesurvivorstrust.org

Umbrella agency for over 120 member organisations which provide specialist support to men, women and children who are survivors of sexual violence.
Helpline: 08088 010818

 

Mind
www.mind.org.uk

Mental health charity.
Helpline: 0300 123 3393

Anxiety UK

www.anxietyuk.org.uk

Advice and support for people living with anxiety.
Helpline: 03444 775 774 (text 07537 416 905)

 

Togetherall
www.togetherall.com

Online mental health community (formerly called Big White Wall). Free in some areas through your GP, employer or university.

 

NHS website

www.nhs.uk

Information about health problems and treatments, including details of local NHS services throughout the UK.

 

Samaritans

www.samaritans.org

24-hour emotional support for anyone who needs to talk.

Helpline: call 116 123, email jo@samaritans.org

 

Health and Safety Executive (HSE)

www.hse.gov.uk
Information and guidance on health and safety law in the workplace.

 

International Stress Management Association

www.isma.org.uk
Information about stress, including details of practitioners who may be able to help you.

 

Stressbusting

www.stressbusting.co.uk
Information about stress, including causes, treatments and coping techniques.

 

Stress Management Society

www.stress.org.uk
Information about stress and tips on how to cope.

 

Time to Change

www.time-to-change.org.uk (England)
www.timetochangewales.org.uk (Wales)
National campaign to end stigma and discrimination against people with mental health problems in England and Wales. The campaign for England ended in 2021, but its resources are still available online.

Apps

Headspace (subscription fee charged after trial period)