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unlikely that something will turn out well. Worry concerns feelings of unease and feeling troubled. Fear is a reaction to immediate danger – your car going into a skid, for example, or a child running into the road – whereas anxiety involves a response to something farther away in the future: something that’s going to happen later today, tomorrow, next week and so on. It could be, for example, an interview, a plane flight or speaking up at a meeting. You could be feeling anxious but you don’t know what exactly you’re anxious about.

      Whether it’s fear, anxiety, worry or doubt, the feelings are very much the same. Why? Why does anxiety so often have such a debilitating effect? It helps to understand what, exactly, anxiety is.

      Just like fear, worry and doubt, anxiety is an emotion. Emotions cause us to feel, think and act in different ways: they can cause us to do something or avoid doing something.

      All emotions, including anxiety, have a positive intent: worrying and feeling anxious about doing well before an exam or giving a presentation, for example, can prompt you to prepare well and keep you alert and focused. However, like all other emotions, anxiety becomes a problem if, instead of prompting you to respond in a way that’s helpful, it overwhelms or paralyses you. In the example of exams, if anxiety takes over, your stomach may be in knots, your heart thumps and negative thoughts can dominate your mind. Your ability to revise, think straight and concentrate suffers.

      It’s not, though, just how and what you think that can make you anxious. Again, just like all other emotions, anxiety has three parts: physical feelings, thoughts and behaviour. Let’s look at each of these aspects more closely.

      Physical aspect

      This part of anxiety involves the physical changes that occur in your body – the internal bodily changes you experience.

      Some of the most common physical symptoms of anxiety are:

      • Muscle tension, which can cause headaches, tension in your jaw, neck and shoulder pain or tightness in your throat and chest.

      • Rapid breathing, which may make you feel weak, light-headed and shaky, and may give you pins and needles in your fingers and toes.

      • Rising blood pressure, which can make you more aware of a pounding heart.

      • A rush of hormones, which can give you hot flushes and make you sweat.

      • Changes in the blood supply to your digestive system, which may cause ‘butterflies’, nausea and sickness.

      • Frequent visits to the loo.

      Anxiety can go undiagnosed – especially if it presents as a physical problem. Stomach problems, for example – a queasy tummy, feelings of nausea and/or a frequent, urgent need to use the loo – can often be the result of feeling anxious about a forthcoming event, but may not be recognized as such.

      Although we each have different thoughts when we are anxious, we all have very similar physical responses. Regardless of age, race or gender, when we are stressed, anxious or frightened our bodies release hormones which spread to different parts of the body. Adrenaline causes your heart to beat faster to carry blood where it’s most needed. You breathe more rapidly to provide the extra oxygen required for energy. You sweat to prevent overheating. Your digestive system slows down to allow more blood to be sent to your muscles. Your senses become heightened and your brain is on full alert.

      These changes help your body to take action to protect you in a dangerous situation, either by running away or fighting. This is known as the ‘fight or flight’ reflex. Once the danger has passed, other hormones are released, which may cause you to tremble and feel weak as your muscles start to relax.

      This response is useful for protecting you against physical dangers – a runaway car or a falling tree, for example – but if there is no physical threat and you don’t need to run away or fight, the effects of adrenaline subside more slowly and you may go on feeling agitated for a long time.

      ‘The feeling of having in the middle of my body a ball of wool that quickly winds itself up, its innumerable threads pulling from the surface of my body to itself.’

Franz Kafka

      Interestingly, two very different emotions – anxiety and excitement – provoke the same physical response: rapid breathing and a pounding heart. In that case, what determines whether what you feel is happy or anxious? Your thoughts.

      Cognitive aspect

      Your thoughts – your beliefs, perceptions and interpretations of a forthcoming event – are the cognitive aspect of anxiety.

      Different people may have different thoughts about a situation. For example, in the case of sitting an exam, one person might be thinking, ‘I don’t know if I can do this. I might be hopeless. I could fail.’ But another person’s thoughts might be, ‘What if I forget everything I revised? Supposing they don’t ask questions related to the topics I’ve revised?’ Often, added to your thoughts and concerns about a situation are the thoughts you might have about how you’ll feel or behave once you’re in that situation. You might think that you will:

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