Living

with
Anxiety
Understanding the role
and impact of anxiety
in our lives

Mental Health
Awareness Week 2014

1
The truth is that anxiety is at once a function
of biology and philosophy, body and mind,
instinct and reason, personality and culture.
Even as anxiety is experienced at a spiritual
and psychological level, it is scientifically
measurable at the molecular level and the
physiological level. It is produced by nature
and it is produced by nurture. It’s a psychological
phenomenon and a sociological phenomenon.
In computer terms, it’s both a hardware problem
(I’m wired badly) and a software problem
(I run faulty logic programs that make me
think anxious thoughts)”.1

1 1. Scott Stossell ‘My Age of Anxiety’.

Contents

05 Executive summary
08 Introduction
08 What is anxiety?
10 Anxiety and modernity
13 Living with Anxiety: Stephanie
15 Anxiety disorders in the UK
18 Living with anxiety: Ian
20 The state of the nation: Anxiety in the UK
28 Living with anxiety: Jane
30 Managing anxiety
36 A new age of anxiety?
40 Useful resources and information
42 References

Acknowledgements
This report was written by Paul Swift, Dr Eva
Cyhlarova, Isabella Goldie and Chris O’Sullivan.
Others who contributed to this report include
Paul Bristow, Joanna Carson, Hanna Biggs
2 and Jenny Edwards, CBE.
Foreword
We all experience anxiety; it is a natural human state and a vital part of
our lives. Anxiety helps us to identify and respond to danger in ‘fight or flight’
mode. It can motivate to us face up to dealing with difficult challenges. The
‘right’ amount of anxiety can help us perform better and stimulate action
and creativity.

But there is another side to anxiety. Persistent anxiety causes real emotional
distress and can lead to us becoming unwell and, at worst, developing
anxiety disorders such as panic attacks, phobias and obsessional behaviours.
Anxiety at this level can have a truly distressing and debilitating impact
on our lives and impact on our physical as well as our mental health.

Some commentators have described this as ‘The Age of Anxiety’. The

Mental Health Foundation’s survey, commissioned for this report, backs
up this sense of widespread heightened anxiety. Alarmingly, almost 1 in 5
people revealed that they feel anxious ‘nearly all of the time’ or ‘a lot of the
time’. More than half of us have noticed that ‘people are more anxious today
than they were 5 years ago.’ The survey highlights ‘finance, money and debt’
as the most common source of anxiety, perhaps reflecting the impact of
the recession and austerity on public mental health and well-being.

Anxiety is one of the most common mental health problems in the UK and
it is increasing. Yet it remains under-reported, under-diagnosed and under-
treated. A good ability to cope with anxiety is key to resilience in the face of
whatever life throws at us. However, experiencing it too much or too often
means we risk becoming overwhelmed, unable to find balance in our lives
or to relax and recover. Our ability to find some inner peace has never
been more important to our well-being.

This report is about framing anxiety as an essential aspect of our humanity

and part of the natural human emotional response to circumstances in our
lives. It is also about challenging the stigma that still gets in the way of our
reaching out for help and support when our levels of anxiety become a real
problem. As individuals and society we need to understand and engage with
anxiety better, recognising when it is helpfully alerting us to pay attention,
and ensuring we have coping strategies when its negative impact becomes
too great.

We need to recognise when the people around us, our friends, family
members and colleagues, are experiencing distressing levels of anxiety
or at risk of this because of life events and circumstances. Local public
health strategies need to identify the points at which people are most likely
to experience high anxiety and to offer a range of help that is simple, quick
to access and non-stigmatising. We encourage public health commissioners
to check the list of the most common sources of anxiety in this survey and

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use them to help identify the best places and partnerships to reach out to
those 1 in 5 people who feel anxious nearly all the time or most of the time.

We consider there could be great benefit in public policy becoming “anxiety

aware”, adjusting its strategies and styles of interaction with the public in
order to prevent and reduce anxiety. If we truly recognised the mounting
costs of anxiety distress to people, their children’s futures, to communities
and employers, we would act now.

In today’s “Age of Apps” where many people are living dual lives, partly online,
then we can develop new and innovative digital approaches to living better
with anxiety, particularly to invest in the mental and emotional well-being of
our children and young people. We hope that this report will act as a catalyst
for a growth in self-help resources to enable us all to manage our response
to increasingly anxious thoughts.

Jenny Edwards CBE

Chief Executive
Mental Health Foundation

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Executive summary ―― While 2.6% of the population experience
depression and 4.7% have anxiety problems,
Anxiety is a familiar emotion because it is part as many as 9.7% suffer mixed depression
of everyone’s experience. Its natural function is to and anxiety, making it the most prevalent
alert us to potential threats, allowing us to evaluate mental health problem in the population
and respond to them in appropriate ways. This as a whole.
heightened state of readiness can also help people
perform better and stimulate creative impulses. ―― About 1.2% of the UK population experience
Anxiety is often regarded as an artefact of modern panic disorders, rising to 1.7% for those
societies, one that is increasingly represented experiencing it with or without agoraphobia.
in visual arts, music, literature and social media.
―― Around 1.9% of British adults experience
For some people anxiety triggers inappropriate a phobia of some description, and women
or disproportionate responses to perceived are twice as likely to be affected by this
threats, leading to persistent and intrusive problem as men.
symptoms associated with anxiety disorders,
such as panic, phobias and obsessive behaviours, ―― Agoraphobia affects between 1.5% and
which often have a debilitating effect on their 3.5% of the general population in its fully
lives. Anxiety is one of the most prevalent mental developed form; in a less severe form, up
health problems in the UK and elsewhere, yet it is to one in eight people experience this.
still under-reported, under-diagnosed and under-
treated. This report explores the intersection ―― Post-Traumatic Stress Disorder (PTSD)
between popular perceptions of anxiety, the affects 2.6% of men and 3.3% of women.
experience of anxiety in people’s everyday
lives and the impact of anxiety disorders. ―― Obsessive Compulsive Disorders (OCD)
affect around 2–3% of the population.
The experience of anxiety often involves
interconnected symptoms and disorders. It is ―― Generalised Anxiety Disorder affects
estimated that one in four people in the UK will between 2–5% of the population, yet
experience a mental health problem each year, accounts for as much as 30% of the
while one in six experience a neurotic disorder mental health problems seen by GPs.
such as anxiety or depression. Anxiety disorders
are also estimated to affect 3.3% of children and Previous survey evidence suggests that:
young adults in the UK. The prevalence of the
most common forms of anxiety are given below. ―― Although, on average, women rate their life
satisfaction higher than men, their anxiety
levels are significantly higher than men.

―― People in their middle years (35 to 59) report

the highest levels of anxiety compared to
other age groups.

―― People in the older age groups tend to be

happier and less anxious.

―― People with a disability are, on average, more

anxious than people without a disability.

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―― Unemployed people report significantly ―― Around a fifth of people who are anxious
higher anxiety levels than those in have a fear of unemployment.
employment.
―― Younger people are much more likely to feel
―― People in the lowest income groups report anxious about personal relationships.
significantly higher anxiety levels than those
in the higher income groups. ―― Older people are more likely to be anxious
about growing old, the death of a loved one
―― On average, all ethnic groups report higher and their own death.
levels of anxiety than people who describe
themselves as White British. ―― The youngest people surveyed (aged 18–24)
were twice as likely to be anxious about
―― Young people aged 16–24 are more likely to being alone than the oldest people (aged
report lower levels of anxiety compared with over 55 years).
adults generally.
―― One-fifth of people who have experienced
―― Women and young adults aged 20–29 are anxiety do nothing to cope with it.
the most likely to seek help for anxiety from
their GP. ―― The most commonly used coping strategies
are talking to a friend, going for a walk, and
Our specially commissioned survey of over 2,000 physical exercise.
members of the public found that:
―― Comfort eating is used by a quarter of people
―― Almost one in five people feel anxious all to cope with feelings of anxiety, and women
of the time or a lot of the time. and young people are more likely to use this
as a way of coping.
―― Only one in twenty people never feel anxious.
―― A third of the students in the survey said
―― Women are more likely to feel anxious they cope by ‘hiding themselves away from
than men. the world’.

―― The likelihood of feeling anxious reduces ―― People who are unemployed are more likely
with age. to use coping strategies that are potentially
harmful, such as alcohol and cigarettes.
―― Students and people not in employment are
more likely to feel anxious all of the time or ―― Fewer than one in ten people have sought
a lot of the time. help from their GP to deal with anxiety,
although those who feel anxious more
―― Financial issues are a cause of anxiety for frequently are much more likely to do this.
half of people, but this is less likely to be so
for older people. ―― People are believed to be more anxious now
than they were five years ago.
―― Women and older people are more likely to
feel anxious about the welfare of loved ones. ―― There is a tendency to reject the notion that
having anxious feelings is stigmatising.
―― Four in every ten employed people ―― People who experience anxiety most
experience anxiety about their work. frequently tend to agree that it is stigmatising.

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―― Just under half of people get more anxious We recommend a stepped care approach be
these days than they used to and believe that adopted to ensure that support for living with
anxiety has stopped them from doing things anxiety is provided in the least stigmatising
in their life. and most inclusive way possible including:

―― Most people want to be less anxious in ―― Universal approaches to learning to

their day-to-day lives. live well with anxiety should be built
into school curriculums from primary
―― Women and younger people are more 1 onwards, including an understanding
likely to say that anxiety has impacted of the role of anxiety in our lives, and
on their lives. techniques for managing stresses
associated with school (such as peer
Surveys suggest we live in an ‘age of anxiety’ relationships, exams and transitions).
which reflects a shared mood about the defining
aspects of modern life: our work, the way we ―― Peer-led approaches should be promoted
raise children, our attitudes to people who are within universal settings such as
disadvantaged, the future of public services, employment, schools and universities,
the threat of terrorism, and so on. At another in recognition of the importance that young
level, there is evidence of the hidden impact of people place on support from peers and the
more severe forms of anxiety upon the lives of a unique level of empathetic understanding
significant number of people. Our understanding that can be provided by those with a
of anxiety disorders has improved in recent common experience.
years due to research, the development of more
sophisticated diagnostics, effective treatments, ―― Access to good quality self-help approaches
and the emergence of a genuine voice for people should be made available across the UK
living with anxiety. While these developments are through quality-assured and co-designed
encouraging, our own work suggests that there digital platforms to ensure they are fit for
are still gaps that need to be addressed in purpose for those who choose not to use
the provision of support for people who face-to-face services (young people, people
experience anxiety. in full time employment).

―― GP training and anxiety-related guidance

should be assessed for equalities impact and
adapted alongside groups of people who are
at highest risk of developing problematic
anxiety and least likely to have their needs
met by current service provision.

―― A sample of psychological services should be

audited to establish how well current referral
processes are working, who is accessing
these, and who is falling through the gaps.
This audit should include IAPT (Improving
Access to Psychological Therapies) in
England and Wales and initiatives to
improve access in Scotland.

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―― Agencies offering support to people with
anxiety should make greater use of peer
mentors and advice and information that
is explicitly based on the life experiences
of people who live with anxiety.

We also recommend that research be

commissioned to better understand:

―― The nature and understanding of anxiety

for different groups in society (women,
people with long-term conditions, older
people, people from black and minority
ethnic communities), and whether current
approaches and interventions can be found
to address specific needs.

―― The relationship between unemployment,

financial distress, and anxiety. The
Department of Work and Pensions should
develop strategies to prevent people who
are not working from becoming marginalised
from the workforce. Processes for accessing
social welfare for those unable to work due
to disability should be assessed for their
impact on anxiety levels.

―― The impact of technological advancements

in self-management for anxiety.

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Introduction around us, or from professionals. However, as we
come to understand anxiety better, there is much
In this report we want to get deeper under the that we can do as individuals to take steps to
skin of ‘anxiety’, one of our most unwelcomed reduce its hold over us, and to learn to appreciate
emotional states, and understand the role that our full range of emotions without fear that they
it plays in our lives―for better and for worse. It will overtake us.
is not our intent to present the case for eradicating
anxiety, for being anxious is an important part of What is anxiety?
what it means to be human. We are often anxious
about those aspects of our lives that we care Everyone has feelings of anxiety at some point
most about: our health; our ability to clothe and in their life, whether it is about preparing for a job
feed ourselves and our family; and our ability to interview, meeting a partner’s family for the first
be connected and valued by others. Anxiety helps time, or the prospect of parenthood. While we
us to get up in the morning and motivates us to associate anxiety with alterations to our mental
step out of our comfort zone. state, experienced as worry or apprehension
perhaps, and physical symptoms such as raised
However, we often go to great lengths to avoid heart rate and adrenaline, we also understand
being anxious, feeling a sense of failure if we don’t that it is likely to affect us only temporarily until
keep our worrying thoughts under tight control. the source of our anxiety has passed or we have
There may be times when these thoughts get learnt to cope with it. Anxiety is therefore one
away from us and begin to feel overwhelming. of a range of emotions that serves the positive
For some they may become habitual, leading function of alerting us to things we might need to
to regular uncomfortable, or even distressing, worry about: things that are potentially harmful.
physical symptoms. Patterns of avoidance may More importantly, these emotions help us to
build up, that can have a limiting effect on our lives. evaluate potential threats and respond to them
in an appropriate way, perhaps by quickening
Anxiety can also be exhilarating. Putting ourselves our reflexes or focusing our attention.
into situations that make us anxious can feel
like an ordeal at the time, but getting through to Fear, like anxiety, is a familiar emotion precisely
the other side can bring an incredible sense of because it is part of everyone’s experience
achievement. Our most important moments in life and we consider it an essential component
are usually not achieved without some sleepless of our humanity, yet it is also a psychological,
nights. Being a new parent, our wedding days, physiological and behavioural state we share
passing exams, and learning to drive bring great with animals when confronted by a threat to our
rewards, but it is unlikely that these were achieved wellbeing or survival. Fear increases the body’s
without some feelings of apprehension. arousal, expectancy, and neurobiological activity,
and triggers specific behaviour patterns designed
Anxiety is an emotional state that can work for to help us cope with an adverse or unexpected
us as well as against us. It is something we all situation. But how do we distinguish anxiety
have in common, but where we often differ is in from fear, given that the two are often
how we perceive these feelings of arousal and used interchangeably?
how we respond to them. Our life circumstances,
our upbringing and our personalities can all be
factors in why one person’s exciting fairground ride
will leave another person in abject terror. Feeling
anxious isn’t a sign of failure and there are times
when it is important to ask for help from those

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“If fear is fearful of something While fear often has a specific, immediate context
which provokes classic ‘fight or flight’ reflexes—
particular and determinate,
the automatic fear response occurs faster than
then anxiety is anxious about conscious thought, releasing surges of adrenaline
nothing in particular and is which can subside quickly once the perceived
or actual threat has passed—anxiety connotes
indeterminate. If fear is directed lingering apprehension, a chronic sense of worry,
towards some distinct thing in tension or dread, the sources of which may be
the world, spiders or whatever, unclear. It can be a vague, unpleasant emotion
experienced in anticipation of some ill-defined
then anxiety is anxious about misfortune. The committee charged with reviewing
being-in-the-world as such. the diagnostic criteria for the latest version of
the Diagnostic and Statistical Manual of Mental
Anxiety is experienced in the
Disorders (DSM)2 similarly distinguish anxiety as
face of something completely “a future-oriented mood state associated with
indefinite. It is, Heidegger preparation for possible, upcoming negative
events” from fear which “is an alarm response to
insists, ‘nothing and nowhere’” present or imminent danger (real or perceived)”;
(Critchley, 2009). but add “importantly, these descriptions represent
prototypes of fear and anxiety that lie at different
places upon a continuum of responding. Along
such a continuum, symptoms of fear vs. anxiety
are likely to diverge and converge to varying
degrees” (Craske et al., 2009). Another writer,
expressing the distinction in less esoteric terms,
suggests “the sudden re-arrangement of your guts
when an intruder holds a knife to your back (fear),
is different from the mild nausea, dizziness and
butterflies in your stomach as you’re about
to make a difficult phone call (anxiety).”3

This report is concerned with the way that different

types of anxiety, found at various points on the
continuum, are experienced by individuals and
how they are represented to the wider public.
It explores the everyday manifestations as well
as what happens when anxiety becomes more
than a temporary experience, and instead is
experienced as either a series of debilitating
episodes or a constant presence in someone’s

2. Published by the American Psychiatric Association, the DSM

offers standard criteria for the classification of mental disorders
for use by clinicians, researchers, pharmaceutical companies,
policymakers, etc. The latest version, DSM-V, was published in
May 2013.
3. From Harriet Lerner, The Dance of Connection blog October
10 11th 2009.
life. Anxiety disorders such as panic, phobias Anxiety and modernity
and obsessive behaviours may be triggered by
traumatic memories, irrational hatred of specific Although it is the most common sign of mental
objects, proximity to particular situations or distress in nearly every country in the world,
physical locations, or a persistent worry that anxiety is often presented as an artefact of modern
something bad will happen in the future. A Western societies; Norman Mailer, for example,
defining characteristic of anxiety disorders is suggested that “the natural role of twentieth-
that psychological symptoms, such as irritability, century man [sic] is anxiety”. The concept of
difficulties concentrating and depression, anxiety per se was first brought to prominence
become persistent and intrusive. Many people as a philosophical and psychoanalytic concept in
also experience physical symptoms, like heart the first part of the twentieth century. Freud was
palpitations, sweating, tensions and pain, heavy a seminal figure in the development of Western
and rapid breathing, dizziness, fainting, indigestion, thinking about anxiety, which he conceived of as
stomach aches, sickness and diarrhoea; in acute a state of inner tension from which humans are
cases, people have described how it felt as though driven to escape. At a most basic level, anxiety is
they were dying. The lives of those with the most a signal to the ego (the aspect of personality that
severe forms of anxiety can become completely deals with reality) that something overwhelmingly
dominated by their condition, meaning they find awful is about to happen and that it needs to
it difficult to relax or achieve regular patterns employ a defence mechanism in response.
of sleep, becoming stuck in circular patterns Freud saw this as deriving from an infant’s
of thought that impair their ability to maintain mental helplessness, which is a counterpart of
preferred lifestyles, hold down a job or sustain its biological helplessness. Humans learn to cope
personal relationships. with anxiety prompted by ‘real’ threats, such as
fear of being bitten by a dog, either by avoiding
situations likely to contain the threat, or by
physically withdrawing from them.

Freud’s typology also included neurotic anxiety

arising from an unconscious fear that we will
lose control of libidinal impulses, leading to
inappropriate behaviour, and moral anxiety, arising
from a fear of violating our own moral or societal
codes. Moral anxiety, he suggested, manifests
itself as guilt or shame. The task of psychoanalysis
is therefore to strengthen the ability of the ego to
find ways of coping with anxiety such as ‘denial’,
‘rationalisation’, ‘regression’ (to a childhood state)
or ‘projection’.

Within the existentialist philosophical tradition,

‘angst’, from the German word for anxiety, is held
to be a negative feeling arising from the
experience of human freedom and responsibility
in a world where faith and traditional social
bonds have been undermined. Kierkegaard’s
classic example of existential angst is of a person
standing on the edge of a high cliff or building;

11
along with the fear of accidentally falling, the Freudian psychoanalysts would recognise as
person feels an irrational impulse to deliberately classical defence mechanisms: “they learn to
fling themselves over the edge. The emotion the seal their anxiety off from public view”. According
person feels upon realising that he or she has to Daniel Smith, “they learn to cork their anxiety
this option is angst. Kierkegaard described the within themselves like acid in a vial. It isn’t pleasant.
burden of making moral choices as a consequence The human mind isn’t Pyrex, it can corrode. But
of free will “the dizziness of freedom”. Existential it works.”6
psychology therefore proceeds from the
presumption that anxiety stems from a crisis in the Perhaps more significantly, the testimony of
exercise of free will, which might be manifested in people living with anxiety affords us a more
anxiety about one’s mortality, the inevitability of rounded appreciation of the role that it plays in
loss, or about accepting personal responsibility shaping their lives; as Scott Stossel, author of My
for one’s thoughts, feelings and actions. Age of Anxiety, puts it, “anxiety can be a spur to
achievement as well as a barrier. Picture a bell
That anxiety “somehow feels new” may be4
curve with extreme anxiety on the far right and
explained partly by the fact that anxiety has been extreme lack of anxiety on the far left. If you’re
the subject of significant scientific research for less too anxious to the point where it’s physically
than half a century, while the psychiatric profession and mentally debilitating, then your performance
first codified diagnostic criteria for all the different suffers. If you’re not anxious enough, if you’re not
disorders as recently as 1980, with the publication engaged and slightly activated by anxiety, as
of DSM-III. Subsequent advances in diagnostic it were, then your performance also suffers.”7
techniques, coupled with the development
of effective pharmacological treatments and The voices of people living with the more acute
psychological therapies, have prompted primary forms of anxiety help us to conceive of anxiety
healthcare professionals to more readily identify as something more than simply a condition that
anxiety in their patients. requires diagnosis and treatment. How individuals
engage with their anxiety, how they manage it and
Anxiety is now recognised as one of the most represent it to the wider world lifts anxiety beyond
prevalent mental health problems in the UK, the realm of medicine and science and into
yet there is good evidence that it is still under- a broader sociological and cultural context.
reported, under-diagnosed and under-treated.
One reason may be that, unlike many other mental
health issues, people whose lives are affected
have not yet found a voice that articulates the
full range of experiences of anxiety, not just those
of people living with anxiety disorders. In recent
years, this has begun to change, as writers,
bloggers and campaigners have provided us
with an insight into “Britain’s silent epidemic”5
by describing the lived experience of anxiety, the
complexities and nuances of the various disorders,
the symptoms that are associated with them,
and the effect that anxiety has upon their lives.
For example, some people living with anxiety
describe feelings of shame and embarrassment
4. Rachel Cooke, The Observer, Sunday 15th September 2013.
at their physical symptoms, such as excessive
5. The Observer, Sunday 15th September 2013.
perspiration, which lead them to adopt what 6. From Monkey Mind: A Memoir of Anxiety by Daniel Smith, quoted
in The Observer, Sunday 15th September 2013.
12 7. Scott Stossel ‘May Age of Anxiety’.
“For as long as I can remember In 2009, the Mental Health Foundation published
I have suffered from a deep In The Face of Fear, which addressed the questions
of how fear and anxiety affect our health and
feeling of anxiety which I have society, and what we can do about it. At that time,
tried to express in my art. fear seemed a natural response to the dramatic
Without anxiety and illness banking crisis of the previous year and the
potential socio-economic consequences that few
I should have been like a ship at the time could predict, except that it was likely to
without a rudder” be the deepest recession for a generation. Indeed,
research carried out for In The Face of Fear found
(Edvard Munch).
that “people perceive our world as having become
more frightening and frightened”. In 2014, five
The representation of these more acute forms of years on, we are exploring whether and how that
anxiety within the arts has long been established mood of fear has translated into a more persistent
as a powerful creative force in a way that fear sense of apprehension and, taking a broader
rarely is.8 From the “dizziness of freedom” has perspective, how that fits into our historical
flowed a rich artistic tradition since the beginning understanding of anxiety. We do this by asking:
of the twentieth century, starting with the close do we live in age of anxiety? In doing so, we want
relationship between early modernist artists to draw attention to the way that anxiety affects
and psychoanalysis and the rise of art practices the lives of the people who live with it and consider
within psychiatric hospitals, which in turn had the contribution of anxiety to our culture.
a significant impact on the development of art
history. Writers have also recognised anxiety This report explores the intersection between
as a “handmaiden to creativity”,9 either as the popular perceptions of anxiety, the experience
motivating spirit acknowledged by Graham of anxiety in people’s everyday lives, and the
Greene, for example, or as the animating theme impact of anxiety disorders. In doing so, we
of novels by Virginia Woolf, Franz Kafka and have reviewed the research evidence on anxiety
Haruki Murakami. Most notably, the First World disorders, commissioned a survey of public views,
War poets, many with the experience of early and collected people’s stories about their own
psychiatric treatments for trauma, brought the experiences. The following chapters set out the
subjective experience of severe anxiety disorders scale and nature of anxiety in the UK and how
into the public realm. In another sphere, musicians it is currently managed, interspersed with case
as diverse as Leonard Bernstein, Marvin Gaye studies describing what it is like to live with anxiety.
and Radiohead have represented anxiety in their We hope that the report will contribute to a wider
work, while The King’s Speech demonstrates that understanding of the role that anxiety plays in
a debilitating social anxiety can be the subject our lives and stimulate discussion about the
matter of a commercially successful film as public health implications of learning to live
well as a critically acclaimed one. well with anxiety.

8. Later this year, the Anxiety Arts Festival will explore anxiety, its
causes, how it affects our lives and how it can act as a motivating
force for creativity.
13 9. Attributed to Aldous Huxley.
 Living with anxiety: Stephanie,
journalist, mid-20s
Your greatest strength is also your greatest
weakness. I’ve always had a natural tendency
to be on edge, to be extremely aware of my
surroundings. I’m alert all of the time and, although
a predisposition to being quite observant is great
for your career, it isn’t always the best for your
personal relationships. As a writer, your job is to
see the things that other people don’t necessarily
see. It’s because of your ability to notice anything
and everything that you are able to draw
conclusions, notice trends or comment on various
social phenomena.

I had a brilliant upbringing and a really supportive

family. But Mum and Dad were in the process of
getting divorced when I went off to university, so
there I was, worried about putting on weight while
I had a lot going on at home. I started to spend
more and more time at the gym because exercise
was a great stress relief (and the endorphins didn’t
hurt either). I started to see results in weight loss,
which made me want to do a bit more and then
a bit more. I guess, because I’m a perfectionist, if
I was going to do something, I was going to do it
well!

My weight loss was drastic, but it never got to

the stage where I was hospitalised. But I was very
well aware that my behaviour was not normal;
even then I didn’t lose that logical side of me.
Mum and Dad could see what was happening and
did encourage me to see a psychologist. It really
really helped. When I got the diagnosis (anorexia
nervosa/bulimia nervosa with mild anxiety
disorder), it was a shock. I was surprised to find out
that I had an anxiety disorder, and it was the eating
disorder that was the symptom, not the other way
around.

14
In my sessions with my psychologist, she used People deal with anxiety in different ways. For
CBT10. Good old CBT, it works every time! I’m a some, it’s addiction; mine is an eating disorder.
big champion of it. The best techniques for me Your weight and your food intake is something that
are the ones that make me separate my emotions will never be out of your control, and that’s why you
from the thoughts; to realise that what I’m feeling find comfort with it. I know it will never completely
inside isn’t necessarily an accurate representation go away—it’s part of my chemistry—but doing
of what the situation is. So, if I’m feeling stressed CBT helped me and prevented me from going
out of my mind, I take a step back and notice that too far and over-thinking things. It helped me to
I’m feeling stressed, then take another step back acknowledge that a thought is simply a thought
and notice that I’m having the thought of feeling rather than the truth. Now I can gauge where I
stressed. That simple dissociation between “I am in my overall wellbeing by my drive to watch
think, therefore I am” really helps. what I eat or how I exercise. Now, if I have dessert,
that’s okay. The more that food or weight is in the
The heightened anxiety I felt during my parents’ forefront of my mind, the more I know that I need
divorce lasted for about a year before I got into to change something in my life that is causing
CBT. Then, within six months I got back to being me that stress.
more like myself. I found that for me, the central
issue affecting my anxiety is control; more
specifically, the lack of control is what precipitates
my anxiety. It definitely flares up when I’m stressed.
I used to repress everything to the point where
I would become overwhelmed with emotion—I
would cut off—but that doesn’t ever help because
you eventually explode; it has to come out at
some stage. Now I allow myself to feel stressed
or anxious for a little period because I know that
ultimately it will subside. I let it wash over me,
but then stop it because I know that the body
can only be in a state of stress for so long; it
ultimately calms itself down.

I’ve had a couple of years now of being more

mindful and trying to observe myself from a bird’s-
eye perspective. I know what my limits are now.
Having recently moved to London, there were
definitely times last year when I fell back into my
old patterns of thinking because I was chronically
stressed about my job situation and repressed my
feelings of loneliness, missing creature comforts,
yet wanting to be this strong person. I was too
proud to acknowledge that I was having a tough
time. I’d never really admit to friends how I was
feeling deep down, because that then meant I’d
have to admit to myself that I had a problem again.
So, I went home and had a couple of booster
sessions with my counsellor.
10. Cognitive Behavioural Therapy (CBT): is one of a broad range of
psychotherapies or ‘talking therapies’ that aims to change the way
15 that you think and behave.
Anxiety disorders in the UK What are the most common
anxiety disorders?
The best estimates suggest that: one in four
people in the UK will experience a mental health The experience of anxiety often involves a bundle
problem each year; one in six will experience a of interconnected symptoms and disorders
common mental health problem such as anxiety characterised by confusing circularity between
or depression; and that these figures have steadily the triggers to anxiety and the responses that
increased over the past 20 years. Estimates of the it invokes. Scott Stossel’s “bundle” includes
number of people who experience anxiety vary emetophobia, a fear of vomiting (especially in
because of the different methods for gathering public), which is a condition that according to
data and the different criteria used in identifying it. Anxiety UK is not widely diagnosed even though
Some surveys rely on self-reporting: people’s own it is fairly prevalent. This is the aspect of his anxiety
assessments of their emotional state. While the that is most debilitating, he says, because it is
results can help us appreciate the general mood entwined with agoraphobia caused specifically
of a population and the distribution of anxiety by a fear of being sick far from home as well
within a population, such surveys lack the as nausea, a commonly experienced physical
consistency of a diagnostic threshold. However, symptom of many forms of anxiety. While the
reports based on service data will, by definition, separate elements to the bundle may not, in
only include those willing and able to seek help themselves, have a decisive impact on his life,
for their anxiety and rely on the correct the effects of their interaction can be devastating.
identification by professionals of the presence
of a problem. Estimating the prevalence of anxiety This can be seen more clearly in people diagnosed
problems is further complicated by the fact that, with co-morbid depression and anxiety, which
in diagnostic terms, anxiety is the common thread often results from a downward spiral in which
linking a range of disorders, from agoraphobia to anxiety leads to low mood which in turn intensifies
obsessive compulsive disorder. Some disorders the anxiety. The most recent national survey of
are linked (for example, agoraphobia and mental health in the UK indicates that while 2.6%
panic disorders), while each displays particular of the population experience depression and
characteristics which themselves impact on 4.7% have anxiety problems, as many as 9.7%
people’s lives. suffer mixed depression and anxiety, making it
the most prevalent mental health problem among
the population as a whole (McManus et al., 2009).
Previous surveys conducted in 1993 and 2000
showed an increase in the prevalence of mixed
anxiety and depressive disorders, but only
small changes between 2000 and 2007 (Self
et al., 2012).

Panic is an exaggeration of the body’s normal

response to fear, stress or excitement. Panic
attacks are a period of intense fear in which
symptoms develop abruptly and peak rapidly.
Panic attacks have been described as a form
of “emotional short-circuiting” (Servian-Schreiber,
2005) whereby the limbic brain suddenly
takes over the body’s functioning, leading to
overwhelming sensations, which might include

16
a pounding heart, feeling faint, sweating, shaky developed form; in a less severe form up to one
limbs, nausea, chest pains, breathing discomfort in eight people, i.e. about 7 million in the UK, may
and feelings of losing control. Adrenaline be troubled by some agoraphobic symptoms.
overwhelms the cognitive functions that would
normally help the brain assess the real nature Post-Traumatic Stress Disorder (PTSD), or
of the threat to the body. The effects can be so syndrome, is a psychological reaction to a highly
severe that people experiencing panic attacks stressful event outside the range of everyday
believed they were dying. It is estimated that about experience, such as military combat, physical
1.2% of the UK population experience panic as violence, or a natural disaster. The symptoms
a separate disorder (Goodwin et al., 2005), rising usually include depression, anxiety, flashbacks,
to 1.7% for those experiencing it with agoraphobia recurrent nightmares, and avoidance of situations
(Skapinakis et al., 2011). that might trigger memories of the event. One
study of UK armed forces personnel deployed
A phobia is an intense and irrational fear of a to Afghanistan found that of 1,431 participants,
specific object or situation, such that it compels 2.7% were classified as having probable PTSD,
the person experiencing it to go to great lengths while a household survey of UK adults estimated
to avoid it. Phobias can be about harmful things a prevalence of 2.6% in men and 3.3% in women.
or situations that present a risk, but they can also Whilst a range of studies investigating the health
be of harmless situations, objects or sometimes challenges of asylum seekers and refugees
animals. Social phobia can include a fear of being have found that PTSD levels can be as much as
judged, scrutinised or humiliated in some way. It 10 times higher than the age-matched general
can show itself with a fear of doing certain things population (Fazel et al., 2005). A range of stressors
in front of others, such as public speaking. have been identified as impacting adversely on
According to the Office for National Statistics, mental health, including those experienced pre-
around 1.9% of British adults experience a phobia migration, such as torture, traumatic bereavement
of some description, and women are twice as and imprisonment, but also post-migration factors
likely as men to be affected by this problem. such as discrimination, detention, destitution
and delayed decision making in the asylum
Although agoraphobia is often associated with process (McColl et al., 2008). One study of women
a fear of open spaces, the main feature is intense asylum seekers in Scotland and Belgium found
anxiety triggering a panic response in situations that 57% were above the cut-point for PTSD
where escape is perceived as difficult or potentially symptomatology (Scottish Refugee Council
embarrassing, or where help may not be readily et al., 2009).
available; indeed, such crises often occur in
confined spaces. People with agoraphobia appear Obsessive Compulsive Disorder (OCD)
to experience two distinct types of anxiety― affects around 2–3% of the population and is
panic, and the anticipatory anxiety related to fear characterised by unwanted, intrusive, persistent
of future panic attacks. Agoraphobia can have a or repetitive thoughts, feelings, ideas, sensations
dramatic limiting effect upon the lifestyle of people (obsessions), or behaviours that makes the
living with the condition, as they seek to avoid sufferer feel driven to do something (compulsions)
situations that make them anxious; for example, to get rid of the obsessive thoughts. This only
only using places where exit routes are known or provides temporary relief and not performing
staying close to exits. In extreme cases, individuals the obsessive rituals can cause great anxiety. A
are so fearful they become homebound altogether. person’s level of OCD can be anywhere from mild
Onset of agoraphobia is usually between the to severe, but if severe and left untreated, it can
ages of 18 and 35 and affects between 1.5% destroy a person’s capacity to function at work,
and 3.5% of the general population in its fully at school or even to lead a comfortable existence
in the home.
17
Generalised Anxiety Disorder (GAD) is the most lifestyle choices such as smoking, drinking too
commonly diagnosed anxiety disorder and usually much alcohol, and a poor diet (Mental Health
affects young adults. Women are more likely to be Foundation, 2009).
affected than men. While feelings of anxiety are
normal, people with GAD find it hard to control Children and young adults
them, to such an extent that it impinges upon their Anxiety disorders are estimated to affect 3.3%
daily life. It causes sufferers to feel anxious aboutof children and young adults in the UK (about
a wide range of situations and issues, rather than 290,000) and while we cannot be sure whether
one specific event. Unlike a phobia, which focuses children and young adults today are more
upon a specific object or situation, generalised anxious than previous generations, mental
anxiety is diffuse and pervades the sufferer’s daily health problems in young people are surprisingly
life. Although GAD is less intense than a panic common, disabling and run a chronic course
attack, its duration and the mental and physical (Cresswell et al., 2010; Hagell et al., 2013). Cohort
symptoms, such as irritability, poor concentration studies carried out from 1974 show significant
and the effects of disrupted sleep patterns, mean increases in emotional problems such as
that people with the disorder often find it difficultdepression and anxiety amongst young people,
and in 2004 it was estimated that 4% of children
to live the life they would prefer to live. GAD affects
2–5% of the population and has increased slightly and young people had an emotional disorder
since 1993 (Self et al., 2012), yet accounts for (anxiety or depression) (Green et al., 2005). The
as much as 30% of the mental health problems absence of similar research in the last eight years
in people seen by GPs, which explains why an means that it is difficult to assess the impact of the
analysis of people seeking help through primary financial crisis on levels of anxiety amongst young
care suggests a higher prevalence rate of 7.2% people. Nevertheless, in 2004, children and young
(Martin-Merino et al., 2010). people with ‘emotional disorders’ were found
to be living in significantly poorer households
Anxiety and health compared to other children and were more likely
The true impact of anxiety can be masked when it to be educationally disadvantaged (Green et al.,
is the symptom of other more obvious or treatable 2005). One commentator has concluded that
physical problems which are likely to be prioritised such “mental health problems have important
in any subsequent medical intervention. Anxiety implications for every aspect of young people’s
problems are common amongst cardiovascular lives including their ability to engage with
patients; for example, panic disorder is up to 10 education, make and keep friends, engage in
times more prevalent amongst people with chronic constructive family relationships and make their
obstructive pulmonary disease than in the general own way in the world” (Hagell et al., 2013).
population (Livermore et al., 2010, cited by Naylor
et al., 2012). People with GAD have been found The results of a major study revealed that
to be at higher risk of coronary heart disease, children and adolescents with an autistic
while anxiety has also been linked to increased spectrum disorder were at particularly high risk
incidence of gastrointestinal problems, arthritis, of experiencing problematic levels of anxiety.
migraines, allergies, and thyroid disease. People Nearly 40% were estimated to have clinically
with anxiety disorders are four times as likely as elevated levels of anxiety or at least one anxiety
others to develop high blood pressure, and many disorder, with specific phobia most common
studies have shown a relationship between anxiety at nearly 30%, followed by OCD in 17%, social
and reduced white blood cell function, a sign of anxiety disorder and agoraphobia in nearly 17%
immune system weakness. There is also emerging and GAD in 15% (Van Steensel et al., 2011).
evidence of a link between stress and Alzheimer’s
disease. Anxiety is also associated with unhealthy

18
 Living with anxiety: Ian,
Environmental Trust Manager,
mid-30s

I heard a psychologist on the radio say that having

anxiety is like sticking your head above a trench
every day. Mine is not that severe; it is more like
getting ready for a job interview, a feeling that
I have to perform more highly than in reality I
actually have to. Some days it is worse than others,
but it is not often that I’m away from thoughts that
distract me from letting go or having a good time;
there is always something at the back of my mind
saying you’ve got to sort this or that out.

What we are talking about is GAD. My head says

I’m under attack and physically I feel like I’m under
attack. I start holding my breath, shallow breathing,
my heart starts beating faster, pacing up and
down. I get shaking―not like my cup of tea would
go everywhere―but more like a buzz, a readiness,
as though I’m preparing for something. Maybe I
ramble on a bit; that’s a product of it. It’s energy-
sapping although I still manage to find energy.

It’s only recently that I’ve realised there is

something that needs to be explored a bit more
deeply. I’m currently working with a CBT therapist,
talking about the time when I first noticed my
anxiety, trying to recognise whether it was a
particular incident that triggered it or whether
I’ve had it from a younger age. My gut feeling
is that I’ve always had a tendency to be anxious.
My grandmother was anxious and I wonder if
there is something genetic there. I was quite
shy and reserved at school but it became more
pronounced when I went to university. It was less
about the stress of moving away from home,
although that may have contributed to it, and more
uncertainty about me and my place in the world.

While I was at university my GP prescribed anti-

depressants, but I wasn’t comfortable taking them.
I didn’t have a diagnosis; I just used to think that
I’m not quite hitting the right note, not quite getting
satisfaction from what I do, or that I’m flawed in

19
some way. Having experienced life a bit more, I do think that sport is a great medicine. I’d love
I’ve noticed patterns of stress for which I sought to do 30 minutes of exercise a day, but the GAD
counselling. I didn’t really nail down a diagnosis means that I feel I have to do X, Y and Z before I
and acceptance of GAD until about 3 years ago. can find time to do some exercise. It’s a form of
That led to me to get involved with Anxiety UK perfectionism which means that you can’t start
and they put me in touch with one of their something until you’ve lessened the anxious
cognitive behavioural therapists and I’m currently feeling about these things that are pressing
looking at ways to change the way I think and because the world will blow up if you don’t do
instil new behaviours and habits. It has taken those. Then you can think about exercising. It’s
me a while to get to that point. difficult to get a well-rounded routine. I find that
taking on responsibilities helps. So I’ve taken
Anxiety is always there, but it is heightened on the responsibility to take this seriously. I used
when there is a transition or anything new, so at to go out and drink and that didn’t help, so now
a micro-level it could be a social situation I am not I don’t drink, or very rarely.
entirely comfortable with. So there are different
levels of anxiety. When you hear the word anxiety, I haven’t ever stopped and that has been
classically you think of worry and you would be one of the problems. Constantly doing things
able to see it, but anxiety can be internalised as is something I feel is necessary as a way of
well. So when I am there with my family at a social preventing things going wrong. But that is actually
event, it might be the most natural, comfortable a negative thing because I haven’t been able to
thing in the world, but in my mind somewhere say, ‘hang on Ian look at yourself a little bit more,
I’ve got doubts and worries and anxieties that think some more positive thoughts because it
aren’t showing. has all been a bit of a rush’. Even if GAD gives me
fear-fuelled oomph, I’d definitely swap it for peace
My personality is positive by default; however, of mind, clarity, and the yearning to just… be. I’m
GAD interrupts my fun and placid temperament often left feeling sad, isolated and frustrated at
and replaces positivity with negative thoughts that the difficult task of simply enjoying life.
I’m not good enough. Sometimes I wonder what
part of it is me and what part of it is GAD. I do get
a lot of things done, and then I think: is it good that
I have GAD? You know what they say: if you want
something done, give it to a busy person. Well, that
happens to me. But really I could use the energy
in much more productive ways. People have said
“You need to learn to say no”, but part of me on
the negative side goes, “If I do say no then what
will people think of me?” The other part of me says
“I really want to get involved in this; I’m going to
do it”. And I know, because of the way I am, that
if I do agree to do something I’ll worry about it.
So I agreed to put on the local carnival alongside
holding down my full-time job, as well as juggling
a social life. I’m naturally an organised person and
I do have a passion for my local community, but my
worry about doing a bad job and worry about what
people will think of me spurred me on to put on
a good schedule of events.

20
The state of the nation: anxiety ―― People in the older age groups tend to be
in the UK happier and less anxious (Understanding
Society, 2013).
To get a picture of the extent and causes of anxiety
amongst the general population of Britain in early ―― The anxiety levels of people with a disability
April 2014, we commissioned a survey of 2,330 are higher, on average, than those of people
adults. The survey complements upon recent
11
without a disability (ONS, 2013).
large-scale survey evidence about anxiety, which
suggests that: ―― Unemployed people report significantly
higher anxiety levels than those in
―― Although, on average, women rate their life employment (ONS, 2013).
satisfaction higher than men, their anxiety
levels are significantly higher than men (Self ―― People in the lowest income groups report
et al., 2012; the Office for National Statistics significantly higher anxiety levels than those
(ONS), 2013). in higher income groups (ONS, 2014).

―― People in their middle years (35 to 59) report ―― On average, all ethnic groups reported higher
the highest levels of anxiety compared to levels of anxiety than people describing
other age groups (Self et al., 2012; ONS, 2013). themselves as White British (Hicks, 2013).

―― Young people aged 16–24 are more likely to

report lower levels of anxiety compared with
adults generally (Potter-Collins & Beaumont,
2012; ONS, 2014).

―― Women and adults aged 20–29 are most

likely to seek help from their GP for anxiety.
(Martin-Merino et al., 2010).

For the purposes of the survey, we defined

‘anxious’ as generally feeling worried, nervous, or
uneasy. The survey explored how often people feel
anxious, the causes of their anxiety, what they do
about it, and the impact of anxiety on their lives.
The findings presented an opportunity to map the
scale of anxiety across a representative sample
of the population, and analyse responses by age,
gender, social class and employment status.

11. Source: YouGov Plc. April 2014. Total sample size was 2,330
adults. Fieldwork was undertaken between 9th and 10th April 2014.
The survey was carried out online. The figures have been weighted
21 and are representative of all GB adults (aged 18+).
How often do people feel In general which ONE, if any, of
anxious? the following statements do
―― Almost one in five people feel anxious
you think BEST describes your
nearly all of the time or a lot of the time. experience with anxiety in your
everyday life? (n=2,330)
―― Only one in twenty people say they never
feel anxious.
I feel anxious nearly all of the time 4%
―― Women are more likely to feel anxious I feel anxious a lot of the time 14%
than men. I feel anxious some of the time 41%
I rarely feel anxious 34%
―― The likelihood of feeling anxious tends I never feel anxious 5%
to decline with age. Don’t know 1%

―― Students and people not in employment The frequency of anxious feelings decreased
are more likely than those who are working incrementally through the age groups of
or retired to feel anxious all of the time respondents, while the proportion of those saying
or a lot of the time. they rarely or never feel anxious increased with
age, from 25% of 18–24 year olds at the lower
When asked to describe how frequently they end of the scale, to 49% of those aged 55 years
experience anxiety in their everyday life, our survey or older at the upper end. People not working for
found that 19% of people feel anxious either a lot other reasons than being unemployed (such as
of the time or all of the time. For this group, anxiety long-term disability) were three times more likely
is something that almost two-thirds (61%) of them (12%) to experience anxious feelings all of the
experience on a daily basis and a third (33%) time than the survey sample as a whole (4%).
experience it at least once a week. There was a Students (26%), people who are unemployed
marked difference between the experiences of (30%), and people not working for other reasons
men and women however, in that almost a quarter (33%) were more likely to feel anxious a lot of
of the women surveyed (22%) feel anxious a lot the time or all of the time compared to the
or all of the time, compared to 15% of the men. survey sample as a whole (19%).
A further 41% of people in the survey feel anxious
some of the time, meaning that six of every ten
respondents said they feel anxious at least some
of the time. Women were more likely to experience
this frequency of anxiety (68%) compared to men
(51%). Additionally, 47% of men said they are
either rarely or never anxious in their everyday
lives, compared to 31% of women.

22
What causes anxiety? We asked people to identify the causes of their
anxiety. Almost half of those surveyed (45%) said
―― Nearly half of the people who said they that financial issues (i.e. money/finance/debt)
feel anxious in their everyday life said that cause them to feel anxious. The survey highlighted
financial issues are a cause of anxiety, but a marked decline in anxiety about finances
this is less likely to be so for older people amongst people aged 55 years and older: nearly
(those over 55 years). one-third (32%) of this age group cited finances
as a cause compared to more than half for each
―― Women and older people are more likely to of the other age categories. Discounting people
feel anxious about the welfare of loved ones. who are retired (who are half as likely as others
to say financial issues are a cause of their anxiety),
―― Four in every ten people who are currently this shows that not only are financial issues a
employed said they experience anxiety significant factor in anxiety for people of working
about issues to do with their work. age, but also suggests that people in part-time
employment (53%), the unemployed (53%), and
―― Around one-fifth of people who are anxious people not working for other reasons (55%) are
have a fear of unemployment. slightly more likely to have anxious feelings about
money. The survey findings further suggest that
―― Younger people are more likely to feel people in social grades C2D&E (49%) may be
anxious about personal relationships. more likely to feel anxious because of financial
issues than people in social grades AB&C1 (42%).
―― Older people are more likely to be anxious
about growing old, the death of a loved one, Work issues, such as long hours, were identified
and their own death. by just over a quarter of people (27%) as a cause
of anxiety and 17% said that the fear of losing their
―― The youngest people surveyed (those aged job or unemployment caused them to feel anxious.
between 18 and 24) were twice as likely Anxiety related to work appears to be consistent
to be anxious about being alone than the across working life and then, as one might
oldest people (aged 55 and over). expect, diminishes sharply as people approach
and enter retirement. Indeed, significantly higher
proportions of those in either full- or part-time
employment cited work issues (39%) and fear
of unemployment (22%) as a cause of anxiety
compared to the survey sample as a whole.

23
Which, if any, of the following Anxiety related to family and relationships featured
specifically cause you to feel prominently in the survey. Personal relationships
were said to be a cause of anxious feelings for
anxious in your everyday life? 26% of people who said they feel anxious in
(n=2,184) everyday life, but significantly more so for people
aged 18–24 (44%) and students (46%), and
significantly less so for people aged over 55
Money/finance/debt 45%
years (15%). Just over one-third of those surveyed
Welfare of my loved ones/children 36%
(36%) identified the welfare of a loved one or
Other work issues 27%
children as a cause of anxiety, but significantly
(e.g. long hours etc.)
more women (44%) than men (28%) cited this
Personal relationships 26%
as a cause, and the likelihood of citing it increased
Growing old 25%
with age so that almost half of people aged over
Death of a loved one 22%
55 years (47%) said that this was a cause
Fear of losing my job/unemployment 17%
of anxiety.
Fear of being alone/isolation 16%
My own death 16%
Age was also a factor in anxiety about growing
Fear of crime/personal safety 14%
old, with 36% of those aged 55 years and above
Other 14%
saying they were anxious about this, compared
Don’t know/can’t recall 6%
to just 15% of 18–24 year olds. Similarly, 29% of
the people surveyed from the oldest age group
felt anxious about the death of a loved one,
compared to 13% from the youngest age group,
and twice as many from the oldest age group
(19%) were anxious about their own death,
compared to the youngest age group (10%).

However, the survey also threw up an interesting

anomaly around fear of being alone/isolation. We
might hypothesise that this would be a particular
source of anxiety for older people, yet young
people aged 18–24 (28%) were twice as likely
to mention it than people in the 55 years and over
age group whose response (14%) was lower than
the survey sample as a whole (16%). This may be
suggestive of the importance placed on belonging
to a peer group by young people. Women (19%)
were slightly more likely than men (13%) to
mention this as a cause of feeling anxious, while
students (27%), people working part-time (23%)
and people not working for reasons other than
unemployment (23%) were also more likely to
have anxious feelings about being alone.

24
How do people cope with their Which, if any, of the following
anxiety? do you do/use to “cope” with
―― Nearly one-fifth of people who have
your feelings of anxiety in your
experienced anxiety do nothing to cope everyday life? (n=2,184)
with it.
Talk to a friend or relative 30%
―― The most commonly used coping strategies
Go for a walk 30%
included talking to a friend, going for a walk,
Comfort eating 24%
and physical exercise.
Physical activity/exercise 23%
Hide away from the world 18%
―― Comfort eating is used by a quarter of people
Alcohol 16%
(24%) to cope with feelings of anxiety and
Relaxation/meditation techniques 13%
women and young people are more likely
Cigarettes 10%
to use this as a way of coping.
Visit my GP 7%
Other 11%
―― Almost one-third of students in the survey
Don’t know 2%
said they cope by ‘hiding themselves away
from the world’.
The most common coping strategy was talking
―― People who are unemployed are more likely to a friend or relative, used by 30% of people who
to use coping strategies that are potentially feel anxious in their everyday life, although women
harmful, such as alcohol and cigarettes, (38%) were more likely to do this than men (21%),
than those who are currently employed. and younger people (42%) were more likely to
do so than people in older age groups. This may
―― Fewer than one in ten people (7%) have also be an indication of the central role of peer
sought help from their GP to deal with relationships in the lives of young people.
anxiety, although those who feel anxious
more frequently are much more likely The survey explored people’s use of three active
to do this. approaches to coping with stress. Almost one-third
of all respondents (30%) said they would go for
We asked people who have experienced anxiety a walk to cope with anxiety, a little under a quarter
in their lives to identify the different ways they said they would undertake a physical activity or do
cope with it. Just under one in five (19%) do not some exercise (23%), while fewer (13%) would
do, or use, anything to cope with anxiety in their use relaxation or meditation. While these ways
everyday lives. The findings revealed an inverse of coping were employed fairly consistently across
relationship between the frequency with which all groups, the results suggest that people from
people experience anxiety and how active they social grades AB&C1 (27%) may be more likely
are in seeking ways to cope with it; so 32% of to undertake physical activities to deal with anxiety
people who rarely have anxious feelings said that than people from social grades C2D&E (19%).
they do nothing to cope with those feelings, while
only 6% of people who live with anxiety all the The survey also included four potentially harmful
time do nothing about it. The proportion of men coping strategies. Of these, comfort eating, was
not using coping strategies was higher (24%) employed by 24% of those surveyed and women
than for women (16%), and older people (28%) (29%) were more likely to cope in this way than
are less prone to using coping strategies than men (18%). People in the younger age groups
younger people. were much more likely to use comfort eating

25
than people in the older age groups. A similar
pattern across age and gender emerged in relation
to hiding away from the world, which was cited by
18% of respondents. Students were more likely
than other groups to hide themselves away; 31%
of students in the survey said they use this as a
coping strategy. The pattern of usage for alcohol
( just over one in six people) and cigarettes (one
in ten people) was not significantly different across
age groups or between men and women.

The findings suggest that unemployment may

be a factor in determining the types of strategies
that people use to cope with anxious feelings.
Unemployed people were more likely than other
groups to use potentially harmful strategies: about
a quarter (23%) said they would hide away from
the world, use alcohol (27%) and use cigarettes
(23%). In contrast, people who are retired are
much less likely than any of the other groups
to use any of these potentially harmful coping
strategies to cope with their anxiety.

Visiting a GP to deal with anxiety was an option

taken up by just 7% of respondents who had
reported anxious feeling at some point in their
lives, a proportion that was consistent across
gender and age groups. Yet those experiencing
anxiety most frequently were over five times more
likely to visit their GP than the survey sample as a
whole, while those experiencing anxiety a lot of the
time were more than twice as likely to visit their GP.

Despite this apparently low rate of self-referral

usage to GP services, 27% of those surveyed
agreed that a problem with anxiety is something
they would see a GP about. Agreement amongst
women was higher (31%) than amongst men
(23%), and more than half (56%) of those
experiencing anxiety nearly all of the time agreed
that anxiety is something they would visit their
GP about.

26
Perceptions of anxiety The impact of anxiety
―― People are believed to be more anxious now ―― Just under half of people get anxious more
than they were 5 years ago. often these days than they used to and
believe that anxiety has stopped them
―― There is a tendency to reject the notion that from doing things in their life.
having anxious feelings is stigmatising.
―― Most people want to be less anxious in their
―― People who experience anxiety most day-to-day lives.
frequently tend to agree that it is stigmatising.
―― Women and younger people are more likely
The survey found strong agreement with the say that anxiety has impacted on their lives
proposition that people are more anxious now in these ways.
than they were five years ago; as one might
expect, agreement is strongest amongst people We asked three questions of those people who
who experience anxiety most frequently (72%). had experienced feelings of anxiety about the
impact it has upon their lives. More people agreed
People were also asked to indicate the extent (47%) than disagreed (31%) that they get more
of their agreement with statements addressing anxious these days than they used to and there
aspects of stigma that may be attached to were similar levels of agreement that feelings
anxiety. Just over a quarter of respondents of anxiety had stopped them from doing things
(26%) felt that feeling anxious is a sign of not in their lives. There was a more clearly defined
being able to cope, but almost twice as many tendency for people to agree (57%) than disagree
(50%) disagreed with this sentiment. Slightly (14%) when asked if they would like to be less
more people (29%) agreed that they would be anxious in their day-to-day lives. In each of these
embarrassed to tell someone they have anxieties, domains, the tendency for agreement was larger
but again just under half (46%) indicated that for women compared to men and for people in
they would not be embarrassed. There was an the younger age groups compared to the older
even stronger rejection of the notion that feeling age groups. People experiencing anxiety on a
anxious is something to be ashamed of; just frequent basis were also more likely to agree
10% of people agreed with this sentiment, while than disagree with these statements.
nearly three-quarters (74%) of them disagreed.
However, people experiencing anxious feelings
most frequently were much more likely to
agree with these stigmatising views of anxiety,
while, conversely, respondents who had never
experienced anxious feelings were much more
likely to disagree with the proposition that they
would be embarrassed to tell someone they
have anxieties (57%).

27
The state of the nation The survey identifies discrete groups within the
populations for whom anxiety may be persistent
Our survey provides an important insight into and at times debilitating, or for whom anxiety has
the impact that anxiety has upon people’s a disproportionate impact. It suggests that there
everyday lives. The findings suggest that feelings is a small but significant group of people for whom
of anxiety are experienced widely and form part anxious feelings are a constant presence that
of a familiar emotional landscape for people taking may provoke a heightened sense of stigma, yet
part in the survey. The survey highlights those they are also more active than most in seeking
areas of people’s lives most likely to generate ways to cope with them and are more likely to call
feelings of anxiety; stresses and worries about upon primary care services for help. This group
families and personal relationships are a major will include people who have a recognised anxiety
cause of anxiety, while financial issues and work- disorder, whether diagnosed or not, as well as
related matters feature prominently in people’s those at risk of experiencing acute episodes
concerns. Overall, people believe that society of anxiety.
is more anxious than it was five years ago and
many of those who have experienced anxiety The survey suggests that gender, age and
in their own lives say that they are more anxious employment status may be factors in shaping
than they used to be. However, the message the experience of anxiety in the UK. It reconfirms
from people taking part in our survey is that that anxiety has a disproportionate effect upon
anxiety is not something to be ashamed of or the lives of women compared to men in terms
embarrassed about, or that anxious feelings of the frequency of anxious feelings, the source
should be interpreted as a sign that someone is of their anxiety and their preferences for coping
unable to cope. This perhaps tells us something with it. Women are also more likely to report that
about the level of awareness about anxiety that their anxiety has had a negative impact upon their
now exists amongst the general public and their lives by, for example, stopping them doing things.
potential receptiveness to initiatives to address Similarly, younger people are more likely to be
the problems posed by anxiety. affected by anxiety than people from older groups,
while people in the oldest age group (55 years and
An important message to emerge from the survey over), and especially retired people, are markedly
is that people find a variety of ways of coping less likely to be affected. Finally, the survey does
with feelings of anxiety that fall short of seeking suggest that people who are not employed are
professional help. Although we made no attempt more likely to experience anxiety more frequently
to gauge the effectiveness of these strategies, than those in work, are more likely to be anxious
the preferences expressed for simple human about financial matters, and be more likely to
interaction and physical activity may suggest that cope in ways that are potentially harmful.
people deal with feelings of anxiety in ways that
have proved helpful with other emotional crises.
The survey also maps a less positive tendency
for some people to use potentially harmful
coping strategies, notably comfort eating or
social withdrawal.

28
 Living with anxiety: Jane,
Volunteer, early 50s
I was probably considered a shy child, but I didn’t
have any major problems in childhood. I had
one or two good friends although I wasn’t really
comfortable in big groups and I did panic if I was
ever invited to parties or if there was a big group
thing in class. My anxiety has always been social
anxiety, so it has prevented me from doing a lot
of things. It really came to a head in my teenage
years―that traditional transition stage when I
was doing exams. That was when it really started
to kick in and I couldn’t go to school, I couldn’t
sit my exams, so I left and I got a job through
a relative. But I struggled with the work so I had
to leave. I tried college and had to leave that too.

I felt very ashamed and very embarrassed about

having anxiety and it was something I tried
desperately to cover up. Of course the more
I tried to cover it up, the more anxious I became.
I thought there was a real stigma around anxiety
at the time; I didn’t realise that young people of my
age had similar experiences and feelings. I thought
it was just something that affected adults. My
father suffered with anxiety and it was something
he was ashamed of. He tried to cover it up and
wouldn’t talk about it. So I picked up on that as
being something to be embarrassed about.

My GP diagnosed anxiety―it wasn’t social anxiety

then, it was just anxiety―and he gave me valium;
I was about 17 at the time. I was also referred to
a psychologist at the local hospital, but I really
didn’t understand what the psychologist or
psychiatrist was telling me; it was very unpleasant.
The tablets worked while I was taking them, but
once I stopped taking them, all the symptoms
came back and I still had all the very negative
frightening thoughts―it didn’t help those. I had
a lot of physical symptoms, blushing and sweating
which people would comment on, so I became
more and more withdrawn. Eventually, I stopped
going out, so I lost friends, had no social life, no
relationships and became quite housebound. My
anxiety has meant that I haven’t been able to work

29
for a long time and even looking for a job is really Because it has been there for such a long time,
really difficult for me. I wanted to do something anxiety has taken root. Maybe I have an anxious
because I’m on benefits and I wanted to give nature, so it is always going to be a part of my life.
something back, also to feel better in myself, But now I understand it a lot better, I know I am not
to boost my own self-esteem. the only one who has it―that helps a lot―and it
doesn’t worry me as much because I have some
I am a member of Anxiety UK and I’ve been coping techniques and know what I can do to
working as a volunteer on their helpline for about reduce my anxiety.
4 years now. I decided to do some volunteering
to help me practise my coping skills. I was always Working here I can give people hope because
terrified of doing it and then somebody gave me when they ring up they often think that anxiety
a push and said “You’ve got to make an effort is going to ruin their lives and they are never going
now”. I had a major panic attack the first day to get better. I tell them, from my many years’
I was here, but one of the staff took me outside experience, “You can learn to manage it, it doesn’t
and had a chat with me; they said, “It’s OK, it’s have to control you, you can still get on with your
understandable, we’ve seen this before, it’s not life. If you nip it in the bud when it starts, you have
only you that this has happened to”. Just hearing a better chance of it not getting really bad. Don’t
that―that it happens to other people as well― be frightened of it and don’t bottle it up; share it
made all the difference. Everybody here has with someone you feel comfortable with”. I also
experience of anxiety or, if they haven’t, they have contribute to a course at a local university, helping
a special interest in it, so I don’t have to hide it. to train therapists of the future. The fact that I
That was the biggest thing: not having to hide it. can use my anxiety in a positive way like this is
I could have anxiety attacks with all the symptoms a massive thing for me because for so many years
and nobody would make any comments about it. I felt ashamed and embarrassed about it. So to be
The people here have encouraged me and given able to talk about it openly and for my experience
me support, and that has really helped me build to be embraced―they really want to hear it―that’s
my self-esteem and confidence. been tremendous for me. And in general, I think it
makes you a more caring person, I really do.
The biggest change has been coming here
because it’s such a supportive environment.
Peer support is the main thing that helps me cope,
but I’ve also done an online CBT course. I’ve seen
some therapists, but it may be part of my anxiety,
I just feel uncomfortable with therapists being
in the room; I feel trapped. I think it’s my social
anxiety. So I’ve not been able to concentrate on
what they are saying because I’ve been focused
on my anxiety and wanting to leave. Doing it online
there were no distractions and I really seemed to
take that in. I’ve used those CBT techniques and
breathing control. There is some excellent self-help
online. So it’s been a combination of things.

30
Managing anxiety period (Walters et al., 2012). A number of reasons
for this apparent under-recording have been
“A person cannot just simply decide not to be suggested, including an increased preference by
anxious anymore” (Anxiety Care UK). GPs for recording the symptoms of anxiety rather
than specific diagnoses. Others have suggested
Although anxiety can be a debilitating condition, a preference for broad diagnostic labels, such as
it is not an illness and therefore is no more ‘anxiety states’, which may reflect a lack of training,
susceptible to being ‘cured’ than other emotional a belief that the distinctions in anxiety states
states that serve important functions as part of are not meaningful in primary care practice,
the human survival kit. Our survey illustrates how or reluctance to use formal diagnoses which
people experiencing anxiety in their everyday lives may be perceived as stigmatising for patients
often find the personal resources to cope through (Walters et al., 2012).
simple remedies such as talking things through or
doing a physical activity, although the finding that Others have pointed to structural problems in
people from social grades C2D&E are less likely the pathways that exist between primary and
to engage in a physical activity may suggest an specialist services following implementation of
inequality in access to such resources. This gives the National Service Framework for Mental Health
pause for thought when considering emerging (Cohen, 2008). This introduced the Improving
evidence on the benefits of this form of coping Access to Psychological Therapies (IAPT)
strategy on wellbeing more generally (Mental programme, which is designed to provide services
Health Foundation, 2013) and in managing stress for those suffering from anxiety and depression
levels specifically (Gerber and Puhse, 2009). disorders; during the year 2012–13, more than
three-quarters of a million people in England were
These self-help strategies are less likely to work referred to IAPT services nationally. Yet there is
for more acute disorders even though most are evidence that only half of the people referred to
highly treatable and full recovery is an achievable IAPT services go on to receive treatment, while
goal. Medicines can ameliorate the worst for those that remain, about half show significant
symptoms and aid the recovery process, but improvements or recover (Richards and Borglin,
are less useful in helping people to manage 2011). Somewhere along the line a great many
the threat of relapse in the longer term. Lingering people who experience anxiety are either
symptoms, vulnerability to ‘normal’ anxiety, and not getting the treatment they require or are
stress-related intensification of symptoms and choosing not to complete the course of therapy.
anxiety contribute to a continuous risk of relapse,
but these are factors that are directly addressed At the same time, the treatment of co-morbid
by psychological therapies which have been health and anxiety problems in acute patients
shown to improve the long-term outcomes appears to be seriously under-developed.
for people who seek this type of help. For example, while 42% of patients with
cardiovascular disease are currently provided
In 2010 it was estimated that there were 8.2 with rehabilitation, only 16% of these programmes
million diagnosed cases of anxiety disorder in have a psychological component, despite 31%
the UK (Fineberg et al., 2013) yet only about of these patients experiencing significant anxiety
one-third to half of sufferers receive treatment problems (Naylor et al., 2012). New collaborative
(McCrone et al., 2008). One of the problems of approaches involving a number of health
tackling anxiety disorders in the UK is the fact professionals working together with a patient
that despite the incidence of anxiety symptoms are likely to help and have been associated with
rising between 1998 and 2008, the incidence of significant improvements in depression and
GP recorded anxiety diagnoses fell over the same anxiety outcomes compared with usual care
(Archer et al., 2012).
31
Several different treatments are available to Health Foundation (2013) that exercise can be
ease the psychological and physical symptoms particularly effective in reducing the symptoms
of anxiety, including psychological therapies and of clinical anxiety when combined with CBT,
medication, as well as a range of guided self- although a review of 7 RCTs found no effect
help strategies and exercise on prescription. The for interventions comprising aerobic exercise
National Institute for Health and Care Excellence only (Bartley et al., 2013).
(NICE) recommends a ‘stepped care’ approach to
treatment, starting with interventions that are the Media link: Gretchen Reynolds ‘How Exercise Can
least intrusive of those likely to be effective (NICE, Calm Anxiety’ (New York Times).
2012). However, the evidence about the most
effective ways of treating anxiety is mixed and Cognitive Behavioural Therapy
we know little about the treatment preferences When someone is distressed or anxious, the way
of those seeking help with anxiety. This is worth they see and evaluate themselves can become
further exploration, as one American review negative. Cognitive behavioural therapy (CBT)
found evidence for enhanced outcomes for those helps people to understand the link between
receiving the treatment of their choosing and negative thoughts and mood and how altering
a marked preference for psychotherapeutic their behaviour can enable them to manage
support over other forms of treatment (McHugh anxiety and feel in control. It is the most effective
et al., 2013). non-pharmacological treatment for reducing
the symptoms of almost all mental health
Keeping active problems, but especially anxiety and depression
Studies on participation in leisure activities have (Stuhlmiller and Tolchard, 2009; Olatunji et al.,
shown improvements in self and life satisfaction, 2010), for people with anxieties about their health
which helps in reducing depression and anxiety (Tyrer et al., 2013), and leads to more general
and enhances a person’s sense of wellbeing improvements in the quality of life of people
(Haworth, 2010), while the evidence about the experiencing anxiety (Hoffman et al., 2014).
effectiveness of exercise alone is mixed. According CBT has also been shown to be effective with
to Sport England, participation in physical activity children and young people, although it is not
and sport has been shown to be effective in yet clear whether it is more effective than other
reducing depression, anxiety, psychological treatments for these younger age groups
distress and emotional disturbance. Low to (James et al., 2013).
moderate physical exercise can reduce anxiety
and have both short and long-term beneficial One feature of CBT is that it is a short-term therapy
effects on psychological health. Taking part in and, it is claimed, can be delivered effectively
sport and spectating can have a positive impact by primary care therapists either face-to-face
on the wellbeing and happiness of young people or as part of a self-help programme (Høifødt et
(ONS, 2014). A major limitation in the evidence al., 2011). There is evidence that CBT delivered
base is that while numerous studies and meta- in primary care settings has a moderate effect
analyses show that exercise is associated with on reducing symptoms of anxiety (Seekles et
reduced anxiety in clinical settings, not enough al., 2013). NICE therefore recommends CBT for
research has been done to map the effect of anxiety and panic disorders, and the availability
exercise on anxiety in real life (Anderson and of it has expanded rapidly in England under
Shivakumar, 2013). A recent systematic review the government-funded Improving Access to
of relevant Randomised Controlled Trials (RCTs) Psychological Therapies (IAPT) programme. The
concluded that exercise is effective in conjunction Scottish Mental Health Strategy (2012–15) has
with other treatments (Jayakody et al., 2014), also committed to improving and monitoring
confirming the conclusions of the Mental access to psychological therapies with an

32
important focus on older people, where there “It may be helpful to think of
remains an equity issue across the UK despite
this approach in terms of a
an emerging evidence base of effectiveness
in treating anxiety and depression in later life radio. That is, imagine that the
(McMurchie et al., 2013). negative thoughts that drift
Media link: Jane Feinmann ‘Coping with anxiety –
into your mind are coming from
on the cheap’ (the Daily Telegraph). a loud radio that is tuned to a
station where the thoughts are
Mindfulness
Mindfulness is a variation of CBT in that it focuses very negative and seem to be
on changing the relationship between the shouting at you.
anxious person and his or her thoughts, rather
The skill in mindfulness is not
than changing the thoughts themselves. Using
meditation and similar techniques, it can help so much about trying to turn
people break out of the ‘automatic pilot mode’ that the radio off, but changing the
leads to negative ways of thinking and responding.
Instead, it is about helping people to experience
way you listen to the radio. In
the world in the ‘here and now’. It does this by this way the volume of the radio
addressing the bodily symptoms experienced station can be reduced, and
when someone is anxious, but rather than avoiding
or withdrawing from these feelings, he or she therefore seem less disruptive
remains present and fully experiences them and and distressing.”
in this way is able to observe their reactions in a
different way. One guide to mindfulness provides
a useful analogy:12

Reviews of studies into Mindfulness Behavioural

Therapy (MBT) have found the approach has a
strong positive effect upon mood and symptoms
of people with anxiety disorders (Hoffman et al.,
2010; Vollestad et al., 2012).

Media link: Julie Myerson ‘How mindfulness based

cognitive behaviour therapy changed my life’
(the Guardian).

33 12. From the Centre for Interventions’ information sheets.

Guided self-help There is good evidence that guided self-help is
Guided self-help has become an increasingly effective for:
popular way of offering treatment because of
its low cost, adaptability to different forms of ―― Certain types of disorder, such as social
digital and social media and its acceptability phobia and panic disorder (Van’t Hof et al.,
to people who might otherwise not receive 2009; Lewis et al., 2012; Mayo-Wilson and
treatment (Andrews et al., 2010) either for reasons Montgomery, 2013).
connected with their anxiety or because of time
pressure from commitments such as caring. ―― Reducing the symptoms of some anxiety-
Most guided self-help is based on cognitive related conditions and improving quality of
behavioural approaches and aims to help the life outcomes (Haug et al., 2013; Stubbings
person experiencing anxiety achieve a level of et al., 2013).
recovery whereby they are able to understand
the nature of their anxiety and what is happening ―― Children with anxiety disorders
physiologically to them. They are then helped (Creswell et al., 2010).
to develop the necessary skills to tolerate and
cope with it, by challenging unhelpful thinking, ―― People who are motivated (Newman et
evaluating their bodily symptoms realistically al., 2011).
and managing graded self-exposure to the
source of their anxiety. ―― Those who have lower level anxiety problems
(Newman et al., 2011).
Computerised CBT can be supported by reminders
from a non-clinical technician or practice nurse, ―― People who are not able or are not willing
or guided by a clinician via telephone, email, live to use other services for people with
links such as Skype, or posts on a private forum. anxiety disorders (Mayo-Wilson and
Many areas of the country also have self-help Montgomery, 2013).
groups that offer peer support. Andrews et al.
(2010) point out that a major advantage of this There are doubts as to the long-term effectiveness
form of CBT is the level of treatment fidelity that of these approaches compared to face-to-face
can be achieved. Similarly, an evaluation of an approaches (Coull and Morris, 2011; Haug et
online mindfulness course has shown promising al., 2013) and there is a lack of evidence of their
results in terms of the acceptability of the means usefulness with older people or people with
of delivering help to people who might otherwise more severe conditions (Newman et al., 2011).
not receive treatments and its ability to decrease Nevertheless, there are good reasons to believe
the anxiety experienced by course participants that where face-to-face CBT treatment is not
(Krusche et al., 2013). available or where individuals would choose
not to use such a service for reasons of control,
stigma or convenience, then it makes sense
to make self-help treatment widely available.

The range and diversity of self-help approaches

and methods of engagement means that
individuals have the ability to select those that
work best for their specific needs. As we engage
in more complex ways with technology then it
seems probable that we will see more innovation
develop in this field of support. More research is

34
needed, but a recent co-production project funded Such developments recognise the new ways
by NHS Greater Glasgow and Clyde et al. found that people want to access support, but also the
that young people valued digital approaches to importance of providing a safe and quality assured
self-help and peer support and recommended space to do so. At the same time it is critical that
increased development of digital assets aimed digital spaces for mental health don’t merely
specifically at and co-designed by young people replicate online what is available offline. A nuanced
(NHS Greater Glasgow and Clyde et al., 2013). understanding of the way different audiences
use technology is needed to best leverage
For the past three years, The Mental Health opportunities. Equally, digital services need to be
Foundation has worked with the Paul Hamlyn an opt in for those who are keen to use them, and
Foundation, Comic Relief and Nominet Trust not an opportunity to remove or ‘reframe’ existing
to deliver the Innovation Labs programme,13 services by forcing people online when they aren’t
working with technology companies, mental comfortable with that modality. In time this may
health organisations and young people to create cost-savings, but this should be a collateral
co-design and deliver seven tools to support benefit and not a driver of digital innovation in
young people address mental health concerns. mental health.
Throughout the process, the value of technology
to young people has been demonstrated, as
has their ability to manage risk and challenge
in online spaces.

We have also seen the development of scaled

technology-based tools for people to self-manage
mental ill health, including anxiety. A range of
products exist, with many health authorities in
the UK having engaged the services of companies
like Big White Wall14 to provide a validated, well
controlled online community for self-management
and self-exploration online. In Scotland, a different
approach is being developed with the Scottish
Government, NHS 24 and New Media Scotland
collaborating on the development of Project
Ginsberg. Ginsberg will provide a route for people
who use technology to gain insight into their
lives, using a range of apps and tools to better
self-manage distress. Ginsberg will provide an
online platform that will provide a selection of
digital products, including access to diagnostic,
treatment and monitoring tools that people can
access independently of face-to-face services.

13. www.innovationlabs.org.uk
35 14. www.bigwhitewall.com
Peer support Medication
Peer support is a system of giving and receiving Among patients diagnosed with anxiety,
help founded on key principles of respect, shared approximately two-thirds are treated with
responsibility, and mutual agreement of what medication, anti-depressants accounting
is helpful” (Mead, 2003). The benefits of peer for almost 80% of prescriptions made out
support have been evidenced in a number of to this group (Martin-Merino et al., 2010).
studies in relation to supporting individuals Pharmacological interventions have been
to self-manage their mental health problems found to be effective at improving quality of life
and for those whose mental health is most by reducing the symptoms of anxiety for some
at risk, such as isolated older people, people patients (Hofmann et al., 2013), although not for
with dementia and young carers. Identified key a significant number (Ravindran and Stein, 2010).
benefits of peer support are the ability for the peer Medication is generally not as effective for older
mentor to provide support based on empathetic adults as it is for younger adults (Wetherall et
understanding and from a position of having al., 2013).
previous experience of developing coping skills
for the particular set of problems encountered. NICE suggests that for particular kinds of anxiety,
Most of the research regarding people such as panic, social phobia and obsessions,
experiencing mental health problems has not GPs should prescribe anti-depressants, especially
been specific to anxiety. However, there are certain SSRIs (selective serotonin reuptake
indications from work in relation to young people inhibitors). SSRIs appear effective in treating
during transitions and people adapting to life social phobia over the short term and the long
with long-term conditions that peer support can term (Stein et al., 2004), while augmentative
provide a helpful approach in learning to cope medications appear to be useful in the treatment
with the anxiety that uncertainty brings. of GAD, which is a more chronic condition
(Chessick et al., 2006). Due to high rates of
UK Governments are recognising the benefits of treatment resistance, there is interest in new
peer support and over recent years there has been pharmacological treatment options such as
a move to embed peer support approaches within second-generation antipsychotics (Depping et al.,
specialist mental health services as an additional 2010). Additionally, beta-blockers and tranquilisers
layer of support. The advancements in digital are sometimes prescribed in the short term to
technology may see further innovations in relation treat the physical symptoms without reducing
to peer support available online and is an area the psychological symptoms of anxiety.
worthy of fuller investigation in relation to anxiety.

For fuller consideration of the role of peer support,

see the Mental Health Foundation’s Need 2 Know
Peer Support Briefing available to download from
the Mental Health Foundation website.

36
“The storm has died away, A new ‘Age of Anxiety’?
and still we are restless,
The term ‘age of anxiety’ has been applied to
uneasy, as if the storm were several periods in modern history and is taken
about to break. Almost all to mean a period of time marked by uncertainty
the affairs of men remain in about how we make sense of life. It is often used
to refer to the period spanning the two world wars.
a terrible uncertainty. We think Previous generations, particularly in the West,
of what has disappeared, and had believed that the trajectory of human society
was inexorably upwards, fuelled by the civilising
we are almost destroyed by
influences of faith, education and science in the
what has been destroyed; we service of industry and commerce. The First World
do not know what will be born, War dealt a shattering blow to those old certainties
and the long period of economic and political
and we fear the future, not turmoil that followed is often characterised as
without reason… Doubt and a time of despair and darkness. It was also marked
disorder are in us and with by a flowering of the visual arts, the emergence
of the social sciences as a discipline, and the
us. There is no thinking man, development of psychiatric medicine.
however shrewd or learned
Are we living in similar times? The shock of the
he may be, who can hope
recent economic crisis may have prompted fear
to dominate this anxiety, to and anxiety in the short term, but some longer
escape from this impression term research suggests that the prevalence of
anxiety disorders is largely impervious to the
of darkness” vicissitudes of the economy, suggesting instead
(Paul Valery, Crisis of the that social trends such as divorce and crime may
Mind, 1919). have greater explanatory validity (Twenge, 2000).
While the notion of anxiety disorders undoubtedly
relates to the individual human condition, is it
possible to speak more generally of anxiety as
a sociological phenomenon, a mood or emotion
that permeates a community of people? Can
an understanding of the state of the nation’s
mood give us an insight into the effects of
wider economic and social forces?

In 2010, the Government introduced a new

measure of wellbeing to broaden the indicators
of economic development in the UK. It is intended
that these indicators be used to inform the
public about the nation’s wellbeing and “lead
to government policy that is more focussed not
just on the bottom line but on all those things
that make life worthwhile” (Number10, 2010;
Hicks, 2011). One of the measures used in the
first of these wellbeing surveys relates to anxiety,

37
because being anxious “is widely used as an The ‘age of anxiety’ narrative is attractive
indicator of poor mental wellbeing, a widely because it appeals to our sense of zeitgeist,
used generic measure of health status” (Dolan a desire to find a shared mood about the defining
et al., 2011). This is important for the ‘bottom aspects of modern life; our work, the way we
line’ because anxiety disorders are estimated raise children, our attitudes to people who are
to cost the UK economy £10.1bn annually15 disadvantaged, the future of public services, the
in direct medical costs as well as indirect costs threat of terrorism and so on. But there is a danger
such as lost productivity due to absence from that in concentrating too much on the cultural
work or early retirement (Fineberg et al., 2013). significance of anxiety, we miss the continuing
For example, during 2011, around 27.4 million hidden impact of anxiety upon the lives of a great
working days were lost due to minor illnesses many people. For those living with the chronic
such as coughs, colds and flu, while as many as forms of anxiety, it is more than a social index
13.3 million working days were lost due to stress, that rises and falls over time. Even within the
depression and anxiety. Moreover, the group of last decade we have achieved a much better
people diagnosed with anxiety and depression appreciation of this, even though we still lack
has one of the lowest rates of employment definitive answers about the causes of anxiety
(27.2%) of groups with a disability defined under disorders. We know more about the complexity
the Disability Discrimination Act. People suffering of anxiety disorders, their symptomologies,
anxiety are heavier users of primary care services manifestations and the multiplicity of factors
than other users of those services (Martin-Merino that may be at play when someone experiences
et al., 2010) and the presence of an anxiety anxiety. Our understanding has been enhanced
disorder significantly increases the costs by a number of developments.
of providing care to people with long-term
conditions (Naylor et al., 2012). Firstly, a recognition by the medical and
scientific communities that anxiety is worthy
Our survey showed that worries about money of attention. The collective clinical gaze has fallen
and jobs are significant components of feelings upon particular aspects of anxiety: developing
of anxiety and that employment status directly diagnostic consistency, the epidemiology of
effects how people assess their own anxiety; the various conditions that fall within the
working conditions, job satisfaction and job diagnostic criteria, causation and treatment.
security are known factors in people’s assessment New technologies have helped, so genetics
of their own anxiety levels (Bryan, 2012; Oguz et is now at the stage of suggesting heredity
al., 2013). The Office for National Statistics (ONS), as a possible factor in anxiety.
which is charged with collecting data to inform the
wellbeing indicator, has detected subtle changes Secondly, the available options for managing
between 2011–12 and 2012–13: a small decrease anxiety are now more sophisticated and nuanced
in people rating their lives as unsatisfactory and we have a more robust evidence base for
corresponding with a small decrease in the assessing the effectiveness of treatments,
same sample reporting high levels of anxiety.16 therapeutic interventions and coping strategies.
Yet the significant decrease in levels of anxiety In particular, the utility of psychological
amongst people in employment was not shared approaches, especially CBT, in managing anxiety
by people of working age who were unemployed either through a therapeutic relationship or
(ONS, 2013). This may reflect a shift in mood as as part of a self-help programme has been
the worst of the recession passes, albeit short established and there is still great scope
of outright optimism about the future. for expanding the availability of these.

15. At 2010 prices.

38 16. Both findings statistically significant at the 0.05 level.
Thirdly, the public profile of anxiety has been Recommendations
raised as part of a wider public debate about
mental health and what we, as a society, need We therefore make recommendations regarding
to do about it. There are a number of strands approaches to helping people with anxiety
to this from campaigning and awareness-raising and the research that is required to further
by organisations such as Anxiety UK, to greater our understanding of the experience of living
interest from the news media and the emergence with anxiety.
of a distinctive voice for people who experience
anxiety through books and social media. These A stepped care approach should be adopted to
have helped tackle perceptions of stigma that ensure that support to live with anxiety is provided
have been associated with anxiety in the past. in the least stigmatising and most inclusive way
possible, including:
While these developments are encouraging, our
own work suggests that there are still gaps that ―― Universal approaches to learning to
need to be addressed in the provision of support live well with anxiety should be built into
for people who experience anxiety. We know, for school curriculums from primary 1 onwards,
example, that people approaching primary care including an understanding of the role
services do not always get the responses they of anxiety in our lives and techniques
need, including accurate diagnosis and referral to for managing stresses associated with
appropriate specialists, and too many people fail school (such as peer relationships,
to complete courses of treatment when they do. exams and transitions).

―― Peer-led approaches should be

promoted within universal settings such
as employment, schools and universities,
in recognition of the importance that young
people place on support from peers and the
unique level of empathetic understanding
that can be provided by those with a
common experience.

―― Access to good quality self-help approaches

should be made available across the UK
through quality assured and co-designed
digital platforms to ensure they are fit for
purpose for those who choose not to use
face-to-face services (young people, people
in full time employment).

―― GP training and anxiety-related guidance

should be assessed for equalities impact
and adapted alongside groups of people
who are at highest risk of developing
problematic anxiety and least likely to have
their needs met by current service provision.

39
―― A sample of psychological services should show how anxiety stems as much from concern
be audited to establish how well referral for family, friends and relationships as it does from
processes are working, who is accessing the demand of the outside world. Most people
these, and who is falling through the gaps. instinctively seek solace and comfort in human
This audit should include IAPT in England interaction when confronted with anxious thoughts
and Wales and initiatives to improve access and feelings, and we know that these are the most
in Scotland. effective ways of dealing with them. But anxiety
can cause us to withdraw from society and
―― Agencies offering support to people with look for solutions in ways that may harm us.
anxiety should make greater use of peer
mentors and advice and information that We can glimpse in all of this the vital function that
is explicitly based on the life experiences anxiety plays in alerting us to threats to the things
of people who live with anxiety. that we hold most dear, as well as the material
things ( jobs, money, possessions) that we need
Research should be commissioned to to sustain a modern existence. The testimony of
better understand: people living with anxiety demonstrates how they
cope and manage anxiety so that it remains a
―― The nature and understanding of anxiety vital component of who they are without coming
for different groups in society (women, to define them. There remains a significant
people with long-term conditions, older amount of work to be done across society to
people, people from black and minority equip ourselves and bring our children up to live
ethnic communities), and whether current with anxiety, not only focusing our attention on
approaches and interventions can be the point where it becomes an identified problem,
found to address specific needs. but ensuring that we are able to get the most out
of life. Living to our full potential not limited by
―― The relationship between unemployment, the fear of anxiety.
financial distress, and anxiety. The
Department of Work and Pensions should
develop strategies to prevent people
who are not working from becoming
marginalised from the workforce.
Processes for accessing social welfare
for those unable to work due to disability
should be assessed for their impact on
anxiety levels.

―― The impact of technological advancements

in self-management for anxiety.

Perhaps the most important conclusion to

be drawn from this report is the importance
of framing anxiety as an essential aspect of our
humanity. All of us could trace a mental bell curve
like the one described by Scott Stossell to plot the
positive and negative uses to which we put our
stock of anxiety, both the creative impulses and
the destructive ones. The findings of our survey

40
Useful resources Self-help guides
and information
Northumberland Tyne and Wear NHS Foundation
Books about the lived experience of anxiety Trust has a self-help guide that has been
commended by the BMA and has been well
Scott Stossel (2014) reviewed by people accessing it online. For more
My Age of Anxiety: Fear, Hope, Dread, and the information and to download a copy, click here.
Search for Peace of Mind published by Heinemann.
The NICE Guide to self-help resources for
Daniel Smith (2013) generalised anxiety disorder is available to
Monkey Mind: A Memoir of Anxiety published download here.
by Simon & Schuster.
Radio and television programmes and films
Blogs about living with anxiety
BBC Radio 4 Woman’s Hour Programme.
Claire Eastham’s Blog weallmadhere.
Psychological therapies
The time to change blog about anxiety.
Directory of IAPT services.
The Anxiety No More website and a blog by
its founder Paul David. The Counselling Directory has a number of articles
about anxiety.

An online mindfulness course is available at

Be Mindful Online.
Mental Health Foundation How to overcome fear
and anxiety.

A video about anxiety from the NHS

Choices website.

Anxiety Care UK website.

Tips on physical activity from the MIND website.

41
National organisations offering Samaritans24-hour helpline
help, advice and information 08457909090
email: jo@samaritans.org
Anxiety UK samaritans.org
08444 775 774 Emotional support for anyone feeling down,
anxietyuk.org.uk experiencing distress or struggling to cope.

Anxiety Care UK Council for Psychotherapy (UKCP)

anxietycare.org.uk 02070149955
psychotherapy.org.uk
British Association for Behavioural and Has a voluntary register of qualified
Cognitive Psychotherapies (BABCP) psychotherapists.
01617054304
babcp.com The Young Minds website has information
Can provide a list of qualified therapists. for parents concerned about a child’s anxiety,
including a helpline (0808 802 5544) Monday
British Association for Counselling and to Friday 9.30am-4pm. 
Psychotherapy (BACP)
01455 883300 YouthNet runs The Site which offers young adults
bacp.co.uk help with a range of problems, including anxiety.
Information about counselling and therapy.
See the itsgoodtotalk website for details of
local practitioners.

The British Psychological Society

01162549568
bps.org.uk
Produces a directory of chartered psychologists.

Mindfulness Based Cognitive Therapy

mbct.co.uk 
Information about the therapy, classes in
Mindfulness and training.

NICE (National Institute for Health and Care

Excellence)
nice.org.uk 
Information and guidelines on recommended
treatments for different disorders.

No Panic
Helpline 08001388889
nopanic.org.uk
Provides a helpline, step-by-step programmes,
and support for those with anxiety disorders.

42
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