With the last of any celebrations over, what is left is for some people a sickly feeling as they face the coming year. That might be because of what’s going on in the world, with wars, acts of terror and the uncertainty of a second term with a more vindictive Donald Trump on the horizon. Or it could be due to issues much closer to home, such as managing financially or dealing with difficult relationships. We all have worries and uncertainty that can often cause symptoms we might describe as ‘anxiety.’
But anxiety is only one part of three ways of feeling that often get lumped together. It’s important to disentangle these because the treatment options for them can be different.
So, what is anxiety, hyperarousal and agitation, and how are they different from each other?
What is anxiety?
If you can imagine a pyramid that has three levels, anxiety is at the bottom and underpins the other two.
You can have anxiety or feel anxious when you are worried, tense or afraid. For example, you might feel anxious during big events like job interviews, waiting for results regarding your health, or trying to find something important that you’ve lost. It can produce symptoms like:
- A racing heartbeat
- Mild sweating
- Mild problems with sleep
- A churning stomach
But with anxiety you can, to a certain extent, ‘switch off’ by distracting yourself from your worries and preoccupations through, for example, work or listening to music or producing some art.
Being able to distract herself is something Souris, who has suffered from long-term mental health problems, can do sometimes when she is anxious. She said: “I try to redirect myself towards some ‘purposeful’ physical activity like cleaning my home, such as washing the floor.”
If you can’t distract or ‘redirect’ anxious feelings or find ways to switch-off and control these worries and preoccupations, then it might be you move up the pyramid to the next level that is ‘hyperarousal’.
Spiralling
This is the situation Souris has been in. She said:
Sometimes my inability to switch-off is just because I’m interested in a topic. But I wish I could shut-it out and go to sleep but instead I’m up for hours and hours arguing with myself.
When it spirals, I wish I could put my head in a container. Somewhere impenetrable where nothing gets in or out. It makes me feel like I want some sort of anaesthetic or respite.
This ‘spiralling’ can be a significant worsening of the anxiety symptoms and one area that’s particularly noticeable is in sleep. This is what Souris pointed to when she said she wanted some type of ‘anaesthetic’. Problems with sleep can include:
- Nightmares,
- Night sweats
- A feeling that you didn’t sleep enough for the next day.
Along with that you may feel hypervigilant – a feeling that you can’t relax even at calm moments, and you may experience physical symptoms such as muscle pains, tension headaches and migraines.
A panic attack is when there is a period of sudden and intense anxiety with both psychological and physical symptoms such as
- A racing heartbeat
- Feeling faint, light-headed or dizzy, and that you are going to pass out.
- Sweating, trembling fingers, shaking
- Feeling like you’re losing control
- Feeling sick
- Shortness of breath.
Such panic-attacks can be very distressing and it’s important to try and find out the triggers for what is causing them as well as get the appropriate therapy and treatment. Contact your GP or 111 to get further help and and look at the support from MIND on panic attacks:
https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/panic-attacks/
Or the support from the NHS:
https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/anxiety-fear-panic/
Escalating symptoms
After this comes agitation that sits at the top of the pyramid and is hyperarousal turned-up to maximum volume. Agitation can be present due to anxiety alone or as part of other mental health problems, such as severe depression, psychosis or during a ‘manic’ phase when someone has bipolar affective disorder. It can be extremely serious as the person suffering might not be able to switch-off at all. Physically that might mean:
- Pacing the floor,
- wringing your hands
But nothing works as you are so wound-up. Sleep is something you never think will ever happen again as you pace indoors, outdoors, throughout the day and night. Suicide is a danger with agitation as the constant agitation won’t stop no matter hard you try.
Due to the potential danger, if you are or know someone who is feeling agitated, then it’s important to get help as soon as possible. If a GP appointment can’t be found soon enough, contact 111 and explain the symptoms – it might mean an A&E visit is required.
How to get help for anxiety
The NHS treats anxiety seriously with several diagnosed conditions that have anxiety at their core such as generalised anxiety, panic disorder, agoraphobia and obsessive-compulsive disorder.
If you feel you need support with anxiety, and anxiety related issues you can now refer yourself for free ‘Talking Therapies’ like cognitive behavioural therapy (CBT) from the NHS without having to wait for a GP appointment.
Here is the link for finding this therapy: https://www.nhs.uk/service-search/mental-health/find-an-nhs-talking-therapies-service
NHS Talking Therapies is the first line of treatment for people with anxiety https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/ and this can be helpful for many people.
If you don’t want to refer yourself for Talking Therapies you can still get the referral through your GP, if you prefer it this way. Also, see a GP if:
- You’re struggling to cope with anxiety, fear or panic
- If the things you are trying –for example the talking therapies, are not helping
- If you’re anxious about a health condition
As we land in 2025, it’s completely normal to feel worried about what’s going to happen this year. But if you can’t ‘switch off’ and these worries are impacting on your daily life – making it difficult to do what you should be doing, then it’s important to seek out help.
Featured image via the Canary
