

WHAT

WORKS

Solid, simple ways to comfort your anxiety

## SEF CHURCHILL
  Copyright © 2019 Sef Churchill

All rights reserved.

DEDICATION

For SLC and ISC
CONTENTS

Acknowledgments

Foreword: Being Alone

I INTRODUCTION TO WHAT WORKS

Who This Book Is For

II WHAT WORKS

1 Warmth

2 Safety

3 Softness

4 Distraction – Phone

5 Distraction - Book

6 Distraction – Other Strategies

7 Motion

8 Fluids

9 Take the Pill

10 Triggers: Avoid and Handle

11 Offering, Giving

12 Self-Protection

Anti-anxiety food

News blackout

More on choice

Practical self-protection to-do list

13 Dealing With Doctors

Strategies for health anxiety

Get a good doctor

Do what the doctor says

Prepare for your appointment

Handle phone calls

14 Anxiety At Work

At your desk

Tell your employer

Don't tell your employer

15 Travel

Planes

Ships

Trains

16 Going on holiday

17 Self-Care Package

18 Fantasy, Bad and Good

III WHAT I WISH I'D KNOWN ABOUT ANXIETY

19 What I know now

20 Reminders

END NOTE: Fine

About the Author

What next?

ACKNOWLEDGMENTS

Thanks to everyone who has helped and supported me over the years.

FOREWORD: BEING ALONE

The suggestions in this book are ones you can do on your own without anyone around you. The reason for that is that many anxiety sufferers are isolated. Of course it is great if you can call your best friend, get them to come round and give you a hug, make you food, listen while you cry, stay with you when you are afraid. But in reality, many of us are alone.

Even those who live surrounded by friends or family can still feel lonely and isolated, especially if those people do not understand anxiety. In fact, it can feel worse - you may feel betrayed by the people who you think should be offering you the most help.

That's why the strategies in this book don't need other people.

Even alone, you can still seek comfort. Maybe you have people, maybe you don't. You can still use these suggestions.

Note: Whatever your situation, I urge you to reach out for help, whether it is from a doctor, a counsellor or therapist or an informal anxiety support group - online or meeting locally. Resources exist to help you, but meanwhile, I hope this book offers comfort.

I: INTRODUCTION TO WHAT WORKS

I have a deep dislike of self-help books which begin with a lot of fluff. It reads like filler added in to bulk up the pages and make the book heavier in the hand. Since this is a Kindle book, I'm not bothered about bulk, only about getting to the point as quickly as possible.

So here it is. This book lists the strategies that have helped me overcome anxiety over the last five years. I wish I'd known about them thirty years ago. I wrote this book so that other people will find a whole bunch of ideas about coping with anxiety, quickly and simply, in one place.

I'm not a doctor and I'm _not_ promising to fix or cure anxiety.

I _am_ saying these things helped me, and I believe they can help you too.

That's it. Let's get on with it.

This is not a book about anxiety

This is not a book about anxiety. This is a book about comfort when you are suffering with anxiety, using techniques that work.

Every anxiety book I've read starts with a big description of anxiety, and it's horrible. There is always a long section detailing the awful symptoms and consequences of mental illness.

I'm going to skip that.

I'm assuming that if you're reading this book, you already know or suspect you have anxiety, and you are very familiar with your particular symptoms. I'm not going to make you read through my guesses at them. Apart from anything else, reading about anxiety makes me anxious. Let's agree that you want to read about helping your anxiety, and move on.

Important note: I'm assuming that for any physical symptoms you may have, you have seen your doctor and been given the physical all-clear.

If you have never spoken to a doctor about this, please do. This book is not intended to constitute medical advice.

Know and Do

Know you are not alone - far from it. Anxiety is common.

Do seek out a group of people you can turn to for reassurance and support.

Know that you are an anxiety expert. You can empathise and make suggestions. Just because you haven't conquered it yet, doesn't mean you're not able to help yourself or others.

Do offer your support to others in the group.

Know that anxiety presents itself in many ways.

Do read a list of how anxiety can make itself known. I was amazed to find the enormous number of ways in which anxiety can manifest itself in the body and mind. I've included some of these at the back of this book. (But please don't look at this list, if thinking about symptoms is one of the things that sets you off.)

**Who this book is for**

I wrote this short book because when I first understood that I had anxiety, there was little advice available for people who were suffering, but coping.

I found a lot of guidance for people who are deeply restricted because of anxiety – people cannot work, and perhaps, cannot leave the house.

I found nothing for people who still go to work, care for a family, drive a car and do the shopping and somehow stay upright despite the horrible state of the inside of their heads.

I couldn't find anything for people like me, people who have deep-ingrained and long-lasting anxiety, but who are still functioning. That made me feel even more alone and afraid – all the books seemed to tell me that if I could get up and dress myself, I must be all right, and should stop making a fuss.

But I knew I was not all right.

So I wrote down all the things that have helped me carry on functioning, even when my anxiety is at its worst. They may not be earth-shattering, or even surprising. But collecting them all together into a neat care package helped me. And it made me acknowledge that just because I am managing, my anxiety should not be dismissed.

This book is that care package, and it is for you, if you are or have been

- at work, despite anxiety

- in a supermarket, despite anxiety

- making dinner for the kids, despite anxiety

- driving long hours or in heavy traffic, despite anxiety

-caring for family members, despite anxiety

- on holiday and trying to have fun, despite anxiety

- celebrating a birthday or Christmas, despite anxiety

- meeting up with friends or colleagues, despite anxiety

- just carrying on somehow, despite anxiety

I have collected in this little book, everything that has helped me, so you don't have to. It contains all the things I wish I'd known when I first started suffering with anxiety, years ago.

The ideas don't need other people. They are all things you can do right now, or with minimal preparation, for instant comfort. Maybe you are the only one who knows about your anxiety. That's OK - you can still help yourself now. (But do seek help).

The ideas here also don't involve medication or faith. They are just practical everyday things to do. They are the things that a friend might suggest, to help get you through a tough time. Treat this book as that friend, as a reminder that you can cope, that you are, in fact, doing an amazing job, despite anxiety.

The ideas and strategies in this book have helped me. I hope they help you.

II WHAT WORKS

1: WARMTH

Warmth is a vital defence against anxiety. I cannot stress enough how important warmth is to feeling better in a panic attack or just when you can sense that the dread is about to start looming. There are strong subconscious associations of cold with abandonment, danger, exposure. Get warm and replace those ideas with security and comfort.

A warm dressing-gown, sitting by a radiator or fire, drinking a warm drink, taking a nice hot bath... These things will calm and console you. Even drying your hair, washing your hands in warm water - or doing the washing up - is comforting. Put on trainers or furry boots, so your feet are cosy. Nothing warms you like having toasty toes.

Outside, wear gloves, and a scarf and hat in cold weather, and zip your coat up. This might sound simplistic and twee, but you are protecting yourself not just from cold, but all its negativity.

I travel a lot and stop in vast motorway service stations, which are generally not warm enough. Rather than have my tea break in a draughty, echoing cavern, I sit in my car drinking takeout hot chocolate. The heater is a bit erratic meaning that it is either off or Saharan, but that's OK with me. If it is a truly cold day, I silently apologise to the planet, and run the engine and the fans.

When you're stressed, or panicking, warmth retreats into your body's core, leaving fingers and toes chilly. Warm yourself up and it sends a message that the stress is done with.

A warm drink is particularly comforting. It's a way of giving yourself a hug, when actual hugs may be unavailable.

But here are some other ideas for warming away the anxiety. I've called them strategies because each is just one thing you might do to feel better. You can do one, or all of them.

Strategies

**Do the washing up** – warmth in your hands and wrists circulates quickly to the rest of you.

**Take a bath** or long shower. Get straight into warm clothes or your dressing gown afterwards.

**Jacuzzi** , if you're lucky enough to have access to one. Try the local leisure centre.

**Relax in the steam room** \- again, check out your local gym or leisure centre.

**Cuddle up** under the duvet or grab a blanket on the sofa.

Wear your big jumper.

**Find your slippers** and thick socks.

**Grab a scarf** and hat when you go out \- or if you're cold indoors. (Draw the curtains if you worry someone will see you.)

**Drink hot chocolate** (but beware of the sugar and fat in this treat.)

**Eat hot food -** any hot meal is good, but soup is particularly easy to prepare and eat. If you're microwaving a meal, you're succeeding at life.

**Enjoy some spicy food**. Ginger is the best for warmth without fiery blow-your-head-off heat.

**Bake a cake.** Really. Not only will you have cake, but the oven will be on. Toasty. (Put ginger in the cake!)

At work, be the one who always makes the brews.

**Sit in the warmest part of the house.** There's a reason why cats curl up right next to the radiator.

**Sit in the car with the warm air on full.** (This is my favourite, although it's not at all eco-friendly. I console myself that I went 30 years without a tumble dryer, which should make up for it.)

**Wear your dressing gown** over your clothes.

**Pasta**. Of course, this is included in hot food, above, but I find pasta especially comforting. Five minutes for the quick-cook stuff, a drizzle of olive oil and pesto and I'm sorted.

Give someone a big warm hug.

**Get the dog** , or cat, to sit on your knee. Bliss.

2: SAFETY

Anxiety dissolves when you feel you are in a place of safety. Make yourself a safe space - or a safe state of mind - and you can always retreat to it when things get tough.

A safe place is somewhere you can relax and let go of tension. This may be a real sanctuary which you can access, or it may be a safe place in your mind, a memory or fantasy of a place where you are free, and supported.

One of my safe spaces is my car. It's my little domain, where I can close the doors and mind my own business and answer to nobody. I can physically move myself to a new location if I want to, helping me feel that I am able to escape any negative things in my life.

But even when it's stationary the car feels secure. It feels great with the doors locked, sitting in the comfortable seats with the radio, the heating and the strange privacy which comes from nobody caring if you've parked beside a viewing-point or are reading the paper in a megastore's car park. Nobody minds. The car is yours.

I used to fantasise about living in my car - or maybe, being practical, a camper van. Would I roam the country, or drift between several favourite local spots? If course that is fantasy. For many, this would be the very definition of insecurity. But that is what makes a safe place special. It only has to make sense to you.

A physical safe place might be your bedroom, or some other place in your house. Perhaps it is a favourite shop or cafe. I can absolutely imagine a beautiful toy shop or tranquil cafe being a literal safe space to escape anxiety.

But a safe place does not need to be somewhere you can visit at will. It might be a memory you can recall, or a vision you can conjure in your mind, to distract and calm yourself. For example -

Somewhere you've been on holiday, where you felt free of cares. Therapists tend to suggest a tropical beach. I dislike tropical beaches - large insects, crushing heat, plus a long-haul flight to get there - no thanks. However, it might work for you! If not, what about beautiful green countryside, or forest, or a perfect postcard village?

A place still on your holiday wish list. Picture yourself among the Pyramids or at Macchu Pichu - or wherever you dream of visiting. See and hear and smell the details of your fantasy location. Make it as real as you can.

Perhaps it is an imaginary place like a spaceship or floating island. You can change an imaginary safe place whenever you like. Create every detail in your mind and make it feel real.

Wherever it is, you should be able to visit in your mind whoever you wish. When the anxiety begins to surface, visualise your place, and fill in every small detail. If your place is a beautiful terrace in Santorini, picture every aspect of it. What colour is the sea, the sky? Maybe it's morning – what will you have for breakfast, and where? What time of year is it there? What clothes are you wearing, what did you pack? Picture the houses, the food, the sea.

Anywhere can provide a rich and detailed scene, which you can immerse yourself in. And if you're in a safe place feeling safe, the anxiety cannot get you.

Strategies

**Close your eyes** – and imagine what it would be like to feel totally, completely safe. Where would that be?

**Make a list** of all the safest places you can imagine.

**Plan a visit** to a place where you feel secure and calm.

**Create an imaginary (or remembered) safe place in your mind.** Visit it often.

3: SOFTNESS

Touching softness is like giving your fingers a treat. The sensory input shoots to the brain and distracts it from anxiety. Give yourself more texture to process, and make that texture pleasant. You can jolt yourself out of anxiety with flicks and snaps of elastic bands - the so-call _Stop_ methods to jar your brain out of its negative thought patterns. Or you can grab a teddy and let a lovelier texture do the job.

Strategies

**Fleece, velour, fur, silk...buttery leather or soft worn** **denim**... These textures have the power to console. Children often carry around a special toy to comfort themselves when their parent is absent. Why shouldn't you have a comforter? Wrap up in a onesie or wear pure silk next to your skin. It's pure sensory pleasure, and grounds you in the here and now, experiencing the rich textures.

**Get a cuddly toy.** Some people have actual soft toys as their comfort objects, and why not? Carrying softness around with you is a form of self-care, a reminder of what's good, a reminder that you are cared for and worth caring about.

**A favourite soft hat,** a scarf, a keyring with a texture your fingers love - whatever it is, seek out soft textures which please you.

4: DISTRACTION: PHONE

When anxiety strikes, I reach for my phone, or a truly gripping book. When my brain is engaged with an activity or an absorbing story, it cannot maintain anxiety. Offer distraction early enough and anxiety can sometimes be dodged altogether.

For ideas other than phone or book, see the chapter on Distraction - Other Activities.

Phone

The first thing to say about using your phone as a distraction is that overuse can be counterproductive. Eye-ache, neck strain, insomnia – the phone is blamed for all of these. Take care not to overdo it.

That said, it is massively convenient to have the internet, TV and gaming in your hand at a moment's notice, wherever you are.

For this reason, the phone can act as an easy way to distract yourself when you feel anxiety spiking.

Just use your phone with care, and not as your only comfort and distraction strategy.

**Social media can be good (but there are problems).** Tumblr and Pinterest are nicely anxiety-numbing, as I must make small snap judgements, one after another, about whether I like a thing, want to share it, or want to move on to the next thing. You can save your favourites and set up lists of pleasant things to return to. Follow people who produce new content that you like. The beauty of the internet is that there is always more.

Pinterest is the easier tool to manage what you are presented with, and to manage your own boards, or lists of saved things.

Facebook (and similar apps like Twitter) I find doesn't work for this purpose. Seeing updates from people I know has the potential to make me more anxious, not less. Even happy updates - or, worse, smug updates - can set off uncomfortable feelings. And if you have the sort of friends who post angry status updates - or who share distressing news photos - then stay well away during an anxious phase. _(See the chapter on Self-Protection.)_

**News and news feeds.** Reading news websites can be absorbing, but there is always the risk of seeing something which upsets you. If news is your hobby, make it nice news. You can set up Google Newsstand* to show you news on subjects of your choice: fashion, gardening, book reviews, sports, the royal family.... Choose topics unlikely to include things which set you off. _(*Google Newsstand is a mobile app. There are others, but Google makes it easier to avoid specific topics.)_

**My top tip: avoid local news at all costs.** It is almost all crime happening distressingly close to your house, or human-interest stories which centre on sick children and stolen dogs. Donate to your local children's hospice or pets rescue centre, and then forgive yourself for never reading another heart-breaking story. You already know these terrible events are happening. Being upset by them doesn't prevent that. Give yourself a break. Do something positive to help those in need and set up your news feed to ignore local things. _(See also the chapter on Offering.)_

**Games are great distractions** , and a phone game can be in your hand in two seconds flat. Again, choose carefully. I used to know someone who claimed that shoot-em-up video games, maximum violence and running around in peril, was relaxing. For me, anything that raises the heart rate while sitting down is not the point for anxiety-distraction.

Choose a game with mental challenges. The aim is to occupy that part of your mind which would otherwise be generating anxiety. Therefore, puzzle-based games are good. Brain training or maths and language games are great for this. I like Loop, an endless series of puzzle-pieces to resolve. There's no prize, no punishment, just level after level of challenges set to soothing music (or none, if you prefer). Or what about Snake, or Tetris? Those old-school games are simple but thoughtful.

If that's not your thing, there's always Candy Crush.

**Shopping** is a difficult one. While searching Amazon, eBay or Wish is undoubtedly distracting, it feeds into the desire for material things which often accompanies anxiety. Sometimes it seems as though a particular item will really help, but this is only a temporary consolation. Most of us do not have endless money, and so the temptation to click _Checkout_ must be avoided.

If you can happily build up a basketful of lovely things and then leave without buying, then shopping on your phone is great. Rack up a massive wishlist for when you win the lottery - it's harmless fun. But if you are the kind of person who tends to think _What the hell! I will actually buy this! -_ then stop. Shopping is not the distraction for you.

**Images**. Humans are visual creatures, and it's well known that viewing certain images produces specific reactions in the brain. This means that image-searching has great potential for distraction. (Yes, even _that_ kind of distraction. Naughty but nice!) Use the same caution that you do for news feeds. _(See also the chapter on News Blackout.)_

**Pretend-book a holiday**. I read recently that going through the motions of planning a fabulous holiday has a high proportion of the same happy effects as actually going on the holiday. Looking at blue skies and sunlit pools and golden beaches and white-painted villas .... research says this is, in happiness terms, almost as good as being there, and without the jetlag. Take yourself on a beautiful, tranquil image-holiday.

**Messaging**. Human contact is the best for anxiety. Messenger, Snapchat, WhatsApp and all the rest are right there in your hand. If you have a supporter who will always answer your message with something helpful and comforting, or who will carry on a distracting conversation to take your mind of things in a crisis, then these are useful tools.

If your contacts are a bit less reliable, then think before messaging. Some people I know are guaranteed to make my anxiety worse with a single reply. Anyone whose first reaction might be _It's probably cancer_ , is not the person you need to be messaging.

Avoid getting sucked into group discussions. You don't want your phone pinging day and night as people add hilarious emojis to the discussion about where to hold the next school reunion. Unfollow the discussion, or Mute it, depending on the app you're using. You don't need to start blocking people (since that can create even more stress) but set up your phone to give yourself a break.

Use messaging for distraction and comfort, but watch out - it may become an unwanted obligation and a cause of more stress.

Strategies

**Social media** can keep you in touch with distant friends and family – but must be used with care. Avoid contentious topics and argumentative comment threads. These are the ones where the general public get involved and begin commenting on a news or social story. Just no.

**Save your eyes** – don't scroll all night.

**Messaging** a friend is good when you are confident you'll get support. Avoid the ping-ping-ping of group discussions.

**Looking at pleasant images** is a great short-term distraction.

**Shopping** is best if you put things in the basket and don't actually buy!

**Fake-book a holiday** with all the trimmings.

**Play an absorbing game** which engages your brain. Word games, picture games, number games. But again look after your eyes!

**Avoid news on your phone** , especially local news, and switch off push notifications.

5: DISTRACTION: BOOK

A novel is distracting, and I think activates the part of your brain engaged in fantasy, the same part which anxiety uses to imagine dreadful scenarios. By presenting the imagination with specific scenarios to imagine, anxiety can't get a look in. The line is engaged.

As with all other comfort choices, consider the book's content before starting it. Things which used to wash over you without a flicker might now be too distressing to read. For example, I used to love the John Simpson accounts of his time as a BBC war correspondent. Now - as excellent as I know they are - I need to feel strong before I tackle his detailed stories of suffering in a war-torn African country.

Personally, I love light, humorous fiction with a definite happy or hopeful ending. I'm not a big reader of romance, but this, too, offers distracting, positive fantasy. Thrillers which focus on the plot rather than the gory details; cosy mysteries of the _Agatha Raisin_ style; gentle comedy - all distracting but not distressing.

Maybe for you it's different, and immersion in _Game of Thrones_ or other grimdark fantasy is what takes your mind off unpleasant reality. In which case, go for it. It's not about the book, it's about escapism. I just prefer to escape somewhere without too many monsters.

Strategies

**Choose your content carefully** – light, escapist fiction or gripping mystery plots work for me. I dislike grisly thrillers or medical stories, but everyone is different. Curate the books you read so that when you relax with a book you are truly taken away from your anxiety. My favourites are PG Wodehouse, MC Beaton, Alexander McCall-Smith, Jane Austen, Jonathan Stroud, Daisy Goodwin.

**Read on your phone –** that way your book is always with you. Most devices can hold Kindle, or an equivalent book reading app.

**Don't read on your phone.** Save your eyes and use a paper book. Use a bookmark so you don't need to remember where you were and can dive straight in.

**Short fiction is great for dipping into**. Try a short story collection – flash fiction – or those quick-read thin books you see in supermarkets.

**Nonfiction is brilliant too**. There's no plot as such and you can pick up wherever you like. Travel, history (nothing too distressing) and food books are all great reads. As someone who enjoys an encyclopedia, I like to open a reference book at random and learn a new factual snippet.

**Poetry is absorbing and beautiful**. Poetry can be accessible and easy to read (or as hard as you like). Wang Wei, the 7th century Chinese poet, wrote wonderfully simple verse which still speaks to today's ideas and feelings. Haiku, old or new, is quick and easy to read. Like non-fiction, you can dip in and out of a poetry book at will. There are a lot of anthologies to choose from, and many are themed. Some even offer specific poems for worry or sadness. Give it a go.

**Read magazines** – and choose those with plenty of content. While sometimes it's all I can manage to flip through _25 Beautiful Homes_ , the best magazines for escaping anxiety are those which engage the brain and occupy it so that anxiety cannot. Special interest mags are great for this. Whether it's science or fishing or hobbies or sport, there are thousands of journals – print and online – and your interest is bound to have a niche publication.

6: DISTRACTION: OTHER IDEAS

If the phone or a book don't offer the distraction you need, here are some other ways to take your mind off your anxious feelings. And many of them revolve around one thing: to create.

Strategies

**Pay attention** **.** This is a kind of mindfulness technique, but it works, especially in a crisis. Stay still and listen for the farthest-away noise you can hear. Look around the space where you are and notice every detail: count the petals on a flower, the number of books on a shelf, the carpet tiles on the office floor. What can you smell or taste right now? What's the texture of something nearby a coffee mug, a mobile phone? Pay close attention to what is around you – pretend you're going to be quizzed on it later. Giving your attention to these tiny details forces your mind away from anxiety and onto something neutral.

**Write** **.** My favourite distraction is writing. I love writing fiction, but also lists, blog articles, letters and journals. Handwriting works best for absorption and escape from the here and now. But I also tap out creative writing on my phone.

**Cook.** Make dinner, make cakes, make meals to freeze ahead. Make food for other people and give it away. You might become the person who always brings home made biscuits to the office - or the person who brings a delicious meal to a lonely neighbour.

**Sculpt.** Grab the Play-Doh or actual clay and make something physical. Work with wood or metal to make something beautiful or useful or both. Working with your hands, like handwriting,  engages more of the brain than mere passive distraction like looking at the Internet or television.

**Grow. W** hether it's herbs on your windowsill, flowers and veggies in a pot or big, leafy houseplants, gardening is supremely relaxing. It's full of variety too - digging, planting, pruning, mowing, watering, feeding. And, of course, later you get to pick and enjoy what you've grown.

**Craft**. Sewing or model-making or scrapbooking -crafts offer a wonderful way to keep your mind and your hands occupied in difficult times.

**Learn.** Another way to engage your brain is to feed it new information. Learn a language from a book, audio or online. There are phone apps that teach you any language you like. Study a period in history, or work towards a qualification. There's a theory  that you need to read ten books on a subject to be an expert. That's not so many.

Online study makes learning an easy option for those who find social situations difficult. Many foundation level courses are free.

And when you can't be actively doing any of these things, turn back to the chapter on _Distraction - phone and book_ and read up on the latest innovations in your favourite activities.

**Move**. Exercise is great for many reasons, as everyone knows. Health and fitness are the obvious benefits, and it's well known that exercise improves mood. But it also offers a welcome distraction. Doing repetitions of weights, following the moves on a video dance class, or counting intervals in a run/walk training session - these all need focus, and focus ends anxiety.

If the thought of exercising in a gym or outside is too horrifying, start small with a DVD or online class. Get a fitness tracker which counts your activity levels. Some phones have this built in, and there are apps which do the same - it doesn't need to be an expensive gadget.

If you've been anxious for a long time, it's quite likely that you have not been looking after yourself. Start today with a few extra trips up and down the stairs. Get moving. The urge to huddle and be still like a hibernating hedgehog is strong, but your body needs activity.

Move a little bit more and concentrate while you do it. (See the next chapter on _Motion_ for more on ways to start moving more.)

7: MOTION

'Go for a walk' is every doctor's default response to all mental and physical health issues. It might feel as if you are being fobbed off, but a huge body of scientific research supports the idea that  exercise is as good for your mental health as your physical health. The two are so intertwined, that improving one will naturally benefit the other.

Walking is the most accessible form of exercise, needing no training, equipment or special location. Just put one foot in front of the other, and you're doing it.

However, it's easy to feel self-conscious about health walking.

The first time I left my house at lunchtime, trainers on (though let's be clear, I was never going to run anywhere) I felt as if the whole street was watching me. _Where is that woman going? I've just seen her walk up here and now she's come back. She didn't even go to the shop!_

That first walk, I aimed for ten minutes of exercise. I was tremendously unfit after various health issues. I managed seven minutes before my anxiety kicked in and I stumbled home, convinced I could not breathe and was about to have a heart attack. I was breathless and my heart was pounding. That's how unfit I had become.

I wanted to lie on the sofa and never move again. But I knew I needed to exercise, and that the less I did, the more genuine health worries I would accumulate.

So I got out my strategies and used logic on my reluctant brain to persuade myself that although I felt terribly, horrifyingly bad as I walked along the slight incline from my house to the telegraph pole beyond the bus stop, I had not in fact had a heart attack or died. I had, perhaps, set off too quickly, my legs remembering how I used to stride everywhere but my body now twice that size and unused to lugging itself around on foot.

Next day I went out again, aiming for just seven minutes since that was all I had managed, and forcing myself to go really slowly. My idea was to move, but not in such a way that my heart started pounding.

This is not conventional exercise technique. Half the internet shouts at you that if you're not hammering it, it's barely worth exercising at all. There are alarming websites which focus on making even basic movements – sit-ups, stretches - into muscle torture.

To all of this I say, forget it. For someone who has not exercised in a very long time, and who has a fear of the consequences, pushing boundaries is a stupid idea.

On my first walk, I plodded very gently indeed along the road, reached the telegraph pole, and - waiting until a car had driven past me so nobody actually saw me do it - turned round and came home along the same stretch of road.

I felt all right. I had survived.

The mental high this gave me cannot be overstated. I felt like Usain Bolt. I arrived home, had a decaff coffee and put my feet up as if I'd burned a thousand calories.

Over the next few months I set a target of walking out at lunchtime three times a week. Working away from home makes that more difficult, so I did a lot of my days at weekends. But between about April and September that year, I moved from terror at taking a step, to jogging, actually jogging, for 20 minutes straight under the Couch 2 5K regime.

I'm no athlete, and I never will be. But I did it, and I survived.

Nowadays if I haven't been out for my walk, I get restless and antsy. I'm writing this now and it's pouring, but I still want to get out there in the lane and walk to my standard destination (now a lot further than the telegraph pole) and back.

Why it's great:

\- Fresh air.

\- Feeling like a champion when you arrive back.

\- Seeing the world at walking pace - you get to really notice small details, like being a child again. A therapist would call that mindfulness.

\- Being fitter.

\- Sleeping better.

\- Knowing you have conquered this task.

Strategies

**Make a simple plan.** For many people, getting into fitness involves hitting the gym, joining a five-a-side team or otherwise taking up a sport they enjoy. For me, all forms of sport and exercise are tedious and unpleasant. Blame my school for that. So, if you know you need to move, but really, really, don't want to, try this:

Go out in your completely ordinary clothes and walk to a set point and back, or for ten minutes, whichever is shorter.

If ten minutes is too much, go for five. The time is not the point. Doing it is the point.

Plan which other two days this week you're going to do it again.

Do it again - just those ten, or five, minutes. Don't be tempted to set ambitious new goals. Just build up a habit of going out three times a week.

Do it for one month. By the fourth week of a ten-minute walk, it will not be enough for you. You'll want to spend a little longer, walk a little further. In which case, do. But no marathons. This is not the Olympics, and nobody is going to give you a score.

In month two, decide if you are going to stick to your current target or increase it a little. Either is fine. Ignore those websites which talk about how many minutes per week is 'enough' for optimum health. They have no idea how hard it can be to leave the house.

In month three, buy yourself some proper trainers - or some other useful piece of fitness gear. For me, this was a waterproof jacket. (I live in the north. It's always raining.) Because now you are one of those people. Those people who Do Exercise. Congratulations!

Keep going. A few minutes, outside the house, three times a week.

It doesn't sound like much but even five minutes - even one minute on days when you cannot bear to do it - has a massive psychological benefit. Do it. When you think you can't, aim for one single minute of walking away from your house and then coming straight back. (You can always do an elaborate mime of having forgotten your phone, if you're worried that people are looking). I promise you that when you really don't want to and think you can't, then if you manage it for even one minute you are a VICTOR.

**Track your progress.** Most hones have an app which counts your steps and/or the number of minutes spent exercising. These are useful, but don't get bogged down with competing against yourself, or the phone. Try setting a (very low) target – 4000 steps? 10 active minutes? – and then sticking to it. Consistency is better than competition.

**Do it indoors if you have to!** For some people, leaving the house presents many difficulties. It might be a phobic issue, or it might, depending where you live, be a safety issue. If you work all day, then in winter it might not be right to go walking in the dark. In which case:

Do the exact same thing I mention above, but in the house. This is sometimes the only way I can reach my daily step target. If I left the curtains open, on many nights you would see me at ten pm, walking round and round my dining table while reading a book, because I still have a thousand steps to go and I can't go out and leave my family unattended. I have developed the ability to dodge the corner of the sideboard on my way past, without looking up from the page.

I read today that climbing the stairs eight times a day is supposed to bring big health benefits. I know I'll be adopting that later.

Don't think, because going outside is hard for you, that you can't add walking to your day. Close the curtains, get a book or put on the radio, and go. Good luck.

8: DRINK AWAY YOUR ANXIETY

-With water, of course. Keeping hydrated is good in lots of ways, but specifically for flushing away toxins. If you sweat with anxiety or panic attacks, you're already flushing toxins out, but you need to replenish that lost fluid. Ditto for crying, and ditto again if anxiety sends you to the bathroom every five minutes.

Problem:

\- Dry mouth

\- Feeling of not being at to swallow

\- Shadows under the eyes

\- Poor skin generally

\- Permanent munchies

\- Headache

Strategies

**Drink more.** How much to drink? Two litres a day, says the NHS. That's the size of one of those giant bottles, usually of pop, that you see in the bulk aisle of Tesco.

**It needn't be plain water.** Personally, the idea of slugging down a massive bottle of unadorned H2O every day fills me with anticipatory boredom. But lots of fluids count as part of your two litres. Tea, for example.

**Anything non-caffeinated and non-alcoholic will do.** Decaff instant coffee is my personal go-to drink, but for others it's herbal or fruit tea, juice or milk.

I also love fizzy drinks, but apart from the fact that a lot of these have caffeine as a flavouring, they are usually loaded with sugar and the bubbles make them somewhat indigestible, so they're not ideal. But better than nothing, better than continual mild dehydration. Drink with caution.

**Fruit it up.** Plenty of places suggest you get one of those bottles that let you plunge bits of fruit in, to flavour your water. I'm not a fan, but if you like fruit (I don't) then this would be good.

**Make it hot.** Warmth is comforting. A squeeze of lemon in a mug of hot water would work. Hot squash, why not? Hot blackcurrant – very traditional!

**Water is simplest and most effective.** Sipping on cool water helps calm panic attacks - it's proof that you're still here and breathing swallowing, still doing OK.

Headaches can be caused by dehydration, so get water down your neck and ease that pain. For more on mild aches, see the chapter called _Take the pill._

9: TAKE THE PILL

Take a painkiller. Important note: I am talking about occasionally taking over-the-counter medicines, as described on the packet or as advised by your pharmacist, for relief of occasional aches and pains. This section is about overcoming worry about treatment. Do see a doctor about symptoms.

For most people, getting a pain, like a headache, and then taking a painkiller is a no-brainer, a logical chain of events, moving by from discomfort to ease. But in the midst of anxiety, it's easy to forget this simple option, and the benefits it may bring.

I generally believe that pain exists to send us a message, in other words, that something is wrong. Masking pain with drugs may allow us to ignore the problem, for example, enabling us to carry on lifting weights when our damaged muscles have been sending out signals telling us to stop.

But for a person with anxiety, the relationship with pain and discomfort is a lot more complicated.

For someone hyper-vigilant about symptoms, a slight pain or discomfort can become disabling, preventing normal activities. A non-anxious person might be able to ignore mild discomfort, carrying on unless symptoms indicate that it's time to see a doctor.

For an anxious person, this is very difficult. Slight symptoms are indistinguishable from severe ones. Setting them aside until a doctor can be seen, is impossible. Worry is constant and escalating. Checking on symptoms is repeated and frequent. And not surprisingly, poking a place that hurts is quite likely to make it feel worse.

In this situation, then, taking a painkiller could have three benefits.

Firstly, it gives mental relief. Yes, mental relief. Diminishing the physical discomfort makes the symptom easier to ignore, until medical help can be found.

Secondly, the actual effects of an anti-inflammatory painkiller may remove the problem altogether. If somewhere has become sore from being over-checked, then a pill could reduce any swelling and remove he symptom.

An example of this is breast-checking. Breast tissue is delicate stuff and prodding it whilst looking for a lump can lead to swelling, which then seems as if it might be a lump, which then leads to more prodding, and ... Breast pain is very common, and poking it makes it worse. An appropriate painkiller (check with your doctor) can relieve the pain and the pain-reminder to check again and again.

Thirdly, taking a painkiller for your pain puts you in control. You have acted. You are not at the mercy of your anxious brain. Take the pill, enjoy the relief it brings, and seek help, if still required, when you can.

A lot of anxious people I've encountered have a fear of medicines, specifically, of their side effects. I share this too, the terror that the information leaflet can induce. I read the Don't take if... section, of course - it's my responsibility to check that what I'm doing doesn't clash with any allergies or other conditions - but I tend to avoid the Side Effects part.

If this seems cavalier, it's not. I know full well that my hyper-vigilance will kick in as soon as the medicine is in me. If I feel in any way strange, I will notice. I don't need a list of specifics for my brain to zoom in on. However weird or rare they may be, my mind can create them if it thinks it needs to worry about them. I read the warnings, take the medicine as described by the medical professional, and carry on, confident that my anxiety will certainly pick up on any side-effects I may have, without me needing to read about them first.

Taking a painkiller is also a good exercise in trust. You are trusting yourself to help the situation. You are trusting the maker of the drug to provide something which will give relief rather than increase danger. You are trusting that there is time to deal with the issue later, after the medicine has taken effect and you can address the symptoms, hopefully with a clearer head.

Note: some painkillers are addictive. Take care.

Strategies

**Follow professional advice.** If the doctor or pharmacists advises a particular thing to treat a minor ailment, then do what they say. They are the experts.

**Have faith.** Trust that the experts want you to be well. Trust that medicines have been tested again and again before being licensed for use. Rust that you have taken this medicine before (perhaps in the days before your anxiety) and it has been fine, ad so it will be fine again. Trust that your own knowledge of what feels OK will tell you if anything is wrong. _See the chapter called Dealing with Doctors for more on this._

10: TRIGGERS – AVOID AND HANDLE

When I'm in an anxious phase - usually coinciding with a high-stress-at-work phase - I want to avoid triggers.

I know the kind of thing that sets me off. I won't give all the details, but one example would be anything medical. It could come in any form - TV, novel, or worst of all, real life.

Avoiding fictional triggers is relatively easy. I was never going to be a fan of _Holby City_. I can choose not to watch those shows.

Real-life triggers are harder to manage, especially when they involve people who expect you (not unreasonably) to take a caring interest in their story.

What to do? Unfriend them because their experience distresses you? Walk away when they start an uncomfortable conversation?

It's not their fault you can't handle it, after all.

On the other hand, is not your fault either. How nice it would be to sympathise without that terrifying total empathy that puts you in everyone's unpleasant shoes. How nice it would be to express your unhappiness at what they're going through \- without playing out a giant imaginary scenario in which you are vividly substituted for them.

I used to wish to glide along, untouched by life, as other people did. Then I realised that people _do_ care, but don't carry it around with them after the event. They can attach an _appropriate_ amount of empathy - for the severity of the situation and their relationship with the people involved - without being avalanched by emotions.

What a skill!

Over-empathising can cause horrible anxiety as well as social paralysis. Putting yourself in someone's place is not only distressing at the time you do it - it's awful again and again as your mind can't let go of the idea and keeps repeating the experience.

_Experience_ is the correct term, too - you don't _think_ about the events, you _live_ them again and again, these terrible things, which have not happened to you.

An appropriate response to, say, a distressing news story is to feel the upset, horror and so on when watching the news, or right afterwards. After that, you stop being very upset, although you remember that it is upsetting.

An inappropriate response might be to spend further time imagining the events from the point of view of those most deeply affected, and to recall upsetting images again and again.

The brain can't differentiate between fantasy and reality. If you reproduce emotions of having lost everything in, say, a volcanic eruption, then the brain understands those emotions as a real experience.

I find this one of the hardest aspects of anxiety to manage. Vividly imagining things is how I get my kicks. I read, I dream, I write fiction, I immerse myself in fantasies. Switching off this talent to avoid anxiety seems wrong.

But is avoidance the right strategy?

Avoidance

Speaking personally, avoidance works for me when I don't have support to confront triggers. If I'm going to handle big stuff, I want to be doing it with support or I won't be able to cope.

Small stuff - well, if it feels small, then hurrah, that means I am coping. If my rational brain is telling me that the issue is small, then I have won - I am responding proportionally to the news story, medical anecdote, and so on.

When avoidance isn't possible

Sometimes you cannot escape a trigger.

Why do they have horrible medical videos in the doctor's waiting room? You need videos about health in there, not sickness. Come on.

And why do hotel breakfast rooms always have the TV tuned to a news channel? Death with your cornflakes, what's that about? It should be a luxury travel channel. Or maybe, here's an idea, _no_ inescapable TV while I'm trying to enjoy my cornflakes before a hectic day.

If it's not possible to avoid a trigger, get out your best coping strategies. Some here are purely practical; some are mental.

Strategies

**Block out the trigger.** Headphones and phone/book are a quick fix for a lot of it _. See also the chapter on Distractions_.

Use your rationalisation reminders:

What I see on TV/internet is not happening to me and I am safe.

There is time to deal with any issue, even though it feels urgent and dangerous.

There are lots of explanations for this issue and I don't have all the facts yet.

**Look at photos** or tokens of anything good which has happened in your own life, removing thoughts of things which have only happened in speculation/on TV.

If something has already set you off, head to the **Crisis Package.**

11: OFFERING, GIVING

Helping others has been shown to offer health benefits to the giver, as well as benefitting the receiver. A win-win! Look for places where you can offer a bit of advice from your own experience - for example in the online community for your hobby or fandom. Whatever the topic, if you can help, do it. This book is part of my offering.

**Give to charity**. I like automated, direct-debit charity giving. One charity offers micro-loans – a few pounds from me, to empower people in faraway countries to build their small business, grow new crops on their farm, or buy a new plot of land. They repay you, tiny bits at a time. and you get updates. It makes me feel connected to the wider world, and reminds me that people everywhere, every day, are busy working and living and meeting their challenges.

**Pack a Christmas box**. I'm new to this but it's an activity run by several charitable organisations. Pack a shoebox with toys and basic healthcare items like combs, small soaps etc, and supply the postage cost so that the charity can deliver it to a child on Christmas day. This is usually for children in countries overseas, although some charities support children in social care in the UK. There are videos you can watch of the children receiving the surprise Christmas box (beautiful!) and you can track where your box was sent.

**Donate with every food shop**. Our local ASDA and Tesco each have a 'food bank trolley' where, having paid for your shop, you can put a few items to be taken to the local food bank. The trolleys often have a list of suggestions, but these include everything you'd imagine would help a person or family in such crisis that they cannot put a meal on the table: pasta, sauce, tinned nest and fish, cereal, porridge oats – and other essentials like toilet roll or washing powder. For a couple of quid, you get a warm inner glow and someone else gets to eat tonight. There's no downside.

At Christmas, supermarkets often do a toy collection that works in the same way but goes to local children's charities for kids in care or in hostels escaping domestic abuse.

I love giving to the food bank trolley because it reminds me to be grateful that I can choose which type of spaghetti to buy - unlike less fortunate people who have to visit the food bank for their loaf of bread or tin of beans. I like including treats as well – choc bars and biscuits because why not. If it was me, I'd like to know someone thought of me in the evening, probably a long and worried evening, and popped a Galaxy bar into my parcel.

**Give items directly to the local women's shelter** or homeless shelter. Fresh packs of knickers and toothpaste, hairbrush - things you night forget to grab when you're fleeing a dangerous domestic situation. This is an issue close to my heart and I try to donate thoughtfully.

It's strange but giving makes me feel richer rather than poorer, grateful for all I do have, even when I am feeling very low or afraid. And it gives a satisfying conviction of having done good.

**Buy charity Christmas cards**. Even this little gesture helps you feel connected. And you can support a cause you care about.

**Collect your slummy** so you always have coppers to throw in the collection boxes. It weighs down your purse and you won't miss the thirteen pence - but coppers given here and there are what keeps charities going.

Putting the 1p change in the charity box every time lets you feel good with every transaction.

**Help someone you know.** Of course, this depends on your circumstances, but a small regular thing can make a huge difference to someone's life. A neighbour of mine pops up every bin day, walks to the kerb and drags in not just his own bins, but those of his elderly neighbours. How nice is that? They don't need to ask.

Something simple - a lift, occasional babysitting, a cake for a bake sale, or an office birthday - or just asking your neighbour if they need anything when you head out, since you're going to Tesco or IKEA or the recycling place anyway. My dad is constantly giving people lifts to the airport. He's like the unofficial Uber of the south east. Part of me wishes he would accept money for it, but also I know he enjoys doing it for people and I'm proud of him.

Strategies

Here is a list of small favours you can do for someone. A friend, a spouse, a neighbour, a colleague – even a stranger.

\- Do the washing up when you don't have to

\- Run an errand for someone if you're going anyway

\- Collect a doctor's prescription

\- Return a library book

\- Clean a car

\- Polish shoes for the whole family

Small gesture makes everyone feel good.

Actual gifts are great too, the more personal the better. And they needn't cost big money. Make a playlist for someone and send them the link. Write a letter or postcard. Grab an extra coffee for a colleague on the way into work. I have a colleague who does this randomly and it's so nice – sometimes it's the only thing that makes me walk through the door that day.

Small gifts make a huge impact.

12: SELF-PROTECTION

Guarding against anxiety might involve counselling – so-called talking therapies. It might need you to learn how to train your mind to handle anxiety. Meanwhile, there are plenty of practical things you can do to defend yourself.

Anti-anxiety food

Minimise anxiety or its symptoms with food and drink. This could be an entire book, if I were a nutrition expert. I'm not. But personal experience recommends the following.

Decaff coffee / tea

Bananas

Raw carrots

Avocados

Apple, pear, strawberry

Oranges, satsumas, mandarins in a tin

Broccoli, cauliflower, Brussels sprouts

Fine beans, soybeans, baked beans, peas, sweetcorn

Chickpeas or hummus

Potatoes – baked, boiled, mashed

Prawns, salmon, tinned fish of all kinds

Eggs

Ginger or mint tea

Porridge oats

Walnuts, almonds, cashews, brazils

Probiotic yogurt

Garlic, onions, leeks

Celery

Marmite

Yes, these are everyday healthy foods. But they contain vitamins, minerals and nutrients and I find including these foods in my diet makes me A, actually healthier and B, less likely to worry about my heath because I know I'm eating well.

Strategies

**Make a shopping list** and include food from the list that you enjoy.

Avoid turning the list into a diet or challenge. Forcing yourself to eat something you hate is not relaxing.

**Make a note of how you feel after eating a meal.** This might help you track what foods have the best (or worst) effect on your anxiety.

**Avoid caffeinated food and drink.** If you're used to a high caffeine day, do this slowly. Cut down on your cups of coffee, cola, chocolate bars, energy drinks. It's amazing how caffeine affects the whole body. And its tendency to set the heart racing does not help anxiety sufferers.

News blackout

This is surprisingly difficult to achieve but I find that avoiding news really helps me keep away negative thoughts and ideas.

I generally avoid reading or watching the details of distressing news stories anyway, but in good phases, I skim the headlines on the BBC website.

However, when things are less calm, I go for total avoidance. It feels awkward at first, because I like to know what's going in in the world, but a single upsetting piece of news or image can throw me into a spin that lasts a week. Not worth it.

So I go for news blackout (see below).

News stories are very important to me. But they affect me too deeply, in a way that makes me less able to campaign, raise money or do anything to stop the horror. I need to be functioning - watching and being news impedes that.

During news blackout I purposely seek out other types of updates. Blogs from my favourite authors or products, arts and book news, and other areas of interest to me - these fill the update gap left by not checking the news.

Hobbyist news is the best! There is no shortage of blogs to satisfy your desire for information. Seek them out.

The strange thing is that once you begin to carve negativity away from your life, you don't miss it. When I feel well, and consider reintroducing news, I question whether I really need it. I could hardly miss the big events of the world - general election, new president, change of monarchy - and when I want information on a specific subject like minimum wage or Brexit, I can certainly find it out.

Do I want to have my knowledge selected for me and pushed into the device in my hand?

When I think about the disproportionate negative impact a news headline can have, I tend to think I don't need news, certainly not push news.

I think of it like being on a country holiday back when I was a child: there was no TV or radio in the holiday home, no routine of Dad fetching a paper, usually far from anything like a town. It was a true break from normal life, even if I did miss an episode of Huckleberry Finn.

More on choice

I don't watch live television. This is not a conscious decision so much as the result of twenty years of working frequently away from home, with many evenings occupied with the practicality of travel, eating and sleeping. But these days, with an hour a day to sit and watch TV, I don't waste it passively in front of whatever is being broadcast. Does anyone?

I choose which programme to catch up on, or which boxset to continue. This is the new way to watch. We collect the shows we like, and watch them when convenient to us. We are in the Netflix age, and that's great, because not only is there always something, but we can choose it and avoid our triggers. When I hear that a show _contains upsetting scenes_ , it's off my list.

Strategies

No BBC News website.

No watching TV news.

Switch off the radio in the car when the news comes on.

No buying or even browsing newspapers.

Switch off news feeds from Facebook and other social media sites.

Switch off any phone notifications for news sites.

Unsubscribe from any news-related email lists.

Avoid conversations about the news. I work from home so am spared the water-cooler dissection of the day's lurid stories. You may need an exit strategy for times when colleagues start going into gruesome detail about recent nasty events.

Move away from TVs tuned to news channels when travelling. Too many hotel breakfasts have been wrecked by having to listen to disasters or terrorism over the cereal.

Seek out hobbyist news. Look for niche news on your favourite pastimes, actors or TV shows.

Avoid live TV and record the stuff you know won't upset you.

Practical self-protection to do list

\- News blackout

\- Unfollow and hide posts from loads of people

\- Unsubscribe from junk email

\- Hide fb posts from work and non-friends.

\- Stock up on healthy foods.

13: DEALING WITH DOCTORS

Isn't it strange how we can go along for months or years telling ourselves and everyone else we are fine, yet when a doctor says we are, we immediately suspect they have missed some vital clue?

Treading the line between convincing yourself that it is nothing, and keeping yourself safe from medical problems, is a daily nightmare for those who suffer from health anxiety. The headache you have is probably nothing, _but what if it isn't?_

When you are young, the reassurance from medical professionals is easier to accept. Statistically, the likelihood of serious illness is small. You're chock full of growth hormones and tend to shake off disease and injury with amazing speed.

As you grow older, you begin to fall into higher-risk groups, especially if your lifestyle includes stresses such as caring for children or elderly parents. Stress makes symptoms worse and is actively bad for you. It's a Catch-22 situation.

If you've never suffered from health anxiety it is very hard to understand. People I know have had symptoms which would terrify me, but they shrug them off, saying, I'm going up the hospital and get checked. That's it. They go, the doc gives them the once-over, maybe a prescription or some advice, job done.

I would have exhausted myself mentally imagining 100 deadly possibilities. That's health anxiety. It used to be called hypochondria, but this was a demeaning term, suggesting you were worrying over nothing and therefore needed to shut up. The term health anxiety reflects the truth, that this is an ongoing condition, affecting your whole life, and which needs management.

Strategies for health anxiety

**Know why** Firstly, find out what lies at the root of your health anxiety. Invest in therapy*, of if that is not an option, find free local support groups through your doctor, our online.

Knowing what started you on this path of small symptom equals imminent death, can really help. A therapist can supply coping mechanisms and advice for your specific circumstances. She will be qualified to offer various types of psychological treatments such as cognitive based therapy.

* _Invest. I say this because unless the doctor considers you a risk to yourself or other people, you will be at the end of a very long list of people waiting for therapy via the NHS. This isn't the doctor's fault, but it means you might wait for years as riskier cases get in the queue ahead of you. Therapy isn't cheap – fifty quid an hour or thereabouts – but it's totally worth it if you can afford it. This is your health. You wouldn't put off buying new specs if you needed them. Don't put this off. Think what an hour a month of professional help could do for you. And because you're paying you can start now. No waiting._

Obviously it would be much better if the NHS could afford to supply all the therapy we need. But it can't. So don't let ideas about how it's wrong to go private, stop you from getting help. Not everyone has that option but if you do, take it.

Get a good doctor

Sounds simple. But sometimes the doctor we see regularly might not be the one best able to help. If you come away every time feeling like the doctor doesn't understand and has not helped, maybe it's time to find a new one.

In the UK it is quite simple to change doctors. You don't to give a reason or explain yourself. If your doctor is part of a large practice, it may be possible to change doctors within the same practice - however I've found that you never know which doctor you'll be given anyway - it depends on who is working that day. If you really want to guarantee not working with a specific doctor again, changing practice is the way forward.

Find another practice and apply to transfer to them. There is an online form on the NHS website which makes it straightforward to find your next nearest practice. Go there, or ring them, and ask for a registration form. You will probably need to be checked by the nurse to be fully registered.

Personal experience: I changed doctors after a long period of feeling as if I was being brushed off. Because the doctor knew I had anxiety there was a tendency to write off any symptom as anxiety. Which, if you have health anxiety, makes it much worse.

I changed practice. Within a couple of months my new doctor (who was aware I suffered with health anxiety) had nonetheless checked out the symptom that was bothering me, made a diagnosis and offered treatment. Fixed. Done. After years of suffering with the symptom, plus worrying it was something serious, I took some commonly used medication and then I was well.

I feel angry that the other place had not even tried to examine me or investigate the symptoms. I feel angry that I could have been sorted out in, say 2012. _Or 1987._ But now it's sorted. I just had to change practice to make it happen.

Do what the doctor says

Don't cheat. If they say do it then do it. Meditation, ditto. Get the doc to talk through the side effects and how the treatment works, get them to print something for you to read.

It's hard for me to listen during a doctor's appointment because I'm automatically wound up by being there. I find that as soon as I step out the door, I can't remember a thing. To help this, I ask the doctor to write down anything complicated like how often, how much, or anything I need to be aware of.

Take someone with to help you listen.

They will be your calm ears for the conversation.

Or record the conversation on your phone and listen back later. (Some doctors don't like this. I have a friend who records surreptitiously from inside her handbag.)

Prepare for your appointment

Write down your symptoms and any questions you have, before you go. The doctor has seen it all before and won't mind.

Even if you just get out your list while you're with the doctor, it will act as a reminder to ask about all the things you're there for. List the symptoms. Note down dates.

I am a confident person. I talk to people for a living and I love a giant room filled with eager listeners, but put me in front of a medical person and I fall apart.

Either I start blurting out my medical life story at a hundred miles an hour, or I freeze up and can't remember a thing about why I'm there. I'm so wound up, so tired from sleepless nights and constant worry about my illness, that I literally cannot hold a conversation about it.

It has taken me a long time to realise that that's OK. My general confidence doesn't mean I have to be strong all the time.

So now I try less. I hand the doc a piece of paper with the issues written down. I don't care what she thinks. I expect she thinks I'm a person who prefers to write it down.

Explain your anxious feelings

The other thing to do which works well, is to tell the medical person straightaway that I suffer from health anxiety. I do it just like that, in those words. Then I ask so can they please avoid tutting or frowning or making discouraging noises while examining me – because I will immediately assume they have discovered something terrible.

Usually the doctor or technician gets it right away. I think a lot of medical people don't realise that tutting and sighing whilst carrying out an exam is really frightening for the person being examined. Most likely the tut is because the machine is on the blink again, but it sends a really worrying message to the patient.

Sometimes explaining it gets me a little bit of extra support. Mostly the NHS staff are super supportive, all the time. But sometimes I think they are busy, and they forget that some people really fear hospitals, doctors, medical equipment.

Explain you are afraid and with any luck they'll treat you extra gently.

Handle phone calls

When you get that horrid phone call from the doctor saying you need a test/to come in/your appointment's been moved to another (terrifying-sounding) clinic:

Don't just go OK and put the phone down and let your mind start racing away with possible reasons WHY. Ask them. Tell them this news has spiked your anxiety and you are now feeling very anxious about it.

The person on the other end of the line can then explain more, or find someone who can, and reassure you.

Usually the reason for these things is purely administrative and not a sign of some sinister new problem with your test/operation/symptoms. Give the person the chance to tell you why it's happening and what is going on, and you will feel better. Let them nip your anxiety in the bud. It's their job to look after you.

Trust the answer they give you. Take it at face value.

Yes, maybe they are 'only' the admin person, but they still know what they're doing and deal with patient queries all the time. If there was some medical thing you needed to know about, the doctor would have called, not the admin person. And the admin person has dealt with many, many patients, some of whom have the same anxieties as you.

Let them reassure you.

Tell them

If you're dealing with someone new, tell them upfront about your anxiety and how it affects your visits to doctors or hospitals.

Prepare

Write down symptoms before you go, including dates or times of when they occurred. Read them out, or hand the paper to the doctor when you go in.

If you don't understand something, ask for a printout or leaflet.

Make a note there and then of any extra instructions.

Try not to read anything extra into the doctor's words or reactions. They are professionals - they are not playing mind games with you.

After your appointment, fetch any medication and take it. Follow any advice exactly and don't cheat.

Trust your doctor. Remember that they want you to be well.

14: ANXIETY AT WORK

A lot of the advice I read for anxiety seems to be aimed at people who are deeply restricted because of it. Their life-limiting condition means they cannot work, or perhaps, cannot leave the house.

I couldn't find much aimed at people liked me, people who have deep, ingrained, long-lasting anxiety, but who still work, manage a family, have chores and responsibilities to maintain. Functioning anxiety sufferers, in other words.

At your desk

Do the worst things first. This is a hard habit to form as anyone might be inclined to put off the gnarliest bits of work until the last possible moment. But this means you dread them for longer – extending the misery. Do one of these unpleasant tasks first thing in the morning, then no matter what happens the rest of the day, you have conquered.

Break down big tasks into smaller pieces. Promise yourself to do one small part of it at a time. Update colleagues on your progress. In between, tackle easier stuff.

Take care of yourself

Take breaks. Escape to the loo. Let people think you have some intimate problem if that's easier for your workmates to handle than knowing about your mental health issues.

Let's face it, for years smokers were allowed to vanish for ten minutes several times a day for their 'fresh air break.' If that's what it takes to escape when you need to avoid a meltdown, then let people think you're a smoker nipping off for their nicotine.

Have water by your side. Dehydration helps nothing, so keep sipping. This can also be a signal to your anxious mind that you're still here, still OK, and everything is working fine.

Make lunch breaks proper breaks. If you like to socialise, do that. If you like to rush away and read your book in privacy while you eat, do that. It can be hard to turn down _come to lunch_ offers, but don't make yourself endure company more than you can handle. Friends will understand. If you feel you need to give an excuse, then white lies about _going to the bank_ or _calling someone at home_ can be employed.

Have comforting things around you

I use my phone as a comfort blanket. I take it into every meeting (switched to silent) and hold it tight when I feel panic coming on.

I also use other items to ground me and maintain a semblance of normal behaviour when my anxiety is very high at work.

A favourite necklace, or special stone on your desk, or picture of your kids (or your dog): have items around to remind you of nicer things.

In meetings, carry out surreptitious soothing exercises – massage your fingers, practise slow breathing, focus on writing down the actions. I take a lot of notes in meetings and it's not just because my memory is terrible. It's to give me something to do and ease the pressure of joining in.

Sometimes it is almost impossible just to eb in the room. The amazing thing is, though, that after I've walked away from a really difficult meeting, people have said they didn't notice anything wrong with me. _You looked fine,_ they say. _Your presentation went really well. I didn't notice you looking ill, you should have said._

If it gets too much, excuse yourself. You can always use the _phone call from school_ or _dodgy tummy_ excuse. Don't feel guilty about this. If you're with a client, it's not usually OK to blurt out about feeling unwell. Just mumble something polite-sounding and run.

**Here's the thing. Being in work, staying in work, is a big effort when you have life limiting anxiety.** You're awake, dressed and upright, and that's more that you probably felt like doing when you opened your eyes this morning. The little bit of work you've done, is more than you'd have achieved if you were signed off sick. So give yourself a break. If you miss a meeting, if you work more slowly than you wish you could, the world will not end.

Tell your employer

If your employer has a HR team or person, you should be able to go to them in confidence and ask for support with any issues. I've found my employers highly understanding. I was amazed to hear them tell me that I was far from the only person to have flagged up a similar issue.

Their practice at handling employee stress, anxiety means they have become very good at it and always offer measures for alleviating the situation.

But reality doesn't always match aspirations. Some workplaces simply don't have the capacity to swap roles and tasks around to help a person who needs extra support. If this is the case for you, then I sympathise. If you can't change this situation, or can't change it right now, seek out self-care in the crest of your life.

Don't tell your employer

It is better if you can be open and honest with your employer about your anxiety. But a lot of workplaces have not got to grips with supporting staff with mental health issues. Some places have a culture where anything of that nature is viewed as a negative on your record.

This seems to be especially true in the places where driven, highly stressed people carry out high pressure jobs. The kinds of people who always want things to eb done excellently, in the kinds of jobs where doing things right is very important.

There's an argument that this is quite likely to lead to staff being off sick with stress and anxiety, but anyway, some employers dislike, and discriminate against, mental health problems. Even in small ways like giving the best work to other people, labelling you as unreliable, or piling on even more pressure to try to make you leave.

This is wrong but being in the right won't help you deal with it. It's for these situations that I recommend the white lie. If you're so sick you can't come to work, then you call in sick. If putting 'anxiety' on the return to work form leads to nasty consequences, put whatever else you like.

An inaccuracy on a return to work form, which allows you to be treated equally with your colleagues, is the lesser evil in my opinion.

Save confrontation about their duty of care as an employer until when you feel up to it, and when you do feel up to it, seek out a better employer.

15: TRAVEL

Managing anxiety when travelling comes down to preparedness. You probably already know the elements of travel you fund hardest to handle.

The strategies below were created with business travel in mind, but can also be applied to leisure travel.

Strategies

**Travel off peak**. This will be cheaper. Sell this to your entire as an economical option.

**Book everything,** including train seats. Most UK train companies require this anyway, for long journeys.

**Use Google maps** to check out routes in advance. use street view to visualise your destination and any obstacles - strange junctions you might have to negotiate in the car or in foot with luggage, multiple changes of train or bus, roadworks... these might make your heart sink, but knowing about the possible blocks in advance allows you to plan extra time, or alternative routes.

**Budget allowing - just get a taxi.** When I have been unable to face the Underground, I jump in a cab. I can't claim this in expenses, but for my sanity it's worth it. Check out your employer's policy on this, they may be more generous than you think.

**Book hotels as close to your destination as possible.** This sounds obvious, but people are often tempted by cheap deals further afield. In my experience, the cost saving is not worth it if you have to commute to your meeting in the morning. Pick a hotel you can walk right to and from if you can.

**Plan your travel perks.** Business travel is rarely as glamorous as movies make out. If you have any notions that a job involving a lot of travel is a world of flying business class to a big-brand hotel and charging drinks to your room, from which you have a fabulous vista of a world city- forget those notions now.

Most business travel is arriving in the dark at a budget hotel in an industrial estate outside Burton-on-Trent. You eat a dinner that fits within your daily meal allowance, then return to your silent hotel room and look at your phone until sleep finally comes. In the morning, you leave in the dark and proceed straight to your meeting without ever discovering if Burton has a beautiful bridge, or friendly locals (it does).

Having said all this, I think it's important to find the perks of business travel where you can. While keeping within your employer's rules, of course.

**If driving, break your journey as pleasantly as possible.** Anyone who regularly travel up the M6 will know what my next words are going to be. _Stop at Tebay Services._ The ones with the farm shop, beautiful cafe overlooking a duck pond and the Cumbrian mountains, and a lovely organic gift shop. Have a drink, go for a quick walk to stretch off driving tension.

If I'm travelling in Scotland or Wales I can usually find some equivalent service stop. If obliged to travel elsewhere in England, well, motorway services are not great but there are several guides suggesting cafes or pubs for a quick break, within easy reach of motorway junctions. The meal will be cheaper and better quality than service station food and drink too.

**Plan your route to suit you**. Hate the M42? Dodge it. You can't always do this, but taking the scenic route (within company guidelines) can be less stressful than joining the end of a mile long stationary traffic queue. And it gives you more opportunities to stop and rest if the journey is a long one.

Public transport is harder. Seek out your safe space. You'll always find me in _Pret_ at Euston station after a long day at a London customer. I sit with my favourite decaff vanilla latte and people-watch and think of nothing, while I gradually unclench my shoulders and steel myself for the long train journey home.

**Travel light.** Anxiety makes me tense. Tense muscles don't do a great job of hauling heavy luggage. I ripped a load of core muscles last year lugging a laptop and suitcase from my hotel to my meeting. It put me out of action for two weeks, not to mention my immediate anxiety about my (very minor) injury. Not worth it.

Now I leave the laptop at home unless I really need it with me. I'm not kidding myself that I work in my hotel room at night anyway. If I need to be in touch, I've got my phone.

**Don't travel light.** Bring your support system with you. Soft dressing gown, cuddly toy. I'm not kidding. If those things help you maintain a healthy routine while away, pack them. Remember any medication or speciality items such as decaff coffee or herbal tea that your (probably budget) business hotel will not have.

**Plan your R &R**. In advance, choose which movie you're going to watch on your phone or tablet in the evening. Plan a phone call home or to a friend. Bring art or craft with you - easier if travelling by car, but many activities, like those little colouring books, are pretty portable. And you can write anywhere. I'm currently on the five fifty-seven from Euston. Magic eh?

**Plan your evening meal.** Dining alone can be daunting. These days I'm indifferent, but you may need to remind yourself that nobody is looking at you, nobody thinks you've been stood up, nobody is judging your lack of mates, nobody is going to bother you. They're all glued to their phones.

All the same, choosing your planned restaurant in advance is good for anxiety sufferers. My comfort food is Indian and I Google nearest Indian to my hotel before I go. My phone guides me there. Done. I stroll in like a local and order from the menu I've already checked out.

**Bring a book.** I like to be occupied as it keeps the anxiety at bay. A physical book is especially good as it signals to everyone that you are busy.

**Plan exercise.** If you've sat at the wheel all day, or been stuck on a train, you need to move. In theory you are doing ten thousand steps a day (see Motion.)

Keen types at work tell me I should go for a run after I arrive at the hotel in the evening. Not going to happen. That's not just laziness, as a lone woman I don't feel right trekking out a night in an unknown location. If you do love to run, then various apps can find you a local park or track for safe jogging.

In the nineties it was possible to book hotels with gyms. I mean, those places still exist but these days, all work travel is budget travel and I need to be more creative to get any exercise in.

I know I could seek out the nearest leisure pool, but realistically that is too much to ask when I'm drained from traveling. The answer is an exercise DVD, a set of floor or stretching moves I've already familiar with, or just dancing to music on my phone. Half an hour of movement boosts the step count a fair bit. This shakes off tension and helps me sleep too.

I'll be honest, I don't always do this. But when I make myself get up and move, I feel better in my body, and in my mind. In fact, I'm smug all the way through dinner.

**Plan your bedtime routine.** Just as you practice self-care at home, don't throw it out because you're away. If you have trouble sleeping in hotels, this is even more important. See the bedtime list for more on routines.

Travelling by plane

**Drink water -** buy it on the far side of Security. Sip regularly. As well as staving off dehydration from the heavily air- conditioned plane, this gives you something to do and reminds you that you are here, well, and drinking.

**Carry a comfort item**. Lucky charm, stone with a lovely smooth texture, favourite book or religious book, soft scarf. Keep it with you to remind you that all is well.

Some people have emotional support animals which they try to bring on board planes. That's great if it works for you, but I find a discreet lucky pendant is a lot easier to manage than a Labrador.

**Occupy yourself with writing.** As ideas come to you, record them. My recommendation would be that these are pleasant ideas about your destination or purpose for travelling. If you're going on holiday, write about all the great and beautiful things at your destination.

If you're travelling for work or some other less pleasant purpose, I suggest writing about something unrelated. Write your packing list for a real or imaginary holiday. Write a detailed description of the best things you've seen while travelling.

Write a wish list of places you want to go and why. Don't limit yourself by budget or reality. Imagine there are no restrictions. If you don't like to travel for your holidays, write out your perfect vacation at home or wherever you would want to be. A lot of my lists involve the invention of a Stargate so I don't need to do long-haul to Japan. I also take a lot of imaginary cruises to the States.

Keep that pen and paper, or phone, in motion. Capture those words.

**Achieve something.** Finish that piece of craft or that difficult crossword. Reach another level on your favourite game. Write a chapter of your memoir or the next bestseller. File your nails, make a shopping list. Turn the journey into a chance to get something done. Concentrate.

You could even do some work.

**Sleep.** If you can, then rest. Think of it as a chance to sit down and do nothing. I have trouble with this - I like to be busy when anxious. But in my younger days I would become sleepy when stressed, so given the chance to close my eyes, I would take it.

**Look at the map.** Knowing where I am on the journey, and being able to identify landmarks out of the window, helps me remain in control. A day spent hanging above an anonymous landscape does me no favours. Some flights have a navigator you can see all the time. I like to look at my own map.

The first time I recognised Long Island, New York out of the window I was irrepressibly excited. Over an expanse of snow which I assumed was Greenland, maybe Canada, I felt panicky, unable to identify anything. Having a map helped me stay secure. Even if you're wrong about your location, it's fun looking for landmarks.

If you're over the ocean at night, it's tougher. But you can watch for ships.

Ships

Being on a ship makes me very nervous. Yet sleeping on a ship is some of the best relaxation I've ever had. I need to seek out my safe place and stay there for the duration. Usually this is a place I cannot fall from, but could, in theory, escape from if I had to.

In my dream of being a millionaire, this would probably be a stateroom with a window but no balcony. Until then, it's usually the viewing area at the front or back, enclosed but light and spacious, with all my favourite things nearby: shop, cafe, internet access.

Trains

Not much improves a hellish commute in a crammed suburban train. Travelling light, having comfort items close at hand, and employing all known strategies to feel in your safe space, are the best I can suggest. If it's your regular journey you'll know the best carriage to get into, where you will be most likely to get a seat, and the best place to get off at the other end for a smooth inward journey.

Often the anxiety stems from not being able to control the environment, or delays. I commuted every day for years and I coped ok with a few strategies.

**Preparation.** Carry what you need in case of delays or discomfort. A drink as a minimum, some sweets or a snack. Everything is worse when hungry or thirsty.

**Plan ahead** so you know how long before your stop, and where to go when you get there. Tools like Google Streetview and interactive travel maps have made this much easier.

**Book all tickets in advance.** **Reserve seats if possible**. No queuing at the station, frustrated at the person in front making you late Collect them from instant machines or have them posted to you.

16: ANXIETY ON HOLIDAY

Someone once told me that the difference between stress and anxiety, was that stress goes away when the source of stress is removed, but anxiety doesn't.

That's as close to a perfect definition as I've ever heard.

It perfectly sums up other people's expectations of how anxiety works, in other words, that when the troubling situation is over (or never arises), you should spring back to normal and enjoy life.

So a person who is very stressed about work can go away for the weekend and totally unwind.

You already know that anxiety doesn't work like that.

This is distressing in many ways, but much more so when you are on holiday. Perhaps it's your summer holiday, or it's Christmas, a family birthday, or a works party. There's a celebration, fun to be had and a chance for everyone to relax and enjoy themselves.

How cruel, then, that you still feel as awful as the rest of the time.

Other people might expect you to be happy. Worse, you might expect _yourself_ to be happy. I remember once sitting by a sparkling turquoise pool with Mediterranean sun beating down and thinking, _I just want to go and lie down with the lights off._

How can you deal with this? For me, the first part is to expect it, and plan to minimise the impact as much as possible – for your own sake, and for everyone else.

**Reduce travel stress.** Carry what you need in case of delays or discomfort. A drink as a minimum, some sweets or a snack. Everything is worse when hungry or thirsty.

Perks of travel

\- See new places, if you make sure you do.

\- Get some quiet time.

\- Watch the movie of your choice

\- Avoid the washing up and other domestic responsibilities

\- Kid free time. Yes, you miss your kids. But look, you can lie in bed until seven am!

One thing: I try not to do work at night when travelling. Sometimes I have to. But just because you have nothing else, theoretically, to do, does not mean your employer is entitled to a load of unpaid overtime. This is your R&R. Take it.

17: SELF-CARE PACKAGE

The terror. It is difficult to convey to non-anxiety sufferers the immediate and incapacitating nature of the terror. It comes on in a heartbeat and eliminates the ability to rationalise away what is happening. Whatever has triggered the fear, be it an external situation or a sudden physical symptom or, as can happen, nothing at all - it's arrived and now you have to deal with it.

The principal feeling is of isolation: a horrible knowledge that you are on your own. Given how dangerous the situation now feels, this is torture. Ironically you can feel so afraid and so fragile, that if people offer to help, you push them away because you'd hate them to witness what is surely going to be your rapid death.

Sensible suggestions seem absurd. Cup of tea, walk round the block \- you won't live long enough to survive any of these. More dramatic ideas such as going to hospital, don't help either. The idea of calling an ambulance seems simultaneously melodramatic and a waste of valuable health service time, and also, to make your problem horrifyingly serious and real.

People want to help. If you reach the point where you are asking a supermarket manager to find you a chair, within seconds you'll be surrounded by people eager to look after you.

That's theoretically good, but actually excruciating. Being at the centre of attention, especially, the attention of people who definitely don't want you to die in their Tesco, only concentrates the pressure.

Taking yourself into a medical setting can make things worse, too. If your anxiety centres around your health, as mine does, then sitting in a bright linoleum room surrounded by fiercely beeping clinical equipment might send you into a proper meltdown. And personally what I find worst about medical places are the posters. Warnings of fatal diseases and lists of symptoms are my absolute worst trigger. It is impossible for me to see an official medical poster and not discover in myself the symptoms it lists - probably not the same day, but weeks or months down the line.

And when what you want is for an expert to pat you on the back and say, This? It's nothing. Terribly common and completely harmless. Go home \- it is awful to sit waiting and wondering if instead the expert will suck in their breath and hurry away to fetch a second expert, who stands there looking grim for a long time and not telling you anything.

I never used to understand why some people avoid the doctor. Now I get it. Why would anyone rush to a place where their worst fears could be played out?

So what can you do about the terror? The heart-thump adrenalin rush and horror of thinking, This is it?

Rationalisation

The strongest armour against the terror is to give yourself solid reasons to rule out the worst.

Youth used to do this for me. Even I could see that half the things I was afraid of were very unlikely for someone of fifteen. This carried on all through my twenties. Most bad stuff was statistically improbable. It was a kind of mathematical first line of defence.

Next, and especially if youth is less on your side, lead a healthy life and let that rule out the things you fear. If you've waked three miles and eaten vegetables for lunch and taken your vitamins, you've taken yourself off the high-risk list for a lot of things.

On a day to day, practical basis, use logic and probability to protect yourself.

Strategies

**Your fear is not very likely.** A lot of anxiety comes focuses on a terrible outcome which has not yet happened. Soothe this fear by using facts to remind yourself that the outcome is not very likely.

A famous example of this is to remember that even if you are nervous about flying, plane travel remains, statistically, the safest form of travel. There are so few accidents every decade, that when one happens, it gets featured on the news. It's an unusual event.

If numbers make you feel better, you can look up statistics to prove how unlikely a plane crash (or other source of your fear) would be.

For a more day-to-day example, imagine you are worried about getting a panic attack. You can't tell yourself 'it will never happen' because that can't be guaranteed. But you _can_ tell yourself _I have had many panic attacks, they are unpleasant but I have always survived. I have never been killed by a panic attack, and I have never been seriously harmed by one._ Those things are all true, and rational.

I cannot bear the kind of positive affirmation mantras that certain parts of the internet recommend. _I am in control, I am calm_ – they are not true! Repeating them doesn't make me feel calm or in control, it makes me feel like a liar. But reminding myself of something true such as _This feeling of being out of control will pass –_ that's a fact. It's true. And it's a good thing to remember.

Crisis package

**Use rationalisation**. Remind yourself that you have experienced this before and survived.

**Ask for help.** This might be asking someone to sit quietly with you until you feel better. Or it might be asking to be left alone.

**Drink** cool water, or a warm (non-caffeinated) drink.

**Move about** to release muscle tension.

**Warm up.** When stress freezes your hands and feet, wrap up in a warm layer or move to somewhere warm.

**Keep breathing.** For some people, focusing on the breath is stressful. If this is you, use other distractions. If you like to count your breaths, do that.

**Distract yourself from the crisis.** Grab your phone and complete a new level of Wordscapes or pick up a book. Put the kettle on, fold some washing, brush the dog. Do something positive and engaging and make your brain busy.

**Watch the clock.** Remember that panic will pass. It might help to roughly time your attacks so that later you can think, _that was twenty minutes, I just have to hang on that long_. Or perhaps you are watching the clock for when you can physically leave a situation, like getting off a train. Remind yourself that time is passing, and so will this crisis.

**Go to your safe place**. This might be a real place or the one you created in your mind.

**Don't forget to eat.** If the adrenaline is not too bad, eat a calming food. You burn up a lot of energy in a panic attack, but if you can manage to eat something, you'll feel less exhausted and more able to carry on.

**Pay attention.** Notice tiny details in your immediate surrounding, ad use this focus to take you away from anxiety.

18: FANTASY, BAD AND GOOD

This might seem familiar:

Reliving previous conversations over and over.

Rehearsing real life future conversations over and over.

Rehearsing totally imaginary future conversations or conflicts, disasters or crossed, over and over.

Visualising in great detail a negative outcome in the future, or an imagined negative version of something in the past.

I find this endless rehearsal takes over when I am doing mundane tasks. I could use this as a brilliant excuse never to fold washing but instead I try to refocus. To do that, I usually employ fantasy.

Fantasy

It sounds a bit peculiar, but you are already very good at fantasy – at placing yourself in a time and place which is utterly imaginary, and immersing yourself in the details. You are so good at this that you experience a physical reaction to your fantasy – heart racing, cold, clammy hands, tremors.

The only trouble is that your fantasy is not at all enjoyable.

There's good news though -you can employ your excellent imaginative skills to conjure something much better and interrupt the unhelpful negative inner conversation.

I generally have an ongoing fantasy at any time, which I can return to. Right now it's early twentieth-century Paris. Why not? When I find myself reliving an awful experience or anticipating a future one, I blink and turn my mind to a dressing room in a hotel somewhere off the _Champs Elysees_ , where various pink and white silks are spread on the bed and I, or some character nothing like me, is deciding in great detail what to wear tonight.

Not bad eh? Better than what was previously in my head.

The detail is important. You already know that the imagination is powerful enough to create visions of negative things. Use it now, to fully imagine a pleasant scene - the dressing table, old fashioned glass bottles of perfumes with their tasselled atomisers, the powder puffs and the white kid gloves laid over the back of a stuffed chair.

Picture it all, then draw in the sounds - horses outside, the crackling of a fire, the hiss of perfume leaving its bottle. Smells and tastes, what will the imaginary heroes of this fantasy eat for dinner? Will it be roast duck, or will they exist off cake and a glass of sherry? How do the gloves feel, and the Edwardian shoes?

The purpose of this is to immerse yourself in a world of your own choosing, something pleasant and distracting. To take control of your imagination and send it in a journey of your choice.

You will know the scenes and ideas that appeal to you. Perhaps you envisage a peaceful glider flight over snow-capped peaks, or a being driven along a smooth road in a luxurious car.

If it's hard to think of something pleasant, here's my own suggestion. _You'll notice my obsession with nostalgia. It is just my thing, one of my many things._

**A journey.** Take a journey on the Orient Express. Picture everything from the ticket hall at a great London station, to the sleeper car, dining car and of course the glamorous views flying past outside.

Lay out specifications for your cabin, for a long journey. Perhaps it is a spaceship, a secure, insulated environment containing everything you might need. Would your ship have a pool, running track, a cafe where you hang out with other passengers, or just with friendly droids? What food would you eat in deep space, what desserts would you to treat yourself to on special occasions? What books, music, and if you're in the mood, what people or pets would you bring with you?

Picture the daily routine of a luxury cruise or hotel vacation. Breakfast, nice things to do, lunch on the terrace or maybe served to you as a picnic on a day trip to ...Venice, Marseille, wherever you like. Then the afternoon, how will you occupy yourself? A tour of London, or relaxing with a book while the staff bring you tea and biscuits? Then dinner, a show, (which one?) and out again somewhere after, or perhaps back to the peaceful bedroom for blissful rest...?

Why not meet a famous person while you're out? What would you say? This is more fun if the celeb is one of your crushes... obviously. What if they offered to buy you a coffee as you were so interesting to talk to? What would it really be like to have dinner with that person? Imagine how relieved they might be to find a fan who's a real person just like them.

Yes, I encourage you to daydream and indulge in fantasies. For sure. You might recoil, and think it's a waste of time, or ultimately pointless because it's not real - but think: you spend a lot of time in unpleasant places, and those are only imaginary too.

III: WHAT I WISH I'D KNOWN ABOUT ANXIETY

19: WHAT I KNOW NOW

This section is the closest thing this book contains to any backstory! I have kept it as brief as possible.

What I know now

**The** range of symptoms anxiety can create is staggering. Things I would never have thought could result from anxiety were on the symptoms list I found in my anxiety online community.

Recovery time after a panic attack gets quicker and quicker as you learn to trust that what you're experiencing is anxiety. A panic which could knock me out for a day, can now be over in half an hour. The actual panic can be extremely fleeting - I just need time to process the adrenaline jolt. But recognising the panic for what it is, saves so much recovery time.

Complete recovery is possible. What seems like a disease which will stay with you forever, is something which can be managed and even cured. I still consider myself an anxious person, but these days I experience what I think of as episodes rather than viewing anxiety as a fixture in my life. I believe that the more I can mould my life to reduce my stress, the more likely I am to teach s point where I never have a reasonless panic again.

Coffee and alcohol can affect anxiety and make symptoms worse. This is such a simple thing to fix that I can't believe medics don't mention this straight away.

It is possible to have a panic attack which begins while you are asleep. Nobody told me this for a long time.

Panic attacks can happen when you relax. It's true. Rather than happen when you're expecting them - during the big work presentation, or before a job interview - they strike afterwards, once you have survived and are driving home, or wandering, relieved, around Tesco.

I have had so many panic attacks in supermarkets. I find supermarkets relaxing! I enjoy the rather aimless wandering, the anonymity, the sense that even though I am looking at candles or magazines, I am still notionally achieving something. I am doing the shopping. Very gradually.

Yet in Tesco is where the panic strikes. The bright lights hurt my head, my breathing goes funny and I feel like I'm going to collapse. I relax, and all the tension which has been holding my body together, runs away and I have a panic attack.

You can have anxiety on holiday. This is so frustrating. But I am having fun! I am off work and with my family, or friends! This is so unfair! Yes. But remember that travel can be very stressful and include common triggers. Being cooped up in a hotel with your family can be the opposite of relaxing. And if you're really relaxed...well, see above.

You can treat mental problems with bodily cures. This seems very strange to me but definitely works. Every doctor I've ever spoken to tells me I need to relax, chill out, be less stressed, and many of my issues will go away. For years I simply could not see how that would work on what was (to me) obviously a serious medical problem I had, which they were failing to diagnose. 'Stress' seemed like such a lazy diagnosis, like they could not be bothered to find out the true issue and were fobbing me off. But...

I cringe at this, but ...

Once I accepted that anxiety could create my symptoms, I accepted that connection between mental health and physical condition. And I began to understand that the connection can be two way. Just as stress can create a cycle of adrenaline jolt and post-adrenaline crash, with all the exhaustion and tension associated - and just as anxiety can create signs of hyper-vigilance including muscle tension and racing heart, to name just two - then so can training your body to calm down create a calming effect in your mind, and help break the cycle.

Meditation is the simplest way to treat your body and your mind. Meditation is the go-to number-one always-top of every doctor's list for relaxation.

Meditation in this sense need not require a Tibetan bell and the Lotus position. It can be simply sitting or lying very still and doing nothing.

There are plenty of things you can do while meditating - focus on your breath, focus on a word or image, focus on sounds you can hear or the sensations in your body. You can try to empty your mind (impossible for me!) or you can just drift, like those moments on first waking, when ideas come and go and you are not concerned with hanging onto them or following them to any logical next step.

Just five minutes a day of stopping, of being still and not trying to do anything, can work miracles. You are sending a signal to your body that it will get this brief respite every 24 hours. As a minimum, it will have this recovery time. In some weird deep way, this reassures your body and rebuilds its trust in you, the driver, the mind in charge of it. I don't know how this works. But it does.

I do twenty minutes of lying still and doing nothing every day. I do this when meditation experts say not to - right before sleep. But given that my first experience of trying to do nothing made me fall asleep almost at once, as if my body was waiting all along for a chance to stop - well, that seemed like a giant hint, so I've just gone with that.

Having a planned, routine meditation that is built into my daily routine – since I will go to sleep every day - means I have a little defence against tension and nastiness. I can think, Well, this is horrendous, but I'll have that twenty minutes later. That will do me good.

You can play music while mediating \- a moment of googling will identify a vast number of suggestions and resources. I like to listen to watery sounds - rainfall, or a trickling stream. I have it on my phone as a music track and play it on repeat if I'm using it just to sleep.

There are phone apps for meditation. Calm and Headspace, both highly rated by therapists, offer timed meditations, guided meditations and other relaxation sounds. Parts of these apps are free, and they have extended options if you pay a subscription.

You can defer anxiety. I discovered I could schedule worry time. When I was at a peak of anxiety with a new tiny person to care for - to keep alive! – I worried constantly. This led me to major anxiety, including intrusive visions of terrible things happening. I felt like it was out of control and I had no way to influence the occurrence of these unpleasant visions.

Then I read something - and I have no idea where or what or I would link to it here - which included the idea that you could schedule in worry time. Plan to give yourself, say, five minutes every day to do nothing but worry. Think of everything. Go over all your current worries and dwell on them as much as you like for five minutes. Then stop until the next day.

I started doing this. My only opportunity was right before sleep, so I would lie in bed with the baby nearby and think of all the terrible things I'd been imagining.

I usually couldn't make it last five minutes, because thoughts, like dreams, compress time. I thought of a lot of things very quickly. And when I ran out of awful scenarios, I would go to sleep.

From then on, every time I caught myself during the day beginning an awful thought about some tragic outcome, I would think, Stop, save it for later, do it then.

You wouldn't think this would work, but it does.

The result is that nine years later, I rarely get intrusive visions during the day. If I have them, I kind of dismiss them. I guess I'm still mentally saving them for later, even though I no longer have a scheduled worry session. The one residue of that very anxious period in my life is that before I fall asleep, I tend to have one, just one, nasty vision involving harm to my family. I can only think that I trained my brain to worry on-demand so well, that it is still trying to please me. But one vision a day I can live with. I open my eyes, dismiss it, and go to sleep. Scheduling worry time is worth trying.

Fresh air and exercise really do reduce anxiety. I always groan when I hear this, because I am such a lazy indoor person. but it's true. When I started walking my child to school, and back, every day - a total outside and active time of 40 minutes \- I noticed an improvement in my mood. I'm lucky that our route to school includes a lane with some trees, the occasional sheep or cow, and plenty of sky.

Even without these benefits, just being outside in the oxygen, experiencing wind, rain, hail (this is Britain after all) and having a brisk walk because I am usually late - it changes something. It made me want to be outside. It made me want to be fitter so I didn't arrive at school sweating like the unfit overweight person I was. And seeing nature - even just seeing the sky, different at all the seasons of the year and times of day - put me in a more positive mood for starting work when I reached my office.

One of my habits for this year is to reinstate my half-hour walk at lunchtime. It doesn't matter now that I walk up the road and back. I no longer care if the neighbours wonder where I'm going or why. It doesn't bother me that I see the same things over and over - in fact I like it, because it allows me to see small differences as the seasons pass. What matters is I'm doing it, at however slow a pace, and that I know it helps.

Anxiety is very common. Once I realised what was happening with me, and reached out to various online resources and communities, I understood that many, many people suffer anxiety in some form. While this isn't great for them, it's good to know that I'm not alone, and that there are plenty of people who can relate to my experiences. When friends and family struggle to understand or sympathise with my bizarre-sounding needs, that can be a huge support.

I encourage everyone who suffers anxiety to reach out - in person if possible, or online if not.

One tiny act of self-care can boost your whole attitude. Remembering to take your vitamin, or doing your hair properly with conditioner, or always ordering decaff coffee because you know that won't set you off - these reinforce your sense of you own strength. You are managing, you are surviving, every day, again and again.

To other people, taking a vitamin is easy. To someone suffering with anxiety, it can be a major victory. I write Vitamin! in coloured pen in my daily planner and tick it off when I've done it. In really bad times, I wrote Shower! and ticked that off too. Anxiety can make you neglect yourself because you're spending all your energy battling with terrible fears - but planning in and then achieving these tiny self-care goals makes a big psychological difference.

There are different types of anxiety. I did not even know anxiety was a thing until five years ago. And now I know there are many types and many types of people who suffer with it.

Before I knew, I thought I was a worrier. I knew my doctor considered me a great timewaster since she could never find anything wrong with me. But she kept saying I had 'stress,' and since however you describe my job, it sounds stressful to most people, I just accepted that stress was what I had. I also went along with my doctor's silent implication that the stress was my fault, for doing this job. She told me to be less stressed. (She was just great, right? That's why she gets such special mentions in this book.)

The one day I had a major meltdown at work. A colleague came to help and told me about her own crash and burn, and it opened my eyes. I was not suffering from work stress, but something much more complicated. (As a bit of a snob, this made me feel immediately better!) My colleague told me about a counselling scheme I could access through work.

I'd had counselling before but found it to be unhelpful since the counsellor, like my doctor, tended to focus on impractical suggestions like Being Less Stressed, for example, changing jobs. Nonetheless I gave this work-counselling a try and found that when you meet the right therapist, everything changes. The person I saw helped me understand that I was suffering - temporarily! - from anxiety, and over the course of our sessions, outlined some possible causes.

It sounds so clichéd to say that but it's true. And being able to identify myself as a person who was not a timewaster, but someone who suffered with anxiety, helped me cope. This horrible thing had a name, and could be treated.

After this I learned that there are different types of anxiety, and people have many different symptoms and responses. I've encountered a lot of people with social anxiety, and health anxiety, which is my particular issue.

Terms used seem to be different in different parts of the world. That's not the point. The point is that what you have has a name. It is a thing. And it can be treated.

20: REMINDERS

Sometimes I just need a reminder of all the things I can do to manage my anxiety and get through the day. I want a checklist to refer back to and gather together all my strategies.

When anxiety starts, I stop myself as soon as I notice, and go through my rationalisations. I have survived this far, and will again.

I have a set of simple, safe distractions I can use if I need to.

I use everything around me for my own comfort.

I remind myself through the day to relax my muscles and release tension.

I care for myself by taking vitamins and any medication.

I care for myself by eating my five-a-day. One portion of juice, the rest vegetables or fruit.

I sip cold water to keep myself grounded when a panic attack threatens.

I use happy memories and visualisations to comfort and distract me.

I have decided what I will and won't tell my employer about my anxiety.

I care for myself by showering every day and washing my hair.

I care for myself by walking in the fresh air every day.

I use alarms, planners and lists to help me remember things.

I write down my small goals and mark them as achievements.

I keep warm when the anxiety starts and remind myself that feeling stressed adds to the cold.

When anxiety starts, I stop myself as soon as I notice, and go through my rationalisations. I have survived this far, and will again.

I have a polite excuse ready, to allow me to leave the room if I need to.

I write down my reasons for seeing the doctor before I go, and refer to my notes when I am with the doctor.

I use happy memories and visualisations to comfort and distract me.

I remind myself that I am not alone.

AFTERWORD: FINE

Way, way before your body starts shouting for help, when it seems like things are Fine, you have too much going on. You are carrying too much, are carrying on when other people would have admitted defeat, until *wham* you are on the edge.

Your mind isn't listening. Your body has to let you know.

It's tried insomnia, it's tried headaches and overeating and undereating and loss of libido and fatigue and irritability and you have just powered through all that saying that you are Fine.

So now it brings out the big guns. Your heart stutters. You get chest pain like how you think a cardiac arrest would feel. Your guts go to pieces. Your throat closes up like you're at the start of anaphylactic shock. Your knees literally go weak, you cannot lift your head. You are clearly very ill.

You go to the doc. You explain, you have tests. And the tests show you are Fine. How that possible? You are obviously not Fine. Just look at the symptoms.

The doctor tells you it is stress, or anxiety, or tension.

But it came out of nowhere, you say.

They say therapy or counselling will help.

As if. Like having a chat will help when actually what you need is heart medicine, something for the obvious bowel or stomach or head cancer.

But you go. The therapist is surprisingly unfazed by your story. She has seen it before. Those things you have are very common among people suffering from anxiety or stress or tension.

She explains how the stress came first and the symptoms after, not the other way round. She helps you see what a powerful thing your mind is, to create signs you cannot ignore so that you have to slow down, get support, seek help. And she helps you see that your mind, and your body, can reverse that process too.

One day you wake up. You look around and realise you are back. God, the house is a mess. The post hasn't been opened for months. It's amazing the kids have been fed, dressed, sent to school, read to, bathed, played with - but they have. You still, somehow, have a job, and emails appear to have been mostly typed correctly. It's a miracle.

At this point, pause.

Do not try to 'get back' to where you were before your body made you stop. Do not pick up the commitments and chores you have missed, however much you long for life to be 'normal' again. Remember the warnings. Remember the power of your mind and body to shut you down when your life gets too 'normal', that is to say, normal for you: busy, frantic, pressured, stressed. And go easy.

Be gentle, listen to the signs, forgive yourself, forget trying to do it all. You don't need to prove anything, and you are Fine.
ABOUT THE AUTHOR

Sef Churchill is a lifelong writer from the UK. She won a national writing award at age sixteen, and promptly did nothing about it.

A long experience of health anxiety and a longer struggle to get medical professionals to accept it, led Sef to write this nonfiction guide to help others who are also on the journey to managing their anxiety and thriving despite everything anxiety can do.

Sef is active in various online anxiety communities but her primary focus is writing.

Nowadays, she writes poetry and microfiction, and is active in several online writing communities. Find details of her attest book, Dread, on her website, or Twitter at SefC_

WHAT NEXT?

_Take a look at my minibook of anxiety fictions,_ Dread _. Check out my blog and my stories. Follow me on Twitter for a daily fix of fantasy and escapism. And thanks for reading – please leave a review letting me know what you thought. -Sef_

