Anxiety can lead some people to spend a lot of time alone. Photo / Getty Images
From not exercising enough to drinking too much coffee, we speak to an expert about the key triggers and how to combat them.
What people don’t realise about anxiety disorders, says Professor Oliver Robinson of University College, London, is just how commonplace they are. One in four of us experience a clinically significant level of anxiety at some point in our lives, and at any given time, “around 20 to 25% of the population report being extremely worried,” Robinson says.
As a mental health condition, anxiety is also unique in that “we all know what it feels like,” says Robinson. While there’s a big difference between feeling down at times and being depressed, anxiety is the body’s healthy response to danger or threats. People with anxiety disorders find that those feelings fire at the wrong time, because of things that don’t pose danger at all – social situations, big deadlines, or even a spider in the corner of the room. Most of us know how that feels, but when it happens consistently, it can get in the way of work, socialising, family time, and a generally healthy life.
There are very effective treatments for anxiety, such as medication (through SSRI drugs, also used to treat depression) as well as exposure therapy and cognitive behavioural therapy. Three quarters to two thirds of patients find one of these, or a mix, highly effective in treating their symptoms, Robinson says. The rest may have to manage their symptoms in the long run. Robinson is clear that “there is no substitute for anxiety treatment” but many people find that anxiety is easier to manage (and bring down to a subclinical level) through some healthy lifestyle tweaks.
Here are the things that may make your anxiety worse – and what to do instead.
Anxiety is prompted by something that is causing you fear. Many of those diagnosed with an anxiety disorder struggle with social anxiety, which can cause fear of big settings like parties, as well as one-on-one interactions in some cases. “This leads some people to spend a lot of time alone,” Robinson points out.
Aside from the health-worsening effects of social isolation, this actually worsens social anxiety itself in the long run. “When you don’t have any real-life examples to rely on, your worst fears become confirmed, in a way, which makes it much harder to then face your fears and go to that party or lunch with friends,” says Robinson.
Time alone without stimulation can also cause rumination, obsessive patterns of negative thinking that are a huge driver of both anxiety and depression.
What to do
“Try not to avoid doing the thing that’s bothering you, even if it’s just once in every 10 times that the fear comes up,” Robinson says. “Evidence shows that facing your fears is the best way to stop being scared of them, as you recognise and gradually re-learn that there is no real danger.”
Easing yourself in gradually, for example by meeting a trusted friend for a coffee before going to an exercise class full of strangers, can be helpful, as this gradually increases your exposure to the source of your fear. This goes for any kind of anxiety. “Avoiding the source of your fear entirely will only make things worse.”
Alcohol makes you relax – it’s a fact as true as the sky is blue. When you have a drink, it reduces your inhibitions and prompts the release of dopamine, the feel-good chemical in your brain. These effects are short-lived, however, and relying on them to soothe anxiety can come with the ugly side-effect of knocking the brain’s hormonal balance out of whack, leading to worsened anxiety the next day (otherwise known as “hangxiety”). Alcohol also interrupts sleep and worsens sleep quality, even if having a nightcap can help you to nod off.
Some research suggests that wine and prosecco may be worse for anxiety than some other drinks. A low-sugar option like a hard seltzer may prove to be easier to tolerate. “Alcohol can help people in social situations, if it’s used in a controlled way,” says Robinson – “only you can know if it’s really helping or causing more problems than it is helping with”.
What to do
Try a different way to wind down in the evenings. Research suggests that a nighttime drink can be calming in its ritual and “treat” feeling as much as in its actual psychoactive effects. Having a hot (caffeine-free) drink can be just as soothing and will not disrupt your sleep. This makes it easier to enjoy the odd drink in a social setting without feeling a knock-on effect on your anxiety.
Sleep is the bedrock of good health, and a lack of it worsens stress like nothing else. No wonder, then, that even healthy adults who are underslept report feeling more anxious and low in the daytime.
Anxiety can both cause and be worsened by poor sleep. “They’re certainly hard to tease apart, as being anxious can leave you tossing and turning,” Robinson points out. In the long term, sleep deprivation impairs the function of the parts of your brain that regulate emotion, while upping activity in the amygdala, the part of your brain in charge of your fear response. An inability to sleep is anxiety-provoking in itself.
What to do
Give yourself the opportunity to get enough sleep, says Robinson. Ideally this is by going to bed at least eight hours before your alarm is set to go off in the morning. If you’re used to tossing and turning, going to bed early might be the last thing you want to do, “but if you’re up for 20 hours a day then there’s no chance that you can get the rest you need”. There are tried and tested tricks to quiet racing thoughts before bed, such as box breathing, and building a bedtime routine can help you drift off to sleep more easily too.
It can also be helpful to distance yourself from the causes of your anxiety before bed. If you’re anxious about work, don’t check your emails while you’re tucked in, or else “your behaviour might prompt worrying thoughts that wouldn’t have come up otherwise,” Robinson says.
On that note, you might well be in the habit of topping up your poor sleep with copious amounts of tea or coffee. This might help keep you alert, but that’s because caffeine is a stimulant, and it prompts the release of cortisol, the “fight-or-flight” hormone. It causes your body as well as your brain to “wake up”, which is why it gives some people jitters and heart palpitations as well as more energy.
The problem here is that “the relationship between your body and your mind works in both directions when it comes to anxiety,” says Robinson. Though even scientists “don’t fully understand the link”, caffeine is known to prompt or worsen symptoms of anxiety, and a number of studies suggest that caffeine consumption can have a detrimental impact on anxiety and also increase the risk of its incidence in the long term. Fizzy drinks may contain sugar or sweeteners as well as all the caffeine in a standard cup of coffee or more, wreaking further havoc on your sleep.
What to do
Avoid drinking coffee on an empty stomach. Eating something before you have your first mug of the day can slow the body’s absorption of caffeine, and release of cortisol with it, reducing the chance that you will feel it enough to worsen your anxiety in the first place.
Cutting out coffee “isn’t one of those panaceas where it will fix your anxiety with no other work,” says Prof Robinson, but if you suffer from anxiety then it is important to experiment with the amount of coffee you drink “to find out what works for you”. Fizzy drinks are best replaced with healthy and caffeine-free alternatives like flavoured sparkling waters, or herbal tea.
Yet it’s easy to rely on sweet treats or a packet of crisps to quell anxiety. The endorphins released when you eat something you enjoy can balance out the anxiety in your brain and body, soothing your nervous feelings. This can lead to emotional overeating or, in the worst cases, food addiction.
Robinson. Like sleeping well, eating well is a core part of that. Plenty of studies show that a diet high in ultra-processed food is linked to increased risk of, and in fact worsened, anxiety. A healthier diet meanwhile is linked to improved symptoms of anxiety and a reduced risk of experiencing it overall.
What to do
Try to stick to a Mediterranean diet. “There isn’t much good evidence for whether specific foods can improve or worsen anxiety,” Robinson says, but we do know that the Mediterranean diet – which is based on whole foods, with lots of healthy fats, nuts and lean proteins – supports overall health as well as brain and hormonal health in the long term.
Just as with alcohol, cutting out the foods you rely on to give yourself a mood boost may not prove helpful in the long run. It’s all about keeping them to an occasional treat, Robinson says.
A number of studies have linked sedentary lifestyles to increased risk of anxiety. Intentional exercise, meanwhile, releases feel-good hormones and can reduce stress. Adults who engage in regular exercise experience fewer symptoms of depression and anxiety, other research has found. Exercise triggers the release of endorphins, which have mood-boosting effects, while also regulating the body’s stress response system.
What to do instead
Try to get in the 150 minutes of cardiovascular exercise recommended each week by the UK NHS. That could mean walking, jogging, swimming or taking part in an aerobics class. “We don’t know exactly why exercise works to help with anxiety in the long term, but it may have something to do with reducing inflammation,” says Prof Robinson. The SSRI drugs prescribed for anxiety also reduce inflammation, he points out.
Other forms of exercise like yoga, which are more meditative, have been linked to reduced levels of anxiety when practised regularly, and may also be worth trying. “The practical accomplishment of picking up something new may also boost your confidence and improve your self-esteem, which can be important in the process of overcoming anxiety,” says Robinson.
Does anxiety worsen with age?
“Normal anxiety is pretty consistent, but clinical anxiety disorders tend to be low in childhood, reach a peak in adulthood and then decline in old age,” says Robinson. Some research suggests that older adults are better at regulating their emotions. This can be attributed to a variety of factors, such as fewer stressors and different life perspectives.
Can anxiety ever go away?
Sometimes “anxiety will go away on its own,” or reduce to a subclinical level over time, says Robinson. However, it is always best to seek treatment if you believe that you may have an anxiety disorder. “Around two thirds to three quarters of people with an anxiety disorder are able to make a recovery that means they no longer reach a clinical threshold,” he says.
Why does anxiety get worse at night?
“Not everyone’s anxiety gets worse at night, but there are a number of possible reasons it might,” says Robinson. “You may have learnt to associate night-time or darkness with threats,” he says, and “there are also less distractions, so when you are lying in bed you start ruminating and worrying about bad things that might happen. You may also start to worry about not getting enough sleep which compounds the other problems, leading to a negative spiral.”