Anxiety
What is anxiety?
Anxiety is a normal human emotion.
Everyone feels anxious sometimes.
We might feel anxious before:
an exam, starting somewhere new, meeting unfamiliar people, travelling, giving a presentation or doing something that feels uncertain.
Anxiety is part of the body's natural warning and protection system.
It prepares us to respond when our brain thinks something might be dangerous.
A small amount of anxiety can sometimes even be useful. It can make us more alert and prepared.
But anxiety can become a difficulty when it is very strong, happens frequently, lasts for a long time or begins to interfere with everyday life.
Someone may then need additional understanding and support.
Anxiety is more than worrying
People sometimes describe anxiety as simply “worrying too much.”
But anxiety involves both the brain and the body.
A person may know logically that something is probably safe while their body is still responding as though they are in danger.
They cannot necessarily switch that response off by being told:
“Don't worry.”
The fear may feel completely real, even when somebody else cannot see the danger.
What does anxiety feel like?
Anxiety can feel different for everyone.
Someone might experience:
fear
worry
panic
uneasiness
irritability
restlessness
dread
or a feeling that something bad is going to happen.
They may find it difficult to concentrate because their brain is constantly looking for possible problems or dangers.
Anxiety can affect the body
Anxiety can cause very real physical sensations.
These might include:
a racing or pounding heart
feeling sick
stomach aches
headaches
shaking
sweating
feeling hot or cold
dizziness
fast breathing
a tight chest
tense muscles
needing the toilet
a dry mouth
difficulty sleeping
feeling exhausted.
Someone experiencing these symptoms is not imagining them.
The nervous system can create genuine physical changes when it believes the person may be in danger.
The body's alarm system
Our brains have systems designed to help protect us from danger.
If the brain detects a threat, the body can prepare to respond.
Heart rate may increase.
Breathing may become faster.
Muscles may tense.
Attention becomes focused on the possible danger.
This is sometimes called the fight, flight, freeze or fawn response.
It is extremely useful if there is an actual emergency.
The difficulty with anxiety is that the alarm can sometimes activate when the person is not actually in immediate danger.
Fight
The fight response prepares the body to defend itself.
In a child or young person, this might look like:
shouting, arguing, becoming angry, pushing someone away or appearing confrontational.
Adults may see the behaviour but miss the fear underneath it.
Sometimes anger is the part of anxiety that is easiest to see.
Flight
The flight response tells the body:
“Get away.”
Someone might:
run away, leave the room, hide, refuse to enter somewhere, repeatedly ask to go home or avoid a situation altogether.
Leaving removes the immediate source of anxiety, so the person's nervous system may quickly begin to feel safer.
This can make avoidance extremely powerful.
Freeze
Sometimes the nervous system responds by freezing.
A person might:
become very still,
struggle to move,
be unable to make a decision,
find it difficult to answer,
or feel as though their brain has suddenly gone blank.
This is not necessarily deliberate refusal.
The person's nervous system may temporarily be making action extremely difficult.
Fawn
Some people respond to anxiety by trying very hard to please other people or prevent conflict.
This is sometimes described as a fawn response.
Someone might:
agree with everything,
apologise repeatedly,
try to keep everybody happy,
hide their own needs,
or find it very difficult to say no.
From the outside, they may appear extremely compliant.
Inside, they may be experiencing significant anxiety.
Panic attacks
Sometimes anxiety becomes extremely intense very quickly.
This can cause a panic attack.
Someone might experience:
a racing heart, shaking, sweating, dizziness, breathlessness, nausea, chest discomfort, tingling or an overwhelming feeling that something terrible is happening.
Panic attacks can feel frightening, but they are not usually physically dangerous.
However, some symptoms can also occur with physical health problems. New, severe or unexplained symptoms should not automatically be assumed to be anxiety.
Anxiety does not always look anxious
Anxiety can be surprisingly difficult to recognise.
It might look like:
anger
avoidance
perfectionism
silliness
controlling behaviour
constant questions
irritability
procrastination
refusal
difficulty concentrating
or repeatedly seeking reassurance.
A child who appears to be:
“being difficult”
may actually be communicating:
“I don't feel safe enough to do this.”
Avoidance
Avoiding something frightening usually makes anxiety reduce in the short term.
For example:
A person feels anxious about entering a busy shop.
They decide not to go in.
Their anxiety immediately decreases.
Their brain learns:
“I escaped, so I am safe.”
The next time they approach the shop, their alarm system may activate even earlier.
This is one reason anxiety and avoidance can sometimes create a cycle.
However, this does not mean somebody should simply be forced into frightening situations.
Support needs to be gradual, appropriate and safe.
Anxiety and uncertainty
Not knowing what is going to happen can be particularly difficult for some people.
Questions might begin appearing:
What if I'm late?
What if nobody talks to me?
What if I get it wrong?
What if the plan changes?
What if something bad happens?
Predictability can therefore reduce anxiety.
Things such as visual schedules, clear information, preparation, routines and warnings before changes may help.
Reassurance seeking
An anxious person may repeatedly ask the same question.
“Are you sure?”
“What time are we leaving?”
“Will you stay with me?”
“What happens if...?”
They may already know the answer.
The question can be an attempt to create a temporary feeling of certainty and safety.
Responding calmly can help, while longer-term support may involve helping the person gradually develop ways to manage uncertainty.
Anxiety and control
When the world feels unpredictable, having control over small things can help somebody feel safer.
An anxious person might become very particular about:
plans, routines, food, belongings, where people sit or exactly how something needs to happen.
This can sometimes be mistaken for somebody simply wanting everything their own way.
It can be useful to ask whether control is helping the person manage an underlying feeling of uncertainty or fear.
Anxiety and sensory processing
Sensory environments can contribute to anxiety.
A person may already be worried while also trying to cope with:
noise, bright lights, crowds, smells, uncomfortable clothing or unexpected touch.
The brain now has even more information to manage.
Reducing sensory overload can sometimes reduce the person's overall anxiety level too.
Anxiety and neurodivergence
Anxiety is not the same thing as neurodivergence.
It is a mental health difficulty that can affect both neurotypical and neurodivergent people.
However, anxiety can occur alongside neurodevelopmental differences such as autism and ADHD.
For some neurodivergent people, anxiety may be influenced by experiences such as:
sensory overload
social uncertainty
executive-function demands
masking
unexpected changes
communication difficulties
or repeatedly being expected to function in environments that do not meet their needs.
Support should therefore consider why the person is anxious, rather than treating every anxious person in exactly the same way.
Anxiety and masking
Some people become very good at hiding their anxiety.
A child might appear:
quiet, polite, compliant and academically successful at school.
They may follow every instruction because making a mistake feels terrifying.
Adults may therefore believe they are coping extremely well.
At home, where they feel safer, the effort of holding everything together may result in:
exhaustion, tears, irritability, meltdowns or withdrawal.
Appearing calm does not always mean feeling calm.
Anxiety and perfectionism
Some anxious people become extremely worried about getting things wrong.
They may:
rub out work repeatedly,
take a very long time to complete something,
refuse to begin,
become distressed by small mistakes,
or constantly ask whether something is correct.
Sometimes:
“I won't do it”
actually means:
“I'm frightened I won't be able to do it perfectly.”
Creating an environment where mistakes are treated as a normal part of learning can help reduce this pressure.
Anxiety and school
School can contain many possible sources of anxiety
These might include
separation from parent
academic expectation
friendship
bullying
noise
crowds
changing classrooms
being asked questions
PE
lunchtime
toilets
assemblies
unexpected changes
or fear of getting something wrong.
Simply knowing that a child is anxious about school does not tell us which part of school is difficult.
Understanding the specific barriers is important
Anxiety and EBSA
Significant anxiety about school can sometimes contribute to Emotionally Based School Avoidance (EBSA).
A child may experience increasing distress around attending school.
This might begin with:
stomach aches, difficulty getting ready, late arrival or avoiding particular lessons
and eventually develop into significant difficulties entering or remaining at school.
The child may want to attend while feeling unable to do so.
Supporting the underlying anxiety and barriers is therefore just as important as focusing on attendance itself.
Separation anxiety
Some children experience significant separation anxiety.
Being away from a parent, carer or another trusted person may feel frightening.
The child might worry:
“What if something happens to them?”
“What if they don't come back?”
or
“What if I need them and they aren't there?”
They may become distressed when separating, follow the person around or need frequent reassurance.
Predictable goodbye routines and carefully planned, gradual experiences of separation can help some children build confidence.
Social anxiety
Social anxiety involves significant fear around social situations.
Someone may worry about:
being judged
saying the wrong thing
being embarrassed
speaking in front of people
meeting unfamiliar people
or other people noticing that they are anxious.
This can make everyday situations such as classrooms, shops, parties, phone calls or ordering food extremely difficult.
Social anxiety is more than simply being shy.
Generalised anxiety
Some people experience anxiety about many different areas of life, rather than one particular situation.
Their brain may constantly move from one worry to another.
They might worry about:
school, family, health, friendships, the future, mistakes or things that might happen.
When excessive worry becomes difficult to control and significantly affects everyday life, professionals may consider conditions such as Generalised Anxiety Disorder (GAD).
Anxiety and sleep
Anxiety can make sleeping difficult.
When everything becomes quiet, the brain may suddenly have space for all the worries it has been carrying during the day.
Someone might:
struggle to fall asleep, wake frequently, experience nightmares or repeatedly seek reassurance at bedtime.
Poor sleep can then make emotional regulation and anxiety more difficult the following day.
This can create another cycle.
Anxiety and eating
Anxiety can affect appetite and eating.
Some people lose their appetite or feel nauseous when anxious.
Others may seek familiar foods because predictability feels safer.
Anxiety may also interact with sensory food difficulties.
Significant changes in eating, drinking or weight should be discussed with an appropriate healthcare professional rather than automatically being attributed to anxiety.
Supporting someone who is anxious
The first goal is not necessarily to make the anxiety disappear immediately.
It is to help the person feel safe, understood and able to cope.
Helpful approaches might include:
calm communication
predictable routines
visual information
preparation for changes
reducing sensory overload
breaking tasks into smaller steps
allowing processing time
access to trusted people
and helping the person recognise what their body is communicating.
Different people need different strategies.
Regulation before reasoning
When somebody is extremely anxious, their brain may be focused on survival rather than problem-solving.
This is usually not the best moment for:
long explanations
lots of questions
or
“You know there's nothing to worry about.”
The person may first need:
space, reduced demands, quiet, reassurance, familiar sensory tools or a trusted person nearby.
Once their nervous system is calmer, conversation and problem-solving may become much easier.
Breathing and calming strategies
Some people find strategies such as slow breathing, grounding, movement, music, sensory activities or mindfulness helpful.
Others do not.
A strategy should not become another demand.
Repeatedly telling a distressed person:
“Just breathe!”
may make them feel even more frustrated if breathing exercises do not work for them.
It is better to build a collection of different strategies and help the individual discover what genuinely helps their nervous system.
Anxiety is not always something to push through
Encouraging someone to gradually experience manageable anxiety can sometimes help them build confidence.
But there is an important difference between:
supporting somebody through something difficult
and
repeatedly forcing somebody through overwhelming distress.
If an environment is genuinely inaccessible, unsafe or repeatedly overwhelming, the answer may involve changing the environment, not simply teaching the person to tolerate it.
When might anxiety need professional support?
Anxiety may need additional support when it:
continues for a long time
causes significant distress
interferes with education
affects relationships
prevents everyday activities
seriously affects sleep or eating
or makes it difficult for somebody to enjoy their life.
For children and young people in the UK, a GP, school SENCO, pastoral team or other professional already involved with the child may be useful starting points.
Depending on the person's needs and local services, support might involve NHS mental health services or other appropriate professionals.
Treatment and support in the UK
Different types of anxiety require different approaches.
Support may include self-help strategies, psychological therapies and, in some circumstances, medication.
One commonly used psychological treatment is Cognitive Behavioural Therapy (CBT), which can help people explore relationships between thoughts, feelings and behaviour.
Treatment should be appropriate for the individual person, including any communication, learning, sensory or neurodevelopmental needs they have.
For current NHS guidance and routes to support, see NHS — Anxiety, fear and panic and NHS — Mental health services.
Helping children talk about anxiety
Children do not always have the words to say:
“I'm anxious.”
Instead of asking only:
“What's wrong?”
it may help to offer more concrete options:
“Does your tummy feel funny?”
“Does this feel scary, confusing or too much?”
“Would you like to tell me, draw it or show me?”
“Do you need help, space or more time?”
Visual scales, body maps, emotion cards and non-verbal communication options can help children communicate before anxiety becomes overwhelming.
Anxiety is not a choice
Nobody chooses to have their heart race.
Nobody chooses to feel sick before school.
Nobody chooses to lie awake worrying about something they desperately want to stop thinking about.
People can learn strategies for understanding and managing anxiety, but this is different from simply deciding:
“I won't be anxious anymore.”
Compassion and appropriate support are much more useful than telling somebody to try harder not to worry.
Remember
Everyone experiences anxiety sometimes.
Anxiety becomes a difficulty when it is persistent, intense or interferes with everyday life.
Anxiety can cause genuine physical symptoms.
Anxiety does not always look like fear.
Anger, avoidance, perfectionism and reassurance seeking can sometimes have anxiety underneath them.
Appearing calm does not necessarily mean feeling calm.
Behaviour can communicate distress.
Regulation often needs to come before reasoning.
Different people need different coping strategies.
Neurodivergent people may need anxiety support adapted to their individual needs.
And perhaps most importantly:
An anxious person is not choosing to make life difficult.
Their brain and body are trying to protect them. With understanding, appropriate support and environments that feel safer, that alarm system can gradually learn that it does not always need to be switched on. 💜