Anxiety is what happens when we feel lots of fear. Anxiety is a disorder of fear. It’s when the fear grips us and we start obsessing about things we’re frightened about. These might be things from our past or future. It’s a natural human response when we perceive that we are under threat. It can be experienced through our thoughts, feelings and physical sensations.

Most people feel anxious at times. It's particularly common to experience some anxiety while coping with stressful events or changes, especially if they could have a big impact on your life. But if some people get frightened then the fear subsides, for those with an anxiety disorder, the fear stays.

The anxiety happens when we’re in a constant ‘fight or flight’ response and our fear becomes far-reaching, chronic and severe.

Anxiety can become a mental health problem if it impacts on your ability to live your life as fully as you want to. It may be a problem for you if, for example:

Your anxiety is very strong or lasts for a long time

Your fears are out of proportion to the situation

You avoid situations that might cause you to feel frightened

Your fears feel distressing

Your fears are hard to control

You regularly experience panic attacks

You find it hard to do things you enjoy.

If you see your doctor, you might be diagnosed with a particular anxiety disorder. But it's also possible to be highly anxious without having a specific diagnosis.

Humans have evolved ways to help protect ourselves from danger. When we feel under threat our bodies react by releasing certain stress hormones, such as adrenaline and cortisol. These hormones help us feel more alert, so we can act faster by making our hearts beat faster, quickly sending blood to where it's needed most.

After we feel the threat has passed, our bodies release other hormones to help our muscles relax. This can sometimes cause us to tremble.

This is known as the ‘fight or flight’ response – it’s something that happens automatically in our bodies, and we have no control over it.

Anxiety can manifest itself in many ways. If your doctor decides your experiences meet specific criteria he/she could diagnose you with a specific anxiety disorder.

Generalised anxiety disorder (GAD) – when you have chronic and uncontrollable worries about many different things in your daily life. This can be quite a broad diagnosis, meaning that the problems you experience with GAD might be quite different from another person's experience.

Social anxiety disorder – this means you experience extreme fear triggered by social situations. Also known as social phobia. Here’s an article explaining more about social anxiety: https://www.alexandramassey.co.uk/post/how-social-anxiety-affects-your-life

Panic attack disorder is when you experience regular panic attacks without having a clear cause or trigger. This means you feel constantly afraid of having another panic attack, to the point that the fear of the panic attack itself can trigger more panic attacks.

Phobias are extreme fears triggered by a particular situation or a particular thing like snakes.

Obsessive-compulsive disorder, or OCD, is when your anxiety problems involve having repetitive thoughts, behaviours or urges.

Health anxiety – this means you experience obsessions and compulsions relating to illness, including compulsively researching symptoms or checking to see if you have them.

Post-traumatic stress disorder (PTSD) is a diagnosis you may be given if you develop anxiety problems after going through something you found traumatic. This can happen even if the traumatic event took place a long time ago.

Find out more about PTSD symptoms: https://www.alexandramassey.co.uk/post/what-are-the-most-common-post-traumatic-stress-disorder-symptoms

It's common to experience anxiety as well as other mental health problems, such as depression or suicidal thoughts. Prolonged anxiety can make it feel like life is extremely difficult to cope with and these thoughts can lead to feeling hopeless and depressed.

“As if someone let a hive of bees into my brain and they are manically buzzing through my whole body and there’s nothing I seem to be able to do about it.”

It’s different for everyone but there are some common themes where most people experience some of these:

Racing heart

Shaking

Sweating

Upset stomach

Being cautious

Unable to catch the breath

Trembling

Dry mouth

Intense fear or terror

Dizziness

A blank mind

Tense muscles

Everyone is different when it comes to how the mind works when you're highly anxious. However, here are the most commonly experienced feelings and thoughts:

Feeling constantly nervous

Unable to relax

Having a sense of dread

Fearing the worst

Feeling like the world is speeding up without you

Sensing the world is slowing down

Feeling like other people can see your anxiety

Sensing people are staring at you and noticing your anxiety

Fearing if you stop worrying, bad things will happen

Worrying about being anxious

Worrying about when the next panic attack might happen

Needing constant reassurance from other people

Worrying that people are angry with you

Worrying that you're losing touch with what’s really going on

Mind racing or thinking over and over again about something that’s happened or might happen

Feeling disconnected from your mind or body, as if you're watching someone else

Feeling disconnected from the world around you

The human body is designed to handle one off anxiety reactions but when the body is flooded with the stress hormones cortisol and adrenaline, there’s a payback. The body isn’t built to be constantly flooded with these hormones yet this is what happens when our over active anxiety response doesn’t quite calm down.

It’s like having your car stuck in first gear when you're driving down the motorway; sooner or later there’s going to be a pay back and that could be a serious forfeit. With that in mind, here are ways anxiety impacts your physical health.

1. Heart Problems

the anxiety response includes the heart pumping out more blood, faster, to get it to the areas of the body that need to respond to a threat. While this is generally reversible once trouble passes, for those with an ongoing anxiety disorder, the heart continues operating at an elevated level which can increase the risk of heart disease, heart attack, and stroke.

2. High Blood Pressure

Similar to heart concerns, as the heart works to pump more blood throughout the body, your blood pressure increases.

3. Asthma and Breathing Problems

studies have shown a strong correlation between anxiety and asthma especially because anxiety and panic for many people includes rapid breathing and tightened airways.

4. Stomach and Gastrointestinal Issues

Feeling sick is another common symptom of anxiety. Therefore, it’s no surprise that ongoing anxiety with little relief can lead to stomach and gastrointestinal issues. They say the second brain lives in the stomach so there is a definite correlation.

5. Insomnia

With anxiety, the likelihood of sleep problems persisting grows exponentially. Anxiety and this can lead to the onset or increase in anxiety disorders themselves. This is often because the physical symptoms of anxiety seem to be too bad to ‘just be anxiety.’

6. Blood Sugar Spikes

When the body releases stress hormones into the body during its flight-or-flight response, the liver produces more glucose, or blood sugar, to give the body a boost of energy. After the emergency passes, usually the body can simply absorb this extra blood sugar unless you're chronically anxious then this can lead to increased risk of diabetes.

Even though studies suggest that experiencing anxiety could increase the risk of developing long-term physical health problems, there's not enough evidence to say for sure exactly what the risks are, or what groups of people are most likely to be affected. Sometimes it might be difficult to work out whether your symptoms are totally related to anxiety, or something else.

Long term anxiety may impact other day-to-day aspects of your life, including:

- Holding down a job

- Trying new things

- Forming or maintaining relationships

- Looking after yourself

- Simply enjoying your leisure time.

A panic attack is a type of fear response. It’s an exaggeration of your body's normal response to danger, stress or excitement. It’s specifically the abrupt onset of intense fear or discomfort that reaches a peak within minutes.

Generally speaking, a panic attack includes at least four of the following symptoms:

- Palpitations, pounding heart, or accelerated heart rate

- Sweating

- Trembling or shaking

- Sensations of shortness of breath or smothering.

During a panic attack, physical symptoms can build up very quickly. It feels like you're:

- Losing control

- Going to faint

- Having a heart attack

- Going to die.

You might find that you become frightened of going out alone or to public places because you're worried about having another panic attack. This can develop into a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

They can happen during the day or night. Some people have one panic attack then don't ever experience another Some people have them regularly, or several in a short space of time. Certain places, situations or activities may seem to trigger panic attacks.

Most panic attacks last between 5–20 minutes. They can come on very quickly. Your symptoms will usually be at their worst within 10 minutes. If you experience symptoms of a panic attack over a longer period of time, this could be because you're having a second panic attack.

You may find yourself in a panic attack loop where you can’t sleep due to panic attacks and nightmares. But, when you do you're awake within the hour with heart palpitations, trembling and sweating.

Panic attacks can be scary but they won’t harm you and there are things you can do to help yourself cope. During a panic attack listen to this audio I’ve created:

This is when you have a lot of panic attacks at unpredictable times and there doesn't seem to be a specific trigger or cause. Your doctor may give you a diagnosis of panic disorder. Not knowing when you are going to have a panic attack can increase your general anxiety levels.

It’s super important to understand what causes anxiety. And unsurprisingly, it all starts with fear, fear of something you’ve seen heard or thought. Something stressful or scary. The fear kick-starts a reaction and that fear is always fear of the unknown - whether it’s real or imagined.

The brain listens to our fear, and when we indicate, we feel stressed or frightened; it knows we need help. This is a normal response by a normal healthy brain. It is the brain’s job to keep us alive. By jolting us into action, it’s fulfilling its role. Consequently, it kick-starts the adrenals, which shoot out a hormone called adrenaline.

This adrenaline acts as a supercharge, giving us extra strength for either fighting or fleeing. It can make us see better, respond faster, hear better, and become more aware of everything around us so we don’t miss anything that could be a threat.

This is called the “fight or flight” response.

However, when someone experiences a stressful event and the fear sends a distress signal to the brain, the changes happen so quickly that we aren't aware of them, and we don’t have control over it. In fact, the wiring is so efficient that the brain starts all this off even before the brain's visuals have had a chance to process what is happening fully. Imagine a car has just mounted the pavement, you jump out of the way even before you’ve thought about it.

As the initial surge of hormones subside and the threat passes, the hormones fall, and the nervous system puts on the brakes and dampens the stress response.

However, for many of us, these brakes often don’t get jammed on because we’re in a constant loop of the fight or flight response.

Difficult experiences in childhood, adolescence or adulthood are a common trigger for anxiety. Going through trauma is likely to have a particularly big impact if it happens when you're very young. It’s in our childhood that we are most likely to form our coping mechanisms.

Things that may have affected us in childhood may be:

Physical or emotional abuse

Neglect

Losing a parent

Being bullied or being socially excluded.

Having a parent or main carer with anxiety problems increases your chances of experiencing anxiety problems yourself simply because you learned to be anxious as a coping mechanism. This make us more vulnerable to developing anxiety as an adult; we naturally lean towards it as a coping mechanism simply because that’s what we were taught.

Current issues or problems in your life can definitely trigger anxiety especially if you feel helpless. For example:

Exhaustion or a build-up of stress

Long working hours

Losing your job

Feeling under pressure while studying or in work

Having money problems

Homelessness or housing problems

Losing someone close to you

Feeling lonely or isolated

Being bullied, harassed or abused.

Other health problems can sometimes cause anxiety, or might make it worse. For example:

Physical health problems like if you’re living with a serious, ongoing or life-threatening physical health condition can sometimes trigger anxiety.

Other mental health problems can happen if you're suffering from other mental health problems like depression.

Anxiety can sometimes be a side effect of taking some prescribed or recreational drugs.

Some types of food or drink can trigger symptoms of anxiety or panic, or make them worse, specifically sugar and caffeine.

I recovered from severe anxiety without medication and I believe for many people this is also possible.

Here’s a link to my Beat Anxiety Programme which will take you through a 30-day course to help yourself overcome anxiety.

Talking to someone you trust about what's making you anxious might be a relief. It may be that just having someone listen to you and show they care can help in itself. However, if you are in need to share about your anxiety all the time just to get some relief, you may need to find other ways to tackle to core anxiety cycle.

It can be really hard to stop worrying when you have anxiety. You might have worries you can't control. Or you might feel like you need to keep worrying because it feels useful – or that bad things might happen if you stop.

And then there is the mind racing which takes each worry and obsesses about it over and over again.

One technique for dealing with worry is a technique called ‘labelling.’ It’s a very simple technique. Whenever you find yourself worrying about something, note to yourself that you’re “just worrying.” You are labelling the worry with a note that says ‘just another worry.’

By doing this you become present as the witness of your thoughts instead of being completely taken over by them. You now have the power to choose to let it go. After you label it turn your focus to your breath or just simply bring your attention into the present moment and what you’re doing. Every time you catch yourself worrying—no matter how often—you employ the technique again.

Work on getting enough sleep. Sleep can give you the energy to cope with anxiety. Pay attention to your diet. Eating regularly and keeping your blood sugar stable can make a difference to your mood and energy levels. Take up a regular physical activity. Exercise can be really helpful for your mental wellbeing.

Breathing exercises can help you cope and feel more in control. Here’s my favourite.

Pretend you have a mug of hot chocolate in your hands. Smell the warm chocolatey smell for three, hold it for one, blow it cool for three, hold it for one. Repeat three or four times.

However, mindfulness can help. At least, I’ve found it extremely beneficial.

It teaches you to pay attention to the moment which turns down the volume in your mind by coming back to the body.

Don’t worry, you don’t have to spend an hour’s pay on a class or contort your body into difficult positions. You likely already have all the tools you need to practice mindfulness.

Try this: set a timer for three minutes and give one task your full and undivided attention. No checking your phone, no clicking on notifications, no browsing online — absolutely no multitasking. Let that one task take centre stage until the timer goes off.

It can help to make a note of what triggers your anxiety or panic attacks. By doing this on a regular basis, you tend to find a pattern in what triggers the anxiety or help you notice early signs that’s the anxiety is about to take off.

It’s also important to see the pattern for what goes well. For example, you could keep a photo diary of all the things you’ve managed to achieve. Whether you’ve attended a presentation, got yourself on and off the bus or even managed just to get outside, having a Picture diary will help you when you are feeling scared and encourage you to do it again.

Peer support brings together people who’ve had similar experiences to support each other. Some people find this helps because listening to others who know how they feel helps them seem less isolated and unusual. However, many people find it does not help to be in a group and this might increase their anxiety.

Everybody is different and it’s a case of trying it out and seeing if it’s something for you.

There are many different types of complimentary or alternative therapies that can help with anxiety. These include yoga, meditation, aromatherapy, massage, reflexology, herbal treatments, Bach flower remedies, hypnotherapy and many more. It’s a case of trying each one out to see if they work for you.

A self-help treatment maybe the first treatment option your doctor offers you because it's available quite quickly, and there's a chance it could help you to feel better without needing to try other options.

For example, my Beat Anxiety Programme is one you do by yourself but there’s lots of support if you need it. Here’s more details:

You might be offered a resource to work through your own, or on a course with other people who experience similar difficulties.

Basically, talking treatments are counselling or coaching. There are some resources through the NHS, specifically cognitive behavioural therapy (CBT). CBT teaches you how to focus on your thoughts, beliefs and attitudes and to see how they affect your feelings and behaviour. It then teaches you coping skills for dealing with different problems. In an ideal world, it can take some time to keep going back to re-condition your mind so that you think differently.

There are several types of medication available for anxiety. These include:

Antidepressants. Usually this will be a type called a selective serotonin reuptake inhibitor (SSRI), but these drugs can sometimes cause side effects such as sleeping problems or feeling more anxious than you did before. If SSRIs don't work or aren't suitable you may be offered a different kind called a tricyclic antidepressant.

Pregabalin. In some cases, such as if you have a diagnosis of generalised anxiety disorder (GAD), your doctor may decide to prescribe you a drug called pregabalin. This is an antiseizure drug which is normally used to treat epilepsy (a neurological disorder that can cause seizures), but is also licensed to treat anxiety.

Beta-blockers. Beta-blockers are sometimes used to treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations and tremors (shaking). However, they are not psychiatric drugs so they don’t reduce any of the psychological symptoms. They may be helpful in certain situations, such as if you have to face a phobia.

Benzodiazepine tranquillisers. If you experience very severe anxiety that is having a significant impact on your day-to-day life, you may be offered a benzodiazepine tranquilliser. But these drugs can cause unpleasant side effects and can become addictive, so your doctor should only prescribe them at a low dose for a short time, to help you through a crisis period.

The first step is to visit your doctor who will do an assessment.

They should then explain your treatment options to you, and you can decide together what might suit you best. Before deciding to take any drug, it's important to make sure you have all the facts you need to make an informed choice.

For talking treatments, NHS waiting lists can be very long. If you're finding it hard to access talking treatments you might consider other alternatives. Again, my course Beat Anxiety Programme is a brilliant way to start calming your anxiety symptoms.

Alternatively, there are charities and specialist organisations that may offer therapy or be able to put you in touch with local services.

Finding a private therapist is another option some people choose to explore, but it's not suitable for everyone because it can be expensive.

Yes, But What If My Anxiety Stops Me From Getting Help?

It may be hard for you to access treatment if leaving the house or attending an appointment makes you anxious. There are alternative ways you can get help.

You can ask your doctor if they will assess you by phone or even come to your house. You may want to get someone else to make the appointment for you but you will have to give your consent to make that happen. Alternatively, you can self-refer for talking therapies at a local Improving Access to Psychological Therapies (IAPT) service. Some IAPT services are delivered over the phone.

If you are seeing your doctor, they should offer you regular appointments to check how you're doing. They should also be looking at how well any treatment is working for you. Different things work for different people, so if a particular medication or talking treatment doesn't work for you, your doctor should offer an alternative.

If you've tried a range of treatments and none of them have helped, you may be referred to a different department like the community mental health team (CMHT). This is made up of a number of different healthcare professionals, such as psychiatrists and clinical psychologists. Your CMHT can assess you separately and offer you a personalised treatment plan.

It's important to remember that recovery is a journey, and it won't always be straightforward. You might find it more helpful to focus on learning more about yourself and developing ways to cope, rather than trying to get rid of every symptom of your anxiety problem.

First and foremost, don't pressure them. It's really important to be patient, listen to their what they're asking for and take things at a pace that feels okay for them.

It's understandable to want to help them face their fears or find practical solutions, but it can be very distressing for someone to feel they're being forced into situations before they feel ready. This could even make their anxiety worse. Their fear is not necessarily your fear.

Try to remember that being unable to control their worries is part of having anxiety, and they aren't choosing how they feel. Trying to argue the case with logic does not help. What does help is accepting that they are anxious and they are suffering with anxiety symptoms.

Compassion and listening goes a long way.

Here’s how I describe depression in my book ‘Beat Depression And Reclaim Your Life”:

Depression is described in the dictionary as being ‘low in spirit; downcast’. What it actually feels like is that a cloud of lead particles has settled on the soul. It is the heaviest weight we are ever going to feel. It is also the most stubborn of feelings and it can drive a person to despair. It sears our very essence and dirties our vision. It has the lightness of a gas but the weight of a concrete overcoat. It seeps into every crevice of our being.

When we are depressed we cannot be bothered with our own potential. We cannot lift our heads enough to see that we have true value in the world. We cannot give ourselves in close relationships because we become absent in the company of those we love. We care less about how we look, or else we overdo it when we go out to act as a mask to the world. We stumble through the day trying to find some meaning to the feelings that ravage us. We lose our motivation to pursue our true vocation and, in so doing, compromise our soul.

We feel like victims – buffeted by the rough winds of life. We cannot grasp onto anything that is solid in order to pull ourselves out of the storm. Either we see nothing but unfairness or we stoop to self-loathing and believe we deserve nothing better. We lose our sense of reason and we are unable to take an objective view on our circumstances and address what is fact and what is fiction.

There’s a line you cross from ‘low mood’ to depression. When you suffer from a low mood, it may feel all-encompassing at times. But you will also have moments when you are able to laugh or be comforted. Depression differs from low mood. The feelings you have will affect EVERY aspect of your life. It may be hard or even impossible to find enjoyment in anything, including activities and people you used to enjoy. You’ll experience constant feelings of sadness. Suicidal thoughts are also a sign of depression, not low mood.

Some symptoms of depression that I included in my book “Beat Depression And Reclaim Your Life” are:

• Overwhelming tiredness

• Insomnia • Self-loathing • Rage

• Immense sadness • Inability to do anything worthwhile • Feeling dead • Feeling stuck • Feeling isolated • Harming ourselves • Feeling lonely • Thoughts of suicide • Not caring whether others like us or not

• Having no feelings – numbed

• Eating junk • Smoking • Sabotaging friendships

• Behaving violently • Stealing • Drug and alcohol abuse • Gambling to excess • Being obsessive about sex

• Losing all interest in sex • Abusing children • Compulsively cleaning • Self harm

Doctors use the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5 criteria) to help determine if someone has low mood or is depressed. You may receive a diagnosis of depression or persistent depressive disorder if you meet the criteria.

The DSM-5 criteria include nine potential symptoms of depression. The severity of each symptom is also weighed as part of the diagnostic process. The nine symptoms are:

Feeling depressed throughout each day on most or all days

Lack of interest and enjoyment in activities you used to find pleasurable

Trouble sleeping, or sleeping too much

Trouble eating, or eating too much, coupled with weight gain or weight loss

Irritability, restlessness, or agitation

Extreme fatigue

Unwarranted or exaggerated feelings of guilt or worthlessness

Inability to concentrate or make decisions

Suicidal thoughts or actions, or thinking a lot about death and dying

Early childhood or teenage trauma

Inability to cope with a devastating life event, such as the death of a child or spouse, or any situation that causes extreme levels of pain

Low self-esteem

Family history of mental illness, including bipolar disorder or depression

History of substance abuse, including drugs and alcohol

Lack of family or community acceptance for identifying as lesbian, gay, bisexual, or transgender (LGBT).

Trouble adjusting to a medical condition, such as cancer, stroke, chronic pain, or heart disease

Trouble adjusting to body changes due to catastrophic injury, such as loss of limbs, or paralysis

History of prior mental health disorders, including anorexia, bulimia, post-traumatic stress disorder (PTSD), or anxiety disorder

Lack of a support system, such as friends, family, or co-workers

Seasonal affective disorder (SAD) – depression that occurs at a particular time of year, or during a particular season. See our page on SAD for more information.

Dysthymia – continuous mild depression that lasts for two years or more. Also called persistent depressive disorder or chronic depression.

Prenatal depression – depression that occurs during pregnancy. This is sometimes also called antenatal depression.

Postnatal depression (PND) – depression that occurs in the weeks and months after becoming a parent. Postnatal depression is usually diagnosed in women, but it can also affect men.

Premenstrual dysphoric disorder (PMDD) a severe form of premenstrual syndrome. PMDD is not a type of depression, but most women who experience PMDD find that depression is a major symptom.

You will feel some of the following:

Very down

Upset

Tearful

Restless or irritable

Guilty

Worthless

Down on yourself

Numb

Isolated

And unable to relate to other people

No pleasure in life or things you usually enjoy

A sense of disconnection from normal life

Low self-esteem

Hopeless

Despairing

Suicidal.

They may do some or all of the following:

Avoid social events and activities they usually enjoy

Self-harm

Exhibit suicidal behaviour

Can't make decisions

Can't think clearly

Lose interest in sex

Difficulty remembering things

Using more alcohol or other drugs than usual

Difficulty sleeping

Sleeping too much

Feeling exhausted all the time

Eating too much and gaining weight

Physical aches and pains

With no obvious physical cause

Move slowly

Feel agitated

Severe depression can include experiencing some psychotic symptoms. These can include delusions, such as paranoia or, hallucinations, such as hearing voices.

These are likely to be linked to your depressed thoughts and feelings. For example, you might become convinced that you've done something terribly wrong. These kinds of experiences can feel very real to you at the time, which may make it hard to understand that these experiences are also symptoms of your depression. They can also be quite frightening or upsetting, so it's important to seek treatment and support.

You might feel worried that experiencing psychotic symptoms could mean you get a new diagnosis, but psychosis can be a symptom of depression. Discussing your symptoms with your doctor can help you get the right support and treatment.

Here’s an excerpt from my book “Beat Depression And Reclaim Your Life”

Thoughts of suicide

“Some of us are frightened that if we surrender then we may not survive. These words are for you.

In our most depressed state of being we can experience thoughts of suicide. We may feel ravaged by the world and think that the only way out is to stop living. Surrendering to our depression in this state may seem like a foolish thing to do. But running from these thoughts may harm us more because it is the running that wears us down. We become too foggy- headed to make clear judgements.

Thoughts of suicide can hit us for two main reasons: either the pain is too much for us to bear or we are so enraged with other people that we want to punish them. In either case we have given up trying to protect ourselves because we have failed in the past. We feel backed into a corner and there seems no other alternative. All reason has gone and we are at a loss to see any other option but to take our life and end the suffering.

It is at this point that we don’t want anyone else to try to talk us out of the way we feel. When we have suicidal thoughts, people may say things like this:

‘Oh, come on, it’s not that bad’

‘Don’t be silly, you don’t really want to do that’

‘Pull yourself together, you’re talking like an idiot’

When we hear those kinds of comments we want to show them exactly what we mean. It can fuel the desire to commit suicide even more and become very, very unhelpful.

If you have thoughts of suicide, surrender to the feelings that lay behind the thoughts. A technique to help you do this is to look down to the floor. This will help you to ‘feel’ whereas looking upward helps you to ‘think’.

Behind your thoughts lies the utmost pain that any human has to bear. You might feel the intensity of human degradation, the devastating pain of loss or the wretchedness of a lifetime’s neglect. You might feel your spirit has dried up and your essence has been ripped away. You might feel like a ‘nothing’ or a ‘very bad person’. You might sense that everything you touch, you damage. You will probably be living in a dark tunnel. You might hate every part of you as much as you hate others. You might feel a desire to injure others as you have been injured. You might want to destroy others as you have been destroyed.

You might simply be lost.

Whatever the passion is, then just for today stay with the feelings and ignore the thoughts or the action.

Just for today hold yourself around the tummy as you recognise the emotions behind the thinking.

In this moment acknowledge that you feel so bad that you want to end your life. Don’t do anything else except surrender into it. Tomorrow you can take action, but just for today, surrender. Hold your hands up and give in to the feelings. Say out loud, ‘I surrender’.“

Here's a link to a blog post about this: https://www.alexandramassey.co.uk/post/what-causes-suicidal-thoughts

Self-harm is very common when you are feeling depressed. Self-harm can be classified as behaviour that’s not good for you. For example, you may start smoking more or eat more junk food.

In terms of actually harming yourself, through cutting yourself, this is a behaviour that is often trying to get the same effect as smoking pack cigarettes or eating a tub of ice cream. These are all things we do to cope with difficult feelings by attempting to numb them. Of course, these behaviours bring us temporary relief from our depression but only add to our distress in the long-term.

Please read more about self-harm here: https://www.alexandramassey.co.uk/post/is-self-harm-attention-seeking

If you're worried about acting on thoughts of suicide, you can call an ambulance, go straight to A&E or call the Samaritans for free on 116 123 to talk.

It’s really normal to feel like isolating when you are depressed. For some people this can be a life saver because curling up in bed and being alone with the depression can feel very soothing. For others, however, this can feel like cutting yourself off from available support.

If you feel you need support but you’re isolating, it is really important to reach out. There are loads of options available and you will find a list of organisations to contact at the end of these questions.