Axe Anxiety

What is Anxiety?

The best way to understand anxiety is to compare it to fear. Anxiety can be distinguished from fear in several ways.

When you are afraid, your fear is usually directed towards a concrete external object or situation. The 'thing' that you fear is usually within the bounds of possibility, such as having a serious car accident, or being mugged while out walking in an unsafe area.

The focus of anxiety, on the other hand, is usually more internal than external, and is often about something that you can't quite specify - you just don't know what it is you are anxious about. Anxiety seems to be an internal response to some vague, distant or unrecognized danger, such as 'losing control' of yourself or a situation, or of 'something bad happening'.

Anxiety affects your whole being - it is a physiological, behavioural and psychological/cognitive reaction all at that same time. On a physical level, anxiety may include bodily reactions such as rapid heartbeat, muscle tension or sweating. On a behavioural level, it can sabotage your ability to act, express yourself, or deal with certain everyday situations. On a psychological/cognitive level, anxiety is a subjective state of apprehension and uneasiness. At its most extreme, it can cause you to feel detached from yourself or think that you are going crazy.

It is useful to know the symptoms of anxiety so that you can get appropriate help either for yourself or a colleague, friend or family member.

Symptoms of Anxiety 

Anxiety manifests itself in three ways: 

1. In your thoughts (Cognitive symptoms)
   Thoughts may range from mild worry to panic. For example;
   - Mild anxiety-evoking thoughts dealing with themes such as misfortune, financial concerns, academic and social performance, rejection.
   - Terrifying thoughts such as dying of suffocation, catastrophe befalling a family member, fear of losing control over bodily functions.
2. In your actions (Behavioural symptoms)
   Usually the person avoids anxiety-provoking situations, for example, they do not go up high places, or travel in a plane. The person may even stay at home, afraid to go out at all. 
3. In your body (Physiological symptoms)
   Our body can manifest anxiety in a variety of ways, e.g. shallow breathing, mouth dryness, cold hands and feet, diarrhoea, frequent urination, fainting, heart palpitations, high blood pressure, sweating, indigestion, tender muscles (especially neck, shoulders and chest)

All of these can be symptoms of normal or abnormal anxiety (an anxiety disorder) – it depends on the intensity, frequency and duration of the symptoms.

Normal anxiety versus abnormal anxiety

It is important to realise that there are many situations in everyday life where it is appropriate and reasonable to react with some anxiety. If we didn't feel any anxiety in response to an everyday threat involving potential loss or failure, then something would be wrong.

This kind of anxiety is a good thing – it keeps us on our toes and stops us from ignoring danger. It can also motivate us to do the things we have to do. We could call this "normal" anxiety, and we all experience this kind of anxiety during the course of our lives. In terms of intensity, normal anxiety is mild to moderate anxiety and we can use our problem-solving skills to cope. We can control the anxiety with a variety of techniques, including relaxation. There may be some minor interference with daily life, but nothing major. Learning from experience can occur with normal anxiety.

Characteristics of normal anxiety:

• Appropriate to the threat.
• The anxiety can be relieved using various techniques.
• The affected person can cope with the anxiety.
• Problem solving abilities may be slower, but are still functional.

Abnormal anxiety is distinguished from everyday, normal anxiety in that it involves anxiety that:

• Is more intense (for example panic attacks),
• Lasts longer (anxiety may persist for months instead of going away after the stressful situation has passed.) or
• Has greater frequency.

Abnormal anxiety interferes in our lives to a much greater extent then normal anxiety, impairing the way we function. The anxiety is disproportionate to the threat, and can be so great that it blocks learning from experience.

Characteristics of abnormal anxiety:

• Anxiety reaction is disproportionate to the threat
• The anxiety is very difficult to relieve on our own.
• We need help to cope with the anxiety.
• The anxiety severely interferes with our ability to problem solve.

When anxiety causes a person such distress they may seek help. Unfortunately, too many people just suffer in silence - not recognising that they actually have an anxiety disorder that can be treated.

Anxiety Disorders

There are a number of different Anxiety Disorders, each with their own set of symptoms (or criteria). At the basis of all Anxiety Disorders, however, is an overwhelming, unrealistic and irrational fear. The anxiety has a negative and restrictive effect on the person suffering from the Anxiety Disorder. Often the object or source of the fear is uncertain and cannot be identified. In some Anxiety Disorders, such as phobias, where the object or situation of fear can be identified, the fear is irrational and far more intense than you would expect.

This pathological fear results in illogical behaviour and thought patterns. It can cause problems in social and work situations and/or causes a lot of discomfort to the sufferer.

Although people with Anxiety Disorders are aware that their feelings of anxiety are irrational and destructive, they still have no control over them. It does not help to tell the person to "stop being silly" or that "there is nothing to worry about" - they already know this, but it does not change their inability to control the anxiety. It does not help to tell the person to "face their fears" and "get on with it." When you are dealing with an anxiety disorder, forcing the person into the situation they fear will only cause greater anxiety and do harm.

Types of Anxiety Disorders

There are many different anxiety disorders. They include:

• Panic Disorder (Unexpected panic attacks)
  • Without Agorapobia* 
  • With Agoraphobia

• Phobias – there are three categories of phobia
  
  • *Agoraphobia - Anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms. 
  • Specific phobias - e.g. animals, blood, heights
  • Social phobia - Anxiety about social or performance situations

• Obsessive – Compulsive Disorder  (Obsessions, which cause the anxiety and compulsions, which then neutralise the anxiety)

• Generalised Anxiety Disorder (Continuous and excessive anxiety and worry about lots of different everyday things)

• Post Traumatic Stress Disorder (After an extremely traumatic event, when the person re - experiences the event and avoids stimuli associated with the event). Refer to my article on Trauma for more information about PTSD.

• Acute Stress Disorder (Similar to PTSD, but symptoms have a shorter duration)

Both Panic Disorder and Phobias involve panic attacks, so it is useful to know what a panic attack is and be able to indentify the symptoms.

What is a Panic Attack?

A panic attack is a period of intense fear or discomfort, which occurs suddenly, often in familiar places, where there is seemingly nothing actually threatening the individual. When the attack comes, it feels as if there is a real threat, and the body reacts accordingly with a range of physical symptoms.

The discomfort and sense of danger the attack brings is so intense that individuals experiencing a panic attack often believe they are having a heart attack, have some other life-threatening illness or are "going crazy."

It is common for individuals who are having a panic attack to seek help at a hospital casualty ward.

Panic Attack Symptoms

A panic attack is accompanied by four (or more) of the following symptoms which develop abruptly and reach a peak within 10 minutes.

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal stress
8. Feeling dizzy, unsteady, lighthearted or faint
9. Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias (numbness or tingling sensations)
13. Chills or hot flushes

This barrage of symptoms usually only lasts for a few seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour.

There are three characteristic types of Panic Attacks:

1.  Unexpected (uncued) Panic Attacks – These panic attacks occur "out of the blue." They are not associated with situational triggers. (The individual has no idea what causes the Panic Attack) 
2.  Situationally bound (cued) Panic Attacks – These panic attacks almost invariably occur immediately on exposure to, or in anticipation of, the situational trigger or cue. If a person is afraid of spiders, for example, they will always have an immediate Panic Attack whenever they see a spider, or even just think that they might see one. 
3. Situationally predisposed Panic Attacks – These Panic Attacks are more likely to occur on exposure to a situational cue or trigger, but are not invariably associated with the cue and do not necessarily occur immediately after the exposure. (There may be a delay or sometimes there may be no attack at all).

"On the spot" tips to help you get through a Panic Attack

• Stop what you are doing and slow down. Slow down your breathing - do a deep breathing exercise - slow down your racing thoughts, slow down your whole body from head to toe. Then slowly resume what you were doing. (Read about the deep breathing exercise in my article "Stressed To Kill"
• Remind yourself that a Panic Attack always ends. Always.
• Remind yourself that a Panic Attack is not dangerous
• Use your imagination to picture a relaxing scene that incorporates all your senses. What do you see, hear, smell, feel and taste? Put yourself into that scene.
• Picture a person you trust, someone who cares about you, believes in you and supports you. Imagine that person is with you offering encouragement.
• Recall a past success and the good feeling it gave you at the time. Try to re-experience that feeling.
• If it is possible, take a stroll.
• If there are people around, talk to someone.
• Count backwards from 20 and with every number, picture a different image of something calm and soothing. These could be real or imagined images.
• Occupy your mind with an absorbing task – plan your dream holiday, think of names of songs that begin with every letter of the alphabet, plan your schedule for the day/evening/ week.
• Focus on the present, on the objects around you. Make a game of noticing details.
  
  

A Panic Attack is not a disorder in itself – rather it forms part of the criteria to diagnose other anxiety disorders such as Panic Disorder and Phobias.

Panic Disorder

The core feature of Panic Disorder is recurrent, unexpected Panic Attacks.

At least one of the attacks has been followed by one month (or more) of the following:

• Constant concern about having more attacks
• Worry about the implications or consequences of the attack (e.g. losing control, having a heart attack or 'going crazy')
• A significant change in behaviour related to the attacks

People with Panic Disorder do not know what causes the panic attacks and so cannot avoid them.

They never know when a panic attack is going to happen. Because of this, some individuals start to discontinue activities that seem to trigger panic attacks, such as going to the park, driving, riding in elevators, or doing anything that brings on frightening body sensations. While avoidance may temporarily help with the fear of the attack and loss of control, it makes normal life nearly impossible. It also does not stop the attacks from occurring. Some individuals thus avoid everything and do not go out at all. This is called Agoraphobia (see above definition).

Do you have Panic Disorder?

Take this quick test and see what your answers reveal.

Phobias

The word phobia comes from the Greek word that means "fear." A phobia is a strong, persistent and unwarranted fear of some specific object or situation. An individual with a phobia experiences situationally bound (cued) panic attacks  

There are three types of phobias:

Agoraphobia

Agoraphobia is NOT a fear of wide-open spaces. It is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms. Agoraphobia is a severe form of phobic avoidance and can cause those with panic disorder to avoid public places, crowds, or traveling by bus or plane. This pattern may progress to the point that the sufferer will not leave home.

Specific phobias

An extreme or excessive fear of an object or situation that is generally not harmful. Individuals know their fear is excessive, but they cannot overcome it. Examples of objects or situations that may trigger a Panic Attack are flying, spiders, animals, blood, heights, receiving an injection.

Social phobia (also called Social Anxiety Disorder)

The essential feature of Social Phobia is significant fear of social or performance situations in which the individual is exposed to unfamiliar people or possible scrutiny by others. The individual fears that they will act in a way that will be humiliating or embarrassing. Common examples are public speaking, meeting people, or using public restrooms.

With phobias, the person knows what causes the panic attacks and so can avoid those situations/ things that will "bring on" an attack. Attempts to avoid the object or situation, however, may significantly interfere with the individual's life. Adults with this disorder realise that their fear is excessive, but children may not.

Nearly anything can become a focus of intense fear. There is even a fear of phobias, called phobophobia!

Some of the lesser known and amusing (as long as you don't suffer from them!) phobias include:

Arachibutyrophobia – fear of peanut butter sticking to the roof of your mouth

Bogyphobia – fear of the bogeyman

Chorophobia – fear of dancing

Consecotaleo – fear of chopsticks

Dementophobia – fear of insanity

Ephebiphobia – fear of teenagers

Ergophobia – fear of work

Genuphobia – fear of knees

Hippopotomonstrosesquipedaliophobia- fear of long words.

Logizomechanophobia- fear of computers

Manophobia – fear of being alone

Omphalophobia – fear of belly buttons

Peladophobia – fear of bald people

Pentheraphobia – fear of mother-in-law

Philemaphobia – fear of kissing

Pogonophobia – fear of beards

Topophobia – fear of performing

Obsessive – Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which time-consuming (more than one hour a day) obsessions and compulsions significantly interfere with a person's routine, making it difficult to work or to have a normal social life.

Obsessions

Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and which cause marked anxiety or distress.

People with OCD recognise that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable. Yet these intrusive thoughts cannot be settled by logic or reasoning. Most people try to ignore or suppress such obsessions, or neutralise them with some other thought or action (i.e. a compulsion).

The most common obsessions are

• Repeated thoughts about contamination (e.g. becoming contaminated by shaking hands)
• Repeated doubts (e.g. wondering whether one has performed some act such as locking the door
• A need to have things in a particular order (e.g. intense distress when objects are disordered)
• Aggressive or horrific impulses (e.g. to hurt one's child or shout an obscenity in church)
• Repeated sexual imagery (e.g. a pornographic image)

Compulsions

Compulsions are repetitive behaviours (e.g. hand washing, ordering or checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession. The goal of compulsions is prevent or reduce anxiety or distress, not to provide pleasure or gratification.

In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Compounding the anguish these rituals cause is the knowledge that the compulsions are irrational. Attempting to resist a compulsion however, only leads to a mounting anxiety or tension that is only relieved by yielding to the compulsion.

Generalised Anxiety Disorder (GAD)

The essential feature of Generalised Anxiety Disorder is excessive anxiety and worry, occurring more days than not for a period of at least 6 months, about a number of events or activities. The affected person finds it difficult to control the worry.

The anxiety and worry are associated with three (or more) of the following symptoms:

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating, or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Panic attacks are not a feature of Generalised Anxiety Disorder.

Adults with Generalised Anxiety Disorder often worry about everyday, routine life circumstances such as job responsibilities, finances, health of family members, misfortune to their children, or minor matters such as household tasks, car repairs or being late for appointments.

Usually the impairment associated with Generalised Anxiety Disorder is mild and people with the disorder do not feel too restricted in social settings or at work. Unlike many other anxiety disorders, people with Generalised Anxiety Disorder do not characteristically avoid certain situations as a result of their disorder. However, if severe, Generalised Anxiety Disorder can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

Do you have Generalised Anxiety Disorder?

Not everyone suffering from anxiety will actually have one of these disorders, but their symptoms will never the less be very distressing to them. It is not so important to label the person (diagnose them with a specific type of Anxiety Disorder), but rather to recognise that they do have some symptoms of anxiety. If you recognise that someone has one of these disorders, you should refer them to a psychologist or counsellor who is qualified to treat them.

How to stop obsessive worry

Obsessive worry is like a negative downward spiral – the more you worry the deeper into it you get, and the more difficult it is to stop worrying. It takes a conscious act of will to stop it. You need to deliberately "get out of your head" and engage in something else, such as a physical activity, interpersonal communication, expressing emotions or some sensory distraction.

Although deliberately choosing to break out of the obsessive thinking may be difficult at first (especially if you are highly anxious), it gets easier with practice. Below are some examples of activities and experiences you can engage in to help stop obsessive worrying.

• Do physical exercise – this can include sport, gym, housework or dancing.
• Talk to someone – about something other than the worry, unless you want to express your feelings about it.
• Use visual distractions – TV, movies, uplifting reading or your computer.
• Use sensory-motor distraction – arts and crafts, repairing something, gardening.
• Find an alternative positive thing to think about – work out a crossword or jigsaw puzzle, do a Sudoku puzzle
• Do a progressive muscle relaxation exercise- keep it up until you feel fully relaxed and free of worrying thoughts.
• Use evocative music to release repressed feelings – these feelings (usually sadness or anger) may 'drive' obsessional thinking.
• Combine abdominal breathing with a positive affirmation that has personal significance – Keep this up for 10 – 15 minutes, or until you are fully relaxed.

Examples of affirmations are:
      "I can let it go"
      "I am relaxed and free of worry."
      "I know and understand that this shall pass"
      "These are just thoughts they are fading away"

For the spiritually inclined...

      "Let go and let God"
      "I abide in God (spirit)
      "I release this negativity to God"

Causes of anxiety

If you are dealing with an anxiety disorder it is only natural to ask yourself the question "Why?" but it is important to bear in mind that knowing what causes your anxiety does not necessarily cure your anxiety.

Knowing the cause of your anxiety is also not necessary to overcome your anxiety. Many of the strategies used to overcome anxiety - such as relaxation, exercise, desensitisation, changing self-talk and mistaken beliefs, and dealing with feelings - do not depend on a knowledge of what causes the anxiety to be effective.

It is also important to be wary of the idea that there is any one cause for an anxiety disorder and that by removing that cause, your anxiety will be cured.

Anxiety disorders are brought on by a variety of causes working on numerous different levels. These levels include heredity, biology, family background and upbringing, conditioning, recent stressors, your self-talk and personal belief system, your ability to express feelings, and so on.

Generally the thinking today accepts the Diathesis Stress Model which states that predisposing factors and precipitating factors influence each other and result in the anxiety disorder, which is then maintained by various other factors.

Diathesis Stress Model

An outline of the causes of anxiety disorders according to the Diathesis Stress Model is presented below:

I. Long-Term, Predisposing Factors

A. Heredity

B. Childhood Circumstances

      1. Your parents communicate an overly cautious view of the world

      2. Your parents are overly critical and set excessively high standards

      3. Emotional insecurity and dependence

      4. Your parents suppress your self-assertiveness

C. Cumulative stress over time

II. Biological Factors

A. Physiology of panic

B. Panic attacks and the Noradrenergic Hypothesis *

C. Generalised anxiety and the GABA / Benzodiazapine Hypothesis *

D. Obsessive-compulsive disorder and the serotonin hypothesis *

E. Medical conditions that can cause panic attacks or anxiety

III. Short-Term, Precipitating (Triggering) Factors

A. Stressors that precipitate panic attacks

      1. Significant personal loss

      2. Significant life change

      3. Stimulants and recreational drugs

B. Conditioning and the origin of phobias

C. Trauma, simple phobias and Post-Traumatic Stress Disorder

IV. Maintaining Causes

A. Avoidance of phobic situations

B. Anxious self-talk

C. Mistaken beliefs

D. Withheld feelings

E. Lack of assertiveness

F. Lack of self-nurturing skills

G. Muscle tension

H. Stimulants and other dietary factors

I. High-stress lifestyle

J. Lack of meaning or sense of purpose

* For more detailed information on these hypotheses, please keep an eye out for a forthcoming article explaining them in more detail.

Source: The Anxiety and Phobia Workbook (2nd Ed.) Edmund J. Bourne. New Harbinger Publications, Inc. California. 1995

Treatment Considerations

When it comes to anxiety disorders, there are a number of treatments that can be used. (They have all proven to be effective to some sufferers some of the time, but none of them have been effective to all sufferers all of the time!)

The fact that anxiety manifests itself in three ways - in your thoughts (Cognitive symptoms), in your body (Physiological symptoms) and in your actions (Behavioural symptoms) has important implications for treatment. A treatment programme should intervene at all three levels to:

• Reduce physiological reactions
• Eliminate avoidance behaviour
• Change thinking patterns (self-talk)

All of these perpetuate a state of apprehension and worry.

Options to consider are:

Psychotherapy

This is also known as "talk therapy" because the individual and the psychologist, or counsellor, work together to uncover emotional conflicts that may underlie the anxiety. By talking about these conflicts and gaining a better understanding of them, the individual is helped to overcome their difficulties.

There are a number of different psychotherapeutic approaches. When it comes to treating anxiety, the two most common therapies are:

Psychodynamic Therapy

Psychodynamic therapy focuses on events of the past and making the patient aware of the ramifications of long-buried issues.

Cognitive – Behavioural Therapy (CBT)

This is a combination of cognitive therapy - which aims to modify or eliminate thought patterns contributing to the individual's symptoms - and behavioural therapy, which aims to help the individual to change his or her behaviour.

Cognitive-Behavioral therapy is considered by many to be a very effective approach for treating anxiety disorders.

Support groups and other social institutions offer further support and encouragement.

Pharmacotherapy (Treatment with medication)

Medications, although not cures, can be very effective at relieving anxiety symptoms. Today, thanks to research, there are more medications available than ever before to treat anxiety disorders, so if one drug is not successful, there are usually others to try. In addition, new medications to treat anxiety symptoms are under development.

As far as medication to help reduce anxiety is concerned, there are four classes of medication:

• Selective Serotonin Reuptake Inhibitors (SSRI's) *
• Tricyclic Antidepressants *
• Benzodiazepines *
• Monoamine Oxidase Inhibitors (MAOIs) *

The drug the doctor chooses to prescribe is based on considerations of safety, efficacy, and the personal needs and preferences of the patient.

Remember to ask your Doctor as many questions as you need to, to find out everything about the medication you are being prescribed. You have a right to be fully aware of what you are taking and why, as well as what side effects you can expect and how to manage them.

Whatever medication you are given, it is important to completely follow your doctor's orders. Do not self-medicate, never change the dosage, and don't stop taking the medication without discussing it with the doctor first. Doing so can create more problems.

* For more detailed information on these medications and how they work, please keep an eye out for a forthcoming article explaining everything you need to know.

Homeopathy

Homeopathy is a natural system of treating all kinds of diseases. It is a subtle, yet powerful, system that works with the energies of life and produces genuine long-term cures in many complaints. It is based on holistic principles. This means that the medicine treats the whole person, not just one part or one disease.

It is possible to take homeopathic remedies with orthodox medicines as both medicines will work unaffected by each other. (The main exceptions are antibiotics and oral steroids; these usually stop homeopathic remedies from working.) Once the homeopathy is working, most orthodox medicines for the treatment of anxiety can be stopped. This must, however, be done with your doctor's knowledge and guidance. Never just stop taking your prescription medicine – the dose must be reduced gradually.

Herbal treatments

There are a number of plant and herbal remedies known to have positive effects on anxiety, but they should only be used under guidance of well-trained health advisers.

Many people assume that because a substance is made from "natural" ingredients, it is automatically "safe." This is not always the case. Poisonous mushrooms and arsenic are natural! So are cocaine and opium. Even something seemingly harmless like Vitamin A can kill you if you take too much.

"Natural" substances are very powerful and you should not just use them because "they helped your friend." We are all different, and what works for one person can harm another.

It is important to seek qualified advice before using such remedies, and inform the health practitioner of all other medicines you are taking, as well as of any medical conditions you may have.

Combination treatments.

It is generally acknowledged that a combination of medication and some form of psychotherapy produces the best treatment response rates. Combination treatments are advantageous as they bring about more rapid relief from symptoms, and usually result in lower relapse rates.

Nutritional Therapy

Most of us are aware that our diet affects our physical wellbeing, but many of us don't realise that what we eat can also affect our mental wellbeing.

If you are anxious it is a good idea to avoid the substances that aggravate anxiety. These include:

Caffeine – widely considered the most notorious of all anxiety and panic attack triggers.

Nicotine – most people do not realise that it is as strong a stimulant as caffeine. Research has shown that smokers tend to be more anxious than non-smokers.

Salt – Too much stresses the body by depleting it of potassium (required for the proper functioning of the nervous system) and raising blood pressure.

Preservatives – generally considered to be detrimental to our health.

Refined sugar – brown or white – causes an immediate sugar high, which drops rapidly (within 20 – 30 minutes) causing feelings of anxiety and restlessness.

Food allergens – eating foods to which we are allergic or intolerant can cause feelings of anxiety and panic.

You should also try to:

• Reduce or eliminate processed meats and foods.
• Reduce your consumption of red meat.
• Increase your intake of dietary fibre.
• Drink more water! (At least one 250 ml glass of water per 10kgs of body weight).
• Eat more raw, fresh vegetables.
• Reduce animal fat.
• Take a high potency B-Complex vitamin and a high dose of vitamin C.

In addition to these treatment approaches you may also find that practicing relaxation techniques and breathing skills, and incorporating exercise into your daily routine, may contribute to making your life more balanced and less anxious. You could also benefit from improving your social and interpersonal skills (for example your assertiveness and conversation skills).

What do you think?

Share your wisdom with others....do you have a suggestion that will help others to reduce their anxiety?