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BWRT for Anxiety

BWRT for Anxiety

What causes anxiety disorders?

We don’t fully understand what causes anxiety disorders. But it is thought that the following factors can cause anxiety:


Some people seem to be born more anxious than others. You may get anxiety through your genes.

Life experience

This could be bad experiences such as being bullied or losing a loved one. It could also include big changes in life such as moving home, losing your job or pregnancy.


Caffeine in coffee and alcohol can make you feel anxious. Illegal drugs, also known as street drugs can also have an effect.


Sometimes you know what is causing your anxiety. When the problem goes, so does your anxiety.

What are the different types of anxiety disorder?

This section provides an overview of the most common types of anxiety disorders.

• Generalised anxiety disorder (GAD)
• Panic disorder
• Social anxiety disorder
• Phobias
• Agoraphobia
• Obsessive compulsive disorder (OCD)
• Skin picking
• Hair pulling
• Body dysmorphic disorder (BDD)
• Post-traumatic Stress disorder (PTSD)

Generalised anxiety disorder (GAD)

GAD is common. The main symptom of GAD is over worrying about different activities and events. This may feel out of your control. You feel anxious a lot of the time if you have GAD. You might feel ‘on edge’ and alert to your surroundings.

This can affect your day-to-day life. You might find that it affects your ability to work, travel places or leave the house. You might also get tired easily or have trouble sleeping or concentrating. You might have physical symptoms, such as muscle tension and sweating.

It is common to have other conditions such as depression or other anxiety disorders if you have GAD.
GAD can be difficult to diagnose because it does not have some of the unique symptoms of other anxiety disorders. Your doctor is likely to say you have GAD if you have felt anxious for most days over six months and it has had a negative impact on areas of your life.

Panic disorder

You will have regular panic attacks with no particular trigger if you have panic disorder. They can happen suddenly and feel intense and frightening. You may also worry about having another panic attack.

Panic disorder symptoms can include the following:

• An overwhelming sense of dread or fear
• Chest pain or a sensation that your heart is beating irregularly
• Feeling that you might be dying or having a heart attack
• Sweating and hot flushes or chills and shivering
• A dry mouth, shortness of breath or choking sensation
• Nausea, dizziness and feeling faint
• Numbness, pins and needles or a tingling sensation in your fingers
• A need to go to the toilet
• A churning stomach
• Ringing in your ears

You may also dissociate during a panic attack. Such as feeling detached from yourself.
Certain situations can cause panic attacks. For example you may have a panic attack if you don’t like small places but you have to use a lift. This doesn’t mean that you have panic disorder.

Social anxiety disorder

Social anxiety disorder is sometimes known as social phobia. Lots of people may worry about social situations but if you have social anxiety you will have an intense fear or dread of social or performance situations. This might happen before, during or after the event.

Some common situations where you may experience anxiety are the following:

• Speaking in public or in groups
• Meeting new people or strangers
• Dating
• Eating or drinking in public

You may be worried that you will do something or act in a way that is embarrassing. You might feel aware of the physical signs of your anxiety. This can include sweating, a fast heartbeat, a shaky voice and blushing. You may worry that others will notice this or judge you. You might find that you try to avoid certain situations. You might realise that your fears are excessive, but you find it difficult to control them.
Your GP will ask you questions about your symptoms, and might ask you to fill out a questionnaire. This will help them find out how anxious you feel in social situations. They may refer you to a mental health specialist for a full assessment.

You can ask for a telephone appointment with your GP if it would be too difficult for you to see them in person.

A phobia is an overwhelming fear of an object, place, situation, feeling or animal. Phobias are stronger than fears. They develop when a person has increased feelings of danger about a situation or object. Someone with a phobia may arrange their daily routine to avoid the thing that’s causing them anxiety.

Common examples of phobias include the following:

• Animal phobias, e.g. spiders, snakes or rodents
• Environmental phobias, e.g. heights and germs
• Situational phobias, e.g. going to the dentist
• Body phobias, e.g. blood or being sick
• Sexual phobias, e.g. performance anxiety


Agoraphobia is a fear of being in situations where escape might be difficult. Or situations where help wouldn’t be available if things go wrong. This could be the following.

• Leaving your home
• Being in public spaces
• Using public transport
• Being in crowded spaces

You might find that these situations make you feel distressed, panicked and anxious. You may avoid some situations altogether. This can affect day-to-day life.

Agoraphobia can make it difficult to make an appointment with your GP to talk about your symptoms. You might not feel able to leave your house or go to the GP surgery. You can arrange a telephone appointment if you have symptoms of agoraphobia. A GP will decide on the best treatment options for you depending on what you tell them.

Obsessive-compulsive disorder (OCD)

You will have obsessions, compulsion or both if you have OCD.

• Obsession – An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. These can be difficult to ignore. These thoughts can be disturbing, which can make you feel distressed and anxious.
• Compulsion – A compulsion is something you think about or do repeatedly to relieve anxiety. This can be hidden or obvious. Such as saying a phrase in your head to calm yourself. Or checking that the front door is locked.
You might believe that something bad will happen if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop.

There are different types of OCD, which include:

• Contamination – A need to clean and wash because something or someone is contaminated
• Checking – The constant need to check yourself or your environment to prevent damage, fire, leaks or harm
• Intrusive thoughts – Thoughts which are repetitive, upsetting and often horrific
• Hoarding – Not feeling able to throw away useless or worn out items

Speak to your GP if you think you have OCD. They should discuss treatment options with you. Or you could try to self-refer to an NHS talking treatment service.

Skin Picking

Skin picking is medically known as dermatillomania. It is an impulse control disorder. You will regularly pick at your skin. Often you will pick healthy skin. This can cause damage to your skin, including bleeding, bruising and sometimes permanent marks. You will usually pick the skin on your face, but might also pick other areas of the body. You might find it difficult to stop yourself doing it.

No one knows the cause for skin-picking. It is thought that it could be a type of addiction. Or it relieves tension and stress. It is common to have OCD and dermatillomania at the same time.

Your GP may arrange for you to see a specialist mental health doctor like a psychiatrist for diagnosis.

Hair pulling

Hair pulling is medically known as trichotillomania. It is an impulse control disorder. You feel the urge to pull out your hair if you have this condition. This can be from your scalp or other places such as your arms, eyelashes, legs or pubic area. You might find it difficult to stop yourself doing this.
You might experience a build-up of tension which you can relieve by pulling out the strand of hair. You might not even be aware that you’re doing it.

It can be difficult to stop, which can lead to hair loss. This in turn can make you feel guilty, embarrassed and affect how you feel about yourself or how your friends and family see you.

Your doctor will look at the following to diagnose your condition:

• You repeatedly pull your hair out, causing noticeable hair loss
• You feel increasing tension before you pull your hair out
• You feel relief or pleasure when you have pulled your hair out
• There are no underlying illnesses, such as a skin condition, causing you to pull your hair out
• Pulling your hair out affects your everyday life or causes you distress.

Post-Traumatic Stress Disorder (PTSD)

You might have PTSD if your anxiety symptoms were caused by a threatening life situation. Such as a train crash or fire. You can feel anxious for months or years after the event even if you weren’t physically harmed at the time.