Author Archives: Jackie Aim

Vicious cycle of anxiety

Anxiety is an emotion which not only effects our bodies. It also impacts on your thoughts and what you do at these times (your behaviours).

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This chain of events is often described as the ‘Vicious cycle of Anxiety’ and can be seen in the diagram:

Thoughts: What we think – When stressed or anxious your thinking can become very fixed on the problem or issue at hand.
You can struggle to see the bigger picture. This limits your ability to think clearly, find solutions, and make the best choices to support your self management.
A situation you may recognise is increased breathlessness even though you have not done any of the things which would normally make you breathless. You may find yourself thinking things such as “Oh I’m breathless….. Oh my god, I’m very breathless, I can’t cope with this, I don’t know what to do”.
This then can lead to a change in our emotions, our body and behaviour.

Emotion: How we feel – Being stressed or anxious can trigger further emotional change – worry, stress, anxiety, frustration, irritability, low mood being some of the emotions experienced. These emotional changes can be subtle or be sudden.

This can lead to a change in your thoughts, your body and behaviour

Physical change: How our body reacts – This anxiety response can be experienced in our bodies in many different ways:

Heart
Stomach
Lungs
Neck/shoulders
Body/skin
Legs
Bladder/bowel
Dry mouth
Brain

This can lead to a change in our emotions, our thoughts and behaviour

Behaviour: What we do – Being stressed or anxious can affect what you do or your behaviour. You may stop doing things you enjoy or avoid situations which trigger increased breathlessness or anxiety.

This can help you to feel safe, and in control, in the short term but in the longer term it affects routines and coping. As you do less, de-conditioning becomes more of a problem. Your confidence is affected and you may start to worry more about what you can or can’t manage to do. This can lead to more anxiety about doing certain things, and can lead to more avoidance or doing even less.

This can lead to a change in your thoughts, your emotions and your body

How anxiety is experienced in our bodies

Day to day we all live with adrenalin in our bodies. It has a positive effect which helps you get up and going. More adrenalin is released when you are stressed, anxious or worried and this can triggers physical changes and sensations in the body. This is often called the Anxiety or the Fight / Flight Response.

This anxiety response affects your body in many different ways:

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Heart: Adrenalin triggers increased heart rate and faster pulse feeding more blood to the muscles, preparing the body to cope with the stressful situation (fight or run away)
Stomach: Digestion slows down or ceases as blood is directed away from the stomach and this can cause nausea, indigestion, or the feeling of butterflies in your stomach
Lungs: Breathing can become faster and shallower as oxygen is supplied to the muscles. This can cause breathlessness, chest pains, tingling, palpitations as the body prepares itself to fight or run away
Neck and shoulders: Neck and shoulder muscles can tense as your body prepares itself to fight or run away. This can trigger aching and tightness in neck / shoulders and back
Body and skin: Adrenalin causes blood vessels in your skins surface to open up making you to feel hot. Sweating is the body’s natural way of cooling itself down. Sweating is the body’s natural way of cooling itself down
Legs: Muscles tense as the body prepares itself to fight or run away. This can trigger shaking or trembling in the body
Bladder and bowels: muscles in the bladder or bowels relax and can cause you to rush to the toilet
Brain: you can only think about the stressful situation and problem solving becomes more difficult. As an automatic response to this you may also get a dry mouth.

It can be difficult to make sense of these symptoms which you may feel you cannot control.

Remember breathlessness related to anxiety is normal. It is our body’s way of trying to help you in situations which you find difficult. For some of you breathlessness may start first and cause anxiety, but for others anxiety may start first.

Emotional change and your illness

A young adult woman showing signs of distress

Being diagnosed with a lung condition, managing chest infections, attending clinic appointments, changing life roles, can all be challenging.

Dealing with these challenges can trigger emotional change – worry, stress, anxiety, frustration, irritability, low mood being some of the emotions experienced. These emotional changes can be subtle or sudden, and can trigger the anxiety response.

Any emotional change is important. Understanding what is going on in your body, and the emotional impact of this, is important. It helps you in developing ways which help you cope day-to-day and supports self management.

Anxiety related to your illness

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Coping with your illness and symptoms day to day
- You may worry about your symptoms, and the impact of your lung condition on your ability to manage day-to-day. This can be challenging, and cause you to worry more.
- You may delay contacting your GP when you notice a change in your normal symptoms as you worry about being a bother.
- You may try to keep going as before, triggering more symptoms including breathlessness, and this may cause you to worry about how you will cope.
- You may just be worried. This may be because you are more breathless than you are used to, or expect yourself to be.
- A previous difficult experience because of breathlessness may put you off doing the same activity again for fear of triggering symptoms, e.g. walking up a slope or up stairs, or going out when you have a chest infection.
Worries about your health declining
- You may worry about what the future holds and about the effect your lung condition will have.
- You may worry about lots of things:
  - Losing your independence.
  - Having to rely on friends, family or neighbours for help with certain things.
  - That you are less able to get out and about to do the things which are important to you.
  - Your current housing is no longer suitable (e.g. 3rd floor flat).
  - That your symptoms become so problematic that you need extra help with personal care.
  - You need to recognise breathlessness and anxiety when they feed each other and become worse. By recognising your symptoms you can take action to prevent their problems escalating.
Worries about hospital visits
You may worry about staying overnight in hospital because you have never liked hospitals or heard ‘bad news’ stories from others or in the media. You may worry if you have a morning appointment and feel this will be a struggle for you to get there on time because of your breathlessness.
Effect of your illness on your family
You may worry about how changes in your health will effect your family and family life. You may not be able to do all the things you did before, or be able to do them in the same way. Families can then step in to help but may end up doing too much for you, or may expect you to carry on as before not realising how your symptoms are affecting you.
Money worries
You may worry about the effect of your lung condition on your finances, about loss of income or having to claim benefits for the first time.
Employment issues
You may worry about you or your partner having to take time off work, and the impact of this. You may worry about being able to continue in your current job or in fact being able to work at all.

Common causes of anxiety

Going on holiday

Moving house.
Bereavement.
Change in relationship.
Holidays.
Family events.
Changing jobs or losing your job.

And many other situations…

There are some people who are more likely to be anxious or stressed than others for no obvious reason, it is just part of who we are. Anyone can benefit from techniques in this section to recognise when your anxiety is affecting you and how to deal with it.

Words to describe anxiety

Scared, panic, worried, fear, jittery, afraid, nervous, butterflies in the stomach,worked up, stressed, in a flap, shaken up

Anxiety is a feeling of fear, worry, and uneasiness. It can cause physical feelings such as nausea, stomach upset, dizziness, dry mouth and tension.

Everyone experiences stress and anxiety at some point in their lives.

Anxiety is normal when faced with difficult or stressful situations.

Living with a long term health condition, such as a lung condition, poses different challenges day-to-day.

For some people living with anxiety or panic can affect some or all of the things you do.

What to do if your child’s breathing is worse

Examples of asthma plans

This condition of altered breathing patterns often relapses. It recurs commonly and the management doesn’t change. The breathing control exercises should be repeated.

If your child has an asthma plan you should also follow the instructions on the plan if you feel your child’s asthma is getting worse. Get help, see your doctor for a check up.

Important

If your child’s breathing control and inhalers are not working follow your child’s emergency plan and dial 999.

Self management

Teenage asthma plan (NHS Scotland 2015) [.pdf, 41 KB]
Child asthma plan (NHS Scotland 2015) [.pdf, 40 KB]

Caroline’s story – experience of recovering from an exacerbation.

The following story is from a real person called Caroline. She is 62 and has been diagnosed with COPD for 5 years. She is talking about her experience of recovering from an exacerbation.

Duration: 3 minutes 35 seconds.
This photo and audio have been recorded by an actor but the words are from a real person’s experience of living with COPD.

View audio transcript

I hadn’t really noticed the breathlessness before I went into hospital. Well, I suppose I had, but I ignored it really as I thought it was just because I was a smoker. I didn’t want to go to the doctors, because I knew I would just get told to stop smoking and it wasn’t like I hadn’t tried. The thing I would tell other people now is to try to stop smoking. I managed it after being in hospital and this time it was easy. I was offered help, but I managed to just stop. I put on a wee bit of weight at first, but I managed to lose it after about a year.

When I was in hospital, I was terrified. I couldn’t even walk to the toilet for the first few days, I was so breathless. It was such a scary time.

For a while after I thought my life was over. I couldn’t manage any of the things that I did before; even being with the grand kids was hard. I couldn’t run after them like I used to. My daughter found this hard as well as I looked after them a few afternoons a week.

My respiratory nurse gave me a self management plan, which became like my bible. I was able to speak to my doctor and let them know how I was feeling. Having the plan gave me back up to know what I was talking about. I had to explain it to some of the GPs but now they know that I’m in control of my condition, it seems to make them listen to me a bit more I think. I know what the signs are for me to look out for now and I can spot them quicker. I have what I call “rescue medication” at home and I tell my doctor what I’m doing. I think this has made such a big difference to my confidence.

The best thing that I did was the pulmonary rehabilitation class. I was lucky that they opened a class near to me, so I didn’t have too far to travel. I must admit I wasn’t keen on it when they asked me. I thought it wasn’t for me. I went though and I have to say it was definitely the best thing I did. I was able to go back to work after and I think it helped give more confidence that I could control the COPD and not let it control me.

I’m sure it’s by doing all of these things that I managed to get back to work. At first I found it really frustrating that I couldn’t manage to do what I did before, but I learned at the class to pace myself. For instance; I used to clean my windows all at once in a couple of hours. Now if I do that, even if I managed it, it would leave me too tired to do anything else for days. I now clean one window a day. It just takes me longer, but it means I can still do these things. Pacing has been a real lesson for me. I’ve learned to prioritise the things that matter to me.

The thing I’m most pleased about is being able to go for a walk. I was scared to try although I wanted to, but I spoke to my doctor and together we came up with a plan. I make sure I have my inhaler and a drink and my mobile phone. These things all make the walk easy for me and I’ve got confidence that I can do it. It does make me breathless, but I use my exercises that I learned from the class and they really help.

As I say, I’m in control of the COPD and it’s not in control of me.

Caroline had two severe exacerbations within a year of diagnosis. Since completing a course of pulmonary rehabilitation and using her self management plan she has not had another hospital admission for 4 years.

Reasons for postponing a spirometry test

Spirometry testing may be postponed;

If you have had recent surgery.
If you have had a chest infection within the past 6 weeks as this may give unreliable results.
If you have had a recent condition called pneumothorax. (This is an abnormal collection of air in the space between lungs and chest wall called the pleura and it interferes with normal breathing).
If you have had a recent operation to your eyes or ongoing eye problems. Spirometry tests can increase pressure in the eyes during the test.
If you have heart problems which are unstable this may prevent you having the test.
If you have been diagnosed with an Aneurysm – in the brain or abdomen. (An Aneurysm is weakness in the wall of a blood vessel causing a bulge) there is an increased risk this may burst due to increased pressure during the spirometry test.
If you feel sick or are sick (as this may affect your effort).

What happens before your test

Female patient having height taken by a female nurse

Before your spirometry test.

You may be asked not to take your medication, as this may be assessed during test.
No vigorous exercise prior to testing.
If you smoke, stop smoking for a short time before your test.
Don’t eat a heavy meal before your test.
Avoid alcohol before your test.
Your height and weight will be measured. This can help to calculate or predict what would be considered to be normal results for someone of your height and weight.
Take your medication with you. Medication and your general health will be checked before proceeding with test.