A Self Help Guide to manage anxiety for Patients and Carers

What is anxiety?

Anxiety is a normal healthy reaction which happens to everyone in
times of danger, stress or as a reaction to particular life events.

Feelings of anxiety can vary from mild anticipation to extreme terror,
as if something dreadful is going to happen. Moderate amounts of
anxiety are useful in our everyday lives but can become a problem if
out of proportion.

Anxiety management techniques can be used to help control your
anxiety. This anxiety support tool will cover ‘Progressive muscle
relaxation’ and ‘Breathing retraining.’

It is also important to ensure that you have a well-balanced healthy
diet. Avoiding blood sugar fluctuations and reducing caffeine intake
can help reduce symptoms of anxiety.

When we are worried or frightened, the body’s nervous system
reacts by releasing a hormone called adrenaline. This causes
physical symptoms resulting in the body’s ‘fight or flight’ response.

Physical symptoms of anxiety may include:

• Increased heart rate
• Increased blood pressure
• Increased breathing rate
• Heart palpitations
• Shortness of breath
• Hot flushes or sweating
• Tingling in the hands
• Dizziness
• Dry mouth and difficulty swallowing
• Muscle tension
• Shaking or fidgeting.

These physical changes may result in more anxiety, producing more
adrenaline and keeping the reaction going. When the anxiety has
passed, the body returns to its normal resting state.

Psychological symptoms:

Anxiety often provokes negative thoughts. These thoughts are likely
to maintain or increase anxiety. These thoughts may include:

• Feeling frightened or panicky
• Feelings of losing control
• Worrying about fainting or being sick
• Worrying about drawing attention and people staring
• Worrying about looking or doing something silly
• Thinking that there is something physically wrong. For example
a stroke or heart attack
• Wanting to escape to a safe place
• Losing self confidence.
Behavioural symptoms:
• Avoiding going out alone
• Avoiding busy places, perhaps preferring to walk or take a taxi
instead of the bus
• Making excuses to avoid going out or doing something
• Crossing the street to avoid people
• Being quiet and not joining in with other people
• Rushing out of places or situations when feeling anxious
• Not sleeping well
• Reduced level of concentration
• Disrupted appetite and eating patterns
• Reduced tolerance and increased frustration.

People with anxiety will often change their behaviour to feel safer
and try to reduce or prevent future anxiety. These are known as
safety behaviours and are not necessarily good habits.

Now think about how you respond to anxiety.

What happens to your breathing when you are anxious?

You are probably already aware that we breathe in to obtain oxygen
and out to expel the carbon dioxide. The normal breathing rate is
10 – 14 breathes per minute. When we are tense and anxious, we
tend to breathe very quickly and shallowly using our upper chest
only. This causes an imbalance of oxygen and carbon dioxide within
the blood. If the body cannot return these levels back to their normal
then you may experience further symptoms such as dizziness,
muscle stiffness, light-headedness, headache, weakness and
tingling to your hands and feet.

Breathing retraining might be helpful for you.

Over-breathing or hyperventilation can leave you feeling exhausted
and ‘on edge’. During times of stress and anxiety, breathing
retraining allows you to gain control over your breathing by focusing
on changing your breathing style and slowing down the rate of your
breathing. With practice breathing retraining can help you to cope
better with anxiety when you are in an anxious situation.

1. Position yourself on a comfy chair or lie down on a bed
2. Through your nose (if possible) take a breath in for 4 seconds
3. Hold the breath for 2 seconds
4. Breathe out through your nose (if possible) for 6 seconds
5. Pause slightly before breathing in again
6. Practise, practise, practise.

You might struggle to slow your breathing rate down when you first
start practising breathing retraining. You might prefer to breathe in
for 3 seconds, hold your breath for 1 second, and breathe out for 4
seconds to start with.

You should use a stomach breathing style rather than a chest
breathing style. Place one hand on your stomach and one hand
on your chest. The hand on your stomach should rise when you
breathe in.

Try to set some time aside each day to practise in an relaxed place
free from distractions. A more relaxed breathing habit will come from
practise.

Do you tense up when you are feeling anxious?

Sometimes we don’t even notice how our muscles become tense,
but perhaps you clench your teeth slightly or your jaw feels tight, or
maybe your shoulders become tense.

If this is the case, a technique called ‘Progressive muscle relaxation’
might be helpful for you.

In progressive muscle relaxation exercises, you tense up certain
muscles and then relax them. This is a technique which you can
then consistently practise. Before starting:

• It is important to select your surroundings carefully
• Minimise any distractions such as television or radio
• Make sure you are seated comfortably. Consider wearing loose
clothing and removing your shoes
• Avoid practicing the technique after a heavy meal or after
consuming any intoxicants, such as alcohol.

Now you are ready

1. Firstly give yourself the time and permission to relax
2. Slow down your breathing
3. Now tense the chosen muscle groups appropriate to you
(you can choose from the sequence on the next page). Keep
the chosen muscle tensed for approximately 5 seconds. Make
sure that you can feel the tension, but you should not feel any
pain at all
4. Now relax the muscles and keep them relaxed for
approximately 10 seconds. You might find it helpful to say ‘relax’
as you relax the muscle
5. Once you have finished your progressive muscle relaxation,
remain seated for a few moments allowing yourself to become
alert.

Relaxation sequence

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Author Urology Department 

Approved by Urology Audit and M&M Meeting

Date of Publication 15/10/2025

Review Date 01/10/2028

Reference No PL/1191 (v3)