Managing Stress and Anxiety – For Patients with Epilepsy

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Useful skills to help you feel calmer

What is Anxiety?
Feeling anxious is normal when we think that we are in danger or when we are stressed. It can make our bodies feel different, for example:
• tense muscles
• a racing heart
• sweating
• rapid breathing

People are normally anxious for short periods of time. If we are anxious a lot of the time, even when there is nothing to be anxious about, it can become a problem. It is then that the feelings we have can get worse and we just think about how worried we are. We get caught up in a circle of anxiety.

When we think about our worries too much we can get upset, which makes us worry more. It is easy to become stuck in this circle which can make it very difficult to manage and control our anxiety.

Overcoming Anxiety
There are a few things we can do that will help to stop us feeling anxious. We need to practice them and the more we do this, the better we will feel. Because we are all different, some will work better for you than others – use the ones that suit you.

Managing our thoughts
Firstly we need to find out what it is we are worried about. When we know this we can ask ourselves these questions to find out how important the worry really is:
• Will it still matter in 6 months or a year?
• How likely is it that what we are worried about will actually happen?
• If it did happen what would that mean?
• Is there another, different way of thinking about this e.g. how would someone else see it?
• What would I say to a friend if they had this worry? It might be that you are worried about something very real in which case you can ask the question ‘can I do something about it?’
• If the answer to that question is ‘yes’, start to write down ways of solving the problem.
• If the answer is ‘no’, write down all the ways that might help you cope, for example:
o I will get support from friends / family by telling them how I feel etc. This will help you to think about the different ways you can cope with your worries. The other skills explained below can also be included in that list.

When we are anxious our bodies tend to become tense. The best way of controlling tension is through deep relaxation. If our bodies are relaxed it is harder for our minds to remain worried. One method of relaxing that can work well is called Progressive Muscle Relaxation. This requires you to tense then relax each muscle group.
• First, find a time and place when you won’t be interrupted, e.g. by the television or the telephone.
• Either sit or lie down – whichever feels most comfortable.
• Then, one part of your body at a time, tense each set of muscles for about 5 seconds and then relax them for 10-15 seconds.
• You can work from head to toe, tensing and relaxing in turn the forehead, eyes, jaws, neck, shoulders, upper back, upper arms, forearms, hands, chest, tummy, buttocks, thighs, calves and
feet or begin at the feet and work up.

People feel stress in different parts of their bodies and you can pay most attention to the muscles that you feel need it most. When you have worked through all the muscles, stay relaxed for a few minutes and enjoy that feeling. There are different ways of relaxing and lots of books and tapes are available.

Controlled breathing
When we are worried and anxious we don’t always breathe the way we should. This is what makes us feel light headed or dizzy. We can stop this by learning to breathe properly. This exercise needs to be carried out for at least 4 minutes to work.

• Place one hand on your chest and one hand on your stomach. When you are breathing properly the stomach should rise and fall rather than the chest.
• Now breathe in to a count of four and out to a count of four.
• Don’t breathe too deeply; just keep it nice and even.

Breathing exercises can be carried out anywhere, whenever you start to feel anxious.

Using your imagination can be another helpful way to relax. Imagine a scene that is calm, quiet and safe, somewhere you would like to be. It could be a real place that you have been to or it could be an imaginary place. The most important thing is that it feels good to think about it. Now imagine every detail, e.g. if you are thinking of a garden you need to imagine:
• all the plants and where they are
• the shape and size of the garden
• the sounds of birdsong
• the smells and colours
• the warmth of the sun
• the touch of a breeze

Imagine yourself walking around it and smelling the flowers, imagine sitting on a bench for a while and seeing birds and butterflies. The more detail you can imagine the more relaxing it will be.

Allow yourself plenty of time in the place you choose.

Distraction / thinking of something else
When we are anxious we think about our worries, and this makes us feel worse. However, if we can think of something else we won’t feel so anxious. There are three ways of doing this: thinking exercises, physical activity and thinking of other things.

• Thinking exercises can include saying the alphabet backwards or counting down from 100 in sevens.
• Physical activity could include walking and other forms of exercise but it could also be simply making oneself busy doing something such as handing round drinks at a party or clearing out a
• Thinking about other things might include looking at people and making up a story about their lives e.g. where they live, what they do for a living, who their family and friends are etc.

What you do to distract yourself depends on where you are and what you are doing when you become worried. Distracting yourself is the best thing to do when you are very, very worried and the other things are too difficult to do. Like everything else, you need to practice and to do it for at least 4 minutes for it to work.

It is easy to get caught in a circle of anxiety. We need to develop skills to break that circle. These include:
• Managing our thoughts
• Relaxing our bodies
• Controlling our breathing
• Using our imagination to take us to a nice place
• Distracting ourselves from our worries.