Anxiety and how to deal with it

KHP speaks to consultant psychiatrist Dr Florian Ruths to discuss anxiety, and learns that the emotion can be embraced rather than feared.

Dr Ruths - pictured below - is a Consultant Psychiatrist and Cognitive Behavioural Therapist trainer at South London and Maudsley NHS Foundation Trust. He has a special interest in depression and anxiety, and has been a mindfulness teacher for the last 20 years, publishing in the areas of anxiety, depression, and personality issues.

What is anxiety?

Dr Florian Ruths KHP News 28 March 2024Anxiety is an evolutionary-determined reaction of all organisms to react to threats – it is purely a physiological response to a perceived threat. In that sense, anxiety is helpful, useful, normal, and promotes safety and survival.

All organisms have a certain amount of ‘anxiety’. We might even call it an ‘aversion against threat’, which we need to position ourselves against. Anxiety is associated with physiological reactions - for example, when people perceive a threat, a hormone called adrenaline is released which leads to physiological changes within a millisecond. The body is a bit like an airbag – it goes off immediately.

Whenever we perceive a threat and the anxiety reaction is triggered, the adrenaline causes everything from our lungs to widen capacity and blood pressure to rise, to an elevated heart rate, activated muscles, and glucose being supplied in the blood.

How we respond to threats is known as the fight, freeze, or flight phase – we decide to run away to escape and avoid the threat, or we freeze and don't do anything. We don't move and hope that we won't be seen. Or we overcompensate and fight anxiety by meeting the anxiety with trying to undo it by working extra-hard and being over-assertive.

For humans, anxiety is complex. We have anxiety about spiders, heights, snakes, where there is a protective element to evolutionary-based threats. Then there is anxiety with regards to other human beings – our need for status in society can be anxiety-provoking. A lot of anxiety that we see now is based in our fear of other people – concerns will my boss like me, will I lose my job etc.

All these anxieties are a threat to our status, and that becomes threatening and anxiety-provoking.

I see repeatedly in mental health and emotional problems that there is a perceived threat to our status and safety among other human beings – this makes anxiety so intractable because we learn it from such a young age that we need to protect our position within the community. 

How is anxiety different from depression?

Anxiety and depression are very different emotions and conditions, but they can overlap. Anxiety disorders can go along with depression, depressive illness can go along with anxiety disorders, but fundamentally they manifest in a different way.

Depression is much more about experiencing sadness over a perceived loss: depression can manifest itself with behaviours like social withdrawal, not wanting to see people, negative thoughts about ourselves, the world or a sense of loss of status, an object, or a person in our lives.

Have you noticed a rise in the prevalence of anxiety and anxiety disorders?

Anxiety is very prevalent in a large part of the community, but experiencing anxiety is different from having a disorder. It’s normal to be anxious and normal to be sad – you don’t necessarily have a disorder when you’re experiencing anxiety. But if your anxieties are preventing you from living a normal life or causing you a disability, it’s more likely to be a disorder. At any one time probably about 4% of the world of the population are suffering from an anxiety disorder, and the rates are likely increasing.

How would somebody know if they're having an anxiety attack?

It is very unpleasant to be anxious, so people will make lots of inferences about what it is they’re experiencing and sometimes people aren’t fully aware of what is going on. People will spend a large effort to reduce or suppress anxiety.

In general, the body gives it away, so we if we check in with our bodies, our bodies will indicate what the most likely emotion is that we have.

When somebody suddenly experiences breathing difficulties, racing heart, shaking, and muscle tension, then it is very likely that they're in the middle of a very severe anxiety attack. However, people sometimes misinterpret these signs of anxiety as physical illnesses – for example feeling like you’re having a heart attack.

Knowing that you are in a state of anxiety can already be extremely beneficial for people. If it's an occasional anxiety attack that doesn't really cause disability or doesn't stop the person doing what they like doing, then you can just experience it. If the anxiety becomes disabling and extremely unpleasant then they will need to seek help professional help from a GP, or share the experience with their loved ones. It is important that we check these feelings it out. It's important not to suffer in silence and share your experience.

It's good to share our emotional experience in general - the good, the bad, and the ugly. Let others know how you're feeling, and they will guide you towards the best way of dealing with your emotions.

How much does social media impact anxiety?

This is a very important question. People’s experiences of social media are personal to them, but social comparison with the whole world makes us anxious that we are missing out or not having the life that others seem to have. To make things worse, we know that commonly used algorithms favour outrage, so social media not only makes us anxious but can also make us angry.

Anger gets a lot of likes and shares, so outrage online is promoted. Our anxiety level will definitely increase with the use of social media because the information shared is unfiltered directly from somebody's mobile phone to us.

In the past we used to read newspapers or watch TV news programme that were always edited for their quality, authenticity, and veracity. We don't have that now - anyone can share anything on social media and you don't know if it's true. Is it real? Is it from today? Is it from yesterday, from a year ago?

It is helpful to use social media with more discernment, particularly if we want to curate and care for our emotions.

Do you have any tips or recommendations for people for day-to-day management of anxiety?

Anxiety is an emotion like all other emotions, so it’s not dangerous. It's important to remember that anxiety is our friend. We get anxious for a reason - to protect our bodies and our lives. The emotion of anxiety is not a negative emotion, people can develop a friendly relationship with their own anxiety. Everybody's a bit different and will experience anxiety in a different way, so it's important to know that.

However, this can be difficult as everybody wants to have nice emotions and avoid negative emotions. Anxiety is seen as a negative emotion. It's really difficult for people to understand that negative emotions are just emotions. And it's about knowing that this is something that we can work with, and somehow manage and learn from. It’s about understanding anxiety and not seeing it as something that we need to stop from happening.

What people can do in the longer term to manage their emotions?

I'm a meditation teacher. We know that meditation and mindfulness is excellent at helping us regulate and help us understand our emotions better, and also help us become more familiar with our emotions.

It's something that I would recommend for people who are prone to anxiety. You will really learn about anxiety or depression from meditating on it, and allowing these emotions to unfold rather than needing to suppress them. Fleeing from emotions is generally associated with longer term illness.

Meta analysis of trials, so that means the summary of many trials, shows that meditation both reduces anxiety and depressive features.

For people who are very anxious or experiencing anxiety disorder or anxiety disability, they may need structured one-to-one help or at least structured help through NHS mental health services. For example, talking therapy services are always good at advising people.


Dr Ruths works with the KHP Mind & Body team to deliver Mindfulness 4 All, a biweekly 30-minute live session that can be attended online. If you would like to be added to the mailing list for the mindfulness sessions, please contact