Lesson 2 Anxiety Disorders


Anxiety is the second most common mental health problem. Worry is part of our life and is a natural warning signal of our body, which reacts in dangerous situations and enables the body to react appropriately. However, if these fears become too great, increase in scope and frequency, and restrict the affected person in everyday life, we speak of an anxiety disorder.

Symptoms of Anxiety

  • is inappropriately severe or persistent
  • occurs without sufficient reason, that is, without a real threat
  • is so strong that it begins to dominate our lives
  • it causes functional impairment

In the case of an anxiety disorder, it is easy to see how physical reactions go hand in hand with a mental illness: Those affected are tense, unfocused, restless, have sleeping problems, etc..

  • Panic disorder

Those who suffer from panic disorder are prone to unprovoked panic attacks with rapid heartbeat, sweating, shortness of breath or trembling.

  • Generalized anxiety disorder

Anyone suffering from generalized anxiety disorder is tormented by worries and fears constantly circling around in their head. 

  • Social phobia

Those who suffer from social phobia are afraid of situations in which they could be the center of attention and be judged (negatively) by others. 

  • Isolated phobia

Those who suffer from isolated phobia are afraid of certain isolated situations and objects, such as spiders, lightning, airplane crash….

  • Agoraphobia

Those who suffer from agoraphobia are afraid of situations in which they cannot flee in the face of danger or believe they will lose control. 

  • Feeling nervous, restless or tense.
  • Having a sense of impending danger, panic or doom.
  • Having an increased heart rate.
  • Breathing rapidly (hyperventilation)
  • Sweating.
  • Trembling.
  • Feeling weak or tired.
  • Trouble concentrating or thinking about anything other than the present worry.

If you want to read more about a particular specific anxiety disorder go to: https://www.icd10data.com/ICD10CM/Index/A/Anxiety


We all know the feeling that our lungs get tight and our air is cut off when we get scared or panic. Therefore, breathing exercises are an important part of treatment and self-care.  You can use this breathing exercise anytime and anywhere, even in the moment when you realize: Attention; the tension is rising.

  • lie flat on your back on your bed or the floor.
  • bend your knees slightly.
  • place one hand on your chest, the other on your stomach.
  • now breathe in slowly and deeply.
  • imagine the breath slowly flowing down to your hand on your belly and finally lifting your hand.
  • you can control it: Which hand moves the most? Deep breathing raises your hand on your belly higher than the one on your chest.
  • now exhale just as slowly. Imagine how the breath flows slowly from the belly over the chest back out over the nose.
  • concentrate on how your hands sink back down one by one.
  • repeat this exercise slowly for 5-10 minutes.
  • practice several times a day.
  • Find a comfortable position.
  • Take a few deep breaths into your belly. Do you feel the first relaxation?
  • Clench both hands into fists as tightly as you can. This can even be sparse. Tense your upper arm muscles and hold the tension for a few seconds.
  • Then let go. Don’t forget any of your muscles – the fingers, the hands, the arms. Can you feel the tension release?
  • Concentrate on this sensation.
  • Let your slightly bent fingers, your open hands, your arm fall to the side.
  • Continue to breathe in and out calmly and deeply, in and out…. and feel the warmth and heaviness that comes with the feeling of relaxation.
  • Repeat this as much as you want (go to other muscle partys or include the whole body).

Further reading: Progressive muscle relaxation (pmr), meditation, autogen training

The best self-therapy against hyperventilation is proper breathing, which will lead to a new balance of oxygen and carbon dioxide in the blood. Here, breathing into a bag is often recommended for a quick effect: Breathe in and out of a plastic or paper bag. Why? A large part of the air breathed into the bag contains carbon dioxide.

When you notice the first signs of hyperventilation:

  1. Sit down or lean against it, if you are driving a car or something similar get yourself to a SAFE place and stop.
  2. Hold your breath without taking a deep breath and count to 5.
  3. When you reach 5, exhale, calmly say to yourself “relax”.
  4. Exhale slowly through your nose. Inhale for three seconds and then exhale for three seconds. Each time you exhale, say to yourself, “Relax.“
  5. At the end of each minute (i.e., after 10 breaths) hold your breath again for 5 seconds, then continue in a six-second cycle as before.
  6. Continue this exercise until all hyperventilation symptoms have disappeared.

The most common response to fear is avoidance. Through this, we initially experience a reduction in anxiety. This leads us to try to avoid the fearful situation further, which leads to our fear gaining more and more power.             

To overcome fear, we have to face the fearful situations. This is achieved with the help of exposure. The more experience they have had exposing themselves to fears, the less sensitive their alarm system becomes. By putting themselves in the situation that triggers fear, they learn to no longer classify it as so dangerous. This is also referred to as desensitization.              

The aim of the exercise is therefore to consciously enter the anxiety-provoking situation. This can happen gradually by increasing the intensity and duration of the situation at regular intervals. 

In the case of fear of oral presentations, for example, you start by writing the presentation, then you speak it to yourself, then in front of friends, then in front of a small group, and so on.

Thus, face your fear and practice enduring it.

Today, a distinction is made between various forms of traumatic disorder. The best known is post-traumatic stress disorder (PTSD). It often develops after violent experiences, accidents, losses or disasters.

Psychosomatic disorders are another aspect of trauma. Trauma is often associated with enormous emotional and or physical pain. These experiences lie outside of what a person normally knows, and these events are fragmented or repressed by our brain.

The ICD 10 defines a trauma as a short- or long-term event or occurrence of extraordinary threat or catastrophic magnitude that would cause profound distress to almost anyone. In the case of a traumatic disorder, the experience cannot be processed and stored in the brain and completed. Therefore, the persistent stress reaction remains.

  • Intrusions: intrusive, distressing trauma memories in the form of thoughts, sounds, images, flashbacks, and nightmares.
  • Avoidance: avoidance of trauma-associated stimuli (places, activities, cues) and/or numbness.
  • Hyperarousal: overexcitement symptoms such as sleep disturbances, jumpiness, increased irritability, affect incontinence.

Trauma is divided into two types: accidental, without human intention (such as natural disasters, life-threatening illness, a difficult birth, but also war, migration, famine) and intentional, between human violence (for example, robbery, bullying, accidents, but also child abuse, domestic violence, terror).

Dissociation may be a symptom of post-traumatic stress disorder. Dissociation represents an involuntary human response to stressful or traumatic experiences that results in a change or withdrawal of consciousness, reducing incoming stimuli and preventing the effect of overwhelming emotions.

Dissociation is a protective mechanism for people in traumatic situations.

5 main symptoms:

  • amnesia
  • depersonalization
  • derealization
  • identity insecurity
  • identity change

These dissociative states are experienced as an agonizing experience of powerlessness and being at the mercy of others. They are no longer able to control their body and possible reactions, statements, etc.

Triggers are stimuli that are closely related to the trauma and can trigger memories/flashbacks/dissociations. 

Traumatized individuals can enter states in which they not only remember but immediately relive what they have experienced. The affected persons experience themselves as if in a film that they cannot stop. Such flashbacks are triggered by internal and external stimuli that are related to the traumatic experience.

 Most important after a trauma experience:

  • Safety and reassurance, finding “oneself” again
  • Reconnect with helpful habits (hobbies, sports, distraction, no stress!).
  • Talking about it (if needed with a professional).


Mindfulness improve self-regulation and managing emotions: Being able to wait and put aside initial impulses to act, bouncing back after disappointment or rejection, sharing, comforting, and showing consideration. Whenever we are aware of ourselves and our surroundings in the moment, we are mindful. Through certain exercises we can train this mindfulness and use it consciously. Examples of this are:

  • Breathing Techniques

Find a quiet place for this and adopt an upright sitting posture – whether on a cushion on the floor, a chair or the sofa is up to you. Keep your eyes open and look straight ahead.

Now try to consciously notice your breathing, for example, by counting your inhales and exhales or mentally accompanying your breaths with inhale and exhale deeply, count slowly to 3 in your mind. Don not evaluate other thoughts that come up – let them pass, then return to the conscious breathing meditation.

  • Mental Photography

To do this, close your eyes and move slowly inwardly through the room or landscape. If you now open your eyes for a short moment, imagine that you are photographing the moment with your eyes.

By focusing on the imagined snapshots, this exercise is also suitable for breaking through stressful thought circles and musings. 

Lie on your back in a comfortable position, for example on a yoga mat. You can stretch out your legs or bend them. Place your arms at your sides next to your body.

Focus on your inner posture, your feelings and thoughts. If necessary, try not to push away unpleasant thoughts, but give them space until they move on by themselves.

Now concentrate on your breathing for a few minutes. Make sure your breathing is calm and slow. Imagine that your breath flows up and down your body like a breeze.

Now begin to mentally scan your body. Direct your attention first to your toes, then to your feet, your lower legs, and so on. Gradually work your way up the body. Pay close attention to how each area of your body feels. If your mind wanders, first return to your breathing rhythm, then to your body, and continue with the Body Scan.

You should spend the last few minutes of the Body Scan as relaxed as possible. You no longer need to actively concentrate on anything, but can simply rest.

To complete the Body Scan, slowly straighten up. You may want to sit up first and remain seated for a moment so that you don’t feel dizzy when you stand up.

Ask yourself the following questions to know your resources and use them positively for yourself:

  • How do you imagine a good-humored guardian angel?/ Is there a person you are thinking of?
  • In which landscape do you feel most comfortable?
  • Which superhero would you like to be?

Create yourself a safe place in your mind, where you feel comfortable and safe. You can come anytime to this place in your imagination and escape daily life for a while.

(Check lesson: Anxiety Disorders)

  • Gratitude Diary

Take time in the evening to reflect on the last 24 hours and write down up to 5 things you are grateful for

  • Vault

Imagine you have a vault, or a safe. If something is bothering you, you can put it there in your imagination.