Written by Dr Sara O’Curry, Chartered Clinical Psychologist

Who wouldn’t get anxious before a medical procedure? Biologically speaking, a procedure is a threat (someone moving towards you with a sharp object) and we are designed to respond to a threat by either fighting it or running away. This is called the ‘Fight or Flight Response’; When we see a threat our body gets ready for action, we have a surge of adrenaline that gets our heart pumping faster, our breathing changes so that we can take more oxygen to the muscles, our muscles tense so that we can spring into action and our senses sharpen so that we can respond quickly to sights and sounds and protect ourselves.

The difficulty is that procedures are not threats that we can fight or run away from (though we’ve all tried both when we were children!) but we get the same biological responses as we would if faced with a wild animal or person with a weapon. For people who’ve had surgery and procedures as children, the threat of a procedure can be even worse because it triggers memories of previous difficult procedures; feeling helpless and out of control, in pain and afraid.

So how can we cope with the anxiety response?

Anxiety is a vicious circle where; we see a threat, we think we’re in danger, we experience a surge of adrenaline and the changes in our body that this provokes (tense muscles, heart racing, shallow breathing, sensitivity to lights and sound, sweating, feeling dizzy or light-headed), make us worry, which in turn creates more adrenaline and physical tension and so on. We can break the vicious circle by managing our breathing, our thoughts and our physical tension.

Breathing: Before the procedure, practice deep slow breathing. You can tell if you are breathing in a relaxed way if you put one hand on your chest and one just below your rib cage. When you breathe in slowly through your nose, the bottom hand should move outwards (you can try lying down with a book below your rib cage and watching it move up and down as you breathe). If you practice this you will be able to use your breathing to calm your anxiety before a procedure. Relaxed breathing is also longer on the ‘out’ breath than on the ‘in’ breath, whereas hyperventilating or ‘anxious’ breathing is the opposite or equally long. If you get good at controlling your breathing, you will be able to trick your body into thinking it is more relaxed, which will make you relax more.

Thoughts: When we feel frightened (or because of all the adrenaline, frustrated or angry) we think all kinds of anxious thoughts from “it’s going to hurt” to “I’m not going to be able to cope”, “I will cry”, ” I will make a fool of myself”, “people will be angry with me” and “I might die”. These thoughts then make the situation seem more threatening and we get in to a vicious circle of anxious thoughts and feelings.

Just as you can trick the body into thinking it’s more relaxed, you can break the vicious circle of anxiety and panic by ‘talking back’ to your anxious thoughts.

To do this you have to first try to catch the anxious thoughts. There can be a lot of thoughts flying around when are anxious. Some thoughts are more like mental pictures of our fears whilst others are more like words. It might help to imagine yourself just before a procedure and then write down all the anxious or negative thoughts you have when you feel worried.

Once you’ve “caught” an anxious thought, examine it (like a scientist examining a new specimen): What does it look like? How much do you believe it? How likely is that to happen? What would be so bad about that? We get into the habit of believing our thoughts or surrendering to them but the truth is we only really pay attention to the ones that bother us. Sometimes it can help to think of the thoughts as like an annoying little brother or sister teasing you from just over your shoulder. What would you say to them if they followed you around taunting you? Most people shy away from their anxious or negative thoughts because they make them uncomfortable, but if you can master the trick of catching and confronting them, you’ll be able to manage your anxious thoughts in any anxiety situation.

Physical Tension: You can break the vicious circle of anxiety and panic by stretching or putting your body in a relaxed posture. If you think about it, when people are nervous they do all kinds of things (fidgeting, wringing hands, sitting hunched over with legs crossed, frowning etc) that lets you know they’re worried. You can trick your body by putting it in a relaxed posture (think couch potato). You can also work through your body from head to toe doing the opposite of a tight anxious pose: splay your hands out (the opposite of a fist) and relax, stretch your jaw out (you might want to do this where no one can see you because its not a pretty sight), gently push your shoulders down (the opposite of your hunched shoulders) and so on through your body. It can also help to do a bit of exercise (even a little walk would do) to use up some of the excess adrenaline.

Finally, you can master your anxiety by preparing beforehand and not avoiding thinking about it. If you think you might need some more help with anxiety, talk to your GP. The NHS is putting a lot of money into Improving Access to Psychological Therapies (IAPT) and you should be able to see a specialist for advice and/or cognitive behaviour therapy (CBT) if you need it.