Anxious about being anxious: why the second layer sticks around

Your heart gives a hard thump, or your chest goes tight, or the room tilts for a second. Then a second wave arrives: here it comes again, what if it gets worse, what if I cannot stop it. The first feeling was uncomfortable. The second one is what turns the evening over.

That second wave is what this post is about. It is common, it makes sense, and it can be loosened.

The short version

• Anxiety often has two layers: the sensation itself, and the fear of the sensation.
• In my view, the second layer is what often keeps the cycle running. Researchers call the fear of anxiety-related sensations "anxiety sensitivity", and a 2008 meta-analysis of randomised trials found that cognitive behavioural therapy (CBT) reduced scores on it compared with control conditions.
• The NHS notes that avoiding what you fear can feed the cycle. In my view, checking and fighting sensations does too, and allowing them to rise and fall is the skill to build.
• If you are struggling, or your own efforts are not helping, the NHS advises seeing a GP. That is sensible, not a failure of nerve.

What the second layer is

The first layer is the body doing what bodies do under threat: such as a faster heartbeat, breathlessness, light-headedness and shaking. The NHS lists these among the physical feelings of anxiety, and says a panic attack usually lasts 5 to 20 minutes and should not harm you.

The second layer is what you do with that information. You notice the thumping and read it as a warning: something is wrong with my heart, I am about to lose control, people will see. In my view, reading it that way can fuel more alarm, and round it goes.

The NHS describes the end point of this on its panic disorder page: you can end up avoiding situations because you fear they will set off another attack, a cycle it calls living "in fear of fear". You do not need panic disorder for the pattern to feel familiar.

The sensation is one thing. The alarm about the sensation is another.

What researchers call it

Psychologists have a name for this: anxiety sensitivity, described in the research as the fear of anxiety and of arousal-related bodily sensations, arising from beliefs that those sensations will have harmful consequences (Ghisi and colleagues, 2016). It is measured on questionnaires with items about sensations such as trembling or a racing heart.

I find the name useful because it frames the second layer as a set of beliefs about sensations, not a character flaw. Beliefs can be tested. One study is relevant, with care over what it can tell you. A 2008 meta-analysis pooled 24 randomised controlled trials with 1,851 participants and found that CBT reduced anxiety sensitivity compared with control conditions. The effect was large in people seeking treatment and moderate to large in people considered at risk, and in treatment-seeking samples its size depended partly on the type of control condition and the amount of therapist contact (Smits and colleagues, 2008). That is evidence about a questionnaire measure of this fear changing, not a promise about how any one person will feel. The authors say more research is needed on how CBT does it.

What tends to make it louder

Three instincts, in my view, can feed the second layer.

Monitoring. Taking your pulse, scanning your chest, watching for the first flicker. If checking has become a habit, the post on the health anxiety checking cycle goes into it.

Fighting. Trying to push a sensation away can tell you it is dangerous. It is a bit like holding a beach ball under water: it takes effort and pops up anyway.

Avoiding. Dropping the gym, the coffee, the crowded train. The NHS describes how avoiding what you fear can feed a cycle of fear. Avoidance buys relief now and, in my view, can teach you the sensation really was a threat. Avoidance and anxiety covers that loop.

What helps instead

These are my own small, practical suggestions, not a treatment plan.

Name the two layers

When it happens, try saying to yourself: that is the sensation, and that is the alarm about the sensation. It takes a few seconds and puts a little room between you and the second wave.

Let it be there

Aim to watch it like weather rather than fight it. Say "my heart is beating fast and that is uncomfortable", then carry on as best you can. It may feel odd to do nothing about it. That is the point. The NHS also lists calming breathing exercises among its self-help suggestions, and notes that a panic attack should not harm you.

Test the prediction

Your alarm makes predictions: I will faint, I will lose control, everyone will notice. Write one down before a situation you have been avoiding, go in, and check afterwards what actually happened.

Rule out the physical, once

If a symptom worries you or you cannot explain it, a GP is the right person to ask. In my view, one proper check beats checking daily in your head. Our posts on physical symptoms of anxiety and heart palpitations cover what is worth raising.

Bring it to a therapist

A CBT therapist can work with you on these sensations in small, agreed steps. brightloaf sessions are 20 minutes long, which means each one is built around a single small thing to look at, such as one sensation or one reaction to it.

When to get help

The NHS advises seeing a GP if you are struggling to manage anxiety, fear or panic, or if your own efforts are not helping, and says adults can refer themselves to an NHS talking therapies service without seeing a GP (aged 16 or over in some areas, 18 or over otherwise). If you find you are rearranging your life around avoiding sensations, that is a good moment to ask for support.

This post is general information and is not a substitute for personal medical advice. brightloaf is not a crisis service. If you feel you are in immediate danger, call 999. You can also call Samaritans free at any time on 116 123.