Anxiety self-help guide

Work through a self-help guide for anxiety that uses cognitive behavioural therapy (CBT).

Section 1 of 21

1. Introduction

Urgent Help

This self-help guide is intended for people with mild-to-moderate symptoms of anxiety.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

This guide aims to help you to:

  • find out if you have symptoms of anxiety
  • understand more about anxiety
  • find ways to manage or overcome anxiety

There are a number of conditions that have anxiety as a symptom, or have anxiety in the name – like social anxiety, social phobia, and obsessive-compulsive disorder (OCD). This guide is designed to help with general anxiety symptoms.

How to use the anxiety self-help guide

Working through this guide can take around 30 to 40 minutes, but you should feel free to work at your own pace.

Work through the guide on your device, using the “Next” button to move forward and use the “Previous” button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

If you’d like to save the guide and return to it later, you’ll need to save it as a PDF on your device before you leave the page. You can then continue filling it out on the PDF. We don’t use a login feature on our mental health self-help guides for privacy reasons.

If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.

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2. Symptoms of anxiety

Do I have symptoms of anxiety?

  • Do you spend large periods of the day worrying?
  • Do you feel nervous, apprehensive or on edge?
  • Do you often experience unpleasant physical sensations like “butterflies” in your stomach, tense muscles, dizziness or breathlessness?
  • Do you find it hard to relax and “switch off”?

If the answer to any of these questions is ‘yes,’ you may be experiencing symptoms of anxiety and you may find this guide helpful.

Other symptoms of anxiety

Feelings you might have

  • On edge
  • Nervous
  • Panic
  • Stressed
  • Scared
  • Overwhelmed
  • Irritable/lack of patience
  • Uptight

How your body might feel

  • Breathing faster or feeling breathless
  • Stomach churning
  • Chest tight or painful
  • Heart racing/heart palpitations – meaning heartbeats that become noticeable
  • Sweating
  • Tense/sore muscles
  • Dizzy/faint
  • Trembling or tingling sensations
  • Difficulty concentrating

Thoughts you might have

  • “I’m going to die”
  • “I’m not safe”
  • “I can’t cope”
  • “Other people aren’t safe/they’re going to die”
  • “Something bad is going to happen”

Things you might do

  • Avoid doing things that make you anxious
  • Find it hard to relax
  • Snap at people easily
  • Avoid people or things you would normally enjoy
  • Talk very quickly

Due to the unpleasant nature of anxiety, people often worry that experiencing it is harmful. You might worry that the physical symptoms of anxiety, like a fast heartbeat, are signs of a serious health problem. These fears can make you even more anxious, which creates a cycle of anxiety.

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3. What is anxiety?

Anxiety is an unpleasant feeling that everyone experiences sometimes. You might describe it as feeling very nervous or “wound up”.

General anxiety symptoms can last for extended periods of time – it could go on for a couple of weeks or longer. It’s more than just being nervous.

You might have anxious thoughts about yourself, other people, and how you think other people feel about you. You might also have anxious thoughts about the world around you and what’s coming in the future.

People who are anxious usually think negatively about:


  • “I can’t cope”
  • “I’m going to die”
  • “I’m not safe”


  • “Other people can cope better than me”
  • “Someone I love is going to have an accident or die”
  • “The people I love aren’t safe”

The future

  • “Bad things will happen”
  • “I’ll not manage”
  • “I won’t be able to cope”

The world

  • “The world isn’t safe”
  • “The world is a dangerous and frightening place”

Section 4 of 21

4. What causes anxiety?

People can feel anxious for lots of reasons – or you might not know what the reason is right now.


  • Negative thoughts about yourself, other people and the world
  • Early life experiences
  • Learning anxious behaviour from someone else, like a parent or loved one


Difficult experiences:

  • Bullying
  • Stress at work
  • Relationship problems
  • Debts


If a parent or close relative has experienced anxiety, there could be more of a chance that you’ll experience anxiety yourself.

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5. What keeps anxiety going? Activity 1

The things you think, feel, and do when you’re anxious can actually keep anxiety going.

When you’re anxious, you might worry all the time and feel like you can’t get it under control. You might spend long periods of time worrying and this can make it difficult to relax or sleep. These worries can stop you from doing things you enjoy, or things you need to do like going to work.

Now fill in the boxes below about a situation when you felt anxious. Filling this in helps you see how your feelings, thoughts, behaviour and how your body feels are all linked, and can all affect each other.

The text you enter will be saved as long as you’re using this guide, but won’t be sent anywhere.

On the infographic you can see how thoughts, feelings and actions affect each other.

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6. How can I manage my anxiety?

Automatic thoughts

Automatic thoughts are unhelpful thoughts that pop into your mind, without you making any effort to think of them. They’re believable and usually upsetting – this can affect your feelings and what you do.

It’s important to remember that a thought isn’t necessarily a fact, or based on reality. You might believe the unhelpful thoughts that pop into your mind, but it’s actually important to question them. They can be based on unhelpful assumptions.

You might have unhelpful thoughts about all kinds of things. Here are some examples:

Being judged negatively by others

  • “They think I’m useless”
  • “They won’t like me”

Being unable to cope

  • “I’ll make a fool of myself”
  • “I’m too anxious to manage that”
  • “I can’t control this”

Something terrible happening

  • “What if I have an accident?”
  • “What if I lose my job?”

Being unable to control worry

  • “If I keep worrying I’ll make myself ill”

Do you ever think in any of the ways outlined above?

Try thinking about a time when you started to feel anxious. Consider what was running through your mind at that time – was it an automatic thought?

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7. Patterns of unhelpful thinking

Knowing the common patterns that unhelpful thoughts follow can help you recognise and challenge them before they have a negative effect on the things you do.

Here are some common patterns of unhelpful thinking:


People often catastrophise when they’re anxious. This means the anxiety makes them feel like something that’s happened is far worse than it really is.

For example:

  • “My partner’s late coming home – they must have been in an accident.”
  • “I’m worrying so much – this worry could harm me.”

Black and white thinking:

People often see things as black or white when they’re feeling anxious – there’s no ‘in between’.

For example:

  • “I failed that exam – I’m going to fail my whole degree.”
  • “My partner is annoyed with me – they’re going to break up with me.”

Emotional reasoning

This means treating emotions as if they’re facts.

For example:

  • “I feel anxious – something bad is going to happen.”
  • “I feel scared in a new situation – I’m not safe.”

Must and should statements:

People often live by fixed rules for themselves about what they “should” do and how they “should” feel, and judge themselves harshly if they don’t meet them.

For example:

  • “I should be able to cope.”
  • “I must be calm at all times.”

When people think like this, they’re being critical of themselves, which makes the anxiety worse.

If you find yourself thinking this way, it can help a lot to accept that things and people aren’t always perfect, and they don’t have to be in order for you to be calm and relaxed.

Jumping to conclusions:

People often assume they know what others are thinking, and the assumptions are usually about the future – there are frightening “what ifs” running through their minds.

For example:

  • A friend doesn’t say hello when you see them across the street. You think you must have done something terrible to upset them. In fact, they just didn’t see you.

Jumping to conclusions can also make you feel like you know the future, and that it will be bad.

For example:

  • “I’m starting a new job tomorrow – no one’s going to speak to me.”


Based on one isolated incident, people with this thinking pattern assume all future events will follow a similar pattern. It becomes hard to see a negative event as a one-off.

For example:

  • After failing your driving test, you think you’ll never be able to drive.

Dismissing the positives:

Often people can ignore the positive aspects of life or situations, and instead focus on the negative.

For example:

  • Your boss gives you a good review, but you’re certain they’re only saying positive things because they have to.


People who are anxious often label themselves in negative ways.

For example:

  • “I didn’t cope well today – I’m pathetic.”
  • “I couldn’t speak at the meeting – I’m stupid.”


People who think this way believe everything is to do with them, and it’s usually negative – they place blame on themselves for no logical reason.

For example:

  • “My colleague is in a bad mood today – I must have done something to upset them.” In reality, your colleague’s bad day could have nothing to do with you.

Do any of your unhelpful thoughts follow these patterns? Make a list of the ones you have most often, and try to put them in one of the categories above.

It’s important to remember that anyone can experience thoughts like this, and that patterns of unhelpful thinking can be managed so they don’t bother you as much, or at all.

Section 8 of 21

8. How to challenge unhelpful thoughts

Once you have recognised an unhelpful thought the next stage is to challenge it. To do this, you can ask yourself a series of questions.

The example below outlines the cycle of anxious thoughts and feelings. It shows how a situation, combined with negative feelings, can create a cycle with unhelpful thoughts. When you have an unhelpful thought, it makes you feel anxious, which creates more negative feelings. It also works the other way around – negative feelings make it more likely you’ll have unhelpful thoughts, which create more anxiety.

In the next section, you can fill out an example of this cycle from your own life.

Section 9 of 21

9. Activity 2

Use the boxes below to write about a time when you had an unhelpful thought. This will help you to understand and remember how the cycle of anxious thoughts and feelings works.

The next time you find yourself feeling anxious or experiencing an unhelpful thought, it will be easier to remind yourself of what is happening and challenge the thought.

The text you enter will be saved as long as you’re using the guide, but it won’t be sent anywhere.

Section 10 of 21

10. Review your responses


My feelings

My unhelpful thought

Section 11 of 21

11. Challenges to an unhelpful thought

Now you can challenge your unhelpful thoughts by asking these questions. Work through the questions below, using the examples to give you ideas.


“My partner was supposed to be home 20 minutes ago and they aren’t back yet. They must have been in an accident.”

1. Is there any evidence against this thought?

  • “The police haven’t phoned me to say there’s been an accident.”
  • “They’re a safe driver; they’ve never had an accident before.”

2. Is there any evidence for this thought (based in fact)?

  • “They’re 20 minutes late getting home.”
  • “They’re usually on time.”

3. Can you identify any patterns of unhelpful thinking?

  • “I’m catastrophising – I’m thinking of the worst thing that could happen.”
  • “I’m using emotional reasoning – I’m thinking that something bad must have happened because I feel anxious.”

4. What would you say to a friend who had this thought in a similar situation?

  • “I’d say they’re just held up in traffic or at work – this kind of thing happens all the time.”

5. Is there another way of looking at this situation?

  • “They’re probably just busy and will be home soon.”

6. Is there a proactive solution to this unhelpful thought?

  • “I could distract myself from worrying by watching TV.”

Section 12 of 21

12. Activity 3

Now complete the table below to challenge your own unhelpful thoughts.

Section 13 of 21

13. Managing your worry

Anxious people can spend a lot of time worrying, but worry is only useful when it reminds you to do something – otherwise it’s just your thoughts getting stuck in an unhelpful loop. One of the most frustrating things about anxiety is that it can make you feel like you have no control over how much you worry. Managing how much you worry can lower your anxiety.

One way you can do this is to set aside ‘worry time’  this can help you to feel in control of your worry, so it doesn’t feel overwhelming.

Worry time:

  1. Decide a time in the day that’s worry time – this should last about 10 to 15 minutes.
  2. At other times, remind yourself that you have worry time put aside already and try not to think about your worries until then.
  3. Once your worry time arrives, start timing yourself, so it doesn’t go on for longer than 15 minutes.
  4. During worry time, let yourself worry – don’t even try to come up with solutions. Focus entirely on being worried.
  5. Stop as soon as your worry time is finished – or earlier, as you might run out of worries before the 15 minutes is up.

Section 14 of 21

14. Improving your quality of life


Doing something you enjoy will give you less time to spend worrying, and make you feel better overall.


  • Do some exercise, like going swimming or cycling
  • Spend time with a friend or family member
  • Read a book
  • Watch your favourite TV show
  • Go to the cinema
  • Do something creative, like drawing or painting
  • Have a bath

You could do a web search for events happening in your area and see if there’s anything you’d be interested in. Just remember it’s important to pace yourself – you don’t have to do everything at once. You’ll know what works best for you.

Feeling calmer

Breathing exercises can help you feel calmer and reduce your anxiety.

The controlled breathing technique involves focusing on and slowing down your breathing. It’s particularly helpful if you feel dizzy or light-headed when you get anxious.

  1. Get into a comfortable position – you could lie on your bed, or sit on a comfortable chair.
  2. Try to breathe in a steady rhythm. Perhaps try to breathe in for three seconds, hold this breath for two seconds, and then breathe out for three seconds. It can be helpful to count as you do this – for example, “in, 1,2,3… out, 1,2,3”.
  3. Repeat the steady breathing for a few minutes.
  4. You should soon begin to feel more relaxed. If you were feeling dizzy then this should also get better after a few minutes.

We have a number of other breathing and relaxation exercises on NHS inform that can help with anxiety and stress. Try doing one of these when you’re feeling anxious.

Breathing and relaxation exercises

Learn new ways of feeling calmer and more relaxed in day-to-day life.

Section 15 of 21

15. Grounding

Exercise 1

Grounding is a good technique to fend off symptoms of anxiety and stress when they feel overwhelming.

Grounding involves trying to take your mind off of uncomfortable symptoms or thoughts.

You can use the 5,4,3,2,1 method to ground yourself.

Start by sitting in a comfortable place and taking a deep breath. Then try to focus on the following:

  • 5 things you can see
  • 4 things you can feel
  • 3 things you can hear
  • 2 things you can smell
  • 1 thing you can taste

Exercise 2

  • Sit or stand in a comfortable position
  • Imagine you have an empty balloon in your stomach
  • Try to inflate the balloon by breathing through your nose – breathe in while counting to 3
  • Now slowly deflate the balloon by breathing out through your mouth
  • Inflate and deflate the balloon a few times until you feel calmer

Section 16 of 21

16. Reducing avoidance

People often get into the habit of avoiding situations that make them feel anxious. This can, unfortunately, make the problem worse. The longer you avoid something, the more intimidating it becomes. Also, if you always avoid situations that cause anxiety, it’s harder to prove to yourself that you can manage them – as a result, you may lose confidence.

For example:

If you worry about other people judging you negatively, you might avoid going out socially. This means:

  • you might stay at home and avoid social events or taking part in hobbies
  • you might avoid speaking when in groups
  • you could avoid any situation where you have to ‘perform’, like giving a speech or a presentation at work

As a result, you never get the chance to practice coping in these situations, and can’t build up confidence about them. There’s no opportunity for you to reduce the anxiety you feel about doing these things.

If you can confront situations that make you feel anxious, you’ll build up confidence. Over time, this will reduce the anxiety symptoms.


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17. Confronting the things you avoid - Activity 4

There are three steps to this activity:

  1. Make a list of situations that you often try to escape from or avoid. For example, you could write “work nights out” or “giving presentations”.
  2. Give each situation a “difficulty score” out of 10. If a situation causes you no anxiety, rate it 0. If it causes extreme anxiety, rate it 10.

Try to put the situations in order, from least anxiety to most anxiety. Here’s an example:

Situation Difficulty score (0 = no anxiety, 10 = extreme anxiety)
Getting the bus to work 4
Talking to someone I don’t know 6
Joining a yoga class 7
Giving a presentation at work 9

Download a table to fill out

3. Confront the lowest-ranked item on your list – this is the one that causes you the least anxiety.

Although your anxiety symptoms might feel worse at first, if you keep going they’re likely to reduce. Try to stay in the situation until your anxiety has reduced.

Remember, you don’t have to be scared of the symptoms of anxiety. They might feel awful, but they aren’t dangerous.


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18. Continuing to confront the things you avoid

Keep confronting the situation that makes you feel the least anxiety – every day if you can. If you can’t do it every day, try not to wait too long between the times you can confront the situation. The more you confront the situation, the less fear you’ll feel.

Every time you experience the situation that makes you anxious, you should notice that your anxiety symptoms get a little better.

Move on to the next situation

When you feel comfortable with the situation that causes the least anxiety, move to the next one on your list and repeat the process. As you work through the list, you’ll start feeling anxious in fewer situations and your confidence will grow. As you progress, you’ll find that the situations you rated as very difficult start to seem much more manageable.

You might confront a situation that doesn’t go as well as you hoped. Try not to give up. If you keep going, it’ll get easier.

If there’s something on your list that seems too much, see if there’s something smaller you can do to build up to it. For example, if you’re anxious about going to an exercise class, start by calling the gym to ask about the class and get more information. This will help you build more confidence before you tackle the main situation.

Look out for other situations that you avoid due to anxiety, and try to reduce your avoidance more and more. In time, you’ll feel much more confident and experience fewer anxiety symptoms.

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19. Problem solving

You might find it more difficult to cope if you have a lot of problems you can’t seem to get on top of. This can make your mood worse and leave you feeling more anxious.

It’s possible to end up worrying over problems without finding a way to resolve them. This can interfere with many parts of your life – even things like eating and sleeping.

Problem solving guide

It can help to develop a structured way of working through a problem. Beginning to overcome some of your problems might help you to feel better.

Section 20 of 21

20. Self-esteem

Self-esteem relates to how we think and feel about ourselves, and how much value you think you have as a person.

People with low self-esteem often ignore their own achievements and positive things about themselves, and criticise themselves even when there’s no reason to.

Low self-esteem isn’t a medical condition or mental illness on its own, although you can experience low self-esteem as a result of mental health issues like anxiety.

Self-esteem self-help guide

Work through a self-help guide that uses cognitive behavioural therapy (CBT) to improve self-esteem.

Section 21 of 21

21. Next steps

Urgent help

This self-help guide is intended for people with mild-to-moderate symptoms of anxiety.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

Keep using the techniques you found helpful from this guide – they should continue to benefit you. If there are some things that you didn’t find helpful to begin with, stick with them for a few weeks – CBT can take a little time to work.

Further help

If you’re feeling distressed, in a state of despair, suicidal or need emotional support you can phone NHS 24 on 111. For an emergency ambulance phone 999.

If you feel you need more help with your mental health, try speaking to your GP, or search for mental health and wellbeing services in your area.

For information and advice when you’re feeling down, you can phone Breathing Space on 0800 83 85 87.

The Breathing Space phoneline is available:

  • 24 hours at weekends (6pm Friday to 6am Monday)
  • 6pm to 2am on weekdays (Monday to Thursday)

If you found this guide helpful and would like to do more work like this, Living Life offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.

Learn more

To learn more about coping with anxiety and related issues, you can visit some other parts of NHS inform:

Learn more about anxiety and your mental wellbeing

Learn about panic attacks

Read about dealing with panic attacks

Find out about stress

Read our 10 stress busters

Try some more breathing and relaxation exercises


Last updated:
27 May 2021