NoPanic

Category: Articles by No Panic Volunteers

  • Learning to Drive with Anxiety

     By Amy Moore, Content Team Contributor

    When I turned seventeen, all anyone would ask me about was if I would start my driving lessons soon. My entire family was so excited for me, but I just remember being swamped with nerves. My friends spent their teenage years constantly talking about what they’d do and where they’d go once they were able to drive. They spoke of road trips across the country and evening trips to the beach for fish and chips, and yet there was no part of me that felt the same excitement. I would play along and pretend as though it was something that I dreamt of, too, when in fact, it was just another change in my life that I was dreading.

     I knew that I was in a privileged position where I had the opportunity to start learning to drive almost immediately after my seventeenth birthday, and yet I just felt so anxious about the whole situation. I feared all kinds of things. I thought that I’d have a panic attack behind the wheel and wouldn’t be able to pull over. I thought that the roundabouts were just impossible to navigate and that I’d annoy all the other drivers because I wouldn’t ever be able to pull out of a junction. I simply thought that I’d never be able to drive. I thought there were too many factors against me.

     However, what I realised soon enough, was that actually the biggest thing holding me back was being unable to trust myself. It took me months of weekly driving lessons, but eventually, I seemed to come to the understanding that unless I fully trusted myself in the driver’s seat, I would never even get through the driving test, let alone be able to gain the freedom that all my friends had wished for.

    Anxiety is very good at making us doubt ourselves. It’s like a constant mantra of ‘what if you can’t do this’, ‘what if this really bad thing happens’, and ‘what if everything goes wrong and it’s your fault’. And when we tell ourselves about these things over and over again, our brains seem to tell us that because it’s so ingrained, then they must be true. The very idea of opposing the thought seems so impossible that it feels unthinkable to even try.

     After nearly a year of driving lessons, I took my driving test. And for months beforehand, all those thoughts had been going around and around in my head. I had convinced myself that there was no way I could pass, even though my driving instructor seemed positive that I could do it, and my parents knew I was a good driver, their words just faded to nothing. I was so fuelled by anxiety that in the days leading up to my test, I made stupid mistakes in my last few driving lessons that knocked my confidence, and I felt so ill from nerves in the days beforehand that it seemed as though there was no chance of me even getting to the test centre, let alone actually attempting the test. But somehow, I managed to get in the car, and I got to the test centre.

     It was only in those last few moments before I drove off for what could have been the worst forty minutes of driving I had ever done, that I just vividly remember thinking to myself that I was in complete control of this situation. Learning to drive is so difficult because you’re pushed into the driver’s seat knowing practically nothing, and then it’s like you’re thrown into the deep end, onto roads with other drivers. But what you have to realise is that you are in complete control of the situation, and you have to have faith in your own abilities. You have to challenge the constant cycle of anxious thoughts, otherwise everything seems impossible.

     I managed to pass my driving test, and now I have the freedom to go wherever I want whenever I want, which has helped me immensely with managing my anxiety. It has taught me that to achieve things, I have to change my mindset. There is no use in doubting yourself all the time; all you need is the smallest spark of strength to confront anxiety. You have to challenge every ‘what if you can’t do this’ with the simple thought of, ‘but what if I can?’.

  • Don’t Fight The Feeling—How Facing Anxiety Helps Me Handle It.

    By Melissa Fleur Afshar, Content Team Contributor

    We’re often encouraged to hide away our fears and anxious feelings, putting on happy faces no matter what instead. Sometimes, it can seem easier to cope that way. You don’t need me to tell you that anxiety, panic and racing thoughts are extremely uncomfortable and distressing. The intense physical symptoms that I would suffer from were enough to lead me to believe I was having a heart attack. But what if embracing that anxiety could actually help us feel better? I’ve found that facing anxiety head-on can not only ease those tense moments but also pave the way for healing.

    I’m a journalist, and my job can be as stressful as it is exciting. Couple that with my busy personal life and the demands of adulthood we all face, and I often feel stressed, anxious or overwhelmed. Sadly, these intense pressures have led to me facing some pretty tough times.

    My first instinct, whenever I felt anxious, used to be to run away—sometimes literally as I was often in a state of fight or flight—but I’ve learned that actually turning to face those feelings, instead of relying on other people or external factors to help distract and reassure me, is where healing can start.

    This approach to anxiety isn’t a quick fix; it’s more about uncovering and understanding our emotions, which has helped me learn how to manage them more effectively over time. And it certainly doesn’t mean that I don’t talk to my friends and family about how I feel, or that others shouldn’t find comfort in the empathy of others. I mean that by sitting with my anxiety, recognizing its presence, and applying various techniques, I can reassure myself that I’m safe and take back control from those overwhelming thoughts and feelings all on my own.

    Facing Anxiety

    When anxiety kicks in, it’s like our bodies’ alarm systems are going off, warning us of danger, either physically or emotionally. But what if we could change the message those alarms are trying to send? Through a lot of practice and patience, I’ve started to see these anxious feelings not as doom and gloom but as an overly cautious friend who simply means well. In a nutshell, that’s why we experience stress: Because our body thinks it will help keep us safe. This change in perspective starts with just being with the anxiety, not fighting it but understanding its intentions.

    Once I figured this out, I’d tell myself in moments of panic: “You are safe, everything is okay.” This doesn’t make the anxiety vanish, but it helps smooth out its rough edges, making it a bit more manageable and a whole lot less scary. After all, while the waves of anxiety and panic can be incredibly scary, they are normal human reactions to things we have perceived as being stressful or threatening. Reaffirming that what I am experiencing is normal, tones that alarm bell down a few notches. This can then open the door for me to use coping strategies that actually work and are easy to practice.

    I rely a lot on methods like Emotional Freedom Technique (EFT) tapping, deep breathing exercises, and meditation. Each of these helps bring me back to the present moment, dissolving immediate fears and slowing my racing thoughts. I also find that physical activities like walking, dancing, or losing myself in a good book once I’ve started to feel a bit more grounded not only distract but also reconnect me with my body, reinforcing a sense of safety within.

    These methods aren’t magic, and some days are certainly harder than others. But each time I manage to find a moment of peace by handling anxiety head-on, I’m building up my resilience and trust in myself. By leaning into feelings of anxiety instead of shunning it, I’m slowly taking away its power to unsettle me. Instead, I try to listen to my body and understand what those feelings are telling me. For me, that often translated into “something bad might happen,” or “you are not safe.”

    Once I’ve been able to calm down a bit by regulating my nervous system, I can then continue to tell affirm that I am safe, even with those stressful thoughts and anxious feelings.

    Taking on anxiety is definitely a challenge—it’s not for the faint of heart. But it’s worth it for the deeper connection I’ve forged with myself and for the arsenal of tools I’ve gathered to not just handle anxiety but to enjoy my life and career despite it.

    I’ve come to realise that for me, thriving in the face of anxiety isn’t about fighting it; it’s about understanding and embracing parts of myself and thoughts that I once feared, turning an old enemy into a trusted guide towards emotional balance.

  • Imposter Syndrome at University: What Is It and How to Manage It?  

    By Megan Pocock, Content Team Contributor

    For many university students, the excitement of starting a new chapter is often shadowed by an unsettling question: Am I in the right place? I certainly felt this way when I first started. New environments, social demands, and academic pressures can leave you questioning whether you belong or deserve to be here at all. If you’ve ever felt out of place, anxious and unsure in your university experience, you’re not alone.  

    Recognising Imposter Syndrome  

    Imposter syndrome is that sneaky, inner voice that tells you you’re not good enough. It thrives on comparison, unrealistic expectations, and fear of failure, often whispering things like: “I don’t belong here,” “I only got in by luck,” or “Everyone else is doing better than me.” This self-doubt creeps in particularly during major life transitions, like university, and can feel overwhelming.  

    A common misconception about imposter syndrome at university is that it only occupies your first year anxieties. This isn’t true, the doom and gloom can be felt throughout your academic journey. As someone in the midst of my second year, I can openly admit I still feel these doubts regularly—but I’ve also picked up a few strategies to help me overcome them.  

    It’s important to recognise imposter syndrome for what it is: an emotional response, not a reality. Feeling like you’re not good enough doesn’t mean it’s true. Often, these thoughts are triggered by stepping out of your comfort zone, which is exactly what university is all about.  

    Strategies for Managing Imposter Syndrome

    1. Reconnect with Your Why

    When doubts creep in, remind yourself why you chose your university in the first place. Was it the course content, the campus, or the chance to grow personally and academically? Revisiting those reasons can help ground you when you feel out of place.  

    2. Stop the Comparison Game

     It goes without saying that this is much easier said than done. But It’s easy to look around and think everyone else has it together. Whether it’s social media or surface impressions, they rarely show the full picture. Everyone has their own struggles—they’re just not as visible as your own.  

    3. Celebrate Small Wins

     Imposter syndrome often comes from focusing on what you haven’t achieved. Flip the narrative by celebrating the small victories: finishing a reading, contributing to a seminar, or making it to a social event. These little wins add up and can truly change your mind set on what you can go on to achieve.  

    4. Talk About It  

    You’d be surprised how many of your peers feel the same way but are afraid to admit it. The best thing I did at the start of the academic year was open up to my tutor about how I was feeling this immense pressure and anxiety to match others. Opening up to friends or even a student support service can make you feel less alone and help you see your experience in a different light. Imposter syndrome can take such an emotional toll on your self-belief and it’s not something you need to tackle alone.

    5. Fake It ‘til You Make It (Within Reason)

     I have always been sceptical of this advice as I felt it meant I needed to pretend to be someone I’m not. But sometimes acting like you belong can help you feel like you do. Confidence isn’t built overnight unfortunately but embracing this will help you practise self-assurance until it eventually becomes natural.

     One of the most valuable lessons I’ve learned is that discomfort is often a sign of growth. It’s easy to mistake the unfamiliar for failure, but university is a time for exploring who you are and where you’re going. You’re not supposed to have it all figured out from day one or even year two like me. I am still uncertain on where I want to take my career aspirations beyond university and that’s more than ok.

    Some days will be harder than others but trusting the process and staying open to change is key. Whether that means switching courses, joining new societies, or just giving yourself permission to rest, every step you take is part of your journey. If you’re struggling with imposter syndrome, I want you to know that you are not alone, you are not a fraud, and you absolutely deserve your place at university.

  • Year 2 of the Content Team

    By Wayne Senior, Content Team Co-ordinator.

    There has been a lot of change at No Panic this year. In the Content Team, our two previous editors Millie and Daniel left to pursue their careers, so we got a couple of new editors, Aimee and Ben. In No Panic, I became Chair. Keeping the Content Team going was initially a challenge, but things have settled down. We even managed to keep the Content Team going when we had serious website problems. That was a stressful time. Here I highlight some of the articles we published in 2024.

    I’m going to begin at the beginning of the year not to be chronological, but because I don’t think we will publish similar articles at the beginning of 2025. One of our young contributors Lila Saw offered her tips on making progress with anxiety. Try these at the start of 2025.

    Many of our contributors are students. Some write academic articles while on placement with us. Mohammed Adil Sethi wrote several articles for us. I highlight his article on Selective Mutism. This is an anxiety condition, but not one that comes up often in No Panic. Conner Keys wrote a few articles. This one is useful for those who struggle to stay away from social media, in case they miss out on something.

    Staying with social themes, Chaima was one of our young contributors. She wrote about the fear of social rejection. No Panic is happy to support the No Phones At Home campaign, which aims to get people spending less time on their phones and more time doing things together. Their founder Charlotte Armitage wrote about how you can reduce your stress levels by digitally detoxing.

    This year’s theme for Mental Health Awareness Day was movement. At No Panic, we encourage people to go for 10-minute walks. Our Patron Ruth Cooper-Dickson wrote an article on the theme of movement. Meanwhile our contributor Hannah Parton wrote about a specific kind of moment, when she shared her experience of moving house.

    We support several people who have anxiety and autism, so I was delighted when Kay Inglis agreed to write about anxiety and autism.

    We like to publish articles by authors of anxiety books. In return, they publicise the articles they have written for us, increasing awareness of the support offered to people who have anxiety by No Panic. Joshua Fletcher is a popular author with our members, so we were pleased to be able to publicise his book, “And How Does That Make You Feel?” Eleanor Segall wrote an article about her book “Arabella and the Worry Cloud”.

    Summer is a time people go on holiday. Some people have a fear of flying. Our contributor Amy had some tips for them. Paris had advice on managing anxiety over the Summer in general.

    Most people find funerals difficult, but they are even more difficult when you have anxiety. All those people packed together. One of our contributors wrote about her experience of funerals, and shared advice on dealing with bereavement when you have anxiety.

    So in year 2, we have covered a lot of different aspects of life, from funerals to holidays. What will we add in 2025? If you have something to add, why not become a contributor?

  • Feeling a little off this Winter? Tips for Overcoming the Winter Blues.

    By Julitta Lee, Content Team contributor.

    Feeling irritable? Unmotivated? Less social or active? Having trouble concentrating? Sleeping or eating more than usual? Or have been feeling a persisting, low mood? If these symptoms resonate with you, you may be experiencing Seasonal Affective Disorder (SAD), a seasonal type of depression also known as the “winter blues.”

    As we’re deep into the winter season it’s completely understandable to feel unlike your usual self. Though, it’s worth paying attention if you feel that it has started to significantly disrupt how you think, feel, or behave. According to Healthwatch, around 5% of people in the UK are diagnosed with SAD.

    The good news? There are steps you can take to ease the symptoms. Here are 6 practical tips to help keep you feeling more like yourself this winter:

    Eat and Drink Well

    What you eat hugely plays into your physical and mental state. Sioned Quirke, Head of Nutrition and Dietetics at Swansea Bay Health Board, puts this simply: “There is a huge connection between what you eat and your mental health, so it’s really important to keep yourself well nourished.”

    Planning ahead is a way to make this easier – thinking about and preparing meals in advance can help you make healthier choices, reduce stress and prevent you from falling back on overly processed foods. It is also important that you mind your portions. It can be incredibly tempting to overindulge in comfort foods, but keeping portions balanced is what helps you feel your best. Additionally, remember to stay hydrated – keep a bottle of water close by to remind yourself to drink regularly!

    Stay Active

    Physical activity increases blood flow to your brain, which releases feel-good endorphins that clears your mind. Research has proven exercise to be one of the most effective ways to manage symptoms of depression, including SAD. 

    It doesn’t always have to be a formal exercise session:

    • Get outside! A brisk walk or jog in daylight can give you a double boost of exercise and natural light.
    • Try something fun. Dance around your living room, do some yoga or take a swim. 
    • Start small. Even 10 minutes of activity can make a difference, like climbing your own stairs or doing some household chores. 

    The key is to find something you enjoy, and it’ll soon grow into your routine. Any movement counts, and the more you do, the better you’ll feel!

    Letting the Light in

    Winter’s shorter days and darker mornings can disrupt your internal clock and contribute to SAD. Try brightening up your environment:

    • Open up your curtains during the day.
    • Tidying and decluttering to open up space and create a more relaxed atmosphere.
    • Invest in a therapy lamp, which mimics sunlight, or install brighter lamps and bulbs.
    • Add a touch of greenery with houseplants to refresh your surroundings, and make your space feel lighter and more inviting.

    Reflect, Plan, Organize

    Taking a little time to reflect on yourself can help you notice patterns and manage your symptoms. You can start a journal to track your thoughts, feelings and activities – treat it as an opportunity for self-care and reflection. This could even help you to plan your days and structure your time to reduce the overwhelm of feeling unproductive. Remember, this is all about giving yourself space to process emotions and feel more in control.

    Connect with Others

    Winter’s cold weather and early sunsets can make socialising feel more difficult and less appealing, but staying connected is vital for your well-being. Take initiative and spend time with friends, family, join a social club or even a group of volunteers! If you can’t meet in person, arrange a video call or check in through texts! Communities and connections can give you a sense of purpose and improve your overall mood during these darker months. 

    Don’t Hesitate to Seek Help

    SAD is a type of depression, and it’s important to take it seriously. If your symptoms persist or start affecting your daily life, don’t dismiss them and speak to a health professional. The National Institute for Health and Care Excellence (NICE) recommends treatments like talking therapy, such as Cognitive Behavioral Therapy (CBT) and, and medication, such as antidepressants.

    For additional support, NoPanic offers resources and talking therapy options. Visit our website for more information.

    And finally, SAD is seasonal, but that doesn’t mean you have to wait it out. Taking proactive steps — like eating well, staying active, brightening your space, and connecting with others — can help you feel more in control and enjoy this time of the year!

    And remember, brighter days are ahead, both literally and figuratively.

    Articles consulted:

    https://www.houseandgarden.co.uk/article/lighting-mood-winter

    https://bjsm.bmj.com/content/57/18/1203

    https://www.health.harvard.edu/blog/stepping-up-activity-when-winter-slows-you-down-202403043021

    https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/symptoms

    https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

    https://www.healthwatch.co.uk/advice-and-information/2024-10-15/what-sad-and-how-can-you-manage-it#:~:text=Seasonal%20Affective%20Disorder%20(SAD)%20is,diagnosed%20with%20SAD%20than%20women.

    Treatments for seasonal affective disorder

    https://sbuhb.nhs.wales/news/swansea-bay-health-news/help-keep-well-through-winter-with-a-healthy-and-balanced-diet/#:~:text=Having%20a%20healthy%20and%20balanced,intake%20of%20fruit%20and%20vegetables.

  • How Walking Helped Decrease Anxiety

    By Amy Moore, Content Team Contributor

     For a long time, exercise was always something that I shied away from doing. It was never something that I enjoyed, and it constantly felt like a chore that I had to participate in. I was always the slowest in school PE classes and swimming, the one sport I could do, unfortunately, became something that felt impossible to do when I began having daily panic attacks. Swimming pools felt so claustrophobic, and my biggest fear was having a panic attack in the centre of a pool and being unable to get out. So I simply stopped doing it. As soon as PE became optional instead of compulsory at school, I stopped doing that, too, and suddenly exercise became virtually non-existent in my life.

     So many people told me that exercise would help me feel better. They said that it would give me something to get up for on days when I refused to get out of bed. At the time, it was hard enough to even go downstairs in my house, so the idea of exercise was the last thing I wanted to think about. And I also just did not want to believe it because it was always something that I had struggled with and had never typically enjoyed. It was actually lockdown which changed my mindset drastically. Suddenly the hour walk we were allowed each day was my saving grace and it became the best part of my day.

     I am here to tell you that actually, those people were correct, and actually, exercise has greatly reduced my daily anxiety. Walking, in particular, is something that I try to make sure I do every day now. There is just something about walking in the fresh air, even if it’s just for twenty minutes, which immediately calms me. I tend to walk at my own pace, often with my dog, in the morning before my day starts and it’s safe to say that I have noticed a huge decrease in my own stress and anxiety.

     I am a person who also gets very anxious about social events, and so I have incorporated walking into my way of dealing with this anxiety, too. I will now purposely park at least ten minutes away from where I need to be so that I can take that time to walk and calm myself down before having to be sociable. I always found that if my anxiety levels were high when entering somewhere busy, then it would be much harder to try and calm down, often leading to panic attacks where I would feel like I needed to leave early. Incorporating a walk into these things has become a way of me taking back control of my own emotions before having to enter a potentially uncomfortable situation.

     I have also found that walking can also be a sociable occasion. Throughout my teenage years, I held a lot of guilt and anger over how I felt anxiety was holding me back from seeing my friends, and I truly felt as though there was no way of getting out of the hold that it had on me. But, as my friends and I have got older and our lives have become busier, walking together has become our way of catching up (it also helps that we forget we’re also doing exercise!) and we usually incorporate a coffee stop somewhere on route, too.

     Within a couple of years, I have gone from someone who despised any form of exercise, overthinking the way that I walk or worried that people would be judging me for walking too slowly, to someone who genuinely credits walking as a crucial aspect of decreasing panic attacks, anxiety, and stress. It has become something that I genuinely enjoy, and I really wish that I had listened to those people who told me years ago that exercise would help my mental health. Every person has different ways of coping with anxiety and panic attacks, but exercise has truly been something that has helped me immensely.

  • Anxiety and a bad case of extremes…

    By A Content Team Contributor

    I’ve recently had cause to seek counselling as a result of a significant bereavement in my life. The bereavement followed a long, drawn-out illness, the witnessing of which was hard, and took its toll on my mental health.

    The run-up to the funeral ended up being even more fraught than might ordinarily be the case, because first, logistical reasons meant we had to wait several weeks to hold it, and secondly, a matter I will describe in an understated manner as ‘family politics’ left me genuinely anxious about the people I would encounter at the event. This was all on top of the fact that preparing for a funeral of a loved one is fairly horrendous at the best of times.

    Someone who doesn’t ordinarily suffer from anxiety would probably have found themselves anxious anyway – but I found my anxiety spiralling in this period. What I didn’t realise until I discussed this with my counsellor was the extent to which my mind was fixated on the extremes; I had entirely concocted in my mind what a ‘worst case scenario’ and ‘best case scenario’ might look like, and it was as though my body was continually in fight or flight mode working out how to respond to these.

    Extremes like these are a massive part of suffering with anxiety. Even if it’s anxiety about, e.g. being late for something, our minds continually try to pre-empt that, and prepare our reactions for dealing with the worst case.

    It was discussing the above with my counsellor that led her to point out that, statistically, and being realistic, the most likely outcome of something you are anxious about probably isn’t the worst case. It may not be the best case either; in fact, it’s probably somewhere in between those two ‘extremes’.

    Sounds obvious and a bit like common sense when you put it like that, then? Well, yes. However, until she had presented my anxious brain with that proposition in those bald terms, I had never considered there might be an alternative, and suddenly it felt as though I had something of a shield against the anxiety. I used it as a mantra to help me face the day – and as it turned out, the counsellor’s prediction about the outcome being somewhere in between turned out to be spot on. The thing I was most anxious about turned out to be not as bad as my anxiety had made me believe it would be.

    So, what are the takeways here?

    First, if you are going through a bereavement, counselling can be a huge help and I would highly recommend it. While I had specific reasons for seeking counselling, even when circumstances changed the extent to which I relied on those sessions surprised me. Grief is one of those emotions where you can be fine one minute, and bawling your eyes out the next – and having an outlet for the latter is a tremendous relief.

    Secondly, even outside of a grief scenario, if you find your anxious brain jumping to extremes, try and remember exactly that: it is an extreme. Chances are, the outcome won’t equal the extreme; that old devil anxiety is playing tricks on you again. Use your defences –  and don’t let that devil convince you otherwise.

  • Selective Mutism’s Overview, Causes, Symptoms and Treatment

    By Mohammed Adil Sethi, Content Team Academic

    Selective Mutism (SM) is an anxiety disorder; it is not a very frequent but a severe type of disorder in which a person can speak fluently but remains mute in some situations only (Muris & Ollendick 2021). However, if not treated correctly, SM can persist throughout childhood and into the adolescent and adult periods of a person’s life. People diagnosed with SM and their families, educators, and caregivers need to know about this condition.

    Overview of Selective Mutism

    SM affects individuals most often in childhood and usually becomes apparent between the ages of 2.5 and 4 years (Steains et al. 2021). One should be able to differentiate between SM and mere social shyness or introversion. Whereas shy children may take time before they can come out and freely intermingle, basically children with SM suffer from such an intense sense of anxiety that it freezes them to the vocal extent of their ability in certain social environments. For example, while the child may be quite vocal about expressing himself or herself in the comfort of home, in school, or in the presence of strangers, the child may not utter a single word.

    For many years, it used to be associated with trauma or wilful silence. However, recent studies indicate that there is a significant correlation between SM and such psychological conditions as social phobia. Freud described a specific type of withdrawal called social Mutism or SM, in which the child can speak physically yet refuses to do so because of anxiety.

    Causes of Selective Mutism

    Genetic Predisposition and Family History: SM often seems to be inherited or passed from one generation of the family to another. SM is common among children with an inherited tendency for anxiety disorders, including social anxiety (Pereira et al. 2020).

    Temperament and Personality: Children who are born introverted or are self-conscious are at a higher risk of developing SM. These children may easily respond to stimuli from the environment and may even be overwhelmed by anxiety in social relations (Haggerty et al. 2022).

    Environmental and Social Factors: SM in children can develop due to stressors such as bullying, family conflict, or changes in the environment, for example, moving to a new country. However, adolescents who experience elevated levels of stress or those whose parents are overprotective, or controlling are also at higher risk (Koskela et al. 2024).

    Co-occurring Conditions: SM is frequently comorbid with other anxiety disorders, such as social anxiety disorders and concerns about speech and language. SM may develop in children with language problems or those who have speaking disorders that stress them when speaking (Gensthaler et al. 2020).

    Symptoms of Selective Mutism

    SM is one of the anxiety disorders presenting itself as a condition in which one can speak fluently in some contexts but finds it exceedingly difficult to in other situations, particularly those that are demanding socially (Mizzi & Sant, 2021). These are instinct reflexes that can lead to a full-blown aphonia, rigidity of the muscles of the face and body, averting eye contact, and little social interaction. Some use sign language other than speech, thus, write or gesticulate; use only simple sounds like ‘uh-uh’ for ‘no.’ Some patients may speak very little and only in low tones, very slowly or in a whisper; may speak with an abnormal pitch or tempo. These are not symptoms of ‘no talk syndrome’ but rather transient vocal responses to severe anxiety overwhelming the child, hence the need for positive ways to respond to the child.

    Diagnosis of Selective Mutism

    SM is usually diagnosed by a mental health expert, for instance, a psychiatrist or a psychologist. Sometimes, a speech-language pathologist or speech therapist might be consulted to exclude other illnesses that can concur and may cause such symptoms. Diagnosis involves some behaviours that are presented, as well as an evaluation of the experiences of the affected person and other factors.

    SM diagnosis is based on DSM-5, in which the mental disorder manifests through the presence of a preoccupation with one’s appearance and bodily image. The key criteria include:

    1. The inability to speak and the inability to speak when there are prerequisites for its use while the ability to speak in situations that do not require the use of speech
    2. Communicative impairment causes reduced communication, including in social, educational, or occupational domains.
    3. The condition continues for more than one month without the individual being able to return to their normal activities.
    4. The inability to speak is not because the child is ignorant of the language or is unable to comprehend it.

    Treatment of Selective Mutism

    Cognitive-Behavioural Therapy (CBT): CBT is the most effective treatment for SM, as it decreases anxiety and teaches the person to speak more. Methods of CBT include exposure therapy, where the child is gradually exposed to speaking in more difficult situations and rewarded for acts of bravery.

    Behavioural Therapy: According to Esmail et al. (2021), positive reinforcement techniques such as shaping, stimulus fading, and contingency management are also common. Shaping involves teaching the child to use different signals to talk, starting with leading the child from the use of gestures toward full speech. These are stimulus fading, which assists the child to come from talking in familiar places to new places, and contingency management, which uses reward systems to encourage good behaviours.

    Speech Therapy: When the child has one or more speech/ language disorders, speech and language therapy can play a significant role in the intervention. There are several reasons why a patient may be referred to a speech therapist, one of which is to manage individual speech phobia. At the same time, he/she is taken through a series of exercises and activities that enhance effective communication.

    Parent and Teacher Involvement: According to Slobodin et al. (2024) SM typically occurs in school settings, the parents and teachers ought to be involved in the management of the condition. Faculty members can also design ideal classrooms where children can express themselves while the parents can further promote helpful language patterns at home.

    Prognosis and Coping Strategies

    SM can be overcome with early intervention so that the prognosis of children with this disorder is often favourable (Hong et al. 2023). Nevertheless, most children outgrow the occurrence, while the rest can control their symptoms as they advance in age. Nonetheless, if it persists with no interference, SM extends to adulthood, entailing difficulties at work and in social relations.

    Some techniques that can be employed when managing SM are creating a conducive environment that will enable the patient to feel comfortable, especially when around people who are close to them; the patient is advised to set specific goals that concern the communication that is involved in a particular social activity, the patient is then gradually exposed to the problematic aspects of social activities. Parents and especially teachers should also avoid pushing the child to talk since this only worsens the situation, and the child gets more agitated.

    Conclusion

    Selective Mutism is a very severe but very treatable illness. If the individual with SM seeks therapy and support when necessary, the person can learn to overcome the fear and can speak in public. SM should be treated with treatment paradigms, blending mental health workers, teachers, and family members to care for such individuals.

    References

    1. Muris, P., & Ollendick, T. H. (2021). Selective mutism and its relations to social anxiety disorder and autism spectrum disorder. Clinical child and family psychology review, 24(2), 294-325. 1) https://doi.org/10.1007/s10567-020-00342-0
    2. Steains, S. Y., Malouff, J. M., & Schutte, N. S. (2021). Efficacy of psychological interventions for selective mutism in children: A meta‐analysis of randomized controlled trials. Child: care, health and development, 47(6), 771-781.  
    3. https://doi.org/10.1111/cch.12895
    4. Pereira, C. R., Ensink, J. B., Güldner, M. G., Kan, K. J., de Jonge, M. V., Lindauer, R. J., & Utens, E. M. (2020). Effectiveness of a behavioral treatment protocol for selective mutism in children: Design of a randomized controlled trial. Contemporary clinical trials communications, 19, 100644. https://doi.org/10.1016/j.conctc.2020.100644
    5. Haggerty, D., Carlson, J. S., & Kotrba, A. (2022). A pilot feasibility study of an intensive summer day camp intervention for children with selective mutism. Children, 9(11), 1732. https://doi.org/10.3390/children9111732
    6. Koskela, M., Jokiranta-Olkoniemi, E., Luntamo, T., Suominen, A., Sourander, A., & Steinhausen, H. C. (2024). Selective mutism and the risk of mental and neurodevelopmental disorders among siblings. European Child & Adolescent Psychiatry, 33(1), 291-302. https://doi.org/10.1007/s00787-022-02114-3
    7. Gensthaler, A., Dieter, J., Raisig, S., Hartmann, B., Ligges, M., Kaess, M., … & Schwenck, C. (2020). Evaluation of a novel parent-rated scale for selective mutism. Assessment, 27(5), 1007-1015. https://doi.org/10.1177/1073191118787328
    8. Vogel, F., & Schwenck, C. (2021). Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal. Child and Adolescent Psychiatry and Mental Health, 15, 1-17. https://doi.org/10.1186/s13034-021-00430-1
    9. Slobodin, O., Shorer, M., Friedman Zeltzer, G., & Fennig, S. (2024). Interactions between parenting styles, child anxiety, and oppositionality in selective mutism. European Child & Adolescent Psychiatry, 1-11. https://doi.org/10.1007/s00787-024-02484-w
    10. Esmail, M. E., Alharbi, M. B., Alayed, I. S., Alqahtani, M. S., Aldeeb, H. F., Alanazi, Y. H., … & Doshi, T. A. (2021). Definitions, importance, and application of selective mutism questionnaire in the primary care setting. International Journal of Community Medicine and Public Health, 8(12), 1. https://dx.doi.org/10.18203/2394-6040.ijcmph20214451
    11. Hong, N., Herrera, A., Furr, J. M., Georgiadis, C., Cristello, J., Heymann, P., … & Comer, J. S. (2023). Remote intensive group behavioral treatment for families of children with selective mutism. Evidence-based practice in child and adolescent mental health, 8(4), 439-458. https://doi.org/10.1080/23794925.2022.2062688
    12. Mizzi, B., & Sant, M. (2021). Professionals’ experiences of selective mutism in children: An interpretative phenomenological analysis. https://doi.org/10.14614/SELECTIVEMUTISM/8/21

  • Social Anxiety Disorder in Education

    By Conner Keys, Content Team Academic

    Social anxiety disorder (SAD) is a fairly common anxiety disorder that is characterised by feelings of intense anxiety and fear. The NHS describes it as ‘a long-term and overwhelming fear of social situations’ (NHS, 2023). Research has shown that SAD has a lifetime prevalence of 12.1% (Kessler, et al., 2005).

    Symptoms–

    There is no one cause of social anxiety. It is a very personal disorder, and various factors can contribute to its development. Such factors may include:

    • Emotional, physical, or other kinds of abuse,
    • Genetics,
    • Hormones,
    • Negative interactions with peers and/or family,
    • Social demands,
    • Trauma.

    Due to these potential causes, social anxiety can be a symptom of other psychological disorders, e.g., PTSD, major depression, and agoraphobia.

    Typically, SAD develops in childhood and teenage years. Research found that among those seeking treatment, ‘the median age of onset is in the early to mid-teens’ (National Collaborating Centre for Mental Health, 2013). However, this isn’t to say that SAD can’t still emerge later in life.

    Effects–

    Although people with this disorder describe physical symptoms such as nausea/vomiting, dizziness, and trouble breathing, alongside the more well-known emotional symptoms, the disorder is often dismissed as mere ‘shyness’. This, however, is clearly not the case: SAD can be extremely distressing. One individual admitted that ‘the thought of leaving the house most days fills me with dread and nausea’, (Taryn, 2023). Due to such symptoms, Social Anxiety Disorder can make daily tasks seem impossible and inconceivable, for example, going to the shops. This is a task many of us don’t think too much about, however, someone with SAD may not be able to complete this action, as they fear things such as how other shoppers may perceive them, and having to talk to the cashier. Additionally, it is likely for them to be consumed by thoughts including, ‘what if I say the wrong thing?’, or ‘what if I am judged for what I’m buying?’, which stops them from going.

    Going to the shops isn’t the only thing that Social Anxiety Disorder can inhibit. A major problem with SAD in younger people is that it greatly affects their education, whether it’s that they just don’t attend, or attend but can’t concentrate enough to study, or any other way an individual might feel isolated in an educational setting. Van Ameringen, et al., (2003) found evidence that ‘young people with anxiety disorders, and perhaps especially social phobia, are at great risk for leaving school prematurely’. Further evidence of SAD affecting education is displayed in a study titled: ‘Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan’. This study followed a cohort of individuals born in Sweden between 1st January 1973 and 31st December 1977, up until 31st December 2013. The observation found that ‘individuals with a diagnosis of SAD were significantly less likely to pass all subjects in the last year of compulsory education’, more specifically these individuals had ‘67%, 56% and 67% lower odds of passing the core subjects (Swedish, English, and mathematics, respectively)’, (Vilaplana-Pérez, et al., 2020). Furthermore, the observational study showed the greatest impairment on education level was finishing upper secondary school, with individuals with SAD having ‘81% lower odds of achieving this milestone’ (Vilaplana-Pérez, et al., 2020).

    However, it is not just in an academic sense that SAD affects education. In 2012, a study on the impact of social anxiety on student learning and well-being was conducted. Across 2 universities, 787 students completed an online survey related to three areas that are often used to assess social anxiety: performance fears, social interaction, and avoidance behaviour (Russell & Topham, 2012). The findings showed that ‘students believed their learning and performance in the classroom was affected by associated thought-blocking, excessive self-focused attention, and physical effects such as blushing and stammering’ (Russell & Topham, 2012). Alongside academic impact, SAD can affect education through social aspects. For example, one person has written: ‘The strain of all this [difficulty socialising with flatmates] had an effect on my university work. I become more and more stressed and found it increasingly hard to concentrate.’ (Max, 2015).

    The question is, what can we do to help?

    Treatment–

    Medical:

    One main clinical treatment method for SAD is Psychotherapy.

    Cognitive Behavioural Therapy (CBT) is thought to be the most effective psychotherapy for anxiety disorders. CBT is a type of talking therapy that helps you manage your problems by focussing on how your ‘thoughts, beliefs and attitudes affect your feelings and actions.’ (Mind, 2024). Essentially, CBT aims to change the way you think and behave.

    Within Education:

    This article has been about SAD in relation to education, so what can we do within education to help?

    One of the main things we can do is promote early detection. If we can detect social anxiety in its early stages, we may be able to better help someone through their struggles and educational journey to ‘beat’ the statistics. The best way of doing this is to educate school staff members, and even peers, on how to recognise Social Anxiety Disorder, so that when they come across it, or feel they themselves are struggling with it, they will be able to help.

    Another step to take is to facilitate referrals to appropriate and helpful mental health services. Although a lot of schools provide spaces where students can express their concerns and emotions, it is important that those struggling with SAD (and any other mental health condition) to be granted access to services that specialise in mental health conditions. For example, school staff could assist with booking GP appointments, and give any information they feel will help the GP understand what the individual is going through.

    The most important thing to remember, if you’re grappling with SAD, is that it can get better. With the right help you can achieve what sometimes feels impossible, even if that’s something as simple as getting out of bed in the morning.

    References

    Higuera, V. & Caplan, E., 2022. Social Anxiety Disorder Treatment Options. [Online]
    Available at: https://www.healthline.com/health/anxiety/social-anxiety-treatment
    [Accessed 21 October 2024].

    Kessler, R. et al., 2005. Lifetime prevalence and age-of-onset distributions’ of DSM-IV disorders in the national comorbidity survey replication. Archives of general psychiatry, June, 62(6), pp. 593-602.

    Max, 2015. Confronting my social anxiety at university. [Online]
    Available at: https://www.mind.org.uk/information-support/your-stories/confronting-my-social-anxiety-at-university/

    Mind, 2024. Cognitive Behavioural Therapy (CBT). [Online]
    Available at: https://www.mind.org.uk/information-support/drugs-and-treatments/talking-therapy-and-counselling/cognitive-behavioural-therapy-cbt/
    [Accessed 21 October 2024].

    National Collaborating Centre for Mental Health, 2013. Social Anxiety Disorder. In: Social Anxiety DIsorder: Recognition, Assessment and Treatment. s.l.:The British Psychological society; The Royal College of Psychiatrists, pp. 15-27.

    NHS, 2023. Social anxiety (social phobia). [Online]
    Available at: https://www.nhs.uk/mental-health/conditions/social-anxiety/

    Russell, G. & Topham, P., 2012. The impact of social anxiety on student learning and well-being in higher education. Journal of Mental Health, 21(4), pp. 375-385.

    Taryn, 2023. What social anxiety feels like for me. [Online]
    Available at: https://www.youngminds.org.uk/young-person/blog/what-social-anxiety-feels-like-for-me/

    Van Ameringen, M., Mancini, C. & Farvolden, P., 2003. The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17(5), pp. 561-571.

    Vilaplana-Pérez, A. et al., 2020. Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan. Psychological Medicine, 51(5), pp. 861-869.

  • Hoarding Disorder: Causes, Consequences, and Treatment Options

    By Mohammed Adil Sethi, Content Team Academic

    Hoarding is a DSM-IV mental disorder where an individual has marked difficulty in discarding or abandoning owned possessions (Ferreira et al. 2020; Ricci et al. 2023). This informative piece will cover the differences between hoarding and collecting items, the prevalence of hoarding anxiety disorder, its consequences, diagnosis, associated mental health conditions, and treatment options.

    The Difference Between Hoarding And Collecting

    Hoarding is considered a subcategory of a distinct form of collecting, however, it is essential to understand that the two are distinct. Collectors usually buy items in a coordinated, purposeful and selective manner. They have a given speciality, and are well-informed about the items that are being collected. These items are then lovingly placed, appreciated and cleaned, without becoming an intrusion in the collector’s home, or their everyday life. Whilst buying behaviour may be carefully planned, and may involve considerable preparation on the part of the consumer, hoarding entails purchase decisions made without prior planning (Jaisoorya et al. 2020). These items accumulated by hoarders are random and have no connecting characteristics. They are often piled up in creative or purposeful ways, making the habitation of living spaces difficult.

    Obsessive collecting of items is not a question of not wanting to tidy up, or of being lazy. It is a manifestation of a mental illness associated with anxiety disorder. Possessing and keeping things often helps reduce anxiety for a while, but this is only temporary. The effects are magnified by the clutter which becomes a source of anxiety in the long run. This makes depression worse, forming a cycle that is hard to circle out of without seeking help from a professional (Vieira et al. 2022).

    Prevalence and Demographics

    Hoarding disorder is evident in about 2.6% of the population, with prevalence rates increasing amongst individuals over the age of 60, and amonsgt those with psychiatric conditions, particularly anxiety and depression (American Psychiatric Association 2021). There does not seem to be any difference in the prevalence rate of the disorder across different countries, irrespective of the culture practised, but it is rampant among both men and women. Personality disorder starts occurring during adolescence and progresses with time, with the symptoms becoming more severe (American Psychiatric Association 2021). People often do not get treatment until middle age, and by that time the disorder is severe, usually interfering significantly with one’s life.

    Consequences of Hoarding Disorder

    Hoarding disorder has an impact on one’s life across the various areas of functioning. The first and probably the most obvious one is the impact on the living environment of the person with hoarding mental disorder (National Health Services 2022). Whenever the clutter piles up, the living spaces may not be usable, and this may pose some health risks, and may increase the risk of accidents. Some of the problems are fire risks, falling risks, and poor sanitation, considering that the structure cannot be cleaned efficiently (National Health Services 2022).

    There are social and emotional effects that are prevalent alongside signs of hoarding disorder. People with hoarding disorder may have marital or family problems (domestic abuse, for example). Their symptoms and their living conditions may inconvenience their friends and relatives (American Psychiatric Association 2021). This may result in them becoming outcasts. They may lock everyone out, or they may be too shy to invite people into their houses for fear that the latter will glimpse into their lives and pity them. In the long run, such isolation leads to feelings of loneliness and consequent depression, which definitely worsens the mental health state of the person (Schou et al. 2020).

    Diagnosing Hoarding Disorder

    A diagnosis of hoarding disorder will follow an evaluation by a therapist, where the symptoms and the effect of hoarding on the life of the affected individual are considered. Diagnostics criteria are as follows: persistent difficulty in discarding items that the individual believes to be of little value or usefulness, and significant distress/ impairment in social, occupational or other important domains (National Health Services 2022). This may include an interview of the affected person, and sometimes their family members, and it may also involve questionnaires, or rating scales, to determine the extent of hoarding the person may exhibit.

    Hoarding disorder is a complex and severe mental health issue, and not everyone suffering from this disorder is fully aware of the fact that they indeed have a problem that needs professional help. In scenarios where the person does not accept the fact that they have a problem, it may be challenging to make him or her accept that they need treatment (Prosser et al. 2024).

    Associated Mental Health Conditions

    Hoarding disorder is usually not seen in isolation, but is usually accompanied by other psychiatric disorders. Persons with hoarding disorder also present other psychiatric disorders such as anxiety disorders, depression, ADHD, and OCD (American Psychiatric Association 2021). These interrelated disorders can all cause difficulties in the treatment process of hoarding disorder as each of them must be treated individually, for example, hoarding disorder is different from OCD, but it interacts with it. Some patients diagnosed with hoarding disorder might use the treatments applied to OCD patients (American Psychiatric Association 2021).

    Treatment Options

    Cognitive behavioural therapy (CBT) is found to be the most helpful treatment method for hoarding disorder since it deals with changes in the perception and behaviour of the hoarder (National Health Services 2022). In CBT one is made to change the thinking that is associated with hoarding, and learn how to face the related anxiety with the aim of gradually stopping the process of hoarding (Kuwano et al. 2020). This process is ordinarily long-drawn, and needs a lot of patience and dedication, but it may drastically enhance the lifestyle of the patient undergoing therapy (Timpano et al. 2020). Family members can support and help in the process of cleaning the house, but it is necessary to do it gently so that the patient does not have more anxiety. In other circumstances, the family therapist can be of assistance as relationship problems are common in families who have a member who suffers from hoarding disorder (Gledhill et al. 2021; Mahnke et al. 2021).

    Conclusion

    Hoarding disorder is a severe and disabling illness, which impacts the lives of millions of people globally. Although it is related to OCD, it is a different disorder that has to be treated separately and needs proper management. CBT helps in treating individuals who suffer from hoarding disorder, and with proper support from family members, the quality of their life improves, most especially when they seek help early enough. The process of recovery is not always easy, and can take a lot of time. It always involves complete dedication, and help from the patient’s side alongside support from family members.