Anxiety is part of life and a feeling we all experience. A little anxiety can help us perform well at tasks and can bring about a heightened alertness that can be useful in situations where we might need to take care of ourselves. Too much anxiety can, at other times overwhelm us and interfere with our daily lives.

Many people contact me about anxiety and panic associated with some aspect of their heart condition e.g. heart rhythm disturbance, pain or discomfort in the chest area, shortness of breath or, related to their experience of surgery and the fears they might have for themselves and the future.

When we feel stressed, anxious or under threat the body responds automatically ready to fight or run away, often called ‘fight, flight or freeze reaction’. Adrenaline is released into the body, breathing becomes quicker and shallower, the heart beats faster, muscles tense, palms become sweaty, thoughts start racing, nausea etc.

Check with your cardiologist if you are unsure what symptoms are associated with your heart condition or with anxiety.

Learning and practise of relaxation exercises can be useful in managing anxiety and panic and switching off the ‘threat system’. Deep relaxation helps lower your heart rate, your breathing and blood pressure. It also reduces the tension in your muscles and metabolic rate and oxygen consumption.

Some of the most common ways of achieving relaxation are:

  • Calming breathing techniques
  • Progressive muscle relaxation
  • Visualising a peaceful scene

Other activities that are particularly helpful are Mindfulness, meditation and yoga.

When we get tense, anxious or panicky our breathing usually becomes shallow and faster, occurring in the upper chest. This can also lead to hyperventilation.

Hyperventilation is when you start to breathe very quickly. This upsets the balance of carbon dioxide relative to the amount of oxygen carried in your bloodstream. Shallow, rapid breathing can lead to hyperventilation which can cause physical symptoms similar to those associated with panic attacks (dizziness, feeling jittery, heart pumping faster, lights seem brighter and sounds louder).

Learning a calm breathing technique is one way to counteract this any time you are feeling anxious or panicky.

Calm Breathing Exercise

One way to calm your breathing is to slow your breathing down so that the ‘out breath’ is slightly longer than the ‘in breath’. Here’s how to practise this calm breathing exercise:

  • Settle into your body sitting on a chair (you can also do this standing or lying down)
  • Notice and follow your breath in through your nose, down into your lungs breathing into your belly and then out again.
  • Breathe in to a count of four
  • Pause
  • Breathe out to a count of six
  • Repeat getting a nice steady, smooth and soothing rhythm as you breathe in and out.
  • Continue for a few minutes.
  • On the out breath you can also say to yourself ‘mind slowing down, body slowing down’.

Practise daily when you feel okay as this helps develop confidence in being able to calm and slow your breathing down when you need to.

Dealing with panic attacks

  • Slow and calm down your breathing (as above) for a few minutes. It’s really helpful if you can try this when you first notice panicky feelings or thoughts.
  • Distraction: shift your focus away from your body rather than focusing on your symptoms or looking for things that are wrong. Look at the people, scenery around you, really notice the detail or count the number of silver cars that go past, listen to someone talking. You could also try singing a song or add up sums in head. Again keep this going for at least 3 minutes to give time for panicky feelings to subside.
  • Reassurance: remind yourself that these panicky feelings are a result of the fight, flight, freeze reaction, they are not dangerous and they will pass.
  • Coping reminder card: write down on a small card your methods of coping, a reassuring phrase etc to keep in your purse or wallet as a reminder.
  •  Some people find a short course of Cognitive Behavioural Therapy (CBT) helpful to identify what triggers their panic, question frightening thoughts and find ways to deal with those thoughts and feelings.

Progressive muscle relaxation

Progressive muscle relaxation involves moving through the body systematically, tensing and relaxing, one after the other the different muscle groups. The idea is to tense each muscle for about 5 seconds, and then to let go of that tension. Then you give yourself about 10 seconds of relaxation, and notice how the muscle feels when it is relaxed in contrast to how it felt when it was tensed.

If you are unable to actively tense/tighten muscle groups because of injury or other health issues, then think about the different muscle groups or parts of your body, noticing any tension and then focus on relaxing those areas.

Visualising a peaceful scene

Visualising or imagining yourself in a peaceful scene can help give a general sense of relaxation and help with anxious thoughts. The peaceful scene could be a warm beach, a calm lake, woodland, in front of a log fire, etc. The important part is to visualise the scene in detail using all your senses so that it completely absorbs your attention.

  • Lie down, or sit in a very comfortable chair somewhere quiet. Close your eyes and take a few deep breaths to help you relax. Now, imagine you have all the time in the world. You are feeling calm and safe.
  • Imagine your own peaceful scene. Describe it in lots of detail appealing to all of your senses: sight, sound, smell and touch. Where are you, what does the scene look like. Notice the colours, sounds that surround you. What is the temperature? What smells are around?
  • At the end take some deep breaths and stretch and relax. Remember, you can return to this tranquil place anytime.

Once you have imagined a peaceful scene you can practise returning to it when deep breathing or relaxing. This helps reinforce it in your mind and then you can return to it at any time when you want to stop anxious thoughts and calm yourself down.


Practising calm breathing and relaxation techniques when you are feeling fine really helps build confidence and body memory, making it easier to put them in place when feeling anxious. Focusing on a nice calm breathing rhythm can be practised almost anywhere, at the bus stop or waiting in a queue, for instance. See how you can build regular practice, even if it’s just for 10/15 minutes, into the routine of your day. If you are finding it difficult, it can be useful to notice what gets in the way.

There are many relaxation tracks that you can download and follow online as well as relaxation CD’s you can buy or borrow from the library.

Remember to build into your day activities that help you unwind, such as soaking in the bath, going for a walk, listening to music etc. Why not create your own peaceful playlist.

Practising relaxation measures as preparation for surgery and other kinds of medical interventions can be really valuable. They can also help in minimising and managing pain and other physical discomforts.

There are a small percentage of people who become more anxious when trying to focus on calm breathing and relaxation and there are many other things they can try that maybe helpful.

Other things that might be helpful

  • Avoid stimulants such as caffeine, nicotine, amphetamines etc. Their effect can set of feelings similar to having a panic attack. They can also aggravate heart rhythm disturbances.
  • Exercise (the amount/type that’s appropriate for your particular heart condition) encourages the release of the body’s own ‘feel good’ chemicals. Sometimes if you are feeling agitated or stressed or finding it hard to relax it can be helpful to do something physically active to disperse that energy.
  • Cognitive Behavioural Therapy – a short-term talking treatment. It aims to make connections between the patterns of thinking, feelings and behaviour that are behind difficulties, and so help change how we respond.
  • Counselling – provides a regular time and space for people to talk about their troubles and explore difficult feelings, in a confidential setting.
  • Mindfulness – combines meditation, breathing techniques and paying attention to the present moment.
  • Meditation, Yoga, Tai Chi.

A few resources and places for more information

  • Anxiety UK has lots of support information on their website +a helpline 08444 775 774
  • The Mood Café has lots of information plus you can listen to breathing exercises and progressive muscle relaxation exercises on their website.
  • The Mental Health Foundation’s Wellbeing Podcasts are free to download. Topics include, stress and relaxation, wellbeing and positive thinking, help with sleep and overcoming fear and anxiety.
  • Sam App is designed for your mobile has been developed by the research team at UWE Bristol to help manage anxiety.


  • The Anxiety and Phobia Workbook by Edmund J Bourne PhD
  • The Relaxation and Stress Reduction Workbook by Martha Davis, Elizabeth Robbins Eshelman and Matthew McKay


(Living Well Workshop: Managing Anxiety and Panic Attacks notes by Anne Crump)