In 20 years of clinical practice I have found that almost invariably anxiety and panic attacks are not conditions in themselves but are signals telling us that something else is wrong and needs to be attended to.

This signal function of anxiety goes back a very long way. Imagine some of our Stone Age ancestors carefully making their way through a deep dark forest. They are feeling very anxious - and they should be. They are in a state of high alert; all their senses tuned to detect any possible threat. They are breathing faster, increasing the level of oxygen supply to the muscles; ready to jump at the slightest sound. Their whole bodies are tensed ready to detect any possible threat and react to it by fighting or fleeing. If our prehistoric ancestors hadn't known anxiety they would probably all have been eaten by predators and we wouldn't be here.

Today we face a completely different range of risks and challenges from our primitive ancestors, but still anxiety is a useful signal to alert us to when something needs our attention.

IS IT A NORMAL REACTION ?

Anxiety could be a normal reaction if you are facing a serious threat to you. Maybe you are not sure about the future of your job, or unsure about your physical safety. If you have to make a presentation to an audience much bigger than you have ever presented to before and you are not completely sure about your material then you will feel anxious. If you are about to serve for the match point in the finals at Wimbledon, again you will feel anxious.

In situations like this anxiety is inevitable. You shouldn't try to reduce it, but instead find a way of channelling it. Find a way to make sure it does bring you to peak performance.

IS IT WARNING YOU OF PSYCHOLOGICAL PROBLEMS ?

Very often when I treat people suffering from anxiety or panic attacks we quickly resolve the anxiety but then find other problems. Particularly common is anxiety masking depression. The patient maybe suppressing or denying their depression but the anxiety is serving as a nagging reminder that it is there underneath and needs some attention. Anxiety could be warning us of physical illness.

We may have a medical problem. Unconsciously we recognise the symptoms but we are afraid and don't want to get a diagnosis in case we hear the worst. The conscious mind can be very good at ignoring the symptoms but again anxiety is a message from the unconscious, telling that something is there, something we ought to be paying attention to.

OR IS IT THE FORERUNNER OF SOMETHING POSITIVE ?

Very often when we make positive changes in our lives such as getting married, moving house, looking for a better job, we start to feel anxious. We recognise that there is a change involved and that change can bring risk. Anxiety here could alert us to details we may have overlooked, to potential risks we need to consider or to deal with. The important thing here is to manage your anxiety, to understand where it is coming from, to make sure that it doesn't prevent you from undertaking potentially very beneficial changes.

SO WHAT DOES THIS MEAN FOR THERAPY ?

The conclusion for therapy is that dealing with the anxiety the patient presents is only the first step. The therapist and the patient are given a warning that something is not quite right. They don't know what it is but when they find out the second stage of therapy can begin. This means that a straightforward behavioural treatment for anxiety or for panic attacks may well remove the anxiety but reveal another, more complex problem. What is needed is a more careful cognitive or analytic approach to the problem which recognises that anxiety is a message, and is prepared to accept and try to understand that message.