Anxiety
Anxiety and panic
Anxiety is the body preparing for a threat that is not there. It is the most common mental health concern globally and one of the most treatable. Expats often experience heightened anxiety in year one and again around the three-year mark, when the honeymoon phase fades.
How it shows up
- Constant low-grade worry that resists reassurance.
- Physical symptoms: racing heart, shallow breathing, muscle tension, gut trouble.
- Avoidance: cancelling plans, procrastinating on decisions, staying home.
- Panic attacks: sudden intense fear, often peaking within 10 minutes.
- Sleep problems, especially trouble falling asleep with racing thoughts.
What actually works
Cognitive Behavioural Therapy (CBT) has the strongest evidence base for anxiety disorders and panic. Acceptance and Commitment Therapy (ACT) and exposure-based approaches also work well. For panic specifically, exposure to physical sensations (interoceptive exposure) is often the missing piece. SSRIs are a first-line medication option and a psychiatrist can guide dose and duration.
Practical steps before therapy starts
- Regular sleep window, even on weekends.
- Aerobic exercise 3 to 5 times a week, sustained for at least 20 minutes.
- Reduce caffeine, especially after noon.
- Practise slow diaphragmatic breathing daily.
- Limit alcohol — it worsens anxiety within 24 hours of drinking.
When to escalate
If anxiety is stopping you from going to work, taking care of yourself, or leaving the house, please contact a professional this week. If panic attacks keep landing you in the emergency room, ask your GP for a referral or search directly for a CBT-trained clinical psychologist.