Examples of common thoughts:

• I'm going to faint

  Feelings of weakness, dizziness, shakiness, or vision changes are perceived as "evidence" for this assumption.

  For some persons, sometimes, their feelings could of course be justified. A prerequisite for fainting is a clear drop in blood pressure and decreased heart rate. However, as most patients with anxiety syndrome know, those symptoms are rather the opposite of an anxiety attack. A consequence of the stress reaction is that blood pressure increases and the heart beats faster. Although it may sound rather drastic: if you should actually faint and fall down, your body will react and adapt to the situation. This means that when you actually faint, at the latest, circulation will be normal again.

  Often the fear of fainting is rather a fear of being perceived differently (eg, being perceived as drunk), or a fear of not being able to manage yourself outdoors and to be dependent on help from strangers.

  For diagnosis and treatment, it is important to find out whether the patient has ever fainted or "just" afraid of it happening.

• I will throw up soon

  As symptoms of anxiety may include nausea, some patients worry that they will throw up. Often the person is not just afraid to vomit but rather that he or she will be perceived negatively by the environment and thus be the centre of everyone's attention. This perception is common among individuals with social anxiety, social difficulties or shyness.

• I'm going to have a stroke or a brain tumor. I may suffer a seizure

  People with anxiety can sometimes be afraid of getting various diseases. Such beliefs often arise in the context of a close relative or friend suffering from a severe physical illness, or the person has for example watched a programme about some severe illness on television.

  In these cases it is common to interpret completely unrelated physical symptoms (eg, transient tingling, feelings of weakness in arms or fingers, headache, visual disturbances) as "evidence" of an attack.

  It may be important to rule out physical causes before the psychotherapeutic treatment begins. Signs of neurological disorders (eg, brain tumour) show very clearly through simple and brief physical examinations and interviews with a patient. In contrast to what the anxiety patient thinks, there are very clear and characteristic changes associated with neurological disorders.

• I choke

  If patients with anxiety disorders feel a lump in the throat or feel tight in the neck, they believe that they will no longer be able to breathe.

  Some patients have difficulty breathing as a result of, for example, asthma or chronic obstructive pulmonary disease. For the majority of patients experiencing breathing difficulties, there is no lung disease. It's rather because an anxiety attack or stress can alter the breathing pattern so that the person breathes faster and more shallowly. The normal deep (belly) breathing is replaced by a shallow chest breathing which is really only meant as a reserve in special emergencies (e g flight). Subjectively it is perceived it as shortness of breath, sometimes as a stitch in your heart.

  This shallow breathing can lead to hyperventilation, but you cannot choke on it.

• I am about to go crazy

  An anxiety disorder is arguably anything but pleasant and leads to uncertainty in the patient because he or she is experiencing their own behavior as unpredictable. The anxiety may then be perceived as a "proof" that you are about to go crazy, but from psychiatric point of view, there is no support for it.