Anxiety and distress management (palliative care)
How a palliative care team helps with anxiety, fear and distress, which are very common when living with a serious or terminal illness, using both talking-based support and, when needed, medicines.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Anxiety and distress are common and understandable in serious illness, and there is usually a reason behind them that can be explored and helped.
- Talking-based support, gentle techniques and addressing practical and physical causes come first; medicines are added when needed, especially for severe anxiety.
- Physical problems such as breathlessness, pain or a medicine side effect can drive anxiety, so the team looks at the whole picture.
- If you ever have thoughts of harming yourself or feel unable to keep going, tell someone straight away - urgent support is available.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
A safe space to be heard and to share fears that can feel hard to say out loud
Medicines alone are not a substitute for support and for addressing the real worries and physical causes behind anxiety.
You are given time to talk, the causes are explored, and physical contributors are checked. You leave with the start of a plan and, often, some immediate...
A named contact and an urgent route to support, including out of hours and for crisis.
You are given time to talk, the causes are explored, and physical contributors are checked. You leave with the...
Practical worries start to be addressed, simple techniques are put into practice, and referrals to counselling...
Talking therapies take effect over several sessions. If an antidepressant has been started, it usually takes a...
Support continues and is adjusted as circumstances and symptoms change. Sedative medicines, if used, are kept...
What is anxiety and distress management in palliative care?
Anxiety means feeling worried, fearful, restless or on edge, often with physical feelings such as a racing heart, tense muscles, a churning stomach, breathlessness or trouble sleeping. Distress is a broader word for the emotional, social and spiritual suffering that serious illness can bring. Both are very common, and entirely understandable, when facing a serious or terminal diagnosis.
There are usually clear reasons behind it: uncertainty about the future, fear of pain or of dying, worry about family or money, loss of independence and routine, or a new symptom that feels frightening. Sometimes a physical problem (such as breathlessness, pain or an unbalanced medicine) drives the anxiety, and treating that helps. Anxiety and low mood (depression) often go together.
Managing anxiety and distress is about understanding what is driving it, offering support and practical help, and using talking-based approaches first wherever possible. Medicines can help some people, particularly for severe or disabling anxiety, and are used thoughtfully alongside everything else. None of this is about 'just thinking positively'; it is real support for a real and difficult experience.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Understanding what is driving it
Exploring the worries, fears and practical concerns behind the anxiety, and checking for physical causes such as breathlessness, pain, or a medicine that may be contributing.
Talking-based and emotional support
Listening, counselling, and a safe space to explore feelings, often from palliative care nurses, counsellors, psychologists or chaplaincy and spiritual care.
Psychological therapies
Approaches such as cognitive behavioural therapy (CBT), mindfulness or relaxation can help some people manage anxious thoughts and physical tension.
Practical and social help
Sorting out worries about money, care, family or future plans can ease a great deal of distress; social workers and benefits advisers can help.
Preparing for your treatment
- If you can, jot down what you are most worried about, and when the anxiety is worst, to share with your team.
- Note any physical symptoms that go with it, such as breathlessness, pain or palpitations, as these can be part of the picture.
- List your medicines, including anything you take for sleep or mood, and any caffeine, alcohol or nicotine you use.
- Think about who and what helps you feel calmer or more supported.
- Consider whether spiritual, religious or existential worries are part of your distress, as support is available for these too.
- Bring someone you trust to appointments if that helps you talk.
- Be reassured that whatever you share is taken seriously and confidentially, within normal safety limits.
What happens
A clinician or nurse will give you time to talk about how you are feeling and what is worrying you. They will gently explore the reasons behind the anxiety, including practical concerns and fears about the future, and check whether a physical problem or medicine could be contributing.
They will distinguish anxiety from depression, which often occur together, and ask, sensitively, about how you are coping and whether you have had any thoughts of not wanting to go on, so that the right support can be offered.
Together you will agree a plan. This often starts with support, practical help and simple techniques, with referral to counselling or psychological therapy where helpful, and to chaplaincy or social work where appropriate. If anxiety is severe or disabling, a medicine may be offered alongside, with a clear plan to review how it helps.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Medicines alone are not a substitute for support and for addressing the real worries and physical causes behind anxiety.
- Long-acting sedatives may be unsuitable, especially in frail or older people, because of drowsiness, falls and confusion risk.
- Antidepressants are not a quick fix for acute distress, as they take time to work.
- If there is significant risk of self-harm, this needs urgent mental-health input, not management by medicine adjustment alone.
Delay or rearrange if…
- There are thoughts of self-harm or that life is not worth living - seek urgent support first.
- A physical cause such as severe breathlessness, pain or an unbalanced medicine has not yet been addressed.
- There is new confusion or agitation that could be delirium rather than anxiety, which needs assessing differently.
- Severe new panic with chest pain or breathlessness needs checking before assuming it is anxiety.
Alternatives to discuss
- Talking-based support, counselling and psychological therapies such as CBT or mindfulness.
- Treating physical drivers of anxiety (breathlessness, pain, poor sleep) and reviewing medicines.
- Practical and social support for money, care and family worries.
- Spiritual or existential support through chaplaincy, for those who wish it.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- A safe space to be heard and to share fears that can feel hard to say out loud
- Helps make sense of what is driving the anxiety, which is often a relief in itself
- Practical worries (money, care, family) can be eased with the right support
- Techniques and therapies can reduce anxious thoughts, tension and panicky feelings
- Treating physical causes such as breathlessness or pain can lift the anxiety too
- Medicines, where needed, can take the edge off severe anxiety and help sleep
Risks & complications
- Talking about difficult feelings can be upsetting at first, even when it helps overall
- Anxiety may ease only partly, especially while real and difficult circumstances continue
- Finding the right support or therapy can take time and a few attempts
- Side effects from medicines, such as drowsiness or unsteadiness with lorazepam, or early restlessness or nausea when starting an antidepressant
- Becoming reliant on a sedative medicine if it is used regularly over a long period
- Antidepressants can take a couple of weeks to help and may briefly worsen anxiety when first started
- A medicine causing confusion, marked drowsiness or falls, particularly in frail or older people
- Worsening low mood or new thoughts of self-harm, which need urgent attention
The most important point is safety: if anxiety or distress ever tips into thoughts of harming yourself, or feeling you cannot go on, this needs urgent support, and help is available day and night. Sedative medicines such as lorazepam are very helpful for severe anxiety but can cause drowsiness, unsteadiness or, in frail people, confusion, so they are used carefully. Tell your team if anxiety is getting worse rather than better.
Published figures to discuss
Anxiety is common in advanced illness, but reported rates vary widely depending on the illness, the stage, the setting and how anxiety is identified, and it frequently overlaps with depression and with physical symptoms. The benefit of any single treatment also varies between people. Because robust, transferable figures for individual outcomes are limited, we have not quoted exact percentages here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Reversible distress trigger missed | Common | Pain, breathlessness, urinary retention, constipation, delirium, medication effects and fear can all drive distress. | Guide sourcesClinical context |
| Sedation or falls from medicines | Dose- and frailty-dependent | Benzodiazepines, antipsychotics and opioids should be matched to the symptom and reviewed. | Guide sourcesClinical context |
| Delirium mistaken for anxiety | Common near end of life | Fluctuating attention, hallucinations or sudden confusion need a different assessment. | Guide sourcesClinical context |
| Family distress overlooked | Common | Supporting relatives can reduce fear, improve communication and prevent crisis escalation. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery as such. This is ongoing support, tailored to you, that grows and changes with your needs. Some things help quickly, while talking therapies and medicines may take a little longer.
- Anxiety that comes and goes, often worse at night or with new worries
- Feeling upset after talking about difficult things, even when it helps
- Needing a few sessions before a talking therapy feels useful
- An antidepressant taking a couple of weeks to start helping
- Ups and downs as your situation and symptoms change
Aftercare
- Use any breathing or relaxation techniques you have been shown, especially when you feel anxiety building.
- Keep up gentle activity within your limits, and try to keep some routine to your day.
- Cut down on caffeine, and on alcohol or nicotine if these affect your anxiety or sleep.
- Stay connected with people who support you, and accept help with practical worries.
- Take any medicines as prescribed, and report side effects or if they are not helping.
- Make use of counselling, psychology or chaplaincy if offered, and give therapies time to work.
- Tell your team promptly if anxiety worsens, or if you have thoughts of harming yourself.
- Breathing or relaxation techniques you can use
- Contacts for counselling, psychology or chaplaincy if offered
- Practical worries (money, care, plans) flagged for help
- A list of medicines and a clear plan for any started for anxiety
- People you can talk to, and how to reach them
- A named contact, and an urgent number for crisis support
- A review date to see how the plan is working
⚠ Get urgent help if…
- Thoughts of harming yourself or of not wanting to go on - seek urgent help straight away
- Feeling unable to cope, or that things are hopeless and overwhelming
- Severe panic with chest pain or breathlessness that is new or frightening - get it checked
- Sudden confusion, marked drowsiness, or being hard to rouse (possible medicine effect)
- New or worsening low mood, loss of interest, or not eating or drinking
- Marked restlessness or agitation that is distressing or unsafe
- Anxiety that is getting steadily worse despite support and treatment
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Good support can reduce anxiety and distress, help you feel heard and more in control, and ease the practical and physical things that fuel worry. For many people, simply understanding what is happening and knowing help is there makes a real difference.
It may not remove anxiety completely, especially while genuinely difficult circumstances continue, and that is not a failure. Talking therapies and medicines vary in how much, and how quickly, they help. The aim is to make each day more bearable and to support you and those close to you through a hard time.
Anxiety and distress tend to rise and fall over the course of a serious illness, often flaring around bad news, new symptoms or changes in your situation. Support is therefore ongoing and reviewed, rather than a one-off. Medicines used for anxiety are kept under review so they continue to suit you, and extra help can be brought in at difficult moments.
Related tests, treatments or support
Emotional support is closely tied to physical symptoms, so it is managed alongside them. Treating breathlessness, pain or poor sleep can ease anxiety, and reviewing medicines that affect mood or alertness may help. Where anxiety and depression occur together, both are addressed. Support for family and carers is also part of the picture, as their distress affects yours and vice versa.
Follow-up & long-term care
Your team will check how you are doing, particularly after starting a therapy or a medicine, with a clear plan to review benefit and side effects. Support is stepped up at difficult times and can include urgent help. You should always know who to contact, including out of hours, if anxiety worsens or you feel unable to cope.
- Keep using breathing, relaxation or other techniques that help you.
- Stay connected with supportive people and keep some daily routine.
- Review any medicine for anxiety regularly so it continues to suit you.
- Keep practical worries on your team's radar so they can help.
- Know how to get extra or urgent support at difficult moments.
Repeat, follow-on and what comes next
- Support and treatment usually need adjusting as circumstances and symptoms change.
- It may take more than one therapy or medicine before the right fit is found.
- Anxiety can flare at difficult moments and need extra or urgent support, which is normal.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and an urgent route to support, including out of hours and for crisis.
- A clear plan covering support, therapy and any medicine, with review dates.
- Sensitive checking for low mood and for thoughts of self-harm.
- Support offered to family and carers as well as the patient.
- Honest, gentle conversation that treats distress as a real and understandable experience.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How much clinician, nurse, counsellor or psychologist time is involved
- The number and type of therapy sessions
- Whether chaplaincy, social work or practical advice are part of the support
- The cost of any medicines and of reviewing them
- Where support is delivered (home, care home, hospice or clinic)
- The clinician, counsellor or psychologist fees involved
- How many therapy sessions are included and how further ones are arranged
- Which medicines are included and how they are reviewed
- Whether family or carer support is included
- How follow-up is arranged and charged
- Who to contact, including out of hours, if distress worsens or there is a crisis
On the NHS? Emotional support, counselling, psychological therapies and palliative care are available on the NHS; private input may be used for speed or choice, but the support itself is the same.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Reaching for a sedative before exploring causes and offering support.
- Not explaining that antidepressants take time to work and may briefly worsen anxiety at first.
- Failing to ask, sensitively, about thoughts of self-harm so that risk is missed.
- Not being clear about who sees what is discussed, and the normal limits of confidentiality where safety is concerned.
Marketing red flags
- Promises to 'cure' anxiety or banish fear with a single product, supplement or session.
- Pressure to start or continue sedatives without review.
- Claims that positive thinking alone will resolve the distress of serious illness.
- Costly programmes that ignore practical worries and physical causes.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Could a physical symptom or one of my medicines be adding to my anxiety?
- What talking-based support or therapy could help me, and how do I access it?
- If I need a medicine, which would suit me, how long would I take it, and what are the side effects?
- How do anxiety and low mood overlap for me, and should both be treated?
- Can my family or carers get support too?
- Who do I contact if my anxiety gets worse, or if I feel unable to cope, including out of hours?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is it normal to feel this anxious?
Will I just be given tablets?
Can physical symptoms cause anxiety?
Are anxiety medicines addictive?
What if I have thoughts of not wanting to go on?
Can my family get support too?
Is this support available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Marie Curie - Anxiety when living with a terminal illness (for professionals) Marie Curie - Providing emotional care (for professionals) NHS - Anxiety, fear and panic NICE NG31 - Care of dying adults in the last days of life PMC - Assessment and management of anxiety in advanced life-limiting disease (survey)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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