We all have different ways of coping with stress. Some people describe a feeling of ‘being wound up’, ‘on edge’ or ‘tense’. It may manifest itself as insomnia or a loss of appetite, poor concentration or irritability. This emotion rarely merits treatment in its own right but excessive or prolonged anxiety can become harmful. Although it is one of the most basic of emotions in illness, it can have a major impact on consulting and health care. Heightened anxiety can lead to increased pain due to the increased sympathetic mediation, treatment is discussed in the following pages.