What to do when it happens

1. Slow your breathing: inhale gently for 4 seconds, exhale for 6 seconds, for 2 to 5 minutes. Do not force deep breaths.
2. Relax the shaking muscles: unclench jaw and hands, lower shoulders, place both feet flat, and gently tense then release each muscle group.
3. Ground yourself: name 5 things you see, 4 you feel, 3 you hear, 2 you smell, and 1 you taste.
4. Reduce triggers: avoid or cut down caffeine, energy drinks, nicotine, recreational stimulants, and excess alcohol. Eat regular meals and drink water.
5. Daily prevention: regular sleep, aerobic exercise, and a brief daily relaxation or mindfulness practice can reduce baseline anxiety. CBT-based therapy is particularly useful when anxiety or panic is recurrent.

Medical treatment

• Cognitive behavioural therapy (CBT) or other talking therapy
• An SSRI/SNRI when an anxiety disorder is diagnosed and symptoms are persistent
• Sometimes a clinician may use a beta-blocker for short, predictable performance anxiety with prominent tremor or palpitations. It is not suitable for everyone, particularly people with asthma, low blood pressure, slow pulse, certain heart conditions, or diabetes. Do not start or borrow it without medical advice.
• Sedatives such as benzodiazepines are generally not a long-term solution because of dependence and withdrawal risks.

Get checked soon if

• The tremor is new, steadily worsening, happens even when calm, or interferes with writing, eating, or walking.
• You have weight loss, heat intolerance, persistent fast heartbeat, weakness, confusion, or symptoms suggesting low blood sugar.
• It began after a new medication or dose change, including inhalers, antidepressants, lithium, thyroid medicine, or stimulants.
• You use alcohol or sedatives regularly and shaking appears after reducing or stopping them.