Anxiety is simply fear about an anticipated event or perceived danger. When your brain experiences fear or senses danger, the sympathetic nervous system (also known as your “fight or flight” response) is activated, sending you a jolt of adrenaline. Your heart rate could increase; you might begin to sweat; blood is diverted from your gut and your extremities, sometimes leaving you feeling nauseous, dizzy, lightheaded, or like you have pins and needles in your hands and feet.
If you are in actual danger, these measures can help you survive, as they did for our ancestors when they encountered a predator in the wild. If you are lying in bed, worrying about your job, hoping for sleep, this reaction is unhelpful.
For many people, anxiety can become so persistent and intense that it has a negative effect on quality of life—these people have an anxiety disorder, and they’re not alone. One in five Americans have an anxiety disorder, according to the National Alliance on Mental Illness.
“Anxiety disorders are the most common mental health condition in humans,” said Dr. Bill Hudenko, PhD, Research Assistant Professor in the Department of Psychological & Brain Sciences at Dartmouth and Global Head of Mental Health at K Health.
While anxiety disorders are a lot more common than you might think, they’re also very treatable with a wide range of therapies. You undoubtedly know people with anxiety disorders or you yourself may have one. Here’s what doctors wish you knew about anxiety and how to treat it.
1. Anxiety Is Nothing to Be Embarrassed About
Everyone knows at least one person who has anxiety, according to Dr. Francis Goldshmid, a family medicine and obstetrics doctor who is Director of Training and Education for K Therapy.
“It’s not just your classic ‘panic attack’ that you see on TV,” said Dr. Goldshmid. “It can manifest as procrastination, or a persistent worrying that keeps you up at night or distracts you from your daily tasks, or as irritability or angry outbursts when things don’t go as planned. It’s not a ‘one-size fits all’ disease.”
Some 40 million Americans experience anxiety disorders. It’s more common than heart disease, which afflicts about 26 million Americans, according to the Centers for Disease Control.
“Mental health still has stigmas. People go to the emergency room because they think they are having a heart attack but it is really a panic attack, an extreme form of anxiety. People think having a mental health issue such as anxiety is a flaw, unlike a physical issue,” said Diane London, LPCC, LPC, who is a K Therapy Clinician.
When we are feeling chest pain and tingling down our arms, we are not embarrassed to say we may be having a heart attack and seek appropriate help, so why do we behave that way with anxiety?
“I’ll sometimes have family members pull me aside to ask me if I think their loved one needs therapy in hushed tones or whispers, as though it’s something out of the ordinary and embarrassing,” said Dr. Goldshmid.
Even people who know they have an anxiety disorder may have misconceptions about how common it is, leading to worsening of symptoms.
“Oftentimes, a person with anxiety will tell me that they feel as though they are the only person they know suffering from it and that help is impossible to find,” said Dr. Goldshmid. “This leads to further loneliness and isolation, which worsens the symptoms of the disorder.”
2. Sometimes Anxiety Is Actually Good
Professional athletes know that anxiety can actually be good sometimes—something we should all internalize.
“At a low level, anxiety can be good,” said Dr. Hudenko. “Athletes know there’s an ideal level of anxiety performance. You want to be amped up, even a little nervous about what you’re doing. It makes you laser-focused.”
In fact, anxiety can increase performance, up to a point. This has been well-studied and even has a name, the Yerkes-Dodson law, after the psychologists who described it in 1908, Dr. Robert Yerkes and Dr. John Dodson. The basic principle is that when your body experiences anxiety at the exact right level, adrenaline and other physiological responses can enhance performance. Too much anxiety, and performance level decreases.
Anxiety can help us feel motivated, help us complete tasks, drive us to meet deadlines, and to take risks. But how do we know when we’ve found that perfect balance, using anxiety to our advantage, rather than letting it impact our day-to-day functioning?
“We start to be concerned when there are things in your life that are hard to do because of anxiety, like your job,” said Dr. Hudenko. “My job is to determine whether your level of anxiety is normal.”
3. Unhelpful Anxiety Means Feeling a Sense of Danger When There Is None
If you see a poisonous snake, it would be considered normal to have anxiety. Hopefully, that “fight or flight” response will help you escape a dangerous situation. If this healthy fear of dangerous snakes increases to the point where you are afraid to leave your house because you’re worried about encountering a snake, “it’s maladaptive,” said Dr. Hudenko, meaning your fear is higher than needed.
“People with anxiety disorders are essentially in a constant state where they’re seeing danger where there is none. It’s a fear mismatch,” said Hudenko.
This can manifest in many ways: catastrophic thoughts about an upcoming event, like a test in school, that prevent sleep; fear of public speaking that leaves one tongue-tied in front of a group of people; agoraphobia, where the fear has convinced you that leaving the house is unsafe; and more. It’s important to note that in each case, the level of fear and the estimated danger is much higher than is warranted by the real-life stimuli being experienced. No matter how tough the test, big the crowd, or leaving the house, outside of the intense anxiety experienced, none will leave you as worse off than a bite from a venomous snake.
4. Unhelpful Anxiety Can Be Biological, Psychological, or Social in Nature
“When a patient presents with anxiety, I think, ‘is it caused by biological, psychological, or social factors, or some combination of them?” said Dr. Vrushali Gersappe, a psychiatrist and sleep specialist.
People who experience anxiety because of biological factors tend to be predisposed to anxiety, according to Dr. Gersappe, adding “My mom is an anxious person. So I know I am biologically predisposed to anxiety.” While it’s more likely you’ll experience anxiety if you are biologically predisposed, it’s not a guarantee.
Psychological and social factors also play a role in the likelihood of you experiencing unhelpful anxiety as well. There are common underlying triggers for anxiety including external stressors (and to what extent we’re doing a good job managing stress), internal stressors (like self-demands and self-talk), and past experiences. The psychological and social factors contribute to how you respond (think) and react (behave) to the triggers, and it’s that response that can lead to unhelpful anxiety.
The biological, psychological, and social triggers for anxiety are extremely common and will likely occur at some point for most people.
“You’ll sometimes hear people say things like ‘it’s just who he is’ or ‘it’s a character flaw,’ as if the patient can control their symptoms of anxiety,” said Dr. Goldshmid. But the truth is, there are many factors that lead to unhelpful anxiety.
5. Anxiety Is One of the Most Treatable Mental Disorders
The good news is that anxiety is one of the most treatable mental disorders.
“There are many treatment options for anxiety,” said Dr. Hudenko, “including medications, therapy, and even off-the-shelf, non-prescribed tools, like meditation, stress-reduction, exercise, or just talking to a friend.”
While medications as well as therapy were both effective at treating anxiety versus placebos in randomized, controlled trials, the combination of the two might be the most effective treatment. Therapy plus medications helps reduce worry in the short term, according to a 2013 paper published in the American Journal of Psychiatry. Therapy plus medications also is more effective for panic over time, according to a 2000 paper published in the Journal of the American Medical Association. And a meta-analysis of studies in 2009 showed that therapy plus medication is more effective for treating anxiety.
“Meds and therapy both work incredibly well, and when you combine the two, the success rates and prevention of relapse rates get even better,” said Dr. Goldshmid.
6. You Can Start to Address Your Own Anxiety With Something as Simple as Breathing
If you’re feeling anxiety, there’s one, simple thing you can try for immediate relief: breathe. The power of breathing can mean a significant difference in both the physical symptoms of what we can experience with anxiety, as well as the cognitive symptoms.
“Breathing can make a significant difference in both the physical symptoms of anxiety, as well as the cognitive symptoms,” said Dr. Jill Kapil, a K Therapy clinician.
The reason it works is that the sympathetic system, that “fight or flight” response that makes you feel anxiety, can’t function at the same time as the parasympathetic system, a corresponding set of processes in your body that calm you down. Breathing slowly and deeply is one of the easiest ways to engage your parasympathetic system.
“A lot of techniques that we use to treat anxiety is simply activating the opponent system in your body, the parasympathetic system,” said Dr. Hudenko. “It calms us down. It will slow your breathing and stop the perspiration process.”
The next time you feel anxiety, try inhaling from your nose and exhaling from your mouth until you feel calmer, or even pausing just to take three deep breaths in a row.
7. You Can Help Someone Else With Anxiety Just by Listening to Them Talk About Their Feelings
When your feelings are overwhelming or negative, talking them out with a trusted friend or relative can be incredibly therapeutic.
Start by listening, hearing if there’s anything going on that they want to talk about. When they tell you about their problems, resist the urge to offer a solution. Instead, validate their feelings; demonstrate that you understand where they are coming from by repeating back to them what they’ve told you and how it makes them feel.
“Almost parrot what feelings they’re naming,” said Dr. Kapil. “If someone is telling you they’re feeling anxious, reflect that right back by saying, ‘I hear you’re feeling anxious. Can you tell me more about what that’s like for you?’”
Asking more specific questions can get them to reflect further, which can be helpful.
“I invite them to listen to their negative self-talk and consider what they would rather say to themselves,” said London. “Even if the person can’t imagine shifting their self-talk to a positive belief, they can sometimes neutralize the negative thought by talking it out. It’s incredibly helpful.”
8. There Are a Wide Variety of Medications that Can Help with the Treatment of Anxiety
When you think of taking medications for anxiety you may think of medications like Xanax or Valium for immediate relief of intense anxiety. While these drugs can be helpful for short periods of distress, you may be concerned about taking them because they can have stronger side effects or the potential for dependency.
The good news is that there are a number of other medications such as Selective Serotonin Reuptake Inhibitors (SSRIs), like paroxetine (Paxil) and sertraline (Zoloft), or Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), like Duloxetine (Cymbalta) and Venlafaxine (Effexor), that are prescribed for anxiety disorders.
“If your anxiety is causing significant distress or impairment in your life, you might consider consulting a physician about one of these treatments that typically have low levels of side effects but that can have a positive impact on anxiety,” said Dr. Hudenko.