By Mike DuBose with Dr. Surb Guram, MD
We all have things that worry us. Sometimes, we feel general stress about our jobs, relationships, health, or finances, or we may fear a specific situation, like an approaching test or medical exam. We also live in a time when national and world events cause a significant amount of concern for many. Reflecting these worries, in the American Psychological Association’s 2017 Stress in America survey, 63% of respondents said they felt stress about “the future of our nation,” with the other top two stressors being money and work.
Having some anxiety is natural, and it can help us make wise decisions to protect ourselves. However, if the anxiety gets out of hand, worry can take over one’s life! Columbia, SC-based psychiatrist Josh Fowler, MD, provided a great explanation of how anxiety can escalate into a problem: “A good way to think about anxiety disorders as a whole is a feeling of ‘loss of control.’ To combat this, many individuals with anxiety tend to overcompensate by attempting to control all factors of their life. Obviously, this is impossible, so when things do not go as expected, their anxiety may spike.”
Some people are genetically predisposed to excessive stress, while others find that past or current circumstances have pushed them into a state of near-constant worry. Anxiety causes, symptoms, and effects are unique from person to person, but one thing is universal: individuals with anxiety disorders should seek treatment to live longer, happier, and healthier lives! Even those who don’t have anxiety disorders can benefit from learning how to reduce general stress and worry.
What to Do If You Think You Have an Anxiety Disorder
If you notice yourself becoming increasingly anxious and the feelings are negatively impacting your life, make an appointment with your primary care physician so that he or she can help decide if your anxiety has escalated into disorder territory by conducting a thorough medical examination. (However, please note that many physicians are not trained to assess, treat, and monitor mental health disorders such as depression, anxiety, and bipolar, so there’s a possibility that you may have to seek help from a more specialized professional.)
Before your appointment, it’s a good idea to attempt to identify situations that trigger your anxious behavior.Is there a specific scenario that tends to make you worried? Are there a certain set of circumstances that have happened several times before you’ve had a panic attack? For example, you may notice a spike in anxious thoughts when you’re hungry or tired. Use a paper or digital journal to record information about your anxiety episodes, then look for patterns.
Another way you can prepare to speak to your doctor about your anxiety is to review the following potential questions (derived from a list provided by The Mayo Clinic):
There are several medical illnesses that can cause anxiety, such as thyroid problems or diabetes, and some medications that have anxiety as a side effect. Therefore, your physician may order tests to rule out medical issues and will want to look carefully at any medications or supplements you are taking that could be potential anxiety inducers. He or she will likely compare your description of your current situation to the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assist in determining if you should be diagnosed with an anxiety disorder. Remember: anxiety is a legitimate illness affecting 18% of the American population, according to the Anxiety and Depression Association of America (ADAA). There is no reason for embarrassment if you are diagnosed with an anxiety disorder.
Whether or not your anxiety has reached the point where it can be considered a disorder, if it is impacting your life, you want to take an active role in reducing your stress and worry. To determine the next steps you should take, consider asking your doctor the following questions (also originating from suggestions published by the Mayo Clinic):
Fortunately, anxiety disorders are highly treatable. You can greatly improve your quality of life by working with the right medical and/or mental health professionals and making some lifestyle changes! The two most common (and, typically, most effective) forms of treatment for anxiety are therapy and medication. According to many different sources, including Consumer Reports, most people find that a combination of both works best for them, but it may take some trial and error depending on your unique situation, background, and triggers.
Finding and Working with an Competent Therapist
If your primary care doctor diagnoses you with an anxiety disorder, it is likely that he or she will recommend talk therapy as part of your treatment plan. Your physician may even suggest a certain type of therapy, depending on the disorder you have been diagnosed with and what they know of your personality. According to psychiatrist Josh Fowler, “Treatment modalities may vary depending on the individual and their age, but also by the form of anxiety they experience.” Here are some common types of therapy and the disorders that they are often used to treat:
Once you have decided on the type of therapy you want to pursue (if you have a preference), the next step is finding a good clinician who matches your personality and needs. First, ask your doctor if he or she has any recommendations and check your insurance website for suggestions. Anxiety is a common issue, and your physician has likely referred other patients to therapists before (and may have heard some feedback on which are good for certain disorders). If you are comfortable doing so, you can also ask friends and family if they have any recommendations. Some of talk therapy’s unfair social stigma is finally dying away, and you may be pleasantly surprised by how many people will offer up glowing endorsements of therapists who helped them through difficult times!
Another way to find a therapist (particularly if you’re dealing with a more specific anxiety disorder like agoraphobia) is to conduct a Google search for the disorder you need help with and your city and state. Several names will likely pop up, either on the therapists’ own websites or through a directory (PsychologyToday.com offers a great one at www.psychologytoday.com/us/therapists/ that you can narrow by disorder, insurance providers accepted, and preferences like the counselor’s gender). If you do not use a search method that allows you to narrow by insurance accepted, make sure to check each potential clinician individually to ensure that your insurance policy will pay for sessions. (Therapy can be very expensive, although finding a competent, experienced therapist is worth every penny!) Most insurance providers will allow you to seek partial reimbursement for appointments with clinicians who are not in their network.
Make a list of several providers who are close to your home or work who deal with the issues you need addressed; then, conduct another Google search with their names (or the practice name), your city, and “reviews.” In a recent New York Times article, Marissa Miller recommended, “Before making your first call, look at a therapist’s online presence on Yelp-like databases like Vitals, ZocDoc, and Healthgrades. Watch out for cookie-cutter positive comments like ‘Good therapist,’ or an overwhelming number of four- or five-star reviews.” Instead, look for details that make it clear the reviews were left by real patients with positive experiences.
If you see a pattern of positive remarks about a specific counselor, call to inquire about scheduling an appointment (double-check that they accept your insurance at this point as well). Depending on where you live, it may be difficult to get your foot in the door with a good provider, but keep trying! If your desired clinician is not taking any new patients, move down your list, but you may want to check back over time to see if any appointments have opened up (Monday is the day that most cancellations occur).
You need to be comfortable talking about sensitive subjects with your therapist, so it’s important that your personalities “click.” That means that you may have to try an appointment or two with several different professionals until you find the one who works best with you. In Columbia, SC, we recommend psychiatrist Josh Fowler, MD and Dr. Fredrick Mau as excellent counselors.
Some people are interested in getting therapy only for the time they feel that it’s absolutely necessary, while others like to “check in” regularly as a kind of maintenance measure. Make sure that you discuss your expectations and needs with your therapist and note that they may change over time. As Miller said, “Seeing a therapist for a while does not necessarily mean it’s a match made in therapeutic heaven. Your relationship or needs may change over time, or the therapist’s career may go in a different direction.” Periodically assess your progress to confirm that you’re improving and feeling less anxious.
Therapy is an important part of treating anxiety disorders, but it can’t change biological factors like brain chemistry. That’s why prescription drugs are sometimes also needed. They can provide anxiety sufferers with the chemical boost they need to regulate their emotions and apply the lessons learned in talk therapy. There are four main types of medications that are usually prescribed:
Important: All medications, including these, have the potential to cause side effects. Monitor yourself for any behavioral or physical changes that may occur and report them to your physician. If the side effects are too extreme, there may be another type of drug that can help you without causing those issues. Above all, don’t suddenly stop taking antidepressants without the help of a trained physician or psychiatrist who can wean you off of them or transition you to another option.
Other Ways to Manage Anxiety
Although therapy and medication are the most common (and most clinically effective) ways to treat anxiety disorders, there are some steps that anxiety sufferers can take on their own to help lessen their worry. Many of these strategies involve behavioral changes that can lead to a healthier body and mind. They are particularly useful for those who have mild to moderate anxiety, or when performed in conjunction with therapy and medication for those with more serious anxiety disorders. Always consult your doctor before making any changes to your lifestyle that will impact your physical or mental health!
Calm Your Mind
Relax yourself through meditation. Many of us have minds that are constantly racing, jumping from one idea, task, or worry to another. That’s what makes meditation—the act of quietly focusing the mind on a particular object or thought, while avoiding all other thoughts—much harder than it sounds! However, scientific studies (including one by neuroscientists at Stanford University) have proven that meditation can help decrease anxiety by reducing activity in the amygdala, which is the part of the brain that makes us feel fear.
Want to try meditation but don’t know where to start? Here is a simple guide from the New York Times:
Anxious people may have difficulties keeping their minds from wandering during meditation, especially at first! Guided meditations, where you follow instructions from a recording, can be very helpful. Fortunately, there are lots of resources available online. The New York Times offers a great, detailed guide on meditation (including sample guided meditations of different lengths) at www.nytimes.com/guides/well/how-to-meditate. Other free examples of guided meditations by Dr. Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School, are available at www.mindfulness-solution.com.
There are also activities that, while not “meditation” per se, have significantly meditative qualities. It just depends on you and what you find most calming! For example, for some people, taking some time to paint a beautiful picture in watercolors can feel meditative. Others might be able to clear their minds while taking a warm bath or listening to soothing music. Even repeatedly stroking the fur of a beloved lap cat can be a meditative experience!
Lay the groundwork for healthy thought patterns. “Catastrophizing” is a tendency of many anxious people to jump from worrying about a normal issue to stressing over the worst-case scenario. Psychiatrist Josh Fowler describedcatastrophizing as “a thought process causing people to assume the worst possible outcomes from an ordinary stressor…for example, ‘I made a B on my last test. I'm so stupid. I'm probably going to fail this class. I'll never get a job.’” (He also noted that adults tend to be most affected by this issue, whereas children are more likely to report somatic symptoms of anxiety like stomach aches or headaches.)
When you recognize that you’re beginning to catastrophize, begin a pattern of calmly bringing your thoughts back under control. If you’re worried about an upcoming medical exam, for example, instead of allowing your thoughts to escalate to something like, “They’re probably going to find a terminal disease,” practice telling yourself that the worst-case scenario is unlikely and that whatever happens (good, bad, or, most likely, a combination of both), you will react to the best of your ability and you will be ok. Eventually, you will break the habit of skipping immediately to the worst-case scenario and can look at situations more rationally from the beginning.
Try light therapy. Light therapy is mostly known for its effectiveness in treating seasonal affective disorder (SAD), which usually occurs during the times of year when there is less natural sunlight. However, some studies have also shown that it can help diminish anxiety. Research suggests that phototherapy may have an impact on the amygdala, the brain’s “fear center,” which plays a large role in anxiety. Some reports indicate that light therapy provides individuals with more energy, reduces stress, and improves anxiety.
One safe way to get more light is by using “light boxes.” These devices are rarely covered by insurance, but good ones can be purchased on Amazon.com for less than $100 (look for the ones that are highly recommended by Amazon readers). Make sure that you get one that emits 10,000 lux of light with as little UV radiation as possible. When using the light box, don’t look directly at it, but just sit with it pointing at you (positioned 16-24 inches from your face) while performing other activities like reading a book or magazine. The Mayo Clinic recommends using a light box within an hour of getting up in the morning for 20-30 minutes for the best results.
Think about a certain mental image. Visualizationis the act of focusing on a soothing mental picture when one realizes their anxiety is about to get out of control. Visualizing the image has a calming effect, and the anxious person can turn to it whenever they begin to get overly stressed. Your image can be whatever you’d like, but in an article for Psychology Today, Eric Maisel, Ph.D., recommends the following three images of “settling:”
Try progressive muscle relaxation. Progressive muscle relaxation, or PMR, was developed by an American physician, Edmund Jacobsen, who realized that some of his patients were unaware of how tense their bodies were, even when told to relax. He created PMR to help them gain awareness of their muscle tension, learn to relax their bodies, and recognize when they entered a state of relaxation.
Jacobsen’s original technique has been modified over the years, but the basic idea is that the patient clenches and releases muscle groups while focusing on how the body part or area they’re focusing on feels. PMR usually starts with deep breathing exercises (such as inhaling deeply through the nose, then exhaling through the mouth for several rounds) and then moves on to clenching and releasing muscle groups from the toes upward. Practitioners work their way through the legs, core, back, hands, arms, shoulders, neck, and finally up to the face, keeping tabs on where they feel stiff or uncomfortable (these areas can be repeated if desired). By the time they take a few more deep breaths at the end, they usually feel much calmer! PMR has been noted to decrease the body’s “fight-or-flight” response, which can help avoid panic attacks. It also reduces physical tension, which can help individuals release emotional stress.
Strengthen Your Body
Exercise. Numerous studies have shown physical activity to be a key component in a healthy life—not just for fitness, but also in terms of happiness, sleep quality, and more! According to the Anxiety and Depression Association of America (ADAA), “Scientists have found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem.”
Although you should always consult your doctor before starting an exercise program, especially if you are in poor health, have a specific medical problem, or are in your senior years, here are some general guidelines you may want to consider:
Take a yoga class (or try a DVD). Over the last 30 years, yoga has become popular in the United States as a way to calm the mind and strengthen the body through gentle stretches. Especially when it is performed in a guided situation, such as by a teacher in a class or by watching a DVD at home, it helps practitioners to become aware of their breathing, which can induce a calm state of mind. Many yoga classes or DVDs also include a guided meditation session after the physical portion is complete, adding to the mental health benefits. According to Harvard Mental Health Letter, “Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.” One thing to note: if you are older or have physical disabilities, talk to your doctor first to make sure your yoga program is safe for your body and balance limitations.
Improve your diet: Some foods, including alcohol, refined sugars, and processed and/or salt-laden “junk” foods like potato chips, have been linked to elevated anxiety. You’ll want to remove these foods from your diet—a great move not only for anxiety, but also for overall health! In some people, plants in the nightshade family (tomatoes, eggplants, peppers, and potatoes) can also promote anxiety. If you think you may be sensitive to these, try keeping a food diary and noting what you’ve eaten before anxious episodes. Limit consumption if you think there is a correlation.
If you drink alcohol, cutting back is a great strategy for anxious individuals. Although a little red wine can be good for the heart, overusing alcohol can dehydrate the body, impair brain function, and disrupt blood sugar levels, all of which can cause anxiety. Anxious people—especially those with social anxiety disorder—are also more likely to lean on alcohol as a crutch, developing unhealthy relationships with it.
One of the biggest anxiety-causers, caffeine, is technically a drug (although widely available in legal substances like coffee and chocolate) because it stimulates the central nervous system, raising heart rate, blood pressure, and body temperature. These responses can mimic or even precipitate a panic attack: in fact, one study from Brazil found that caffeine could actually induce panic attacks in people who had the disorder! Cutting back on caffeine is a great idea if you have an anxiety disorder. Start by reducing your consumption of caffeinated foods and beverages (maybe replacing your coffee with decaf or choosing water over soda a few times a week), gradually decreasing the amount of caffeine you consume. As a bonus, your sleep quality will also likely improve, which can also help with anxiety!
In addition to eliminating certain foods, there are some you may want to incorporate into your diet. In a Men’s Health magazine article, registered dietician Tanya Zuckerbrot recommended eating avocados to obtain B vitamins, which are key to healthy nerve and brain cells. Vitamin C, which reduces levels of the stress hormone cortisol, can be found in foods like citrus fruits and blueberries; magnesium (plentiful in spinach) and omega-3 vitamins (like those found in salmon, walnuts, and flaxseed) also help regulate cortisol. Zuckerbrot also suggested eating turkey and old-fashioned oatmeal for a serotonin boost and milk for its protein lactium, which can lower blood pressure. Research has also suggested that probiotics, the healthy bacteria that naturally occur in our stomachs and intestines, are linked to neurotransmitter production. Consider incorporating a probiotic supplement into your diet, or add healthy gut bacteria food sources, such as pickles or yogurt.
Improve Your Environment
Limit time spent on social media. If you have a tendency to compare yourself to others, social media can be a big source of anxiety! Based on the posts and photos individuals share about their vacations, relationships, and fun activities, it can seem as if others have “perfect” lives, while yours is boring. Of course, this is likely untrue—these individuals probably carefully cultivate their online personas to present a certain image—but it can still leave you feeling down. Try to limit your time spent on social media platforms. Even better: spend the time you otherwise would have used on Instagram or Facebook enjoying a fun, real-life activity with friends or family. Social interaction can help support healthy emotions and decrease anxiety.
Change the channel from negative news. Every time you turn on the TV, it seems like the 24-hour news stations are reporting on yet another disaster! While there’s nothing wrong with staying informed, constantly watching negative news can sour your mood and make you more anxious. So, turn off that cable TV news and take a walk—another great way to fight anxiety!
Dial back smartphone usage. Functioning as tiny computers, smartphones offer users the ability to make phone calls, exchange text messages, write emails, and access the internet, all on a device that can fit in a pants pocket. The prevalence of smartphones—68% of U.S. adults own one, according to Pew Research Center—means that we are all more interconnected than ever...but is that a good thing? In some ways, smartphones can be very helpful, but in others, they can cause undue stress. People may feel as if they have to respond immediately to messages that could be left for later, interrupting work or family time and causing emotional distress. To help avoid this, turn off notifications for work emails during non-work hours, and if you’re participating in an activity that requires your full attention (say, going to dinner with your spouse), put away your phone for the duration so you’re not tempted to check it. Switch sounds for texts and other alerts (such as Facebook notifications) to “silent” instead (even vibrations can be distracting) and turn off pop-ups on your laptop or desktop. Removing these distractions will improve focus and allow you to clear your mind, reducing worry!
Seek better sleep. Sleep problems and stress are interrelated: lack of sleep exacerbates stress, and stress can make it difficult to sleep. However, sleep is essential for the body to heal itself both mentally and physically each night. According to Time magazine, children and teens 17 years old and below need 8-10 hours of sleep each night, while adults 18-64 need 7-9 hours. Seniors aged 65+ only need 7-8. Of course, the exact amount needed varies from person to person; however, most of us don’t always get enough sleep. Here are some tips compiled from articles by Harvard University Medical School, WebMD, and the National Sleep Foundation:
If you find that these suggestions do not work, we highly recommend undergoing a sleep study with a trained sleep physician. At a sleep lab, professionals will attach a variety of harmless sensors to monitor you while you sleep as normal. Then, the physician can make recommendations to improve your sleep. We recommend Dr. Joseph Gabriel in Irmo, SC for sleep studies.
Decrease workplace stress. Work is a major stressor for many Americans, according to the American Psychological Association (APA). The organization recommends tracking which situations at work cause the most anxiety, then developing healthy solutions (taking a quick walk around the building, for example) to help diffuse the worry. If interpersonal conflicts are the main source, speak privately to a manager or supervisor about the issue at a good time and seek advice on how it can be addressed. They need to know, and it’s a part of their jobs to manage people and create the most productive environment possible. The APA also recommends utilizing vacation time as a way to recharge: “When possible, take time off to relax and unwind, so you come back to work feeling reinvigorated and ready to perform at your best.” Although it may seem counterintuitive, taking a few days off can actually make you a better employee, as you’ll be able to tackle challenges with vigor and excitement!
Take care of yourself. Doing little things to pamper your body can improve your mood and put you in a better mindset. If you can afford it, schedule regular haircuts with a good salon, and consider booking a massage to increase the relaxation even more. (If money is tight, book an appointment with a training school, where students administer services under the watchful eyes of instructors.) You can even relax at home with a warm bath, some aromatherapy oils (many find lavender to be a calming scent), and comfortable, soft clothes of your own!
If you must worry about something, designate a specific time slot for it. Sometimes, you will be faced with situations you can’t help but worry about. Rather than letting anxiety take over your whole day, set aside 10-15 minutes at a predetermined time to allow yourself to go over the issue. You can think about it or even write in a journal, pondering over worst-case scenarios and potential solutions. However, once time is up, tell yourself that you must put the problem out of your mind until the designated time tomorrow.
Declutter your home and office. Our environments often impact how we feel. When our homes or offices are messy, it can feel like the walls are closing in on us—not to mention, how difficult it is to find things! Getting organized can help decrease stress and anxiety. If organizing a whole house or room seems daunting at first, break it down into smaller sections. Set aside items you don’t use or need, then decide whether to donate, sell, or throw them away. Losing the clutter can make you feel as if a weight has been lifted from your shoulders!
The bottom line: Anxiety is a very common issue in America today. If you have an anxiety disorder or are generally anxious, you are not alone! There are many avenues of treatment available to help you enjoy a lower-stress life, including therapy, medication, and lifestyle changes. The first step is often the hardest, but don’t wait any longer. See your doctor to get started on the path toward health and happiness!
To learn more about the causes of anxiety, see https://www.mikedubose.com/blog/what-causes-excessive-anxiety-fear-and-worry.
About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can email us at [email protected].
Mike DuBose, a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.
Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.
Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.
© Copyright 2018 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at [email protected] and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!