Coping With Anxiety

Tip: Change What You Can, Accept the Rest

From the WebMD Archives

Divorce, layoffs, threat of terrorism -- there's plenty of anxiety around for everyone these days. And very often, the source is something we can't change. How do you know when it's time to get help dealing with your anxieties?

To better understand the underpinnings of anxiety -- and how to better cope -- WebMD turned to two anxiety experts: Jerilyn Ross, MA, LICSW, director of The Ross Center for Anxiety and Related Disorders, Inc., and Linda Andrews, MD, assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine in Houston.

Normal vs. Harmful Anxiety

The cold sweat of anxiety is that "fight or flight" response that kept our early relatives safe from grizzly bears and other scary characters, says Andrews. "That adrenaline rush still serves us well under certain circumstances. Anxiety is a natural reaction to those very real stresses."

In today's world, "that reaction helps motivate us, prepares us for things we have to face, and sometimes give us energy to take action when we need to," adds Ross.

Big job interview is coming up, and it's got you in knots. So "you spend a little more time getting dressed or rehearsing what you're going to say," Ross says. "You've got an appointment with the divorce lawyer, so you do more homework. That kind of anxiety can motivate you to do better. It helps you protect yourself."

But as we know too well, sometimes it doesn't take a specific threat -- only the possibility of crisis -- to send humans into anxiety mode. "The difficulty comes in learning to tone down that automatic response -- to think, 'How serious is the danger? How likely is the threat?' "says Andrews.

"The thing about anxiety is, it can take on a life of its own," she adds. "Everything becomes a potential crisis. The unthinkable has happened. So around every corner, there's the next possible disaster."

The Anxiety Toll

When anxiety is taking a toll, your body knows it. You have trouble sleeping, eating, and concentrating. You get headaches; your stomach is upset. You might even have a panic attack -- the pounding heart, a feeling of lightheadedness.

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Anxiety may also feel like depression. "The two sometimes overlap," Ross says.

When anxiety becomes so overwhelming that it interferes with day-to-day activities -- when it keeps you from going places, from doing things you need to do -- that's when you need help, says Ross.

Generalized anxiety disorder is a bigger syndrome -- "like a worry machine in your head," Ross says. "If it's not one thing, it's another. You're procrastinating to the point that you're almost afraid to take a step. You're so nervous about going to your child's school to talk to the teacher, you just don't go -- you miss the appointment."

In the case of such overwhelming anxiety, "people are not making good decisions," says Ross. "They're avoiding things, or they're unable to rise to the occasion because the anxiety is too much. They're procrastinating because they can't concentrate, can't stay focused. It's really interfering with their day-to-day life. At that point, they may have a more serious anxiety problem and need professional help."

How Do You Cope?

To cope with plain-vanilla anxiety, "get real," as they say. "Separate out the real risks and dangers that a situation presents and those your imagination is making worse," advises Ross. It's a twist on the old adage: "Take control of the things you can, and accept those you can't change."

"Ask yourself: Where can you take control of a situation? Where can you make changes? Then do what needs to be done," she says. "What things do you simply have to accept? That's very important."

Very often, it's possible to get past an anxiety cycle with the help of friends or family -- someone who can help you sort out your problems. But when anxiety becomes overwhelming, it's time for a therapist, or perhaps medication.

Here are two strategies that therapists use to help us conquer anxiety:

Challenge negative thoughts.

Ask yourself: Is this a productive thought? Is it helping me get closer to my goal? If it's just a negative thought you're rehashing, then you must be able to say to that thought: 'Stop.' "That's difficult to do, but it's very important," Ross says.

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Rather than becoming paralyzed with anxiety, here's another message you can send yourself: "I may have to take a job I don't like as much, may have to travel further than I want, but I'll do what I have to do now. At least I will have the security of income in the short term. Then I can look for something better later."

The most important thing: "to realize when you've done everything you can, that you need to move forward," Ross says.

Learn to relax.

You may even need "breathing retraining," Ross adds. "When people get anxious, they tend to hold their breath. We teach people a special diaphragmatic breathing -- it calms your system. Do yoga, meditation, or get some exercise. Exercise is a terrific outlet for anxiety."

Most of all, try not to compound your problems, adds Andrews. "When things are bad, there is a legitimate reason to feel bad," she says. "But if you don't deal with it, you're going to lose more than just a job -- you'll lose relationships, your self confidence, you could even lose technical abilities if you stay dormant in your profession. Try not to compound one stress by adding another."

Often your ability to work through anxiety -- get past it -- varies depending on the type of crisis you faced. "The more severe, the more surprising it was, the longer it's going to take to get over it," says Andrews. "You may be on autopilot for several weeks. If you're depressed, that can complicate things. In the case of divorce, it may take months to years to really get back to yourself."

But take heart. "If you're doing well in one aspect of your life -- in your work or your relationships -- you're probably on your way," she says. "Fear and anxiety are no longer running your life."

Medication for Anxiety Disorders

Medication will not cure an anxiety disorder, but it will help keep it under control. If anxiety becomes severe enough to require medication, there are a few options.

Antidepressants, particularly the SSRIs, may be effective in treating many types of anxiety disorders.

Other treatment includes benzodiazepines, such as Valium, Ativan, and Xanax alone or in combination with SSRI medication. These drugs do carry a risk of addiction so they are not as desirable for long-term use. Other possible side effects include drowsiness, poor concentration, and irritability.

Beta-blockers can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia.

WebMD Feature Reviewed by Louise Chang, MD on December 31, 2009
© 2005 WebMD, Inc. All rights reserved.

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