Guide to Understanding and Managing Anxiety
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About Anxiety
Most people are familiar with feelings of anxiety.
Anxiety is a normal part of life. Anxiety is our body’s way
of responding to a physical, emotional or intellectual challenge.
What student has not felt a bit anxious before a final exam or oral
presentation? In fact, moderate anxiety during these situations can
be mobilizing, resulting in better performance. However, if your test
anxiety is at the point where you are too anxious to go to the exam,
or if your mind consistently goes blank during the exam and you cannot
recover, you are probably not experiencing ordinary, everyday anxiety.
Anxiety is a medical problem when it is persistent, overwhelming,
and interferes with your day-to-day functioning. Symptoms of anxiety
commonly include unrealistic fears and worries, physical complaints,
such as upset stomach or rapid heart rate, and the avoidance of anxiety
producing situations. Over 19 million American adults struggle with
anxiety. While the exact cause of anxiety disorders is uncertain,
the problems probably result from a combination of factors including
genetics, brain chemistry, personality, and life events.
Anxiety can be successfully treated. The goal is not to eliminate
anxiety, but to reduce it to a manageable level. With the right treatment,
many people begin to feel better immediately or in just a few weeks.
What are the different types of anxiety?
Generalized Anxiety Disorder (GAD)
I can’t stop worrying. I feel keyed up and unable to relax.
At times it comes and goes, and at times it seems constant. I worry
about everything from making enough money to send home to my family
to what to give my best friend for her birthday. Now that I’m
about to graduate, there’s even more things to worry about.
I have trouble sleeping or concentrating when studying. Sometimes
I feel a little lightheaded. My heart races or pounds. And that makes
me worry more. I’m always imagining things are worse than they
really are: when I get a stomach ache, I think it’s an ulcer.
I can’t turn off the worry—I’m miserable.
Generalized anxiety disorder (GAD) is much more than the normal anxiety
people experience day to day. It’s chronic and fills a person’s
day with exaggerated worry and tension, even though there is little
or nothing to provoke it. Having this disorder can mean always anticipating
disaster, often worrying excessively about health, money, family,
school or work. Sometimes, though, the source of the worry is hard
to pinpoint.
Worries are usually accompanied by physical symptoms, such as fatigue,
headaches, muscle tension and aches, difficulty swallowing, trembling,
twitching, irritability, sweating, and hot flashes. People with GAD
may feel lightheaded, out of breath, nauseated, and easily startled.
Concentration and sleep problems are also common.
Social phobia
In any social situation, I felt fear. I would be anxious before
I even left the house, and it would escalate as I got closer to class,
a party, or whatever. My heart would pound, my palms would get sweaty,
and I would get this feeling of being removed from myself and from
everybody else.
It happened again last year. I had to give a report in front of
my class and I got so nervous and tongue-tied. I think I stammered
something, sat down, and stared at my right shoe the rest of the class.
I was so humiliated. My friends tell me they feel nervous before presentations
too, but at least they can talk. I just go blank and stare.
Social phobia is characterized by an intense fear of situations, usually
social or performance situations, where the risk of embarrassment
is present. It can disrupt normal life, interfering with school, work
or social relationships. It’s not uncommon for people with social
phobia to worry for days or weeks in advance of a social or performance
situation. Physical symptoms often accompany the anxious feelings
and include blushing, profuse sweating, trembling, nausea, shortness
of breath, racing heart and difficulty talking.
Specific phobias
I’m scared to death of flying, and I never do it anymore.
It was an awful feeling when that airplane door closed and I felt
trapped. My heart would pound and I would sweat bullets. These days
I only go places where I can drive or take a train. My friends always
point out that I couldn’t get off a train traveling at high speeds
either, so why don’t trains bother me? I just tell them it isn’t
a rational fear.
A specific phobia is an intense fear of something that poses little
or no actual danger. Some of the more common specific phobias are
centered around closed-in places, heights, escalators, tunnels, highway
driving, water, flying, dogs, and injuries involving blood. Facing,
or even thinking about facing, the feared object or situation can
bring on a panic attack or considerable anxiety, even when the person
recognizes how irrational the fear is.
Panic disorder
It started 2 years ago, when I was sitting in a seminar and this
thing came out of the blue. I felt like I was dying. In between attacks
there is this dread and anxiety that it’s going to happen again.
I’m afraid to go back to places where I’ve had an attack.
People with panic disorder experience sudden episodes of intense fear
that occur without any warning or apparent reason. They can’t
predict when an attack will occur, and many develop intense anxiety
between episodes, worrying when and where the next one will occur.
A panic attack is marked by a group of symptoms that can include dizziness,
racing heart, perspiring, shortness of breath, tingling hands, fear
of dying or “going crazy.” Attacks usually last no more
than about 10 minutes.
Post-Traumatic Stress Disorder
I was assaulted when I was 22 years old. For a long time, I spoke
about the attack as though it was something that happened to someone
else. Then I started having flashbacks. They kind of came over me
like a splash of water. I would be terrified. Suddenly I was reliving
it. Every instant was startling. I wasn’t aware of anything around
me, I was in a bubble, just kind of floating. Having a flashback can
wring you out.
Post-traumatic stress disorder (PTSD) can develop following a terrifying
event that a person experienced or witnessed. Whatever the source
of the problem, some people with PTSD repeatedly relieve the trauma
in the form of nightmares and disturbing memories during the day.
Other symptoms may include sleep problems, feelings of detachment
or numbness, hypervigilance, irritability and aggressiveness. Some
people avoid certain places or situations that are reminders of the
trauma, and anniversaries of the event are often especially difficult.
Ordinary events can trigger flashbacks or intrusive images. A person
having a flashback, which can come in the form of images, sounds,
smells, or feelings, may lose touch with reality and believe that
the traumatic event is happening all over again.
Obsessive-Compulsive Disorder (OCD)
I couldn’t do anything without rituals. Counting really bogged
me down. I would wash my hair three times as opposed to once because
three was a good luck number and one wasn’t. It took me longer
to read because I’d count the lines in a paragraph. I knew the
rituals didn’t make sense, but I couldn’t seem to overcome
them until I had therapy.
Obsessive-compulsive disorder, or OCD, involves having distressing
thoughts or rituals that are time consuming and excessive.
Distressing thoughts or images, such as worries about germs or dirt
are called obsessions, and the rituals that are performed to try to
prevent or get rid of these anxious thoughts, such as the washing
of hands over and over are called compulsions. The more common compulsions
involve washing and cleaning, counting, repeating or checking actions.
A lot of healthy people can identify with some of the symptoms of
OCD, such as checking to see if the stove is turned off before leaving
the house. But for people with OCD, such activities consume at least
an hour a day, are very upsetting, and interfere with daily life.
Depression
Depression often accompanies anxiety and, when it does, it needs to
be treated as well. Symptoms of depression include feelings of sadness,
hopelessness, changes in appetite or sleep, low energy, and difficulty
concentrating. There are effective treatments for depression.
Treatment of anxiety disorders
Getting help: treatment works
Some individuals are able to manage their anxiety on their own through
self-help techniques. Others benefit greatly from professional attention.
If you think you have an anxiety problem, please don’t hesitate
to discuss this with a health care professional who can evaluate your
concerns.
A number of effective treatments for anxiety are available and can
provide relief from symptoms immediately or in just weeks. The most
common treatments are psychotherapy, medication, or a combination
of the two. A specific type of psychotherapy, cognitive behavioral
therapy, is particularly effective in managing symptoms of anxiety.
Individuals respond differently to treatment, and you may need to
try more than one type before you find the right one. However, before
considering other options, give the treatment plan a fair chance.
It’s important not to get discouraged and stop attending psychotherapy
sessions and/or taking the medications before they have had a chance
to be effective.
Cognitive Behavioral Therapy
Research has shown that a form of psychotherapy that is effective
for several anxiety disorders is cognitive-behavioral therapy (CBT).
A major aim of CBT is to reduce anxiety by eliminating beliefs or
behaviors that help to maintain the anxiety disorder.
The cognitive component helps people change thinking patterns that
keep them from overcoming their fears. Specifically, this therapy
identifies unrealistic beliefs and helps individuals develop more
objective ways of thinking that make stress and anxiety more manageable.
For example, a person with panic disorder can learn that the panic
attacks are not really heart attacks as previously feared. The behavioral
component seeks to change people’s reactions to anxiety-provoking
situations. A key element of this component is exposure, in which
people confront the things they fear. A person with social phobia,
for example, may be encouraged to spend gradually increasing time
in feared social situations without giving in to the temptation to
flee. In some cases the individual will be asked to deliberately make
what appear to be slight social blunders and observe other people’s
reactions. Generally through the use of exposure techniques, real-life
outcomes are not nearly as harsh as feared, and the person’s
social anxiety diminishes.
Antidepressants for anxiety
A number of medications that were originally approved for treating
depression have been found to be effective for anxiety disorders as
well. If your health care professional prescribes an anti-depressant,
you will need to take if for at least a few weeks before symptoms
begin to fade. Some of the newest of these antidepressants are called
Selective Serotonin Reuptake Inhibitors (SSRIs). These medications
act in the brain on a chemical messenger called serotonin. Some people
report feeling mildly nauseated or jittery when they first begin taking
SSRIs, but those symptoms usually disappear over time and are lessened
by gradual increases in dosage. Others may experience sexual or other
side effects on these medications. Adjusting the dosage or switching
to another SSRI is usually helpful in these circumstances.
Tricyclics and monoamine oxidase inhibitors (MAOIs) are two other
groups of antidepressant medications that have been around longer
than SSRIs, and may be prescribed for various anxiety disorders, though
side-effects are more frequent in general. Other newer antidepressants,
for example, venlaxafine (Effexor), with similar side effects to the
SSRIs, may be effective as well.
Anti-anxiety medications
Benzodiazepines can relieve anxiety symptoms relatively quickly and
have few side effects, although drowsiness can be a problem. They
are sometimes used to treat generalized anxiety disorder, panic disorder
and social phobia. Benzodiazepines may be useful for short term treatment,
but because of the potential for decreased effectiveness over time
and the risk of physical dependence, they are not generally appropriate
for ongoing use.
Buspirone (BuSpar), a member of a class of drugs called azapirones,
is a newer anti-anxiety medication that is used to treat generalized
anxiety disorder. Possible side effects include dizziness, headaches,
and nausea. Unlike the benzodiazepines, buspirone must be taken consistently
for at least two weeks to achieve an anti-anxiety effect.
Other medications
Beta-blockers, such as propranolol, are often used to treat heart
conditions but have also been found to be helpful in certain anxiety
disorders, mainly social phobia or performance anxiety. When a feared
situation, such as giving an oral presentation, is known in advance,
a beta-blocker may be taken beforehand to help keep your heart from
pounding, your hands from shaking, and other physical symptoms from
developing. Regular, daily doses of beta-blockers are not recommended
due to the risk of side effects. Also, they don’t address the
psychological components of anxiety.
Working together
When you undergo treatment for an anxiety disorder, you and your health
care professionals will be working as a team. Together, we will find
the approach that is best for you. If one treatment doesn’t work,
the odds are good that another one will.
| Help yourself: manage your
stress |
| You can increase your ability to cope with stresses
that contribute to anxiety. If you are prone to anxiety, it’s
important to keep your baseline stress level as low as possible.
Here are some self-care tips: |
| Make wise lifestyle choices: There’s
no substitute for eating well, exercising regularly, and getting
enough sleep. They help boost your energy level and increase your
overall sense of well-being. Keep in mind that caffeine, tobacco,
alcohol, marijuana, cocaine, and other “recreational”
drugs can contribute to sensations of anxiety. |
| Be good to yourself: Schedule in fun with
friends, family, classmates. The benefits of spending time with
other people-and helping others-are immeasurable. Also, set aside
regular time to enjoy some quiet relaxation. Relaxation techniques
such as deep breathing exercises (taking slow, deep abdominal
breaths) or progressive relaxation (tensing and relaxing muscles)
can relieve the physical symptoms of stress, and can help when
anxiety “hits.” |
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Engage in constructive thinking: When you notice you
are thinking in a negative way, pause a moment and tell these
thoughts to STOP! Then, refocus your thoughts on something positive
and constructive. For example, if you find yourself thinking,
“I got a lousy “B,” everyone is smarter than
I am,” say to yourself, “STOP!” followed by “I’m
doing my best; I’m learning and I’ll do fine in this
class.”
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| Seek meaning from different sources: Having
a positive outlook, accepting what you can’t control, and
trusting that things will work out go a long way in helping to
keep stress levels low. In addition, many people find meaning,
comfort and support in spiritual beliefs and in being a part of
a spiritual community. Spiritual practices such as prayer (using
words, chanting, meditation, silence, etc.) can add to some people’s
sense of inner strength and satisfaction. |
Related Services at the Tang Center
For Students
Stress
and Anxiety: Medical, Counseling and Educational Services
For Faculty/Staff
CARE
Services for Faculty and Staff: (510) 643-7754
For the Campus Community
Self-Care
Resource Library
Visit the Self-Care Resource Center on the second floor of the
Tang Center -- a health information library containing hundreds
of books and videotapes (including dozens of anxiety-related materials),
and internet access to health websites.
Here are a few recommended books:
• Bourne, Edmund. The Anxiety and Phobia Workbook
• Burns, David. Feeling Good: The New Mood Therapy
• Davis, Martha, Elizabeth E. Robbins, and Matthew McKay. The
Relaxation and Stress Reduction Workbook
• Hauri, Peter and Shirley Linde. No More Sleepless Nights
Additional Online Resources
A Word on Getting Help
There are many people on and around campus who can offer help and
support. In addition to the resources listed above, the staff at your
living center, your family health care provider, and your clergy can
be helpful resources for getting help. If you are not eligible, or
don’t know whether you are eligible for the services listed above,
contact University Health Services (UHS) anyway. People are sometimes
reluctant to seek help because they are concerned about the cost of
treatment. If you are a Cal student, contact UHS to discuss the coverage
provided by your student registration fees and your insurance plan.
Related Topics
Disclaimer: The information provided here is not intended to diagnose,
treat or provide a second opinion on any health problem or disease.
It is meant to support, not replace, the relationship that exists
between an individual and his/her clinician.
Last revised: August, 2005
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