Doctor-Recommended Tips for Anxiety

Does worry about your job, family and health control your life? It’s no surprise: More women than men report anxious feelings. Fortunately, there are ways to keep your cool. Learn more about 6 common anxiety disorders, including doctor-recommended tips and techniques to lessen the stress. Plus, are you having a psychological breakdown? Take our quiz to find out…

Anxiety’s a drag – and it’s supposed to be, says Simon Rego, Psy.D., director of clinical training at the American Institute for Cognitive Therapy in New York City.

That’s because it mobilizes us to act, says clinical psychologist Steven M. Sultanoff, Ph.D., professor of psychology at Pepperdine University in Irvine, Calif.

“If we’re anxious about a speech, we practice,” he says. “It motivates actions to deal with threatening situations.”

But anxiety’s benefits disappear when it fills our days with worry and disrupts work, school or social life.

About 19.1 million Americans deal with chronic anxiety, according to the National Institute for Mental Health. Most of them seem to be women.

The reason? They may simply be more open to seeking treatment, experts say.

Fortunately, there are plenty of treatment options, from simple natural breathing and relaxation techniques to medications.

Of course, before you know which therapy is right, you have to know what you’re dealing with. Here’s a guide to common anxiety disorders, plus expert advice to get you back in control of your life:

1. Generalized Anxiety Disorder (GAD)
Do you lie awake at night stressing over nearly everything – unable to push aside worries and stress? It’s a classic symptom of generalized anxiety disorder.

People with GAD “have six months of worries” about jobs, relationships, finances and health, Rego says.

Even worse are physical signs, such as restlessness, rapid heart rate, quick breathing, tight muscles and sweaty palms. GAD sufferers may get headaches or stomachaches too.

Get Anxiety-Free
Cognitive behavioral therapy: In this natural treatment, therapists usually help GAD sufferers examine the validity of common worries, says Joe Wegmann, a licensed pharmacist and clinical social worker who specializes in treating anxiety and author of Psychopharmacology: Straight Talk on Mental Health Medications (Pesi).
For example, if a person is anxious about flight delays, Wegmann asks: “Do you believe you have any control over when the plane leaves? If the flight is canceled, are there other viable options?”

The key question: If you don’t get there on time, what’s the worst that can happen?

The goal is to take a perceived threat and “transform it into something more logical,” he says.

Relaxation techniques: Progressive muscle relaxation is another effective natural option, Rego says.

Lying down, “a patient tenses various muscle groups and then releases them so they learn what tension feels like,” he says.

Some therapists also use guided imagery, asking the patient to imagine a pleasant scene, like a beach, and then engage all her senses, for example, smelling the salt air and hearing birds call.

“The mind calms as the body relaxes,” Rego says.

Exercise, yoga, meditation and deep breathing can all be relaxing as well, he says.

Medication: Antidepressants like Paxil, Prozac and Zoloft are also prescribed. But deconstructing the irrationality behind the worries is preferable to medication, Wegmann notes. Otherwise, you’ve just masked the anxiety instead of working through it.

2. Workplace Anxiety
Workplace anxiety is just what it sounds like: Stress that stems from a work-related problem, like downsizing, says Rego. You may not be performing as well as usual or feel depressed.

“You might get into a fight, drink inappropriately or drive recklessly,” he adds. Even small triggers – for example, your boss looks at you funny – can set off a physical response.

“Your heart races, you’re light-headed, muscles tense,” he says.

Once you address or accept what’s stressing you out, your anxiety probably will disappear.

Get Anxiety-Free
Cognitive behavioral therapy: For job-related worries, work with a therapist to identify triggers and examine your response to them, Rego advises. Controlling the physical response will lead to less anxiety.
Relaxation techniques: You can teach your muscles to relax through breathing, meditation and mindfulness, a technique of paying close attention to the present moment. (See “Generalized Anxiety Disorder” above.)

Medication: Short-term use of an anti-anxiety drug, such as Xanax or Ativan, may help if you're stressed over losing your job.

“It can help you begin the recovery process and get a handle on the loss,” Wegmann says.

But be cautious with anti-anxiety medications such as Xanax or Ativan. Althought they work within 20-30 minutes to quell physical symptoms, they can be addictive. The Food and Drug Administration (FDA) recommends limited use for no longer than two weeks.

Antidepressants can also make you feel less vulnerable to day-to-day work worries like job criticisms, low evaluations or upcoming deadlines.

“They can help people feel less sensitive to things that bother them,” he says. But again, they’re no substitute for psychotherapy to get to the root of the stress.

3. Panic Disorder
Have you ever felt overwhelmed by fear? You can’t breathe, your heart starts racing. You may even feel dizzy or sick to your stomach.

That’s panic disorder, “an intense surge of anxiety,” Wegmann says. The panic often seems to come out of the blue, he says.

Besides physical symptoms, people with panic disorder often feel emotionally out of control.

“With women, [the panic is more often] about relationships and children: [for example] ‘What if something happens and I’m not there to help them?’” Sultanoff says.

Get Anxiety-Free
Cognitive behavioral therapy: It helps patients examine and realign thoughts and beliefs.

“I teach simple techniques like distraction and humor,” Sultanoff says.

For example, when you’re anxious, imagine a situation where you laughed so hard you fell down, he says. Then assess your anxiety, from 0-10.

“Clients always say zero,” Sultanoff says. “The exercise convinces them that they can manage their anxiety independently.”
Deep breathing: “It helps you be in the moment and free of distractions,” he says. “It also slows your heart rate and helps you relax.”

To practice, close your eyes and inhale to a count of 5, then exhale to a count of 5. Do several times and repeat as needed.

Medication: For fast-acting, short-term relief, anti-anxiety medications are effective, but longer term they can be addictive. Doctors may prescribe 2-4 days of anti-anxiety medication and then switch to antidepressants.

“Certain antidepressants, such as Celexa or Paxil, also tend to be calming,” Wegmann says.

4. Agoraphobia
People with agoraphobia fear going out into a public place, where they feel a sense of danger or helplessness. Overwhelmed with anxiety and panic, most stay at home and avoid the outside world.

Get Anxiety-Free
Cognitive behavorial therapy: “The treatment is for patients to go into situations that have a minimal threat and then work up to more threatening situations,” Sultanoff says.

For example, they start with a walk around the block and work up to going to the grocery store.

“At each level, they build confidence,” he says.

Such treatment may take only 10 hour-long sessions.

Medication: A doctor may prescribe 2-4 days of anti-anxiety medications, followed by long-term antidepressants.

5. Social Anxiety Disorder
“People with this disorder feel anxious going into any social situation where they might have to perform,” because they’re terrified of embarrassment or humiliation, says Sultanoff.

He’s not talking about giving a speech – even talking to other people can trigger debilitating anxiety.

Get Anxiety-Free
Cognitive Behavioral Therapy: As with agoraphobia, “the treatment is exposing oneself to the event that they’re anxious about,” Sultanoff says.
He asks patients to help them think about the occasion differently:

“If you throw up in front of everyone, how bad would it be?” he asks. “If you’re embarrassed, so what?”

Anxiety Management Techniques: As with panic disorder, deep breathing, humor exercises or simple distraction are effective in getting rid of social anxiety.

Medication: “Antidepressants like Celexa or Paxil may help many people to enter a room with more confidence because they feel more energetic and motivated,” Wegmann says.

But they should also be in therapy to deal with the root of the anxiety, he says. “The drug is a kick-start.”

6. Obsessive-Compulsive Disorder (OCD)
This disorder has two parts: First, unwanted, intrusive thoughts or images – the obsessions – run through your mind. They’re often focused on a specific theme, like dirt, germs or orderliness.

Second, you feel compelled to take repeated actions so you’re less anxious about the obsessions, for example, “washing your hands over and over if you feel your hands are contaminated,” Rego says.

But you don’t have to experience both obsessions and compulsions, although that’s common.

Often on top of those are feelings of shame, guilt, self-doubt and anguish, says Wegmann.

A woman who washes her hands repeatedly, for example, is ashamed of the compulsion, so she might try to hide it and delay getting treatment.

Get Anxiety-Free
Cognitive Behavioral Therapy: One primary intervention, says Rego, is a technique called Exposure and Ritual Prevention (EXRP).

With a therapist, you create a list of thoughts and compulsions. Then you work through each systematically, moving from easier to more challenging ones, he says.

For example, if you’re obsessed with germs, you might first touch a wall, then the floor and a garbage can – and then not wash your hands.

“If you’re exposed to what makes you anxious and you don’t do the compulsion, the anxiety subsides and you realize you don’t have to rely on the compulsion,” Rego says.

Treatment typically lasts 3-6 months.
Medication: Antidepressants, like Prozac, Zoloft, Celexa and Lexapro, have been the best but nonetheless limited option, says Wegmann. “They have a 50% success rate."

The latest trend, however, is to combine antidepressants with one of the newer anti-psychotics, such as Risperdol and Abilify.

“Antipsychotics – Abilify in particular – augment the [serotonin-boosting] effects of antidepressants,” he says.

The neurotransmitter serotonin often relieves the anxiety and obsession that drive OCD. Unfortunately, antipsychotics can have side effects, such as Parkinson’s disease-like tremors and increase blood sugar levels, triglycerides (blood fats) and cholesterol in 2%-10% of patients.

Health writer Dorothy Foltz-Gray is a frequent contributor to Lifescript.

Are You Having a Psychological Breakdown?
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