Cultivating the Calm:
Understanding Anxiety and How to Outsmart It
by Natasha J. Thomas, MD
“I’m in full-fledged panic mode right now.”
- Actual account of a person learning to recognize anxiety.
​
​
I thought I dubbed anxiety, in all its various forms, “The Great Shape-Shifter”. Come to find out, other doctors and therapists have noticed its wily ways and call it that, too. It’s tricky and smart. Sometimes it’s a phobia about planes, then suddenly it’s fear of hearing people bite their nails. On a Sunday it can be intense worries about your children and by Thursday it’s a panic attack in the middle of Wal-Mart. Then clear out of the blue, you freeze and can’t think of words to say when in a crowd or at the window at the bank. By being intense, unpredictable and sly – anxiety finds a way to draw us into ourselves in a fretful tornado. Not everyone will experience anxiety in all these ways but some people do. And having the experience of at least one type of anxiety is the most common mental health issue in America. This article will explain how anxiety manifests itself – and how, with simple techniques, you can learn to outwit it just about every time.
THE STATS
In the US, we have a bit of a problem with anxiety. At just about 40 million adults affected, anxiety disorders are the most common mental disorder in this country. More women than men are diagnosed and unfortunately, less than 40% of people affected are receiving treatment. There are various types of anxiety, as we’ll discuss below. Many forms begin in childhood, adolescence or by young adulthood. Certain types of anxiety in children are thought to be linked to development of panic disorder in adulthood.
The most common type of anxiety disorder is Social Anxiety Disorder. It typically begins in early adolescence, affects 15 million people, and is associated with the development of depression and substance misuse. Most of the young men I care for that struggle with alcohol misuse developed the problem while in college – drinking before parties so they wouldn’t be afraid to socialize. Social Anxiety Disorder, unlike most other anxiety issues, affects men as often as women. And in America, there is no difference in anxiety by culture or ethnic background. International studies seem to indicate that we’ve got more anxiety in the US than anywhere else in the world! So, whether you’re living with it, or know or love someone who is, we’re all feeling it!
THE SCIENCE
To me, the causes of anxiety are very “swirly,” (Ok, multifactorial if you want to be formal. “Swirly” paints a better picture, in my opinion). We think it’s the interplay between genetics and one’s environment that determines if, or how intensely, anxiety develops. Resilience is often the deciding factor. There are the psychological theories that anxiety comes from a conflict between primitive urges or aggression and the civilized self you try to present to the world. Childhood trauma, or just trauma in general, is often a contributing cause – but so are things like serious illness, major loss and memory of embarrassing public events. Then there are a host of impaired genes, receptors and hormones that get into the mix. Stimulating chemicals like caffeine, decongestants and some illicit drugs can induce anxiety as well. See, it’s swirly!
THE SYMPTOMS
Generalized Anxiety Disorder
There are numerous types of anxiety, but the most common types are Generalized Anxiety Disorder (GAD), Panic Disorder, Phobias, and Social Anxiety Disorder. GAD is pretty much what it sounds like – generalized worry about “everything” (or most things) in everyday life. I once had a teacher jokingly say, “You can’t diagnose moms with GAD, it’s their job to worry about everything!” But seriously, the worry can last for months on end, interrupt what really needs to get done during the day and cause mental and physical exhaustion.
Panic Disorder
Panic attacks, as part of Panic Disorder, can make you feel like you’re dying or having a heart attack - that something is definitely wrong. You may have physical manifestations like sweating, getting cold or hot flushes, having the sensation of a racing heartbeat, tearfulness, breathlessness, etc. Episodes typically last for several minutes and leave you feeling absolutely wiped out when they’re done. The hallmark of panic disorder, though, is not just the panic attacks. It is the worry about having more attacks that defines the experience as a “disorder.”
Phobias
Everybody has things they’re not all that fond of because they seem a bit scary. Phobias, however, produce irrational fear of certain events, situations or objects. We often hear of someone being deathly afraid of insects or snakes, planes, bridges or public speaking. One of the most unique phobias I’ve heard of, though, is fear of soda cans being opened. Irrational fear can cause people to self-isolate and go through great lengths to avoid their phobic object, event or situation – as if their lives depend on it.
Social Anxiety Disorder (or Social Phobia)
I find Social Anxiety Disorder to be one of the most interesting manifestations of anxiety – primarily because of the way it tricks us into believing we’re “on stage” any time we’re in a social situation. I’ve heard people describe their experience with Social Anxiety Disorder as the feeling that when they walk in a room, everyone is staring at them, judging them, and can possibly see their anxiety or fear of the situation. They often judge themselves to see if they “sound stupid.” And naturally, because they are observing themselves at the same time they try to interact with others, they feel the natural flow of conversation is interrupted and awkward. The truth, though, is that when we walk into a room or restaurant, make small talk or a corny joke or otherwise try to do the social thing, no one actually cares (sorry to break it to you)! Over time and repeated interactions, this awkward and fearful experience around other people can cause true impairment in our abilities to socialize, go on dates, visit new places or do a job interview.
THE SOLUTIONS
See your doc
At the first sign of anxiety you can’t control or that interrupts the way you’d normally function, sleep or think, consider seeing a doctor. It’s best to see your primary care physician (PCP). Anxiety can be due to physical conditions, so seeing the PCP first can help rule-out a medical problem. This is done by a physical exam and lab work. Once your PCP has ruled-out a medical reason for the anxiety, they may recommend you start medication, see a psychiatrist or therapist or may give you anxiety management tips. The more severe it is, the more intensive the treatment recommendation will be.
​
Be in the moment
There is one place in the world where anxiety barely exists – that’s in the present moment. Anxiety lives in worry about the future or regret about the past. Usually serious crises in our lives are outweighed by typical days. When we are in the moment, there is no reason to be anxious. Stop now and examine your present moment. I can tell you what mine looks like. It’s 6:50 am, I’m sitting in my bed, covered by blankets, my feet feel cozy in socks. My back feels cushioned against the headboard, the heater is blasting, I’m a little hungry. Now, though it sounds like I’m chillin’ in bed and have no reason to be anxious, I still have to get up for work and see patients today, without letting myself get all spun up in worry because my daughter is away visiting relatives. I can worry about her with every single breath if I let myself.
So, you try. Describe your present moment. What are you wearing? How does it feel against your skin? What can you see, hear, smell, taste? How does your body feel on the surface you’re sitting on? Do your muscles feel relaxed or tense? How is your breathing? If your muscles feel tense, see if you can do this exercise. If your breathing is quick or shallow, try this one.
These days, everyone is calling this technique “mindfulness”. It is a great remedy for Generalized Anxiety Disorder and other anxieties.
Retire the fear engineer
One phenomenon I consistently see in my practice is that of the overthinking worrier. Often people with GAD, these folks tend to have an uncanny ability to think of, and imagine, the worst-case scenarios of any possible situation. I am of the opinion a brain that tends to overthink needs to be provided extra “work” to do. Sometimes, patients will share with me that when they wake up in the morning, their mind will search for things to worry about until it finds something. Our brains are designed to solve problems – and sometimes when there’s no problem to solve, it will create one. To avoid this busy-bodied brain behavior, plan for mind puzzles, activities, tasks and home projects to give your brain a productive way to demonstrate its power!
Ride the wave
There are times when it’s advisable to temporarily suppress overwhelming emotion. If you are about to burst into tears, but are in a work meeting, you probably want to suppress your emotions until you get to a bathroom, or back to your own work space. Temporarily suppressing emotions is perfectly fine and often necessary. You just can’t forget to unpack the emotions later.
When the chance permits, though, let yourself experience emotions as they come – even anxiety. I call it “Riding the wave.” Have you ever felt yourself about to have a panic attack and then did everything in your power to hold it in? Chances are the anxiety became stronger in response to being pushed down. The next time you feel that overwhelming anxiety, ride it out. Tell yourself you’re not dying or “going crazy.” Your body is just experiencing anxiety, or your mind is. If you can allow yourself to let the anxiety pass through you once it starts, it will be less intense and last a shorter time. The same works when exposed to phobias, nerve-wracking social situations or any time you feel the anxious drive to flee.
Discipline the mind
A wandering, bored mind is a trouble-maker and we all know it. I notice a common idea in our collective American consciousness. We tend to feel the mind is a god of sorts. Whatever it thinks intently, we believe we must follow, or acknowledge as holding the secret to self-understanding. If the mind repeatedly brings up concerning thoughts or fears, we think that indicates we’re “going nuts” or need to make some drastic change. Usually not! It chatters to us literally all day long and we move to and fro trying to fulfill its demands or follow its random, and often purposeless, streaming. The brain can fire nearly 50 thoughts a minute, which can be exhausting when those thoughts are useless or negative.
Your mind is your tool and key to success, you are NOT its puppet. To have the ability to turn down the dial on mind chatter, you have to work on finding a way to engage the mind differently, and to discipline it in the same way we do our bodies in physical fitness endeavors.
Meditating to learn the ability to focus on one thought or thing at a time improves the ability to think clearly when needed. If you are making spaghetti, just make spaghetti. Don’t try to analyze the political landscape, help your kid with a math problem and pay bills online at the same time. Just make spaghetti. Look at the boiling water and actually see it! Look at the noodles change in consistency and actually see them! Once you learn this skill, you can command your mind to assist you in achieving whatever goal you desire. You will be able to shut down anxiety whenever you want, because you will have cultivated the coveted award of laser focus. My “mindfulness” meditation is simply to sit on my front porch and listen to the sounds outside. If I start thinking about work obligations, family stuff or money, I just bring myself back to the sounds. Nothing spooky, nothing deep.
​
* If, for religious reasons, you feel uncomfortable about meditation, please find a meditative practice that lines up with your faith and Scripture. Each and every holy book teaches its followers its definition of meditation and mindfulness. It is not new, New Age, Buddhist or bad – it’s a wisdom as old and diverse as mankind.
Walk on by
Another thought technique is to imagine your thoughts like strangers in a waiting room and engage them accordingly. If you met a stranger in a waiting room, and they seemed menacing, intrusive, or rude to others in the space, you’d either avoid making eye contact with them, leave or report them. Do the same with negative thoughts. Don’t give roots to a thought that is negative. Think of it as a sketchy stranger that you have no obligation to entertain. Give your mind something else to focus on. Do NOT ask yourself what it means that you’re having annoying thoughts (that just sucks you in and scares you). Tell other people if it’s getting scary in your thought world and you need to be pulled out.
However, if you happen on a good and pleasant thought – hold it in your mind and examine it in as many ways as you can. That practice will turn the occasional good thought into a reliable good thought habit.
Face that fear!
For this, I truly recommend you enlist the help of close family, friends AND a therapist. If you are struggling with fear, avoiding it will make it grow into a cozy little box that makes you first feel safe, and later, suffocated. If you deal with fear in any form, work with a counselor on gradually working your way up to conquering it. Fears are annoying and limiting. They’re just illusions anyway. Once faced, they evaporate. I have helped people conquer everything from fear of sounds and touch, to standing outside or braving the grocery store.
Move it out
If you have a busy, overthinking, chatter-box brain, there’s good news! All that mental energy can be effectively dropped – into your body. Some people feel a lot of anxiety in their bodies. I help them move it into their mind so they can think about it rationally, manage thoughts and feel better. Some people feel a lot of anxiety in their minds, and for them, I encourage movement!
Yes, physical exercise is good for us. I don’t think anyone needs me to say that. But usually we just think it’s going to help our bodies look fly or help our blood pressure and cholesterol. Studies exploring the effect of fear, trauma and anxiety on the brain have also found that movement reduces overactivity in the limbic system, helps the brain learn better and for a few reasons, prevents dementia. Anxiety moves out of your brain and flows out of your body when you get physical.
​
Feeling so panicky you can run a marathon? Do it! Make a practice out of training. 5K races are all the rage these days anyway. Get on trend and get yourself moving. In an acute panic attack, walking it off may actually help. The brain associates movement with self-agency and reduces the perception of being powerless. Physical activity helps with all the types of anxiety I listed above – and even those I didn’t list, like separation anxiety.
​
Eat a “calm cuisine”
No article on mental wellness is ever complete without discussing the fuel we give our brains. Eat healthily, please people! What’s good for you, is good for you, plain and simple. Say it with me now, fruits, vegetables, legumes, fish, poultry and lean meats (if you’re not a vegan or vegetarian). Limit sugar, alcohol, energy drinks and preservatives. If you have anxiety, caffeine is probably not your friend. It can perpetuate physical and mental anxieties, fatigue, insomnia and irritability. It literally blocks some brain-calming chemicals. Try decaf, herbal teas, coffee substitutes (as long as they’re healthy – read your labels). And don’t load up your drink with sugar. Develop your palate with more subtle tastes – it’ll make you feel fancy!
Anxiety is so common we ought to help each other wrestle it down. If you have other ideas on managing anxiety, write in and share. Otherwise, take these tips and move toward your calm place.
* If you are living in an abusive environment, are an abuse survivor or have experienced other trauma, the suggestions in this article may not be for you. See my PTSD article here or check out this website for the National Coalition Against Domestic Violence.
* If you or a loved one is in a mental health crisis, please call 911, go to the nearest emergency room, or reach out to 1.800.273.TALK or other national crisis hotlines.
Links to resources:
https://emedicine.medscape.com/article/286227-overview
https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders
https://www.webmd.com/balance/stress-management/stress-management-breathing-exercises-for-relaxation
​
*This article is for informational purposes only, is not intended to diagnose or treat any condition, and does not take the place of a medical assessment or treatment by a licensed professional.