According to the Anxiety and Depression Association of America, an estimated 284 million people worldwide have an anxiety disorder. That is a lot of people if you ask me! When I bring up anxiety in conversations, I am always shocked at how many other women deal with it. Some would even tell me how ashamed they were to tell anyone and that it was not until someone related to them when they did not feel as alone.
One of my projects for graduate school is creating a new blog. I decided to make one for young adult women (18-25-year-olds) in the Philadelphia region who suffer from anxiety, called Anxiety Squad. I deal with it myself, and I want to help other women cope with theirs too. I know there is a way to stop anxiety with practice and varied strategies. I did it before! I want to help others going through the same thing I did/am. We are in this together.
My story? In my sophomore year of high school, I gained anxiety for a year after being bullied by one of my best friends that I grew up with in grade school. It was to a point where I did not want to go to school because of how bad my anxiety was affecting me. I did not know what anxiety was or why I was feeling the way that I did. Now, I know it is because I was feeling guilt. As if I did something wrong. If only I could tell my younger self today that I most certainly did not do anything wrong and that jealousy brings out the worst in people. That same year I found ways to cope with my anxiety by going out and making friends, and it eventually vanished. By my junior year, I found my group of girlfriends. It all works out.
It is all going to work out, and tomorrow is a new day. If you work hard at your mental health, it will get better. Remember that.
It's all going to work out and tomorrow is a new day. If you work hard at your mental health, it'll get better. Remember that.
My anxiety never returned until my senior year of college. I was not sure why it came back. I went so many years without it! Why now? I thought. Everyone that I talked to who has gone to therapy has told me the same thing. There has to be a reason for your anxiety, and there is something that is bothering you. I started to brainstorm on what could have changed in my life or what triggered it. I could not figure it out. Unfortunately, I did not understand why until the end of my past relationship. What I realized was that I was dating a bully. Somewhere in my brain, this sense of abuse/bullying resurfaced the emotions I felt when I was a teenage girl.
That is when I decided to cut that person out of my life for good. Although you cannot take back time with regret, you can learn from it. Since then, my anxiety has decreased tremendously, and I am so grateful for that. But, I still deal with it today. I am not sure if it is a bit of PTSD from the mental abuse, but I know I am so close to saying a final goodbye. I can feel it! I'm not here to gain sympathy. Instead, to tell you that my struggles have only made me stronger. Now, if someone were to talk to me maliciously, they'll know right away that I don't like it. I'm at a point in my life where I don't tolerate any disrespect anymore. Nope.
I'm not saying this journey is going to be easy. You have to work hard at it. But, with time, practice, and different strategies, you can do it. I believe in you! I'm happy where now. I'm currently in a relationship with someone who makes me extremely happy. I'm, of course, not telling you to get into a relationship to get rid of your anxiety. You can find happiness by yourself. However, to share that he has helped me an extreme amount and makes me feel so special. If you've read my other blog post, The best things in life can come from the worst what I am saying will make much more sense to you. If you haven't already, do it!
Do you know what the crazy thing is?
I'm sure people had no idea I even had anxiety other than my close friends and family members because you couldn't tell. Exactly. That's what the issue is today. So many people can relate to having anxiety. But, when you don't know that, you feel alone. If you're reading this and you can relate to it, I'm here to tell you that you are certainly not alone, and you can get through this! I have found tactics that have helped me, such as yoga, affirmations, reading self-help books for a small reminder, etcetera. However, I'll share that for another post. For now, I thought I'd go to a professional for answers.
One of my assignments was to write an article for my new blog. I decided to interview a psychologist and ask them a series of questions. I found a clinical psychologist, Kelly Landman. Since my purpose is to help other young adult women suffering from anxiety, I figured I'd go directly to them. I wanted to find answers to the questions they may be wondering surrounding it. I went to social media for help and posted a questionnaire on my Instagram story.
I asked my Instagram followers the following. If you're an 18-25-year-old woman and have anxiety, are there any questions you'd want a psychologist to answer? I was surprised at how many replies I received. To me, this represents that numerous women are going through the same thing. If you have anxiety or realize you might, remember that you're not alone. If you're a male and suffer from anxiety, Dr. Landman talks about men as well.
So, the same questions may apply to you. Since several of the questions I received were so alike, some questions are combined and organized accordingly. Feel free to skim past the questions until you find one that is most helpful to you. It is a lot of information, but it's worth the read.
1) What is anxiety?
To understand anxiety, let's first separate it from stress and fear. Stress is a person's physiological, emotional, cognitive, and behavioral response to a challenging or threatening situation, and the source of stress is called a stressor. Stress can be motivating at certain levels and debilitating at others. Stressors can be positive and negative events - anything that offers a challenge (exciting or threatening) to a person, from preparing for a holiday party or a new baby in the family to having to pay one's bills to fighting in a war. Fear is one's emotional response to an actual threat in the environment, such as if an intimidating bear walked up to a person while out for a walk. There is a real and present danger, so it makes sense that the person feels afraid. Anxiety is very similar to stress and fear in that one's body reacts in a similar fashion. However, anxiety is about PERCEIVED and FUTURE threats in the environment, even if there is no evidence that the threat will ever actually be present. It is often irrational in nature, and the person suffering sometimes knows it is irrational. Anxiety is one of the most commonly reported mental health conditions, along with depression. An estimated 19% of adults in the US experience anxiety in any given year.
2) What are the symptoms of anxiety?
When a person experiences anxiety, there can be a variety of symptoms. Physically, their heart starts pounding, their palms get sweaty, their pupils dilate, their muscles engage, they have hot flashes or chills, shortness of breath, dizziness, nausea, and some people have chest pain and believe they are having a heart attack. Emotionally, they feel afraid and worried. Cognitively, they often have thoughts of doom and helplessness, and it is very common for people with anxiety to experience running thoughts they do not think they can control. Many have "rumination," or getting stuck thinking about the same worrisome thought over and over again. Behaviorally, people experiencing anxiety may freeze or feel their muscles tense up to be prepared to fight or run (fight/flight/freeze). They also may have a sudden urge or desire to escape, and some have tried to escape while experiencing panic.
Not all people who experience anxiety qualify for an Anxiety Disorder diagnosis. In order to be diagnosed with one of the Anxiety Disorders, a person must meet a certain number of symptoms in a specified period of time AND it must cause them distress AND it must interfere with their day-to-day functioning. All people experience anxiety sometimes; not all people qualify for an Anxiety Disorder diagnosis.
"Anxiety Disorder" is not a diagnosis itself, it is a category of diagnoses (such as Anxiety Disorders, Mood Disorders, Personality Disorders, and so on). The actual diagnoses within this category, for adults, include Generalized Anxiety Disorder, Social Phobia/Social Anxiety, Specific Phobia, Panic Disorder, and Agoraphobia. Children can experience the diagnoses listed for adults, and in addition, Separation Anxiety and Selective Mutism.
3) Why do I get nauseous when I'm anxious?
When your body responds to stress, all of the symptoms described above are possible, including nausea. When you experience stress, fear, and anxiety, your sympathetic division of your nervous system (the arousal system) kicks in to keep you alert and get you ready to respond. In your nervous system, you have two major divisions, the Central Nervous System (the brain and the spinal cord) and the Peripheral Nervous System (everything else). The Peripheral is broken down into the Somatic system (voluntary movements, such as kicking a ball) and the Autonomic system (automatic things your body does that you're not aware you're controlling, such as breathing, digestion, blood circulation, and so on). Your Autonomic division is split into the sympathetic division (arousing - heart rate increases, pupils dilate, breathing gets shallower and faster, and so on) and parasympathetic division (calming - heart rate slows, pupils shrink, breathing gets deeper and slower, and so on). People with anxiety have their sympathetic division "on" more often than do others, as they're regularly anticipating threats.
The "General Adaptation Syndrome" describes the three physiological stages your body goes through when you're experiencing a stressful situation: the alarm stage, the resistance stage, and the exhaustion stage. During the alarm stage, your sympathetic division is kicked into gear. Because you were likely calm before the sympathetic division quickly springs into action, it's a shock to the system. When the fire alarm goes off in the firehouse, the previously calm firefighters have a rush of adrenaline and many feel those symptoms of panic - racing heart, dizziness, and so on. One of those symptoms is nausea. During the alarm stage (when the fire alarm goes off, when you're about to run a race, when you're about to stand up to give a speech in class, etc.), all of these changes flush your system and make you feel uncomfortable to get you ready to fight the stressor. While fighting the stressor during the resistance stage (or, while actively fighting the fire, running the race, giving the speech), you get in the groove and actually feel better. After you're done facing the stressor and the fire is out (the race is over, speech is done), you're exhausted.
I've always thought a great example of this process is highlighted in Eminem's Lose Yourself...before the rap battle, "palms are sweaty, knees weak, arms are heavy, there's vomit on his sweater already, mom's spaghetti, he's nervous but on the surface he looks calm and ready to drop bombs, but he keeps on forgetting what he wrote down.....he opens his mouth but the words won't come out..." - alarm! You can see physiological, emotional, behavioral, and cognitive symptoms listed in his lyrics, including the bodily reaction of Eminem feeling nauseous and actually getting sick to his stomach. Then, he "snaps back to reality" and performs - resistance. And at the end, the music slowly fades out - exhaustion. It is clear that nausea is a common aspect of the alarm stage when facing a stressor.
4) Should I avoid coffee if I have anxiety?
While many people who experience anxiety are able to drink coffee regularly without issue, it is important to note that coffee includes caffeine, which is a stimulant. Any stimulant will activate the arousal, sympathetic division of the nervous system. For some, that physiological arousal will mimic an anxious reaction and may increase the experience of anxiety and exacerbate symptoms. If that happens for you, it may be wise to reduce your use of stimulants. Additionally, using stimulants may negatively impact sleep, and sleep deprivation may exacerbate anxiety.
5) Who is impacted? Does it impact men and women differently? Are any geographic regions impacted more than others?
Anyone can be impacted by anxiety, regardless of age, race, nationality, ethnicity, sex, gender identity, religion, sexual orientation, and so on. However, there are some demographic trends to point out. Women are diagnosed with anxiety significantly more often than are men, with some reports stating that women are two times more likely to be diagnosed. Women - and girls - seem to experience what we would consider the "internalizing diagnoses" (mood disorders, anxiety disorders) more often than do men. Men and boys are more likely to show behavioral issues, or externalizing problems. There are multiple potential explanations for these differences. It could be that there are actual differences in incidence. It could be that there are differences in hormones between men and women. It also likely involves socialization, with boys being encouraged not to cry or discuss their emotions from a young age. Perhaps women are more likely to come forward to seek treatment. There also could be a bias in the way professionals assess and consider symptoms of diagnoses.
Basically, many combinations of reasons may help explain the differences we see between men and women, but women are diagnosed and treated more often for both depression and anxiety. Geographically, the United States seems to have higher rates of internalizing mental health diagnoses than other countries. Again, it could be a true difference or a difference in how we culturally discuss mental health and promote seeking assessment and treatment. Within the United States, rates are higher near cities. There are multiple explanations for this phenomenon as well. Do people with higher levels of stress (and more "Type A" personalities) seek high stress jobs in and near cities? Are there increased stressors related to living in a city (cost of living, noise, pollution, less space for coping, etc.)? The explanations likely involve a combination of these factors.
6) Do there have to be triggers to experience anxiety, or can it come on randomly? Is it normal for anxiety to surface when driving?
For many people, there are identifiable triggers to their anxiety. For others, their anxiety is more "free-floating" and does not appear to be tied to any one particular stressor. Or, it's tied to too many triggers, and the person worries about health, finances, the weather, and many other topics, such as in Generalized Anxiety Disorder.
Many people who experience panic attacks have an onset in situations from which it's harder to escape, such as while driving. It can be dangerous for those who cannot control their desire to escape and want to get out of the car as quickly as possible. The car can also serve as a trigger for some people given past experiences. Through classical conditioning, the person may have learned to have a naturally occurring panicked reaction to any aspect that could have served as a conditioned stimulus in the learning process if they've witnessed or been part of a scary experience in the past, such as an accident or close call when they're on a bridge, are driving next to a truck, hear squealing tires, and so on. Driving after those original scary experiences may result in a learned response of fear.
7) Is Posttraumatic Stress Disorder (PTSD) connected to anxiety?
There are a handful of diagnoses that were considered Anxiety Disorder options in the past and are very closely connected to or include symptoms of anxiety. These include Obsessive Compulsive Disorder (OCD) and Posttraumatic Stress Disorder (PTSD). When the American Psychiatric Association published the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition in 2013, they reorganized the categories and put OCD into its own category called Obsessive-Compulsive and Related Disorders, including with it a few other diagnoses, and PTSD into its own Trauma- and Stressor-Related Disorders category, with a few other diagnoses. While they are now in their own categories, they still have some symptoms that overlap with the Anxiety Disorders.
PTSD in particular involves experiencing or witnessing a traumatic event that threatened someone's sense of safety and subsequently reexperiencing the traumatic event (through flashbacks, nightmares), avoiding triggers (people, places, things) that remind the person of the traumatic event, and experiencing hyperarousal (such as feeling uneasy, jumpy). Many people who have PTSD experience high levels of anxiety. It is possible to be diagnosed with PTSD alone or with both PTSD AND an Anxiety Disorder, which we call "comorbidity."
8) What are universal tips to help? What are the best ways to cope?
I like to think of coping as an individual toolbox - no one's toolbox is exactly like anyone else's. People often get frustrated when well-meaning loved ones say "you just have to...." and fill in the blank with something that works very well for them. While it's great to hear ideas that work for others, something that works well for your best friend may not work as well for you. Therefore, it's important to come up with a toolbox that is filled with a variety of things that have been tried and true for you. Variety is key - if you keep just one or two things in your toolbox, you may find that you can't always use them when needed, and then you feel even more stuck.
For instance, if the only thing that currently helps you cope with stress is running, what happens when you break your leg and cannot run for 8+ weeks as you heal? You'll need other options to try in the event that your favorites aren't accessible in the face of any stressor. I like those "101 Stress Buster" handouts that give a lot of different creative options, such as baking, listening to music, calling a long distance friend, and so on. Focus on including a variety of ideas that rely BOTH on things you can do by yourself to feel better and those that incorporate social support. Also, good sleep, a healthy diet, exercise, and relying on faith, for those who are spiritual/religious, seem to positively impact coping as well.
The key ingredient in most interventions for anxiety is BREATHING. Think about it - if your sympathetic division is activated, and you want your parasympathetic, calming division to take over, how can you make that happen? The good news is that you CAN take control of your body and kick that calming system into gear. Your heart can't beat quickly and slowly at the same time. Your breathing can't be shallow and deep at the same time. If you find that your body begins to react with stress, use deep breathing to take over and take control of your body. Focus on breaths that mimic how you breathe when you blow out the candles on a birthday cake or when you blow bubbles through a bubble wand. Breathe in through your nose and out through your mouth.
Next, some use their imaginations to put themselves in a calm space mentally. Guided imagery, meditation, and other mental exercises can help. For those who feel stress and anxiety mostly in their body (a knot in their stomach, nausea, muscle tension, and so on), some use a technique called Progressive Muscle Relaxation to teach one's muscles how to tense and then relax on command. There are many PMR scripts available online, focusing on one body part at a time and then eventually being able to engage one's entire body at once.
It's important to note that it's best to practice your coping skills when you are calm. The more you practice when calm, the more easily the methods will come to mind when you're experiencing anxiety. If you try to only incorporate good coping when you're upset, it will be harder to remember how to work your way through the steps. Just like any workout, the movements get easier and more natural with more practice.
9) What are the best treatments for anxiety? Is medication necessary? Is therapy necessary?
Each person wondering if they qualify for a diagnosis should pursue a thorough evaluation/assessment to determine with a mental health professional if they actually meet the criteria for an Anxiety Disorder diagnosis. If they do not, and they are struggling with mild anxiety or adjustment related issues, counseling can be beneficial for many to deal with these life stressors.
If you do qualify for one of the Anxiety Disorder diagnoses, I have some great news! There are many interventions that have been shown through research to help; we call these "empirically supported treatments." Because the research is vast, we are pretty clear with anxiety about what helps and what does not. For many people, the most effective combination of treatments includes medication and psychotherapy simultaneously. For others, medication alone helps, and for others, psychotherapy alone helps.
The type of psychotherapy that is most effective often involves gradual exposure, systematic desensitization, and other cognitive-behavioral methods, sometimes in combination with interventions from other theoretical perspectives. Deciding to pursue therapy does not have to be a several year commitment; many people with anxiety are well-treated in a brief 12-20 session model. Often, skills are developed to help with prevention in the future or to simply help the person suffering identify when their symptoms are increasing again and when it may be beneficial to seek help again.
Like some other diagnoses, including depression, anxiety may wax and wane for an individual throughout his or her life. Yes, you can leave it untreated and find that your symptoms reduce at some point, simply by "doing nothing." However, seeking treatment often allows for a shorter duration of symptoms, a reduced intensity of symptoms, and an increased ability to recognize and prevent future bouts of anxiety.
Some people get better without treatment, just over time. However, research shows that psychotherapy is more effective than no treatment at all, and 80% of untreated people have poorer outcomes than the outcomes of the “average” person in psychotherapy. The greatest predictor of strong outcomes in therapy is the goodness of fit, or comfort, the client feels with his or her therapist. Finding the “right fit” goes beyond if he or she is the top expert in their field – your comfort is most important. If you’re not comfortable or not feeling like you’re connecting well, you are more than encouraged to find a new therapist, because there is one out there who can very much help you on your path to a less anxious life!
I want to thank Dr. Landman for taking the time out of her day to answer these questions. Every single answer was very informative.
Associate Professor of Psychology, Delaware County Community College Clinical Psychologist kmlandman@gmail.com
If this was helpful to you in any way, and you want to read more stories about anxiety like this one, make sure to follow my other blog Anxiety Squad. Thanks for reading!