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At this point in my life — three decades in — I’ve accepted that my anxiety is just a part of who I am. I know that I’ll stay up at night tossing and turning before a big meeting, my arms will tingle and my heart will race when I need to have a difficult conversation, and I’ll always feel a sense of panic when I know someone is upset with me. Thankfully, I’ve learned how to manage my anxiety in ways that work for me: I see a therapist, I (try to) exercise regularly, I take anti-anxiety medication, and I work hard to distinguish rational and emotional reactions.
And I know I’m not alone in this. At the basic level, anxiety is an emotion we all feel at some point in our lives. But more than that, over 40 million U.S. adults suffer from anxiety disorders — so that’s 18 percent of the U.S. population. A lot of my friends and colleagues have been open about seeking treatment for their own struggles with anxiety and depression, but not everyone has all the information they need to cope.
Here, Dr. James Murrough, an assistant professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York, shares some tips for recognizing anxiety, stopping attacks, and managing symptoms.
First off, what exactly constitutes anxiety?
Well, according to Murrough, anxiety is one of those things about which it’s a bit difficult to offer a complete explanation, since it can encompass so many things. “Anxiety, in general, is a feeling of fear, worry, apprehension, or dread. It is something that is an ubiquitous part of the human experience,” Murrough explained. “But like so many things in psychiatry, there can be an extreme version of it.”
Okay, great. But what’s this about an “extreme” version?
Basically, there’s the normal anxiety a person can feel if they’re about to take a big test, for example. But for some people (like me), anxiety can become overwhelming. “So clinically we define anxiety as essentially that mental state of fear, apprehension, worry, dread, which is so extreme in either its intensity or duration that it’s outside the bounds of normal human experience and results in some type of specific functional impairment,” Murrough said.
How do you know if your anxiety is “extreme,” though?
Remember, feeling some degree of anxiety is normal — to go back to the example of studying for a test, your anxiety might even motivate you to study a couple of extra hours, which could be a good thing. And even if you’re still feeling anxious as you walk into the classroom, receive the test booklet, and sit down at your desk, your anxiety will usually start to melt away as you focus on the task at hand. But that might not be the case for certain people, according to Murrough.
So what would that person’s reaction to the test be, then?
In a person who has clinical levels of anxiety, they might have the whole melting-away-of-their-worries thing happen. But in some instances, they instead might go from being nervous to having a full-fledged panic attack (often referred to as an anxiety attack, although Murrough told me that “anxiety attack” is not a clinical term — and often when you think you’re having an anxiety attack it’s actually a panic attack), which could preclude them performing well or from even finishing the test.
And what does a panic attack look like?
I’m so glad you asked. Here are some basic symptoms:
• A racing heart
• Shortness of breath
• Chest pain
• Tingling sensations
• Chills (or hot flashes)
There’s some more symptoms here, but those are the main ones. Panic attacks usually have a sudden onset and are accompanied by that tell-tale overwhelming fear, worry or dread with the host of physical symptoms — which the psychiatrist says indicates a “hyper-arousal” or “fight or flight” response.
Uh, that kind of sounds like a heart attack?
Indeed it does! Murrough says that he often sees patients at Mount Sinai who think they’re having a heart attack, when it’s actually just a panic attack. “They feel that there’s something terribly wrong — it’s very physical — and they feel like they’re dying or their heart is pounding in their chest,” he explained. “Imagine you’re a 20-something person, that’s not normal. So you show up at the ER, get all your tests, and then your tests come back good, so then we suggest you see a psychologist. That’s how anxiety often presents.”
So how can you stop an anxiety attack when it’s happening?
Just like most things in life, apparently stopping an anxiety attack from happening generally comes down to practice. According to Murrough, skills and techniques that a person would learn through cognitive behavior therapy can help them learn how to control or stop the symptoms — before the symptoms even occur.
One such technique, the doctor explained, is to close your eyes and try to remove yourself from the stimuli that’s around. Instead, focus on your breathing and count four beats while you breathe in, count one or two, and then count four beats as you breathe out. “Practice ahead of time,” he instructs.
But how can I prevent an anxiety attack?
Anything that’s known to relieve stress — like regular exercise or just having a healthy lifestyle in general — can help. Even if you have a stressful job, the psychiatrist recommends building in time for things that you like to do. “It’s an active effort. People will just get completely consumed by their go, go, go lifestyle,” he said. “Unless people actively wall off time to decompress, they’re not going to have it.” But of course, if you find your anxiety to be overwhelming, you should talk to a doctor or therapist about it.