Experiencing uncomfortably high levels of anxiety is one of the most common reasons for seeking psychological help.
While a certain level of anxiety is natural, especially during stressful times, what is not normal is anxiety accompanied by serious, debilitating symptoms like relentless worrying and dread, inability to be at ease physically (almost as if one has been placed on “high alert”), and having to struggle through situations that used to be “no problem.”
The experience and meaning of anxiety is highly variable, however, the major categories of anxiety disorders, as demoted in DSM-5, are: separation anxiety disorder, selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, and generalized anxiety disorder. OCD, which was included as an anxiety disorder in the previous version of DSM, now has its own section.
Anxiety is like a “false alarm.” The mind and body feel “as if” they are in a dangerous situation that requires some type of decisive action. This is known as “fight or flight.” However, despite this distressing state, most people simultaneously recognize that their heightened concerns and reactive bodily sensations are excessive, even irrational. Unfortunately, anxiety is progressive in many cases because natural instincts, like avoiding stressful situations (e.g., finding “safety signals,” sitting near an exit), or constantly seeking reassurance, only makes this problem worse over time.
Some theorists have speculated that present high rates of anxiety are due to an increasing discrepancy between the ways our bodies learned to respond to danger over the course of thousands of years and our more sedentary and “safer” modern world. In other words, our “alarm systems” have become more prone to going “haywire” because we don’t have enough opportunity to face truly dangerous, real life or death situations. In a sense, the nervous system can’t differentiate between a real tiger and a symbolic “tiger,” such as a big test or being criticized. Compounding this situation is our accelerated pace of social, economic, and technological change.
With proper and timely intervention, anxiety often can be treated successfully. Yet, barriers to effective intervention are quite common. Many with anxiety conditions are concerned about getting help or being stigmatized. Thus, they often needlessly delay obtaining necessary treatment, often trying every home remedy, regardless of lack of evidence. Some may feel as if they are being weak and need to deal with it on their own, or that they are letting others in their lives down. Others may experience shame or embarrassment. In fact, many people with severe anxiety become “experts” in learning how to hide their symptoms, even from close relatives or friends. They are often described as “white-knuckling” their way through anxiety. Ironically, once they decide to be more open, they often find that they have become so good at putting up a façade that others have difficulty understanding just how much of a problem anxiety has been for them.
Although every person has their own threshold for how much anxiety they can bear, a good rule of thumb is to consider seeking professional assistance when your level of inner distress and avoidance behaviors (e.g. “making excuses”) are increasing, when it feels like anxiety is “taking over your life” by negatively affecting your education, job, or relationships, and when “common sense” approaches aren’t working. As untreated anxiety worsens and becomes more time consuming, depression or self-medicating with drugs, alcohol, gambling, or food can become overlapping problems. Sometimes anxiety and its related problems can become so intense that thoughts about wanting to die occur. Suicidal ideations always need to be taken seriously.
Although medications can be very helpful for anxiety, some experts think that learning to understand and manage stressful situations, upsetting thoughts, and uncomfortable sensations is often an effective first step to try in many cases. If a psychological approach is not achieving the desired outcome after a reasonable time period, or if symptoms are severely worsening or associated with unsafe impulses or behaviors, considering medicinal strategies then becomes more urgent. In some cases, the best results will result from combining psychological approaches with a medication regimen. Also, obtaining a thorough medical check-up is often recommended at the outset of treatment because there are a number of medical conditions that can present like an anxiety disorder (e.g. ear infections causing dizziness).
In terms of specific psychological treatments, Cognitive-Behavioral Therapy (CBT) is an evidence-supported approach for anxiety disorders, one that has been studied extensively. CBT focuses on “extinguishing” anxiety through building stress management skills, increasing “exposure” to anxiety triggers, challenging anxious thought patterns, dealing with uncomfortable physical sensations, and gradually eliminating avoidance behaviors.