Anxiety Disorders: Q & A with Dr. Paul Foxman

Why and how does anxiety develop?

Anxiety is related to the survival instinct. Normally, we react self-protectively to threat or danger with the “fight, flight or freeze response.” This state of high mental alertness and physical arousal prepares us to “fight”, “flee”, or “freeze” from perceived danger. However, the fear reaction can occur when there is no present danger or threat. For example, children and adults can struggle with performance around work or school assignments. Sometimes, concerns around performance can cause an adult or child to avoid completing the assignment or taking on new assignments and projects. This performance anxiety can start to negatively impact the child's or adult's ability to complete work on time, and may even cause the adult or child to refuse to attend school or go to work.   In other words, anxiety is the fear reaction to perception or anticipation of danger when no actual threat is present. Sensitive people—those who react strongly to external or internal experiences—have a higher risk of developing anxiety. In an effort to control anxiety, we may avoid certain situations, worry frequently, or develop obsessive or compulsive behaviors. These patterns are not productive and they usually interfere with daily life.

What is the difference between common experiences of anxiety and anxiety that interferes with daily life?

Anxiety can be a very common experience. Taking an exam, starting school or college, meeting with a boss or authority figure, or having a near accident can all evoke anxiety. Anxiety can even be helpful and motivating in preparing for a challenge or change. There are also some natural worries in childhood, adolescence, and adulthood such as: concerns about school/work performance, appearance, social acceptance, major life transitions, and death of parents.

When anxiety is intense or persistent, or when it interferes with performance in daily life, it may become an anxiety disorder requiring professional help. Children and adolescents are susceptible to the same anxiety disorders as adults. The key anxiety disorders are:

  • Separation anxiety disorder
  • Generalized anxiety disorder
  • Panic disorder
  • Phobias (including social phobia)
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Anxiety disorder associated with a medical condition

Are certain personality traits associated with anxiety?

People who develop anxiety disorders tend to match an “anxiety personality profile.” This is a set of personality traits that include the following:

  • Perfectionism
  • Frequent worry
  • Difficulty relaxing
  • High need to feel in control
  • High sensitivity to criticism or rejection
  • Tendency to please others at one’s own expense
  • Difficulty with assertiveness

It is important to note that these traits have a positive and a negative side. The positive side is that this type of person generally has high standards, does quality work in school or on the job, and is kind and sensitive to the feelings of others. The negative side is that this personality style can create stress/anxiety, and this type of person can be vulnerable to exploitation by less sensitive people.

What is the relationship between depression and anxiety?

Depression and anxiety are two distinct emotional conditions but they frequently occur together. Depression is diagnosed when a person experiences a persistently sad or depressed mood, shows a loss of interest in pleasurable activities, social withdrawal, and lack of motivation and energy. When a person is chronically anxious, or when anxiety interferes with restorative sleep, depression may develop as a secondary component. Depression is also common in social anxiety due to avoidance of social contact and loneliness. Such “secondary depression” usually subsides when a person gets help for anxiety. In other cases, there may be both an anxiety disorder and a depressive disorder. For example, a person who experiences a break-up or loss of a loved one may develop both anxiety and depression, especially when there is a significant change in routine. Anxiety and depression are also common in cases of post-traumatic stress disorder. Understandably, experiencing a loss or traumatic event can create feelings of sadness, hopelessness and safety concerns.

What are some typical signs and symptoms of anxiety?

While there are distinct symptoms for each of the key anxiety disorders, the typical symptoms of anxiety include the following:

  • Excessive and unrealistic worries
  • Somatic complaints with no established medical basis
  • Difficulty relaxing
  • Excessive avoidance of situations associated with anxiety
  • Difficulty sleeping
  • Lower concentration and attention
  • Decrease in academic or work performance

What is the relationship between stress and anxiety?

Stress is one of three ingredients in the development of anxiety (genetic sensitivity, anxiety personality traits, and stress overload). Stress is the when factor that triggers an anxiety reaction in sensitive people. Stress may consist of a single, powerful event, or a series of changes or stresses occurring over a period of time. In virtually all cases, the onset of anxiety is preceded by a period of high stress. Sometimes, anxiety spontaneously subsides without professional help when stress level goes down. One of the best ways to counteract anxiety is to manage stress on a regular basis. The three key steps for managing stress are:

  • Signals—recognizing the signs of stress
  • Sources—changing (if possible) the causes of stress
  • Solutions—regular stress management (e.g. adequate rest/sleep, exercise, proper nutrition, time management skills, relaxation)

What are some steps individuals can do to counteract anxiety?

There are many steps people across the lifespan can take to reduce anxiety. Here are some suggestions:

  • Create a stable, consistent supportive environment with predictable routines
  • Encourage emotional communication among support systems (e.g. family, friends, co-workers)
  • For children with anxiety use discipline methods that do not frighten them (e.g.use positive rewards for desirable behavior)
  • Make time for relaxation, self-care, and enjoyable activities
  • Manage stress with adequate sleep, regular exercise or recreation, and good nutrition
  • Use an organized system for keeping track of appointments and activities
  • Slow down and simplify your life if it is overbooked or overstressed
  • Choose a special word and repeat it while relaxing (e.g. “peaceful,” “calm,” or “tranquil”)
  • If you are a perfectionist, make enjoyment a new goal for yourself
  • If you worry a lot, choose one time (about 10 minutes) each day for worrying and do it only then
  • Write down your worries to get them out of your mind
  • If faith is important to you, think about the ways spirituality or religion can help to counteract anxiety
  • If you are unsure what is best for you or would like more information, seek advice from reliable sources:
    • For additional resources, please refer to the Guides Section on our homepage: https://interface.williamjames.edu/guides
    • For mental health provider options, please call our INTERFACE referral service at 617-332-3666 x1

What are some ways to relax?

Everyone relaxes in different ways but simple, quiet activities tend to be the most relaxing and help reduce the stress associated with your anxiety. Here are some examples of calming activities to help you relax:

  • Reading
  • Going for a walk
  • Listening to soft or soothing music
  • Spending quiet time with a family member or friend
  • Taking a hot bath or shower
  • Create a list of things you are grateful for today; it can help you look at things in a positive light
  • Journal

Finding other relaxing activities, including mediation, aromatherapy, or yoga, may also help to slow down racing thoughts and reduce worry or rumination.

What can individuals do to manage anxiety at school or work?

Children, adolescents, and adults may find that school or the workplace is anxiety arousing due to performance demand, social issues, safety issues, and/or stress-inducing responsibilities. Here are some ways to manage anxiety at school or work:

  • Develop a predictable schedule or  routine
  • Set smaller goals or break down larger goals into more manageable short term goals
  • Seek support when feeling overwhelmed or ask for help when needed (e.g. a teacher, a manager)
  • Focus on individual tasks one at a time
  • Improve time management skills
  • Develop small relaxation techniques appropriate for the school or workplace, such as: taking a walk, deep-breathing exercises, pressing on acupressure stress points, squeezing a stress ball, or applying soothing hand lotion
  • Remember to make time for yourself outside of school and work to relax or enjoy other activities

Are there any dietary recommendations for reducing anxiety?

There are some dietary guidelines for managing anxiety. One issue is the tendency for sensitive or anxious people to react strongly to fluctuations in blood sugar as well as certain stimulants such as caffeine and food preservatives. Here are some recommendations:

  • Decrease caffeine intake by eliminating regular coffee and caffeinated beverages (e.g. many sodas and drinks)
  • Maintain consistent blood sugar by reducing sugary and refined foods such as cakes, candies, ice cream, cookies, and highly sweetened cereals
  • Eat smaller amounts of food more often (four or five times a day)
  • Drink enough water (e.g. about 3 liters a day or six regular sized water bottles)
  • Eat good foods include: fresh fruit, vegetables, grains, diary, and protein
  • Choose healthy snacks (e.g. popcorn, pretzels, rice cakes, trail mix, raw vegetables, dried fruit, and fresh fruit)

When should you seek professional help for yourself or your anxious child or adolescent?

It is important for individuals and parents with a child or adolescent struggling with anxiety to know when to seek professional help. When it appears that anxiety is interfering with an individual’s or child’s ability to function effectively in daily life, it may be appropriate to seek professional advice. Below are listed some of the conditions under which professional advice is indicated:

  • Frequent physical complaints
  • Social isolation
  • Persistent difficulty going to sleep and/or staying asleep (e.g.  night waking, nightmares)
  • Avoidance of school, work, social situations, telephone use
  • Frequent crying or irritability
  • Difficulty relaxing or chronic hyper-arousal (e.g. tension, restlessness)
  • Overeating, weight gain, or loss of appetite
  • Significant change in academic or work achievement
  • Behavior problems (e.g. aggression, avoidance, defiance)

What are the pros and cons of medication for anxiety?

Medication prescribed by a psychiatrist or physician can be helpful in controlling anxiety symptoms. It is appropriate to consider a referral for medication when anxiety persistently interferes with sleep, concentration, or functioning in daily life. Research has shown that medication is most effective when combined with psychotherapy, and that anxiety relapse rates are lower when people stop taking medication if they have had the benefit of psychotherapy. However, medication is not a good long-term solution for anxiety, especially when it is used without psychotherapy, and there may be some additional factors to consider. These factors include some undesirable side effects, the time it takes to determine the right medication and the correct dose (this can take many visits to the prescribing doctor), addiction potential with certain medications, and safety concerns with children under 18 or women who are pregnant.

Are there any natural alternatives to drugs to help treat anxiety?

There are some safe and effective natural alternatives to medications for anxiety, notably certain herbs and homeopathic preparations.  Alternative approaches for anxiety may include acupuncture, reiki massage, or meditation classes. It is strongly recommended that you refer to your primary care physician before pursuing alternative approaches.

Resource Organizations » Anxiety Disorders

In Massachusetts

Organizations with hotlines

Samaritans

(877)870-4673

617-536-2460

Email: info@samaritanshope.org

Samaritans’ Crisis Services are available 24 hours a day/seven days a week. If one is feeling isolated, desperate or uncertain about anything in your life, this orginization is here to  hear about it – contact us anytime. The services are free, confidential, and anonymous. There are Samaritans staff on-site 24 hours a day to support those who phone, chat or text our volunteers for help. Samaritans' Crisis Services include a 24-hour befriending service and online emotional support via text and phone call. 

Organizations without hotlines

MGH Center for Anxiety and Traumatic Stress Disorders

1-866-449-6779

The Center is investigating the efficacy of treatments for Panic Disorder, Post-Traumatic Stress Disorder, Social Anxiety Disorder, Complicated Grief, and Generalized Anxiety Disorder, while seeking to learn more about the underlying causes and course of Anxiety Disorders.

National Center for PTSD

802-296-6300 (Information Voicemail Line)

Email: ncptsd@va.gov

The mission of the National Center for PTSD is to advance the clinical care and social welfare of America's Veterans and others who have experienced trauma, or who suffer from PTSD, through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. The National Center for PTSD is dedicated to excellence in research and education on the prevention, understanding, and treatment of PTSD. Its purpose is to improve the well-being and understanding of veterans and others suffering from PTSD. The website includes the definition of PTSD, fact sheets on topics related to PTSD, and information of finding professional help.

School Psychiatry Program and MADI Resource Center

For Children and Adolescents: 617-726-2725

For Adults: 617-724-7792

Email: info@schoolpsychiatry.org

Schoolpsychiatry.org is a joint project of the School Psychiatry Program and the Mood & Anxiety Disorders Institute (MADI) Resource Center, both of the Department of Psychiatry at Massachusetts General Hospital (MGH). Schoolpsychiatry.org is committed to enhancing the education and mental health of every student in every school. The Mood & Anxiety Disorders Institute (MADI) Resource Center translates the latest research advances into practical information, helping people work with their clinicians toward the most accurate diagnosis and best possible treatment results. The Center also offers resources and support to help people manage daily living with mood and anxiety disorders and cope with the disorders' effects on family relationships.

Teenage Anxiety and Depression Solutions

Email: info@tadsma.org

The mission of TADS is to raise awareness about mental health issues in society, especially depression and anxiety, and in so doing, help to prevent suicide. TADS believes education is the key to prevention and that the best way to prevent suicide is through the early recognition and treatment of depression and other psychiatric illnesses.  Therefore, TADS concentrates its efforts on advocacy, funding for school-based suicide prevention and mental health education programs, and enabling community-based services.

The National Alliance on Mental Illness - Veteran and Service Member Resources

617-580-8541

Toll Free: 800-370-9085 (M-F 9am-5pm)

Fax: 617-580-8673

Email: info@namimass.org

The National Alliance on Mental Illness maintains a helpline for information on mental illnesses and referrals to local groups. The local self-help groups have support and advocacy components and offer education and information about community services for diverse communities comprising of LGBTQ individuals, veterans, active duty military members, teens, young adults, older adults and families. Local chapters can be found through the main website. For information about the Alliance's affiliates and activities in MA, contact NAMI Massachusetts.

Outside Massachusetts

Organizations with hotlines

Crisis Text Line

Text START: 741-741
Email: support@crisistextline.org

Crisis Text Line serves young people in any type of crisis, providing them access to free, 24/7, emotional support and information they need via the medium they already use and trust: text. Just text "START" to 741-741. Here's how it works:

  • A teen texts into CTL anywhere, anytime.
  • A live, trained specialist receives the text and responds quickly.
  • The specialist helps the teen stay safe and healthy with effective, secure counseling and referrals through text message using CTL's platform.

CTL partners with existing organizations that are experienced, highly trained, and well-equipped to respond to teens in crisis: experienced crisis centers, youth-serving organizations, and experts in the youth and mental health fields. CTL also lists resources on a variety of topics with helplines or email addresses where they can learn about additional support.

Organizations without hotlines

Anxiety and Depression Association of America (ADAA)

240-485-1001

Email: information@adaa.org

The Anxiety and Depression Association of America (ADAA) - formerly The Anxiety Disorders Association of America - is a nonprofit organization whose mission is to promote the prevention, treatment and cure of anxiety disorders and to improve the lives of all people who suffer from them. ADAA is dedicated to informing the public, health care professionals, and media that anxiety disorders are real, serious, and treatable. ADAA promotes professional and public awareness of anxiety and related disorders (such as PTSD, OCD, panic disorder, social anxiety) and their impact on people's lives. The organization also links people who need treatment with the health care professionals who provide it. The ADAA website also provides listings of anxiety disorder support groups offered across the United States.

AnxietyBC

(604) 620-0744

AnxietyBC contains a wealth of information to help people learn about and practice effective strategies to manage anxiety on their own, at their own pace. All content is grounded in scientific research and developed by professionals who specialize in helping people with anxiety.

Authentic Happiness

Email: ahinfo@authentichappiness.org

Authentic Happiness is the homepage of Dr. Martin Seligman, Director of the Positive Psychology Center at the University of Pennsylvania and founder of positive psychology, a branch of psychology which focuses on the empirical study of such things as positive emotions, strengths-based character, and healthy institutions.Positive psychology theory and research has been applied across many domains, from education to health to neuroscience. Now on Authentic Happiness you can read overviews of some of the largest initiatives currently underway, including: positive health, positive education, comprehensive soldier fitness, positive psychotherapy, and positive neuroscience.

Blue Pages

BluePages provides information on treatments for depression based on the latest scientific evidence. BluePages also offers screening tests for depression and anxiety, a depression search engine, and links to other helpful resources.

Freedom From Fear

(718) 351-1717

Email: help@freedomfromfear.org

Freedom From Fear is a national not-for-profit mental health advocacy association. The mission of FFF is to impact, in a positive way, the lives of all those affected by anxiety, depressive and related disorders through advocacy, education, research and community support. There is plenty of information on anxiety and depression along with self-screening tools for these conditions, referrals for support groups and mental health professionals, and resources on accessing treatment for those with and without health insurance. This website contains valuable information based on research findings on anxiety and depressive illnesses and the treatments that work.
 

Geriatric Mental Health Foundation

(703) 556-9222

Email: web@GMHFonline.org

The Geriatric Mental Health Foundation was established by the American Association for Geriatric Psychiatry to raise awareness of psychiatric and mental health disorders affecting the elderly, eliminate the stigma of mental illness and treatment, promote healthy aging strategies, and increase access to quality mental health care for the elderly. Explore the site for mental health information for older adults and their families, to find a geriatric psychiatrist, for news of Foundation programs and events, and much more.

Man Therapy

Man Therapy is giving men a resource they desperately need: a resource to help men understand the realities of suicide and mental health, in the hopes of helping put a stop to the suicide deaths of so many. This interactive website featuring "Dr. Rich Mahogany" provides psychoeducational information geared towards men about stress, anger, depression, substance abuse and suicide, as well as tools to manage these concerns. It also includes an "18 point head inspection" where men can take a survey about how they are coping, and there is a provider search screen with options from groups and active activities to lists of professional counselors.

Mental Health America

Toll-Free: 800-969-6642

Office: 703-684-7722

TTY: 800-433-5959

Mental Health America (formerly known as the National Mental Health Association) is the country's leading nonprofit dedicated to helping ALL people live mentally healthier lives. With more than 320 affiliates nationwide, they represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation -- everyday and in times of crisis.

Mood Gym

MoodGYM is an Australian website with an interactive program designed to help you:

  • Identify whether you are having problems with emotions like anxiety and depression,
  • Learn skills that can help you cope with these emotions.

MoodGYM is based on two programs which are successful in preventing and treating depression and anxiety. These are: Cognitive Behavioral Therapy and Interpersonal Therapy. MoodGYM is designed to be used by people who would like to prevent mental health problems or manage problems which are troubling but not incapacitating. MoodGYM is not specifically designed for use by people with clinical levels of depression or anxiety. MoodGYM suggests that those with depression scores above 2-3 seek contact with a health professional.

Project Semicolon

1-866-707-3177

Email: michael@projectsemicolon.com

"Project Semicolon is an organization devoted to the prevention of suicide. Our work is based on the foundation and belief that suicide is preventable and everyone has a role to play in preventing suicide. Through raising public awareness, educating communities, and equipping every person with the right tools, we know we can save lives."

 

This organization also provides information and resources about other mental health topics and disorders as well as the chance to share one's own story, personal screenings tools, and helps one find services right on their website.

The Balanced Mind Parent Network

Helpline for Resource and Referral: 800-826-3632

312-642-0049

Email: helpline@thebalancedmind.org

The Balanced Mind Parent Network (BMPN), a program of the Depression and Bipolar Support Alliance (DBSA), guides families raising children with mood disorders to the answers, support and stability they seek. The Balanced Mind Foundation envisions a world where children living with mood disorders thrive because their families have the resources, community and support they need.

Worry Wise Kids

This site was launched because of the urgent need to address the growing needs of our children to be equipped to cope with and overcome the stress, worry and anxieties in their life. Our mission is to improve the quality of life for anxious children and their families by providing parents, educators and mental health professionals with comprehensive, user-friendly information on the full range of anxiety disorders. Because children may be secretive about their worries and suffer in silence, our goal is to help adults who care about kids to be on the lookout for red flags. We offer information about treatment options, kid-friendly explanations for the mechanisms that create and maintain anxiety, parenting do's and don'ts, how to handle school issues and more.