How to stop worrying

Studying alone in her dormitory alone one evening at the University of Victoria, Canada, student Jill Taylor suddenly felt a tightening in her stomach and found it difficult to breathe. “My heart was racing, my vision tunnelled,” she says. “I was scared. I didn’t know what was happening to me.” It was November 2006 and the then second-year university student phoned for an appointment with her doctor the next day.

He diagnosed her with “test anxiety”, and because she hadn’t been sleeping or eating well, he prescribed sleeping pills. Having a diagnosis—a name she could give to her frightening episodes of anxiety—and the medication helped Jill.  

For the next few years, she pushed herself through university, graduation, getting a job, falling in love and getting married. For a time, things seemed to be on a more even keel. But she continued to suffer unmanaged and frequent anxiety attacks—most often when faced with tests of any kind, talking on the phone, and thoughts of the future.    

Then Jill fell into a serious depression brought on by her continued and unaddressed anxiety. She could no longer function: she quit her job, stopped going out and retreated into a shell.

Finally, urged by her wife to seek help, Jill went to see her family doctor in Vancouver where she now lived. Her doctor referred her to a psychiatrist at the Mood Disorders Clinic of British Columbia. There, finally, in June 2014, Jill received an accurate diagnosis—she suffered from General Anxiety Disorder (GAD). With this diagnosis in hand, her doctor prescribed some anti-anxiety medication and encouraged her to find a qualified person with whom she could work to help manage her disorder.

 

—even when there’s nothing concrete to worry about. “People with GAD attempt to plan for every eventuality, all of the time,” says Dr Melisa Robichaud, a psychologist in Vancouver. “It’s cognitively exhausting.” It can be physically taxing, too, with symptoms ranging from sleep problems, irritability and difficulty maintaining concentration to restlessness or agitation.

At its core, anxiety is the body’s most basic survival mechanism, Robichaud explains, the fight-or-flight response you experience when you feel threatened. “Anxiety is like the body’s smoke alarm: whether there’s smoke or fire, it makes the same noise.” It can be triggered by real danger but also by anything that we simply perceive as dangerous.

People with GAD think up “what if” scenarios excessively, and this provokes more anxiety. “They can’t stop their worrying once it begins,” says Robichaud.

 

While scientists aren’t sure why some people are more prone to GAD than others, part of the risk is genetic. GAD also often coincides with other illnesses, like depression, and women are twice as likely as men to be affected. 

The World Health Organisation reports that the number of people suffering from depression and/or anxiety increased by nearly 50 per cent between 1990 and 2013. Mike Ward, a psychotherapist and founder of the London Anxiety Clinic in the UK, has seen a 30 per cent increase in patients with GAD clinic-wide in the last two years alone. He says the condition is influenced by everything from gene expression and early family relationships to individual thinking styles.

“GAD is not a simple fact of cause and effect,” he explains. As anxiety disorders go, GAD is one of the most common, especially in older adults. “GAD is more common than social anxiety disorder, panic disorder and major depression in seniors,” says Julie Wetherell, a psychologist at San Diego Healthcare System and professor of psychiatry at the University of California, San Diego.

The condition also manifests differently in people 55 and older, whom Wetherell says, tend to worry less about work and more about personal health and family issues. “Sometimes people have a lifelong history of anxiety that they’ve coped with through distraction or workaholism,” she says. “The pervasiveness of the worry only becomes apparent when they’re no longer working or are unable to engage in previous coping strategies.”

Anxiety symptoms are associated with several health issues, which can make diagnosis tricky. Conditions that can cause—or mimic—anxiety include chronic obstructive pulmonary disease, coronary artery disease and hyperthyroidism. “It’s possible for a person to have both a medical condition and anxiety, so when the medical condition is diagnosed, the anxiety may remain overlooked and untreated,” Wetherell says.

Anxiety-like symptoms can also be caused by many medications, including blood pressure pills, hormones, steroids and antidepressants, as well as over-the-counter treatments that contain caffeine, like some cough syrups 
and decongestants.

GAD sufferers will often see a medical doctor first about their physical symptoms and, unfortunately in some cases, professionals brush off both the physical and psychological concerns.

“Many people think that worry isn’t a legitimate mental 
health complaint because everybody frets,” Robichaud says. She’s seen patients who endured symptoms for 15 years before seeking help. Luckily, Jill’s doctor recognised the signs of a mental health issue, and referred her to the appropriate professionals.

 

Today, after three years of ongoing work with her therapist, Jill is living a full life with her wife and baby son. In addition to talk therapy, she works on Acceptance and Commitment Therapy (ACT), a mindfulness-based programme, to manage her anxiety.  Jill still has attacks, but much more infrequently, and she’s currently not on medication.

However, if her anxiety starts to overwhelm her or she feels herself sinking back into a state of depression, she and her doctor work together on a course of medication to help her through—and she’s carefully monitored.

Medications to help treat anxiety can come with serious side effects, such as sedation, cognitive impairment (over long-term use) and sometimes even the development of tolerance, which can lead to addiction. Wetherell recommends a non-pharmaceutical approach using relaxation and meditation. “Our research team is currently using mindfulness-based stress reduction, which has no side effects,” she says.

MBSR techniques include paying attention to breathing and doing mental scans of your body to increase awareness of physical sensations. “We found that MBSR reduces cortisol, a stress hormone that damages the brain’s hippocampus and frontal lobe, so it may have beneficial effects on memory and thinking, as well as on anxiety.”

An important aspect of mindfulness is to learn to focus on present-moment experience, says Robichaud. “For GAD patients, worries involve a stream of thoughts about potential negative events that might occur in the future, so being able to focus on the present time can be beneficial.”

 

For mild cases of GAD, lifestyle changes may help. One of the most important ones is exercise. Researchers at Princeton University found that physical activity reorganises the brain in a way that reduces the organ’s response to stress, making anxiety less likely to interfere with normal brain function. Ward says yoga is a good choice, as it helps relieve physical tension. Meanwhile, any type of exercise that can tire you out helps you sleep better—and sleep is key. Lack of shut-eye can contribute to excessive worrying.

For Jill, walking is a priority and she strides out a minimum of 30 minutes whenever she can. She plays ultimate frisbee once a week, and when she needs quiet but good exercise, she swims.

Last year, a study published online in Computers in Human Behaviour showed that using multiple social media platforms increases the risk of both anxiety and depression. And, Ward says, his patients often use social media as a way to distract themselves, which may provide short-term relief but is actually a cognitive avoidance of their anxiety.

There’s also evidence that what you eat may play a role in your ability to calm your mind. Jill now pays more attention to what she eats, and has cut way back on caffeine and processed foods. She cooks mostly with fresh ingredients, and also drinks more water. A 2015 study in the journal Psychiatry Research found that eating foods high in probiotics may protect against symptoms of social anxiety. And a 2011 US study found that meals high in omega-3 bear a link to lower levels of anxiety.

 

Even though you can reduce—or even overcome—generalised anxiety, maintaining solid mental health remains an ongoing process.

Jill continues her mindfulness practice—including breathing exercises, learning to let go of anxious feelings, and when in a full-blown attack, grounding herself with sounds around her, for example. “These techniques are great, but don’t happen overnight; it’s a practice that has to be diligently worked on, but works wonders in the midst of anxiety,” Jill says.

In addition, she has found that being open and forthcoming about her condition and speaking honestly with her friends and family members—and even strangers—has been of tremendous benefit.  

“The scariest part of anxiety can be the feeling you’re the only person who feels this way. When I share my story, it helps others realise it’s not just them.

“Don’t be afraid to say you need help,” she says. “You’re not alone.” Says Jill, “I now consider my anxiety an overbearing and difficult roommate. But I don’t fight it. I manage it, rather than allowing it to manage me.”