Hi, I’m Sara Anderson, an anxiety specialist. AMA

Did you know that there is actually more than just the fight / flight response?

It's true! There are actually a few more responses, but we hardly ever talk about them.

In addition to Fight / Flight, there is also Freeze, Fall Asleep, and Have Fun.

Kids tend to freeze a lot. Think of when you ask a kid if they did something or you tell a teen to get up and move. Sometimes they look like deer in headlights. Other times they simply don't move. It's not always that they're being ornery or defiant; sometimes it's simply that their defense mechanism kicked in an they froze--particularly if they were just about to get in trouble for something; the stress of that can be too much, leading to freezing.

Have you ever laughed in a really stressful situation? Sometimes you might see nurses or EMTs laughing during a crisis. It's not that you or they are being insensitive; it's another defense mechanism that kicks in to help you manage the stress of the situation.

And sleeping: I always think of opossums who play dead. Teens tend to do this a lot and it's something that parents or teachers complain about because they seem to feign being asleep during class, and in reality, they might have fallen asleep because what was going on was too much to handle.

It's a good idea to know about all of these because sometimes what we think might be inappropriate or wrong is simply the body's way of protecting a person during an overwhelming moment.

Oh my gosh, the sleeping thing makes SO much sense! I am much more likely to just fall asleep while trying to finish an assignment because it's stressing me out so much! Or if I've been putting off chores, like if my room is really messy or I have a lot of laundry to do. I'll just crash. I think it's because the thought is too overwhelming.

Yep, the overwhelm just causes you to shut down. Glad you recognize this!

And sleeping: I always think of opossums who play dead. Teens tend to do this a lot and it's something that parents or teachers complain about because they seem to feign being asleep during class, and in reality, they might have fallen asleep because what was going on was too much to handle.

Huh, this makes sense. I'm diagnosed with anxiety and a mood disorder (back before the DSM-V stuck 'NOS' on stuff) and I enjoy the feeling of curling up and drifting off. Not so much the sleep itself so much as the relaxing feeling of just letting my mind float. We tend to ascribe this behavior to depression and it's good to know that it could also be anxiety.

I'm the complete opposite! I'm forever rattled and unable to sleep correctly at any time due to plagued thoughts, I envy you.

Have you tried turning the air temp down in your apartment? Our body reacts to cold by slowing our cognitive functions. It's the only way I can fall asleep during an anxiety attack

I read once that the optimal sleep temperature is 66 degrees. Don’t remember the source or if it was researched, but you’re right many people do find sleeping at lower temperatures helpful.

Definitely another response to anxiety (hyperaeousal versus hypoarousal). Doing some relaxation exercises and calming before sleep, practicing good sleep hygiene, and learning some calming techniques for when you seal panicked can help. Sometimes, too, people do have to have a conversation with their primary doctor about sleep aides to help short term.

I am diagnosed with general anxiety and depression. Something I am finding incredible hard to deal with, is guilt. Sometimes I will stay up for hours cringing over mistakes that i made long ago. Things which "normal" people will just be over with after dwelling over it for 2 minutes, feels like it tears me up incredibly. A couple of days ago i overtook someone on my bike on the cycling road, forgetting to use bicycle bell, and he got so angry and yelled at me. I looked back and said "I am sorry!", but he was still mad at me. I got scared and drove off as fast as I could, and cried the whole evening while browsing /r/suicidewatch. People often tell me I am too hard on myself, but how do I learn the ability, to just let things go and "move on"? I feel like I'm living in the past constantly, and it's horrible.

EDIT: This got a lot more attention than I expected. I want to thank you all for your kind words and suggestions. It makes me happy to know that I am not the only one with these feelings.

Oh the struggle you are describing is so real for people with anxiety! The ruminating, looping thoughts are too often what keeps anxiety so prominent. "Letting go and moving on" is really another way of trying to avoid anxiety. Anxiety doesn't get better with avoidance, unfortunately. There are some strategies that can sometimes help, such as sharing your cringe-worthy moment with a friend. Brene Brown, a well-known psychological researcher, talks a lot about shame resilience and breaking through the shame by opening up (here's one of her videos on that: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0ahUKEwiHu8jhn8naAhVk9IMKHYgTD2kQtwIIOzAD&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DpsN1DORYYV0&usg=AOvVaw2ZrK8vzvoX-9dCZTOtpU2K

But sometimes it's important to learn how to accept the feelings rather than try to avoid them. There are a few psychotherapies that can help with this, such as ACT or EMDR, which can be powerful. DBT, another type of of therapy, can also help with increasing distress tolerance, which is what happens when you continue to ruminate about situation. Mindfulness training and Mindfulness-Based CBT (a form of therapy) can help you to recognize the ruminating thoughts but not engage in them (which is where the looping happens).

Therapy can certainly help and be sure to find a therapist that uses Mindfulness-Based CBT, ACT, EMDR, DBT, or has a lot of good training with anxiety.

I am a middle school teacher, and I have a student who suffers from anxiety. How can I best help her when she has an anxiety attack? Fridays are hardest for her since she is worn out from the school week. She is a gifted poet.

So glad you are reaching out for this because, as you and I both know, kids spend more time at school than anywhere else and having a caring teacher like you is so important. :)

If the two of you can identify some the triggers that lead to the anxiety attack, and then develop a plan ahead of time, it can really help to manage and lessen the full attack.

Sometimes noises, smells, or just the general overwhelm of a classroom can be too much, so you might consider ways that she could "check out" in order to "check back in," such as listening to a calming song with headphones, moving to the back of the classroom, or taking out a sheet of paper and writing or drawing.

You might also rehearse a signal she can use with you about when she becomes too overwhelmed so that you'll know she's going to implement the plan you've developed.

With anxiety, the body actually dysregulates--becomes hyperaroused (which is anxiety, but can also be outbursts, anger, overwhelm) or hypoaroused (disconnected, on auto pilot, shut down, flat, frozen), it's important to try to bring it back to homeostasis. You can do this by having her do some calming breaths, moving her body through stretching, do some grounding techniques, or even take a drink of water of a small snack. Some these things might be good to build into a plan for when she feels she is being triggered.

Perhaps, too, the school counselor can help you brainstorm some specific strategies that will work in your school system.

Hey, poet with anxiety here! Offering some unsolicited and non-professional advice about your student's anxiety in general (not an attack in particular).

Can you talk with her about how writing helps her--if indeed it does?

I help run a poetry open mic, and sometimes I think it's hugely satisfying for first-timers (some of whom are teens) to get up and read/perform. I know several regulars at our poetry series have found a lot of help with their issues by just getting up and reading, again and again and again.

Can you help her find a writing group, either online or (ideally) in person? Channeling her attention into her art could build her self-esteem, if my own life is any evidence of that.

Thanks for caring.

Love these suggestions! :)

I recently lost my job (and thus, my health insurance) due to profound anxiety issues. I’ve been struggling to get out of the cycle of petrified procrastination since (even filing for unemployment is too daunting as the last time I was on it, I made a mistake and had to pay back tons of money). In addition, I don’t want to go back to doing what I did before because it really exacerbates my anxiety, to the point I’ve started to have medical issues from it.

My question is: what do you recommend to get out of this feedback loop of inability to act so that I can make some kind of progress with getting back on my feet? I’m scared if I don’t do something soon I may lose my apartment, which would make everything exponentially worse.

Not sure where you live, but many countries to have some sort of behavioral health program for those that are uninsured--and I'm assuming you're in the States because you've lost health insurance. Maybe check out your state's behavioral health program because most offer free counseling and psychiatric treatment, which could give you some professional support to begin to tackle the impact of your anxiety on your work and your life.

But in the short term, it might be helpful to set up small goals each day rather than taking on the huge task of trying to get back on your feet. The overwhelm from that can freeze you--the procrastination you experience--and make it too difficult to try to work on the large project of getting everything straightened out.

But setting mini-goals each day can help you begin to take action. Such as deciding to make just one phone call today that you need to make. And then doing the next task tomorrow.

With each success, your brain begins to learn that the whole of what you're trying to do is not so overwhelming and it can even expand your window of tolerance for this amount of stress.

So maybe even today's goal might be to google behavioral health services in your area and get started with some good support.

Wishing you much success as you move forward.

[deleted]

Yep, that was the giveaway to me, too.

As a therapist in the US, I spend a RIDICULOUS amount of time doing "insurance stuff". What plan does my client have? How long can their session be? How often do I have to do an "update", and what is that for insurance company #73? At what point does my client drop out (without meeting their goals) because their insurance ran out or was dropped, sometimes because of their mental health issues? I spend at LEAST 1-2 hours each day dealing with crap that would never happen in any other country (aka, wasting time not helping people in any way). God bless capitalism, or whatever...

So true. That’s why many therapists are self-pay.

Thank you, that is helpful!

You're welcome! :)

Do you think anxiety as we see it today existed throughout human history or do you believe that human civilization and the end of survival-based living allowed anxiety to flourish in our species?

Such an interesting question! I like this article that talks about the evolutionary aspects of anxiety disorders: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181631/

I'll read this as soon as I get out of work, my father suffers from crippling anxiety, kept him out of work for the last 30 years and my brother also suffers although he has been more functional than my father. I feel it too but I always do my best to swallow it and keep moving.

Anxiety can certainly be linked to biology and is often present in multiple family members. Sorry to hear that you all suffer so.

My brother could really benefit from therapy but my mom is one of those "anxious / depressed people need to just snap out of it" people. He won't do anything without her blessing. How can I help this situation?

That's so hard, but so common, unfortunately. I've seen a lot of child clients over the years who have, unfortunately, had a parent or two who did not really appreciate nor understand the impact of anxiety and depression and that it's not always a matter of "just get over it." Perhaps providing your mom with some research about depression / anxiety? And if your brother is over the age of 18, may be the same? Sometimes just keeping the conversation going can help to promote an atmosphere of understanding and may allow your brother to decide whether he's ready for counseling or not.

I set an alarm on my phone for this.

Okay, here we go.

In the summer of 2016, out of the blue I noticed I was having trouble breathing. I have a hard time getting a deep breath. I went and saw a doctor and they couldn't really pinpoint it. I did one of those breathing tests for asthma and they did see that my bronchial tubes were spasming but nothing changes when I use an inhaler. Also- this breathing problem is constant. I haven't been able to normally breath for almost two years now. Anyway, I saw a lot of other specialists and they couldn't really either. They just gave me vague advice like exercise and eat healthy, both of which I was already doing.

Side Note: The only health history I have is a mild case of Crohn's disease. I was diagnosed with Crohn's in 2015 and by 2016 I was having absolutely no symptoms and my blood tests all showed healthy. The slight inflammation in my colon / large intestine was no longer there.

Anyway, fast forward to August of 2017. I still have this breathing problem. I'm driving home from a party when I suddenly have this thought:

"I'm all alone. It's past midnight. What if I have a breathing episode and no one is there to help me?"

I had the worst anxiety attack of my life in that moment and had to pull over. I thought I was going to pass out and for a second I swore I saw myself a third person's view.

Ever since that moment, I've had extreme anxiety. And yes, I still have the breathing problem. I'm convinced if/when the breathing problem goes, so will be anxiety, but I'm not so sure anymore.

Since then I haven't been able to get into a car by myself. I just can't drive anywhere without feeling terribly anxious, dizzy, faint, etc. I can't sleep by myself. I sleep in my parent's room because I wake up with attacks, thinking I'm gonna stop breathing in my sleep. I get anxious in public places because I think I'm gonna have a breathing episode in front of a lot of people. Now- I'd like to point out this isn't a social anxiety thing- at least I think it isn't. This is all new to me so I'm not really sure. I love going out, seeing people, meeting friends, etc. Admittedly, I've always been intensely excited when I go out, but never anxious.

I don't know what to do anymore. I'm trying to take baby steps to get myself back to where I was. For example, the other day I went out with a friend on a walk and I felt fine. I didn't need to text / call my parents, I genuinely enjoyed myself. It was a much needed victory. But this anxiety has really taken a toll on me. I've stopped exercising because I'm too afraid of my breathing to get heavy, I don't socialize because I'm having too much discomfort when I try and see friends, I'm not driving because I'm afraid I'll pass out at the wheel. I've never had anxiety before, so this is all very new to me. Either way, it's terrible. I feel useless.

I'm 19 and I want to feel like all the other 19 year olds out there: Invincible. Instead, I'm practically homebound and need to be around someone 24/7.

I'd love some insight on this. Thank you!

Edit: I've received many replies and DMs about this, and I just want to thank you all who've reached out. People are sharing their similar situations. stories with me, offering advice, etc. It's such a beautiful and reassuring thing to know that there are others facing this. It's so easy to think you're alone, and I often did that myself. Thank you all.

First of all, I'm so happy and honored that you set your alarm for today. Thank you for being here!

You're doing the right thing by taking baby steps to try to get your life back on track. Anxiety can seem almost like a slinky--it twists and turns and spirals down.

One of the hardest things is that when anxiety happens, the fear and panic from a situation like being short of breath becomes so real, that the natural thing to do is to try to avoid anything that reminds you of what's happened (that's an anxiety trigger).

Unfortunately, avoidance feeds anxiety and makes it worse.

The scary solution for anxiety such as this is facing the fear and actually moving through it. But you'll need a lot of support to do that because you'll first need to learn different types of relaxation and calming skills to manage the flood of body sensations and fear that will come as you begin to confront this head on. You'll also need to work up to getting behind the wheel or being on your own without the panic that you might stop breathing.

Unlike when you go swimming in a cold pond or lake and jump right in, it's not a good idea to treat anxiety like that. It's much better to wade in with a guide that can help you if it gets too overwhelming or too much.

Therapists are the guides in this situation and a good therapist training in anxiety and stress-related disorders can really make a difference as you go forward.

Every hero has a guide (think Luke and Yoda), so don't be afraid to find your own. With good support and a good plan, your baby steps will definitely pay off.

Hi Sara Anderson. How do you feel about Sarah Andersen and her Scribbles?

I love her Scribbles! And I really wish I could draw. Yesterday a 4 year old made fun of my effort. 😂

What is your opinion on using medication to treat anxiety? Recently I have been experiencing higher anxiety and my doctor wants to prescribe Effexor.

Such a great question! Truth is, it can be quite helpful as part of a comprehensive plan to manage anxiety. Counseling can help you identify strategies to manage anxiety, such as grounding techniques, relaxation techniques, and even learning to identify and reframe anxious thoughts. But sometimes it's not enough. People can sometimes hit a brick wall despite using all the best and known techniques for managing anxiety. Medication can help turn the brick wall into a jello wall and make it easier for some the other strategies to work.

Please do a lot of research on Effexor, its side effects, and alternatives before you agree to take it. Yes, it can help some people, but a lot of us have had horrendous experiences both on it, and trying to get off it. I lost my job, my marriage, and my house because of that drug!

That's awful!

A lot of psychiatrists are using DNA drug testing to see what types of psychotropic medications--like anti-depressants--respond best with a person's genetic make up. This might be something to explore as you consider taking medication because it can help target the specific medication that would most helpful to you.

How can one convince someone with undertreated anxiety (with accompanying depression) -- and who does not believe in talk therapy -- to get help? What kind of help could it be? Would it need to start with their primary care physician who prescribed the anti-anxiety med (that has also killed libido that was already low due to anxiety and depression, thus causing relationship problems)?

It's pretty hard to convince someone to do anything, but what can help is having some conversations about things that can help anxiety--such as therapy, but also meditation, yoga, exercise, etc. Even some youtube videos about deep breathing (check out this cool link:https://itherapy.com/mindful-breathing/) can begin to give some relief from anxiety and sometimes once someone begins to feel better, they seek out more help, which might also lead to trying some therapy. And, one last thing, there are a ton of therapies that don't rely on just talking, such as EMDR, art therapy, and even yoga therapy.

What kind of therapist/counselor should someone who is experiencing ptsd-like anxiety after having a spouse go through cancer twice, look for?

Accompanying a loved one through cancer is really hard and doing it twice can leave you fearful, exhausted, and panicked. For many years I have worked with childhood cancer and children and their families who are on this journey.

My experience has taught me the importance of finding a therapist that, 1. You feel really hears, sees, and understands you, 2. Has training in trauma.

A therapist that uses ART (Accelerated Resolution Therapy), EMDR (Eye Movement Desensitization Reprocessing), or Brain Spotting can help you address the PTSD-like anxiety symptoms in addition to helping you heal the experience you have.

My thoughts are with you and your spouse and I wish you the very best.

how do i verify that i have a problem? is there a checklist for me to use? a lot times ppl might just feel "bad" all the time but they would never even think of professional help due to the lack of awareness/knowledge.

There are actual symptoms of anxiety that help support when a formal diagnosis is made. Excessive worry (that seems really inconsistent with an actual problem or perhaps no problem at all), sleep disturbance, irrational fears (again, doesn't seem to correlate with an actual real problem), and even physical symptoms such as stomach or urinary conditions and muscle aches are general symptoms of anxiety. Here's a good review of some these:http://www.health.com/health/gallery/0,,20646990,00.html#sleep-problems-4

You're right that sometimes people don't think about getting professional help. Sometimes it's because they think help is only for "crazy" people or they don't think professional help can actually be helpful for them.

I guess that's why so many therapists and professionals jump on AMAs like this one: to continue to spread awareness and knowledge that there is help available.

But if a person is constantly experiencing all of the above, they themselves wouldn't recognise that they have a disorder at all right? then they will continue living their lives suffering till the very end?

So would you say that it is almost entirely dependent on the people around them to prod them or notify them that they have a disorder?

What happens if the persons have no one at all in their lives?

So what are some ways to combat this issue given what i mentioned above in this comment?

Many people know they are suffering from anxiety, but suffer silently. Kids, for example, will keep worries inside, but they might demonstrate anger or irritability or have difficulty following directions because they've checked out because their brain is preoccupied with worry. Adults are no different. So most people do know they have anxiety, but they work very hard to try to avoid it and silence it themselves. It's not necessarily a requirement that support people prod someone to get help for anxiety, but it can help to have a supportive network willing to encourage help. Too often people become embarrassed about their struggle and avoid talking about it openly, even with professionals. But having a supportive love one say, "I can be there with you while you get some help," can be encouraging. But if there is no identified supports--and this can happen because of the isolation that anxiety and stress can create--then it really is up to the person to decide if they want to continue to suffer silently or risk getting help. Sometimes the pain of anxiety or stress becomes too much and that eventually leads someone to get help even though it's really scary.

So what can we do for people who don't know that they are suffering from anxiety that have "no identified supports" ?

We can continue to make it known that there is help available and it's not as scary as it seems to be.

i seem to have all of the elements mentioned in your link except for stage fright (which i have the opposite of, i seem most relaxed on stage as opposed to in non stage related situations) but how do i know that i am not being hypochondriac?

The interesting thing about anxiety is that for many people, it doesn't show up everywhere in their life. There are a lot of people who do struggle with stage fright, but are not anxious in any other area of their life; and there are people who struggle with social anxiety or situation anxiety or even generalized anxiety, but have no difficulty getting up in front of a crowd. This really has to do with how the brain interprets risk (which is the cause behind anxiety) and what the brain can tolerate as stress.

Ah it seems that direct close personal contact is interpreted by my brain as extremely risky whilst the large crowd is the total opposite.

Definitely!

My 17 year old daughter suffers with GAD. It started in middle school with the PE pacer test (teachers stressed how IMPORTANT the test was, to run back and forth as many times as possible within timings). She was in therapy and also on medication, but gave up therapy because she didn't feel it was helping, and medication taking ended shortly after that (she didn't like how tired it made her feel, and I think she might have felt it was making her feelings artificial or something). She has been white knuckling ever since.

What can I do to be most helpful to her?

Truth is, not all therapists know how to help kids. The reason: Therapists are trained to work with adults, not children, in their initial programs. Child therapists (those that work with kids and teens), have specialty training and many become certified as Registered Play Therapists. Unfortunately, when a child doesn't feel that therapy is helping or a therapist feels a child is not able to be helped, therapy ends--but the truth is, it really means that the therapist hadn't yet found a way to help the child. Now that she is a little older, it might be worthwhile trying a different therapist--one trained in anxiety, trauma, and working with children--because there are a number of skills and strategies she could use to learn to manage her anxiety rather than suffering through it. Consider going to therapy together, but be sure to really interview the therapist and find out how, specifically, they work with anxiety and with teens. The Association for Play Therapy (a4pt.org) has a list of therapist trained to work with kids and teens, and this might be a good starting point for you.

I have social anxiety, I don't feel depressed but have been diagnosed with major depressive disorder also. My issue is I'm just super paranoid about everything in life, kind of like a doomsday syndrome. I always think of the most negative thing that could happen, or I feel like when I walk into a party or bar everyone is staring at me, or I over think everything that I say. I always feel people are negatively talking about me or I said something wrong. This has caused me to binge drink quite heavily (Usually black out every weekend that I go somewhere, have a hard time remembering the events of the prior night, but never drink on weekdays). My issue is therapist will only prescribe me antidepressants which I've tried a few, and nine help with my anxiety and they only give me horrible side effects. My question is, why won't they prescribe me anxiety meds? I think it's bc I drink, but how am I not supposed to drink if I have so much anxiety when I go out I'm not comfortable until I drink. Wouldn't anxiety meds make me feel less anxiety so in turn lead me to not drink?

It sounds like you might experiencing some catastrophic thinking. This is actually pretty common with anxiety and is often called a "thought distortion" because your own thoughts seem out of proportion to what might be happening. One thing to consider is working with a therapist trained in Cognitive Behavioral Therapy (CBT) to help you with identifying the thought distortions and then developing strategies to begin to change these. The interesting thing about how we work as humans is that often what we think impacts how we feel and then the action we take. So if we can begin to change the thought distortion to something more reasonable (such as "Everyone turned to look at the door opening, not directly at me), it can actually change how we feel about the situation (not as nervous), and can then change how we act (more open and perhaps smiling as we greet a friend).

The concern with using alcohol and medications such as anti-anxiety meds is that the effect is quadrupled and the risk of accidental overdose is high.

It might be that you'll need to talk to your prescribing doctor about your use of alcohol and establish a plan--with therapeutic support--to become abstinent from alcohol as the two of you evaluate what types of psychotropic medications might work best for you.

Thank you.

You're welcome. :)

“Trauma-informed care” That’s something I heard a lot in training for my juvenile detention job. Is there anything I can do to help the youth in my facility deal with their anxiety and help them integrate better into our environment? Also, for myself, what techniques can I used to deal with stress and my personal anxiety?

I love that you're interested in trauma-informed care. There are soooo many resources out there for working with you, but some of my favorites is from ACE Connection (Adverse Childhood Experiences) where they have a toolkit for trauma-informed care in child caring institutions:http://www.acesconnection.com/blog/trauma-informed-care-toolkits-1

In terms of your own stress and personal anxiety, working with traumatized youth can really create vicarious or secondary trauma, which can exacerbate your own stress levels. Taking good care of yourself through diet, exercise, and mindfulness activities (like yoga and meditation) can go along way in ameliorating the effect. But also making sure that you have a good support system that understands how hard your job is and that you spend time doing things you love to do, whether that's gardening, listening to music, or going for a drive.

I know anxiety is not a new phenomenon, but do you feel it is getting more common, and common these these days? Or do we just admit it more easily now than we don't have to struggle to stay alive and have ostensible anonymity?

Hard to know, but I would imagine that more people are willing to talk about anxiety more readily now than before because there has been so much de-stigmatization about mental health issues, such as anxiety, over the past couple of decades as our understanding of it has evolved and treatment options and approaches have increased.

You mention inspirational quotes but do your clients actually find them helpful? Because I’ve got to say I don’t.

Oh, I use those primarily for myself. I enjoy them, but not everyone does. Just like I enjoy 80's metal music (and Blues), but some people prefer country or gospel, not everything is for everyone. If it's not helpful, it won't help--at least that's what I say to my clients who don't like quotes.

I've never had an issue with public speaking before. Last summer, I was giving a quick status update in a meeting of 30 people at work, like I do every week. While speaking, I started getting light-headed and couldn't read my writing and fumbled my words and had to excuse myself from the room. I felt embarrassed and worried-- I wasn't sure what it was. The next week, it happened again. I did some googling and found I was having some form of panic attack/anxiety.

Someone has since taken over this speaking responsibility for the most part. I've had to step in and do it a few more times over the months and I've felt those feelings come on lightly and then subdue. The weird thing is, I speak in other meetings and settings without issue. I know it's my own brain doing it, but having a hard time training myself to resolve this issue in this setting. Do you have any tips for situations like this?

What often happens is that your brain, for whatever reason, suddenly experienced a threat as you were speaking in the meeting. It's hard to know why, but sometimes it can be as simple as having a new person join the meeting and feeling unsure whether they will judge your contribution or not. One suggestion is to continue to do the speaking even though it's hard--the more you do it, the more your brain realizes that you're not being threatened and it can stand down. But set yourself up for success before speaking. Do some calming breathing activities, stand in a power pose (though the research doesn't fully support this, many people find it truly helpful--I know I do and I did it before the AMA started!), and recognize the feelings you're having by naming it (such as: I'm experiencing anxiety). By not avoiding the uncomfortable feeling, working to accept it and calm it, and naming it, you can begin to tame the overwhelm that has been hitting you as you go to speak.

Here's a link on power pose:https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwiflp_8isnaAhWCzIMKHRvXBFgQtwIIUTAE&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DC4ACeoqEjeA&usg=AOvVaw0CN2q-Rcu79hV8SIAVPS2U Here's a link for a breathing exercise:https://www.youtube.com/watch?v=854KaVUgyr0

I struggle from anxiety from event-specific guilt. I feel like this type of anxiey is often overlooked and more focus is given to generalized anxiety.

What are tools to deal with event-specific guilt vs. generalized anxiety?

Guilt--or shame, which is more often called--can have such a profound effect and cause a tremendous amount of anxiety, as you describe.

Brene Brown, a psychological researcher, has done a lot of work around shame and shame resilience that can be quite helpful to understanding this.

But with trauma, or past upsetting events, the guilt can linger causing anxiety. Therapy with a trauma-informed therapist is important for moving through the guilt in trauma-related experiences.

Brene Brown:https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0ahUKEwiHu8jhn8naAhVk9IMKHYgTD2kQtwIIOzAD&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DpsN1DORYYV0&usg=AOvVaw2ZrK8vzvoX-9dCZTOtpU2K

How can someone better deal with agoraphobia?

Agoraphobia is tough because of the amount of panic and stress that results in just considering leaving the house or traveling in a car, etc. Exposure therapy is one of the best therapeutic modalities for agoraphobia, research shows. Finding a therapist that is able to apply exposure therapy in a very supportive way is important. Through exposure therapy, small steps are taken to increase the window of tolerance for the stress of the situation that is so feared its led to agoraphobia. These are planned steps with good support and a lot of preparation, so it would be best to do this with a trained therapist.

(1) This isn't my first anxiety rodeo. I'm in my 50s, and I've had it my whole life. I have chronic depression and anxiety; the results are very similar, so when I need to talk about them together, I think of them as Hulga, this stereotypical '60's B-movie prison warden who bullies my life. I've had a bad run of therapists in the last decade or so. (Who calls their client a "honey badger"?) How do I find a therapist who will work out for me? Is it just hunt-and-peck?

(2) Are you a fan of Spinal Tap? Did you know they have an umlaut over the "n"?

(3) How can I best deal with the anger that's a major part of my condition?

(4) What's the biggest mistake the average person with anxiety (or beset by Hulga) can make in self-care?

(5) How can I minimize the damage to my loved ones that my condition causes me? I don't want them to be hurt, and the guilt doesn't help me, either.

(6) How can music be used to deal with anxiety? Should I crank it up?

1. Many clients come to me by word of mouth, so first begin the search by asking friends, relatives, co-workers, church friends, and your doctor who they might recommend. Then do some google searches and see who has good reviews (like every other business, even therapists get reviewed). Do a phone interview with the therapist and ask hard questions about training, experience, and get a feel. Most therapists offer 10-15 min free phone consult, so definitely use it. Try the therapist for three sessions. if you don't feel it's a match, move on. There are too many of us out there to stick with someone calling you Honey Badger.
2. Yes!
3. Anger is part of the hyperarousal that happens when you're out of your window of tolerance (resource:https://www.drmariedezelic.com/window-of-tolerance--traumaanxiety-rela). Similar to anxiety, try deep breathing, refocusing your attention to your current awareness, and acknowledging that you're angry.
4. Biggest mistake: Trying to avoid or ignore anxiety or "get over it."
5. Be honest about your anxiety with your loved ones; help them know the triggers you struggle with and the steps you are trying to take to manage the anxiety and irritability that comes. Help them to become a part of your solution.
6. Absolutely music helps with anxiety! Definitely crank it up. Find music that lightens and lifts your mood; music that calms and grounds you; and music that refreshes you. Create a play list and rock out. :)

I would say I have self diagnosed myself with General Anxiety, probably inherited from my Mom. I have been using CBD pills for about the last year to treat it and it seems to work great for me. While it doesn't solve all my problems, I can say for sure it helps keep the stress down on a daily basis.

Have you read much on the subject of CBD or experienced using it yourself?

Many people actually self-diagnosis with anxiety long before any professional renders a formal diagnosis, so you're in good company. :)

CBD is still controversial. (In addition to specializing in anxiety, I'm also board certified as an addiction counselor, board certified trauma, and board certified as a child therapist--I like to learn. 😁).
The research studies around CBD for anxiety (or any medical issue) isn't as robust as research around THC, but it is expanding. Some people do report it helps with stress and anxiety. Others say it worsens it.

Any tips on how to deal with moderate anxiety or overthinking everything? Not sure if that violates the counseling above. Thanks for doing this!

Thanks for being considerate about asking this question.

Overthinking is such a huge component of moderate anxiety: processing, reprocessing, reprocessing what you just processed... it's the cycle of overthinking.

Mindfulness techniques have shown to be helpful with this because the focus becomes learning to simply be aware of the thoughts rather than continuing to think the thoughts.

It's like when a dog incessantly barks at your neighbor's house. You can focus 100% on the distraction of the dog's barking, the frustration of it, the nuisance of it, how disrespectful your neighbors are... on and on (the overthinking); or you can simply acknowledge it and say, "Oh, a dog is barking." And move on. This is what mindfulness helps people do: To simply say, "Oh, I'm thinking about this. Ok." And then move on without continuing to engage in all the thoughts.

And, of course, working with a therapist can help you learn more strategies to manage anxiety, even moderate anxiety. 😉

Hi Sara.

I'm studying my Masters in Counselling.

Odd question... How was your experience when you first started out? I'm due for internship soon and I'm a mixture of excitement, nervous, etc

Excitement and nervous are definitely a huge component to beginning as a therapist (and, the brain struggles sometimes to determine the difference, which can heighten the nervousness!).

Like all new things, it takes practice to become really comfortable with the art and craft of doing therapy. Be sure to have good formal and informal supports as you begin this journey--it's so important to doing this work.

Good luck with your internship! And most importantly: Have fun! :)

Best advice for a person suffering from a long term agoraphobia?

Exposure therapy has been shown to be really helpful for people struggling with agoraphobia.

Why can I feel my body becoming tense and my breaths becoming more and more shallow when I'm in a certain situation where I know I have no reason to be anxious but my body still reacts that way. How do I take control over this?

Before the logic part of our brain every realizes a potential or perceived threat, our brain has already communicated it to our body. That's why your body tenses, your breath becomes more shallow, and your digestion is interrupted (which can lead to voiding--think pee, poop, puke); your body is preparing to defend itself either by fighting, fleeing, freezing, falling asleep, or fun (laughing).

The good news is that you are equipped with logic and reason (your pre-frontal cortex--your human brain) and you can reason whether there is a real or perceived threat. If real, you take action to defend yourself. If perceived, you can take action to calm your body down. When your body calms, your mind can calm (in essence, a calm body = a calm mind). Take some deep breaths; focus on how your feet feel on the ground or how your body feels in the chair; try progressive muscle relaxation where you tighten and relax every major muscle group in your body... by doing some of these, you can relax your body.

Thanks for AMA

1. How to determine you have anxiety disorder or not?

2. How can you help a person with the disorder but doesn't have access to therapy?

Thanks for asking these questions! :)

1. There is a diagnostic manual for mental health disorders and the most recent volume of that is called the DSM 5. The DSM 5 has all of the criteria needed to render a formal diagnosis for anxiety disorders (and there are actually several different types of anxiety disorders, so differential diagnosis is really important). Professionals trained in diagnosis use this manual along with any additional tools and instruments needed to determine if someone meets the criteria to be diagnosis with an anxiety disorder or not.

2. Therapy is a good resource for working through such things as anxiety, but as you indicate, not everyone has access to it. With some research, reading, and a YouTube video or two, many people can learn some basic ways to manage anxiety (such as calming skills and relaxation skills).

One of the things to understand about anxiety is that it doesn't ever really go away; people learn to manage it. By building skills to manage it, many people are able to get a handle on anxiety. But just like some people are good at DYI (did you ever see the video of the woman who built a house for herself and kids by watching YouTube?), some people need more help because their situation is more complicated or their problems are more difficult. In that case, working with a primary doctor or someone else trained in mental health would be important.

Seems like especially with online counseling, anyone you are talking to is going to come to the assumption that they have anxiety.

The symptoms for anxiety are so long, that literally any human could say they experience those symptoms.

I feel like people will use this to cover up problems. Oh I got fired from my job? It's because of my anxiety and not because my skills suck.

Anxiety can be a normal part of being human, like you suggest. Many people do experience normal anxiety, but that's very different from anxiety disorders.

Online counseling is like traditional counseling: People come for a host of different reasons, such as anxiety, but also because of past trauma, current upsetting experiences, life transition, depression, relationship problems, parent / child relationship problems, dissatisfaction in life.

I happen to focus on anxiety, though my training is quite broad beyond anxiety.

Sometimes, sure, people can make excuses their life. Folks find lots of reasons to make excuses for things that happen (I recently heard someone say they lost their job and it wasn't their fault because their alarm clock broke).

But people who struggle with anxiety--and meet the criteria for diagnosis--have a real problem that isn't just an excuse for poor work performance.

So I do believe people can have anxiety that cripples or affects their lives, but do you think some people try to use it as an excuse for things? Or maybe they have usual anxiety like all humans do but try to play it as having an anxiety disorder, like some tend to do with things like OCD?

Sure, there could be some people who exaggerate the symptoms. But then the question might be: What might be the reason that someone would try to gain attention in this way?

Another thing to consider is that as people become more familiar with the vernacular of mental health conditions--like OCD--it's easier for it to enter the general lexicon and become over used or misused to describe certain behaviors.

Being someone who likes a neat and organized space is not the same as being someone who struggles with OCD, but it's become pretty accepted for people to describe a neat, organized person as OCD.

I was diagnosed with GAD last year and still struggle with anxiety quite a bit. What are somethings I can do to distract myself from racing thoughts? Being around family helps but they are not always around. I also took pills for anxiety for a short time when I went to the hospital after an anxiety attack

Grounding exercises are good for bringing yourself into present awareness rather than focusing on the racing thoughts, even if you're trying to ignore them.
A simple grounding exercise is to look at the room around you and notice 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.

Another is to become focused on feeling yourself fully in the chair you are sitting in, taking notice of how your body feels in it, what parts of your body are touching the chair, noticing whether you can feel a difference between the areas that are and aren't touching the chair.

Mindfulness techniques such as these--where you bring your awareness into the here and now--can go a long way in interrupting and disrupting the racing thoughts.

And, of course, there are lots of other techniques, so working with a therapist to build a full toolbox for yourself can be really helpful for longterm management of your anxiety.

thoughts on nutrition? i started having panic attacks prior to being diagnosed with celiac.

There's a lot of new evidence about how the digestive system could be related to anxiety and panic, and certainly change in nutrition can aide in this. But also when people get newly diagnosed with a chronic--and debilitating--health condition, it, too, can lead to an increase in anxiety and panic. Learning strategies to calm the panic, such as grounding techniques, breathing techniques, can help soften some of the overwhelm that comes with managing a chronic a health issue. Here's a link that might help with incorporating breathing techniques:https://itherapy.com/mindful-breathing/

Thanks Dr. Anderson. I will use the breathing technique. Have a great day!

Glad to be helpful. :). Hope your day goes well!

How to cope/get out of anxiety and stress?

It's hard to get out of anxiety and stress because they are simply the communication tool your brain has that says that a situation or experience is overwhelming or threatening.

Anxiety.org has a lot of information about how to cope with anxiety, but some basic things are to learn strategies to calm and relax your body and mind; develop skills to be in the here and now (mindfulness awareness) rather than to feed the anxiety; consider diet and exercise as important; and be aware of your own window of tolerance for stress.

Hey there, thanks for this AMA. I think I have GAD. Last time I visited the doctor, I felt like I wasn't taken seriously. He suggested I see the uni counselling service, which has I have done but I haven't felt any improvement. I want to visit again, but I am scared of not being taken seriously. How can I get my doctor to see that I need more help?

Sorry you haven't yet found any relief. Continue to talk to your doctor about what you're experiencing and talk about what you've been trying to do so far to manage it, but what isn't working. Also, be sure to tell the counselor at the uni counselling services that you're not finding any help yet; many therapists are trained in several different types of therapies and approaches, so sometimes it's a matter of letting the counselor know it's not helping yet and working together to find ways for it to help.

What are some of the advantages to working with you via online video therapy vs. in an office?

What's your favorite 80's metal band?

Favorite 80s bands: Poison and G&R. You??

Online counseling is much more convenient because there's no travel involved; it provides greater privacy (no one sees you coming and going from the therapy office); and a lot of clients like being able to ground themselves in their own surrounding with their own comfort items, like a favorite chair, blanket cup of tea.

I always saw GnR as more of a 90s band. They didn't have the glam to be a 80s metal band.

Lol! You're probably right. :)

What is the most common cause for an anxiety problem and is it possible to avoid anxiety in advance?

There are actually a couple of causes of anxiety, such as environmental triggers, past trauma or overwhelming stress, or just a hereditary predisposition to anxiety. Often, it's really a combo of all of these. It can be possible to manage anxiety in advance, but avoiding it actually can lead to more anxiety. One of the better techniques that research shows is to increase a tolerance for stress and anxiety by repeated trials of activities that could be anxiety-provoking and combining that with learning strategies to calm down.

Can anxiety manifest itself as procrastination? I started my masters thesis 8 years ago and something is just keeping me from finishing it and no matter how hard i try to psyche myself up to finish it (which i know is totally doable) i end up putting it off.

Absolutely anxiety can lead to procrastination. Procrastination is really just a product of being "frozen" which is one of those fight or flight responses (along with fun and fall asleep--think opossum). Sometimes the stress of a project really expands beyond your window of tolerance and this an lead the flight or fight response to kick in. Doing some mindfulness activities, taking mini-breaks, and breaking the project into chunks can help a lot in making more doable and keeping you in your window of tolerance.