Anxiety

Illustration of anxiety

We all experience occasional anxiety and worry as a part of everyday life. Maybe it’s a test you need to take, or a challenging physical task you have to perform, or perhaps a difficult problem you must solve. 

Whatever it is, anxiety is the way our brain mobilizes all of our resources by flooding our body with hormones (including cortisol and adrenaline) to make it strong, fast, and powerful. 

This mechanism has been keeping us alive for thousands of years. Whether the threat is perceived or real, we are ready to respond with fight, flight, or freeze. 

The problem occurs when our brain becomes a little overprotective and hits the panic button "just in case."  One of the awful things about anxiety is the way it can launch without warning, and often without need, sending an unsuspecting body unnecessarily into fight or flight.

If such a response becomes consistent, gets worse over time, and interferes with daily activities like work, school, or relationships, we recommend talking to a licensed mental health professional and starting treatment.  

You can reach out to the Resiliency & Well-being Center staff for a consultation. 

Consultation Request Form
 

The Neuroscience of Anxiety: Anxiety Pathways 

There are two pathways to anxiety—“low road” or thalamus to amygdala and "high road" or thalamus to cortex to amygdala.  

I.    “Low Road”—Thalamus to Amygdala

This pathway travels from the thalamus directly to the amygdala and gets there before any sensory information reaches the cortex.  The time difference is why we react before we can think. The amygdala gets raw, unprocessed information, reacts instinctively, and has many ways to influence the cortex.  For example, walking into a dimly lit basement and seeing a dark, curved shape on the ground. The amygdala reacts with fear to an image that might be a snake before the cortex can notice that it is a rope on the ground.

II.    "High Road"—Thalamus to Cortex to Amygdala 

Sensory Information comes in and is directed to the thalamus.  This pathway travels from the thalamus through the cortex to the amygdala, although the amygdala is always watching what is happening in the cortex.  The cortex has more detailed information and can think.  The cortex has fewer ways to influence the amygdala.  For example, a child has a scary experience with Santa. The child now responds with fear to seeing anything resembling a Santa suit.  The amygdala does not initially instinctively react with fear, it needs the cortex to tell it that Santa suits are scary, and then it reacts, producing symptoms of anxiety until it has learned the association of Santa-like sights and fear and a trigger is formed.

Anxiety Disorders
Signs & Symptoms

Anxiety disorders are the most common mental health disorders and affects nearly 30 percent of adults at some point in their lives. (Source: American Psychiatric Association)

Anxiety symptoms manifest in both the body and the mind.  People with anxiety experience excessive worry more often than not for at least six months and are unable to control the worry.

Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk.  

Physical symptoms also accompany feeling anxious. The presence of at least three physical signs along with excessive worry is the criterion for clinical diagnosis of generalized anxiety disorder.

  • Restlessness, or feeling on edge
  • Being easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

Source: The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Addition, 2020

There are different types of anxiety disorders that you need to be aware of:

  • Generalized Anxiety Disorder: You feel excessive, unrealistic worry and tension with little or no reason
  • Panic disorder: You feel sudden, intense fear that brings on a panic attack. During a panic attack you may break out in a sweat, have chest pain, and have a pounding heartbeat (palpitations). Sometimes you may feel like you’re choking or having a heart attack.
  • Social Anxiety Disorder: Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You obsessively worry about others judging you or being embarrassed or ridiculed.
  • Specific phobias: You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.
  • Agoraphobia: You have an intense fear of being in a place where it seems hard to escape or get help if an emergency occurs. For example, you may panic or feel anxious when on an airplane, public transportation, or standing in line with a crowd.
  • Separation anxiety: Little kids aren’t the only ones who feel scared or anxious when a loved one leaves. Anyone can get separation Anxiety Disorder. If you do, you’ll feel very anxious or fearful when a person you’re close with leaves your sight. You’ll always worry that something bad may happen to your loved one. 
  • Selective mutism: This is a type of social anxiety in which young children talk normally with their family but don’t speak in public, like at school.
  • Medication-induced Anxiety Disorder: Use of certain medications or illegal drugs, or withdrawal from certain drugs, can trigger some symptoms of anxiety disorder.

Source: WebMD https://www.webmd.com/anxiety-panic/guide/anxiety-disorders
 

Treatment

If you experience anxiety symptoms see your doctor to make sure there are no physical problems causing the symptoms.

If an anxiety disorder is diagnosed, discuss your treatment options with your health care provider, including a mental health professional in this dialogue, as those options may include lifestyle changes, psychotherapy, and possibly medication.

In milder cases of an anxiety disorder, medication may not be necessary, and therapy and lifestyle changes (e.g., smoking cessation, decreased caffeine intake, regular exercise, medication, and mindfulness) may be sufficient to manage symptoms.

The GW Office of Integrative Medicine and Health offers free, weekly, online mind-body sessions Fridays at 2 p.m. ET.  Register for upcoming events here.  (The mind-body session begins at 2:30 pm ET.)

Self Care and Lifestyle Approaches

Chronic stress contributes to anxiety and anxiety disorders, which is becoming recognized widely.  Hence, more people use self-care and lifestyle approaches to prevent and reduce anxiety and as an complement for conventional therapies such as medications:

  • Stress Management Techniques
    • Mindfulness-based stress reduction (MBSR) and other similar techniques often combine breathing practices and focused attention (mindful meditation) to calm the mind and body. These techniques can be especially important in treating phobias or panic disorder. MBSR has been shown to reduce symptoms of burnout (emotional exhaustion), stress, psychological distress, depression, and anxiety.
    • Yoga. The combination of physical postures, breathing practices, and mindful meditation found in yoga have helped many people improve the management of their anxiety disorder. Yoga also increases physical activity (see below).
  • Physical Activity. Physical activity includes exercise and natural movement throughout the day. People who are more physically active are less likely to experience anxiety. Increasing physical activity can reduce stress and anxiety and has been shown to be beneficial for anxiety disorders such as post-traumatic stress disorder, agoraphobia, and panic disorder.

Psychotherapy

Cognitive Behavioral Therapy (CBT): One of the most researched psychotherapy for anxiety disorders. Studies show that it is at least as effective as medication. It targets the cognitive processes, the uncomfortable physical symptoms, and the behavioral consequences of anxiety.  Patients are taught to challenge their automatic thoughts, rather than to accept them at face value. They learn to identify all-or-nothing thinking, jumping to conclusions, catastrophizing, ignoring, or discounting positive evidence, and other cognitive distortions.

Exposure Therapy: A psychotherapy for specific anxiety disorders like phobias and social anxiety. It helps a person develop a more constructive response to a fear by gradual exposure to a trigger in a controlled environment. The goal of such an approach is to increase the level of tolerance to a trigger and experience less anxiety over time with newly developed coping skills in place.

Sources: NAMI Anxiety Disorders Treatment ; SAMSHA Understanding the Anxiety Disorders; NIH Anxiety Disorders; Psychology Today

Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008

Janssen M, Heerkens Y, Kuijer W, van der Heijden B, Engels J. Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review. PLoS One. 2018;13(1):e0191332. doi:10.1371/journal.pone.0191332

Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019;99(10):620-627.

Kandola A, Vancampfort D, Herring M, et al. Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep. 2018;20(8):63. doi:10.1007/s11920-018-0923-x

Anxiety Management Apps
  • Headspace: This mindfulness app takes the seriousness and intimidation out of meditation with practices for managing stress, anxiety, sleep, and more.  It is now available to benefits-eligible GW faculty and staff.
  • Calm: Sleep, meditation, and relaxation are in your hands with Calm.  These guided meditations are good for complete novices and seasoned practitioners.
  • Sanvello: A program for reducing stress and treating anxiety and depression that includes a coach or groups.
  • Meru Health: A program for clinical anxiety or depression that uses an app and therapist, and biofeedback monitor is optional. Referral from a health care provider is necessary.
  • The Loveland Foundation: Provides therapy support for African-American women, girls, and gender nonbinary.
  • National Queer & Trans Therapists of Color Network: Resources from a healing justice organization actively working to transform mental health for queer and trans Black, Indigenous and People of Color (QTBIPOC).
  • Happify: Some free content, including stress reduction and cognitive techniques to address anxiety.
  • MindShift CBT: Free content, including cognitive behavioral therapy strategies to address general worry, social anxiety, and panic.
  • PTSD Coach: Created by VA’s National Center for PTSD and the Department of Defense’s National Center for Telehealth & Technology. This app provides you with education about post-traumatic Stress Disorder (PTSD), information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help you manage the stresses of daily life with PTSD.
  • PTSD Family Coach: In conjunction with PTSD Coach, the PTSD Family Coach app is for family members of those living with PTSD. The app provides extensive information about PTSD, how to take care of yourself, how to take care of your relationship with your loved one or with children, and how to help your loved one get the treatment they deserve.
  • Mothers and Babies Online Course: A well-validated, web-based program for depression (available in both English and Spanish) for pregnant women, new mothers, and those who want to support them.
  • Shine: An app with a mission to make caring for mental and emotional health more accessible, representative, and inclusive that was founded by two BIPOC women.
  • COVID Coach: Created for everyone, including veterans and service members, to support self-care and overall mental health during the coronavirus pandemic.

If you don't see an app that meets your needs, please check out this list compiled by Healthline.

Coping Skills

Relaxation and Breathing

Exposure

  • Exposure is a process of “teaching” the amygdala by providing the “experience” that it needs to learn healthier ways to react, by gradually shifting the association of the trigger from a negative event to a positive one.
  • Exposure rewires the circuitry of the amygdala, producing lasting change.
  • Exposure makes new connections.
  • Myths about exposure therapy from Psychology Today.

Physical Activity: Exercise & Natural Movement

  • Physical activity is like a reset button in the amygdala, which is designed to elicit the programmed fight/flight/freeze response. Exercise or movement complete the circuit.
  • Regular exercise reduces sympathetic nervous system activation, counteracting amygdala activation.
  • Anxiety decreases after only 20 minutes of exercise or movement.
  • Milken Institute GW School of Public Health offers a wide range of lifestyle, sport, and physical activity courses. (registration fee may be required)
  • DeStress Mondays: This 13-week series designed to show users how they can use physical activity to stimulate positivity and improve their mental wellbeing.

Sleep

Sleep deprivation increases activation of the amygdala. In contrast, the more sleep (especially REM sleep) we get, the less activation of the amygdala.  The Sleep Foundation has compiled resources to help you sleep.

Better Sleep Tips

  • Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
  • Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
  • Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom. 
  • Avoid large meals, caffeine, and alcohol before bedtime.
  • Get some exercise. Being physically active during the day can help you fall asleep more easily at night.
  • Use relaxation techniques to prepare for sleep.

•    If you can’t fall asleep after 30 minutes in bed, get up and do something to relax in another room.

Source: CDC tips for Better Sleep 

Distraction

We are less anxious when we are busy.  Psychology Today has complied a dozen mindful distractions to help reduce anxiety and stress.

  • If we can distract our thoughts, it may interrupt the cortex alerting the amygdala, it may lessen the intensity of a response, we may be so distracted that we do not pay attention to the amygdala’s response.
  • Distractions may be sensory, like listening to music, a walk in nature, exercise, crafting, etc.
  • Distractions can include focusing on writing, drawing, reading, making music, etc.

Cognitive Restructuring

•    We can begin to pay more careful attention to what was going through our minds when we began to feel anxious.
•    This gives us a way to recognize how our thoughts contribute to our anxiety.
•    When that anxious moment has receded, we can look back on whether our thoughts were appropriate, and if not, use that understanding to create coping thoughts for the next time. 

Try These Apps: Thought Challenger, Worry Knot.
 

 

CHC Virtual Workshops

The Colonial Health Center (CHC) serves GW students and engages the entire GW community, working to build a culture of support and connection with student well-being.  CHC supports mental health and personal development by collaborating directly with students to overcome challenges and difficulties that may interfere with academic, emotional, and personal success.  CHC offers a series of virtual workshops on the following topics:

  • Anxiety
  • Depression
  • Conflict resolution
  • Cultural competency
  • Mindful self-compassion
  • How to Find a Therapist 101
Other Helpful Modalities for Anxiety Relief


Acupressure 
Tai Chi and Qi Gong
Grounding Techniques
Safe Havening
Emotional Freedom Techniques (Tapping)