Studying in her dormitory room alone one evening at the University of Victoria, student Jill Taylor suddenly felt a tightening in her stomach and found it difficult to breathe. “My heart was racing, my vision tunneled,” 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 in Victoria, Canada, 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. Here are some more signs you might have an anxiety disorder.
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 B.C. There, finally, in June 2014, Jill received an accurate diagnosis—she suffered from a 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.
GAD is a condition characterized by persistent, excessive worry—even when there’s nothing concrete to worry about. “People with GAD attempt to plan for every eventuality, all of the time,” says Melisa Robichaud, PhD, a psychologist in Vancouver who specializes in the treatment of anxiety with an emphasis on generalized anxiety disorder (GAD). “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 says, 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 we 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. Know someone who suffers from anxiety?
Who is affected?
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 Organization reports that the number of people suffering from depression and/or anxiety increased by nearly 50 percent between 1990 and 2013. Mike Ward, a psychotherapist and founder of the London Anxiety Clinic in the UK, has seen a 30 percent 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 says.
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. (Here’s how to combat social anxiety disorder.)
The condition also manifests differently in people 55 and older, says Wetherell—they 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.”
A difficult diagnosis
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. Here are some signs you’re taking too many prescriptions.
GAD sufferers will often see a medical doctor first about their physical symptoms; in some cases, unfortunately, professionals may brush off their 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 recognized the signs of a mental health issue and referred her to the appropriate professionals.
Medication vs. therapy
Today, after three years of ongoing work with her counselor, Jill is living a full life with her wife and baby son. In addition to her talk therapy, she works on acceptance and commitment therapy (ACT), a mindfulness-based program, to manage her anxiety. Jill still has attacks but far less often and it has allowed her to go off medication.
However, if her anxiety starts to overwhelm her or she feels herself sinking back into a depression, she and her doctor work together on a course of medication to help her through—and she is 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 [MBSR], 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 potentially negative events that might occur in the future, so being able to focus on the present can be beneficial.” Here are some mindfulness tips that could help.
For mild cases of GAD, lifestyle changes may help. One of the most important is exercise—a 2017 systematic review in Psychiatry Research found that exercise decreased anxiety symptoms. 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.
Research published in 2017 in Computers in Human Behavior shows that using multiple social media platforms increases the risk of both anxiety and depression. And, Ward says his patients often use social media to distract themselves, which may provide short-term relief but is actually a cognitive avoidance of 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 her diet and has cut way back on caffeine and processed foods. She cooks mostly with fresh ingredients and also drinks more water. Here’s more about what to eat—and what to avoid—if you suffer from anxiety.
Staying the course
Even though you can reduce—or even overcome—generalized anxiety, maintaining solid mental health remains an ongoing process.
Jill continues her mindfulness practice—including breathing practices, 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 do not happen overnight; it is 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 to friends and family and even strangers, has been of tremendous benefit.
“The scariest part of anxiety can be the feeling you are the only person who feels this way. When I share my story, it helps others realize it’s not just them.
“Don’t be afraid to say you need help,” she says. “You are 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 it managing me.”
Here are the top tricks from therapists on how to deal with anxiety.