On Anxiety

07 Jan

It is one thing to describe a health condition and another thing to experience and live with it.  So I appreciated Scott Stossel’s article in The Atlantic about his lifelong struggle with severe anxiety.   In My Anxious, Twitchy, Phobic (Somehow Successful) Life, Stossel eloquently captures what it is like to daily do battle with panic attacks, phobias, and generalized worry.  The piece is also very funny in a David Sedaris kind of way. 

I do, however, wish Stossel had displayed a bit less of a nihilistic attitude toward his mental nemesis.  Readers likewise afflicted with severe anxiety might come away from the article concluding that there is little hope for effectively addressing their condition.

The reality I see in my medical practice is quite different. In my experience, most people who seek help for their anxiety disorders are able to achieve a good quality of life and level of functioning. 

Many good books have been written on managing anxiety in its various manifestations.   (I recommend Dr. Ed Hallowell’s Worry) One blog post cannot do justice to this huge topic.  Nonetheless, here are 3 scientifically validated ways to effectively address anxiety.   I have seen them enable people crippled with anxiety disorders to live full lives again.


When we feel anxious, the body’s sympathetic nervous system kicks into high gear.  Our adrenal glands release epinephrine and norepinephrine, raising blood pressure by constricting our arteries and making our hearts beat faster and harder. Peristalsis, the natural movement of our gut, is slowed down.  Cortisol is secreted, releasing more glucose into our bloodstream.  All of this contributes to the disturbing symptoms experienced during panic attacks and the feelings of fear that afflict people with anxiety disorders.   Exercise decreases the activity of these stress systems in our body. This is evident in research showing that people who engage in regular exercise experience fewer symptoms of anxiety.

The best form of exercise is an activity that you find to be enjoyable.  It is also important that it is feasible to fit into your schedule.  For this reason, I often encourage people to start off with a vigorous 30 minute daily walk around their neighborhood.  Yoga is a type of exercise that can be especially useful for decreasing anxiety since it may activate the body’s relaxation response, a state of deep rest that changes physical and emotional responses to stress.  Yoga and other forms of exercise that require intense concentration also allow people to take a break from anxious thoughts.

Cognitive Behavior Therapy (CBT)

People suffering from anxiety disorders often adopt counterproductive ways of responding to the problems life throws their way.   For instance, when something bad happens, they might overestimate how serious and damaging it is.  They may also engage in destructive behaviors like procrastinating that ultimately result in experiencing more anxiety.  In cognitive behavioral therapy (CBT), individuals develop more healthy and functional ways of thinking and behaving.  Multiple studies show that CBT is highly effective for treating anxiety disorders.  In my work as an internist, it is inspiring to see people once severely burdened by anxiety be empowered by working with a skilled, compassionate therapist. 


Again and again I have seen patients afflicted with severe anxiety disorders have their lives transformed by getting on the right medication.  The first-line meds for anxiety disorders are selective serotonin reuptake inhibitors (SSRIs), such Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), and Paxil (Paroxetine).  SSRIs usually take a few weeks to become effective.  So patients are often prescribed medications called benzodiazepines while waiting for SSRIs to kick in.  Benzodiazepines such as Ativan (Lorazepam), Xanax (Alprazolam), and Klonopin (Clonazepam) are effective for this purpose, but in most cases should be not be used chronically on a regular basis.  This is because over time, a higher and higher dose of benzodiazepines are sometimes required to be effective.  In addition, benzodiazepines, like alcohol, can be used inappropriately as a kind of escape from the world.  The goal in treating severe anxiety is enabling people to successfully reengage with reality.

In Summary

Scott Stossel correctly points out in his piece that anxiety is a necessary part of being human.  We must think ahead about what could go wrong in our lives, so we can plan and prepare appropriately.  But as Ed Hallowell writes, anxiety becomes toxic when it is “unnecessary, repetitive, unproductive, paralyzing and life-defeating.”  When this happens, it is important to seek help because there are solutions that work.


1 Comment

Posted by on January 7, 2014 in Uncategorized


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