Common symptoms of anxiety

  • Always thinking through or replaying the worst-case scenario

  • Panic attacks or feeling overwhelmed, on edge, jittery

  • Racing thoughts or rumination

  • Distracted often, difficulty with concentration

  • Avoidance of whatever activates anxiety, including people, situations, and tasks (through procrastination)

  • Difficulty being present, in your body or in the moment

  • Fidgeting

  • Poor sleep or insomnia

  • Changes in appetite (stress eating or loss of appetite)

  • Muscle tension and headaches

  • Reassurance seeking (asking friends, family, internet searches)

  • Repetitive behaviors such as checking that everything is in place, checking for certain thoughts

Anxiety sabotages our ability to live in the present

Feeling capable, resourceful, and present in our daily lives is wonderful. Struggling with anxiety makes this seem next to impossible. According to the ADAA (Anxiety and Depression Association of America), anxiety affects nearly 1 in 5 adults every year, making it the most common mental health concern for individuals 18 years of age and older. Unfortunately, far less people seek professional help despite there being numerous evidence-based therapies that are highly effective in the treatment of anxiety. Even if the symptoms described above may seem obvious, it may be hard to recognize that you are struggling with anxiety.

If you have always “been a worrier”, being anxious may feel like the norm or even be a way you motivate yourself in life. It may never have occurred to you to imagine your life (or head space) without an anxious voice playing out every scenario. This is often be the case for high achievers or those in high-performing workplaces where the effects of anxiety (e.g., preparing in advance, identifying risks) were rewarded. The truth is that anxiety does have a purpose in our lives, and a little anxiety can be helpful. All that worst-case scenario-ing pushes us to anticipate the future, which is certainly needed for planning and problem solving. However, long-term, chronic anxiety is debilitating. More often than not this kind of anxiety results in an imagination stock piled with negative “what-ifs” and endlessly stressed feedback loops. Chronic anxiety ends up having a significantly negative impact on your physical health, relationships, and general outlook.

statue of rodin thinking man
“A therapist can demystify what anxiety is and explain how it works - including differentiating when it helps you versus when it hurts you.”

What is an anxiety disorder

While everyone experiences some anxiety from time to time, if your anxiety becomes significant and you begin to struggle at work, in relationships, or in managing parts of your daily life, you may have an anxiety disorder. The good news is that you don’t have to continue to feel this way - research shows that anxiety disorders are very treatable through therapy and with professional support.

  • Generalized anxiety disorder is characterized by chronic, excessive worry about a range of topics and situations, more days than not in a week, that is difficult to control, for over 6 months. You may also experience muscle tension, difficulty focusing, irritability, fatigue, feeling keyed up, or changes in your sleep.

  • Panic disorder is characterized by recurrent panic attacks, which are surges of intense fear and physical distress peaking in a few minutes. A panic attack includes physical symptoms, such as shakiness, sweating, dizziness, heart palpitations, chills, shortness of breath, chest pain, or a sense of being detached from your body or about to die. In panic disorder, there is a persistent worry of future panic attacks and changes in your behavior to avoid panic attacks for at least a month.

  • Obsessive compulsive disorder is characterized by the time-consuming presence of obsessions (intrusive, unwanted, repetitive thoughts or images) or compulsions (repetitive behaviors or mental acts). Obsessions often cause distress and attempts are made to neutralize the thought. Compulsions may feel absolutely necessary or to prevent unwanted outcomes.

  • Social anxiety disorder is characterized by the worry of negative scrutiny by others in social situations, often having to do with being afraid of embarrassment or judgment, lasting over 6 months.

  • Phobias are characterized by anxiety about a specific situation or object considered disproportionate to the actual threat, resulting in immediate fear and endured with intense dread or avoided completely for over 6 months.

A multicultural note: oppression is a risk factor for anxiety

Well known individual risk factors for anxiety include genetics, personality or temperament, physical health, and traumatic experiences - each of these variables increase the likelihood that you will struggle with anxiety. However, we tend not to think of societal level risk factors. A substantial body of research shows that experiencing racism impacts physical and mental health. A meta-analysis of nearly 300 articles published across 30 years found that the correlation between racism and poor mental health was twice as large as the correlation between racism and poor physical health (Paradies et al., 2015). Experiencing race-based discrimination has been specifically connected to generalized anxiety, even when controlling for other confounding variables that may explain the reason for one’s anxiety (Soto, Dawson-Andoh, & BeLue, 2011; Cuevas et al., 2020). For many, this information is intuitive - as any form of social oppression is often frequent, systemic, and unresolved, resulting in chronic stress and disempowerment. Living in this context keeps our “fight or flight” nervous system on for prolonged periods of time. Yet mental health interventions rarely target racism or other forms of social oppression despite it being an established risk factor for anxiety. It is important to understand that bringing up and addressing your experiences of race-based stressors may be a key part of you successfully working through your anxiety.

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How can therapy for anxiety help me?

A therapist can demystify what anxiety is and explain how it works - including differentiating when it helps you versus when it hurts you. Your therapist can act as a stabilizing source of information and support while you learn to make changes that help you move away from a life that is reactive or fear-driven. While your worries may be valid, it doesn’t mean that every decision should be guided by worry. These changes in your life may include learning ways to coach your body out of a “fight of flight” response or creating more constructive of self-compassionate thought patterns. Sometimes the things we try to feel better when we’re anxious end up making us feel worse. Therapy for anxiety can increase self-awareness about what you’re experiencing and build confidence that you can respond effectively to life moments.

Sometimes the reasons for anxiety may go farther than the situations we’re in, like significant unresolved past experiences or a self-critical sense of self. In this case, therapy can help you process out loud what may be overwhelming to do alone, gain insight, and value yourself. Working with a therapist means that you don’t have to “just stop worrying” or pretend you’re fine when you might feel chaotic inside. You may be encouraged to try alternative resources, such as support groups, psychotropic medication, or lifestyle changes known to reduce anxiety. These resources can further re-instill a sense of personal power that chronic anxiety threatens to extinguish. You can experience relief, self-confidence, and peace.

Finding an anxiety therapist in NYC - we’d love to help

Our team of psychologists at Manhattan Therapy Collective are trained in a range of relational, multicultural, and evidence-based therapy approaches for anxiety, such as Cognitive Behavioral Therapy and mindfulness interventions. We encourage you to reach out for support - we would love to connect with you and answer your questions. Ever consider what the worst case scenario is of untreated anxiety? Chronic distress, physical health conditions, and a life propelled by fear, avoidance, and reactivity instead of one filled with what actually matters to you. While seeking therapy for anxiety can and often provides immediate and significant relief, the ultimate goal of therapy for anxiety is to develop the resiliency to cope with life’s stressors without sacrificing the ability to experience joy, gratitude, or calm.

Common questions about therapy for anxiety

 

  • There is a lot of overlap - you may feel a similar sense of being overwhelmed or having trouble sleeping when you’re stressed and when you’re anxious. People also use the words interchangeably, which doesn’t help. A helpful distinction is that stress is the activated response we have to a real external pressure or situation happening in the present. A stress response has a cause and effect relationship with existing circumstances. Anxiety is a broad spectrum of physical, mental, or emotional responses we have to a perceived or hypothetical future situation. These scenarios have not yet come to pass and may never occur.

  • Ultimately, the decision to try therapy is up to you, and we support you either way. Yes, everyone does experience anxiety about possible future scenarios from time to time. However, we encourage you to consider therapy if you have noticed that your anxiety is frequent, persistent, and starts getting in the way of your work, relationships, health, personal goals, or daily routines.

  • Absolutely not. We will never push you to try or do anything that you are not interested in. We have found that sometimes people who have not found mindfulness or relaxation techniques effective have not received adequate coaching or support in their skills practice, making it unlikely that they would feel any real benefit. Since there is a neurobiological basis of anxiety, we do find that the use of behavioral techniques (such as deep breathing and meditation, among many others) can result in significant progress. That being said, there are many ways to address anxiety effectively, and we will work together to use what works for you!

  • If you are interested in medication, we can discuss that decision with you and can provide a psychiatric referral. We will work with you and your physician or prescriber to create a sustainable treatment plan that works best for you. This may or may not include medication for a short-term period or a more open-ended period of time. Sometimes patients are interested in trying out psychotherapeutic techniques prior to trying medication for their anxiety. Since anxiety can affect things like concentration and sleep, sometimes starting a medication prior to starting therapy creates helpful stability so you can be more present for your sessions. We will always collaborate and reevaluate what makes the most sense for you.

 
 

References:

Cuevas, A. G., Mann, F. D., Williams, D. R., & Krueger, R. F. (2021). Discrimination and anxiety: Using multiple polygenic scores to control for genetic liability. Proceedings of the National Academy of Sciences, 118(1), e2017224118.

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PloS one, 10(9), e0138511. https://doi.org/10.1371/journal.pone.0138511

Soto, J. A., Dawson-Andoh, N. A., & BeLue, R. (2011). The relationship between perceived discrimination and generalized anxiety disorder among African Americans, Afro Caribbeans, and non-Hispanic Whites. Journal of anxiety disorders, 25(2), 258-265.