ICYMI 👉 check out my recent newsletters on:
Submit your questions (about anything) for Friday’s Q&A right here!
The first time I sought help for anxiety was in medical school. I remember studying the receipt the therapist handed me at the end of our first session. “Anxiety Disorder,” it read. In an instant, my self-image was called into question. The relief from talking through my worries suddenly turned into panic about my own sanity.
I wondered, Does this mean I have mental illness? I made another appointment and walked home.
Last month, the U.S. Services Preventive Task Force recommended that adults ages 19 to 64 be routinely screened for anxiety. This is a big step toward recognizing the relevance of mental health to our whole health. (Although we seem to have forgotten that people ages 65+ can be anxious, too. 🫣 ) It also means that next time you go to see the doctor, you’re likely to be asked about it.
So, are you anxious? And should you be anxious about … your anxiety?
Let’s first remember the basics.
The #1 risk factor for having anxiety is being human.
Anxiety is built into our DNA. It exists for a reason. For thousands of years, anxiety has protected us from harm—even death—by alerting us to danger. It was good for our primitive ancestors to be anxious about predators in the wild and to worry about storing enough food for extreme weather.
Today, anxiety helps us stay alert. It reminds us to pay our taxes on time, to look both ways before crossing the street. It can even raise our performance. Ask any athlete and they will likely tell you that a little anxiety before a competition keeps them on their toes.
Anxiety can also do serious harm.
When triggered inappropriately and/or consistently over time, the “fight or flight” axis can cause cognitive distortions, racing and intrusive thoughts, excess worry, and ruminations. It can cause physical symptoms such as headaches and heartburn and high blood pressure. It can drive us to engage in unhealthy behaviors, from extreme dieting to excessive alcohol use to social isolation.
When anxiety negatively affects a person’s quality of life, physical health, relationships, and/or ability to function, it’s considered a disorder. In the U.S., the lifetime prevalence of anxiety disorders in adults is estimated at 26.4% for men and 40.4% for women (although I suspect the true numbers are higher).
Anxiety isn’t binary.
Anxiety exists on a continuum. Each of us has a baseline level of anxiety, plus the ability to travel up and down the continuum. Some proportion of our anxiety helps us survive; some can do harm. In other words, the question isn’t: Do you have anxiety? It’s: So what?
I suggest asking yourself:
Where is your baseline anxiety located on the continuum? Are you generally a 3 out of 10, where things that normally worry other people don’t really bother you? Or are you typically a 9, where your level of anxiety is out of proportion to the degree of actual danger?
To what extent does your baseline level of anxiety/fear/vigilance interfere with your quality of life, physical health, relationships, and ability to function?
How far up the continuum do you travel when faced with a threat (i.e., illness, loss, or stress)?
What coping tools do you employ in order to bring yourself back to your baseline?
Mental health begins with self-awareness.
Scan your body the next time you’re feeling anxious. Is your neck tight, jaw clenched, your back stiff? Is your heart racing and gut churning? When we connect the dots between our emotional and physical states, we can worry less that our body is malfunctioning and direct our attention to the anxiety itself.
Then tune into internal and external triggers for anxiety. Consider how past experiences and your current life situation affect how much you worry, ruminate, and react to real or perceived threats. Did you experience childhood trauma or neglect? Are you in a difficult relationship or do you have tense family dynamics? Each of these can cause you to experience hyper-alertness, constant striving, and even underlying fear. These feelings can also affect your blood pressure, your sleep, and your routines. How do your behaviors change when you feel worried or vulnerable?
Everyone needs a coping kit.
Regardless of where we live and travel along the continuum of anxiety, we all need tools to bring us home. Some of us need to change our baseline. So maybe it’s time to re-enroll in yoga, call the therapist your friend recommended, or schedule a walk with your neighbor. Maybe putting away your phone before bedtime would help quiet the noisy brain at bedtime. In conjunction with therapy and behavioral modifications, medication can also play an important role in helping with anxiety.
Your toolbox doesn’t have to include paid professionals. It can be an app (like Reframe to manage your relationship with alcohol or Calm to help with mindfulness). You can get the structure and support you need from a pup, a set of friends, AA, or your rabbi. Whatever you did—healthfully and legally—to cope with the stress of the pandemic, make it a double.
Health includes having agency where able.
Anxiety thrives when we give it a home. It festers when we try to control the uncontrollable, fix the unfixable, and predict the unpredictable. So instead of hand wringing about the past and perseverating about the “what ifs” of the future, we must try to accept the fixed, unpleasant realities of our lives and direct our energy toward the things we can control. Whether it’s resuming an exercise routine, prioritizing lunch, or meditating before bed, being intentional about how we spend our time and energy can help us refocus on the present moment. The bottom line is that we do have the ability to break cycles of negative self-talk and self-sabotage. We can give ourselves permission to feel anger and sadness. We have the ability to ask for help.
Health is not about being anxiety-free. It’s a process of self-awareness, acceptance, and agency. Twenty-five years (and a whole lot of therapy) later, I’ve accepted—even appreciated—my anxiety. I’ve also forgiven myself for being human.
Bonus coping tool!
is a registered nurse with a doctorate in Integrative Health and is a board-certified, Mayo-Clinic-trained health coach. Her newsletter, is a breath of fresh air. Her humor, realism, and evidence-based approach to health fills a void in the internet wellness bubble. You might love her Unpopular Opinions on Wellness Culture or her 20-Minute Guided Journaling Session which are Kate at her finest: making wellness feel simple and realistic for busy people.Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
If you enjoyed this post, click the ❤️ or 🔄 button on this post so more people can discover it on Substack 🙏
Excellent post about anxiety and how to deal with it! Thanks for your insights.
Dr. Lucy!
1) THANK YOU so much for this post. I definitely face moment of anxiety, and this post helped me to reframe those. I love the prompt "where is your anxiety on the continuum?". That made me think! (But not *over*think, ha!)
2) What a day maker to see this shout out for my newsletter. I am so happy that Substack connected us. I feel so aligned with your responsible (yet relatable work!), and can't wait to connect with some of your readers!
Have the best week!
-Kate