How to Manage Anxiety When the World Feels Like It’s Falling Apart 🌎

Welcome to being human

Apr 15, 2025

ICYMI 👉

This Friday’s LIVE Q&A is about “Addressing Anxiety in Times of Uncertainty.” Join me HERE on Friday 4/18 at 3 pm ET!

Paid subscribers can submit their questions for me to answer live, right here!

(This story is told with permission from my patient. Her name has been changed.)

Last week, my patient Michelle came to see me with what she described as "out of control anxiety." As an executive in her mid-fifties, Michelle typically managed stress well—she even prided herself on it. Her colleagues often remarked at her composure during high-stakes presentations and impossible deadlines.

But something had shifted more recently. Michelle found herself waking at 3 AM with her heart racing, checking news headlines compulsively throughout the day, and getting into tense arguments with her adult daughter over politics at family dinners. When her college-age son called her asking for advice about his roommate situation, she found herself catastrophizing about his entire future instead of offering the measured counsel she normally would.

selective focus photo of pink bougainvillea flower — Photo by J A N U P R A S A D on Unsplash

"I've always been the steady one," Michelle told me, her voice tight as she twisted the tissue in her hands. "But now I feel like I'm coming apart.” She went on to describe her worries about everything happening in the world: wars, political division, climate disasters, plus concerns about retirement security and her mother's declining health. She reported having to mute myself during a board meeting because she couldn't catch her breath.

“I feel completely overwhelmed.”

This sentence stuck with me, because lately I’m hearing variations of it almost daily. Regardless of political persuasion, many of my patients feel undone. They wonder if their heightened anxiety is simply the new normal, if persistent worry is just the admission price for living in today's world, or if there is something medically wrong with them. I feel it, too.

Welcome to Being Human

The most important thing to understand about anxiety is this: If you're worried about being worried, take a deep breath and welcome yourself back to Earth. You're simply human.

We are wired for survival. Anxiety evolved as a protective mechanism, alerting us to potential dangers and preparing our bodies to respond. Your amygdala, the brain's threat detection center, doesn't distinguish between a saber-toothed tiger and a troubling CNN headline. Both trigger the same physiological cascade: elevated heart rate, shallow breathing, muscle tension, and a flood of stress hormones like cortisol and adrenaline.

This response is brilliantly designed for immediate physical threats that require quick action. It's far less helpful when the "threat" is an endless scroll of global crises on your phone or a vague sense that something terrible might happen tomorrow.

What makes this particularly challenging is that these responses aren't entirely irrational. The world does contain real dangers. But when anxiety becomes chronic, it stops serving its protective function and starts becoming the problem itself. As I often tell my patients with health-related anxiety: sometimes the anxiety becomes the cancer.

Medical Reality vs. Psychological Experience

From a strictly medical perspective, anxiety disorders represent a dysregulation of normal stress responses. But I've found this framing alone rarely helps my patients. The experience of anxiety isn't just biological—it's deeply psychological and contextual.

When I talk with patients about anxiety, I encourage them to consider three dimensions:

The physiological dimension: What's happening in your body (racing heart, shallow breathing, muscle tension, sweaty palms, upset stomach)
The cognitive dimension: What's happening in your mind (worried thoughts, catastrophizing, rumination, marinating in “What Ifs”)
The behavioral dimension: How you're responding to these experiences (avoidance, seeking reassurance, distraction, self-medicating with food, alcohol, other substances, etc)

All three dimensions are important, because each offers different entry points for intervention. Some patients find relief by starting with the body—using breathing techniques or exercise to calm the physiological arousal. Others need to begin with their thoughts, identifying and challenging catastrophic thinking patterns. Still others benefit most from behavioral changes, like limiting media consumption, canceling certain apps on their phone, recommitting to sobriety, or reconnecting with routines that provide structure amidst chaos.

The Anxiety Spectrum

Like my patient Michelle, many people I see don't meet the full criteria for an anxiety disorder but are still significantly distressed. They exist in what we might call the "middle ground" of anxiety—not incapacitated, but living with enough background anxiety that interferes with their quality of life.

In clinical practice, we often find ourselves working with categories and thresholds. Does this person meet the diagnostic criteria for generalized anxiety disorder? Is this level of distress clinically significant? These distinctions can be helpful for treatment decisions, but they don't always capture the lived experience of anxiety.

The reality is more nuanced. Anxiety exists on a spectrum, not as an either/or proposition. Each of us has a baseline level of vigilance, and we move along this continuum depending on our circumstances, resilience factors, and coping resources. Some amount of anxiety is adaptive, even productive. You need a little adrenaline to file your taxes on time! But too much becomes problematic. And the point at which it crosses from helpful to harmful varies tremendously from person to person.

I remember my own encounters with anxiety in medical school, and the surprise I felt seeing "Anxiety Disorder" on my therapy receipt. It made me realize how differently we can experience the same internal states. What feels like appropriate concern to one person might be debilitating worry to another.

During challenging times—a global pandemic, social upheaval, or personal crisis—even those with typically robust mental health may find themselves experiencing more anxiety than usual. This doesn't necessarily mean something is "wrong" with them; it might simply reflect a normal response to abnormal circumstances. Conversely, just because you can point to a cause for your anxiety doesn’t mean you don’t need medical or psychological support.

So how do we navigate this complex terrain of anxiety? I suggest a framework I've found helpful with my patients:

The 3 As Approach to Managing Anxiety

1. Awareness

The first step is developing awareness of your unique anxiety pattern. This means noticing:

Your personal triggers: Is it watching the news? Scrolling through social media? Health concerns? Financial worries? Identify what sets you off.
Your physical manifestations: Scan your body when anxiety hits. Is your neck tight? Jaw clenched? Heart racing? Palms sweaty? Stomach churning? When we connect these physical sensations to our emotional state, we worry less that our body is malfunctioning and can address the anxiety itself.
Your thought patterns: Notice the "what ifs" and "Oh my Gods" that cycle through your mind. Are you catastrophizing? Ruminating on worst-case scenarios? Experiencing intrusive thoughts?
Your behavioral responses: Do you reach for comfort foods, pour an extra glass of wine, or stay up late scrolling? Do you snap at loved ones or withdraw completely? It's critical to recognize how easily we default to factory settings when stressed.

This self-awareness isn't about self-judgment; it's about creating a map of your personal anxiety landscape so you can navigate it more effectively.

2. Acceptance

This is perhaps the most challenging but crucial step. Acceptance doesn't mean resignation or approval. It means acknowledging reality as it currently exists.

In practical terms, this involves:

Recognizing that some degree of anxiety is normal and even adaptive. If you weren't a little worried sometimes, you wouldn't be human.
Acknowledging that certain stressors are beyond your control. As I wrote in my "COVID Serenity Prayer" piece for The Atlantic, anxiety festers when we try to control the uncontrollable, fix the unfixable, and predict the unpredictable.
Understanding that perfectionistic standards for mental health can actually increase suffering. Give yourself permission to be a little undone sometimes, to eat too much Halloween candy if you must. Beating yourself up about fear is the birthplace of self-sabotage.
Practicing self-compassion when anxiety arises rather than layering on self-criticism. You're going through a lot. It's okay to not be okay.

One patient described acceptance as "making room for anxiety to exist without letting it drive the car." I find this metaphor quite apt. Anxiety can be present without being in control.

3. Agency

The final step involves reclaiming agency within the parameters of what's actually within your control. This isn't about eliminating anxiety entirely—an unrealistic goal that often backfires—but about developing tools to manage it effectively.

Here's your anxiety management toolkit:

Simple at-home techniques: Practice deep breathing (breathe in for 4 counts, hold for 7, exhale for 8). Stretch your entire body for 10 minutes. Take a long walk. Dig in the garden. Listen to calming music. Play with your pets. Organize your underwear drawer. Do whatever brings you joy—as long as it's legal and doesn't harm anyone.
Social connection: Call family and friends to talk about anything but your worries. Talk about hilarious memories or reminisce about better times. Human connection is one of our most powerful anxiety antidotes.
Humor as medicine: Watch ridiculously funny things—SNL skits, crazy cat videos, whatever makes you spit your drink out laughing. Laughter actually changes your brain chemistry in positive ways.
Digital boundaries: Create a politics-free zone. Take breaks from the news. Put your phone away at least two hours before bedtime. Sometimes the most powerful thing you can do is simply unplug.
Professional support: Consider therapy, meditation apps (like Calm or Insight Timer), or medication when appropriate. Your toolbox doesn't have to include paid professionals, but they exist for the important reason of helping people make sense of their internal narratives and emotional responses. I saw my therapist this morning, and it’s the reason I can calmly write this newsletter!

For many in the anxiety gray zone, these approaches—alone or in combination—can significantly improve quality of life without requiring medication. However, it's important to note that for some patients, especially those with more severe or persistent symptoms, medication can be an appropriate and helpful part of treatment.

When to Seek Professional Help

While everyone experiences anxiety, certain patterns suggest it might be time to consult with a healthcare provider:

Anxiety that consistently interferes with daily activities or relationships
Panic attacks that occur regularly or unpredictably
Anxiety accompanied by thoughts of self-harm or hopelessness
Physical symptoms that persist despite self-help strategies
Anxiety that leads to problematic coping behaviors (excessive alcohol use, etc.)

If you recognize these patterns, consider speaking with your doctor or a mental health professional. Many effective treatments exist, from therapy to medication to lifestyle modifications, often used in combination. There's no prize for suffering in silence.

The Upshot

In our hyperconnected world with 24/7 exposure to global crises, some degree of anxiety is a normal, even rational response. The goal isn't to eliminate all anxiety but rather to develop a relationship with anxiety that allows you to function (and even flourish) despite uncertainty.

Twenty-five years (and a whole lot of therapy) later, I've not only accepted my own anxiety—I've come to appreciate it as part of what makes me human, what connects me to my patients, and what helps me navigate an uncertain world.

And remember: You're probably going to be just fine. Most of us are remarkably resilient, even when it doesn't feel that way.

QUESTIONS FOR YOU! 🙋🏻‍♀️

Which part of your anxiety toolkit needs restocking right now? Is it time to book that yoga class, call that therapist, or set firmer boundaries with your phone or at work?
If you could give your anxious self one piece of compassionate advice, what would it be?

I'm all ears!