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Expert Q&A

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How can I calm my anxiety?

Asked by Dawn Armstead, Queens, New York

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How can I calm myself down when anxiety strikes? I hate feeling nervous.

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Dawn,

Bad anxiety is about the most unpleasant feeling a person can have. Most people who suffer from anxiety and depression will tell you that although depression is horrible, anxiety is even more excruciatingly painful. Anxiety is especially miserable when it comes on suddenly in the form of a panic attack, when the heart starts pounding, the breath gets short, the chest tightens and hurts and a feeling of impending doom frequently overwhelms one.

In the last several years, the true damage done by anxiety has become increasingly clear. I could give you lots of examples. When people are depressed, acute anxiety is the best predictor of suicide risk. Anxiety also makes depression much harder to treat. If anxiety doesn't go away with treatment, depression is very likely to return, even if the treatment leads to a remission of depressive symptoms. Finally, like depression, anxiety is now known to damage the brain and body in ways that increase the risk for a whole host of serious medical diseases.

I can't tell you how to get rid of your particular nervousness because I don't know anything about it other than your brief question. But let me talk a little about how to treat nervousness in general. As with all psychiatric issues, the problem can be attacked through three primary avenues: lifestyle, psychotherapy and medication. In terms of lifestyle, you might try to get the best understanding you can of what things set off your anxiety. If you can avoid them without crimping your life or depriving yourself of things, you might explore this option. Usually people can't run from the things that make them nervous, so it is then a matter of practicing with oneself to face these things and try to get through them. Many therapies for anxiety are built on this principle: When one confronts one's fears they tend to diminish.

Many people find that meditation or some other type of relaxation strategy can be helpful when the anxiety starts. Similarly, aerobic exercise can significantly reduce anxiety. Many times when the pressure is really on me, I find that a run through the woods will clear my head and relax me enough to cope with things. But be careful -- some people with serious anxiety problems can actually be made more anxious by things such as meditation and exercise. In fact, meditation and exercise are two common ways that researchers induce anxiety in the laboratory when they want to study it!

Psychotherapy can be hugely helpful for anxiety. The type you would most benefit from depends on what your actual symptoms and circumstances are. If your anxiety is more within the normal range and occurs in response to understandable situations, therapy might focus on helping you understand what makes you so anxious and why. On the other hand, if you have panic attacks, you would most likely most benefit from forms of behavioral therapy aimed to help you tolerate the panic attacks without letting them keep you from living your life.

There are two primary classes of medication that work well for anxiety. Benzodiazepines are the classic anti-anxiety drugs. They work quickly and have few side effects, but they also carry a risk for dependence that sometimes can be a problem. Antidepressants are also powerful anti-anxiety agents. They do not produce the same degree of dependency as benzodiazepines, but they do have side effects and often take up to eight weeks to work for anxiety disorders. Many people find that a combination of antidepressants and benzodiazepines -- especially early in treatment, before the antidepressants have had time to work -- is an ideal strategy.

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