#2 Q&A Series: Let's Talk About Anxiety
You asked, I answer. Today we discuss common myths, realities and concerns about anxiety.
Welcome to The Feel Good Life! A newsletter about health, prevention, empathy, and hope. Join me, Dr. Mariana, as we explore all sides of good health and life. Today, we talk about anxiety.
Two weeks ago I asked your opinion on which topics would you like to see me writing next on the Q&A series. I love writing and sharing everything I know, but more importantly, I want to write about things that you, dear Feel Gooders, need to learn more about.
Your top answer was loud and clear: Anxiety.
So, today we are diving into our second edition of the Q&A series focusing on the most common concerns among patients and readers about anxiety. If you’d like to add, ask or comment, please feel free to join the comment section. Let’s make this a safe space for everyone to express freely, and to feel heard and seen without judgment or shame.
Q&A Series #2: Common Myths, Realities & Concerns About Anxiety
The most common questions I get asked as a physician about anxiety are:
What is anxiety?
How do I calm my anxiety?
Is anxiety for life?
Can anxiety levels improve over time?
Is medication the only solution for anxiety?
Can alcohol or coffee affect my anxiety?
Can period or menopause affect my anxiety?
How do I talk to family or friends about my anxiety?
Because this is such a huge topic, I want to make this Q&A a bit different by diving deeper rather than just answering these questions in turn. In the following sections, we’ll explore emotions and the brain in order to better understand yourself, and learn how best to react when anxiety shows up.
Disclaimer: We are discussing anxiety as a general symptom, like we all feel from time to time. It’s important to state the difference between anxiety as a common symptom vs. general anxiety disorders (GAD) as a medical diagnose. Today we are not delving into medical diagnoses as it is a vast and complex realm that needs to be addressed professionally.
First of all, let’s define anxiety.
The NHS offers a clear and simple explanation:
“Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.
Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview.” ~ Overview - GAD in Adults
Like eustress, a little anxiety can be a normal, everyday response to normal stressors in your life, but when it becomes a crippling nd unrelenting feeling affecting how you function on a daily basis, it then becomes a health concern requiring attention, and above all, support.
Mind (a wonderful and reliable source for everything mental health) defines anxiety like this:
“Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future.”
The American Psychological Association offers an important perspective to consider when talking about anxiety:
“Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.
Anxiety is not the same as fear, but they are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.”
Understanding that we all experience temporary anxiety and negative emotions, and that in their mildest form both are extremely common and nothing to be ashamed of, is vitally important - and so is encouraging open conversations on this point. This is why today we are talking about common myths, realities and concerns about anxiety.
1. Let’s Tackle Myths
There are many outdated beliefs in society speaking on how we all should act or feel in our daily lives. These beliefs put enormous pressure on people, forcing them to live under constant stress. Becoming aware of such pressures and understanding them as myths will let us lead a calmer, more truthful life.
A myth is defined by the Oxford dictionary as “a widely held but false belief or idea. A false notion.” Let’s see some of the most common myths about anxiety and why they are in fact wrong.
Myth #1: Anxiety is ‘all in your head’ and you’re just worrying too much.
Fact: Anxiety is a blanket term for both the everyday human emotion and a formally diagnosed medical condition. But either way, it’s not nothing. What you’re feeling shouldn’t ever be dismissed by anyone else (or yourself!) in an offhand or judgmental way.
Anxiety directly impacts your health! An excessive state of worrying will activate the alarm/survival systems in your brain leading to all sorts of physical sensations and disturbances. In order to help your anxiety, you should be able to acknowledge what you are feeling is valid and important, so that you can take action towards improving it.
Myth #2: Anxiety is a sign of ‘weakness’.
Fact: Shyness can be tagged as a personality trait, whereas social anxiety (different from agoraphobia) is an anxiety disorder where an extreme worry on how to act or perform takes place. A fear of self-embarrassment or fear of judgement can really impede someone’s ability to function in social settings. It’s important to assess your social anxiety with a professional healthcare provider so that you can be guided in the process of understanding what you feel. It matters.
Myth #3: Anxiety medications are addictive.
Fact: There are many types of medications to help regulate anxiety attacks and anxiety disorders. Not everyone suffering from anxiety will be diagnosed with an anxiety disorder, and not everyone will require medication. Antidepressants from the SSRI and SNRI families are the most common meds used, and they aren’t addictive. (On the other hand, benzodiazepines can generate tolerance or resistance when used for longer periods of time, hence the importance of having a proper prescription and medical control when taking such medications.) A licensed healthcare provider should be the one to make an evaluation and prescribe medications if necessary.
Myth #4: People with anxiety should always avoid stressful situations.
Fact: While removing yourself from a stressful situation may help with symptoms in the moment, it won't solve anxiety or its triggers in the long run. What matters is that you learn over time (and with support) what your triggers are and how to recognise their effects, so you can catch yourself before or when debilitating anxiety happens.
Some people traditionally believed that our ability to manage these triggers cannot improve (“you’re just an anxious person”), but based on the effectiveness of modern treatments, this is now regarded as a myth. Professional support can help you address and understand your anxiety, where it might be stemming from, and give you the right diagnosis, therapies and/or medication where needed.
Myth #5: Anxiety isn’t real.
Fact: yes, anxiety is commonplace - but this means it’s been normalised as an inevitable or even meritocratic part of our busy modern lifestyles. This is a dangerous assumption to make. Anxiety is a protective mechanism from the brain, alerting us to triggers and danger in our surroundings. It’s a normal part of our cognitive ‘survival mode’. The problem starts when this alert mode stays ON as a normal part of life, generating both physical and mental longterm health issues. Analysing your anxiety is vital in determining if it is stemming from temporary or chronic stressors in your lifestyle.
Important: Let’s not forget that all these can affect adults and children alike!
For more frequently asked questions about anxiety, you can read here, here and here.
2. Now Let’s Talk Realities: Anxiety in Numbers
According to the World Health Organisation, ‘anxiety disorders are the world’s most common mental disorders, affecting 301 million people in the world’. And that is data from 2019, a.k.a. before the Covid-pandemic!
A few more credible headlines on this topic:
WHO reports a 25% increase of mental health issues amidst Covid-Pandemic
United Nations Brief on Covid-19 and the need for action on mental health
Also, in this comprehensive paper from the 2024 Global Economic Forum, the World Affairs Council of Philadelphia reports:
‘Globally, diagnosed anxiety and depression increased by 25 percent, according to the World Health Organization. iv Columbia University Mailman School of Public Health conducted a similar study that corroborates WHO’s work, which also yielded that the prevalence of depression and anxiety during the pandemic was 24 percent and 21 percent.’
One other thing seems clear: this is not a temporary anomaly in the data. This aspect of public mental health has been a concern for a regrettably long time, but it’s only now that we have the facts and the tools to fully understand the scale of the problem.
3. Concerns: What Can We Do About Anxiety
When I think of concerns, I think mostly about what generates the most worry in my patients, my readers or my loved ones. However, when searching for ‘anxiety concerns’ on the web, no clear info shows up other than the same definitions of anxiety itself - which we’ve already covered.
So let’s focus on the major concerns people normally express to me about their anxiety:
- What is causing my anxiety?
- Can anxiety turn into something worse?
- Who can I talk to about my anxiety?
- How can I control it?
The first step to anything in health (and in life) is awareness. The minute you become aware of something, you become empowered. You become the person in charge of doing something about your concern.
We are all a unique inner universe, and so are our emotions.
Let’s see how emotions work in the brain.
Anxiety is a common human emotion which generates (and reacts to) different substances in the brain, sending signals throughout the entire body. For example, when we’re feeling anxious, we can suddenly get a loose stomach, weak legs or shortness of breath. These are easy examples of how anxiety sends signals to other parts of the body - in this case, respectively: stomach, muscles and lungs.
Everything in the human body is a chemical reaction. Cells talk to each other by exchanging substances of different kinds. Each organ has specific cells and receptors to send and receive signals. These signals are the biological language in which the body performs every single activity since the moment you are conceived. Fascinating, right?
Anyway, back to the brain.
Inside the brain, there are different areas (let’s call them neighbourhoods) in charge of specific functions. The brain is really well-organised place. Among the functions organised and controlled by these neighbourhoods are: temperature regulation, pain sensations, critical thinking, emotions and their regulation, visual recognition such as colours or faces, and creative thinking, just to mention a few.
For educational purposes only, let’s say the neighbourhoods looks something like this:
The main ‘neighbourhood’ where emotions live in the brain is called the Amygdala - a super tiny almond-shaped centre:
‘Located right next to the hippocampus, the left and right amygdalae play a central role in our emotional responses, including feelings like pleasure, fear, anxiety and anger. The amygdala also attaches emotional content to our memories, and so plays an important role in determining how robustly those memories are stored. Memories that have strong emotional meaning tend to stick.’
This is a human brain, seen from the side and from above, respectively.
If we grabbed the image on the right, cut it in half through that middle canal, and then flip it to the side, we would have this view:
The amygdala, that tiny green spot, is that small part of your brain where emotions live, remember? In the words of the Cleveland Clinic, the Amygdala is:
“A major processing center for emotions. It also links your emotions to many other brain abilities, especially memories, learning and your senses. When it doesn’t work as it should, it can cause or contribute to disruptive feelings and symptoms.”
We know that emotions and their regulation have an intricate connection with behavioural patterns, trauma and many other emotional disorders.
The way in which we learned how to deal with emotions in the early, formative years of life, is how our brain knows how to react in adult life. This is also how we know that therapies helping the brain remember, rewire or re-learn certain patterns are effective towards healthy emotional regulation.
It is difficult to talk about anxiety in general terms because, as I’ve said, everyone’s experience is different. Just know that:
What you feel is real and is valid.
What you feel matters.
Always acknowledge your feelings, and if possible talk about them.
If in doubt, assess the situation with a professional healthcare provider.
Now, how to calm down your anxiety?
As I have said, anxiety needs to be acknowledge in the first place. Seeking support is next.
But during any crisis, the emergency key is this: Oxygen. Let me explain why.
Anxiety is a really uncomfortable feeling of despair, combined with confusion, sadness, feeling lost, desperate and short of breath. It’s an absolute state of fear in which our survival system takes over, activating stress mode ON. When the body is under stress mode, many signals and reactions take place, such as making the heart and the lungs work faster.
Under normal conditions, the lungs take the oxygen from the air we breath and send it to the bloodstream. From there, it will flow towards all organs in the body - most importantly: to the brain.
When anxiety kicks in, the lungs have to work faster, making it more difficult to catch enough oxygen properly. This means less oxygen to the brain, which instantly activates survival mode, releasing stress hormones and engaging your fight/flight/freeze responses. The brain is simply trying to keep you safe and alive.
In any anxiety emergency, breathing deeply is the first call to action. Why? Because as you take deeper breathes, adequate amounts of oxygen will be restored in the brain, signalling to turn OFF survival mode and letting your mind and body recover within minutes.
After the crisis is under control, there are many steps you can take to help improve this anxiety:
If you’re on your own, seek for help. Call someone you can trust and let them know what’s happening. I remember after my divorce and while going through therapy, my therapist gave me one of the best advices I’ve ever got. She said: ‘who are your top 5 people you’d call in an emergency without even blinking? Write their names next to their phone numbers on a post-it note and stick it next to your phone/landline/charger.’ When a crisis kicks in, you can’t think as clearly, leaving you not knowing what to do. The post/it note will be your ‘emergency brain” and it will tell you what to do. It was the most effective thing ever. Highly recommended! You are not alone.
Address your sensations and write them down. Doing this might come handy when another anxiety crisis shows up, or when you attend your next therapy session. For many people it can be confusing or difficult to recognise an anxiety attack, specially if it’s their first time. Talking about this will help you become aware and understand what is happening (or what could happen). Prevention is everything.
If it becomes too frequent and debilitating, seek professional support. Anxiety in any of its forms is not easy to navigate. Hence why the importance of having guidance to help you overcome what you’re feeling, and most importantly, to help you understand where it might be stemming from. Therapy can truly do wonders - and I say this from personal experience. ;)
Talk to a trusted friend or relative. Apart from therapy and emergency trusted contacts, having an emotional safety net on your daily basis activities can be an absolute game-changer. Being able to share and decompress with regularity will heal your nervous system in ways we can’t see right away, but that will be clearly noticeable in the long run.
Look for resources. There are great tools and communities, both online and offline, to serve as support. Having a sense of community will be the most effective tool in any healing journey. Again, you are not alone.
Alternative therapies can be a wonderful ally in any mindfulness journey, and I think anxiety can highly benefited from many of these practices. It is well known that Eastern health philosophies have an integrated health view of mind and body. Traditional Chinese Medicine is a good example of it. I personally love Ayurveda and Vipassanna Meditation as I have been able to practice them. And because they have helped me deeply, I like recommending them when appropriate. Here are some good options on alternative support for anxiety:
Breathing Exercises (Lung health guide that can be applied to anxiety)
Physical Exercise (Yoga, Stretching and Pilates are particularly good in combining motion, breathing and mind-calming techniques, making them great for anxiety management in the long run.)
Meditation (Plus a quick, easy guidance here by Calm)
You can find detailed further reference on alternative therapies for anxiety here, here, here and here.
If you encounter someone who’s struggling with anxiety - whether at home, at work or even on the street - here is a practical guide by John Hopkins Medicine on how to help someone with anxiety.
For further info and resources on anxiety, please check this list:
Anxiety Self Help Guide by NHS Inform
Anxiety and Panic Attacks by Mind
Resources by Anxiety & Depression American Association
Free “How To” guides for caregivers, parents and educators by Anxiety Canada
Managing anxiety (for healthcare professionals) by Macmillan
Know someone who could benefit from this info? Pass it along! You might help them more than you know.
As always, thank you for being here!
I hope this has been both insightful and helpful. This Q&A is intended to be an informative guidance only. Make sure you get proper medical attention as needed, and always consult with your local healthcare provider.
Is there anything you would like to add, ask or comment? Let’s talk in the comments section! I might not have all the answers, but what I do have is a massive disposition and desire to create safe spaces for everyone to share and to learn from. :)
Much love,
Dr. Mariana
Hey, this is such a well-written piece—love how it breaks down those anxiety myths so clearly! Whenever I start feeling anxious, I turn to my go-to tool: https://breathingexercise.net/en . It’s super easy to use—you just set the number of breaths, follow along, and don’t even have to count or time anything yourself. It really helps me calm down fast.
Looking forward to vagus nerve exercises! As a veteran of anxiety through the ages, I find success with breathing, guided meditation, diet, but am feeling slammed with new challenges. So hopefully trying something new is just what I need. Thank you