Anxiety

WHEN TO SEE YOUR DOCTOR

* You find yourself avoiding situations, places or people in order to avoid feeling anxious.

* You have chronic symptoms, such as tension, headaches, muscle aches, bowel trouble, shortness of breath, chest discomfort, stomach problems or dizziness.

* You have panic attacks (short, unexplained periods of intense fear or discomfort).

What Your Symptom Is Telling You

How could you possibly prepare for a test, meet a deadline or psych yourself up for an important event without at least a few butterflies flitting through your stomach? "Some level of anxiety is probably healthy," says Jack Maser, M.D., a psychiatrist with the National Institutes of Mental Health. "It motivates you to get up and do something."

But when the butterflies feel more like swarms of skittering bats, and you feel trapped in a cycle of uneasy fears that just won't let up—your anxiety has become a problem.

Symptom Relief

Those bats can be turned back into butterflies. There are a variety of therapies, practical approaches and medical treatments to help control anxiety.

Take a motion potion. Ventilate your anxiety by taking it for a walk. A daily exercise program of at least a half-hour will help, says Bernard Vittone, M.D., a psychiatrist and director of the National Center for the Treatment of Phobias, Anxiety and Depression in Washington, D.C.

Make yours decaf. When you're anxious, drinking caffeine is like pouring gasoline on a fire, Dr. Vittone says.

Ban the bottle. Even though alcohol may seem to calm you at first, the next day you will feel much more anxious, because of the irritating effect that withdrawal from alcohol has on the brain, says Dr. Vittone.

Breathe easy. Hyperventilation, or overbreathing, is a prime suspect in anxiety and can leave you feeling light-headed, anxious and depressed, says Herbert Fensterheim, Ph.D., clinical professor of psychology in psychiatry at Cornell University Medical College in New York City.

"The main difficulty is not breathing too fast but breathing with the upper part of the chest rather than the diaphragm," Dr. Fensterheim says. Breathing more deeply can help you relax, he says. To do that, lie down and place one hand on your chest and the other on your abdomen. Breathe through your nose, letting only the hand on your abdomen rise and fall. Practicing a deep-breathing exercise such as this one will help teach you how to control your breathing when your anxiety level creeps up, says Dr. Fensterheim. Focusing on your breathing can actually help you cope with anxiety, he says.

Sit in the worry chair. One common cause of anxiety is letting yourself become overwhelmed by all your worries, says Dr. Vittone. Instead of worrying aimlessly all day, he suggests, set aside 30 minutes a day to sit and do nothing but worry. When anxiety sneaks in during the day, tell yourself, "I'm going to worry about that later, during my worry time."

Quick Fixes for Anxious Moments

Ruth Knowles Grainger, Ph.D., an advanced registered nurse practitioner and clinical director of the Therapy Research Institute in Miami, Florida, offers these tips for instant anxiety relief.

Look up. Research shows that our feelings intensify when we're looking down. Scan the ceiling.

Breathe calmly. Slow your breathing, exhale completely and mentally add a one-word soother with each exhalation, like "Calm...calm...calm."

Soften that shrug. Raised shoulders and tension go together. Lower your shoulders to ease the tension.

Slow your thinking. Think in slow, complete sentences when anxious thoughts are coming on too rapidly.

Alter your voice. Slowing, lowering and softening your voice conveys calm and control to others as well as yourself.

Move your body. Run in place or dance for a few moments when you feel your anxiety level rising.

Let your face fix it. When you smooth out your forehead and turn up the corners of your mouth, you can fool your brain into lightening up.

Be a fly on the wall. Change your perspective by imagining yourself watching a tense, anxious person (you) from another angle—the ceiling or the other side of the room.

When Anxiety Just Won't Yield

Tried everything and still shaking in the breeze? You might want to talk to your doctor about anti-anxiety medication, or ask him for a referral to a therapist.

Try the thinking therapy. Your doctor may recommend that you visit a cognitive therapist. These anxiety experts can help you change the thoughts that might be triggering your anxiety.

"There's nothing mysterious, magical or frightening about therapy," says Jerilyn Ross, psychotherapist and director of the Ross Center for Anxiety and Related Disorders in Washington, D.C. "You'll be taught various exercises and techniques to help you understand and face what's keeping you stuck."

Find help at your pharmacy. Your doctor may prescribe medication for short-term or occasional use. Effective drugs include benzodiazepines, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). There are important dietary restrictions to follow with MAOIs, so be sure to ask your doctor for a list of foods to avoid.

What If It's a Panic Attack?

A panic attack is anxiety run amok. Some people prone to anxiety may suffer sudden, short periods of intense fear or discomfort. Symptoms can include shortness of breath, dizziness or faintness, trembling, palpitations or rapid heartbeat, sweating, choking, stomach upset, numbness or tingling, flushes or chills, chest pain or discomfort and fear of dying or going crazy.

Panic attacks are a problem that you should discuss with your doctor. There are, however, a few things that you can try on your own. Dr. Vittone offers these six steps.

1. Reassure yourself that the attack will pass, usually within five or ten minutes.

2. Remind yourself, even though you may feel terrified, that no one has ever died or gone mad from a panic attack. Tell yourself, "This will pass."

3. Ride with your feelings, telling yourself, "These are just feelings." Allow yourself to experience having trouble breathing, and just breathe slowly. You are getting sufficient oxygen.

4. Every minute or two, rate your anxiety on a scale of one to ten. You'll find that although levels fluctuate, it's gradually going down.

5. Take ten slow, deep, diaphragmatic breaths. Check your anxiety level again.

6. Focus on physical things around you. Mentally describe the room, your clothes, sounds, smells. Stay in the present, and get your attention from inside your body to outside.

Repeat these steps until the panic subsides.