Unmasking Anxiety: Facing the Culprit to Find Control


by Heather Allmendinger


Is it an inner voice, lightning through the chest, an uneasy stomach or a little green monster? In disguise and unexpectedly, anxiety can creep into daily life and set up shop ready to disassemble stability, piece by piece. According to a 2017 National Institute of Mental Health study, nearly one in five adults meets the criteria for a mental health diagnosis in any given year, the most common being generalized anxiety disorder. This condition fosters intense fear over a number of concerns, including illness, job insecurity, financial status or death, and typically takes a mighty toll on social exchanges, close relationships and professional development.  


Although more common in adults, affecting almost 6.8 million each year, this debilitating disorder does not exclude for age, race, gender, profession or socioeconomic status. From the most vivacious and blameless children to the most driven professionals and paramount celebrities, anxiety can strike anyone at any given time after an increased amount of stress, trauma, grief, or for no apparent reason.


As society has become more familiar with the disorder, we often refer to anxiety in broad terms covering a lot of psychological ground. We also regularly interchange the meaning of stress and anxiety, which are physiologically similar in the way they impact the body and gain its response, like developing insomnia, difficulty concentrating, fatigue, muscle tension and irritability. They are also similar in how they intersect and co-exist with each other. However, the conceptual differences between the two are important to note for purposes of identification and an approach to resolve.  


Externally generated, stress streams from the experience of certain pressures that are typically happening in the present. The pressure is usually a real-time, relatively short-term demand — a presentation, a job interview, a project deadline, a medical or dental procedure or planning a dinner party. When the taxing activity is over, the stress is eliminated. 


Anxiety, on the other hand, is generated internally by fixating on and fearing certain anticipated stressors that might occur in the future and their realistic or unrealistic impacts. When absent of stressful burdens, pervasive worry and the overpowering yearning to diffuse fear or “what ifs” of future challenges linger. Anxiety becomes an issue when it extends beyond logical concern and penetrates normal activities in an unhealthy or uncontrollable way. 


With a tendency to mimic the presentation of other physical and mental behaviors, anxiety may be tough to diagnose at first. “Anxiety in modern times often looks like avoidance,” says Kate McCalman, LCSW, of Argenta Counseling. “We learn to avoid what makes us anxious, including the normal triggers of threatening people, places and things. However, it can be harder to recognize other triggers, such as thoughts and emotions, and we learn to avoid these without being aware we’re even doing it. Rather than lessening it, avoidance actually fuels anxiety.”


Difficulty in pinpointing an anxiety disorder also lies in anxiety’s natural occurrence. Some degree of stress and/or anxiety is not a bad thing. A certain amount of ongoing pressure may prompt a wave of the yellow caution flag along the big racetrack of life and signal a much-needed tire change.  A healthy dose of stress or anxiety, when acknowledged and managed properly, leads to adjustment that often spawns personal growth and opportunity. That same teaspoonful may also add a dash of incentive and motivation to successfully push through lofty goals. 


Our bodies depend upon manageable levels of fear to inherently react quickly to life-threatening situations, carefully consider outcomes, effectively problem-solve and help us relate with others in an empathetic way. 


“Fear and anxiety are expected, as they are the mind and body’s natural response to danger and uncertainty,” says Maggie Young, LCSW, CEAP with Southwest EAP.  “Having anxious thoughts is an expected form of anxiety everyone will experience from time to time, so feeling anxious or worried is not a diagnosis of anxiety.”


If an unhealthy emotional response has developed gradually over time or seems age-appropriate, the response could appear “normal” in an adult or child dealing with anxiety for the first time. For example, separation anxiety and phobias are issues more commonly seen in children but could easily be mistaken for classic toddler tantrums over leaving a mother’s side or fear of the dark. A rollercoaster of pubescent emotions might be just that, or it may be a sign of chronic anxiety over forming new relationships, rejection or balancing increased amounts of schoolwork all while maintaining performance in extracurricular activities. Gauging the timing of onset, patterns and intensity of behavioral, physical or mental change against a person’s baseline of well-being and quality of life prior to the change will help determine if a medical evaluation and diagnosis are needed. 


“The major difference in anxiety in children and adults is the ability to recognize and communicate it,” Young says. “Children have a more difficult time vocalizing their feelings, while adults can verbally acknowledge when a feeling or behavior disrupts life.” 


Surprisingly, fewer than 40 percent of adults who have symptoms of anxiety seek treatment of any kind, according to the Anxiety and Depression Association of America.  


When not addressed, general anxiety disorder can lead to other significant physical and mental health problems, particularly depression, obesity and cardiovascular issues. Based on Harvard Medical Health studies, continuous, unnecessary surges in physical and hormonal responses caused by generalized anxiety disorder may produce heart arrhythmias, increases in blood pressure and damage blood vessels, as well as arteries. These occurrences also may promote blood thickening, which could lead to deadly blood clots. Any and all aforementioned outcomes increase the risk of heart attack or stroke. 


As the body repeatedly experiences heightened anxiety, it releases an entourage of stress hormones, one of which is the extended-release of cortisol. Chronic, elevated levels of this steroid hormone overcompensate for the replenishment of stored energy that fluctuates during every anxiety-ridden spell. This disbursement of cortisol increases appetite and contributes to a buildup of fat tissue that leads to weight gain, which in turn, places more pressure on the heart to efficiently circulate blood throughout the body.


Studies have also shown that severe anxiety and acute stress have damaging effects on cognitive processes, such as working memory — the ability to attentively gather, manipulate, hold and use information while also staying on related or unrelated tasks. Working memory is crucial to reasoning and guided decision-making functions. 


Compared to the potentially devastating effects of generalized anxiety disorder, seeking help early to uncover the root of a mounting issue is worth investigating. Treatment comes in many forms, from implementing physical activity, a stress management plan or coping skills, such as breathing techniques, meditation and expressive writing exercises, to prescribed medications. 


It is not unusual for someone with generalized anxiety disorder to form unhealthy, and often addictive, habits like drug use, alcohol consumption or smoking in an attempt to lessen anxiety. In reality, these will increase anxiety and have a long-term impact on relationships, work performance and overall quality of life. It is also not uncommon to experience a co-occurrence of depression, panic attacks, attention-deficit/hyperactivity disorders, or sleeping disorders. In any case, treating both co-existing issues to achieve maximum, long-term relief is imperative. 


ABC News anchor Dan Harris and award-winning actress Emma Stone have been publicly candid with their personal struggles and coping methods in hopes that others will find refuge in similar outlets. Attempts to suppress his anxiety and depression by self-medicating and occasional recreational drug use led to Harris suffering a panic attack while on air in 2004. After seeking professional help and identifying the source of his battle, his inner voice — a former strength turned worse enemy. In 2014, he authored the No.1 New York Times bestseller, 10% Happier — a comical account of his journey toward reluctantly discovering the life-changing benefits of meditation and calming his inner voice. He later published Meditation for Fidgety Skeptics, a follow-up quest to debunk misconceptions surrounding meditation and a scientifically practical guide to rewiring the brain through the practice. To further encompass his story and reach others seeking support, Harris founded the 10% Happier podcast and app where users can find helpful discussions, guided meditations, access to experts in the field of meditation and actionable ways to gain peace of mind and achieve happiness. 


Unlike Harris, Stone lived with anxiety most of her life before having a fruitful career in an ultra-competitive industry in Hollywood. She was diagnosed with general anxiety and panic disorder at the age of 7 after her school nurse and mom noticed a daily pattern of lunchtime requests to go home due to sickness. However, her body language pointed to anxiety. In an interview with InStyle, Stone recalled her therapist using expressive writing and drawing as a way to help her visually separate herself from the feelings consuming her. A little green monster played the role. The monster perched atop her shoulder grew or shrunk based on the amount of listening power Stone gave it. The handcrafted book is a keepsake, and the numerous coping techniques she learned are now a part of her routine to maintain her mental health. She shares that reading, meditation, dancing, journaling and keeping a gratitude list are among her go-to tools. Stone’s passion for helping children overcome their challenges with anxiety is apparent in her active involvement with the Child Mind Institute, an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. From participating in virtual mental health campaigns and public forums discussing the connections between creativity and anxiety to now serving as a board member, she strives to keep the conversation going about a disorder that is often minimized and misidentified. According to the organization, 80 percent of anxiety disorders in youth go untreated. Of those treated, 81 percent improve with evidence-based anxiety treatments like cognitive behavioral therapy.


Physicians frequently recommend seeing a counselor before, or in addition to, trying medication. McCalman says, “Medication can be very helpful in allowing some space to think more clearly in caring for ourselves, especially when anxiety has been in charge for some time.” However, McCalman warns that, when medicating anxiety, it’s important to evaluate all options before getting a prescription. She also notes that the right prescription or dosage may take time and careful supervision by the prescribing physician. “Anxiety in the mind can easily twist what could be a helpful tool into a crutch that reinforces unhealthy thoughts like, ‘I need my medication to be myself,’ or ‘Without my medication, I can’t handle anything.’ This often disempowers and demoralizes patients who are already suffering with extreme anxiety. 

“Research suggests that psychotherapy provides a more effective and more sustainable method of caring for mental health, as well as increases the efficacy of medication.” 


Daily activity for everyone has been altered significantly this year in efforts to contain the spread of COVID-19, and “business as usual” is a term of the past for most professionals. Nuances of the novel coronavirus, nauseating volumes of opinions, election-year noise and ever-changing scientific data have collectively brewed a perfect storm of uncertainty and disruption, leading experts to believe that conditions are ripe for a national upswing in mental health issues. Results from U.S. Census Bureau surveys that included mental health screenings support this potential trend. The data collected showed that, compared to adults surveyed in the first half of 2019, adults gauged in April to May 2020 were more than three times as likely to screen positive for anxiety disorder, depressive disorder, or both, with more than one out of three screening positive for one or both in the 2020 samples. 


McCalman and Young agree that they, too, have seen an increase in concerns of stress, anxiety and relationship conflict over the past several months. “We anticipate this to continue rising as families settle into a transitioning school year and look towards fall and holiday planning,” Young says. 


Pandemic or not, take a moment to self-assess. If signs suggest anxiety is sneaking into your life, unmask and tackle it. Chances are that softening your inner voice or taming your little green monster will leave a lot more space in your life for happiness to dwell. 


Graph about coronavirus and mental health


READ MORE: How Do I Stop Anxiety? 10 Things You Can Do in the Moment to Keep Calm