Anxiety is one of the most common mental health concerns globally—and it's on the rise. More people are saying they face persistent worry, stress and fear, than in decades past.
Is it stress, or something more? Greg Westmoreland, NP, Medical Director of Community Counseling Services at Tufts Medicine Community Care, helps us understand what anxiety is and when to seek help.
Q: What is anxiety? Is it different from depression?
A: Anxiety is a natural response to stress or danger, provoking feelings of worry, nervousness or unease. These responses serve a purpose, they can help us stay alert and focused in challenging situations. Unlike depression, which is typically marked by persistent sadness, low energy, and a loss of interest or pleasure, anxiety centers more on fear, tension and anticipation of future threats. While the 2 can occur together, they are distinct conditions with different symptoms and treatments.
Q: Are there “normal” levels of anxiety? How much is too much?
A: It’s important to understand that some anxiety is normal. Nearly everybody has some anxiety in everyday situations—before a big test, job interview or public speaking. It becomes too much when:
- It occurs frequently or intensely
- Feels out of proportion to the situation
- Interferes with daily activities, relationships or work
- Causes significant distress or leads to avoidance behaviors
If your anxiety is persistent and hard to control, it may be considered an anxiety disorder.
Q: How can I tell if I should be screened for anxiety?
A: We recommend you get screened for anxiety if you:
- Feel anxious most days for several weeks or more
- Avoid places or activities out of fear or anxiety
- Experience physical symptoms (like racing heart, nausea or insomnia) without a clear cause
- Struggle to manage daily responsibilities due to worry or panic
Q: What happens during an anxiety screening?
A: Your PCP typically screens for anxiety and usually involves the following:
- A conversation about your symptoms, history and how anxiety affects your life
- Standardized questionnaires or checklists
- Questions about your physical health, lifestyle and any other mental health symptoms (like depression)
- Sometimes, a physical exam or lab tests are needed to rule out medical causes
If you are referred to a mental health professional, a more detailed screening will typically occur on your first visit. Usually, towards the end of the appointment, your mental health provider will review what they are seeing and have an open discussion with you about any potential mental health diagnosis, like a specific anxiety disorder. The main goal of this first appointment is to gain a thorough understanding of your concerns and then set goals with you for treatment moving forward.
Q. What are some of the most common anxiety disorders?
A. There are several types of anxiety disorders, including:
- Generalized anxiety disorder: Ongoing, excessive worry about various aspects of life (e.g., work, health, relationships) that lasts for months or more.
- Panic disorder: Recurrent, unexpected panic attacks—sudden episodes of intense fear accompanied by physical symptoms like chest pain, dizziness, or shortness of breath.
- Social anxiety disorder: Intense fear of being judged or embarrassed in social situations.
- Specific phobias: Strong, irrational fear of particular objects or situations (e.g., flying, spiders, heights, needles, blood).
- Separation anxiety disorder: Extreme fear about being apart from attachment figures (more common in children but can affect adults too).
- Agoraphobia: Fear of being in situations where escape might be difficult or help might not be available, often leading to avoidance of public places.
Q: How is anxiety treated?
A: The good news is that anxiety is highly treatable. Your clinician or therapist will work with you to create a personalized treatment plan based on the severity, as well as your preferences and response to therapy. Your plan may include some or a combination of the following:
- Psychotherapy, including cognitive behavioral therapy (CBT), which helps change negative thought patterns and behaviors
- Medication, such as antidepressants or anti-anxiety medications, which can help manage symptoms and typically prescribed by your PCP or a psychiatrist/psychiatric nurse practitioner.
- Lifestyle changes, including regular exercise, mindfulness, healthy sleep and reduced caffeine and alcohol use
- Support groups or stress management programs
The bottom line?
You don’t have to suffer and you don’t have to do it alone. If your anxiety is impacting your life, seeking help is the first step toward managing anxiety effectively.
