presentation anxiety

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You may start by seeing your primary care provider to find out if your anxiety could be related to your physical health. He or she can check for signs of an underlying medical condition that may need treatment.

However, you may need to see a mental health specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).

To help diagnose an anxiety disorder, your mental health provider may:

• Give you a psychological evaluation. This involves discussing your thoughts, feelings and behavior to help pinpoint a diagnosis and check for related complications. Anxiety disorders often occur along with other mental health problems — such as depression or substance misuse — which can make diagnosis more challenging.
• Compare your symptoms to the criteria in the DSM-5. Many doctors use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose an anxiety disorder.
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The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

• Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you've avoided because of anxiety.

CBT includes exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.

Medications

Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. For example:

• Certain antidepressants are also used to treat anxiety disorders.
• An anti-anxiety medication called buspirone may be prescribed.
• In limited circumstances, your doctor may prescribe other types of medications, such as sedatives, also called benzodiazepines, or beta blockers. These medications are for short-term relief of anxiety symptoms and are not intended to be used long term.

Talk with your doctor about benefits, risks and possible side effects of medications.

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Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:

• Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
• Avoid alcohol and recreational drugs. These substances can cause or worsen anxiety. If you can't quit on your own, see your doctor or find a support group to help you.
• Quit smoking and cut back or quit drinking caffeinated beverages. Both nicotine and caffeine can worsen anxiety.
• Use stress management and relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
• Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.
• Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.

Alternative medicine

Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. Herbal and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe. Some of these supplements can interfere with prescription medications or cause dangerous interactions.

Before taking herbal remedies or dietary supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.

Coping and support

To cope with an anxiety disorder, here's what you can do:

• Learn about your disorder. Talk to your doctor or mental health provider. Find out what might be causing your specific condition and what treatments might be best for you. Involve your family and friends and ask for their support.
• Stick to your treatment plan. Take medications as directed. Keep therapy appointments and complete any assignments your therapist may give you. Consistency can make a big difference, especially when it comes to taking your medication.
• Take action. Learn what triggers your anxiety or causes you stress. Practice the strategies you developed with your mental health provider so you're ready to deal with anxious feelings in these situations.
• Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
• Join an anxiety support group. Remember that you aren't alone. Support groups offer compassion, understanding and shared experiences. The National Alliance on Mental Illness and the Anxiety and Depression Association of America provide information on finding support.
• Learn time management techniques. You can reduce anxiety by learning how to carefully manage your time and energy.
• Socialize. Don't let worries isolate you from loved ones or activities.
• Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.

Preparing for your appointment

You may start by seeing your primary care provider. He or she may refer you to a mental health professional.

What you can do

Before your appointment, make a list of:

• Your anxiety symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect your day-to-day activities and interactions.
• What causes you stress. Include any major life changes or stressful events you've dealt with recently. Also note any traumatic experiences you've had in the past or as a child.
• Any family history of mental health problems. Note if your parents, grandparents, siblings or children have struggled with any mental health problems.
• Any other health problems you have. Include both physical conditions and mental health issues.
• All medications you're taking. Include any medications, vitamins, herbs or other supplements, and the doses.
• Questions to ask your doctor to make the most of your appointment.

Some basic questions to ask your doctor include:

• What's the most likely cause of my anxiety?
• Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?
• Do I need any tests?
• Should I see a psychiatrist, psychologist or other mental health provider?
• What type of therapy might help me?
• Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
• In addition to treatment, are there any steps I can take at home that might help?
• Do you have any educational materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you several questions, such as:

• What are your symptoms, and how severe are they? How do they impact your ability to function?
• Have you ever had a panic attack?
• Do you avoid certain things or situations because they make you anxious?
• Have your feelings of anxiety been occasional or continuous?
• When did you first begin noticing your feelings of anxiety?
• Does anything in particular seem to trigger your anxiety or make it worse?
• What, if anything, seems to improve your feelings of anxiety?
• What traumatic experiences have you had recently or in the past?
• What, if any, physical or mental health conditions do you have?
• Do you take any prescription drugs?
• Do you regularly drink alcohol or use recreational drugs?
• Do you have any blood relatives who have anxiety or other mental health conditions, such as depression?

Preparing and anticipating questions will help you make the most of your time.

• Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Feb. 26, 2018.
• Anxiety disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed Feb. 26, 2018.
• Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. March 5, 2018.
• Anxiety disorders. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders/Overview. Accessed Feb. 25, 2018.
• Help with anxiety disorders. American Psychiatric Association. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Accessed Feb. 28, 2018.
• Reinhold JA, et al. Pharmacological treatment for generalized anxiety disorder in adults: An update. Expert Opinion in Pharmacotherapy. 2015;16:1669.
• Bandelow B, et al. Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology. 2015;30:183.
• Find support. National Alliance on Mental Illness. https://www.nami.org/Find-Support. Accessed Feb. 26, 2018.
• Bazzan AJ, et al. Current evidence regarding the management of mood and anxiety disorders using complementary and alternative medicine. Expert Review of Neurotherapeutics. 2014;14:411.
• Natural medicines in the clinical management of anxiety. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 26, 2018.
• Sarris J, et al. Plant-based medicines for anxiety disorders, Part 2: A review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27:301.
• Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2018.
• Bystritsky A. Pharmacotherapy for generalized anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2018.
• Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. March 21, 2018.

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