Here’s the thing about anxiety, you wear it from head to toe like a shaky suit of armor that can break with just a budge. When it takes hold, outwardly, it emanates angsty energy from every pore, while internally, there’s a sense of panic, worry, fear, and doom.

From a clinical perspective, “anxiety is a state of distress characterized by varying degrees of emotional and physical signs and symptoms arising from both internal and external factors,” says psychiatrist Grant H. Brenner M.D., FAPA, co-founder of Neighborhood Psychiatry, in Manhattan. But that doesn’t do justice to how you feel anxiety. “It’s a sense of unease, worry, and mild fear, often accompanied by repetitive negative thinking,” says Dr. Brenner.

Who Gets Anxiety?

You’ve probably asked yourself a million times: “Why do I feel this way? Does everyone feel like this?” Some people are genetically predisposed to anxiety, but for others, it’s triggered by life experiences, Dr. Brenner says. And it’s incredibly common. According to the Anxiety and Depression Association of America, anxiety disorder affects over 18 percent of adults in the US every year and over 25 percent of children between 13 and 18 years old. When you look at the numbers, you can see just about everyone either has anxiety, is married to someone with anxiety, or is related to someone with anxiety.

How Do You Know It’s Anxiety?

For starters, with anxiety you feel it in your mind and your body. Sometimes people notice things like a fast heartbeat and think they’re having a heart issue. Other physical symptoms could be:

  • Nervousness
  • Jitters, tremors or shakes
  • An unsteady voice
  • Sweating
  • Muscle tension
  • Difficulty relaxing
  • Insomnia

On the mental and emotional front, anxiety often causes:

  • Worry
  • Obsession
  • Irritability
  • A general sense of unease
  • Negative thinking
  • Confusion
  • Indecision

And, what’s tricky is things like obsessing can actually be rewarded, so you might not focus on the fact that it’s harming your overall wellbeing.

“Anxiety may also have behavioral manifestations, as people may cope with anxiety with more or less adaptive responses. For example, some people tend to withdraw when anxious, behave aggressively, or self-medicate with drugs and alcohol, all of which may worsen the problem,” Dr. Brenner says.

When it’s severe, anxiety may become panic, accompanied by a strong sense of fear, or manifest as specific fears or phobias.

How Can You Tell You Need To See Someone?

A little anxiety (not an anxiety disorder) can be an okay thing. When it comes in the form of that slight nagging feeling that you could fall short in some way, so you better prepare, then it’s actually even helpful. The problem is when those feelings are so ingrained they become your default mode.

Even if you don’t have those physical symptoms, like insomnia or heart palpitations, your thoughts can still be downright destructive. Constant cycles of second-guessing, indecision,  and negative self-talk, can be just as debilitating. Seeing a pro can help you break the cycle and look at things more realistically, which is actually a pretty useful skill.

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How Do You Know What Kind Of Doctor To See?

If this were a flow chart, we’d start with this question: Do you think you might need a prescription? If the answer is yes, you’d want to see a psychiatrist since they can prescribe. But, that isn’t exactly true. Psychologists can write prescriptions in Iowa, Idaho, Illinois, New Mexico, and Louisiana. Besides, with anxiety, there are options besides meds, like cognitive behavioral therapy and talk therapy.

Since there’s really no right answer on what kind of pro to see, here’s some info to help you at least make sense of the choices.

  • A psychiatrist went to medical school (they have an MD or DO after their name) and can write prescriptions in every state. Because of their training (they have to do rotations in everything from pediatrics to surgery), they get how the whole body works and may have more broad expertise in addition to their specialty.
  • A psychologist may have about the same amount of training as a doctor (at least four years post-college, externships, and board exams for a PhD or PsyD), but the type of training is different. Psychologists only focus on mental health. They have a lot of expertise in assessment and research-based treatments like cognitive behavioral therapy. You can also be a psychologist with just two years of training or be a counselor.
  • Social workers also go to grad school, earning an MSW (master of social work) or LCSW (licensed clinical social worker) degree. Their specialty is usually on connecting people to support services.

All of this is made even more confusing when you add therapists. Basically, a therapist can be any one of these specialists. It’s more of a generic term rather than one that reflects a specific degree.

How Much Will Therapy Cost? Will Insurance Pay?

The rates depend on what kind of pro you see. A psychiatrist is going to be more expensive than a social worker. And, where you live also matters. According to SimplePractice, a business software pros use to manage their practice, a session can be anywhere from $68 to $250.

The most expensive cities for therapy are:

  • Miami-Fort Lauderdale-West Palm Beach, FL, $250
  • New York-Newark-Jersey City, NY-NJ-PA, $175
  • San Jose-Sunnyvale-Santa Clara, CA, $165

The least expensive cities for therapy are:

  • Orlando-Kissimmee-Sanford, FL $68
  • Detroit-Warren-Dearborn, MI $75
  • Minneapolis-St. Paul-Bloomington, MN-WI $75

Your healthcare insurance probably will pay some portion of this, depending on your plan and if you go in-network. Here are some tips for finding affordable therapy.

How Do You Get A Doctor Referral? Do You Need One?

Speak to your primary care doctor for a referral. While online referral services are becoming more popular, it’s hard to know the quality of the referral, Dr. Brenner says. You can also contact your state professional psychological association, which has a referral service on hand and can help you find a professional in your area.

Finding someone qualified seems obvious, but don’t forget to also look for someone whose style and approach is a good fit for you. Don’t be afraid to meet with a few people, and make sure you have important questions prepared in advance, Dr. Brenner says. Having the foremost expert of cognitive behavioral therapy isn’t going to do a lot of good if you can’t stand the person. It helps to think about it as a relationship—you’ll spend a lot of time with this person and should feel comfortable.

How Should You Prepare For Your First Appointment?

Writing down questions ahead of time can help you organize your thoughts and ensure you get all the answers you need so you don’t go home with even more worry. These include:

  • What’s causing my anxiety?
  • Do I need to see a specialist?
  • What types of therapy can help me?
  • Do I need medication to manage my symptoms?
  • Are there side effects from medications?
  • What can I do at home to help myself?
  • What resources can I use to read more about anxiety?

What Kinds Of Questions Can You Expect From A Therapist?

In order to gauge how you’re feeling and the severity of your symptoms, your doctor might ask any of the following questions:

  • What are your symptoms and how are they impacting day-to-day life?
  • When did your symptoms start and how long have they lasted?
  • Does anything trigger your anxiety or make it worse?
  • Do you have a family history of anxiety or other mental health conditions?
  • Are you currently taking any medications?

What Tests Might Be Given? 

While anxiety in and of itself cannot be diagnosed via a blood test, your primary care doctor might do a physical exam or conduct some blood work to rule out any underlying conditions. They also may give you a standardized questionnaire that surveys symptoms of anxiety consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association to diagnose an anxiety disorder.

A psychologist may conduct a psychological evaluation using a battery of tests that typically involve standardized questionnaires, personality inventories, and structured interviews that assess emotional functioning to determine whether you meet the DSM-5 criteria for an anxiety disorder.

What Types Of Therapy May Be Used?

Cognitive behavioral therapy (CBT) is the most common therapy for generalized anxiety, Dr. Brenner says. CBT targets thoughts, physical symptoms, and behaviors, like the over-preparation, planning, and avoidance, that come with anxiety. It’s about teaching specific skills to improve symptoms and help you return to the activities you may have avoided because of anxiety. CBT focuses on identifying, understanding, and helping you make changes with thinking, temperament, and behavioral patterns. Your therapist will offer practical approaches to problem solving to help change your thinking patterns and help you gain control over your thoughts.

Phobias and post-traumatic stress treatment often involve exposure therapy, which is part of CBT, Dr. Brenner says. This involves exposure to the activity, object, or situation that’s triggering the anxiety to help you manage it and be less afraid of the presence of anxiety, so that you can ultimately make better choices.

Some mental health professionals are now using technology such as virtual reality to enhance exposure-based therapy. Virtual reality involves treating anxiety through realistic computer-generated environments within a controlled setting. It provides the opportunity for a sense of immersion in the feared environment to help you become less afraid of it.

Mindfulness based approaches can also help you to understand the nature of the anxiety itself and better manage it. Mindfulness is about learning to respond to anxiety with awareness about what’s happening in the present moment. By focusing on the present moment, you can learn to counteract worry so that your reactions are less rash and maladaptive and more adaptive.

Other more long-term, insight-oriented therapy, such psychodynamic or psychoanalytic therapy, can help provide greater understanding of the roots of anxiety and one’s personality, Dr. Brenner says.

What Types Of Medication May Be Prescribed?

For short-term management of anxiety, benzodiazepines are often prescribed as the first line of defense, but these are not usually appropriate for long-term use due to concerns about dependency, lack of effectiveness, and adverse reactions. Common benzodiazepines include Ativan, Valium, Xanax, and Klonopin. They act as a sedative by enhancing the tranquilizing effects of the neurotransmitter GABA by slowing down activity in the brain and reducing the symptoms of anxiety.

They take effect more quickly than the antidepressant medications often prescribed for anxiety. But there are drawbacks. You can build up a tolerance to them if they are taken over a long period of time and then you need a higher dose to get the same effect. Some people may even become dependent on them.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are a mainstay treatment for anxiety and considered an effective treatment for all anxiety disorders.

  • SSRIs relieve symptoms by blocking the reabsorption of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. Common SSRI medications include Lexapro, Prozac, and Zoloft. Side effects may include insomnia or sleepiness, sexual dysfunction, and weight gain.
  • Serotonin-norepinephrine reuptake inhibitors, or SNRIs increase both the levels of the neurotransmitter serotonin and norepinephrine by blocking their reabsorption into cells in the brain. By stabilizing these neurotransmitters, SNRIs can help improve mood, reduce anxiety, and help alleviate panic attacks. Common SNRI medications include Cymbalta, Effexor, and Pristiq. Side effects may include stomach upset, insomnia, headache, sexual dysfunction, weight gain, and a minor increase in blood pressure.

Additional classes of medications including tricyclic antidepressants and mood stabilizers may be used when anxiety is harder to treat.

How Should You Prepare For Follow Up Mental Health Appointments?

Keeping symptom logs and doing homework may be a useful part of some forms of therapy. “It’s helpful to keep track of sleep, irritability, anxiety, behavioral problems, functional disturbances and timing, duration, and triggers of symptoms,” Dr. Brenner says. You can try an app like Daylio or IMood Journal. Or, if you don’t want to have a digital record of your every mood, go old-school with a downloadable worksheet.

If you’re thinking about online therapy, read this article on how to maximize your appointments and what to expect.

Last Updated: May 6, 2020