48 of the Best Resources to Help with Overcoming Anxiety (Includes Help with Anxiety for Adults and Children!)

Anxiety is a treatable condition. Depending on the intensity, some people can get better on their own and others need therapy and/or medications to help with anxiety. Either way, recovering from anxiety is possible! There are great self-help options available to assist with the treatment of anxiety which includes websites, apps, and books on overcoming anxiety.

 

I compiled a list of 48 of my favorite anxiety resources that are full of information for both adults and children. Get your list here:

 

Imagine what life would be like without anxiety. Would you do things differently?

If you got help with anxiety would you:

  • Pursue different careers or hobbies?
  • Try to get that promotion you deserve even if it requires travel and public speaking?
  • Fly in a plane or go back to school to complete your degree?
  • Drive on the highway so you can take road trips?
  • Say yes to that party at your friends’ house? Or to a work gathering?
  • Go to a store instead of ordering everything online?
  • Have some peace of mind?
  • Fall asleep easier and wake up without fear?

Overcoming Anxiety

Anxiety can be healthy and normal. It’s a motivator and is our body’s way to remind us we need to pay attention. If we are anxious about something we may try harder to be prepared. Anxiety can be a helpful tool for our success and survival.

 

But sometimes anxiety stops being helpful and starts to run the show. It becomes so powerful anxious feelings are overvalued and evidence that might contradict worry thoughts is ignored. Naturally, the tendency is to avoid the things that feel unpleasant yet once the avoidance cycle starts anxiety has the upper hand.

 

Anxiety can be a helpful signal and enhance your life, but it is a problem when it begins to rule decisions. Get help with anxiety so you can stop responding to fears and worries in ways that end up making it worse.

Treatment of Anxiety

Here is my comprehensive list of recommended treatment options for children and adults, including websites, apps, and books on overcoming anxiety. It includes 48 different resources to get you recovering from anxiety so you can take back control of your life.

 

Download this resources list to help you get started overcoming anxiety now!

 

Adventure Awaits! How to Overcome Fear of Flying Phobia.

Recently, I took an international trip with my family that required a 16-hour plane ride. Stuck in an uncomfortable middle seat for this unpleasantly long flight I had lots of time to think and reflect in order to make the most of this extended period of nothingness. One of the topics I thought about is how life would change if I had a fear of flying phobia and the trips and family adventures I would miss out on. Fear of flying is common and many of my patients talk to me about this very thing. You can learn how to overcome fear of flying phobia. There are many adventures that await you (or business trips). Don’t let the anxiety and fear that accompany this hold you back- get treatment and put the anxiety behind you.



What is a fear of flying phobia?

Fear of flying, or aviophobia, is a type of “specific phobia” involving unreasonable and out-of-proportion levels of intense, persistent, fear of specific objects, situations, activity, or people.

Taking control to manage (and avoid) anxiety

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

Oftentimes, people with anxiety manage it by doing something that makes them feel in control. Anxiety causes such out-of-control feelings it’s a natural response to reflexively do things to feel back in control. Not all forms of “taking control” actually help us in the long run but they need to be recognized as attempts at self-soothing and anxiety management.

 

These attempts to regain control over anxious feelings may take the form of:

 

  • Obsessively organizing the house,
  • Deciding to drive backroads to avoid a bridge or highway,
  • Choosing to drink alcohol before an event to calm down,
  • Or most commonly, to avoid the anxiety-provoking event entirely.

Flying in an airplane is the ultimate loss of control.

You aren’t flying the plane (well, I hope you aren’t!) and you can’t get off if you want to. If you have a panic attack you will be “trapped” in the airplane for the duration of the flight. It’s no wonder that so many people with anxiety have a fear of flying.



Avoiding the anxious trigger (flying)

Avoidance is usually the coping mechanism that wins with fear of flying. People with a flying phobia will do whatever they can to avoid a flight. I have patients who are willing to drive for 24 hours to make it to an event that they could have flown 3 hours to get to. And 2 days later they have to turn around and drive back. Oftentimes, they insist this doesn’t bother them but I wonder how much that is a defense because the idea of flying is UNTHINKABLE to them.

Is a flying phobia really a big deal?

Having a fear of flying phobia may sound like it wouldn’t cause many difficulties in one’s life since most people don’t need to fly often…. until you hear individuals describe how it has changed their life. I have had patients completely alter their professional trajectory out of fear they would need to travel. This includes declining promotions that they otherwise wanted because the jobs would involve distant business meetings or deciding to change careers entirely to one that will never require airplane travel.

The whole family is affected by this

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

This phobia interferes with family life when people end up staying home from family trips that require flying. Weddings missed and distant adventures never experienced, a flying phobia can be made into a whole family affair.

 

When people do acquiesce to taking a trip, their anxiety may skyrocket and they often fret and seek reassurance from the time the trip is booked until it happens… sometimes declining to go at the last minute. It can be paralyzing for them. If a trip is booked a year in advance, without treatment a person with a flying phobia may spend the majority of the year with anticipatory anxiety worrying about this upcoming vacation.

Good news! There are excellent treatments available to overcome fear of flying:

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

Many people seek out medication from their doctor to alleviate the terror they feel about flying. This usually takes the form of as-needed anxiety-relieving medication they can take just before getting on the flight. Although this can reduce the person’s anxiety, and be the reason they agree to fly, there are more effective preventative treatments available.



In the situation of occasional airplane travel, using an as-needed benzodiazepine is possibly reasonable (I say possibly because it depends on the particular person’s history. Benzodiazepines are not appropriate for everyone even if the situation is a reasonable one to use it for). Oftentimes, when a person knows they have a medication that will reduce anxiety, this is enough for them to agree to travel. They may never love flying, but they know they can “white-knuckle” it and get through when they need to.

 

Solely having treatment be an as-needed benzodiazepine isn’t ideal if:

 

  • A person has to travel regularly,
  • They experience high anxiety at the thought of flying,
  • Avoiding flying impacts their life negatively.

 

People can overcome this fear by doing cognitive behavioral therapy (CBT) specifically aimed at addressing their fear of flying.

How to overcome fear of flying: A great treatment option

Created by a pilot (he is also a therapist) who knows everything about airplanes, Soar is a great example of a successful program to address the fear of flying.

 

I love this program because it combines his flying expertise with specially created CBT programs to target fear of flying. He has DVD’s to listen to on your own time, and some packages include 1:1 counseling with him. He even has an emergency program called “Help Me Now” targeted to people flying the next day who need immediate intervention so they can get on a plane.

 

I have had patients terrified of flying use this program who can attest to its benefits. They now fly comfortably without the need for anxiety medication.

 

Watch these educational videos from Captain Bunn about fear of flying. They include pointers about how to get rid of it.

Fear of flying does not need to control you!

Don’t miss out on any other family vacations or work trips that are needed for your career. There are treatments available that can successfully treat flying phobia so you don’t need to avoid and worry any longer.

 

Get the help you need. Talk to your physician and/or check out the Soar program so you can eliminate this fear of flying permanently.



For additional help and information about anxiety read these articles:

Shifting Thoughts and Taking Control: Cognitive Restructuring for Anxiety Management

5 Ways to Stop a Panic Attack

The Best Resources for Anxiety

 

Fall Prevention in the Elderly: Improve Sleep and Reduce Anxiety Without an Increased Risk of Falling

Preventing falls in the elderly can significantly improve quality of life. Unfortunately, falling and injury happen too frequently. Fall prevention in the elderly is the result of common sense safety planning and education regarding contributing factors that set people up to fall. Many frequently used medications increase these risks, especially sleep aids and certain anxiety medications. But insomnia and anxiety also impair quality of life and need to be treated. Learn more about the risks and safer alternatives that can help.



Why is fall prevention in the elderly so important?

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

Here is a quote from the National Council on Aging that sums up why it is essential to do everything we can to minimize the risk of falling. These are some scary facts!:

 

“According to the U.S. Centers for Disease Control and Prevention:

  • One in four Americans aged 65+ falls each year.
  • Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
  • Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
  • In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75% of these costs.
  • The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by 2020.”

Why are so many older adults prescribed medication that can increase the risk of falls?

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

Many medications increase the risk of falling in the elderly but oftentimes psychotropic medications are the culprit. It would be easy to say “just don’t prescribe them!” but, of course, it isn’t that simple.

Here are 3 examples of why a medication that increases fall risk gets prescribed:



1. Decreased quality of sleep: An unfortunate reality of aging is decreased quality sleep. (This article tells you why. Hint: It’s related to melatonin). Lack of sleep can feel torturous and sleep deprivation also sets people up to make clumsy or careless mistakes that they may not have made if they were more rested.

 

Naturally, people want to sleep so

they ask their physician for a sleep aid.

 

2. Anxiety: Anxiety is a common and uncomfortable condition and people understandably want to feel better as quickly as possible. Medications that work quickly to minimize anxiety increase the risk of falls in the elderly. Safer alternatives don’t work as quickly as a benzodiazepine so this makes these quick-acting medications tempting (and sometimes necessary) to use.

 

3. A person is already on the medication or was treated with it successfully in the past so they want it back: Maybe the person has tried multiple different medications and has found certain medications are the only ones that work well for their particular condition. They took the medication in the past and want it restarted or perhaps they are currently taking the medication. If the medication helps them feel better and they have no noticeable side effects they may have no motivation to come off the medication based upon theoretical risks.

Preventing falls in the elderly: Sleep aids and risk

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

There is a clear, established, association between certain sleep aids and increased risk for falls (and an increased risk of dementia! This risk is becoming clearer with recent data).



Here is a quote from a research article published in Sleep:

 

Compared with older adults who did not use sleep medications, those who used physician-recommended sleep medications at baseline were approximately 34% more likely to report a fall at follow-up.

These hypnotic (sleep-inducing) medications like the benzodiazepines and “Z-drugs” can all increase fall risk:

  • Xanax/ alprazolam,
  • Ativan/ lorazepam,
  • Klonopin/ clonazepam,
  • Ambien/ zolpidem,
  • Sonata/ zaleplon,
  • Lunesta/ eszopiclone.

RULE:

If a medication causes sedation (it’s hard to help people fall asleep without some sedation!) it can increase fall risk. Reaction time and postural control (the ability to know where your body is in space and correct balance when it gets off center) decrease when someone is sedated.

 

For example: Think about how often falls happen when people get out of bed at night and try to walk to the bathroom. They are not only sedated but the risk is elevated in dim lights when the eyes can’t compensate for the bodies’ lack of spatial awareness.

What are the alternatives to improve sleep and anxiety?

Behavioral treatments for sleep are effective. These include maximizing sleep hygiene (for a review of what this is and how to improve sleep hygiene read this article) and dealing with sleep-related worries through cognitive behavioral therapy for insomnia (referred to as CBTi. Read more about this here). Mindfulness and relaxation exercises can help and don’t have any side effects.



If medication is necessary, there are options that have less risk than classic sleep aids.

2 medications that have less risk of falls:

1. Melatonin:

Melatonin, an over-the-counter sleep aid (Read my recommendations for dosing melatonin). This medication may have less risk however that doesn’t mean NO risk. It is still sedating and can cause morning drowsiness for some people.

2. Trazodone:

Trazodone (a really old antidepressant medication that is SO sedating people cannot tolerate it in the doses necessary to treat depression) is used pretty much exclusively for sleep now. This medication can have side effects too and also can interact with some other medications. There is more information on these facts in this article,

Alternatives for the treatment of anxiety:

For anxiety, there are treatments like psychotherapy (how therapy works is explained here), and antidepressants. Both of these options can treat anxiety without the same risk that happens with a benzodiazepine (listed above).



Fall prevention in the elderly

Insomnia and anxiety impair quality of life and need to be taken seriously. Weighing the risks and benefits of each treatment option is essential to come up with the best (safest and most effective) choice for each person. The crux of fall prevention in the elderly is to balance treating the symptoms while taking the risks seriously and minimizing them with safer alternatives whenever possible.

For more discussion on sleep and aging read this article:

Sleep and aging: What happens to our sleep and how to make it better

 

The Controversy Around Use Of Benzodiazepines. What Are Benzodiazepines Used For And Is It Ever Okay? (Yes)

There is controversy around use of benzodiazepines but benzodiazepine medications are necessary and helpful sometimes...just not always. What is a benzodiazepine? What are benzodiazepines used for when they are helpful?

Benzodiazepine medications have gotten a bad rap and there is much controversy in the psychiatric community about their use. Some people feel they should never be used and some feel they are highly useful. Like most areas of life, there is likely a middle ground- sometimes the use of benzodiazepines is essential and quite helpful…sometimes they are harmful and impede the progress of treatment. Let’s look at some situations where a benzodiazepine could be useful or could be potentially harmful. But before we do that, I will review some definitions and basics. What is a benzodiazepine? What are benzodiazepines used for? And then we can break down situations where they may be helpful for treatment or should be avoided.

 

There are effective techniques to get rid of anxious thinking. Download this worksheet so you can start taking control back now!

What is a benzodiazepine?

There are different types of treatments for anxiety and one of the medications used is called a benzodiazepine. Think of the word “benzodiazepine” as the last name for a family and the individual medications are the family members. The individual members of the benzodiazepine family are medications like Xanax/ alprazolam, Ativan/ lorazepam, Klonopin/ clonazepam, Valium/ diazepam, etc…

 

The medications in the family are all similar but they vary in how fast they take effect and how long they last.



What are benzodiazepines used for?

These are called anxiolytic medications which means they work to alleviate anxiety. But benzodiazepines don’t prevent anxiety. They are a bandaid that helps to minimize it when it happens. Similar to taking ibuprofen or acetaminophen for a headache, benzodiazepines are taken when someone is feeling anxious. Read more here: Benzodiazepines: Do They Treat Anxiety?

 

There are other uses for benzodiazepines (for example treating a seizure or alcohol withdrawal) but today we will mainly focus on its uses for anxiety.

 

Benzodiazepines can be helpful: 

1. People with a specific phobia like a fear of flying:

There is controversy around use of benzodiazepines but benzodiazepine medications are necessary and helpful sometimes...just not always. What is a benzodiazepine? What are benzodiazepines used for when they are helpful?

Let’s take the example of someone with a phobia of flying who only has to fly occasionally (if they need to fly more often the treatment would be different).

Is this really a big deal?

Having this phobia may sound like it wouldn’t cause many difficulties in one’s life since most people don’t need to fly often…. until you hear individuals describe how it has changed their life. I have had patients completely alter their professional trajectory out of fear they would need to travel. They have refused promotions because the jobs would involve distant business meetings or decided to change careers entirely to one that will never have that requirement.



This phobia can interfere with family life when people end up staying home from family trips that require flying.

Relief comes from knowing there is a “rescue”

Oftentimes, when a person knows they have a medication that will reduce anxiety before their flight, this is enough for them to stop avoiding travel. They may never love flying, but they know they can get through it when they need to. In this situation, using an as needed benzodiazepine is possibly reasonable (I say possibly because it depends on the particular person’s history. Benzodiazepines are not appropriate for everyone even if the situation is a reasonable one to use it for).

With regular travel, or for someone who wants to eliminate this anxiety forever regardless of how often they travel, there are excellent treatments available:

If a person has to travel regularly, solely having their treatment be an as-needed benzodiazepine isn’t ideal. People can overcome this fear by doing cognitive behavioral therapy (CBT) specifically aimed at addressing their fear of flying. Soar is a great example of a program to address the fear of flying. I love this program because it is created by a pilot who knows everything about airplanes and combines this knowledge to create targeted CBT programs, most of which can be done online. I have had patients terrified of flying use this program who now fly comfortably without the use of any medication.

 

Watch these videos from Captain Bunn about fear of flying and how to get rid of it.

2. Specific time-limited events:

There is controversy around use of benzodiazepines but benzodiazepine medications are necessary and helpful sometimes...just not always. What is a benzodiazepine? What are benzodiazepines used for when they are helpful?

When someone has a predictable and time-limited situation that causes significant anxiety, an as-needed benzodiazepine may be useful.

 

Here are some examples of what I mean:

 

Public speaking: This is an option, however, benzodiazepines aren’t always the best selection for public speaking anxiety. For some people, it works fine but others may feel a bit foggy when they take it. There are other medications (like propranolol) that can be prescribed in this situation and aren’t sedating or cloud thinking.



A particular social event: As long as the social event doesn’t involve drinking alcohol, people who have tremendous anxiety about a situation may be helped by a benzodiazepine before it.

3. Occasional panic attacks:

People that have infrequent, occasional panic attacks may be helped by a benzodiazepine that would be taken when they are starting to have an attack. The medication can interrupt the panic attack shortening its course and lessening its intensity.

 

If panic attacks are a regular occurrence, benzodiazepines aren’t the most effective treatment. They still may be useful, however other preventative medications combined with therapy targetted to address panic attacks would be recommended.

Dangerous or generally not useful:

1. In combination with an opiate:

There is controversy around use of benzodiazepines but benzodiazepine medications are necessary and helpful sometimes...just not always. What is a benzodiazepine? What are benzodiazepines used for when they are helpful?

This is a potentially dangerous and lethal combination. Although there are many people with chronic pain and severe anxiety who have used this combination safely for years this should be avoided if at all possible. For people with addictions, benzodiazepines can enhance a “high” when combined with an opiate and can increase the chance for a lethal overdose.

2. Frequent panic attacks and daily anxiety

When someone has frequent panic attacks or daily anxiety a preventative medication like an antidepressant and/or therapy such as Cognitive Behavioral Therapy is more useful than a benzodiazepine. When the only treatment is a benzodiazepine, people get in a situation where they end up having to chase the anxiety to keep up with it rather than preventing it from the beginning.

 

Unfortunately, not all people tolerate antidepressants (the primary preventative treatment for anxiety) so occasionally, benzodiazepines will still need to be used even when their anxiety is daily.

3. During Cognitive Behavioral Therapy and Dialectical Behavioral Therapy

There is controversy around use of benzodiazepines but benzodiazepine medications are necessary and helpful sometimes...just not always. What is a benzodiazepine? What are benzodiazepines used for when they are helpful?

Certain treatments, like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), need people to experience the situation and the emotions happening in order to practice using skills to get through it. Although this may sound unpleasant, it can be a key in recovery. No longer does someone need to be controlled by the fear of panic or distress if they know they can handle it.



In this type of treatment, taking a benzodiazepine can interfere with learning and practicing coping strategies that will allow a person to overcome panic attacks or episodes of emotional distress on one’s own.

 

4. People who struggle with addiction, particularly to alcohol

Alcohol and benzodiazepines can be lethal in combination. They have synergistic effects and the results aren’t always predictable. There is cross-dependence between both of these substances as they both affect the same receptors in the body.

 

The side effects of benzodiazepines and alcohol are similar to each other so using both at the same time can multiply the body’s response and make the symptoms worse.  Both benzodiazepines and alcohol slow breathing and a major danger of using them together is it increases the chance that the person will stop breathing.

 

Sometimes, a person with an addiction, will not take this medication as prescribed and instead use it as a way to escape or feel high (by taking higher doses) and not as a way to alleviate anxiety. Obviously, in this situation, it is not recommended to prescribe the medication.

 

A side note on addiction potential:

Long term use of benzodiazepine medications can cause physiological dependency and withdrawal. This is not the same as addiction. What this means is that we need to taper benzodiazepines slowly to help avoid physical withdrawal.



There is no physical dependence that happens when these medications are not taken daily.

 

Benzodiazepines: Good or bad?

Like in all parts of life, things generally aren’t all-or-nothing and don’t fall into black and white categories crisply delineating them as good or bad (read more about black and white thinking here). Benzodiazepine medications have a bad rap (sometimes for a very good reason) but can also be extremely helpful for the right type of situation in the appropriate person.

 

Ask your physician if you are wondering if a benzodiazepine would be helpful for you.

 

Learn more about controlling and treating anxiety. Here are my most popular posts:

5 Ways to Stop a Panic Attack

Shifting Thoughts and Taking Control: Cognitive Restructuring for Anxiety Management 

This post has a free worksheet on how to get rid of thoughts related to anxiety so they don’t keep coming! You can also signup to download it here:

 

Catastrophizing Anxiety

The Best Resources for Anxiety

Do what you are afraid of! Stop letting anxiety control you

 

 

***There may be affiliate links in this post. I do not recommend anything I would not use myself or recommend to a family member. These links give a small commission to help cover the cost of running this website but cost you no extra money.***

 

Shifting Thoughts and Taking Control: Cognitive Restructuring for Anxiety Management

Anxiety management and recovery require recognizing anxious catastrophic thinking when it is happening (read here for more details). Once recognized, you can reduce anticipatory anxiety by changing thoughts and interrupting projections. Break down these thoughts and create a framework to analyze them with cognitive restructuring techniques.

First, let’s review some definitions.



Anticipatory anxiety is all the time wasted dreading, worrying, and panicking over a future event (a projection of an imagined outcome) where every imaginable negative outcome is thought of (catastrophizing). Cognitive restructuring techniques are tools to help break down these thoughts and analyze them using a series of questions. These questions help to identify when a cognitive distortion (a thought that isn’t accurate or based in current reality) is driving your anxiety.

Cognitive restructuring techniques: Rethinking anxious catastrophic thinking An important part of anxiety management is cutting down anticipatory anxiety. Manage anxious catastrophic thinking using cognitive restructuring techniques.

Cognitive distortion scenario:

 

You had a friend over for dinner and when they left you told them to text you when they got home. You were worried because it was at night. Later, you realize your friend didn’t text but it is late so you are afraid to call and wake them if they are asleep. But what if they are in trouble? What if they got in an accident and that is why they didn’t call you. What if they have been attacked outside their home and are being killed right now?

Using this example I will give you an idea of how to break a thought down using cognitive restructuring techniques.



1. Are you overestimating the risk?

What is the evidence to support your worries?

Your friend didn’t text you when they got home and they said they would.

 

Is there another way to look at it?

Your friend was exhausted and forgot. They are now asleep.

2. Are you catastrophizing?

What’s the worst that can happen? 

Your friend is killed and you could have intervened if you had called the police.

 

The best?

They are asleep in bed.

 

What is the most realistic outcome?

They are asleep in bed. They are a safe driver and have never been in an accident before. Altho an accident or attack could happen, it never has before and they are cautious. The likelihood that this is why they didn’t call is very low.

3. Is there another way to look at this?

Is it all or none or is there something in between? A shade of grey?

This is similar to the above answers but continues to break the thoughts down and provide alternative explanations with the most realistic outcomes.

4. How would I cope?An important part of anxiety management is cutting down anticipatory anxiety. Manage anxious catastrophic thinking using cognitive restructuring techniques.

Am I underestimating my ability to cope? What resources do I have to get through this? 

 

If you think back to times negative things have happened you will likely remember that it was unpleasant or painful but that you were able to reach out for help when you need it and gather up resources to recover. What difficult situations have you navigated through in your life? Did you learn something about your strength?



Many times, anxious catastrophic thinking isn’t about a life or death but a concern for an unpleasant outcome. For example:

 

  • Not being able to fall asleep and then having a disastrous next day because of it.
  • Losing control of your bowels because you can’t find a bathroom.
  • Failing an exam.
  • Having a panic attack while driving.

 

In all of these situations, it is important to step back and realize that you would be able to cope and your life will continue to go forward. Yes, it would be embarrassing if you had a “bathroom accident” but its a mere blip on the radar in life and doesn’t deserve the level of life-altering panic and avoidance that it gets.

5. Am I accepting anxious thoughts as fact without evidence?

Am I overvaluing anxious thoughts and feelings and accepting them as fact?

It’s important to realize anxiety thoughts for what they are: thoughts that will pass. Just because we are feeling anxious doesn’t mean it is evidence a certain situation will turn out disastrously.



How have your previous catastrophic predictions turned out?

Generally, catastrophic predictions are incorrect given they are not based on real facts. If you search back to other times you have catastrophized the likelihood is that you haven’t been correct with your prediction. Do you ever feel like the catastrophizing has helped you more than it is hurt you?

Putting cognitive restructuring techniques into action:An important part of anxiety management is cutting down anticipatory anxiety. Manage anxious catastrophic thinking using cognitive restructuring techniques.

Use this practice sheet to walk through the questions when you have anticipatory anxiety and catastrophic thinking. If you are prone to catastrophizing, the good news is that you will have plenty of opportunities to practice! (That’s one way to put a positive spin on it, right?)

While learning cognitive restructuring techniques write out the worry and the answers to the questions. As you practice, it will become a more natural and ingrained process.

 

Try these exercises and let me know how it goes. Are there places you get stuck? Have you found a particular technique helpful?

Related articles about management of anxiety:

5 Ways to Stop a Panic Attack

The Best Resources for Anxiety

Do what you are afraid of! Stop letting anxiety control you

Black and White Thinking- Don’t Fall Into the Trap!

 

Catastrophizing Anxiety

We all know what a catastrophe is but what about catastrophizing? Catastrophizing is a common occurrence in people that are feeling anxious. Catastrophizing is caused by anxiety but also serves to fuel anxious symptoms. Because of the cyclical worsening that happens with symptoms of anxiety it is important to interrupt this cycle. People stop living in the moment and spend much of their time worrying about the future.



Feeling anxious? 

An anxious person can turn almost anything into a possible catastrophe.

Headache? Definitely a brain tumor.

Some people with anxiety are over-sensitive to normal bodily sensations. They may catastrophize any physical symptom they feel. Physical symptoms, intermixed with anxiety, are a common driver of panic attacks.

Have a school exam coming up? Likely you will fail and become homeless.

People can catastrophize about finances, friendships, or may jump from one catastrophic thought to the next.



  • “What if I don’t ever get a job?”,
  • “If I make the wrong decision it may cause ______ bad thing to happen!”,
  • “What if the plane crashes?”,
  • “Am I dying?”

Sure, some of these worries might be reasonable at times. But an anxious person will take a very small thought and turn it into a huge worry based on very little evidence.

Worrying about the future with projections:Catastophizing anxiety causes worrying about the future. When feeling anxious people project the future negatively. Catastrophizing is an anxious symptom.

Catastrophizing thoughts are generally not based on current reality but future projections related to worry thoughts. Catastrophizing anxiety thoughts aren’t productive projections and don’t cause you to improve your future. It’s energy wasted and not energy spent on improving life.

 

And projections associated with anxiety are never positive. They don’t uplift you or make you feel hopeful. Instead, they cast a shadow of gloom and doom on life and make you feel out of control.

Recognizing catastrophizing anxiety is the first step to stop it

The first step to stop worrying about the future is to recognize when you are doing it! Some people have been feeling anxious and catastrophizing for so long that it comes naturally to them.

Think about your anxious symptoms

When you are feeling anxious are you worrying about the future? Catastrophizing the consequences without evidence? Take a minute to think about your anxious symptoms and ways that you project into the future. When you are worrying, stop to ask yourself if you are projecting a consequence and using catastrophizing anxiety.



The first goal is to recognize it! Stop and take some time to look at your worry thoughts when you are feeling anxious.

 

For helpful techniques that will help with catastrophizing read this blog: 5 Ways to Stop a Panic Attack

Look for the next post for ways to stop these anxious symptoms!

The next post will talk about how to interrupt the cycle of catastrophizing and projection.

 

6 Questions You Must Ask Before Choosing an Antidepressant

Which antidepressant is right for me? Sometimes we can figure out what is the best antidepressant just by asking the right questions. Before choosing an antidepressant, I think about these 6 questions with my patients. We can frequently narrow down the choices so we know which antidepressant to try first.

 

If you are considering starting an antidepressant, make sure to read my last post on common side effects of antidepressants, how long the side effects will last, and tips for how to deal with side effects. My next post talks about what to expect for a treatment response from antidepressants (ie the important question of “When will I feel better?”)



 

What is the best antidepressant?

I explain to people all the time that one antidepressant isn’t necessarily “better” or more effective than another antidepressant. The best antidepressant is the one that will work for you!

But how do we figure that out?"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

 

Just because a new antidepressant has commercials full of happy people that say they have responded wonderfully to the medicine doesn’t mean that it is better than a medicine that has been around for 20 years.

 

Unfortunately, we don’t usually know for sure which medicine will be the best antidepressant for you. There isn’t a blood test or brain scan that tells me a particular drug will work wonderfully for you.

 

Some people hope to get that information from genetic testing but genetic testing doesn’t actually tell us which antidepressant you will respond to. Genetic testing tells us how efficiently you will process the medicine in your body but not what will work. I think down the road genetic testing will be able to give us this information but, unfortunately, we are not at that point yet.

 

“Which antidepressant is right for me?”"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Although we have no guarantees a particular medication will work, we are usually able to narrow the choices. We can better answer “Which antidepressant is right for me?” if we go through each of the following 6 questions.

6 questions to ask to get closer to your answer:

1. Have you taken an antidepressant in the past and done well?

 

I’m shocked by how often I see people who have a history of doing well on a medication but aren’t restarted on that same medicine later when symptoms return.



I think sometimes people are started on new medications because:

 

  1. A thorough medication history wasn’t taken.
  2. Someone (doctor or patient) falls for the promise of happiness shown in the commercials of new shiny medications.
  3. The patient wants to take something that has free samples available.
  4. Although the medication worked really well, the person had side effects. Hopefully, a different medication will work as well but without the same side effects (btw this would be a great reason for trying something new!).

 

Whatever the reason, if you have done well on a medication in the past there ought to be a very good justification as to why a different medication is being chosen!

2. Is there a family history of success on a particular medication?"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Another important indication of the best antidepressant to choose is if there is a family history of success on an antidepressant. If your mom and sister both take a particular medication and have a good response, I can’t see any reason not to start you on the same antidepressant. The genetics are similar in your family and people often respond well to medications that others in their family use.

Know your families mental health history!

 

Sometimes it’s hard to talk to family about their mental health history but it’s important information to know. Ideally, before you go see a doctor for an assessment ask your family if anyone has any psychiatric history, has taken any psychiatric medications, and what their response was.

 

If it turns out someone in the family has done well on a medication for a similar condition this can save you a lot of time trying other medications that may not be effective.

 

3. Generic vs Brand name: "Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Newer isn’t always better and it’s a heck of a lot more expensive! For the most part, people do fine on generic medication and I recommend using them. Most people do not notice any difference between them.

 

That being said, there is a certain amount of allowed variability in the amount of active ingredient in a generic medication as compared to brand. This can be significant for someone that is barely taking an effective dose to control their symptoms. If the generic has 5% lower levels of active ingredient someone may experience a return of symptoms. If the generic has 5% higher levels they may feel better. Or if someone is prone to side effects, the side effects may increase if the active ingredient is higher.

 

One reason to choose brand is for people with allergies to inactive ingredients (fillers) that the active medication is mixed with. Generic medications do not need to have the same inactive ingredients as the brand medications so these fillers will vary between different companies. Since a pharmacy may frequently switch the generic company they get a medication from (whoever is offering the best price wins) it can be hard to keep track of which generic is OK to take. For these people, taking brand name may be worth it.

 

4. What symptoms are we trying to treat?"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Some antidepressants work better for certain symptoms. Do you have:

  • Anxiety?
  • Obsessive Compulsive Disorder?
  • Depression?

 

Defining which symptoms predominate for you will help us with choosing an antidepressant to start. Some antidepressants are better for depression than for anxiety. If you are mainly anxious, I wouldn’t put certain medications as first-line options unless there is a compelling reason (like a family history of response).

 

5. What side effects are we trying to avoid?



  • Fearful of sexual side effects?
  • Weight gain?
  • Did you have a terrible experience with withdrawal side effects on a different antidepressant?

 

Which antidepressant we start may depend on the side effects we are trying to avoid.This may be a great medication to start first

 

For example, Wellbutrin/bupropion doesn’t have the same risk of sexual side effects as other medications. When choosing an antidepressant for someone with depression who is worried about sexual side effects Wellbutrin may be a great medication to start first (as long as the person doesn’t have a seizure disorder).

 

6. Are there any drug interactions?"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Certain medications affect the clearance of other medications by either speeding clearance up or slowing it down. Let’s use an example: medication A speeds up the clearance of medication B. If you have been successfully taking medication B and I give you medication A, the levels of medication B will go down. When medication B levels go down you may no longer be at an adequate dose to control your symptoms (because your body is clearing it quicker).

 

The reverse happens if a medication slows the clearance of another medication. With this, medication B now builds up in the body and the person is at higher risk for side effects. Increased levels can be dangerous with certain medications.



A “real life” example of this is with Prozac and Tamoxifen. Tamoxifen is a medication used for certain types of breast cancer. Tamoxifen reduces the risk of their breast cancer coming back. If Prozac (an antidepressant) is added to Tamoxifen it causes the body to clear Tamoxifen quicker. The levels of Tamoxifen will be reduced so the medication may be less effective at minimizing the risk of breast cancer recurrence. Obviously, drug interactions can have serious consequences and we have to use care when choosing an antidepressant that can have interactions.

Choosing an antidepressant: So which antidepressant is right for me?"Which antidepressant is right for me?" Great question! Sometimes we can figure out what is the best antidepressant by asking the right questions. These are the 6 questions I think about with my patient's before choosing an antidepressant.

Make sure to go through each of these 6 questions when trying to make the decision about which antidepressant to start. It may still end up being a frustrating process of trial and error, but we have more of a chance of getting it right the first time if we ask the right questions.

 

Don’t forget: Depression and anxiety are treatable conditions! Antidepressants are only one part of the treatment equation. There are other great ways to help yourself feel better and sometimes doing a bit of all of these will get you better faster. Add in these other symptom management techniques that I review in the following posts:

 

Visit my mental health bookstore for a list of books I recommend for anxiety and depression (and many other mental health topics).

Stay tuned for the next post on antidepressant treatment response. I will talk about how soon to expect a response and how to know if you are having a response. Follow my blog so you don’t miss any of these posts!

Do what you are afraid of! Stop letting anxiety control you

If you didn’t have anxiety what would you do differently? How would you live your life? Let me tell you how to deal with anxiety and how to stop anxiety from affecting your life.

 

Imagine what life would be like without anxiety

Would you:

  • Pursue different careers or hobbies?
  • Try to get that promotion you deserve even if it requires travel and public speaking?
  • Fly in a plane or go back to school to complete your degree?
  • Drive on the highway so you can take road trips?
  • Go to a party at a friends house? Or a work gathering?
  • Go to a store instead of ordering everything online?


Dealing with Anxiety: Anxiety can be healthy!

Anxiety can be a healthy and normal feeling. It’s a motivator! Anxiety is our body’s way to remind us we need to pay attention. If we are anxious about something we may try harder to be prepared. We may study a few more hours until we are confident we can pass the test or use extra caution when doing something that we perceive has some risk. Anxiety can be a helpful tool for our success and survival.

Dealing with Anxiety: Anxiety can be unhealthy!anxiety

But sometimes anxiety stops being helpful. It almost forgets its place as a background motivator and thinks it runs the show. We forget that anxiety is a message we can choose to accept or ignore. Anxiety doesn’t make the decisions for us but is just one of our many advisors. We start to overvalue our anxiety and stop looking at all the other evidence when we assess a situation. We begin to only pay attention to our anxious feelings and start to avoid the things that make us anxious.

Example: Fear of driving on the highway

What if we get anxious and pass out?! Our anxiety tells us we MUST avoid the highway so we can be safe. Anxiety causes us to imagine every catastrophic outcome possible for what will happen if we drive on the highway.

 

But what about the years and years of evidence that negate that fear? We may have driven on the highway for 20 years and have never passed out. Yes, there was that one time we were really anxious and started to feel a little woozy but we had plenty of time to get off the highway and collect ourselves before continuing our drive. We have no evidence that we were actually ever close to passing out.

 

Is the conclusion valid then? We feel less anxious by avoiding the highway but what have we given up? We have given up some of our freedom. Our world becomes a little smaller everytime we decide we can’t do something due to anxiety.

Every time we avoid we make our anxiety more powerful.

What happens when we avoid something that makes us anxious? We feel better, relieved…. but only temporarily. We give power to our anxiety every time we choose not to do whatever it is that makes us anxious. The anxiety gets internalized and we lose our self-confidence.

 

We make associations between our anxiety and certain events and accept them as facts. Example: I felt anxious on the train once so, therefore, I will always feel anxious on the train. I can never take a train again.



How to stop anxiety: So what happens if we stop avoiding?

When we face something that makes us anxious our anxiety will build. It will keep building until it peaks but then it starts to come down on its own. When we avoid, we never experience anxiety resolving itself. We prematurely end the experience, feel a relief of the anxiety, and therefore draw the conclusion that avoidance is the treatment. However, with avoidance, we never get better. 

How to stop anxiety

If we continue to do what is making us anxious we experience a success and shift the feeling of control back to ourselves. Every time we repeat this process we lessen the anxious associations we have made. We gain our confidence back and learn that we can do the things we previously feared.

How to stop anxiety: What are you avoiding?

Make a list of things that make you anxious. Rate your anxiety for each item on your list on a scale of 1 (no anxiety) to 10 (the worst anxiety). Start with something small and push yourself to do that first. Tackle your anxiety bit by bit by bit. Keep challenging yourself. Don’t let fear cloud your honesty.  Even if you are absolutely unwilling to challenge yourself with something put it on your list anyways. It is important to take an accurate snapshot of all of the things you avoid. Every time you push yourself through you will gain confidence and be able to tackle bigger items.

Example: Fear of driving over bridges

If fear of driving over a highway bridge is rated as 10/10 but driving over a town bridge is 7/10 then start practicing driving over the town bridge.

It takes repeat performance to outdo your anxiety. You will not be anxiety free after driving over a bridge once. Go out and drive over a bridge repeatedly- do it for 30 minutes at a time if it takes that long for the anxiety begin to resolve.

 

What happens to your anxiety as you keep crossing the bridge. Does it creep down a notch every time you go over the bridge? The first time you cross it may be a 10/10 but the 7th time is a 4/10? The next day, go back and do it again. This time did you start at a 6/10 and end at 3/10? Keep practicing this until the anxiety no longer is the ruler.

 

You may never like driving over bridges but that is OK. You don’t have to like it but you need to stop changing your life to avoid it. Your anxiety may also never go to 0/10. But that’s also ok. We can be anxious and still do things. Stop anxiety from taking control.

Treatment for Anxiety: Anxiety doesn’t need to rule your life!

Anxiety is only one part of your life. It can be a helpful signal and enhance your life. But it is a problem when it begins to rule your decisions in life. Start dealing with your anxiety now! Read more here about different techniques you can use to overcome anxiety.

Do you need anxiety medication?

Some people with anxiety conditions are too anxious to even get started tackling their anxiety and may benefit from medication to help lower their anxiety first. Speak with your doctor if you think you may need medication to help your anxiety. ( Here is a piece I wrote about benzodiazepines as a treatment for anxiety)

 

Unfortunately, even if the medication works, the anxious associations and avoidance patterns have already been ingrained. We can lower the powerful drive of your anxiety with medication but cannot break habits. Medication is only one part of treatment for anxiety. Worrying becomes a habit when you do it for years and avoidance will remain if it isn’t directly challenged.

Treatment for Anxiety: You can recover fully from anxiety!

As anxiety begins to decrease, continue to push yourself forward to do the things that make you anxious. This is the way to recover fully and stop anxiety from controlling you. Once you stop being ruled by anxiety, keep anxiety in check by practicing the skills you have learned.

 

We all know that if we get in shape physically we have to do maintenance to stay in shape. It would be fantastic if we could just get physically fit once and maintain that shape forever without additional exercise. We can recognize the absurdity in that expectation.

 

It is the same with conquering anxiety. Hard work can produce lasting benefits but it will also take ongoing maintenance to remain free of unhealthy anxiety.

 

Get started now! What will be your first challenge? Make your list of avoided items and pick the one with the lowest anxiety rating. Do it over and over again. Experience the success of conquering the anxiety that used to be triggered by this item. Once the anxiety is manageable, move on to the next item on the list.  Keep pushing yourself until you work through your whole list. You can do it!

Are you looking for additional resources to help master your anxiety?

The following books are highly recommended:

Visit my bookstore for additional recommended mental health resources.

 

Benzodiazepines: Do They Treat Anxiety?

Are Benzodiazepines a Treatment for Anxiety? A quick fix or a long-term problem? They are frequently used but there are potential side effects of benzodiazepines and, even worse, risk of dangerous benzodiazepine withdrawal.  Learn more about when it may be reasonable to use a benzodiazepine for anxiety treatment and what the risks are.

What benzodiazepines are used for anxiety treatment?



There are several different medications in the benzodiazepine family of medicine. Some common ones are Xanax/alprazolam, Klonopin/clonazepam, Ativan/lorazepam, and Valium/diazepam. Any of one of these can be used as a treatment for anxiety.

 

These medicines differ in how long they take to have an effect and how long the effect lasts in your body. Xanax is short acting. It works quickly going in and out of your system so it can be helpful for a panic attack. Klonopin, on the other hand, lasts longer so can be more useful for people that have ongoing anxiety.

 

Here is a chart showing the relative strength of each benzodiazepine:

Benzodiazepines are often used as a treatment for anxiety. Read further to find out the pros and cons of using benzodiazepines as an anxiety treatment. Know the potential side effects of benzodiazepines and risks for dangerous benzodiazepine withdrawal.

Benzodiazepines as Treatments for Anxiety

Benzodiazepines are often used as a treatment for anxiety. Find out the pros and cons of using benzodiazepines as an anxiety treatment including potential side effects of benzodiazepines and risks for dangerous benzodiazepine withdrawal.

First the good news: Benzodiazepines can help as a treatment for anxiety

They can help! For anxiety, benzodiazepines can be helpful for short-term and as-needed relief of symptoms. Benzodiazepines work quickly and can ease anxiety symptoms temporarily. For people with a specific phobia (like fear of flying) they can be useful as an adjunct to skills learned in cognitive-behavioral therapy (although ideally, you won’t need medication once you learn skills!).Benzodiazepines are often used as a treatment for anxiety. Read further to find out the pros and cons of using benzodiazepines as an anxiety treatment. Know the potential side effects of benzodiazepines and risks for dangerous benzodiazepine withdrawal.

 

Benzodiazepines can also be helpful while waiting for an antidepressant to kick in. Antidepressants generally start to work 3-5 weeks from when you are at a therapeutic dose. This can feel like a lifetime for someone who is suffering from anxiety. In addition, some antidepressants can have an initial side effect of making people feel jittery. This is not pleasant for anyone but especially if you are already anxious! Benzodiazepines can be helpful for this temporary side effect.

Now the bad news: There are potential side effects of benzodiazepines and dangerous withdrawal




YES, YOU CAN DIE FROM BENZODIAZEPINES!

 

Some people wonder why I want to take them off their benzodiazepine when they feel it is helping. Unfortunately, benzodiazepines aren’t good as a long-term cure for anxiety. They can produce dependency and a growing tolerance to the effects of the medicine (where larger doses are needed to get the same effect).

 

Here is a great blog post on the history of benzodiazepines and concerns about their long-term effects.

Benzodiazepine withdrawal:

Benzodiazepines are often used as a treatment for anxiety. Find out the pros and cons of using benzodiazepines as an anxiety treatment including potential side effects of benzodiazepines and risks for dangerous benzodiazepine withdrawal.

With regular use, benzodiazepines need to be tapered. Dangerous withdrawal symptoms can happen if they are stopped abruptly (similar to what happens when people go into alcohol withdrawal). Many other unpleasant withdrawal symptoms including insomnia and rebound anxiety can happen once dependent.

 

In addition to physical dependence, there is always a concern for psychological dependence and addiction. Here is additional information on benzodiazepine withdrawal.

Treatment for anxiety:

There are many different approaches to treating anxiety and some of the most effective treatments aren’t medicine (cognitive-behavioral therapy is one). Benzodiazepines can be helpful for short-term management of anxiety in the right person but are not generally a great long-term solution. They work well as a band-aid but not as a cure!

 

I have written several posts that talk about ways to overcome anxiety:

 

Do what you are afraid of! Stop letting anxiety control you

5 Ways to Stop a Panic Attack

 

Although this series was geared towards overcoming depression, people with anxiety will also benefit. Exercise is a treatment for depression but also benefits anxiety. These posts will be helpful to get started:

 

Treating Depression with Exercise

Exercise and Depression: How to get started when you want to stay in bed

3 Tips for Exercise: How to stay motivated when depressed

 

Tapering off benzo’s:

If you are on a benzodiazepine and want to taper off make sure you do this with the help of a medical professional. The time it takes to get off of benzodiazepines will depend on how high your dose is. Let your doctor help you taper off in a safe way to minimize your withdrawal and come up with a treatment plan for your underlying anxiety.

 

I recommend the following books to learn more about anxiety and how to take control of it. There are additional resources (like great apps!) to target anxiety listed on my resources page and in my bookstore.

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