Anxiety is the great immobilizer.  Anxiety disorders affect approximately 25 to 28 million adult Americans. According to statistics reported by the Anxiety Disorders Association of America, they utilize 1/3 of the mental health costs each year or more than 42 billion dollars. More than half of that amount is due to repeat users of healthcare services seeking relief for symptoms or seeking treatment for health care problems that are actually caused by anxiety and not health related. Anxiety can take many forms. The symptoms can be mild or severe ranging from worry and irritability up to extreme dread and physiological arousal causing tachycardia (heart racing), stomach distress and other neurological physical symptoms, such as dizziness, numbness and tingling.

Severe symptoms can be very debilitating. They affect fewer individuals with anxiety disorders but can cause the person to lose ability to function. When people experience a constellation of physical symptoms related to hyper arousal, this is called a panic attack. They experience fast shallow breathing accompanied by a feeling of breathlessness and a devastating sense of dread or impending doom. They can experience symptoms similar to a heart attack with heart pounding, tachycardia, shortness of breath and perspiration. The physical symptoms coupled with a feeling a dread sometimes causes the person to believe they are physically ill and that death is imminent.

Fortunately for most people anxiety is mild to moderate. A less common form of an anxiety disorder is expressed as anger and irritability. This form is more common in men. Someone who repeatedly is angered by minor occurrences may be experiencing anxiety. They feel as though they  have no control over their lives or personal relationships. As the anger is expressed, the anxiety is discharged. The person has no awareness that he or she is actually anxiety ridden. Not all expressions of anger are anxiety based.

When people have obsessive thoughts about their health status and experience the normal aches and pains as possible signs of cancer or some other debilitating disease, they are having anxiety. The anxiety becomes focused on health concerns but in reality they have anxiety and the health concerns are masking the real anxiety underlying this obsession.

Most people with an anxiety experience a moderate level and they worry. The may have sleep disturbance, either difficulty falling asleep or waking up early. They avoid. Avoidances can be around potential conflicts with others or any situation they believe may be unpleasant.

Judith has an anxiety disorder. “I have this back breaking job which I hate. I am underpaid and I am completely unappreciated. I have been working this job for years. I just can’t see how to get myself going. The company keeps laying people off and I keep taking on more and more work.”

When Judith is asked to rationalize her decision to stay, she says “I can’t just let things go. I have to be on top of everything. Besides no one wants to hire me.”

Judith’s anxiety is based in negative projections about the future. It is also grounded in her fear of conflict. After all, if she were to say no and create a potential conflict with her boss, she fears the experience, but not necessarily the outcome. She says sometimes she fantasizes about being fired so that she’ll feel free to leave. She masks her anxiety with overeating. She use to smoke marijuana regularly but gave it up when she realized her deepening dependency on the substance. Instead she overeats and has gained 80lbs!

Jim’s anxiety takes on a different form. He works 14 hours a day and is usually angry about something or everything. Jim describes his problem as having a job that keeps him too wound up. He finds his work very demanding on his time and on his mental and emotional energy. He feels he must always be “on”.

Jim describes his work. “There is always a pressure to be on top on your game every minute of very day. It doesn’t matter how much time and effort you put in, you can never get ahead. I am always annoyed about something. My wife says I have an anger problem that I need help for. My kids tiptoe around me. I don’t want to alienate my family, but I think the things that annoy can be easily resolved if they would just listen to me.”

Jim’s anxiety is masked by obsessive work habits. He attempts to control his environment with his anger. Through this control he thinks he will feel better. If he can’t control the outcomes at work then maybe he can control them at home. His anger is triggered by his constant state of anxiety or being on edge and it takes very little to push him over it.

Anxious people fear a loss of control. The loss of control can be focused on work, relationships, one’s health or situations. In an attempt to regain control, sometimes people use substances to quell the anxious feelings, such as alcohol, drugs, food, sex, gambling or compulsive work/behavior. Of course, these attempts to regain control are illusory and ultimate fail. It’s like chasing a carrot on a stick—they think any day now it will resolve.

Judith describes her overeating: “Sometimes when I see that chocolate, I can’t help myself. It feels so good to eat it. I feel some pleasure and relief for a few minutes.”

Jim explains his compulsive work behavior. “If I don’t stay on top of everything, it will just pile up on me, then it will be too much to do. I will get overwhelmed. My wife doesn’t understand the pressure I’m under. I try to get her to make some changes, such as spending less money to help ease up on the financial pressure, but she doesn’t and I think I have a right to be angry about her spending.”

Jim was told to observe the behavior or his peers at work. People who were doing the same job were not working 14 hours days. Instead they worked regular hours and were on top of their performance. Some things did not get done in the same time frame that Jim imposed on himself, but it turns out there was no dire consequence for working at the same pace as his peers. Jim came to realize that his anxiety was driving him to over perform. He was imposing impossible standards on himself to quell his fears that he was a poor performer.

Judith had to confront her fear of rejection. She believed that no one would perceive her value as an employee. She overworked as well but her fear of rejection ran deeper. She truly believed that no one would want to hire her. She had to confront her poor self concept and rebuild her sense of self based on her true skills. She was able to work several jobs at once, but she did not perceive this as an organizational skill. She was very dedicated to doing a good job and yet she didn’t perceive this as a marketable skill either.

Judith learned with the help of her life coach that she had very marketable skills and that she was very valuable employee. Once she felt better about herself, she relied less on substances to alter her feelings. She was able to get herself into the job market and within a few months had received half a dozen interviews to jobs as good if not better than the one she had. She is debating several offers now.

Jim had to admit he was always worried about his ability to handle everything. He had a very high powered executive job, a growing family, college tuition for 4 children in his future and expenses were piling up. Jim had to admit that he was anxious about his ability to handle it all. Jim had to rebuild his self confidence and learn how to rely on a confident self that could plan for and handle the important responsibilities of an executive, husband and father.

“I didn’t realize how much I was wound up. I kept pushing everyday harder and harder. I was creating my own stress and tension. No one had any problems with my performance. My executive coach helped me to understand what was going on. She taught me how to let go of the stress. Oddly, my  performance is better and I’m getting along better with my family.”

Judith is thrilled with her change. “I really had things turned all around. I really believed that no one would want to hire me. Now that I see my options, I’m taking my time to pick the right company with a good future. I feel so relieved now that I can tackle these problems. I am learning that I do have strengths and skills to offer my boss but more importantly to help myself succeed. My life coach helped me to identify my strengths and taught me interview skills that helped me to move on.”

If you have anxiety, you too can take steps to manage it effectively.

Dr. Vanessa Gourdine is a psychologist, executive and life coach and Director of Specialized Therapy Associates, LLC and Life Work Strategies, LLC. She can be reached She has a behavioral health column in BC Magazine and is a regular contributor to lifestyle publications. She has developed a coaching model based on using strategies to influence growth and change for successful living. She can be reached at 201-224-5200.