Make an appointment with a therapist and say "hi I think I have anxiety." If you aren't able to see a therapist, a therapy workbook like this works almost as well according to a few studies so it's worth a try https://www.amazon.com/gp/product/1626250154/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=1626250154&linkCode=as2&tag=slastacod-20&linkId=6L2MG4TUCRLOZ533

https://www.amazon.ca/gp/product/1626250154/ref=ewc_pr_img_2?smid=A3DWYIK6Y9EEQB&psc=1

I haven't received it yet, so I can't speak to it's effectiveness, but the reviews suggest that's a pretty objective individual thing. One of my oncologists recommended it though, so that's good enough for me eh.

Talk therapy can almost be counter-productive for OCD because it requires you to keep focusing on obsessions and look for meaning in them that isn’t there. This is doubly true for pure O. CBT focuses on practical ways to interpret your obsessions. If possible, I would look for a doctor with some degree of specialization in OCD because in my experience, some psychiatrists and psychologists just don’t know how to treat it. In the meantime, you could consider using a workbook similar to this to assist you in getting started. I go back to doing worksheets whenever my ocd flares up and at this point sometimes I don’t even need to go back to therapy or change my meds to get it under control again; I just do the work and know that in time it will produce results.

Thank you! 21 days ago I felt terrible! It gets so much better.

CBT is basically homework - you learn about the core beliefs at the root of your anxiety (e.g. “All my friends hate me”) and then you practice challenging those beliefs with facts (e.g. “here are 5 examples of my friends demonstrating that they care about me”) which prove that the core beliefs can’t be correct. I didn’t use this particular resource but it looks extremely similar to the exercises my therapist had me do:

The Cognitive Behavioral Workbook for Anxiety: A Step-By-Step Program

https://www.amazon.com/dp/1626250154/ref=cm_sw_r_awdo_49PQ29VTHPYTPT3GRT51

Hey, sorry you're dealing with this. I've been experiencing similar anxiety issues too. I hope your wait for help doesn't end up being 8 months! Here's a book I've used previously to help with anxiety: https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154 And in general, try to find ways to comfort yourself, not as a way to fix the anxiety but as part of your routine throughout the day. Listen to soothing music or guided meditation. Be kind to yourself and try not to criticize yourself for experiencing anxiety.

I think you should address the anxiety head on. (Almost) everybody gets nervous when searching/applying for jobs, but you don't have to experience debilitating anxiety.

You write that "there's a few things about work prospects that cause enough anxiety to be almost debilitating on themselves" but that's not literally true. It's really your THOUGHTS about those things that cause the anxiety. It is possible to examine those thoughts and convince yourself that they aren't necessarily true. This greatly reduces anxiety.

Therapy can help with that of course, but you could also try books used/recommended by therapists. I love Feeling Good: The New Mood Therapy but I think that might be more for depression. Maybe something like this would help: https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154?

Hey it terrible to have to be on a waiting list for this!

There might be groups that you can join. It is very common for there to be groups for social anxiety and for OCD (especially SAD). If you can find one for SAD that would be especially helpful for many reasons and would propel your growth. If you can’t find one for SAD you can look into something called a process group.

Also, it can be helpful to look into CBT. If you follow it in a very committed and disciplined way in is likely to help a solid amount. It’s best with a therapist but until then here is a work book link

https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154/ref=nodl_

I wanna add here, there are other ways to get CBT that don’t require a lot of money. Finding an in-person therapist is best (don’t use the online/app ones, they’re mostly really terrible), some therapists take sliding scale, and there are occasional low-cost community or training centers (I don’t know exactly where you live so I can’t recommend a particular one).

If the logistics are too hard to find an in-person therapist, good-quality workbooks have been shown in studies to be at least a little effective, and are better than nothing! Here is a good CBT workbook on Amazon for like $20. There’s also one for depression you can find if you search, same series. You just have to be diligent about working through them and practicing and you can get a lot of relief!

I’m on clonazepam (PRN) and I’ve had to start taking Wellbutrin as well.

I also purchased this CBT workbook for anxiety. It has helped a lot!

CBT from a CBT therapist is the best option if you can get one. If not, a workbook like this type of thing is almost as good

You've got this. Tell your self there's nothing to be afraid of, out loud might help. With practice, you will change the response. It's a vicious cycle - your anxiety is causing the phenomenon which is causing the anxiety. You can interrupt this cycle. There may be other sources of anxiety that also need to be addressed. Consider CBT as well - if you can't afford to or don't want to see a therapist, you can try to help yourself with this book: https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154/ref=sr_1_7?ie=UTF8&qid=1522946327&sr=8-7&keywords=cognitive+behavioral+therapy+workbook or others like it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

If you are in the US:

Therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

It can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent. Meditation can be self-taught, with lots of patience and practice. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

It's not as if there will be a neon sign emblazoned on your forehead "I SEE A PSYCHIATRIST, I GO TO THERAPY!". No one will know, unless you choose to tell anyone.

As for affordability, make sure to check how much of it your insurance covers. On my insurance, it's no more expensive than a regular doctor's appointment, it's the same copay.

If you are in the US, therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

If you're deadset against professional therapy, therapeutic techniques can be self-taught to an extent.

• Education. This is really the foundational pillar of therapy and it is so important. You have to understand your condition and the cycle of anxiety. Understanding what you have and why you feel the things you feel is so important, it really can't be overstated. Please take the time to educate yourself on whatever your condition is or what you suspect it to be, based on the diagnostic criteria. Take it from me, it really does help so much to understand why you're feeling the way you are, which symptoms are typical.

• Monitor your anxiety levels over time. Before you start, and then at regular intervals (like every two months), take a self-assessment to evaluate your progress.

  For GAD: Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire or Depression, Anxiety and Stress Scale

Also, look online for CBT interventions and control strategies for anxiety, such as:

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Identification and restructuring of "cognitive distortions": this sounds big and scary, but basically what it means is that anxiety disorders twist your thought patterns (cognitive distortions), and you need to learn to identify that, consciously challenge it (that's the hard part) and reframe it. When we modify thoughts, we actually change the brain! Practicing different types of thought patterns over and over actually rewires our brain so that new, more realistic and helpful patterns of thought become more natural. This doesn't mean that our brains are permanently changed by thinking something new just once. It takes consistent practice, just like it takes consistent exercise to make the body healthy. We don't think like regular people think. It's really hard - in fact, it feels downright impossible at first, because you're literally trying to change the way your brain works. It's frustrating as hell. Identification is easy, without practice or anything we can easily say "Yes, I'm aware that my brain is telling this ridiculous thing and I know it's ridiculous". That very thing is what keeps our self-esteem in the toilet, that we know and we can't fix it. But you can. Very slowly. It takes a shit ton of practice and hard work and perseverance. You are literally retraining your brain. Like, you think meditation is hard? (I do.) This is hard. I'm still working on this part of my treatment myself and it's been many months, but I do see progress.

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

>I started having panic attacks literaly last week

>For the past few days i've had a persistent anxiety

>It's only been a few days

I really doubt you need medication at this point, tbh. Probably just a phase or a temporary increase in stress. You don't meet criteria for any sort of diagnosis at this point, far too early. Look into CBT techniques, stress relief techniques, meditation, ways to cope with panic attacks and reduce stress.

Panic attacks often come out of nowhere, but can have identified triggers as well. Clinically, according to the DSV IV and V, panic attacks can be uncued; coming out of the blue, being completely unexpected - or cued; being reliably triggered by a particular situation. It is very common to feel like you're dying during a panic attack, or to mistake it for a heart attack or life-threatening allergic reaction - many of us have called ambulances or ended up in the emergency room because of panic attacks. But they are perfectly harmless.

Panic attacks are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat

• Abnormal sweating

• Trembling or shaking

• Instances of shortness of breath or feeling smothered

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Dizziness, unsteadiness, light-headedness or faintness

• Chills or hot flashes

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)

• Fear of losing control or “going crazy”

• Fear of death

If you have panic attacks or heightened anxiety, these things will help you take your focus off your anxiety and panic and bring you back into the present, ending your episode a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex. When we dive into cold water, our heartbeat automatically slows, blood moves from the limbs to the chest and breathing slows down. We can trigger this response without actually diving into water. Washing your face with ice water should be cold enough to shock your body and break the pattern of panic. Alternatively, try taking a cold shower.
• Look for things around you: five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

There is one particular song that I loop when I'm anxious or feeling a panic attack coming on or trying to knock myself out of the post-panic hangover: Be Still by The Killers. It has this magical soothing quality for me, like musical Xanax.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home. Most online therapy is face-to-face; live virtual video appointments. You are not even supposed to use your therapist as an immediate crisis support in a life-threatening situation - that's not their role and they are not available 24/7. Go to the emergency room, urgent care, call 911, a crisis line or a suicide hotline.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Teletherapy

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Teletherapy

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

They don't prescribe benzodiazapines in some states, but there are online options for medication such as Cerebral, Lemonaid Health and KHealth. KHealth is only $19 a month for the medication and appointments, $29 if you want it shipped. Otherwise - self care and therapeutic techniques can be self-taught. Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

You can get diagnosed and treated entirely over the internet.

If you are in the US:

Therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy. It is only one (long) text a day or a series of texts responding to your own, so not like a constant back-and-forth all day.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Yes, you need a doctor for actual medication.

But not if you want to try the supplement route, there's Vitamins D3, B5 and B6, magnesium, ashwagandha, Silexan, L-theanine, St John's Wort (but do not take SJW if you take any sort of antidepressant), etc. Fish oil boosts the effectiveness of SSRIs.

I had some success with a supplement called Calm Now by Zhou Nutrition that combines most of the anti-anxiety herbs and vitamins. It took the edge off of my irrational anxiety, lowered it noticeably. It's nothing compared to my SSRI (which obviously is not the solution for everyone), but it served me well for more than two years and it's a good option - if my SSRI takes me down to 0, Calm Now takes me down to like a 6, which I think it pretty impressive for a supplement. If my SSRI stopped working, as they are prone to doing after 2-10 years, I wouldn't hesitate to return to Calm Now.

Silexan, made from an isolate of lavender oil, has a wealth of clinical research proving its effectiveness in the treatment of anxiety disorders. It's comparable to a low dose of a benzodiazapine without addictive properties or side effects.

If you are in the US:

Therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans. These are completely online, no need to go anywhere.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Therapeutic techniques can be self-taught to an extent.

• Education. This is really the foundational pillar of therapy and it is so important. You have to understand your condition and the cycle of anxiety. Understanding what you have and why you feel the things you feel is so important, it really can't be overstated. Please take the time to educate yourself on whatever your condition is or what you suspect it to be, based on the diagnostic criteria. Take it from me, it really does help so much to understand why you're feeling the way you are, which symptoms are typical.

• Monitor your anxiety levels over time. Before you start, and then at regular intervals (like every two months), take a self-assessment to evaluate your progress.

  For GAD: Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire or Depression, Anxiety and Stress Scale

Also, look online for CBT interventions and control strategies for anxiety, such as:

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Identification and restructuring of "cognitive distortions": this sounds big and scary, but basically what it means is that anxiety disorders twist your thought patterns (cognitive distortions), and you need to learn to identify that, consciously challenge it (that's the hard part) and reframe it. When we modify thoughts, we actually change the brain! Practicing different types of thought patterns over and over actually rewires our brain so that new, more realistic and helpful patterns of thought become more natural. This doesn't mean that our brains are permanently changed by thinking something new just once. It takes consistent practice, just like it takes consistent exercise to make the body healthy. We don't think like regular people think. It's really hard - in fact, it feels downright impossible at first, because you're literally trying to change the way your brain works. It's frustrating as hell. Identification is easy, without practice or anything we can easily say "Yes, I'm aware that my brain is telling this ridiculous thing and I know it's ridiculous". That very thing is what keeps our self-esteem in the toilet, that we know and we can't fix it. But you can. Very slowly. It takes a shit ton of practice and hard work and perseverance. You are literally retraining your brain. Like, you think meditation is hard? (I do.) This is hard. I'm still working on this part of my treatment myself and it's been many months, but I do see progress.

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Yes. And please take your medication.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Therapeutic techniques can be self-taught to an extent.

• Education. This is really the foundational pillar of therapy and it is so important. You have to understand your condition and the cycle of anxiety. Understanding what you have and why you feel the things you feel is so important, it really can't be overstated. Please take the time to educate yourself on whatever your condition is or what you suspect it to be, based on the diagnostic criteria. Take it from me, it really does help so much to understand why you're feeling the way you are, which symptoms are typical.

• Monitor your anxiety levels over time. Before you start, and then at regular intervals (like every two months), take a self-assessment to evaluate your progress.

  For GAD: Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire or Depression, Anxiety and Stress Scale

Also, look online for CBT interventions and control strategies for anxiety, such as:

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Identification and restructuring of "cognitive distortions": this sounds big and scary, but basically what it means is that anxiety disorders twist your thought patterns (cognitive distortions), and you need to learn to identify that, consciously challenge it (that's the hard part) and reframe it. When we modify thoughts, we actually change the brain! Practicing different types of thought patterns over and over actually rewires our brain so that new, more realistic and helpful patterns of thought become more natural. This doesn't mean that our brains are permanently changed by thinking something new just once. It takes consistent practice, just like it takes consistent exercise to make the body healthy. We don't think like regular people think. It's really hard - in fact, it feels downright impossible at first, because you're literally trying to change the way your brain works. It's frustrating as hell. Identification is easy, without practice or anything we can easily say "Yes, I'm aware that my brain is telling this ridiculous thing and I know it's ridiculous". That very thing is what keeps our self-esteem in the toilet, that we know and we can't fix it. But you can. Very slowly. It takes a shit ton of practice and hard work and perseverance. You are literally retraining your brain. Like, you think meditation is hard? (I do.) This is hard. I'm still working on this part of my treatment myself and it's been many months, but I do see progress.

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I did. I didn't know I had anxiety at the time, I thought it was just me. It sucked. I also have trichotillomania and it's exacerbated by stress and anxiety and it was awful in college, bloody bald spots everywhere, especially around finals. I have a public speaking phobia and so every month had public panic attacks in front of all my professors and classmates when I had to attempt presentations.

My best advice? Your school will have a counseling center that is likely free. Take advantage of it from the start for therapy. Take advantage of the health center for medication, if needed. Use meditation, exercise, coping skills, therapeutic techniques to get on top of it as much as you can and since you know about it beforehand, come prepared - learn about this stuff before you go. Get a workbook, do research on anxiety disorders, practice meditation.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

You can get evaluated by a licensed therapist or psychiatrist/psychiatric nurse practitioner online, and then receive therapy or medication.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

If you want resources for therapy and medication, I can provide that as well.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

While I believe that medication can be a godsend (it is for me), some people simply do not need it - I think it is best to give therapy a fair shot for 6-12 months and then look at adding medication to your treatment plan if therapy alone proves insufficient.

Here are some resources that may be of use to you:

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV or a competitor may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Also: I have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

So many of the posts of "does anyone else have ___, is this an anxiety symptom?" on here could be avoided if people would bother to Google properly and educate themselves on their own medical conditions. The symptoms of anxiety are all readily available from reputable sources - Healthline, Mayo Clinic, Harvard, NAMI, Cleveland Clinic, American Psychiatry Association, American Psychological Association, etc. The information is all out there, if only you look.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here. Do you qualify for Medi-Cal or Medicaid?

There are online options as well. These typically require out of pocket payment.

Teletherapy

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

https://www.health.harvard.edu/blog/do-i-have-anxiety-or-worry-whats-the-difference-2018072314303

There's online therapists like Betterhelp if you're having trouble finding one on your insurance. Their rates are prorated to your income so you might be able to get it cheaper that way.

Even if you can't find a therapist, I've found a lot of help from doing Cognitive Behavioral Therapy workbooks for anxiety and depression. They've been a lot more helpful for anxiety with me. It's a method that involves becoming aware of your thoughts and trying to counteract the ones that aren't useful to you. I've also had some relief with meditation, though I've fallen off. Even 5 minutes a day had an impact after a week or so.

Routine is good. I found that exercising every day is really crucial. I prefer to wake up and work, and then exercise before lunch, but I have to be diligent about forcing myself to stop working. It's also been helpful scheduling time to cook so I'm not tempted to eat junk or order takeout. I cook about 2x a week and make things to heat up throughout the week. I also have to schedule time to recharge - things like reading, going for walks, etc. Reading for pleasure can feel wasteful and it can be hard to make myself do it, but it helps me a lot.

I try to start everyday with a priority list of things I want to work on or what I want to get done. I have basic, average, and stretch goals because I tend to want to do too much and then beat myself up when I miss my goals. With my 3 tiers I can say hey at least I did X.

On Sundays I reevaluate the week before, write about what worked and didn't work and try to adjust my schedule and think about what's realistic for the coming week.

I also schedule hangouts with friends in advance so I have to see them.

Your family echoing your doubts isn't going to help so really just cut off that line of inquiry. You're quitting work to start a business.

There's also weeks where the above doesn't happen and I try not to beat myself for that, but just look and see why I fell off. Routine + forgiveness for being off routine is what it boils down to.

(Example of workbook: https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154/ref=asc_df_1626250154/)

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis and some people do have panic attacks, but don't have them frequently or severely enough to be classed as "panic disorder" - panic disorder also has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

You are correct. People with mental health issues rarely are able to eliminate them. But you can learn to manage them and not let them control you. I suggest you see a therapist and make one change every week to make your life a little better. If you keep this up your mental health will improve and you will have accomplishments that will give you self-esteem. There is also a good workbook for anxiety written by mental health professionals.

https://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step/dp/1626250154

this workbook saved my life. this + psychotherapy really rewired my brain in the best way possible to deal with my anxiety and depression! its available on kindle too

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Good for you seeking treatment so quickly!!!! It took me sixteen years of daily suffering before I got the courage to seek therapy, and then another nine months before I tried medication.

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Coping skills. Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

If you are in the US:

Therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer your child to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your child's doctor, a teacher or school counselor or health center.

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Ok, I am pretty sure I can help in terms of giving you perspective and advice, but - I'm not gonna lie. The work that's needed isn't going to be easy or fast. BUT - now is the perfect time in your life to do this work, so, I hope you think it through seriously.

>It was very toxic but I still have immense feelings for her

First things first, you need to not date until you figure this out. Why are you holding feelings for an abusive person? There is something going on inside you that is drawing you towards someone who treats you terribly. Maybe it's insecurity, thinking you can't do better? Maybe it's loneliness, thinking abuse is better than being alone? Maybe it's anxiety, believing you can't leave even if you want?

I have no idea, and I think you also have no idea. It is crucial that you start here and figure this out and address it.

Resources like learning to understand your emotions, things like learning ways to manage anxiety and depression, and using methods like Cognitive Behavioral Therapy on your own (no therapist needed, although I encourage you to explore therapy also) - these types of things can help you start that journey.

You also need to go completely no-contact with her. Remove her from your life in any way, shape, or form.

None of my advice is easy! I totally get that. But if you want to move on and get healthier, that's what you need to do.

sis I am so so so sorry. I have absolutely no words wallahi. I want you to understand that you did not deserve any of this. you don’t deserve it. you were just an innocent baby who deserved to be loved and protected and cherrished by those surrounding you and I am so sorry you were robbed of that. your innocence was taken from you way too soon and that is an awful thing. I can’t imagine what you are going through. I hope you know that even if I don’t know you irl or I’m not your bff, as a woman and as a muslimah I love you and I pray that you will succeed and you will heal. may you be the one to cure generational curses. Allahuma Ameen.

I understand that a lot of girls use marriage as the only ticket out of abuse and I would never judge them for that. I think my realistic advice for you is distance yourself from your parents. ofc don’t be mean or provoke or anything. just distance yourself even if you live with them. be cordial and say hi how are yous ie common courtesy when needed but keep yourself safe and distant. understand that your parents are their own people with their own experiences and struggles. how they treated you is not a reflection of you. it is a reflection on them and their own childhood. its such a devastating thing to realize that a lot of parents have their own traumas too. this ABSOLUTELY does not excuse how they raise their kids or the abuse they put them through. nothing will ever excuse that. I’ve always said on yawn al qiyammah there will be a lot of parents who thought they were doing the right thing who will be in for a tragic surprise. may Allah protect us from that.

save your money. get a job and if you have one just keep saving. make sure you have your passport with you! you can take it to the bank so they can put it in a safe just in case you’re scared. it is a smart thing to do. when you graduate, apply to jobs and grad school in other countries. in shaa Allah you will get accepted into grad school but apply to jobs simultaneously as a back up plan! imo I say get a big girl job first, save up, then grad school so that you won’t rely in your parents financially. but ofc thats not necessary if you get accepted on a scholarship that pays for everything whoch I pray you do.

I say this with love, but I truly don’t think you are in a position and a state of mind to consider marriage. I don’t think you’re there yet. and that is perfectly okay. one day you will be. in my own opinion when I’ve seen girls from abusive homes get married as a ticket out of abuse, they just go from one abusive home to another. ofc this is not for all cases but it is just smth I have noticed.

get a therapist if you are able to! look into your university’s student plan and see if they have theraoy services or search your local area to find therapists who give discounts to students! a lot of them do!!!

one day you will find an amazing man who will love you the way you deserve to be loved. but for now, you need to take care of yourself. you are worthy of love. but you have to mourn your childhood and the love you never received. you will have to sit with that pain and it will be the worst thing you have ever felt but after that there will be clarity. you will be able to see things for what they are. you have to parent yourself. look into inner child work! it has been extremely beneficial for me. this is my fav resource for nner child therapy and work they are both licensed therapists! their videos have been so helpful to me and have made it easier for me to navigate my own healing. the idea of the inner chuld is essentially parenting yourself in a caring, loving and gentle mannwr. it is healing the young version of you that is still inside all of us, to then healing the adult version of you.

you don’t need to tell a potential anything. I don’t. you can tell them once you’ve seen that they have emotional intelligence but personally I’ve always just believed in not telling potentials anything personal. maybe its a trauma response but oh well lol. I just think that I would tell them once I’m married to them but even then it might take me years?

lastly this is also another fantastic book! the author has some tailored to panic attacks too and more things! I recommend getting one bc you will learn a lot about yourself!

https://www.amazon.com/dp/1626250154/ref=cm_sw_r_cp_apa_glt_fabc_VE920JYMPQJ7EJ29FKDS?_encoding=UTF8&psc=1

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Panic attacks often come out of nowhere, but can have identified triggers as well. Clinically, according to the DSV IV and V, panic attacks can be uncued; coming out of the blue, being completely unexpected - or cued; being reliably triggered by a particular situation. It is very common to feel like you're dying during a panic attack, or to mistake it for a heart attack or life-threatening allergic reaction - many of us have called ambulances or ended up in the emergency room because of panic attacks. But they are perfectly harmless.

Panic attacks are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat

• Abnormal sweating

• Trembling or shaking

• Instances of shortness of breath or feeling smothered

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Dizziness, unsteadiness, light-headedness or faintness

• Chills or hot flashes

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)

• Fear of losing control or “going crazy”

• Fear of death

If you have panic attacks or heightened anxiety, these things will help you take your focus off your anxiety and panic and bring you back into the present, ending your episode a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex. When we dive into cold water, our heartbeat automatically slows, blood moves from the limbs to the chest and breathing slows down. We can trigger this response without actually diving into water. Washing your face with ice water should be cold enough to shock your body and break the pattern of panic. Alternatively, try taking a cold shower.
• Look for things around you: five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. It's a grounding exercise, called The Five Senses.
• Realizing that the panic attack is actually harmless and cannot hurt you helps a lot of people and takes the power of the panic away, calming them. You can try writing mantras or a paragraph about how you are safe, it's harmless, it's normal when you are of sound mind, and reading it aloud repeatedly to yourself when you have a panic attack.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic can make you breathe shallowly and the feeling that you lack oxygen makes it much worse.

There is one particular song that I loop when I'm anxious or feeling a panic attack coming on or trying to knock myself out of the post-panic hangover: Be Still by The Killers. It has this magical soothing quality for me, like musical Xanax.

Try treating your anxiety without medication. While medication can be a godsend, some people simple don't need it.

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy. It is only one (long) text a day or a series of texts responding to your own, so not like a constant back-and-forth all day.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy. It is only one (long) text a day or a series of texts responding to your own, so not like a constant back-and-forth all day.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

If you are in the US:

Therapy and psychiatric services can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy. It is only one (long) text a day or a series of texts responding to your own, so not like a constant back-and-forth all day.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

You'd go to your doctor and ask to be evaluated for an anxiety disorder, but since you don't have a car:

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans. The turnaround is quick, 24-72 hours from sign up and assessment to speaking with your therapist.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

If you live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent - look online for CBT interventions and control strategies for anxiety, such as:

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Teletherapy

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Therapeutic techniques can be self-taught to an extent.

• Education. This is really the foundational pillar of therapy and it is so important. You have to understand your condition and the cycle of anxiety. Understanding what you have and why you feel the things you feel is so important, it really can't be overstated. Please take the time to educate yourself on whatever your condition is or what you suspect it to be, based on the diagnostic criteria. Take it from me, it really does help so much to understand why you're feeling the way you are, which symptoms are typical.

• Monitor your anxiety levels over time. Before you start, and then at regular intervals (like every two months), take a self-assessment to evaluate your progress.

  For GAD: Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire or Depression, Anxiety and Stress Scale

Also, look online for CBT interventions and control strategies for anxiety, such as:

• Distraction (i.e., get involved in a distracting activity, or replace worry with more positive thinking)

• Threat reappraisal (i.e., reappraise the imagined threat of the concern)

• Engage in problem solving (i.e., develop an action plan for dealing with the concern)

• Relaxation (i.e., engage in meditation)

• Scattered counting (pick a number at random and jump around haphazardly, i.e., 71, 69, 4, 17, 43, 22...if you were to count chronologically, your mind isn't sufficiently occupied and is still free to ruminate endlessly on whatever's making you anxious. It takes more concentration to come up with the next number when you have to think about what it will be, and that helps take your mind off the thoughts that are troubling you.

• Identification and restructuring of "cognitive distortions": this sounds big and scary, but basically what it means is that anxiety disorders twist your thought patterns (cognitive distortions), and you need to learn to identify that, consciously challenge it (that's the hard part) and reframe it. When we modify thoughts, we actually change the brain! Practicing different types of thought patterns over and over actually rewires our brain so that new, more realistic and helpful patterns of thought become more natural. This doesn't mean that our brains are permanently changed by thinking something new just once. It takes consistent practice, just like it takes consistent exercise to make the body healthy. We don't think like regular people think. It's really hard - in fact, it feels downright impossible at first, because you're literally trying to change the way your brain works. It's frustrating as hell. Identification is easy, without practice or anything we can easily say "Yes, I'm aware that my brain is telling this ridiculous thing and I know it's ridiculous". That very thing is what keeps our self-esteem in the toilet, that we know and we can't fix it. But you can. Very slowly. It takes a shit ton of practice and hard work and perseverance. You are literally retraining your brain. Like, you think meditation is hard? (I do.) This is hard. I'm still working on this part of my treatment myself and it's been many months, but I do see progress.

Meditation can be self-taught, with lots of patience and practice. Look for guided meditations on YouTube, as well as CBT informational videos. Educate yourself on body scanning, progressive muscle relaxation, etc. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water, regular exercise, having a consistent daily routine.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, which I acquired through my employer - a children's mental health agency. This workbook is targeted towards teens and young adults with anxiety disorders and is one of the resources we provide to clients on intake, if they want it.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

It can be quite affordable if you know where to look. If you have Medi-Cal or Medicaid and live in a populous blue state, you can typically call your county's mental health department and ask to be referred for mental health services. They will evaluate you and refer you to a local agency for therapy and/or medication. You can also ask for a referral to therapy through your doctor, a teacher or school counselor or health center.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Therapeutic techniques can be self-taught to an extent. Meditation can be self-taught, with lots of patience and practice. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

I'm sorry, this is such a tough situation.

Panic attacks often come out of nowhere, but can have identified triggers as well. Clinically, according to the DSV IV and V, panic attacks can be uncued; coming out of the blue, being completely unexpected - or cued; being reliably triggered by a particular situation. It is very common to feel like you're dying during a panic attack, or to mistake it for a heart attack or life-threatening allergic reaction - many of us have called ambulances or ended up in the emergency room because of panic attacks. But they are perfectly harmless.

Panic attacks are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat

• Abnormal sweating

• Trembling or shaking

• Instances of shortness of breath or feeling smothered

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Dizziness, unsteadiness, light-headedness or faintness

• Chills or hot flashes

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)

• Fear of losing control or “going crazy”

• Fear of death

If you have panic attacks or heightened anxiety, these things will help you take your focus off your anxiety and panic and bring you back into the present, ending your episode a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex. When we dive into cold water, our heartbeat automatically slows, blood moves from the limbs to the chest and breathing slows down. We can trigger this response without actually diving into water. Washing your face with ice water should be cold enough to shock your body and break the pattern of panic. Alternatively, try taking a cold shower.
• Look for things around you: five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. It's a grounding exercise, called The Five Senses.
• Realizing that the panic attack is actually harmless and cannot hurt you helps a lot of people and takes the power of the panic away, calming them. You can try writing mantras or a paragraph about how you are safe, it's harmless, it's normal when you are of sound mind, and reading it aloud repeatedly to yourself when you have a panic attack.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic can make you breathe shallowly and the feeling that you lack oxygen makes it much worse.

There is one particular song that I loop when I'm anxious or feeling a panic attack coming on or trying to knock myself out of the post-panic hangover: Be Still by The Killers. It has this magical soothing quality for me, like musical Xanax.

Educating yourself about anxiety and panic attacks will help.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

This is the most affordable online psychiatric service:

KHealth // $19 per month, $29 per month for shipping of medication

And for therapy;

Open Path Collective // $30-60 per session

Panic attacks often come out of nowhere, but can have identified triggers as well. Clinically, according to the DSV IV and V, panic attacks can be uncued; coming out of the blue, being completely unexpected - or cued; being reliably triggered by a particular situation. It is very common to feel like you're dying during a panic attack, or to mistake it for a heart attack or life-threatening allergic reaction - many of us have called ambulances or ended up in the emergency room because of panic attacks. But they are perfectly harmless.

Panic attacks are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat

• Abnormal sweating

• Trembling or shaking

• Instances of shortness of breath or feeling smothered

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Dizziness, unsteadiness, light-headedness or faintness

• Chills or hot flashes

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)

• Fear of losing control or “going crazy”

• Fear of death

If you have panic attacks or heightened anxiety, these things will help you take your focus off your anxiety and panic and bring you back into the present, ending your episode a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex. When we dive into cold water, our heartbeat automatically slows, blood moves from the limbs to the chest and breathing slows down. We can trigger this response without actually diving into water. Washing your face with ice water should be cold enough to shock your body and break the pattern of panic. Alternatively, try taking a cold shower.
• Look for things around you: five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. It's a grounding exercise, called The Five Senses.
• Realizing that the panic attack is actually harmless and cannot hurt you helps a lot of people and takes the power of the panic away, calming them. You can try writing mantras or a paragraph about how you are safe, it's harmless, it's normal when you are of sound mind, and reading it aloud repeatedly to yourself when you have a panic attack.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic can make you breathe shallowly and the feeling that you lack oxygen makes it much worse.

There is one particular song that I loop when I'm anxious or feeling a panic attack coming on or trying to knock myself out of the post-panic hangover: Be Still by The Killers. It has this magical soothing quality for me, like musical Xanax.

Educating yourself about anxiety and panic attacks will help.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

Panic attacks often come out of nowhere, but can have identified triggers as well. Clinically, according to the DSV IV and V, panic attacks can be uncued; coming out of the blue, being completely unexpected - or cued; being reliably triggered by a particular situation. It is very common to feel like you're dying during a panic attack, or to mistake it for a heart attack or life-threatening allergic reaction - many of us have called ambulances or ended up in the emergency room because of panic attacks. But they are perfectly harmless.

Panic attacks are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat

• Abnormal sweating

• Trembling or shaking

• Instances of shortness of breath or feeling smothered

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Dizziness, unsteadiness, light-headedness or faintness

• Chills or hot flashes

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)

• Fear of losing control or “going crazy”

• Fear of death

If you have panic attacks or heightened anxiety, these things will help you take your focus off your anxiety and panic and bring you back into the present, ending your episode a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex. When we dive into cold water, our heartbeat automatically slows, blood moves from the limbs to the chest and breathing slows down. We can trigger this response without actually diving into water. Washing your face with ice water should be cold enough to shock your body and break the pattern of panic. Alternatively, try taking a cold shower.
• Look for things around you: five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. It's a grounding exercise, called The Five Senses.
• Realizing that the panic attack is actually harmless and cannot hurt you helps a lot of people and takes the power of the panic away, calming them. You can try writing mantras or a paragraph about how you are safe, it's harmless, it's normal when you are of sound mind, and reading it aloud repeatedly to yourself when you have a panic attack.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7 seconds, exhale for 8 seconds. The length of time isn't super important, the idea is just to breathe more deeply as panic can make you breathe shallowly and the feeling that you lack oxygen makes it much worse.

There is one particular song that I loop when I'm anxious or feeling a panic attack coming on or trying to knock myself out of the post-panic hangover: Be Still by The Killers. It has this magical soothing quality for me, like musical Xanax.

Educating yourself about anxiety and panic attacks will help.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

Have you explored other, more affordable avenues to get therapy? There are also workbooks that can be used in the interim between sessions to help you cope - and of course the coping skills and therapeutic techniques that your therapist taught you. Do you have a friend you can talk to, rather than family?

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

Go to your PCP, but just be aware that some PCP/GPs are uncomfortable with psychiatric disorders and will prefer to refer you to a psychiatrist instead so you might need to do some convincing or choose a new PCP if you don't want a psychiatrist. And in general, I believe psychiatrists are superior for psychiatric services than jack-of-all-trades PCPs; it's obviously their specialty, they're more knowledgeable, confident and comfortable, and they're also usually more up-to-date on recent studies and options for treatment.

One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out - so for example if you have chronic diarrhea or nausea and vomiting or dizziness, all of which are common physical symptoms of anxiety, they'll want to do tests first to rule out medical causes and conditions first.

Your doctor will ask if you've been having any problems with anything or if you have any concerns. Just bring up your history of anxiety, talk about when it started, how it makes you feel in as much detail as possible, your mental and emotional and physical symptoms and their frequency and intensity and duration. If your anxiety keeps you from doing anything, if you avoid anything because of it. If you struggle in social situations, new situations, public speaking, test taking, etc. Can't get thoughts out of your head, panic attacks, general feeling of dread and unease? Whatever it is.

There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale (often in an informal manner, more like a conversation) such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment. And once you've told them everything you can, they'll bring up treatment options, e.g. therapy, medication, etc.

Therapeutic techniques can be self-taught to an extent. Meditation can be self-taught, with lots of patience and practice. Self care helps. General good practices help; educating yourself about your condition, getting enough sleep, eating enough, drinking enough water.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I also have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Many things. Therapeutic techniques can be self-taught to an extent. Meditation can be self-taught, with lots of patience and practice. Self care helps. General good practices; getting enough sleep, eating enough, drinking enough water.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

I empathize and I am so sorry. I was in your exact same position myself from 11 until this time last year at the age of 26, still living with my parents. They have always been very derogatory towards any mention of mental illness in the news or media; they think it's a personal flaw or a weakness of character, it's your fault, you're a wimp or a nutjob or just plain a bad person. When I was eleven, my trichotillomania onset; compulsive hair pulling related to/exacerbated by stress and anxiety. So did my GAD, panic attacks and phobias, but the trichotillomania was the most outwardly obvious sign, something I couldn't hide and honestly wasn't even aware that I was doing.

After a few months I'd pulled until my part was an inch wide. My mother noticed, held me down physically to inspect it and grabbed scrissors and chopped all my hair off right there while I was screaming and crying, calling me a little bitch and a freak then choked me when I wouldn't stop crying and screaming, while my dad just stood there and watched.

So I learned real quick to hide everything, to spread out my hair pulling and pick from less obvious places, to go to my room or go out when I feel a panic attack encroaching, etc. My older sister made the mistake at the age of 26 to tell my parents about her own anxiety and depression, it triggered a huge fight, and they coerced her into stopping her medication and therapy. To this day, my mother makes snide comments about my sister to me.

I don't drive due to my driving phobia and some cognitive and spatial awareness impairments - my disorders are all the result of brain damage. So I thought I was never going to be able to seek treatment, having to live with my parents and being unable to drive. I finally snapped last year and my hand was forced, literally - I ended up trying to amputate my own fingers in myissle of a panic attack and finally realized that this was clearly a mental illness (turns out, five of them; generalized anxiety disorder, panic disorder, trichotillomania and phobias) and not an unfortunate assortment of personality flaws like I'd spent my life desperately trying to convince myself.

Here are some resources that may be of use to you if you have your own source of income:

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

For my own experience, I ended up doing Talkspace for therapy and Lemonaid Health for medication. Lemonaid ships overnight via FedEx for free (though if you want them to use USPS because it's more discreet, you can!) and the package comes in a plain black padded envelope or white FedEx padded envelope with the only identifier being LP Health in small print on the shipping label. No mention of mental health or medication, no cutesy loud packaging to draw attention. This way, I can do therapy and medication completely in private and secret.

On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore, to be honest. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person. So you will need be ready to hold yourself accountable more in text-based therapy.

Text-based on Talkspace also has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

And if you don't have a job and debit/credit card, I have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders. You can also go to your school counselor or pediatrician and open up, ask for a referral to therapy or a psychiatrist through them and have the counselor or doctor talk to your parents; perhaps they can make them look past the stigma (news flash, parents: an anxiety disorder is "crazy") and help them see sense.

I hope this helps! :)

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Also: I have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV or a competitor may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

Also: I have a free Workbook for Anxiety and Worry on my Google Drive HERE, targeted towards teens and young adults with anxiety disorders.

Insomnia

Insomnia - including difficulty falling and staying asleep, nightmares, restless unsatisfying sleep and sleep disturbances - is a hallmark of anxiety disorders. It is one of the six possible required symptoms for diagnosis of GAD, in fact.

In general, these things may help with sleep quality if you haven't given them a shot already:

• Avoid alcohol and caffeine
• Melatonin is paradoxically most effective in small doses under 1 mg. In larger doses, it has been shown to worsen insomnia and sleep disturbances and cause nightmares.
• If you struggle with chronic nightmares (I didn't have a single non-horrifying dream between the ages of 11 and 26, just an endless impenetrable wall of nightmares that woke me up screaming and crying) you may want to ask your doctor about medications that are typically used for PTSD patients - prazosin and topiramate. I take topiramate, 50 mg twice a day and it has eliminated 80% of my nightmares. Such an incredibly amazing relief, I could cry. I dream like a normal human now.
• Make sure you're going to sleep and waking up on a consistent schedule, whether or not you have to go to work or have plans that day
• You may find yoga or exercise a few hours before bed helpful, or meditation just before bed
• Have a consistent bedtime routine
• Avoid bright light and screens before bed
• Try not to eat 2-3 hours before bed - when you're still digesting food in your sleep it can increase nightmares and sleep disturbances
• Try listening to audiobooks or podcasts on a 30-60 minute timer to prevent ruminating, racing thoughts and overthinking from keeping you awake
• Be sure to stay hydrated throughout the day and particularly keep up on your electrolytes as they help with sleep regulation; an electrolyte powder such an Liquid IV may be of use
• Try a sleep medication such as hydroxyzine - I have insomnia and with hydroxyzine I've gone from waking 7-8 times a night to only 3-4
• Making sure the air that room you're sleeping in is cool will help you sleep better; near 65F/18C is ideal. Due to circadian rhythm, your body temperature drops at night when you sleep, and when the surrounding air is too warm (thus warming you) it results in disrupted sleep and makes it difficult to drift off to sleep in the first place

Fatigue, Brain Fog & Forgetfulness

These are also perfectly normal symptoms of anxiety - fatigue is another of the six hallmark symptoms and brain fog, memory and cognitive troubles and forgetfulness are very common.

Think about it; your mind and body are on high alert most of the time, convinced that you are in grave danger - your brain isn't going to waste precious power trying to remember every little thing when you're in danger. It has its priorities sorted out. And it is constantly aware, constantly misfiring and misidentifing threats - your threat detection system is broken and going haywire. That's exhausting. Being a normal brain is hard enough; being an anxious brain is a thousand times more tiring. Your brain works hard.

Resources

If you live in the US and being uninsured is a barrier to seeking therapy, you can secure insurance here: https://www.healthplans.com/

In certain US states (mostly blue states, to be blunt) you can simply call your county's mental health department and ask to be referred for mental health services - these agencies typically accept most insurances including Medi-Cal and Medicaid. I work for a mental health agency that receives all of our referrals through the county this way, as well as through pediatricians and PCPs/GPs, hospitals, and school counselors - but all of those people have to go through the county to get to us. For our clients, services and meds are 100% covered by insurance but it all depends on what agency, insurance, state, etc.

Teletherapy

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Talkspace // $260 per month

Calmerry // $227 per month for text therapy, OR $360 per month for text therapy + four 30-minute live video appointments per month

Better Help // $240-$320 per month, sliding scale

Open Path Collective // $30-60 per session

Mood Health // $89 per session

Online Psychiatric Services

Usually 100% out of pocket but some are partially covered by certain private insurance plans.

Cerebral // $85 per month (certain insurance plans cover their services; you would pay $29 + copay + cost of medication if that is the case)

KHealth // $19 per month, $29 per month for shipping of medication

Lemonaid Health // $95 per month, no extra charge for medication or shipping (free overnight shipping)

Talkspace Psychiatry // $199 for initial evaluation, $125 for each successive follow-up appointment

Mood Health // $95 per month, no extra charge for medication or shipping

Brightside // $95 per month, no extra charge for medication or shipping

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

There have actually been studies that online therapy can be more effective; people are more forthcoming and the therapist benefits from seeing a glimpse of their home, apparently.

From my own experience, I've done text-based like Talkspace and the live sessions and would definitely recommend a live session one if you can. The drawback is possibly being interrupted or overheard, which I found too stressful and had to switch to Talkspace. On Talkspace, you'll get matched to a therapist very quickly, so it has an edge there. Bonus points for privacy, being text-based - no chance of being overheard, like in teletherapy. But for me it felt like such a chore. I found myself dismissing the notifications because I didn't have the mental energy to read and respond and to the homework and tasks she was assigning. Can't do that in a live session with a person.

It has the benefit of being able to go back and re-read messages and handouts from your therapist and save them for the future, for future reference, instead of like...actively having to take notes which would be even more of a chore. You even have access to all correspondence between yourself and your therapist even after your subscription has ended - I graduated from therapy and stopped the subscription, but can still read through everything my therapist told me if I need to! So that's very handy.

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.

Chronic stress and anxiety causes tons of physical symptoms as well as mental and emotional distress. Obviously, go to a doctor and get medical causes ruled out if you experience any of these on a regular basis. One cannot be diagnosed with an anxiety disorder or any other mental illness without first having medical causes for symptoms ruled out.

• Muscle tension, aches and pains, weakness, cramps, painless muscle twitches, jaw clenching
• Chest pain or racing heart, heart palpitations, pounding heart, audible heartbeat
• Temporary hair loss, particularly on the crown of the head (telogen effluvium)
• Body-focused repetitive behaviors - skin/scab picking, lip/nail/cheek biting, hair pulling, bouncing of legs or wringing hands, tapping fingers, fidgeting, etc.
• Fatigue, exhaustion, irritability, difficulty focusing, forgetfulness or trouble with memory, insomnia, nightmares or trouble sleeping, frequent sleep disturbances
• Headaches, dizziness, weakness, lightheadedness, sweating or shaking
• High blood pressure
• Rapid breathing or shortness of breath
• Hot flashes or chills, feeling overheated or very cold
• Nausea, vomiting, gas, bloating, frequent urination, stomach or digestive problems including diarrhea and constipation
• Weak immune system, often getting colds for example

There are several types of anxiety (generalized, social, etc) and only a therapist or doctor could give a definitive assessment and diagnosis, but this is the diagnostic criteria for generalized anxiety disorder, just one of the types of anxiety.

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder/social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

- - -

And for social anxiety disorder/social phobia:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.  

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.  

• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.  

B. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

C. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

D. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or another medical condition.  

E. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

F. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

- - -

A panic attack includes at least four of these symptoms (as you can see above, panic attacks are NOT a requirement for GAD - panic disorder is a separate diagnosis that has its own criteria that must be met, which is as follows:

A. The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:

• Palpitations, pounding heart or quickened heart beat
• Abnormal sweating
• Trembling or shaking
• Instances of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal pain
• Dizziness, unsteadiness, light-headedness or faintness
• Chills or hot flashes
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from his or her self)
• Fear of losing control or “going crazy”
• Fear of death

B. One or more of the attacks were followed by a month (or longer) of one or both of the following:

• Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
• A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.

C. The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.

D. The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.

If you have panic attacks, these things will help you take your focus off your panic and bring you back into the present, ending your panic attack a bit quicker:

• Count backwards from 100 by threes, write your name with your non-dominant hand or sing the ABCs in your head, but skip every other letter. This takes enough focus that it takes your mind off your panic and helps end the panic faster.
• Wash your face with ice water; this triggers the diver's reflex, slowing your pulse and breathing, moving blood from limbs to chest, forcing calm.
• Look for things around you: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste. It's a grounding exercise, called The Five Senses.
• Inhale deeply, hold your breath for a bit, exhale deeply. Technically this is the 4-7-8 method. Inhale for 4 seconds, hold your breath for 7, exhale for 8. The length of time isn't super important, the idea is just to breathe more deeply as panic makes you breathe shallowly and lack of oxygen makes it much worse.

Treatment

Professional treatment is best, and therapy+medication combined is proven to be the most effective treatment but some don't need medication. If you're in the US and being uninsured is a barrier to therapy, you can secure insurance here.

There are online options like Talkspace, Calmerry, Cerebral, Better Help, Lemonaid Health, Open Path Collective, Mood Health. Those typically don't take insurance, but some do. Open Path and Mood Health are the cheapest. If you live in the US, you can call your county's mental health department - they will evaluate you and refer you to a local agency. These often take insurance, including Medi-Cal/Medicaid.

Cognitive Behavioral Therapy Workbook / Anti-Anxiety Notebook

The bottom line is that if your anxiety interferes in your day-to-day functioning, you should try to get treatment. There are various assessments used to determine if someone has an anxiety disorder. If you go to a doctor or licensed therapist, they will administer or ask you to complete a scale such as the GAD-7, Liebowitz Social Anxiety Scale, Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-T), Penn State Worry Questionnaire and Beck Anxiety Inventory (BAI). In some places, you can only be treated if you meet medical necessity - if you have a diagnosable condition and are deemed at risk of worsening or continued impaired functioning without treatment.