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In September 2022, the United States Preventative Services Task Force (USPSTF) issued a draft recommendation that all adults younger than 65 to be screened for anxiety. This unprecedented move is part of a process that began before the COVID-19 pandemic and is well-timed in response to rising rates of anxiety disorders among U.S. adults.
From 2008 to 2018, anxiety rates nearly doubled among U.S. adults age 18-25—much faster than among patients age 26-49. For many people, the COVID-19 pandemic initiated, revealed, or worsened symptoms of excessive worry that indicate anxiety. According to the Centers for Disease Control and Prevention (CDC), national anxiety scores increased 13% during the pandemic, peaking in January 2021.
The USPSTF screening recommendations reflect rising anxiety levels among U.S. adults—and obstacles to effective treatment, such as cost, not recognizing symptoms, or inability to get an appointment due to critical staffing shortages among mental health professionals.
Programs like integrated behavioral healthcare at MedStar Washington Health Center are one way we can help more patients get streamlined anxiety treatment. Behavioral health experts provide brief interventions to patients experiencing acute anxiety and other symptoms. Through education and follow-up, patients who might not have been able to access mental health services can get on the path to treatment.
While anxiety is common, not every experience of anxiety is the same. The good news is several effective options are available to treat anxiety.
Types and symptoms of anxiety.
We all experience stress, and we all have some degree of anxiety. The ability to anticipate what’s coming next is a skill that humans have adapted since prehistoric times. But when we experience a degree or duration of fear, worry, and stress response that interferes with our daily life, that’s an anxiety disorder.
Anxiety disorders develop from a complicated group of risk factors, including genetics, brain chemistry, personality, and life experience. Anxiety can be expressed in many ways, and anxiety disorders fall into four broad categories.
Generalized Anxiety Disorder
Feelings of excessive worry about everyday situations, with episodes lasting longer than six months. It affects 6.8 million U.S. adults, with symptoms that can include:
- Difficulty concentrating
- Difficulty controlling feelings of worry
- Feeling restless or on edge
- Headaches, stomach or muscle aches, unexplained pain
- Sleep disturbances, including difficulty falling or staying asleep
Repeated, unexpected episodes of intense fear and physical distress often known as panic attacks. Not everyone who has a panic attack will develop panic disorder, which affects 6 million U.S. adults and causes symptoms such as:
- Chest pain
- Feelings of impending doom
- Feeling out of control
- Pounding or racing heart
- Trembling or tingling
Social Anxiety Disorder
Intense, ongoing fear of being watched and judged by others. At least 15 million U.S. adults have social anxiety disorder symptoms that can include:
- Blushing, sweating, or trembling out of context
- Difficulty making eye contact or being around unfamiliar people
- Feeling self-consciousness
- Fear of being judged
- Pounding or racing heart
- Rigid posture or an overly soft voice
Uncontrollable fear or worry over specific situations or events. Approximately 19.3 million U.S. adults have phobias such as heights and flying; specific animals such as dogs or snakes; getting shots; and blood.
People with a phobia may experience:
- Immediate, intense anxiety upon encountering the feared object or situation
- Irrational or excessive worry about encountering the feared object or situation
- Taking active steps to avoid the feared object or situation
- Enduring unavoidable objects and situations with intense anxiety
Multiple anxiety disorders can be experienced at the same time, including obsessive compulsive disorder and post-traumatic stress disorder. Some patients can experience other mental health conditions comorbidly, including depression, substance uses disorders, and more. Anxiety screening is a helpful tool in understanding the difference between these conditions and beginning the path toward effective treatments.
Understanding anxiety screening tools.
Anxiety screening is an important way to help doctors and patients understand the context for feelings of worry and stress response. There are several validated screening tools that can help.
The most common of these is called the Generalized Anxiety Disorder 7 or GAD-7. This simple, seven-item questionnaire asks patients to answer questions related to how often they experience anxiety symptoms like feelings of nervousness and irritability, too much worry, difficulty relaxing, and others.
Other common anxiety screening tools include:
- The Generalized Anxiety Disorder Severity Scale (GADSS), in which patients answer questions about their anxiety to measure both intensity and frequency of symptoms.
- Beck Anxiety Inventory (BAI) is used to measure severity of anxiety symptoms. This highly reliable test can also help distinguish between patients with GAD or PTSD (anxious populations) and those with depression and dysthymic disorder (non-anxious populations).
- Leibowitz Social Anxiety Scale (LSAS) measures social anxiety with 13 questions related to performance anxiety and 11 about situational social anxiety.
- Overall Anxiety Severity and Impairment Scale (OASIS) provides information about a broad range of symptoms and anxiety disorders. Like the other tools, it has been validated in a clinical setting.
Tools like these are not used to make a diagnosis on their own but are very effective instruments to start conversations between patients and their primary care providers about behavioral health. A diagnostic assessment with a mental health provider will inform an effective, personalized treatment plan.
There are many effective treatment options for anxiety disorders. Finding the right combination of therapies or medication dosage for you may take time. With personalized care, most patients can find lasting relief from anxiety symptoms.
Treatment options for anxiety.
Psychotherapies are effective treatments for anxiety. By empowering patients to understand how their thoughts contribute to symptoms of anxiety, therapists can help them look at situations in new ways with less fear and develop coping strategies to help. Effective psychotherapies for anxiety disorders can include:
- Cognitive behavioral therapy, in which patients work with a therapist to become more aware of unhelpful thought patterns in order to respond to anxiety-provoking situations more effectively.
- Mindfulness based cognitive therapy combines meditation and in-the-moment attitudes called mindfulness with cognitive therapy to reassess negative thought patterns and replace them with positive thinking.
- Exposure and response prevention prepares patients with coping strategies and the introduces gradual exposure to situations designed to provoke anxiety in a controlled environment to help build effective responses.
- Prolonged exposure therapy helps patients understand the foundation for their anxiety before they are exposed to a stimulus that causes distress in a safe environment to help decrease avoidance and overcome fear.
Medication for anxiety is a common treatment for disruptive symptoms. More than 15% of adults in the United States are taking prescription medications to support their mental health, many for anxiety disorders. Some of these medications include:
- Benzodiazepines (Valium, Ativan, Xanax) increase the levels of the neurotransmitter gamma-aminobutyric acid, which has a calming effect on nerve cells.
- Beta-blockers (Inderal, Sectral, Zabeta) stop the effect of the hormone epinephrine, which results in lowering he rate and force of the heart to relieve symptoms of palpitations or racing.
- Serotonin-norepinephrine reuptake inhibitors (Pristiq, Cymbalta, Effexor) increase levels of the feel-good hormones serotonin and norepinephrine in the brain to improve mood.
- Selective serotonin reuptake inhibitors (Lexapro, Prozac, Celexa) increase levels of serotonin in the brain to help improve mood and relive anxiety symptoms.
Challenges to accessible anxiety treatment.
Estimates indicate that the U.S. will soon have a deficit of more than 10,000 therapists, 15,000 psychiatrists, and 25,000 counselors, stretching thin the mental health professionals already on the job. With more Americans receiving screening for anxiety, it is likely the unmet need will grow.
To close the divide, MedStar Washington Hospital Center has launched an integrated behavioral health care program, which is embedded in medical clinics to provide patients with brief, immediate mental health interventions in conjunction with routine and specialized medical visits.
We have created tools that help our patients understand how to regulate their emotions, tolerate distress in the moment, and more. Our behavioral health experts provide mindfulness and breathing exercises alongside educational materials about anxiety, sleep, and how to manage symptoms.
MedStar Washington Hospital Center serves a patient population that is challenged by systemic barriers such as wealth inequality that can stand in the way of their access to mental health care. Without our integrated program, many of the patients we see in our clinics would not have access to mental health services due systemic barriers.
Across the board screenings for anxiety will likely reveal that many patients who are part of underserved communities are not receiving adequate care. It will be our challenge and our privilege to help these patients receive the care they need. For example, research has shown that:
- African American patients with mood disorders are more likely to be misdiagnosed with schizophrenia than their white counterparts.
- There are significant racial and ethnic disparities in mental health diagnosis and treatment.
- Patients who are from an indigenous, African American, Asian, or Latinx background are less likely to receive and continue mental healthcare.
For many people, a newly recommended anxiety screening in their doctor’s office will be the catalyst that helps them get the services they need to support their mental health. As the need for mental health services grows, new systems will be built to serve this expanded population and help them access effective treatment and achieve relief.
If you experience symptoms of an anxiety disorder, talk with your doctor about ways to access treatment. Getting treatment early can help prevent symptoms from getting worse—and can give you more happy, healthy days to enjoy.