How can I manage overwhelming anxiety and stress caused by excessive demands from others?

Managing Overwhelming Anxiety from Excessive Demands

You need to recognize that your symptoms—feeling overwhelmed by constant demands, becoming upset, and reaching a breaking point—represent clinically significant anxiety that requires both immediate stress reduction strategies and potentially formal mental health intervention. 1

Immediate Assessment and Recognition

Your presentation of excessive worry about tasks and demands, combined with feeling unable to handle situations, is characteristic of Generalized Anxiety Disorder (GAD). 1 The key features include:

• Uncontrollable worry about multiple demands and responsibilities 1
• Feeling overwhelmed to the point of functional impairment 1
• Irritability and emotional reactivity when faced with others' needs 1

Rule out medical causes first: Before attributing everything to anxiety, ensure you're not experiencing hyperthyroidism, hypoglycemia, or excessive caffeine intake, all of which can mimic or worsen anxiety symptoms. 1

Evidence-Based Treatment Approach

The most effective strategy combines medication (SSRI) with Cognitive Behavioral Therapy (CBT), as this combination is superior to either treatment alone. 1 This dual approach provides both immediate symptom relief and durable skills to prevent relapse. 1

Pharmacological Management

• Start an SSRI such as sertraline or paroxetine as first-line treatment 1
• Diazepam may be used for short-term relief of acute anxiety symptoms (2-10 mg, 2-4 times daily depending on severity), but is NOT recommended for long-term management beyond 4 months 2
• Benzodiazepines like diazepam carry risks of dependence and should be avoided if you have any history of substance use 2

Psychological Intervention

Cognitive Behavioral Therapy must be initiated concurrently with any medication, not as an afterthought. 1 CBT specifically targets:

• Identifying and challenging catastrophic thinking about others' demands 1
• Developing concrete strategies to set boundaries and manage requests 1
• Building skills that persist even after medication is discontinued 1

Addressing the Root Causes: Workload and Boundaries

The evidence strongly indicates that your symptoms stem from work overload and chronic worrying—these are the two stress domains most powerfully associated with anxiety. 3 After controlling for all other factors, only these two remained significant predictors of anxiety. 3

Concrete Stress Reduction Strategies

To decrease your workload burden, you must: 4

• Eliminate nonessential tasks and redundant activities from your daily responsibilities 4
• Stop accepting overtime or additional commitments beyond your standard capacity 4
• Delegate tasks to others or utilize support systems to assist with demands 4
• Increase your autonomy in decision-making about which demands you accept 4

Establishing Protective Boundaries

The evidence from healthcare worker burnout research (which directly parallels your situation of constant demands) shows that survival requires: 4

• Mandated rest periods between high-demand activities 4
• Strict adherence to time limits for availability to others 4
• Mental health breaks following stressful interactions, particularly after conflicts or emotionally draining encounters 4
• Physical fitness opportunities to manage physiological stress responses 4

Building Resilience and Support Systems

You cannot manage this alone—isolation worsens anxiety outcomes. 4 The evidence shows that individuals without strong social support are at highest risk for burnout and anxiety disorders. 4

Essential Support Structures

• Establish peer support networks with others who understand similar demands 4
• Access mental health resources that are voluntary, stigma-free, and easily available 4
• Consider drop-in mental health sessions or virtual services if in-person feels overwhelming 4
• Ensure basic needs are met: adequate sleep, nutrition, and physical activity, as physiological deprivation directly worsens anxiety 4

Monitoring Your Progress

Schedule follow-up assessment at 2 weeks, then monthly for the first 3 months to monitor: 1

• Reduction in overwhelming feelings and worry frequency 1
• Improved ability to set boundaries with others' demands 1
• Better sleep quality and decreased irritability 1
• Enhanced functional capacity in daily activities 1

Critical Pitfalls to Avoid

Do not dismiss this as "just stress from everyday life"—the FDA specifically notes that anxiety from everyday stress does not require anxiolytic treatment, but your description of being unable to handle situations indicates you've crossed into clinically significant territory requiring intervention. 2

Avoid relying solely on benzodiazepines for management, as they lose effectiveness with prolonged use and create dependence risk. 2 They are appropriate only for short-term acute relief while establishing CBT and SSRI treatment. 2

Do not attempt to "power through" by accepting more demands—the evidence unequivocally shows that excessive workload without adequate recovery time leads to progressive deterioration and potential complete burnout. 4

The relationship between chronic stress from demands and anxiety is dose-dependent: the more demands you accept without boundaries, the worse your anxiety becomes. 5, 6 Your immediate priority is reducing demand load while simultaneously starting combined SSRI and CBT treatment. 1