What can I do about my anxiety and symptoms?

Managing Anxiety and Physical Symptoms

Start by completing the GAD-7 screening questionnaire immediately to quantify your anxiety severity, then follow the treatment pathway that corresponds to your score—this structured approach determines whether you need self-help strategies, professional counseling, medication, or emergency evaluation. 1

Immediate Safety Assessment

Before anything else, answer this critical question: Are you having thoughts of harming yourself or others? 1

• If YES: You need emergency evaluation by a mental health professional right now. Go to an emergency department or call 988 (Suicide & Crisis Lifeline). 1
• If NO: Continue with the assessment below. 1

Step 1: Complete the GAD-7 Screening

The GAD-7 asks how often in the past 2 weeks you've experienced: 1

• Feeling nervous, anxious, or on edge
• Cannot stop or control worrying
• Worrying too much about different things
• Trouble relaxing
• Being so restless it's hard to sit still
• Becoming easily annoyed or irritable
• Feeling afraid as if something awful might happen

Rate each: 0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day. 1

Step 2: Follow Your Treatment Pathway Based on Score

Score 0-4 (None/Mild Anxiety) 1

You can manage this yourself with supportive care:

• Education: Understand that stress and anxiety are normal responses to life challenges. Your physical symptoms (racing heart, sweating, trembling) are your body's alarm system, not dangerous. 1
• Stress reduction techniques: Practice progressive muscle relaxation daily—systematically tense and release muscle groups from toes to head. 1
• Sleep hygiene: Maintain consistent sleep/wake times, avoid screens 1 hour before bed, keep bedroom cool and dark. 1
• Physical activity: Engage in structured exercise 30 minutes daily—this has direct anxiolytic effects. 1
• No medication needed at this level. 1

Score 5-9 (Moderate Anxiety) 1

You need low-intensity professional interventions:

• First-line approach: Start with CBT-based self-help programs or computerized CBT programs. These teach you to identify and challenge anxious thoughts systematically. 1, 2
• Group psychosocial interventions: Join professionally-led support groups focused on stress reduction, problem-solving, and coping skills. 1
• Monitor response: Reassess with GAD-7 every 4-6 weeks. 2
• If symptoms persist or worsen after 4-6 weeks: Escalate to the moderate-to-severe pathway below. 1

Score 10-14 (Moderate-to-Severe Anxiety) 1

You need high-intensity treatment with a licensed mental health professional:

Psychological Treatment (Start Immediately): 1, 3

• Individual cognitive behavioral therapy (CBT) is superior to group therapy for GAD (effect size Hedges g = 1.01, which is large). 3, 4
• CBT includes: cognitive restructuring to challenge distorted thoughts, relaxation techniques (breathing exercises, progressive muscle relaxation), gradual exposure to feared situations, and structured problem-solving. 1, 3
• Duration: 12-20 sessions for significant improvement. 3

Pharmacological Treatment (Consider Adding): 3, 4

Start with an SSRI as first-line medication: 3, 5

• Sertraline: Start 25-50 mg daily, increase by 25-50 mg every 1-2 weeks to target dose of 50-200 mg/day. 3
• Escitalopram: Start 5-10 mg daily, increase by 5-10 mg every 1-2 weeks to target dose of 10-20 mg/day. 3

Timeline expectations: 3

• Some improvement by week 2
• Clinically significant improvement by week 6
• Maximum benefit by week 12 or later
• Do not stop before 12 weeks—premature discontinuation is a common pitfall. 3

Continue medication for 9-12 months after recovery to prevent relapse, as GAD is often chronic. 3, 5

Score 15-21 (Severe Anxiety) 1

You need immediate referral to psychiatry or psychology for comprehensive evaluation and aggressive treatment:

• Combination therapy is mandatory: Both individual CBT and medication (SSRI or SNRI) started simultaneously. 3, 4
• SNRI options if SSRIs insufficient: 3
  • Venlafaxine extended-release 75-225 mg/day (requires blood pressure monitoring)
  • Duloxetine 60-120 mg/day (particularly good if you have comorbid pain)
• Confirm formal DSM-5 diagnosis before finalizing treatment plan. 1

Critical Medical Considerations

First, rule out medical causes of your symptoms: 1

• Uncontrolled pain or fatigue
• Thyroid disorders (hyperthyroidism)
• Cardiac arrhythmias
• Medication side effects (steroids, stimulants)
• Substance use (caffeine excess, alcohol withdrawal)
• Delirium from infection or electrolyte imbalance

Your doctor must address these before treating anxiety. 1

What NOT to Do

Avoid benzodiazepines (alprazolam/Xanax, clonazepam/Klonopin) as first-line treatment. 1, 3, 6, 7

• They cause dependence, cognitive impairment, and don't address underlying anxiety pathology. 1, 3
• Reserve only for short-term crisis use (days, not weeks). 1
• If prescribed, use time-limited per psychiatric guidelines. 1

Common Pitfall: Follow-Through

Anxiety makes you avoid things—including treatment. This is a cardinal feature of anxiety disorders. 1

• You may feel too anxious to call a therapist or fill a prescription. This is the disorder talking. 1
• Have someone help you make appointments and attend initial visits. 1
• Your provider should check monthly whether you've followed through on referrals until symptoms improve. 1

When to Reassess

Reassess with GAD-7: 2

• Every 4-6 weeks during treatment
• When symptoms change or worsen
• During major life transitions or family crises
• If current treatment isn't working after 6-8 weeks