Deborah Sloss, LCSW


Understanding and Coping with Anxiety

By Deborah Sloss, LCSW

Most of us have experienced anxiety at some point in our lives. Some people even feel a moderate amount of anxiety spurs them to action. However, for others, anxiety can start to interfere with their day-to-day functioning. According to the National Institute of Mental Health, anxiety disorders are among the most common mental disorders experienced by Americans; as many as 25% of teens and adults will experience some form of significant anxiety during their lifetimes.

While anxiety is a normal reaction to stress, when anxiety becomes overwhelming, it can be debilitating and affect general well-being, social life, academic performance and social interactions. And while the person suffering may realize their worry is excessive, they may also have difficulty controlling it. For example, a person may avoid situations that cause anxiety or suffer through them with little enjoyment and lots of distress.

If anxiety is interfering with your day-to-day life, there are steps you can take to reset this balance. Understanding more about anxiety itself and learning ways to identify the anxious components in your own thoughts, feelings and behavior can lead to effective ways to cope and manage anxiety.

Three Components of Anxiety

There are three major components of anxiety: physical sensations, thoughts (cognitions) and behaviors.

The physical sensations of anxiety may include feeling wound-up, tense or restless, fatigue, difficulty concentrating, irritability, muscle tension, difficulty with sleep, and stomach pains. In more severe cases, panic attacks may result in heart palpitations, shortness of breath, lightheadedness, nausea, sweating, shaking, a choking feeling, chest pain, chills, and numbness.

Anxious thoughts (also called cognitions) can be about suspected danger, fear of dying, fear of losing control, and worry about having additional panic attacks. For example, one might fear that chest pains caused by anxiety are a deadly heart attack or that the shooting pains in one’s head are the result of a tumor or aneurysm. One might have intense and recurrent thoughts of dying. Anxious thoughts may also result in nightmares/bad dreams, and feeling like everything is scary.

Anxious behaviors might include: reduced eye contact, nail biting and other

nervous habits, or an increase in motor activities, like foot tapping. One may also avoid situations or withdraw from activities that previously caused discomfort.

It is important to note that “...when a person becomes anxious, the cognitive, physical, and behavioral components of anxiety interact with each other... For example, an anxious thought may lead to increased heart rate and muscle tension, which in turns leads to more anxious thoughts.” Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach (Workbook) Hope, Heimburg and Turk p 29-30.

What can we do to manage anxiety?

While there are a number of methods that have proven helpful in addressing the physical component of anxiety, this article will focus on Cognitive Behavioral Therapy (CBT), a research-based technique that helps manage the thoughts and behavior generated by anxiety.

CBT was developed in the mid 1950s and early 1960s by Drs. Albert Ellis and Aaron Beck. CBT therapists realized that understanding the interaction between thoughts, feelings and events is the first step in successfully managing anxiety. These ideas were later expanded on by Dr. David Burns. In his book, Feeling Good, The New Mood Therapy, Burns explains that our interpretation of events is often governed by negative or “automatic” thoughts, which can result in anxiety.

Here are some examples of automatic, negative and anxious thoughts that may sound familiar:

I’m going to fail this test
I will never get into a good college
The kids at school all think I’m a looser

Talking Back to Automatic Thoughts

It can take time to figure out how one’s thoughts are tilted toward the negative. Once we can do that, we can start “talking back” to our thoughts and we are on the way to feeling less anxious. Dr. Burns says, quite simply and powerfully, that by changing the way we think, we can change the way we feel. (Burns, p 29).

One example of a more balanced, less negative thought to “talk back” to anxiety might look like this:

I’m afraid I am going to fail this test and so sometimes I want to throw my hands up and not study.

• Here the student is acknowledging where her anxiety is coming from.But, I’m kind of ignoring the positives here.

• This is identifying how this thought might be distorted.

I actually have studied all week and kind of know what I am talking about!

• This is a more balanced thought about the situation, with some hope added in.

By stepping back and looking at her automatic thoughts more objectively, the student was able to create a shift in her thinking. By substituting a more positive and realistic thought for the negative one, she is on the road to changing how she feels.


Anxiety is something we all deal with. This article focuses on the cognitive aspect of anxiety. When we find ourselves feeling anxious or upset, it is important to tune into our feelings and identify negative or automatic thoughts that accompany these feelings. Can we take a step back and ask ourselves if there is another way to look at the situation? If we can substitute realistic, positive thoughts for negative ones, then we are on our way to managing anxiety.