How to Manage Anxiety

Your phone buzzes with a message from your manager: “Can we have a quick chat tomorrow?” Nothing else. Within seconds your mind has written the whole story. You’ve made a mistake. You’re in trouble. Maybe worse. Your stomach tightens, your heart picks up speed, and for the rest of the evening you can’t quite settle, even though, as it turns out the next day, she only wanted to ask about holiday dates.

That is anxiety. Not a rare or exotic condition, but one of the most ordinary experiences there is. Anxiety disorders are among the most common mental health problems in the world, and almost everyone knows the milder version: the knot before a difficult conversation, the 3 a.m. what-ifs, the background hum of worry that never quite switches off.

The good news is that anxiety is also one of the best understood emotions, and one of the most treatable. This guide brings together what helps.

What anxiety is

Anxiety is fear’s close relative. Fear responds to a danger that is here now: a car swerving toward you. Anxiety responds to a danger that might happen: the car you imagine swerving toward you on tomorrow’s drive. Worry is the thinking side of anxiety, the stream of “what if” thoughts that tries to solve problems that haven’t happened yet.

The body reacts in much the same way to both. The nervous system releases adrenaline, the heart beats faster, breathing quickens, muscles tense and digestion slows down. This is the fight or flight response, and it is excellent at what it was designed for: getting you out of danger quickly. It is less good at helping you through a performance review, a mortgage application or a hospital waiting room. We describe the physical side in detail in What Does Anxiety Feel Like?

A little anxiety is useful. It makes you prepare for the exam, check the stove, slow down on an icy road. It becomes a problem when it is too strong for the situation, when it goes on long after the situation has passed, or when it starts to shrink your life.

Why anxiety gets stuck

Anxiety tends to keep itself going through a few predictable loops. Knowing them is half the battle.

Avoidance

When something makes you anxious, avoiding it brings instant relief. You don’t make the call, you skip the party, you put off opening the letter. The trouble is that the relief teaches your brain that the thing really was dangerous, so next time the anxiety comes back stronger. Avoidance is the main reason anxiety grows.

Overthinking

Worry feels productive. It seems as if going over every possible problem will prepare you for it. But most worry circles the same ground without reaching an answer, and it keeps the body on alert while it does. We look at how to break the loop in How to Stop Overthinking.

Fear of the feeling itself

Many people with anxiety become afraid of the symptoms: the racing heart, the dizziness, the tight chest. They start to watch their bodies for signs of trouble, which makes them notice more sensations, which makes them more anxious. This loop is at the heart of panic attacks.

Running on empty

Short sleep, too much caffeine, alcohol, skipped meals and long stretches without rest all make the nervous system jumpier. Anxiety is often worse at the end of the day, which is one of the reasons we wrote Why Is Anxiety Worse at Night?

What to do in the moment

When anxiety is high, thinking your way out rarely works. The body has to come down first.

Breathe out longer than you breathe in

Slow breathing with a long out-breath is one of the quickest ways to calm the nervous system. Try breathing in through your nose for a count of four and out through your mouth for a count of six to eight, for two or three minutes.

A 2023 study led by researchers at Stanford, published in Cell Reports Medicine, compared several five-minute daily breathing practices with mindfulness meditation. The one that improved mood most was cyclic sighing: a deep breath in through the nose, a second short sip of air on top, then a long, slow breath out through the mouth.

Ground yourself in the present

Anxiety lives in the future. Bringing your attention to the present gives it less to work with. A simple version is the 5-4-3-2-1 exercise: name five things you can see, four you can feel, three you can hear, two you can smell and one you can taste.

Name it

Say to yourself, “This is anxiety.” Not “I’m in danger” or “something terrible is about to happen”, but simply naming the feeling for what it is. Putting a feeling into words tends to lower its intensity.

Let the wave pass

Anxiety rises, peaks and falls. If you don’t fight it or feed it, a surge of anxiety will usually start to ease within minutes. You don’t have to make it go away. You only have to let it pass through without doing what it says.

What helps over time

Stop avoiding, gradually

The most powerful long-term treatment for anxiety is facing what you fear, in small, manageable steps. Psychologists call this exposure. If phone calls make you anxious, start with a short call to a friend, then a call to a shop, then the call you’ve been putting off. Each time you do it and nothing terrible happens, the brain updates its picture of the danger.

Give worry a time and place

In the 1980s, the psychologist Thomas Borkovec and colleagues tested a simple idea: instead of worrying all day, people set aside one fixed half hour for it, and postponed any worry that came up at other times. Worry time reduced the amount of time people spent worrying. It sounds odd, but it works because you aren’t fighting the worry, just rescheduling it.

Question the prediction

Anxiety speaks in predictions: it’ll go wrong, they’ll think I’m stupid, I won’t cope. When you notice one, ask a few questions. How likely is this, really? What has happened before in similar situations? If the worst did happen, how would I handle it? This is one of the core skills of cognitive behavioral therapy, the most widely researched treatment for anxiety.

Reduce the load

Anxiety often rises when life asks for more than you have. If you feel constantly stretched, the most useful step may not be a technique at all, but doing less. Feeling Overwhelmed: Why It Happens and What Helps looks at how.

Look after the body

Regular exercise has good evidence behind it for reducing anxiety. So does protecting sleep. Cutting back on caffeine can make a real difference for some people, and so can cutting back on alcohol, which often brings anxiety back the next day stronger than before.

Try calling it excitement

Before a performance or a big moment, many people try to tell themselves to calm down. The researcher Alison Wood Brooks found something different in a 2014 study: people who said “I am excited” before singing, speaking in public or taking a math test performed better than those who tried to calm down. Both feelings come with a racing heart. Reframing it as excitement gave people somewhere to go with the energy.

When to get help

Please talk to a doctor or mental health professional if anxiety is constant or very intense, if you have panic attacks, if you are avoiding more and more of your life, or if anxiety comes with low mood. Cognitive behavioral therapy has strong evidence for anxiety, and medication can help too. Chest pain, fainting or breathing problems should always be checked by a doctor, even if you suspect anxiety.

A small practice

Choose one thing you have been avoiding because it makes you anxious. Not the biggest thing, a small one. Make a plan to do it in the next three days, and decide in advance exactly when. Afterwards, write down two things: how anxious you expected to feel, from 0 to 10, and how anxious you actually felt. Keep the note. It is evidence your anxiety will try to forget.

For the bigger picture of how emotions work, see How to Understand Your Emotions.