Few of us have escaped a situation in which we have felt overwhelming anxiety and are unable to contain it. Public speaking, musical, theatrical or athletic performances, test-taking, starting a new school or job, or being on an airplane flying through a thunderstorm are a few examples of situations that may trigger almost unbearable anxiety. And almost everyone who has waited for information about the outcome of surgery for a family member or friend has had anxiety as a companion in the waiting room.

The symptoms will be familiar: a dry mouth, lightheadedness, an increased heart rate, shallow rapid breathing, feeling nauseous or lightheaded, diarrhea, and difficulty thinking about anything else except the situation causing the anxiety. Indeed, as someone who is incapable of continuing to work or read when the plane is flying through turbulence, I am always awed by others who are unperturbed and continue to work on their computers or read. “How can they concentrate?” I ask myself while holding onto the armrests as tightly as possible.

This type of anxiety is situational rather than chronic although, in anticipation of the worrisome situation, one can feel anxious and fearful, have trouble sleeping and concentrating for days before the event. A scheduled operation or important examination like the Bar Association exams may disturb sleep, provoke gastrointestinal problems and result in rapid breathing for an uncomfortably long period of time.

What Can Help with Situational Anxiety?

People who experience performance anxiety—athletes, musicians, dancers, and actors, for example—may be prescribed propranolol. Propranolol is a member of a class of drugs known as beta-blockers and has been used since the early l960s by millions to decrease elevated blood pressure. But it has also been used for years to help decrease performance and also social anxiety by decreasing the physical symptoms of anxiety. You still may be worried about delivering a major address or blowing the opening notes of a symphony on your trumpet before an audience of hundreds, but propranolol will decrease the dryness of your mouth, make your knees stop shaking, your hands stop sweating, and your heart from feeling as if it is jumping out of your chest. It is non-addictive, unlike other medications for anxiety, and makes bearable the anxiety experienced by many whose career depends on their being able to perform.

However, other interventions may also be used to decrease anxiety that may accompany an anticipated event like giving a speech or a piano recital. Preparation is an obvious defense against anxiety and knowing intellectually that you have practiced, rehearsed, or studied sufficiently will (or should) remove much of the anxiety. Of course, who hasn’t had the classic nightmare of showing up for a final exam without attending any of the classes? A cartoon in the New Yorker magazine on August 16, 2021, has a professor standing in front of a blackboard with the words "Final Exam" written on it and saying to the class, “I’d like to extend a special welcome to those of you who are joining us for the first time, as part of a nightmare you’re having.” That anxiety, of being unprepared, won’t be helped by anti-anxiety drugs.

Being realistic about what can go wrong is also very helpful: I know that the chances the plane will break apart when flying through choppy air is extremely unlikely and that is somewhat reassuring. Often discussing your fears ahead of time with a friend, family member, mentor or physician gives you a chance to reality test. “Is this operation risky?” “Am I sufficiently prepared?” “Will anyone really notice if I miss a line in the performance?“ “I don’t have to get everything correct to pass the exam or course.”

Meditation, deep breathing and relaxation techniques are helpful during the days leading up to the anxiety-provoking situation, especially when lying awake at 3 a.m. Becoming familiar with these techniques before being confronted with a situation that causes you to worry excessively is useful, while figuring out how to deep breathe five minutes before your oral thesis exam is not going to be too helpful.

Someone to Turn to in Times of Unexpected Anxiety

Most of the recommendations given to modulate the symptoms of situational anxiety assume that the individual knows that an event is going to occur. But how does one deal with an unanticipated anxiety-provoking event such as an accident, medical emergency, work or home-related disaster? Anxiety may be so overwhelming that it is difficult to think rationally, or even think at all. Yet often action, problem-solving, and decision making is called upon at that moment. You the recipient of bad news don’t have the luxury of being anxious because you are being called upon to act, whether it is to dial 911 or the emergency line for the plumber.

Perhaps what we all need in such circumstances is someone who is a designated “anxiety calmer.” This may be someone with medical, legal, financial (or plumbing) expertise who is a close friend or family member. It could be a neighbor or co-worker. The person should be able to do two things: help you take the appropriate action to contact whoever is necessary to help with the situation and be willing to listen to your worries. The second function is important because articulating your fears allows them to be looked at objectively and evaluated by someone other than yourself. And during this process, the “anxiety calmer” can share your worries, while at the same time testing their reality.

It is almost impossible to go through life without confronting some situation that lifts us out of a calm and controlled state and plunges us into the chaos of stress and anxiety. But if we know there is someone we can turn to in the midst of our worries, we may be able to subdue the anxiety sufficiently to get through whatever situation is causing it.

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