The most effective solution is to find and address the source of your stress or anxiety. Unfortunately, this is not always possible. A first step is to take an inventory of what you think might be making you "stress out":

• What do you worry about most?
• Is something constantly on your mind?
• Does anything in particular make you sad or depressed?

Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that is needed to relieve anxiety. Most communities also have support groups and hotlines that can help. Social workers, psychologists, and other mental health professionals may be needed for therapy and medication.

Also, find healthy ways to cope with stress. For example:

• Eat a well-balanced, healthy diet. Don't overeat.
• Get enough sleep.
• Exercise regularly.
• Limit caffeine and alcohol.
• Don't use nicotine, cocaine, or other recreational drugs.
• Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation. Try biofeedback, using a certified professional to get you started.
• Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.

Your doctor can help you determine if your anxiety would be best evaluated and treated by a mental health care professional.

Call 911 if:

• You have crushing chest pain, especially with shortness of breath, dizziness, or sweating. A heart attack can cause feelings of anxiety.
• You have thoughts of suicide.
• You have dizziness, rapid breathing, or racing heartbeat for the first time or it is worse than usual.

Call your health care provider if:

• You are unable to work or function properly at home because of anxiety.
• You do not know the source or cause of your anxiety.
• You have a sudden feeling of panic.
• You have an uncontrollable fear -- for example, of getting infected and sick if you are out, or a fear of heights.
• You repeat an action over and over again, like constantly washing your hands.
• You have an intolerance to heat, weight loss despite a good appetite, lump or swelling in the front of your neck, or protruding eyes. Your thyroid may be overactive.
• Your anxiety is elicited by the memory of a traumatic event.
• You have tried self care for several weeks without success or you feel that your anxiety will not resolve without professional help.

Ask your pharmacist or health care provider if any prescription or over-the-counter drugs you are taking can cause anxiety as a side effect. Do not stop taking any prescribed medicines without your provider's instructions.

Your doctor will take a medical history and perform a physical examination, paying close attention to your pulse, blood pressure, and respiratory rate.

To help better understand your anxiety, stress, or tension, your doctor may ask the following:

• When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular like an event in your life or a circumstance that scares you?
• Do you have physical symptoms along with your feelings of anxiety? What are they?
• Does anything make your anxiety better?
• Does anything make your anxiety worse?
• What medications are you taking?

Diagnostic tests may include blood tests (CBC, thyroid function tests) as well as an electrocardiogram (ECG).

If the anxiety is not accompanied by any worrisome physical signs and symptoms, a referral to a mental health care professional may be recommended for appropriate treatment.

Psychotherapy such as cognitive-behavioral therapy (CBT) has been shown to significantly decrease anxiety. In some cases, medications such as benzodiazepines or antidepressants may be appropriate.

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White KS, Farrell AD. Anxiety and Psychosocial Stress as Predictors of Headache and Abdominal Pain in Urban Early Adolescents. J Pediatr Psychol. 2005.

Lubit R, Rovine D, Defrancisci L, Eth S. Impact of trauma on children. J Psychiatr Pract. 2003; 9(2): 128-138.