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Anxiety by Alex Dimitriu, MD

Living with anxiety feels as if everything is a big deal: always hurried, easily overwhelmed and rarely happy. Some people don't understand that life doesn't have to be that way. Here are some useful tips I've gathered over years of working as a psychiatrist in the San Francisco Bay Area.

Anxiety disorders affect about 40 million Americans each year, or about 18% of the population. That's nearly one in five people. But only one-third of those people will get help. In my experience, an even lower number will stay the course long enough to get better. But it is always such a delight to see people on the other side, and this is an opportunity no one should miss.

The Spectrum of Anxiety

Anxiety comes in many different flavors, such as phobias, social anxiety and generalized anxiety. It helps to think of anxiety as a spectrum that naturally ranges from severe to mild. Let's start with the scariest first.

Most severe: panic attacks

Panic attacks are, in my opinion, the most severe form of anxiety. These are brief periods of feeling a sense of "impending doom," palpitations and the kind of fear that makes you think about going to the ER.

Less intense than panic: chronic worry

Chronic worry is what most people associate with anxiety. People with high anxiety are always thinking of what will go wrong. They obsess over past mistakes and future possibilities. In the words of Ekhart Tolle, author of The Power of Now, people experiencing anxiety live in the past and in the future, but certainly not the present. As one therapist once said, they "should" on themselves a lot. Life goes by with no joy in the present, constant worry over the future, remorse or reliving the better times of the past.


Some people are cool, calm and composed (when left alone in a silent retreat on a hilltop monastery), but they react intensely when life throws them curveballs. Moods can vary significantly by the hour and circumstance. People can have excellent mornings and terrible afternoons, depending on events. Their moods zigzag all over the place, leaving them without any understanding or ability to predict how they will feel next. It's hard to get help when you feel amazing sometimes and terrible at others. Anxious people can feel terrific … sometimes. This leads them to think everything is fine until the next thing happens. The frequency and intensity of reactions are important to note in deciding when to get help. Journaling helps.

Hypervigilance and "jumpiness"

These are other features I see in anxious people. And it's no surprise if you recognize that anxiety is part of the "flight or fight response" we evolved to have in response to physical threats—like saber-tooth tigers. It makes sense to react, perhaps prematurely and intensely, to avoid physical harm in such situations. Anxious people are physically and mentally fast. They check and respond to emails in minutes. They drive well but make terrible backseat drivers, watchful of everything on the road. They (over)react to perceived threats. They are often also easily spooked and easily startled. The common thread here is reactivity. Rapid reactivity is useful in the jungle, less so in the office.

Thinking too much (and sleeping too little)

This is perhaps the most benign and least apparent form of "anxiety." For these people, decisions get confused by too much data: the forest gets lost in the trees. I often say these patients live too much in their minds and not enough in their hearts. In the absence of feeling and flooded by too much thinking, every meaningful decision becomes challenging. Overthinking also makes it hard to fall and stay asleep, so these people do not get enough sleep. Many anxious people I work with have trouble sleeping in. They wake up too early—not anxious, but excited, planning the day, preparing. They are thinking too much when they should be sleeping.

What can you do to help reduce anxiety?

  • Exercise — the intense kind that requires a shower afterward, four times per week.

  • Get enough sleep — seven-plus hours per night. This means putting down screens a good while before bed, so you can actually have a chance to get sleepy. Dim lights help, too.

  • Meditate — Ten minutes per day to start. You will be terrible in the beginning. Accept that your mind will be active. See the entire process as learning to bring your thought back to your breath.

  • Slow it down — Speed kills, and rushing creates stress. Plan downtime, schedule fewer things, say no to invitations more often. Learn to like being quiet and enjoying just breathing. To paraphrase Alan Watts, the mind is like muddy water. Leave it alone, and it will settle itself.

With the use of these tips, medications and therapy, I have seen mind-blowing miracles in my work. Racing thoughts subside. Sleep deepens and elongates. My patients' inner beauty shines as they move back into their bodies from their minds. They find peace and presence. The constant hurry, the feeling of being overwhelmed and the irritability with self and others all melt away. I hope that anxious readers can find hope in this. I often say that love is the opposite of anxiety. Indeed, when anxiety ebbs, love emerges: love for work, love for family, love for friends, love for the now. And most importantly, love for self. Peace at last. "I didn't know I could feel this way." *Article originally featured in Psychology Today.


Alex Dimitriu, MD

Dr. Alex Dimitriu brings a deep respect for science and spirituality to his work. He completed his training in the Stanford Division of Sleep Medicine and has dual board certification in psychiatry and sleep medicine. He specializes in the complex interplay between the mind and body, and he helps his patients optimize peak performance by day and peak restorative sleep by night. He has been featured in The New York Times, Men’s Health, Cosmopolitan, Psychology Today and on NBC News, among other media. He serves as a medical reviewer for Business Insider and the Sleep Foundation and is a contributing author to The Encyclopedia of Sleep Medicine.

Away from work, Alex loves spending time with his family and in the ocean: sailing, kite-boarding and surfing.

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